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The Senate confirmed Alex M. Azar II on Wednesday to be secretary of health and human services, clearing the way for President Trump’s second health secretary to begin controlling more than a trillion dollars a year in spending on medical insurance coverage for about one-third of all Americans. The vote was 55 to 43. (Pear, 1/24)

A 50-year-old Ivy League-educated lawyer, Azar says he has four main priorities for the Health and Human Services Department: help curb the cost of prescription drugs; make health insurance more affordable and available; continue bipartisan efforts to focus Medicare payments on quality; and confront the opioid addiction epidemic. (1/24)

Republicans praised Mr. Azar as a detail-oriented lawyer familiar with the workings of government and the health industry. Mr. Trump nominated Mr. Azar in November, saying in a tweet that “he will be a star for better health care and lower drug prices!” Democrats, noting that Mr. Azar recently headed an affiliate of Eli Lilly & Co., warned he would do little to bring down drug prices and would undermine the ACA. (Armour, 1/24)

Azar said at a nomination hearing that he would consider implementing some sort of drug negotiation in Medicare Part B, the part of the government health program for the elderly that covers drugs administered by doctors. But he dismissed a similar move for Medicare’s larger prescription-drug benefit, known as Part D, saying private companies already bargain on the government’s behalf. (Tracer and Edney, 1/24)

Azar, 50, will take over as policies in the sprawling department, with its budget of more than $1.1 trillion, are tilting to the right. A new civil rights division has just been created to protect health-care workers who refuse to provide contraception and other services inconsistent with their moral or religious beliefs. For the first time, new rules allow states to impose work requirements as part of their Medicaid programs. Other priorities Azar will oversee include trying to control rampant opioid addiction that is ravaging many U.S. communities. He will be under pressure to find ways to constrain drug prices — a realm in which suspicions of him run high given his years as a top executive of Eli Lilly. In addition, he will be at the vortex of the ongoing political feud over the Affordable Care Act, the 2010 law that has spread insurance to millions of Americans and is a main target of the administration and congressional Republicans. (Goldstein, 1/24)

He'll take over the agency at a time when rising drug prices are a huge political issue. Azar acknowledged as much in his confirmation hearing in early January. He told members of the Senate Finance Committee that dealing with high drug prices would be a priority. But Azar won't have the power to get Congress to change the law to let Medicare negotiate prices directly with manufacturers. He told senators that allowing the insurance companies that contract with Medicare is more effective. "These are incredibly powerful negotiators who get the best rates available," he said. (Kodjak, 1/24)

“I think he’s incredibly competent,” said Democratic Sen. Heidi Heitkamp. “I don’t share a lot of his philosophy, but I think he understands — as someone who has been at the administration — the importance of the rule of law and compliance.” (Cancryn, 1/24)

Azar knows the regulatory process well. Under former President George W. Bush, he served HHS as general counsel from 2001 to 2005. He then became deputy secretary for two years under Secretary Mike Leavitt, who asked Azar to oversee the department’s regulatory process. “He understands the process and he knows the levers and how you make it work and where the potential roadblocks are,” Leavitt told The Hill last year. “I think he would be of particular value given the fact that ... so far a repeal bill has not occurred and they’re going to need to make their imprint on existing laws through replacing the ideology underpinning it.” (Roubein, 1/24)

Former colleagues praise Azar's efficiency and leadership—traits that make Democrats who oppose his policies wary of the direction he is likely to take the department. "This nomination is about more than just the administration's failure on prescription drug prices," Oregon Sen. Ron Wyden, the ranking Democrat on the Finance Committee, said on the Senate floor Tuesday. "It's a referendum on an entire healthcare agenda." (Luthi, 1/24)

Kaiser Health News: Big Pharma Greets Hundreds Of Ex-Federal Workers At The ‘Revolving Door’

Alex Azar’s job hop from drugmaker Eli Lilly to the Trump administration reflects ever-deepening ties between the pharmaceutical industry and the federal government. A Kaiser Health News analysis shows that hundreds of people have glided through the “revolving door” that connects the drug industry to Capitol Hill and to the Department of Health and Human Services. (Lupkin, 1/25)