The Senate Health, Education, Labor, & Pensions (HELP) Committee held the first hearing on the confirmation for Secretary of Health and Human Services (HHS) nominee Alex Azar on Wednesday, November 29. Notably, only the Senate Finance Committee has jurisdiction to vote on the nomination and advance it for consideration by the full Senate. Senate Finance has yet to schedule a confirmation hearing.

Mr. Azar has extensive experience in the pharmaceutical industry, having previously served as president of Lilly USA until stepping down from his role in January. Prior to his decade-long career at Eli Lilly, Mr. Azar served in top executive roles at HHS — including as HHS General Counsel and as Deputy Secretary — under then-President George W. Bush. He is also the chairman and founder of Seraphim Strategies, LLC, a strategic consulting firm focused on the biopharmaceutical and health insurance industries.

Azar’s confirmation has been considered highly likely, with no Republican wavering on his nomination. 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. Ultimately, the tough questioning came from the Democrats. For example, Sen. Elizabeth Warren (D-MA) released a 21-page letter (attached) yesterday detailing questions she has for the nominee.

Overwhelmingly, the questions centered around the price of prescription drugs, based on Azar's past experience as an executive at Eli Lilly. Azar remarked that other parts of the supply chain such as insurers and drug plans also bear responsibility for the increasing cost of prescription medications. He also noted that he would address rising drugs prices by increasing generic and branded competition and by fighting the gaming in the system in which companies use patents to prolong the exclusivity they have before generic drugs reach the market. 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.

Additionally, Azar was questioned on his stance on women’s health/abortion. In response to these questions, he largely sidestepped. He noted that he had not studied a 2011 recommendation from 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.

Azar was also pressed on this stance on the Affordable Care Act (ACA). He indicated support for the choices made to date by the Administration and showed no sign of disagreeing with the Administration’s opposition to the ACA. During the past several months, he has said in interviews that the Affordable Care Act is “certainly circling the drain” and a “fundamentally broken system” that should be replaced by free-market principles and a smaller federal role.