Democrats are going after Trump's pick to replace Tom Price and are using his history with drug prices to do it

• President Donald Trump has said that Alex Azar, his pick for Health and Human Services secretary, will "be a star for better healthcare and lower drug prices."
• Some senators are using Azar's experience in the pharmaceutical industry to argue otherwise.
• In particular, Azar was a senior executive at Lilly during a time when the price of insulin steadily increased. 
• Insulin prices rose three-fold during the period he was there, including when he served as president of the company, even though the medicine remained the same.

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Alex Azar, the new nominee for secretary of the Department of Health and Human Services, is being pitched as someone who will help lower the price of prescription drugs. 

"He will be a star for better healthcare and lower drug prices," President Donald Trump said in a tweet announcing Azar as his pick on Monday. Azar is Trump's choice to replace Tom Price, who resigned from the position in September after his use of private jets was reported to have cost taxpayers more than $1 million.

Trump, who once said that drugmakers are "getting away with murder," has promised to get rising drug prices under control. 

But Azar's own track record with drug prices is giving Democrats fodder to attack the choice. Even though he's already served in the department that he's now being tapped to run, Azar was also a senior executive at
Eli Lilly. 

Lilly is one of three companies that have substantially increased the price of insulin, the lifesaving drug used to treat diabetes. Some of those increases came while Azar was president of the company's US unit.

The opposition was quick to point this out:

Decade of price hikes

Azar worked as HHS deputy secretary from 2005 to 2007 under President George W. Bush.

In 2007, he joined the drugmaker Eli Lilly as a senior vice president of corporate affairs and communications and eventually became president of Lilly USA, according to his LinkedIn profile. He left Lilly in January this year and has since consulted with pharmaceutical and health-insurance companies. Lilly did not immediately respond to a request for comment on Azar's time at the company. 

Over the 10-year period when Azar was at Lilly, the price of insulin notched a three-fold increase. It wasn't just Lilly's insulin product, called Humalog. The price of a rival made by Novo Nordisk has also climbed, with the two rising in such lockstep that you can barely see both trend lines below. 

The gains came despite the fact that the insulin, which as a medication has an almost-century-long history, hasn't really changed since it was first approved.

What Azar might do about drug costs

As secretary of the Department of Health and Human Services, Azar would 
oversee health agencies including the Food and Drug Administration, which regulates pharmaceutical companies and medical devices, and the Centers for Medicare and Medicaid Services, which pay for prescription drugs.

It's likely that should Azar try to do something about drug prices, he might look at taking action against more than just pharmaceutical companies. Instead, he may target the middlemen who many drugmakers blame for jacking up prices. Lilly, for example, says that that the net price for its insulin Humalog was actually down 24% in the third-quarter of 2016, from the third-quarter of 2015 - because of the complicated system of payments. 

Azar's spoken out about this before:

"We're trying to usher in a golden age of medicines with a payment system that is in its golden years," Azar said at a Manhattan Institute event in 2016, Bloomberg reported. "That system needs to be retired and replaced. The only way to do that is for every private health care institution, drug companies, insurers, employers, PBMs, hospitals, to work together to create a better way to pay for medicines."