(Bloomberg) — The drug executive President Donald Trump has picked to lead the U.S. Department Health and Human Services (HHS) isn’t likely to shy away from the topic of sky-high medication prices — but it may be insurers and drug plans that feel the heat as much as his former industry.
Trump’s pick, former Eli Lilly & Co. executive Alex Azar has talked about drug prices during interviews, speeches and panel appearances before leaving Lilly in January and in the months after. His remarks have paralleled a common industry argument, that it’s other parts of the pharmaceutical supply chain that bear a large share of the blame for U.S. outrage over drug costs.
“Why did things erupt? They erupted because we have seen a complete and fundamental restructuring of health insurance in the United States over the last three to five years,” Azar said at a conference in May hosted by a medical software company.
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Trump has made the cost of drugs a major part of his message. Saying that drugmakers are “getting away with murder,” he has suggested using the government’s buying power to restrain prices. He’s also said other countries — which in general pay less for brand-name medicines than the U.S. — should pay more.
The choice of Azar will likely set up a vigorous discussion about the issue when his nomination eventually comes before the Senate.
“It is not the pick you would expect from someone who is going around calling the pharmaceutical industry a bunch of murderers,” Walid Gellad, who heads the Center for Pharmaceutical Policy and Prescribing at the University of Pittsburgh, said in a phone interview, referring to Trump’s comment about the industry.
Azar didn’t respond to a request for comment on Monday.
Trump’s deeds haven’t matched his rhetoric. The administration has taken few actions that directly impact brand-name drug costs. Azar, likewise, has in the past opposed government intervention on drug prices.
“When the government gets involved it is more likely than not to create perverse incentives and unintended consequences than when the market players can work together to figure that out,” Azar said at a drug costs panel hosted a year ago by the Manhattan Institute, a free-market think tank.
Amid the U.S. debate over costs, the drug industry has consistently pointed a finger at health insurers and pharmacy benefit mangers, the companies that negotiate drug coverage on behalf of health insurers and employers. The plans, also known as PBMs, make agreements with drugmakers to cover certain treatments, working to lower overall costs for their clients.
Those discounts are often passed along in the form of rebates to insurers or benefit managers. The result has been rising list prices, and rebates that rise in turn. While many patients don’t feel the effect, those that have to buy drugs out of pocket can be surprised.