Doggett, O’Rourke Call on Senate Finance Committee to Hold HHS Secretary Nominee Accountable for Record of Prescription Drug Price Increases

WASHINGTON, D.C. – Today, Congressman Lloyd Doggett (TX-35) and Congressman Beto O'Rourke (TX-16) led a letter urging the Senate Finance Committee to scrutinize Department of Health and Human Services (HHS) Secretary nominee Alex Azar's record of overseeing prescription drug price increases at Eli Lilly and his former statements on the Affordable Care Act. During Mr. Azar's tenure as President of the company, Eli Lilly more than doubled the list price for insulin between 2012 and 2017. Mr. Azar is set to testify before the Senate Finance Committee on Tuesday.

"Mr. Azar is just another Trump broken promise," said Congressman Doggett. "Instead of stopping the ‘murder' Trump said Big Pharma was committing, he has put another of their hitmen in charge. Families struggling with high prescription drug prices deserve better."

"The leader of our nation's health care system must be committed to addressing prescription drug costs that are squeezing families all across Texas," said Congressman O'Rourke. "If history is any guide, we have good reasons to question whether Alex Azar meets that standard. That's why I'm urging my Senate colleagues on both sides of the aisle to scrutinize his history and views on prescription drug pricing before voting on his nomination."

The letter was also signed by Representatives Judy Chu, Steve Cohen, Keith Ellison, Michelle Lujan Grisham, Marcy Kaptur, Carol Shea-Porter, and Jamie Raskin.

The full text of the letter is copied below:

Dear Chairman Orrin Hatch and Ranking Member Ron Wyden:

We urge the Senate Finance Committee to hold Alex Azar, President Donald Trump's nominee for Secretary of the Department of Health and Human Services (HHS), accountable for prescription drug price increases at Eli Lilly and his intentions to uphold the Affordable Care Act (ACA) during his upcoming confirmation hearing.

During the Senate Health, Education, Labor, and Pensions (HELP) Committee hearing on Azar's nomination on November 29, 2017, senators from both sides of the aisle scrutinized the nominee's views and history on drug pricing and the ACA. The Senate Finance Committee, which will vote on whether to send the nomination to the Senate floor for a final vote, will also hold a nomination hearing for Azar.

The incoming HHS Secretary will need to tackle several critical health care issues, including health care accessibility and skyrocketing prescription drug costs. The ACA made commendable progress in expanding coverage to approximately 20 million people, but there is still more work to be done to cover the remaining quarter-million that remain uninsured and curb health care costs. Further, almost two-thirds of all Americans say that lowering the price of drugs should be a top priority for President Trump and Congress, according to a recent Kaiser Family Foundation poll.[1] Even President Trump has said repeatedly that drug companies are "getting away with murder."

Due to the urgency with which we must address the affordability crisis, it is critical that we hold the nominee to the highest standards as he seeks to be confirmed as the next leader of our nation's health care system. Azar's history as a top executive at Eli Lilly when drug prices rose exorbitantly, along with his recent statements about the ACA, demonstrate that he may not meet those standards.

While Azar was President of Lilly, the list price for Humalog insulin more than doubled from $123 per vial in 2012 to $255 per vial in 2017, according to Truven Health Analytics; in 1996, Humalog cost only $21.[2] As a result, a class-action lawsuit alleges that Lilly fixed high prices for insulin with other drug companies. In the filed complaint, plaintiffs report "underdosing their insulin" and "skipping refills"; "some patients starve themselves, forgo[ing] one or even two meals a day." The complaint also cites financial difficulty, where "[m]ultiple class members spend over 50% of their income on their insulin drugs."[3] The next HHS Secretary should have more respect for patients than Azar and his company seemed to show during this period of extortionary drug prices.

Azar has made troubling statements about the ACA as well. He has noted that getting rid of the individual mandate, employer mandate, and cost-sharing reductions (CSRs) – payments that help lower out-of-pocket costs for families that cannot afford them – would "hasten its demise".[4] Despite the Trump administration doing just that – i.e., eliminating CSRs and voicing support to repeal the individual and employer mandates – Azar stated in the HELP hearing that he does not believe "there's any effort to sabotage the program". Azar's comments signal that he may seek to build on the efforts to dismantle the Affordable Care Act, potentially resulting in millions of individuals losing health insurance.

The Senate Finance Committee has an opportunity to press Azar further on these concerns, and we put these questions before the Committee:

• Sen. Isakson asked Azar to provide some ideas on how to fight "the gaming of the system" by pharmaceutical companies. However, Azar seemed unwilling to propose solutions to the drug price crisis that would require reforms from the drug manufacturing industry. Is he now willing to propose solutions that will increase transparency, lower costs, and protect the American public from runaway monopoly pricing? If not, can he firmly commit to providing a list of concrete recommendations to lower prices within the next six months?
• As President of Eli Lilly, Azar also served as a board member of the Biotechnology Innovation Organization, the primary lobbying group for the biotech industry. BIO, and as a member, Eli Lilly, continue to fight efforts to make drug pricing more transparent. Can Azar commit to defending the interests of patients and prioritize transparency as an important step to lowering drug prices?
• The Bayh-Dole Act of 1980 established important taxpayer protection rights, allowing the government to protect "reasonable access" for the American public to drugs developed with taxpayer funding. The National Institutes of Health has refused to utilize this important provision. Can Azar commit to upholding the law and using this tool to lower unreasonable drug prices?
• Can Azar provide any additional context for Eli Lilly's decision to increase insulin prices while he was president of the company? Does Azar know how many individuals were unable to afford their medication as a result?
• Can Azar guarantee that he will defend and implement the Affordable Care Act as the law of the land, as consistent with his constitutional duty? The previous Secretary of HHS, Tom Price, seems to have spent taxpayer money designated to promote the individual marketplace to campaign for its destruction. Does Azar agree that this is an improper use of taxpayer funds, and will he commit to being more responsible if he is confirmed?

As Members of Congress concerned about making health care and prescription drugs more accessible, we ask the Senate Finance Committee to conduct a thorough examination of Azar's nomination and ensure his responses affirm a strong commitment and vision to decreasing drug costs and upholding the ACA.

Sincerely,

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