Alex Azar,

HHS nom­i­nee sup­ports com­pe­ti­tion be­tween brand names, gener­ics

The Washington Post - - FRONT PAGE - BY AMY GOLD­STEIN AND JULIET EILPERIN

the for­mer phar­ma­ceu­ti­cal ex­ec­u­tive who is in line to be­come sec­re­tary of Health and Hu­man Ser­vices, tes­ti­fied at a con­fir­ma­tion hear­ing that pre­scrip­tion drug prices are too high.

Alex Azar, in line to be­come the next health and hu­man ser­vices sec­re­tary, tes­ti­fied Wed­nes­day that pre­scrip­tion drug prices are too high and that the fed­eral gov­ern­ment has a role in try­ing to make medicine more af­ford­able for con­sumers.

The fo­cus on drug costs dur­ing Azar’s nom­i­na­tion hear­ing be­fore the Se­nate Health, Ed­u­ca­tion, La­bor and Pen­sions Com­mit­tee re­flected an at­tempt to get ahead of crit­i­cism that the decade he just spent as a top ex­ec­u­tive at a ma­jor phar­ma­ceu­ti­cal com­pany makes him ill-equipped to wres­tle with one of the most vex­ing fi­nan­cial is­sues in the U.S. health-care sys­tem.

“I think there are con­struc­tive things we can do” to bring down the price of medicines, Azar said, sit­ting alone at the broad wit­ness ta­ble in a pan­eled Se­nate hear­ing room. He said he fa­vors fos­ter­ing com­pe­ti­tion be­tween brand­name drugs and generic equiv­a­lents — an is­sue he worked on in the early 2000s while he was the HHS gen­eral coun­sel dur­ing the Ge­orge W. Bush ad­min­is­tra­tion.

He said he also sup­ports wider use of drug re­bates, but he did not men­tion any po­ten­tial con­straints on the prices that phar­ma­ceu­ti­cal com­pa­nies set.

The com­mit­tee’s rank­ing Demo­crat, Sen. Patty Mur­ray ( Wash.), quickly re­torted that the prospect of Azar pre­sid­ing over fed­eral pol­icy on drug prices would be akin to “the fox guard­ing the hen­house.”

Drug prices were one of four pri­or­i­ties that Azar said would guide him as HHS sec­re­tary if he is con­firmed. The oth­ers, he tes­ti­fied, would be mak­ing health care more af­ford­able and avail­able, shift­ing Medi­care fur­ther in the di­rec­tion of cre­at­ing in­cen­tives for good health out­comes rather than the vol­ume of med­i­cal care, and fight­ing “the scourge of the opi­oid epi­demic.” He did not ad­dress how he would ap­proach the other three pri­or­i­ties.

In re­sponse to ques­tions from Demo­cratic sen­a­tors about his views on health cov­er­age of con­tra­cep­tives — an ide­o­log­i­cal flash point — Azar largely sidestepped. He said he had not stud­ied a 2011 rec­om­men­da­tion from what was then the Na­tional Academy of Sciences’ In­sti­tute of Medicine that women should have ac­cess to free pre­scrip­tion birth con­trol. And he said the ad­min­is­tra­tion al­ready has struck a bal­ance be­tween mak­ing af­ford­able con­tra­cep­tives avail­able and re­spect­ing “the con­science ob­jec­tions” of peo­ple and or­ga­ni­za­tions op­pos­ing that.

He in­di­cated that he fa­vors a goal of the pres­i­dent and many GOP con­ser­va­tives to con­vert the Med­i­caid pro­gram for poor Amer­i­cans from its half-cen­tury tra­di­tion as an en­ti­tle­ment sys­tem open to any­one el­i­gi­ble into a block grant that would al­lot states a fixed sum and more free­dom from fed­eral rules. It “can be an ef­fec­tive ap­proach,” he said.

Azar was pressed on whether he agreed with steps that Trump and ad­min­is­tra­tion of­fi­cials have taken to un­der­cut the Af­ford­able Care Act. “My un­der­stand­ing was that the choices made were about what’s work­ing and what’s not work­ing,” he said. He gave a vari­ant of that an­swer to ques­tions about fund­ing cuts for en­roll­ment “nav­i­ga­tors” who pro­vide guid­ance to con­sumers, as well as on Trump’s de­ci­sion to end pay­ments to in­sur­ers to off­set dis­counts the ACA re­quires them to give lower-in­come cus­tomers on de­ductibles and other out-of-pocket costs.

As for a 90 per­cent re­duc­tion in fed­eral money for ad­ver­tis­ing and other out­reach ac­tiv­i­ties to en­cour­age con­sumers to sign up, Azar said that move “reg­u­lar­ized” fund­ing — an ap­par­ent ref­er­ence to HHS of­fi­cials’ as­ser­tion that the cut brought ACA ad­ver­tis­ing money in line with that for long-stand­ing Medi­care drug ben­e­fits. “At some point the in­sur­ers have to do their own dog­gone job,” he said.

Azar’s con­fir­ma­tion has been con­sid­ered highly likely, with no Repub­li­can wa­ver­ing on his nom­i­na­tion since Pres­i­dent Trump se­lected him ear­lier this month. At the hear­ing, how­ever, Sen. Rand Paul (R-Ky.) said his vote would hinge on whether the nom­i­nee backs a con­tro­ver­sial strat­egy of low­er­ing drug prices by reim­port­ing ones man­u­fac­tured do­mes­ti­cally and sold for less in other coun­tries. Specif­i­cally, he chal­lenged Azar to de­scribe a method by which HHS could cer­tify as safe cer­tain drugs sold in Europe.

“If you can’t do that, I can’t sup­port you,” Paul said. “You need to con­vince those of us who are skep­ti­cal that. . . [you] won’t be be­holden to big pharma.”

Azar re­sponded that “there are clearly abuses, Se­na­tor, in the sys­tem,” adding that he is “against un­safe reim­por­ta­tion.” When he noted that both Demo­cratic and Repub­li­can HHS sec­re­taries had been un­able to cer­tify that im­port­ing drugs sold in Europe would be safe, Paul coun­tered, “They’ve been wrong and be­holden to the drug com­pa­nies.”

The three-hour hear­ing was the first of two that sen­a­tors will con­duct on Azar’s nom­i­na­tion. Wed­nes­day’s ses­sion was a cour­tesy hear­ing be­cause the com­mit­tee does not vote on the con­fir­ma­tion. That power rests with the Se­nate Fi­nance Com­mit­tee, which has not yet sched­uled its hear­ing.

Azar, 50, would suc­ceed the pres­i­dent’s first HHS sec­re­tary, Tom Price, who re­signed un­der pres­sure in late Septem­ber amid in­ves­ti­ga­tion of his use of non­com­mer­cial planes for of­fi­cial busi­ness at tax­pay­ers’ ex­pense.

Azar’s back­ground is dis­tinc­tive. All but one pre­vi­ous HHS sec­re­tary has come out of pol­i­tics or academia. A lawyer by train­ing, Azar would be the first who has worked as a se­nior ex­ec­u­tive in the phar­ma­ceu­ti­cal in­dus­try, plus held pre­vi­ous se­nior roles at HHS.

Azar was the depart­ment’s gen­eral coun­sel from 2001 to 2005, then spent two years as its deputy sec­re­tary. The Se­nate con­firmed him for each of those po­si­tions.

From there, he was hired by In­di­anapo­lis-based Eli Lilly as its se­nior vice pres­i­dent of cor­po­rate af­fairs and com­mu­ni­ca­tions, and he rose to be­come pres­i­dent of its largest af­fil­i­ate, Lilly USA, in 2012.

He re­signed that po­si­tion early this year, say­ing he wanted to ex­plore new lead­er­ship op­por­tu­ni­ties, and formed a con­sult­ing firm.

Asked by Sen. Chris Mur­phy (D-Conn.) about the in­flu­ence of his years at a phar­ma­ceu­ti­cal com­pany, Azar replied: “This is the most im­por­tant job I will ever have in my life­time, and my com­mit­ment is to the Amer­i­can peo­ple and not any in­dus­try I have worked for.”

CAROLYN KASTER/ASSOCIATED PRESS

Alex Azar at the Se­nate Health, Ed­u­ca­tion, La­bor and Pen­sions Com­mit­tee’s nom­i­na­tion hear­ing. Be­fore he was nom­i­nated to lead the Depart­ment of Health and Hu­man Ser­vices, he worked for HHS un­der Pres­i­dent Ge­orge W. Bush and served as an Eli Lilly ex­ec­u­tive.

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