As lawmakers blast pharma ties, HHS nominee Azar pledges to fight high prices

HHS secretary nominee Alex Azar came under tough questioning during a confirmation hearing on Wednesday.

Drug prices took center stage at a contentious hearing for former Eli Lilly executive Alex Azar, who's up for the top job at the Department of Health and Human Services. During the hearing, many senators grilled the nominee for his pharma experience, while Azar discussed his plans to address the pricing issue. 

Azar told the lawmakers the "current system of pricing may meet the needs of many stakeholders," but isn't working for patients who are stuck with growing out-of-pocket costs. He said pharma, along with other stakeholders and government, are all responsible for costs that continue to spiral upward. 

The former Lilly executive is being considered for the spot after former HHS head Tom Price stepped down amid criticism over his travel.

What are his plans to fight costs? Azar said he would work to increase generic competition and fight "gaming" of regulations by drugmakers, among other strategies. Both, as industry watchers know, are issues FDA commissioner Scott Gottlieb has been working to address during his time at the agency. 

 Azar added that he's willing to listen to multiple perspectives in handling the issue if confirmed. 

Sen. Rand Paul wasn't convinced. During the questioning, he spent much of his time focusing on drug reimportation, which is often discussed as a strategy to reduce prices but has never been implemented. Paul said it's a false argument that the tactic wouldn't be safe, and that if Azar can't endorse importation, then the nominee isn't serious about fighting high drug prices. 

Piling on, Sen. Paul said drug companies use their "economic clout" to "manipulate" the system to lengthen their patent protections and increase prices.  

"Everybody says they are going to fix it, but I tend to be a downer because these problems go on and on and on," Paul said. 

Azar didn't exclusively run into criticism at the hearing. Former HHS secretary and Utah governor Mike Leavitt said he "unequivocally" recommends Azar for the job, noting that there "may not have been a nominee to this office … better prepared to hit the ground running." 

Sen. Lamar Alexander called Azar's experience a "big help" because he's able to understand the "byzantine situation" of drug prices. He said a different nominee approaching the issue from another background "might be gone" before they get a grasp on drug pricing. 

On the other side of the coin, Sen. Elizabeth Warren blazed Azar's experience as a "how-to" guide for getting rich from government service. She criticized the "revolving door" in Washington, and said the public needs to have confidence the HHS secretary has their best interests in mind.  

Sen. Warren further brought up Lilly's groundbreaking marketing settlement on antipsychotic med Zyprexa, saying she didn't believe the deal amounted to "adequate accountability." Since the 2009 deal, Sen. Warren noted, Pfizer and other drugmakers have made similar settlements. 

"These settlements have become a cost of doing business for the drug companies," Sen. Warren told Azar. 

Azar declined to answer a yes or no question from Sen. Warren on whether he believes pharma CEOs should be held accountable when a company breaks the law. 

The hearing came after a two-year period for pharma when drug pricing came under intense public and political scrutiny. Still, no proposals on the issue have gained steam in Washington and many states are taking the issue into their own hands. FDA commissioner Scott Gottlieb has also been active in working to reduce costs, though his agency isn't in charge of regulating prices.