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Alex Azar’s Unusual Spin Through the Revolving Door

Washington’s infamous revolving door took an unusual turn for former Health and Human Services secretary Alex Azar.

Azar spent about a decade with pharmaceutical giant Eli Lilly and Co. before coming to the nation’s capital to lead HHS in the Trump administration. But in September 2020, just a couple of months before former president Donald Trump lost reelection, Azar certified the safety of drugs imported from Canada — a policy opposed by the U.S. drug industry. 

Now Azar chairs the board of a company trying to make prescription drug imports happen. In January 2022, a year after leaving his Cabinet post, Azar became chairman of the board of LifeScience Logistics, the firm managing Florida’s Canadian importation program, which just won approval from the Food and Drug Administration.

Florida Gov. Ron DeSantis’s (R) government is paying the Dallas-based company as much as $39 million to buy drugs from Canadian suppliers, contract with a lab to verify their authenticity, store the medicines and distribute them to state agencies. 

Officials at LifeScience, which manages nearly 6 million square feet of warehouse storage across 11 states, confirmed Azar’s position but didn’t respond to questions about how much he’s paid or whether he’s involved in the Florida work. Azar didn’t return messages left for him with employers, including the University of Miami, where he teaches part-time, or sent to a personal email address.

Robert Weissman, president of Public Citizen, a government-watchdog group, called Azar’s journey through the revolving door atypical. That’s because HHS’s certification of drug imports from Canada was opposed by the U.S. pharmaceutical industry, where Azar had once worked. Drugmakers argue that the policy puts patients at risk of consuming counterfeit medicines.  

DeSantis had pushed Trump to authorize importation from Canada, and the former president had said he supported importation before Azar certified it was safe.

Azar’s position with LifeScience “can appear as a conflict of interest,” said Ivana Katic, assistant professor of organizational behavior at the Yale School of Management, because Azar’s HHS policy decision later benefited him professionally.

Last week, the FDA announced that it would approve Florida’s first-in-the-nation import plan. 

Top U.S. officials in both parties, of course, commonly leave government service for what are often better-paid jobs or board seats at companies in the industries they formerly regulated.

About 57 percent of presidential Cabinet-level officials later served on corporate boards of directors, according to a 2019 study by researchers at Boston and Harvard universities in the Journal of Politics, which examined 84 Cabinet members who served from 1992 to 2014. 

“In general, we favor Cabinet secretaries not going into industries which they once regulated, because the possibility of conflicts of interest are unavoidable,” Weissman said.

Canadian drug importation has been the subject of decades of debate, and before signing off on it, Azar was a skeptic. In 2018, he called importation a “gimmick,” saying Canada’s pharmaceutical market wasn’t large enough to meet U.S. demand. 

Indeed, the Canadian government has repeatedly warned the United States it would block any scheme that poses a risk of causing shortages in Canada.

The country has implemented regulations “to prohibit certain drugs intended for the Canadian market from being sold for consumption outside of Canada if that sale could cause, or worsen, a drug shortage in Canada,” Health Canada, the national agency responsible for drug safety, said in a Jan. 8 statement after the FDA’s approval of Florida’s plan.

President Biden supported drug importation during his 2020 campaign, but after the election his administration moved slowly to advance the process. DeSantis has accused the Biden administration of slow-walking a decision and his government filed a lawsuit over the FDA’s delay.

Florida’s plan — aimed at helping the state health department and other agencies, including prisons and its Medicaid program, obtain lower-cost medicines — still faces many hurdles. On top of Canada’s reluctance to participate in U.S. importation programs, some drug manufacturers have deals with Canadian wholesalers preventing them from exporting medicines.

The drug industry’s major lobbying group, the Pharmaceutical Research and Manufacturers of America, or PhRMA, previously sued to stop Azar’s importation decision. It’s expected to file suit to block Florida’s program as well. A PhRMA spokesperson declined to comment on Azar’s role.


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