Department of Health and Human Services Secretary nominee Alex Azar would be the first former drug industry executive to lead the agency if he is confirmed by the Senate.

A Tarbell review of past HHS secretaries – and before that leaders of its predecessor bureau, the Department of Health Education and Welfare — finds Azar would be the first pharmaceutical company insider to hold the office since the federal agency was created in 1953. He was president of Lilly USA and held other positions at the company starting in 2007.

The 23 previous HHS secretaries have been former governors, physicians, members of Congress, lawyers and academics. The most recent, former Rep. Thomas Price (R-Ga.), resigned September 29 over criticism of his use of private and government aircraft for official travel.

If Azar wins the job, it would signal a final industry takeover of the levers of influence in Washington, say critics. The drug industry is already one of Washington’s most powerful lobbies, with money that flows to key politicians and groups to ensure assistance or silence.

Azar has been a fixture over the years in key drug industry groups including stints on the board of the Biotechnology Innovation Organization and the Healthcare Leadership Council. The Council has been a leader, for example, in lobbying to privatize the Medicare program. It characterizes its work as “an on-going initiative to restructure the health care delivery system based on market principles.” The Council’s membership includes some of the most recognized brands in health care.

Robert Weissman, president of Public Citizen issued a dire warning: “If Alex Azar’s nomination is confirmed, then Big Pharma’s coup d’etat in the healthcare sphere will be virtually complete.”

The Department of Health and Human Services has a broad purview, including management of the FDA, which regulates new medicines. It also has oversight of the National Institutes of Health, the Center for Medicaid Services which runs the Medicaid program, the Centers for Disease Control which tracks disease outbreaks, and the Health Resources and Services Administration a lesser known agency that coordinates care to economically vulnerable Americans.

Azar formerly served as Deputy HHS secretary under President George W. Bush, and several influential healthcare lobby groups stepped up to sing his praises.

“We are confident that his extensive background in business, healthcare and medicine distinguishes him as a uniquely qualified candidate for the vacancy,” said Rick Pollack CEO of the American Hospital Association, in a statement.

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Drug industry consultant Adam Fein thinks Azar is the perfect pick: “He is one of the very few people who can effectively and thoughtfully tackle the issues around patient affordability for prescription drugs,” he said. “[Azar] understands our complicated drug distribution and reimbursement system, which makes him one of the very few people who can put in place policies to lower costs for patients.”

Weissman doesn’t buy it. The advocacy group points to Azar’s tenure at Eli Lilly, where it says the company pushed up the price of Humalog insulin by 345 percent from $2,657.88 per year to $9,172.80 per year.

“It is highly unlikely that a pharmaceutical company executive who has made passionate arguments against price restraints is going to advance real reform,” said Weissman in a statement. “Much more likely is that he serves as the instrument by which Big Pharma aims to defend its monopolies and unaffordable prices.”

Ben Wakana, executive director of Patients For Affordable Drugs agrees: “Drug corporations have undue influence over health policy in America, and they use it to make money on the backs of patients and taxpayers. To have a former drug company executive nominated as HHS Secretary adds to our concern that this administration may continue to disappoint through its lack of action on skyrocketing drug prices.”

Neither the drug industry lobby group PhRMA nor BIO, which represents companies such as Amgen that make biologic large-molecule medicines, issued public statements regarding Azar’s nomination.