Alex Azar Nomination for HHS Causes Controversy

Alex Azar, JD

This week, President Donald Trump nominated Alex Azar, JD, for the secretary of Health and Human Services (HHS), causing a stir in the medical community and the news.

Azar, the former general counsel and deputy secretary of the department from 2005 to 2007, was also previously the US division president of Eli Lilly and Company from 2012 to 2017, is Trump’s selection to replace former secretary Tom Price, who resigned in September amid controversy about his use of private planes, costing the taxpayers a total of upwards of $1 million.

Pitched by the president as a contender for the position that will “be a star for better healthcare and lower drug prices,” Azar has made headlines recently for his track record while with Lilly, which increased the prices of its premier diabetes drug, an insulin lispro injection (Humalog), by 300% in the past decade - up from roughly $125 to over $250 in Azar’s tenure as Lilly USA president alone.

Happy to announce, I am nominating Alex Azar to be the next HHS Secretary. He will be a star for better healthcare and lower drug prices!

— Donald J. Trump (@realDonaldTrump) November 13, 2017

In Azar’s time as the head of Lilly USA, the insulin prices increased 20.8% in 2014, 16.9% in 2015, and 7.5% last year. Its insulin lispro injection is now more expensive than it was when it was first approved in 1996. At the time Azar started working with Lilly in 2007, during his rise to the US division head, the price of the drug was $74. According to the American Diabetes Association, an estimated 30.3 million Americans have the disease, accounting for almost 10% of the US population. The prices of insulin have increased over the last decade not just from Lilly, but from its competitors Novo Nordisk (Novolog and Levemir) and Sanofi (Lantus, and the recently approved Admelog).

The president has stated that pharmaceutical companies are “getting away with murder” in a press conference at the beginning of the year, promising to get drug prices under control. The democratic opposition to Azar’s nomination has already made attempts to prove that his nomination would imply an adverse effect to this goal.

Eugene Gu, MD, of Vanderbilt University Medical Center, wrote in an editorial in The Hill that “doubling the price of insulin personally outrages me. Physicians have an incredibly tough time making sure that patients keep their blood sugars under control when they leave the hospital, especially if they cannot afford the price of the drug.”

Records made public have shown that Lilly has spent millions - $5.7 million in 2016 - lobby Congress and the HHS, with Azar specifically having ties to the Biotechnology Innovation Organization (BIO), a lobbying group for the pharmaceutical industry. These lobbying groups have often expressed that drug pricing is “complicated.”

Azar has echoed the sentiment. He has spoken about the issue of drug prices publicly, stating that the net price for insulin lispro was down 24% in Q3 2016 from Q3 in the year prior, placing the blame on the payment system.

"We're trying to usher in a golden age of medicines with a payment system that is in its golden years," Azar said at a Manhattan Institute event last year, as reported by Bloomberg. "That system needs to be retired and replaced. The only way to do that is for every private health care institution, drug companies, insurers, employers, PBMs, hospitals, to work together to create a better way to pay for medicines."

Currently, Lilly's activities during Azar's tenure are under investigation by multiple state attorneys general for price fixing, as well as a class action lawsuit for collusion with Sanofi and Novo Nordisk for allegedly controlling an uptick in insulin prices in the United States, as reported by The Nation.

Alex Azar is an experienced and highly capable leader who knows what it takes to tackle big challenges in health care. The Senate should swiftly confirm him as our next @HHSGov secretary.

— Paul Ryan (@SpeakerRyan) November 13, 2017

Pleased that POTUS has nominated Alex Azar to be the next @HHSGov Secretary. I look forward to his confirmation and will work with him to ease Americans from the burdens of Obamacare.

— Richard Shelby (@SenShelby) November 14, 2017

The Nation also reported that the US leads every other country spending on diabetes, with the average patient with type 1 diabetes spending a $571.69 per month. Insulin was developed in Canada in 1921 and sold for $1. Now, the price is more than 200 times higher.

Azar’s nomination has not been met with just pushback, however, as several Republicans have voiced their support of the choice. Speaker of the House Paul Ryan (R-Wisc.) called Azar an “experienced and highly capable leader” in a tweet. Senator Richard Shelby (R-Ala.) tweeted that he was “pleased” with the nomination.

The Health, Education, Labor, and Pensions Committee will hold the first of a series of confirmation hearings for Azar’s nomination on November 29.

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