If Alex Azar, Secretary of Health and Human Services, thought the public sector would be easy, he may be having second thoughts.


During his swearing-in ceremony in late January, President Donald Trump promised that under the former pharmaceutical executive, prescription drug prices will come “rocketing down.”


“The same pill, in an identical box from the same factory, costs us much more than it does in other countries,” Trump said during the ceremony. “Nobody knows that process better than Alex.”


Trump’s promise that Azar can single-handedly send the price of prescription drugs plummeting is optimistic at best. Democrats quickly pointed out that Eli Lilly, where Azar served as a senior executive, was one of a small handful of companies to substantially raise the price of insulin.


However, drug pricing experts say Azar is well-suited for the challenge. Rachel Sachs, associate professor at the Washington University School of Law in St. Louis, who focuses on health law, predicted a price cut will not happen as quickly as the White House expects.


“Secretary Azar is thoughtful, smart, and clearly understands the pieces that go into the drug-pricing equation, in large part because of his service at Eli Lilly,” she noted. “He knows how hard it is going to be to address these questions, and many of the strategies he might want to put in place won’t bear fruit for quite some time.


That doesn’t mean short-term actions aren’t feasible. The Centers for Medicare and Medicaid Services (CMS), Sachs added, has moved to lower out-of-pocket payments for some Medicare Part D beneficiaries. In addition, FDA Commissioner Dr. Scott Gottlieb implemented an initiative to promote generic competition.


Azar’s proposals that appeared in Trump’s budget included making sure seniors in Medicare obtain discounts negotiated by benefit managers with drugmakers and capping out-of-pocket prescription costs. However, skeptics warned the president’s budget was a political non-starter.


Dr. Gerard Anderson, professor of health policy and management at the Johns Hopkins University Bloomberg School of Public Health and a veteran of HHS, noted Azar will be surrounded by colleagues with roots in pharma that are unlikely to support cost-lowering measures.


“A secretary can’t do it alone,” he said. “He’s going to have to motivate a lot of people who will be reluctant.”