The nomination of Alex Azar is unusual because HHS secretaries have tended to come from the ranks of elected officials such as governors, leaders in academia and medicine, or top executive branch managers - not industries regulated by the department.
Trump has a track record of making industry-friendly nominations, such as tapping former ExxonMobil CEO Rex Tillerson as secretary of state and wealthy investor Wilbur Ross as secretary of commerce.
Azar, who ran Indianapolis-based Lilly's USA operations until earlier this year, has been an advocate for more state flexibility under Obamacare. "If he wants to take meaningful action to lower drug prices, we want to help him". "The drug companies, frankly, are getting away with murder", the president said at a Cabinet meeting this fall.
Trump has been a sharp critic of the industry. Azar also served as the former Deputy Secretary of the HHS under former President George W. Bush from 2005 to 2007. Prices are "out of control".
"Drug corporations have undue influence over health policy in America, and they use it to make money on the backs of patients and taxpayers", said Ben Wakana, executive director of Patients For Affordable Drugs, an advocacy group.
Professionally, Azar has another set of skills that may be valuable to the president.
Azar previously worked at the department as deputy secretary under President George W. Bush before joining the pharmaceutical industry.
Azar admirers say his industry experience should be considered an asset, not a liability. Ron Wyden (OR), for instance, spoke for many of his colleagues when he wondered how Azar could faithfully work to bring down prescription drug prices given his former employment.
As secretary, Azar would have broad authority over many aspects of the program.
Mr Azar would replace Tom Price, who resigned in September after it emerged he spent up to $1m on private travel.
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