Senate Confirms Alex Azar as HHS Secretary

Enough moderate Democrats joined Republicans in the Senate to approve President Donald Trump's choice of Alex Azar to be HHS secretary by a 55-43 vote. Azar replaces Tom Price, MD, who resigned in September 2017.

Orrin Hatch, R-Utah, chair of the Senate Finance Committee, praised Azar's experience in the public and private sector, saying during open floor debate before the vote that if enough senators would set aside "pre-conceived notions" about industry, he believed Azar would receive a nearly unanimous vote.

But some Democratic lawmakers, such as Patty Murray, D-Washington, and Jeanne Shaheen, D-New Hampshire, continued to oppose to the nomination of the former Eli Lilly executive, questioning his committment to community health centers, combatting the nation's opioid crisis, and other issues.

Sen. Chris Murphy, D-Connecticut, said his decision to vote no was not "a slam dunk." He prefaced his remarks by giving his fellow senators a mini-lesson by explaining the terms fee-for-service, alternative payment models, and value-based care, and said Azar mentioned all the right things on those topics in his testimony before the Senate Finance Committee last week, even going so far as to praise Sylvia Burwell, HHS secretary under former President Barack Obama, for accelerating alternative payment models during her tenure.

However, Murphy said any positives are outweighed by his fear that Azar will not be "a responsible steward of the Affordable Care Act," which he said has greatly benefitted Connecticut.

Azar has said he opposes the ACA as a matter of policy.

When he appeared before Hatch's committee, Azar decried high pharmaceutical prices and assured the committee that he has the extensive knowledge of insurance, manufacturing, pharmacy, and government necessary to address the problem of high-cost drugs.

Earlier this week, the Health Care Cost Institute reported that rising prescription drug costs helped cause overall healthcare spending in 2016 to grow faster than at any time in the last 5 years, even as Americans used the same amount or less healthcare in 2016 compared with 2015.

Rather than intervening in pharma pricing, Azar has suggested that pharmacy benefit managers (PBMs) would be the most effective tool to negotiate for lower drug costs, and said that PBMs should negotiate physician-administered drugs covered under Medicare Part B.

Azar had been president of the US division of Eli Lilly until January 2017. Before he joined Lilly in 2007, he had been a deputy secretary at HHS under the George W. Bush administration. He also has a legal background that includes working as a clerk to former Supreme Court Justice Antonin Scalia.