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WASHINGTON — Alex M. Azar II, President Trump’s nominee for secretary of health and human services, said Wednesday that he would try to reduce the burden of high drug costs, but he largely absolved drug companies from blame, placing the responsibility on a system that encourages price increases on medicines.
Mr. Azar sailed through the first of two hearings on his nomination without making major missteps. But he did not appear to dispel the doubts of Democrats who distrust him because of his experience as a top executive at a major drug maker, Eli Lilly and Company, for 10 years.
Democrats said that Mr. Azar had enriched himself in going from government to private industry and was potentially tainted by his work in the sector. One Republican, Senator Rand Paul of Kentucky, joined that chorus.
“You’ve got some convincing to make me believe that you’re going to represent the American people and not Big Pharma,” he told Mr. Azar.
Mr. Azar’s first confirmation hearing came two months after Tom Price resigned as health secretary in the face of multiple federal inquiries into his use of private and government planesfor travel. Mr. Azar has ample policy experience, including a stint as deputy health secretary under President George W. Bush.
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But he would assume control of the Department of Health and Human Services at a sensitive time. HealthCare.gov and the Affordable Care Act are in the middle of the first open-enrollment period of the Trump era, and Mr. Azar’s background in the pharmaceutical industry is raising questions about the president’s campaign promise to bring down the cost of prescription drugs, by allowing the government to negotiate drug prices for Medicare and possibly permitting the importation of medicine from Canada.
Mr. Azar pledged that if confirmed, he would work “in the interests of all Americans, not in the interests of any trade group, not in the interests of any company.” He added, “This is the most important job I will ever have in my lifetime.”
He said he wanted to maximize the number of Americans with health insurance, but he supported Republican efforts to repeal the Affordable Care Act’s requirement that people have coverage or pay a penalty. And he disputed Democrats’ assertions that Mr. Trump had tried to undermine or sabotage the 2010 law.
“What I do not support is forcing 6.7 million Americans to pay $3 billion of penalties to not buy something they don’t want to buy through a mandate upon them, 90 percent of whom make $75,000 a year or less,” Mr. Azar said.
As a top health official in the Bush years, Mr. Azar helped carry out a 2003 law that provided drug benefits to millions of older Americans through a program known as Part D of Medicare. He joined Lilly in 2007 and stepped down as the president of Lilly USA in January.
Senator Lamar Alexander, Republican of Tennessee, who presided over the hearing as the chairman of the Committee on Health, Education, Labor and Pensions, said Wednesday that Mr. Azar’s experience in the industry would help him improve the byzantine arrangements under which drugs are priced and distributed.
“Drug prices are too high,” Mr. Azar testified. “The president has made this clear. So have I. Through my experience helping to implement Part D and with my extensive knowledge of how insurance, manufacturers, pharmacy and government programs work together, I believe I can bring skills and experiences to the table that can help address these issues.”
Senator Patty Murray of Washington, the senior Democrat on the committee, expressed skepticism. “As a pharmaceutical executive,” she said, “you raised drug prices year after year. Eli Lilly is currently under investigation for working, under your tenure, with other drug companies to needlessly raise the price of insulin.”
In announcing Mr. Azar’s nomination, Mr. Trump said he would be “a star for better health care and lower drug prices.”
Mr. Azar said Wednesday that some pharmaceutical companies had abused the nation’s patent system to prolong their exclusive rights to market certain drugs and to thwart the sale of equivalent generic products that cost less.
“There are clearly abuses in the system,” Mr. Azar said, adding that “full generic competition” should start at a specific time defined by the law.
“You shouldn’t be able to evergreen your patents,” Mr. Azar said, referring to the practice by which brand-name drug makers delay generic competition by securing additional patents for relatively minor variations on a profitable drug.
He was hard-pressed to defend big price increases for diabetes treatments.
“Insulin prices are high, and they’re too high,” he testified. “This system that we’ve got may fit for the stakeholders behind the scenes.” But for many patients, he said, it is not working.
“Everyone shares blame here,” he said.
Senator Elizabeth Warren, Democrat of Massachusetts, said that Mr. Azar “helped manage the fallout” when Lilly in 2009 paid a criminal fine of more than a half-billion dollars to settle accusations that it had promoted an antipsychotic drug, Zyprexa, for uses not approved by the Food and Drug Administration.
“These settlements have become a cost of doing business for the drug companies,’’ Ms. Warren said. Mr. Azar declined to answer directly when she asked whether top executives should be held “personally accountable when drug companies like Lilly break the law.”
Mr. Azar echoed Republican criticism of the Affordable Care Act.
“Under the status quo,” he said, “premiums have been skyrocketing year after year, and choices have been dwindling. We must address these challenges for those who have insurance coverage and for those who have been pushed out or left out of the insurance market by the Affordable Care Act.”
Mr. Azar said he supported the idea of converting Medicaid, the program for low-income people, to a block grant, with a lump sum of federal money for each state and fewer federal requirements for coverage and benefits.
“States are most effective in determining benefit packages for their citizens,” he said.
Ms. Murray and other Democrats said they were disappointed with Mr. Azar’s comments on health care for women, especially their access to birth control through employer-sponsored insurance. “We have to balance a woman’s choice of insurance that she would want with the conscience of employers” who may object to covering contraceptives, he said.
Mr. Azar praised Sylvia Mathews Burwell, the last secretary of health and human services under President Barack Obama, for promoting “alternative payment models” that reward doctors and hospitals for achieving better outcomes for Medicare patients. The Trump administration has curtailed or ended some of those alternatives to the traditional fee-for-service system.
