Trump’s Drug Pricing ‘Dream Team’ And Prospects For Change

“We’re not looking for a lot of turnover. I think we have a team that works very well together,” HHS Deputy Secretary Eric Hargan said.

HHS Deputy Secretary Eric Hargan is “hopeful” there won’t be much turnover at the department following the US mid-term elections and is not expecting a lot of re-shuffling at this point, he told Prevision Policy’s Biopharma Congress Nov. 14.

Although the period after the mid-terms is often a time for change in federal agency and department heads, “to be candid, I don’t expect a lot at HHS,” Hargan said.

He acknowledged rumors that HHS Secretary Alex Azar is being considered as a successor to former Attorney General Jeff Sessions. (Azar reportedly has said he is not interested in leaving HHS.)

But without addressing the reports specifically, Hargan pointed out the department is looking for continued stability under Azar after an unsettling period with a series of different leaders.

“HHS within a year went through six [leaders], including acting secretaries, so I think we’re all hopeful there’s not a lot more,” he said. Hargan himself served as acting secretary for four months after former Secretary Tom Price resigned in September 2017.

“We’re not looking for a lot of turnover. I think we have a team that works very well together and so I’m hopeful…that no one shows up in my office and says, ‘I’m out of here,’” he concluded.

Azar, FDA Commissioner Scott Gottlieb, Centers for Medicare and Medicaid Services Administrator Seema Verma, and HHS Deputy Assistant Secretary (Health Policy) for Planning and Evaluation John O’Brien have worked closely together as the Administration’s so-called “dream team” for advancing President Trump’s agenda for lowering drug prices.

The late Dan Best, who was senior advisor to the HHS secretary on drug pricing reform, was also a key member of the team. Best died suddenly Nov. 1. He brought a valuable mix of experience to his job, combining past roles as an executive at pharmacy benefit manager CVS Health Corp. and 12 years at Pfizer Inc. HHS has not announced plans for his successor.

Major changes in the makeup of the team could impact the roll-out of HHS policies on pricing reform. Many of the proposals in the HHS blueprint are designed to be implemented by regulation. Azar has made drug pricing a top priority for the department.

“Anybody working in health care” in the Administration “hopes that Secretary Azar stays at HHS,” Office of Management and Budget Associate Director for Health Programs Joe Grogan told the conference. He has also collaborated with HHS on drug pricing policies.

OMB’s Grogan Moving On?

However, Grogan may be leaving his own job soon, based on the experience of his predecessors.

The OMB official, who has held his current position since March 2017, spoke about the rigorous demands of his job and the typically short tenure of individuals in his role during a recent briefing with reporters. “The average tenure is anywhere from 18 to 24 months and I’m right in that zone,” he said. (Also see "Medicare Part D ‘Modernization’ Policies Still Priority Reforms – OMB’s Grogan" - Pink Sheet, 20 Sep, 2018.)

Among the factors that could encourage officials to move on is the incoming Democraticly controlled House, which will likely bring investigation pressure and political hurdles to any administration policy initiatives. (Also see "Triangulation Or The Bermuda Triangle: Can Trump Work With House Dems On Drug Prices?" - Pink Sheet, 11 Nov, 2018.)

Addressing plans for a possible successor, Grogan said, “in the private sector and every job I’ve had, I’ve been a big believer in succession planning because anything could happen at any time. There will be a number of good candidates we could vet when it’s my time to move on.”

Grogan outlined the qualities he thinks would be needed in his successor. “They will have to be conservative and willing to work hard,” he said. But “first and foremost, at OMB the job is to protect the taxpayers.

“The HHS secretary or an undersecretary or deputy administrator could have a great health care idea. But it has to be balanced against protecting the taxpayers and the cost of that over time. If you’re spending more on health care, you’re spending less on something else.”

He stopped short of recommending specific private sector experience for his successor. Grogan brought a background in the biopharma industry to the job from stints at Gilead Sciences Inc. and Amgen Inc. His expertise was an important asset, particularly early on, as he participated in the development of the Administration’s plan for lowering drug prices.

That kind of background may not be as important now, with former Eli Lilly & Co. executive Azar at the helm at HHS and Scott Gottlieb in charge of FDA, assuming they continue with the Administration.

For an FDA commissioner, Gottlieb has demonstrated an unusual level engagement in drug pricing and reimbursement policy, drawing on his past experience at CMS and in the private sector. He has been an active voice on a wide range of drug pricing policies, including those outside his immediate purview. (Also see "A World Without Rebates: Is FDA’s Gottlieb Offering New Vision?" - Pink Sheet, 9 May, 2018.)