Azar blames PBMs for ‘broken system’ in Senate Finance hearing dominated by immigration debate

A Senate hearing on the Trump administration's efforts to tackle high drug costs on Tuesday quickly become engulfed in a debate on immigration. 

The hearing by the Senate Committee on Finance was intended to discuss the Trump administration's plans to lower drug costs, but senators on both sides of the aisle were eager to comment on ongoing immigration concerns.

In between pointed questions about separating parents and children at the border, Department of Health and Human Services Secretary Alex Azar addressed the administration's plan for lowering drug prices, issuing a few shots at pharmacy benefit managers.

Azar said "many major drug companies" have tried to make "substantial and material price decreases," but were rebuffed by PBMs, exemplifying "just how broken our system of drug prices and drug distribution is in the United States." Two weeks prior, Azar defended PBMs during a hearing before the Senate Health Education Labor and Pensions committee, saying the organizations would protect patient choice.

RELATED: Azar defends PBMs in Trump administration's plan to bring down drug costs

"The reaction of some has been, if you were to decrease your price, you would actually be harmed in terms of formulary status and patient access versus your competitor who has a higher price," he said on Tuesday. "I would encourage the Senate and Congress to inquire of pharmacy benefit managers as to whether they have received suggestions or approaches from drug companies for lower list prices and what has the reaction been. 

"[Drug companies] set their prices, they're accountable for that," he added. "But the channel is definitely not making it easier." 

Other Democrats pushed Azar on the status of promised drug price reductions. At the beginning of the month, President Trump said that drug manufacturers would announce voluntary "massive" drops in prices within two weeks.

Azar said HHS is "not counting on voluntary reductions" from drug companies and that the administration wants to focus on "reversing the incentives" to increase list prices by going after rebates.

Meanwhile, Sen. Claire McCaskill, D- Mo., hit Azar on cost-sharing reductions to stabilize the individual marketplace. Azar said the White House supports funding for CSRs but that Congress needs to do its job and authorize funding for the reductions and reinsurance, and pointed specifically to inaction on the bipartisan Alexander-Collins bill.

"Secretary, that bill hasn't even been brought to the floor. Mitch McConnell has decided we're not allowed to vote on that bill," the Missouri senator said. "You all are in charge of healthcare. You control the White House, you control Congress."

Discussion shifts to immigration

Sen. Ron Wyden, D-Ore., ranking member of the committee, was the first to bring up HHS' involvement in the immigration battle, which involves housing and caring for thousands of migrant children. 

"The American people are owed answers on what's going to be done to protect the thousands of children the Trump administration separated from their mothers and fathers and put in the custody of today's witness," the Oregon senator said. 

RELATED: In the middle of an immigration debate, healthcare organizations face real-world impact

Azar, the hearing's only witness, said 2,300 separated children were in the custody of HHS, but that number has now been reduced to 2,047.

He added that every parent in detention has access to information on how to locate their children.

Wyden, who asked how many detained parents were told where their children are, seemed displeased by the answer.

"This does not line up with the firsthand accounts of parents that I hear from who desperately want to know where their kids are," Wyden shot back.

Sen. Debbie Stabenow, D-Mich., also brought up her concerns on whether these parents were able to locate their children.

"These children ... are experiencing trauma and pain," the third-term senator said. "This needs to get fixed and has to be your top priority. This is on your watch and we will hold you accountable."

Sen. John Coryn, R-Texas, defended the secretary and said he visited two detention facilities and was impressed by the quality and care the children were given. He added that 83% of migrant children in detention came across the border without a parent.

"I haven't heard a word from our democratic colleagues about that," he said.

Sen. Bill Nelson said he was not allowed in a detention center in Florida on Saturday to speak with 70 children who were separated from their parents.

"We are very happy to arrange visits from members of Congress to visit these facilities, but we need to do so in a way that is orderly because our priority is the safety and well-being of these children," Azar said.