Alex Azar fills vacancy left by Tom Price, MD
On Jan. 24, 2018, the U.S. Senate approved Alex Azar as secretary of the U.S. Department of Health and Human Services (HHS) by a 55-43 vote. Mr. Azar, who spent much of his career in the pharmaceutical industry, fills the vacancy left by former secretary Tom Price, MD. Mr. Azar previously held high-level positions at HHS during the George W. Bush administration and is the former president of the U.S. division of drug manufacturer Eli Lilly and Company.

During his confirmation process, Mr. Azar outlined the four key areas, summarized below, that he intends to prioritize as HHS secretary.

Value-based care
Mr. Azar suggested harnessing the "power of Medicare to shift the focus in our healthcare system from paying for procedures and sickness to paying for health and outcomes." It has been suggested that Mr. Azar may be open to mandatory payment programs under the Center for Medicare and Medicaid Innovation (CMMI), where his predecessor—Dr. Price—was staunchly opposed to the concept. "If, to test a hypothesis around changing our healthcare system, it needs to be mandatory as opposed to voluntary to get adequate data, then so be it," Mr. Azar said. He also emphasized the need to improve health information technology, transparency, and accountability.

Drug prices
Emphasizing that drug prices are too high, and with his extensive knowledge in this area, Mr. Azar said he hopes to address the issue "while still encouraging discovery so Americans have access to high-quality care." He said he intends to serve the best interests of the public, and suggested that solutions to the problem could include increased generic competition and addressing patent issues. However, many Democrats questioned Mr. Azar's commitment to this effort, pointing to his ties with the pharmaceutical industry.

"The same Donald Trump who said almost exactly one year ago that price-hiking drug companies were 'getting away with murder' has nominated a drug company executive with a documented history of raising prescription drug prices to captain the administration's healthcare team," said Sen. Ron Wyden (D-Ore.).

Other members of Congress praised Mr. Azar's experience, including his tenures under President Bush and with Eli Lilly, as law clerk for Supreme Court Justice Antonin Scalia, and as founder of a consulting firm.

"Mr. Azar brings with him nearly two decades of experience in the healthcare system, working in both the private and public sectors," stated Sen. Orrin Hatch (R-Utah). "I think that broad expertise will serve him well, particularly at this critical time when the HHS Secretary will need to be intensely focused on the opioid epidemic and other major problems facing our country."

Affordable health care
Mr. Azar said that health care in this country must be more affordable, more available, and more tailored to what individuals want and need. He noted that the Affordable Care Act has pushed some individuals out of the insurance market and reduced their coverage choices.

On this point, Sen. Lamar Alexander (R-Tenn.) suggested taking steps to lower premiums and stabilize the market, such as approving states' innovation waivers, "which could increase access to lower cost plans and incentivize younger and healthier individuals to purchase insurance," he said. "The American people deserve healthcare reform that is done in the right way, for the right reasons, in the right amount of time. It is about working toward long-term solutions that work for everyone."

Opioid epidemic
Finally, Mr. Azar expressed urgency in addressing the opioid epidemic. He suggested "aggressive prevention, education, regulatory, and enforcement efforts to stop over-prescribing and overuse of these legal and illegal drugs," as well as compassionate treatment.

"These are serious challenges that require a serious-minded sense of purpose, and, if confirmed, I will work with the superb team at HHS to deliver serious results," said Mr. Azar.

Elizabeth Fassbender, Esq., is the communications manager in the AAOS Office of Government Relations. She can be reached at fassbender@aaos.org.