As expected, President Donald Trump has picked a former top pharmaceutical and government executive to be his Health and Human Services secretary.
If confirmed by the Senate, former Eli Lilly and Co. exec Alex Azar will oversee a $1 trillion department responsible for major health insurance programs, medical research, food and drug safety, and public health.
Trump's announcement confirms reports that emerged last week from sources familiar with the matter.
Azar, 50, a lawyer by training, had spent the last 10 years with Lilly, rising to president of its key U.S. affiliate before leaving in January to start his own consulting firm. He's seen as an expert on government health care regulation.
(See video below of Azar at IBJ's Health Care & Benefits Power Breakfast)
In making the pick, Trump turned to an industry he's often rebuked.
The nomination of Azar is unusual because HHS secretaries have tended to come from the ranks of elected officials such as governors, leaders in academia, or top executive branch managers—not industries regulated by the department.
"He will be a star for better healthcare and lower drug prices!" Trump tweeted in announcing the nomination Monday morning.
As HHS secretary, Azar would have to scrupulously avoid conflicts with Lilly's far-reaching interests, from drug approval to Medicare reimbursement. The drugmaker has drawn criticism from patient advocacy groups for price increases to one of its biggest products: insulin.
Americans consistently rank the high cost of prescription drugs as one of their top health care priorities, putting it ahead in public opinion polls of divisive issues like repealing Obamacare.
Trump has been a sharp critic of the industry. "The drug companies, frankly, are getting away with murder," the president said at a Cabinet meeting this fall. Prices are "out of control" and "have gone through the roof," Trump said.
In the spring, a Trump tweet sent drug stocks tumbling after the president said he was working on a new system that would foster competition and lead to much lower prices. In meetings with industry executives, however, Trump has focused on speeding up drug approvals, a cost-reducing tactic they would back.
Professionally, Azar has another set of skills that might be valuable to the president.
As a top HHS official during the George W. Bush administration, the Yale law graduate developed an insider's familiarity with the complex world of federal health care regulation, serving first as the department's chief lawyer and later as deputy secretary.
Frustrated by fruitless efforts to overturn the Affordable Care Act in Congress, Trump might see the regulatory route as his best chance to make a mark on health care.
Congressional Democrats are likely to pounce on Azar's drug ties, reminding Trump of his promise to "drain the swamp" of Washington influence-peddling.
Azar admirers say his industry experience should be considered an asset, not a liability.
"To the extent that the Trump administration has talked about lowering drug prices, here's a guy who understands how it works," said Tevi Troy, who served with Azar in the Bush administration and now leads the American Health Policy Institute, a think tank focused on employer health insurance.
"Would (Azar) have been better off if he had been meditating in an ashram after serving as deputy secretary?" asked Troy.
Azar spent his formative years in Maryland. He got his bachelor's degree in government and economics from another Ivy League institution, Dartmouth. He once clerked for the late Supreme Court Justice Antonin Scalia, a revered figure for conservatives. During the Bill Clinton years, he served a stint with independent counsel Kenneth Starr.
If confirmed, Azar would be Trump's second HHS secretary, replacing former Georgia congressman Tom Price, who stepped down after just seven months, when his use of private charter planes for government travel created a public controversy that displeased the president.