Alex Azar confirmed as HHS Secretary

The U.S. Senate confirmed former Eli Lilly executive Alex Azar as the next HHS Secretary on a largely party-line vote, with seven Democrats joining all but one Republican in supporting his nomination.

The 55-43 vote saw Democratic Sens. Tom Carper and Chris Coons of Delaware, Joe Donnelly of Indiana, Heidi Heitkamp of North Dakota, Doug Jones of Alabama, Joe Manchin of West Virginia and Angus King of Maine, an independent who caucuses with the Democrats, vote yes.

Several of the Democrats who voted against Azar cited how Eli Lilly increased drug prices while he ran their U.S. division. During his tenure, the price of one of its insulin products, Humalog rose from $122 for a vial in 2013 to $274 in 2017 and osteoporosis treatment Forteo more than doubled in price from $1,032 to $2,728.

Sen. Patty Murray, D-Washington, the top Democrat on the Senate health committee, also pointed to his past comments saying the Affordable Care Act was “circling the drain” and stances on the law’s contraceptive mandate in justifying her opposition.

“As a nominee Mr. Azar may try to assure us that he will fight for patients and protect the health of our communities, but after looking at his record, after reading his past statements, after discussing these issues with him, I am alarmed that he might not stand up for women and families,” Murray said on the Senate floor. “I am alarmed that he might not stand up to the pharmaceutical industry. And I am alarmed that he might not stand up to President Trump’s agenda driven by sabotage and ideology.”

The one Republican to oppose Azar’s nomination, Sen. Rand Paul, R-Kentucky, had also cited his record as a pharmaceutical executive as the reason for his "no" vote. Paul said at a November 2017 hearing before the Senate health committee that Azar needed to convince him he wouldn’t represent “Big Pharma” with policies such as opposing prescription drug importation.

Supporters of Azar, however, said his experience at HHS under President George W. Bush, overseeing implementation of the Medicare Modernization Act of 2003 (which created Medicare Part D) and Medicare Advantage should mean more than what company he worked for in the private sector.

“If we set aside the partisan and the pre-conceived notions some have about certain industries, Mr. Azar would likely get a near-unanimous vote,” Sen. Orrin Hatch, R-Utah, said on the Senate floor.

Azar has many similarities on policy matters with his predecessor as HHS Secretary, Tom Price, MD, such such as favoring turning Medicaid into a block grant program, he’s also broken with HHS policy over the past year. Most notably, he signaled at his last confirmation hearing that he would support mandatory payment models, like the cardiovascular bundled payment models canceled under Price.

“I believe that we need to be able to test hypotheses,” Azar said. “I want to be a reliable partner. I want to be a collaborative in doing this. I want to be transparent and follow appropriate procedures. But if to test a hypothesis around changing our healthcare system it needs to be mandatory as opposed to voluntary to get adequate data, then so be it.”

Since Price resigned in September 2017 over his use of publicly-funded charter flights, Eric Hargan has been serving as acting head of HHS. With Azar’s confirmation, he’ll return to his role as deputy secretary.