President Donald Trump is considering nominating Alex Azar, a former executive for pharmaceutical giant Eli Lilly, as the next secretary of HHS, which could place the agency in the hands of man who has been skeptical of value-based care and opposed drug price controls.
POLITICO first reported Azar was the frontrunner, adding that other potential contenders like CMS Administrator Seema Verma, MPH and Food and Drug Administration Commissioner Scott Gottlieb, MD, are now out of the running.
Azar does have experience with HHS, serving as its general counsel and deputy secretary during the administration of President George W. Bush. The Washington Post reported the two HHS secretaries he worked under, Mike Leavitt and Tommy Thompson, would be supporting his nomination.
“If the president is looking for an experienced, competent conservative who is confirmable, Alex would be a great choice,” Leavitt said to the Post.
Unlike departed secretary Tom Price, MD, the first physician to serve as secretary in 24 years, Azar’s healthcare experience in the private sector has largely been in pharma. He left HHS in 2007 to become Eli Lilly’s senior vice president and corporate affairs and communications, rising to become president of the company’s U.S. operations in 2012 and leaving in January 2017. He has since founded a pharma and health insurance consulting practice while also serving on the board of Irving, Texas-based Healthcare Management Systems.
Azar’s past comments on healthcare policy appear unlikely to garner support from Democrats were he to be nominated. POLITICO reported he’s spoken against the idea of importing prescription drugs from countries where they’re cheaper, calling the U.S. distribution system “a crown jewel.” He also said European countries’ “radical price controls” have given them a “free ride of the investment and innovation” of U.S. pharma manufacturers.
Here are five quotes from Azar offering clues on what his policy priorities could be at HHS:
1. On insurers being to blame for drug prices: “When the patient is going into the pharmacy, they’re getting the sticker, they’re getting the list price,” he said at the Veera Summit in May 2017.
2. On value-based care: “I worry a lot when we talk about moving to value-based systems [because] we actually know in the U.S. with a competitive insurance market how to discern value,” he said at an event hosted by the Bipartisan Policy Center in 2016.
3. On whether the ACA’s Medicaid expansion has been successful: “Instead of throwing more money and more beneficiaries into state-run, single-payer, government programs, we’ve demonstrated that it works to use the government money through these private sector vehicles and deliver quality healthcare that way,” he told the Zetema Project.
4. On turning Medicaid into a block grant program: “I think there’s lot to commend with the block grant approach because the states are the laboratory for experimentation,” he said in another comment to the Zetema Project.
5. On major insurers leaving the ACA exchanges: “It’s certainly circling the drain,” he told Fox Business in May. “Obamacare plans are following the laws of economics. If you’re running an insurance company, you have to be able to make money. To make money, you have to be able to predict risk. The Obamacare system has made it impossible to predict risk.”
If Azar is nominated, his confirmation is no guarantee. Healthcare lobbyists like Anders Gilberg of the Medical Group Management Association have predicted the battle over the ACA may mean no permanent HHS secretary could be confirmed by the Senate in 2018.
“Whereas previous Senates usually give some degree of deference to the president for their nominations, I don’t think that’s the case there,” Gilberg told HealthExec.