The Senate on Wednesday voted 55-43 to confirm Alex Azar as HHS secretary.
All but three Republicans voted to confirm Azar's nomination. According to The Hill, Sen. Rand Paul (R-Ky.) voted Azar's nomination out of concern that Azar would not support importing drugs from other countries into the United States as a way to address rising prescription drug prices. Republican Sens. Bob Corker (Tenn.) and John McCain (Ariz.) were not present for the vote. Independent Sen. Angus King (Maine) voted in favor of Azar's confirmation, while all but six Democratic senators voted against Azar's confirmation.
Azar will replace Eric Hagan, who has been serving as acting HHS secretary since former HHS Secretary Tom Price resigned in September 2017 amid federal investigations and growing criticism over his use of private planes for official business. According to the Washington Post, Azar is expected to be sworn in as HHS secretary on Thursday or Friday.
Azar served as general counsel and deputy secretary at HHS under former President George W. Bush's administration. Azar while at HHS worked on issues including:
- Anthrax attacks that occurred in the United States;
- Stem cell policy;
- The Sept. 11, 2001, terrorist attacks; and
- The start of Medicare Part D.
Azar from 2007 until January 2017 held executive-level positions at Eli Lilly and Company, which is among three drugmakers at the center of a class-action lawsuit that alleges insulin makers and pharmacy benefit mangers colluded to raise prices. In 2007, he worked as the company's senior vice president of corporate affairs and communications, and in 2012, he began overseeing the company's U.S. operations.
During his tenure at Eli Lilly, Azar focused on counterfeit treatments, health information technology, and federal and international government affairs and public policy. After resigning from Eli Lily, Azar founded a health care consulting firm called Seraphim Strategies.
During testimony before the Senate Finance Committee, Azar outlined four areas he would prioritize if confirmed as HHS secretary:
- Addressing high prescription drug prices;
- Combating the opioid misuse epidemic;
- Making health care more affordable and accessible; and
- Using Medicare to help transition the U.S. health system from a fee-for-service to a value-based payment system.
Some Democrats during the hearing questioned Azar's commitment to lowering prescription drug prices given his industry ties. However, Azar during the hearing discussed potential ways to address rising drug prices, such as allowing the government to negotiate drug prices in some instances. He said, "If the government is the purchaser, let's say for instance, we are going to be buying (drugs) as part of the opioid crisis program, and we're directly buying that and supplying it out to states and first responders, there's absolutely nothing wrong with the government negotiating that."
Azar during the hearing also signaled his openness to mandatory payment models—representing what could be a major shift in the Trump administration's policy should he be confirmed. In response to a comment from Sen. Mark Warner (D-Va.) that some payment models under the Center for Medicare and Medicaid Innovation should be mandatory, a point on which he and Azar "might have a disagreement," Azar replied, "Senator, we actually don't disagree there."
Azar said, "I believe that we need to be able to test hypotheses, and we have to test a hypothesis, I want to be a reliable partner, I want to be collaborative in doing this, I want to be transparent and follow appropriate procedures, but to test a hypothesis there around changing our health care system, it needs to be mandatory as opposed to be voluntary to get adequate data, then so be it."
Azar's nomination for HHS Secretary in November 2017 was generally well received by industry stakeholders, with provider, insurer, and patient advocacy groups praising Azar's experience and expertise.
Following the Senate's vote Wednesday, several industry stakeholders called on Azar to support certain interests.
For instance, the Medical Device Manufacturers Association said, "We are committed to working with [Azar] to expedite patient and provider access to the cures and therapies developed by medical technology innovators."
The Partnership to Fight Chronic Disease said, "We urge [Azar] to address the growing burden of chronic illness in America by assuring that people have meaningful, affordable access to recommended care and services needed to avoid the onset and progression of chronic diseases and their costly complications."
The National Latina Institute for Reproductive Health said, "Azar must demonstrate integrity and commitment to making quality health care, including reproductive health care, affordable and accessible for ourselves and our families" and "work to hold all of HHS' staff to those same standards."
Community Catalyst said it "hope[s] … Azar will change course on many of the Trump administration's policies that threaten to undermine the quality of care and health security of women and LGTBQ individuals" (Mangan, CNBC, 1/24; Kodjak, "Shots," NPR, 1/24; Goldstein, Washington Post, 1/24; Leonard, Washington Examiner, 1/24; Diamond, "Pulse," Politico, 1/25; Roubein, The Hill, 1/24).
Next: How to combat the opioid epidemic
Opioid misuse and abuse is one of the most pressing public health issues in the U.S., and hospitals and health systems are on the front lines. Currently, most health systems focus their opioid management efforts on select medical specialties.
This report outlines three imperatives to guide hospitals and health systems in their efforts to reduce the impact of inappropriate opioid prescribing and misuse.