5 Takeaways from Alex Azar's Confirmation Hearing

Trump's nominee to lead HHS was in the hot seat, answering questions about lowering drug prices, Medicare expansion, and his private-sector work.

Alex Azar, President Donald Trump’s nominee for Secretary of the Department of Health and Human Services, testified Tuesday during his confirmation hearing before the U.S. Senate Finance Committee.

Senators questioned Azar on several aspects of his previous work as president of Eli Lilly & Co.’s U.S. operation, as well as his policy goals relating to Medicare expansion. If confirmed, Azar would be Trump’s second HHS secretary within one year, replacing Tom Price, who resigned after a scandal involving questionable use of public travel funds.

Below are five key takeaways from the two-and-a-half hour testimony:

1. Republicans praise Azar’s experience, while Democrats remain skeptical.
 

In his opening statement, Azar referenced his previous experience in the Bush administration, where he served for six years as general counsel to HHS and then as deputy secretary.

“Through my experience helping to implement ‘Part D’ and with my extensive knowledge of how insurance, manufacturers, pharmacy, and government programs work together, I believe I bring skills and experiences to the table that can help us tackle these issues while still encouraging discovery so Americans have access to high-quality care,” Azar said.  

While Republicans praised Azar’s prior public service, Democrats took issue with his work over the past decade as a leader in the pharmaceutical industry. Sen. Ron Wyden, D-Ore., referred to Azar as “a drug company executive with a history of raising prescription drug prices.”

2. An industry rife with problems is on top of Azar’s list to fix.
 

In an attempt to rebuff criticism, Azar said his prior experience as a pharmaceutical executive provides him with the knowledge to address issues within the industry.

Azar highlighted the need to impede branding and exclusivity arrangements by drug companies while encouraging generics manufacturers. He also said he would work to reduce abuses to patent drug laws, though he stressed there is no “silver bullet” to solve the problem.

3. Azar opposes Medicare cuts, but Democrats argue his positions are in line with Trump’s.
 

Though Azar has criticized the Affordable Care Act, he said he would work to make it effective for Americans. Answering a question from Sen. Bill Nelson, D-Fla., Azar indicated support for certain provisions in the ACA, such as the “donut hole,” which lowers expenses for seniors through Part D.

Azar repeatedly said he does not support cuts to Medicare or ending state expansion. He also argued that the Trump administration’s policies do not represent cuts but rather policies “slowing the rate of growth” over the next decade in the interest of sustainability.

Democrats voiced opposition to his view on federal healthcare spending as well as his openness to block-granting, which they characterized as an inefficient response to the proposed entitlement cuts.  

Azar supports the continued move toward value-based payments, saying it represents a shift from “paying for procedures to paying for outcomes.”  

4. Discussion between Sen. Claire McCaskill about drug prices raises tension.
 

Rising drug prices, an issue which Azar and Trump have both sought to address, came up during a testy exchange with Sen. Claire McCaskill, D-Mo.

The senator said the federal government currently lacks the ability to negotiate for lower prescription drug prices based on volume. Azar countered that the government does have the ability through “middle men” to negotiate Part D drug prices, which have led to pharmacy benefit managers achieving the best net pricing of any commercial payers in the U.S.

McCaskill said “there’s something really wrong” with the system if a provision allowing the government to negotiate for lower prices wouldn’t benefit consumers. She added that the pharmaceutical industry has a reason for opposing the repeal of the provision.

Azar said the Congressional Budget Office found no evidence that a repeal of the provision would lower drug prices, but he expressed interest in analyzing what aspects of the Part D negotiating arrangement could be applied to Part B drugs.

5. Hatch urges Congress to move on long-term funding solution for CHIP.
 

The funding issue for the Children’s Health Insurance Program (CHIP) arose during the committee’s hearing as Sen. Orrin Hatch, R-Utah, signalled that he would work to ensure a long-term funding solution by January 19, when a continuing resolution to fund the government runs out.

Hatch, who was an original sponsor of the legislation which created CHIP in 1997, said it is an important part of his legacy and deserves a long-term funding solution. He said Senate Majority Leader Mitch McConnell is supportive of a proposed agreement to fund CHIP, while Wyden countered that the bill was not crafted in a bipartisan manner.