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ASHINGTON — Alex Azar, President Trump’s pick to lead the Health and Human Services Department, didn’t mince words when he described his top priority for the agency, telling lawmakers Wednesday that drug prices are too high and must be lowered.

“The president has made this clear, so have I,” Azar said.

The message was aimed directly at Democrats and critical consumer groups, who have questioned whether Azar would use his post to deliver on Trump’s campaign promise to bring down drug prices after he spent 10 years as an executive at pharmaceutical giant Eli Lilly, at a time when the company substantially raised its prices on insulin in particular.

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Indeed, the first two questions at Azar’s confirmation hearing Wednesday — from both Senate Health, Education, Labor, and Pensions Chairman Lamar Alexander (R-Tenn.), and Sen. Patty Murray of Washington, the panel’s top Democrat — centered directly on his tenure at the company and his plans to bring down prices.

Azar defended his time in the private sector, saying it would give him needed insight to address the high prices.

“Through my experience helping to implement [Medicare’s prescription drug benefit] Part D and with my extensive knowledge of how insurance, manufacturers, pharmacy, and government programs work together, I believe I can bring the skills and the experiences to the table that can help us address these issues while still encouraging discovery so Americans have access to high-quality care,” he said.

“I believe I can hit the ground running to work with you and others to identify solutions here,” he added to Alexander.

He also specifically addressed Lilly’s high price of insulin, a key line of attack against his nomination, after highlighting in his opening remarks that he had not overseen diabetes drugs at the company.

“The current system of pricing insulins and other medicines may meet the needs of many stakeholders, but that system is not working for the patients who have to pay out of pocket, and we have to recognize that impact,” Azar said.

When Murray asked specifically about how he might use the tools at HHS to bring down prices — when he hadn’t managed to do so in the private sector, Azar stuck to traditionally conservative policy ideas, like encouraging the development of more generic drugs and limiting abuses of the patent system.

Though the HELP committee doesn’t have the ultimate authority to advance Azar’s nomination — that power rests with the Senate Finance Committee — its membership shares jurisdiction over the health department and many health policy issues.

And those members didn’t let drug pricing issues drop. In one heated exchange, Sen. Elizabeth Warren (D-Mass.) pressed Azar about a Lilly settlement related to the company’s fraudulent marketing of the drug Zyprexa, a case that led to the company paying what was then the largest criminal fine in history. She suggested the CEOs of companies engaging in that bad behavior should be held personally responsible. Asked if he agreed, Azar dodged — twice.

Sen. Maggie Hassan (D-N.H.) also pressed Azar to comment on a recent move from Allergan, which controversially shifted its patents for the eye drug Restasis to a sovereign Native American tribe to avoid some challenges to its drug patents. She called the behavior “unacceptable.”

Azar agreed, saying he would “share [Hassan’s] concern” with the behavior, though he added he might not have jurisdiction over those issues.

Republicans took up the case, too. Sen. Rand Paul of Kentucky lambasted “big pharma” for using its economic clout to game the system — even suggesting he would oppose Azar’s nomination unless he develops a plan to import drugs from Canada or other countries safely. Sen. Lisa Murkowski of Alaska raised a similar question.

“You’ve got some convincing to make me believe you’re going to represent the American people and not big pharma. I know that’s insulting and I don’t mean it to be,” Paul told Azar. “But we all have our doubts because big pharma manipulates this system to keep drug prices high. … We have to really fix it and you need to convince those of us who are skeptical that you’ll be part of fixing it and won’t be beholden to big pharma.”

Azar pushed back on the idea in the hearing, echoing earlier comments he had made that referred to the idea of drug importation as too risky.

Even the senators themselves expected fireworks. Alexander warned Azar’s family even before the hearing started that the nominee was in for something of an inquisition.

It might get heated in here, so “don’t fall out of your chairs,” he told them.

Ike Swetlitz contributed reporting.

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