Alex Michael Azar II, the former president of the American branch of Eli Lilly & Co. pharmaceuticals, was sworn in on Monday, January 26th as the new Secretary of the Health and Human Services Department. Azar, who was President Donald Trump’s first choice for the position, will be replacing the former HHS Secretary Tom Price. Tom Price resigned late September of 2017 amid allegations of chartered flight misuse and blame for the failure of ACA reform. Trump insists that with Azar at the helm, the prices of previously inaccessible prescription drugs will plummet, giving more people the chance to utilize medications they need. Still, there is a lot of controversy surrounding Azar’s ascension into the position of HHS Secretary; a man of Big Pharma will now be advising the president on matters of general public health and welfare.
The Job Description of HHS Secretary and Azar’s New Responsibilities
The U.S. Department of Health and Human Services (HHS) is a cabinet-level agency in the executive branch of the federal government. Its mission is to enhance and protect the well-being of all Americans by providing effective health and human services and fostering advances in medicine, public health, and social services.As the new head of Health and Human Services, Azar will handle a budget of more than $1.1 trillion to oversee the operations and uphold the policies of the department’s eleven operating divisions:
- Administration for Children and Families (ACF)
- Administration for Community Living (ACL)
- Agency for Healthcare Research and Quality (AHRQ)
- Agency for Toxic Substances and Disease Registry (ATSDR)
- Centers for Disease Control and Prevention (CDC)
- Centers for Medicare & Medicaid Services (CMS)
- Food and Drug Administration (FDA)
- Health Resources and Services Administration (HRSA)
- Indian Health Service (IHS)
- National Institutes of Health (NIH)
- Substance Abuse and Mental Health Services Administration (SAMHSA)
As the Secretary to manage the FDA, Azar will also be responsible for regulating the pricing and distribution of prescription drugs— including those produced by Eli Lilly & Co., his former employer.
Azar’s Questionable Track Record of Setting Drug Prices
During his campaign as a presidential candidate, Trump had promised lower drug prices. So far, the White House has taken little measurable action to make this happen. Again, when Trump announced his nomination of Azar to be the next HHS Secretary, he boasted Azar’s plans for implementing better healthcare and lower, more affordable drug prices. However, Azar has been widely criticized for his role in raising prescription drug prices during his time as Lilly USA’s president, which only ended in January. During his ten years with the pharmaceutical company, Azar saw the price of insulin triple. In 2016 senators requested the Department of Justice investigate manufacturer conspiracy to raise insulin prices high, including Eli Lilly in a class action complaint. In 2010 the company had previously been fined in Mexico for similar behavior.
As the HHS Secretary, Azar must shift gears entirely. Many prescription drugs cost far too much for most middle-class Americans, and a major part of Azar’s new job is to change that. There are many methods he could employ to make medications more affordable for the masses. Ideas that have circulated Capitol Hill include:
- allowing private citizens to purchase their prescriptions abroad
- giving insurance programs like Medicare room to negotiate prices with the prescription drug manufacturers whose products are covered by their plans
- keeping the interactions between drug companies, pharmacies, and pharmacy benefit managers disclosed publicly to reduce private dealings
While these and similar options would be an effective means of reducing prescription drug prices, there is warranted skepticism that Azar would pursue any of them as they are tougher on the bottom line of Big Pharma. Instead, Azar is more likely to apply less-effective methods of price reduction that are pharma-friendly. Many are doubtful that his past advocacy against regulation will change with his new position as HHS Secretary.
The Controversy Surrounding Azar’s Appointment to HHS Secretary
The general public has been asking for federal intervention for lower drug prices for years, and now the demands for it are at an all-time high as premiums and prescriptions soar. So, the appointment of a Big Pharma insider as the new HHS Secretary is nothing short of controversial. Trump’s decision to appoint Azar as the new HHS Secretary is unexpected, but not unsurprising given his preference for corporate insiders. Still, what inspired the choice for a pharmaceutical executive to oversee departments regulating the pharmaceutical industry? Who, many say has been directly responsible for keeping prescriptions affordable for years. The reasons may be traced back to campaign contributions and personal ties.
Eli Lilly & Co.’s American branch has had deep ties to the Trump administration dating back to the start of the election campaign. In 2016 alone, this company has spent almost $5.7 million on lobbying Congress and putting pressure on the Human Health and Services department for favorable regulations. The company’s current CEO, David Ricks, has also very publicly supported Trump’s repeatedly proposed (and recently signed) tax plan, and was one of the first business leaders to meet with Trump following his inauguration in January of 2017. Vice President Mike Pence also has direct ties with Azar dating back to his time as governor of Indiana, where Eli Lilly & Co.’s American branch is headquartered. It’s clear that Azar’s appointment as HHS Secretary follows a very favorable relationship with the administration including Eli Lilly & Co. advocating for the Trump campaign and policies. This all brings much scrutiny to Azar’s merits.
Objections and Concerns from Others in Office
These details have not gone undetected by others in office. In fact, several Democratic senators were very vocal about opposing Trump’s nomination of Azar for the vacated position of HHS Secretary. Perhaps the most vocal was the Committee on Finances’ Senator Ron Wyden, who openly accused Azar of inflating drug prices during his time as President at Eli Lilly & Co., stating with confidence that there was plenty of evidence to suggest he was correct. Many others took his side on the matter.
Fellow Senator Bernie Sanders expressed similar concerns in a press release, stating:
“The nomination of Alex Azar, the former head of Eli Lilly’s U.S. operations, shows that Trump was never serious about his promise to stop the pharmaceutical industry from ‘getting away with murder.’ The last thing we need is to put a pharmaceutical executive in charge of the Department of Health and Human Services.”
What Does This Mean for the Fight Against the Opioid Crisis?
At a White house ceremony President Trump charged the new HHS Secretary with the following remarks: “He will help lead our efforts to confront the national emergency of addiction and death due to opioids and I think we’re going to be very tough on the drug companies in that regard and tough on doctors in that regard, because what’s going on is pretty incredible,”
One of the biggest and arguably most critical government responsibilities that now falls on Azar is leading the general public out of the wide-reaching opioid addiction epidemic that has gripped communities across the country. Given Azar’s past of running a very successful pharmaceutical company, combined with the Trump administration’s lack of measurable action thus far— many are skeptical the opioid crisis will be a priority for the new HHS Secretary.
The crisis is worsening with inaction; Azar’s newfound position of power within the White House may offer more protection for Big Pharma, a driving force behind the continuance of the opioid crisis. With roll-backs of government oversight and shifts in protection from consumers to businesses, the same trends should be expected for the pharmaceutical industry. For now, the future is uncertain, but it’s hard not to imagine the worst: Azar’s appointment as HHS Secretary could mean a deepening crisis as it is inadequately addressed, coupled with less affordable access to addiction treatment.
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