HHS nominee Alex Azar talks drug pricing and ACA politics

As secretary for the Department of Health and Human Services (HHS), Alex Azar would oversee a trillion-dollar budget, over 90,000 employees, and a healthcare system that is ground-zero for heated bipartisan politics.

So where does Trump’s new nominee stand on the major issues?

On Wednesday, Azar appeared before the Senate Committee on Health, Education, Labor, and Pensions to outline his credentials and his vision for the role. The hearing was live streamed on the committee website.

In an opening statement, Azar acknowledged that it can be hard to prioritize specific tasks in such an expansive role. However, if confirmed, he aims to focus his personal efforts in four critical areas: lowering out-of-pocket drug costs for patients, ensuring choice and affordability in healthcare, a shift to preventive (not reactive) public health, and addressing the opioid epidemic.

But it turns out, the senators mostly wanted to talk about drug prices.

Drug prices

While he has held both government and industry roles, the senators were particularly interested in Azar’s 10-year stint at Eli Lilly & Co. He worked at the pharma company from 2007-2017, which included five years as president of Lilly USA. During that time, Eli Lilly was caught up in a lawsuit over the price of its insulin products (one product, Humalog, has risen 1,157 percent). Senator Patty Murray, (D-Washington) conjured the “the fox guarding the henhouse” analogy.

Azar denied he was personally involved in those pricing decisions and was unequivocal about his stance in his opening statement.

“Drug prices are too high. The president has made this clear; so have I,” he told the committee.

At the same time, he doesn’t want to stifle innovation and discovery — the biopharmaceutical industry’s go-to rebuttal when accused of exploitive pricing. Does that mean the blame and regulations will be pointed elsewhere; perhaps at pharmacy benefit managers or insurers?

His chief complaint is that, while the system may work for various stakeholders, it isn’t working for patients who are burdened with high out-of-pocket costs. Once again, his focus isn’t the list price determined by the industry manufacturer, it’s how much patients ultimately pay.

When pressed on the specific measures he is considering, Azar cited the need for greater competition. That means encouraging more generic drugs and limiting the abuse of the patent system. Beyond that, he open to new ideas.

Implementing ACA

Azar’s second stated priority in his opening remarks involved the wider health system.

“We must make healthcare more affordable, more available, and more tailored to what individuals want and need in their care,” he said.

Under the status quo, premiums have been skyrocketing year-after-year and choices have been dwindling, he declared, echoing President Trump’s stance (in a more measured way). However, if confirmed, Azar will be placed in charge of implementing the ACA — irrespective of his personal beliefs.

Sen. Robert Casey (D-Pennsylvania) asked Azar directly: “Do you commit to faithfully implementing the Affordable Care Act?”

While he noted that he, and the administration, believe statutory changes to the ACA would be beneficial, he did commit to faithfully implementing the law… with some discretion.

“If it remains the law, my goal is to implement it in a way that leads to affordable insurance, leads to choice of insurance, insurance that leads to real access… and insurance that has the benefits that the people want, not what we say in D.C. for them,” Azar stated.

So how does this sit with cuts in advertising for the open enrollment period? Would he enable or sabotage the current system?

“I would disagree that there is any effort to sabotage the program,” Azar stated.

The hearing lasted just under three hours. Azar will now appear before the Senate Finance Committee, charged with making the final decision.

If confirmed, Azar would replace Trump’s initial nominee Tom Price, who resigned in September after Politico revealed he had racked up a tab of over $1 million flying private and government planes.