Trump's HHS Pick Alex Azar Is the Worst Pharma Bro of All

Lilly's greatest marketing triumph may have come with Prozac, the antidepressant that arrived with a massive social impact and the sheen of proven science regarding serotonin, only years later was it revealed that that pharmacological effects of these drugs were "clinically negligible."

The year Azar joined Lilly, 2007, was the same year the drug manufacturer was accused of misleading consumers about its canine version of Prozac. It looks like the company was willing to overhype a cure for depressed dogs, too.

Did Azar help Lilly clean up its act, of just sweep its misdeeds under the carpet?

Azar became the head of Lilly's U.S. division in 2012, and under his leadership -- if "leadership" is the right word -- the company stands accused of illegally conspiring with other manufacturers of insulin to keep prices high, a practice that reportedly began in 2002 and continued at least until 2013.

As the New York Times reports, prices for insulin have risen in "near lock step" for years, without any apparent increase in costs. The consumer group Patients for Affordable Drugs (P4AD) said in a statement that "Eli Lilly is one-third of an insulin cartel that has driven up prices by more than 300 percent." A major class action suit accuses the three companies of racketeering, and probes of insulin pricing by attorneys general in multiple states remain underway.

And this isn't just a case of financial fraud or malfeasance. Lives are at stake. Websites like this one offer advice to desperate diabetics struggling to stay alive in the face of sky-high insulin costs. Sometimes diabetics are forced to choose: insulin or food.

As the Times reports, one lawsuit recounted horror stories of diabetics who can't afford up to $900 per month for insulin and have instead injected expired insulin, or starved themselves in an attempt to control their blood sugar levels. The lawsuit said that other patients allowed themselves to develop a potentially fatal condition in order to obtain insulin in the hospital emergency room.

Lilly has also been accused of making billions by avoiding its tax responsibilities through offshore profits. Lilly reportedly had $21 billion parked offshore in 2013. Lilly reportedly paid an effective U.S. corporate income tax rate of only 14.8 percent from 2008 to 2012. Like other drug manufacturers, it has also been accused of dodging taxes in Australia and Lithuania.

Donald Trump has accused drug companies of "getting away with murder" -- an assertion that is, sadly, more than a metaphor -- and promises that Azar will be a "star" in reducing drug costs, despite his track record leading a pharma industry giant that has been sanctioned for its price-gouging practices.

How likely is that?

Not very. Azar is a right-wing ideologue with close ties to Vice President and longtime corporate minion Mike Pence. His public comments about drug prices have blended misdirection and bullshit in roughly equal measure.

"The issue shouldn't be just to focus on drug prices," Azar said on the Fox Business show. "The issue is what are people paying when they go to the pharmacy to get their drugs."

Actually, it's both. Insurance companies and pharmacy benefit managers have sometimes conspired to overcharge customers for medications, as David Dayen reported last March. But Azar's line is standard drug-company spin. Big Pharma wants Americans to think about the prices they see when they fill prescriptions. That's why they often offer programs that waive copayments for certain high-priced medications.

But the costs we don't see are just as important. Overpriced medications are taxing the entire health care economy, and Americans pay for them in a number of less visible ways: in higher insurance premiums, less covered services, and higher copays and deductibles. Azar wants us to forget about those costs, even as the insurance companies pocket undeserved billions.

Azar also spewed standard-issue Big Pharma doubletalk in 2014 when he said, "The narrow focus of costs of medicine to the exclusion of innovation would be self-defeating in the long run."

Drug companies love to claim that we need to pay exorbitant drug prices because research and innovation are so expensive. But a recent study of new cancer drugs in the Journal of the American Medical Association showed that drug companies have been wildly exaggerating those costs and enjoying huge margins on new drugs.

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