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, or top executive branch managers, not industries regulated by the department.
"He will be a star for better healthcare and lower drug prices!" Trump tweeted in announcing the nomination today morning.
As HHS secretary, Azar would have to scrupulously avoid conflicts with Lilly's far-reaching interests, from drug approval to Medicare reimbursement. The drugmaker has drawn criticism from patient advocacy groups for price increases to one of its biggest products: insulin.
Americans consistently rank the high cost of prescription drugs as one of their top health care priorities, putting it ahead of divisive issues like repealing "Obamacare" in public opinion polls.
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In the spring, a Trump tweet sent drug stocks tumbling after the president said he was working on a new system that would foster competition and lead to much lower prices.
In meetings with industry executives, however, Trump has focused on speeding up drug approvals, a cost-reducing tactic they would back.
Professionally, Azar has another set of skills that may be valuable to the president.
Frustrated by fruitless efforts to overturn the Affordable Care Act in Congress, Trump might see the regulatory route as his best chance to make a mark on health care.
Congressional Democrats are likely to pounce on Azar's drug ties, reminding Trump of his promise to "drain the swamp" of Washington influence peddling.
Azar admirers say his industry experience should be considered an asset, not a liability.
"Would (Azar) have been better off if he had been meditating in an ashram after serving as deputy secretary?" asked Troy.
Azar spent his formative years in Maryland. He got his bachelor's degree in government and economics from another Ivy League institution, Dartmouth.
He once clerked for the late Supreme Court Justice Antonin Scalia, a revered figure for conservatives. During the Bill Clinton years, he served a stint with independent counsel Kenneth Starr.