Alex Azar reaffirmed his commitment to take on skyrocketing drug prices at his confirmation hearing on Tuesday, telling the Senate Finance Committee that both regulators and pharmaceutical companies need to "put our money where our mouth is" on the issue.
Azar, President Donald Trump's nominee to replace Tom Price as secretary of the Department of Health and Human Services, said that drug prices are too high "across the board," but stopped short of saying he would support a plan to allow Medicare to negotiate directly with drug manufacturers.
Doing so, he said, may require establishing a single national formulary for Medicare beneficiaries, potentially limiting options for patients.
"I don't believe we want to go there in restricting patient access," Azar said.
Azar said that Medicare is already negotiating drug prices in Part D using pharmacy benefit managers, and trying to determine whether what works in that program could be applied to Part B as well, instead of having the government negotiate directly with drug companies.
Despite Azar's assurances that he intends to work to reduce drug prices if confirmed, Democrats pushed him on price hikes that occurred under his leadership at Eli Lilly and on the amount of advertising drug makers spend to market prescriptions directly to patients.
Oregon Sen. Ron Wyden, the committee's ranking Democrat, noted that the price of two major medications—Forteo and Strattera—more than doubled in price under Azar's watch. Azar said that individual drug companies aren't enough to solve the drug price issue, and it will instead require efforts from a diverse set of stakeholders including the government.
Alex Azar had a MAJOR role over drug price increases for every product Lilly marketed in the U.S. Under his watch, the prices of both Forteo and Strattera more than DOUBLED. pic.twitter.com/HGbvaqmRK0— Ron Wyden (@RonWyden) January 9, 2018
"I don't know that there is any drug price that's ever gone down from any company in the U.S.," Azar said. "No one company is going to fix that system."
Azar also said that pharmaceutical companies may advertise too much to patients, and that he'd be willing to work with the Food and Drug Administration on the issue. However, he noted that drug advertising may allow patients more autonomy in choosing the medications they take and can prompt crucial conversations with physicians.
Azar on the Affordable Care Act
Though drug prices and Azar's ties to Eli Lilly dominated much of the conversation at the hearing, senators did also pose plenty of questions on how Azar would handle enforcement of the Affordable Care Act as HHS secretary.
Azar said that the law is not working for all and needs changes, but he will enforce the law of the land if confirmed. Sen. Dean Heller, R-Nevada, one of the sponsors of the Graham-Cassidy legislation, asked Azar for his opinion on the bill, and the nominee said he approved of its goal to offer more autonomy to states on how they operate their Medicaid programs.
"The elements that are positive are empowering states to run their budgets," Azar said. "Incentives can be reoriented with more state empowerment, as you see in Graham-Cassidy-Heller."
Sen. Sherrod Brown, D-Ohio, said that both Azar and Centers for Medicare & Medicaid Services Administrator Seema Verma had hinted at support for work requirements for Medicaid, as each had described "able-bodied adults" enrolled in the program.
The concern, Brown said, is in states like Ohio where a significant number of Medicaid enrollees need the program to cover the cost of their opioid addiction treatment, but could potentially be considered "able-bodied" otherwise.
Azar said he didn't have a personal definition for who exactly would be considered able-bodied, but didn't distance himself from supporting Medicaid work requirements.