Drug prices a key focus of Senate HELP examination of Azar nomination



Escalating drug prices topped the agenda as members of the Senate Health, Education, Labor & Pensions Committee interviewed Alex Azar regarding his nomination as secretary of the Department of Health & Human Services.

Mr. Azar, a former HHS deputy secretary and general counsel during the Bush Administration and a former president of Eli Lilly’s U.S. operations, outlined his priorities to the Senate HELP committee during the Nov. 29 hearing.

Alex M. Azar II Wikimedia Commons/WWsgConnect/CC-SA 4.0
Alex M. Azar II
“With a department the size of HHS, it is often difficult to prioritize. Nonetheless, should I be confirmed, I do envision focusing my personal efforts in four critical areas,” including lowering drug prices, improving health care access and affordabilty, paying for outcomes, and tackling the opioid crisis.

Drug prices were the focus of many senators’ questions, and while many contentious questions came from panel Democrats, Sen. Rand Paul (R-Ky.) signaled he was not yet on board with his approval for Mr. Azar’s nomination.

“I think many [Americans] perceive [that drug companies use] their economic might to manipulate the system to maximize profits,” Sen. Paul said. “It’s not like they are selling a cheaper product to more people. They are using government to maximize their profits. Do you acknowledge that, under the current system, Big Pharma uses their economic clout to manipulate the patent system to increase drug prices?”

“There are clearly abuses, Senator, in the system, and that is why one of the steps that I mentioned ... that I believe we have to go after, is the gaming of that,” Mr. Azar responded. He suggested that although Hatch-Waxman rules give innovators a time frame to exclusively sell products “there should be a certain moment” when full generic competition should begin.

Sen. Paul also challenged Mr. Azar on the notion of drug importation.

There has not been a successful path to certify that drugs being imported are “safe and reliable,” Mr. Azar noted.

Sen. Paul countered that “you would have to sit there and say that the European Union has unsafe drugs. It would be unsafe for Americans to buy drugs from the European Union or from Canada or Australia. It’s just frankly not true.”

Sen. Paul told Mr. Azar that if he cannot come up with a way to reimport drugs as a means of addressing the high cost of pharmaceuticals in the United States, “I can’t support you.”

Sen. Paul continued that a lot of people have talked about how they are going to change the system, particularly patent issues that stand in the way of generic competition, and “you’ve got some convincing to make me believe that you are going to represent the American people and not Big Pharma, and I know that’s insulting, and I don’t mean it to be because I am sure you are an honest and upright person. But we all have our doubts because Big Pharma manipulates the system to keep prices high. ... We’ve got to fix it. We can’t tepidly go at it. We have to really fix it, and you need to convince those of us who are skeptical that you will be part of fixing it and won’t be beholden to Big Pharma.”

Regarding his other priorities, Mr. Azar noted that, through his “experience helping to implement [Medicare] Part D and with my extensive knowledge of how insurance, manufacturers, pharmacy, and government programs work together, I believe I can bring the skills and experiences to the table that can help us address these issues, while still encouraging discovery so Americans have access to high-quality care.”

He called for making health care “more affordable, more available, and more tailored to what individuals want and need. … Under the status quo, premiums have been skyrocketing year after year, and choices have been dwindling. We must address these challenges for those who have insurance coverage and for those who have been pushed out or left out of the insurance market by the Affordable Care Act.”

Mr. Azar signaled that he will continue the push toward value-based care and will use the power of Medicare to lead the rest of the health care delivery system to follow suit.

“We can better channel the power of health information technology and leverage what is best in our programs and in the private competitive marketplace to ensure the individual patient is the center of decision making and his or her needs are being met with greater transparency and accountability.”

Regarding the opioid crisis, Mr. Azar said that “we must heed President Trump’s call to action and tackle the scourge of the opioid epidemic that is destroying so many individuals, families, and communities. We need aggressive prevention, education, regulatory, and enforcement efforts to stop overprescribing and overuse of these legal and illegal drugs. And we need compassionate treatment for those suffering from dependence and addiction.”

Mr. Azar also was challenged on women’s health issues, particularly the ability of employers to exclude health insurance coverage of contraception because of religious objections. He noted that there needs to be a balance between the medical needs of the patient and the rights of an organization to follow its conscience.

When queried about making contraception available over the counter, he noted that the regulations regarding OTC conversion are outdated, and he was encouraged that FDA Commissioner Scott Gottlieb, MD, is looking into that.

Mr. Azar also committed during the hearing to working with improving interoperability of electronic health records as well as working with physicians to reduce the associated documentation burden.

He voiced his support of reforming the Affordable Care Act, adding that, “if it remains the law, my goal is to implement a way that leads to affordable insurance, leads to choice of insurance that leads to real access and not a meaningless insurance care, and insurance that has the benefits that people want, not what we say in D.C. for them.”

He also expressed support for the use of block grants to help fund Medicaid.

Mr. Azar’s appearance before the HELP committee was a courtesy as the Senate Finance Committee holds jurisdiction over his nomination. No confirmation hearing had been scheduled at press time.


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