Trump's Pick for HHS Chief Raises Questions About Plans to Tackle Drug Prices

Despite making clear since he first hit the campaign trail that he believes prescription-drug prices are too high, President Trump did little to address the issue in his first year in office.

Now Trump has chosen a former pharmaceutical executive, Alex Azar, to be Health and Human Services secretary—touting him Monday as a “star for better healthcare and lower drug prices”—but it remains unclear whether the president plans to take actions that match his strong rhetoric.

“The drug companies, frankly, are getting away with murder, and we want to bring our prices down to what other countries are paying, or at least close, and let the other countries pay more,” Trump said last month.

There has been little administrative action on this front so far, and a rumored executive order on drug prices appears to be friendly toward the pharmaceutical industry, according to numerous reports.

Azar spent a decade at the pharmaceutical giant Eli Lilly and Company, including five years as president of Lilly USA, LLC. He was also a member of the board of directors for the biotechnology lobby, Biotechnology Innovation Organization, and served as deputy HHS secretary under President George W. Bush.

Should Azar become HHS secretary, he could bring focus to the issue. “What’s been missing is a clear policy agenda that will actually accomplish the job of reducing drug costs. That’s something that the new HHS secretary can bring to the table,” said Mark Merritt, president and chief executive officer of the Pharmaceutical Care Management Association.

But advocates and lobbyists are now wondering whether Azar would pursue regulations that may not be supported by his former peers in the pharmaceutical industry.

“Mr. Azar is clearly qualified for the job; that is unquestionable,” said David Mitchell, president and founder of Patients for Affordable Drugs. “It is unclear whether he will do anything to address drug pricing.”

Mitchell noted Azar’s past at Eli Lilly as a concern, but also pointed out his government experience. “Given Mr. Azar’s experience in the private industry, in the government, he knows how to help patients. We hope he uses that knowledge,” he said.

One health care lobbyist who requested anonymity to speak frankly on the subject said that if anything were to happen to address drug pricing, it would have to be initiated by Trump—who so far has shown little willingness to do so.

Even if the president were to act, there is a question as to what kind of policies would get past Azar and Joe Grogan, former lobbyist for Gilead Sciences who now serves as the associate director of health programs at the Office of Management and Budget.

“Can anything anti-pharma get by them? That’s everybody’s legitimate question,” the lobbyist said.

Grogan has reportedly led Trump’s Drug Pricing and Innovation Working Group, which in a June meeting discussed pharma-friendly recommendations such as extending patent life of drugs in foreign markets, according to Kaiser Health News.

When it comes to drug pricing, there are several places where Azar can concentrate his efforts, not just pharmaceutical companies. “The whole drug-pricing and distribution system is rigged,” Mitchell said. “Everybody makes more money when the price of drugs goes up.”

Another group that focuses on the issue is encouraging Azar to deliver on the president’s promise of lower drug prices. “[W]hile the [Food and Drug Administration] is working hard to address anticompetitive abuses by branded manufacturers, there remains much to be done both by the administration and by Congress,” said Campaign for Sustainable Rx Pricing spokesman Will Holley. “We sincerely hope that Secretary-nominee Azar will follow through on the president’s commitment to achieve lower drug prices for all Americans.”

And Democrats immediately sent the signal that they want Azar to distance himself from drug companies. “Alex Azar should join Democrats for real bipartisan action to lower health costs for families, particularly by reducing skyrocketing prescription-drug prices. … House Democrats will hold Mr. Azar accountable for putting the health of the American people before the profits of his Big Pharma friends,” House Minority Leader Nancy Pelosi said in a statement.

Rep. Elijah Cummings’s response was less welcoming. The congressman, who has met with Trump on the issue of high drug costs, tweeted this Monday afternoon: “#POTUS promised to “drain the swamp” and “lower drug prices” but he hasn’t taken any action. Instead, he is nominating Azar, the CEO at #EliLilly, which raised drug prices by double digits under his watch.”

But Republican leaders on a key House committee commended the president’s decision. “[Azar] is a veteran of HHS, bringing with him a wealth of institutional knowledge that will be instrumental in delivering patient-centered health care and combating the opioid crisis. We look forward to working with Mr. Azar on these critical issues and many others in the future,” Energy and Commerce Committee Chair Greg Walden and Health Subcommittee Chair Michael Burgess said in a joint statement.

And Trump’s rhetoric means the pharmaceutical industry may still have reason to worry. “I think there is some concern,” said Kurt Karst, industry attorney at Hyman, Phelps & McNamara. “They don’t know what they don’t know yet. I think it’s absolutely natural to have some concern."