Alex Azar speaks about his efforts to lower drug prices multiple times each week with President Trump, he said Tuesday. But it is his conversations with other Republicans on that issue that have often proven more difficult, the Health and Human Services secretary acknowledged.
The conservative resistance to several key Trump administration proposals to bring down the cost of medicine is substantial enough that Azar isn’t even seeking praise from members of his own party — he counts Republicans’ tempered criticisms of the administration’s signature proposal to cap some U.S. payments for drugs as a win.
“Let me put it this way: I don’t think you’ve seen any Republican leadership or Republican chairman come out firmly against what we’re doing,” Azar said. “They’re remaining open-minded and considering it.”
In an interview at STAT’s headquarters in Boston, Azar said it is his track record both as an administration figure during the George W. Bush presidency and as a top executive at Eli Lilly that has enabled him to assuage fellow conservatives’ concerns. He acknowledged, too, that the effort has taken a significant investment of time.
The proposal, which would limit U.S. payments for some Medicare drugs based on prices in other countries, has drawn considerable opposition from groups including the Chamber of Commerce and the American Conservative Union, which have said the model “imports foreign price controls.”
“I don’t want foreign countries setting our drug prices,” Sen. Chuck Grassley, the Republican chairman of the Senate Finance committee, said in January.
Azar said he’s open to alternatives and acknowledged that some conservatives have proposed other ways to tackle the issue. But, he added, “I still like mine.”
Indeed, the concept is still gaining steam in Washington. Sen. Bernie Sanders (I-Vt.) introduced a bill similar to the Trump administration’s proposal in November. Sen. Rick Scott (R-Fla.) recently unveiled his own.
Azar declined to take a position on either bill, but said his health department was “open for business” with members of Congress from either party.
Nevertheless, he downplayed the significance of recent talks between John O’Brien, his senior adviser on drug pricing, and Wendell Primus, a top aide to the Democratic House speaker, Nancy Pelosi. Those talks, which are still in their early stages, are seen as having the potential to yield a sort of drug-pricing compromise between the GOP White House and a Democratic-controlled House.
“I’d want to be careful not to be describing things as negotiations,” he said. “That conveys a different tone and tenor to interactions.”
Nonetheless, Azar said he has spent “a considerable amount of time” with lawmakers from both parties in recent months, even following the Democratic takeover of the House of Representatives.
“I’ve met with Elijah Cummings, I’ve met with Chairman [Frank] Pallone, Chairman [Richard] Neal,” Azar said, referencing the Democratic chairs of the House Oversight, Energy and Commerce, and Ways and Means committees, respectively. “I’ve talked to Leader [Steny] Hoyer, the Speaker — I’m quite ecumenical.”
Azar’s interview with STAT took place just hours after Pelosi emphasized in a speech that Democrats would pursue a campaign plank central to their 40-seat pickup in 2018: allowing Medicare to negotiate directly with manufacturers for drug prices. Azar expressed significant skepticism.
He cited findings from Peter Orszag, formerly the top budget adviser to the Obama administration to argue that negotiation, in order to be effective, could diminish seniors’ access to drugs.
“What I am very reluctant to do, and what I think a lot of people who talk about direct negotiation in Part D don’t quite realize is how negotiations work,” Azar said. “To get a better discount than what a PBM can get would require, as Peter Orszag has said, a single national formulary for all seniors that has some drugs in and excludes other drugs. I haven’t heard any seniors asking for that.”
He drew yet another red line against policy proposals to challenge some of the intellectual property rights granted to drug makers for their products, expressing opposition to what he interprets as “violence to the incentives for innovation.”
While more than 100 Democrats have signed onto an aggressive fix — using “compulsory licensing” to break drug company monopolies for companies who don’t agree to negotiated prices — Azar said he was unfamiliar with their proposal.
“I don’t know what precise proposal you’d be talking about there, because there’s no legal authority to strip intellectual property in the United States,” Azar said. “We actually have a constitution to prevent that, taking away property rights.”
Some Democrats, in fact, have pressed the National Institutes of Health to use existing authority to access intellectual property under the Bayh-Dole Act, and Pelosi has threatened drug companies with a separate statute allowing the federal government access to many private-sector inventions.
Though the administration has made clear which Democratic policies it opposes, Azar said he still believes a majority of the drug pricing ideas floating around Washington could win bipartisan support. And Trump has pushed as hard as anyone else in Washington for lower prices, Azar said — as evidenced by the pace at which his phone continues to ring.
“He’ll call me, I’ll call him, we’ll be in meetings even on other topics and he’ll pull me aside or even in the meeting ask me about drug pricing,” Azar said, asked how much the details of health policy interest the president.
“I find him to be appropriately engaged,” Azar said. “He fully understands the issues that we’re dealing with and has set very clear goals for me of what we have to achieve.”