By Sy Mukherjee
November 13, 2017

President Donald Trump on Monday announced that he is nominating Alex Azar, a former top executive at U.S. pharmaceutical giant Eli Lilly, to be the next Secretary of the Department of Health and Human Services (HHS). Trump’s previous HHS Secretary, Tom Price, resigned in September following a scandal centering on his use of private chartered jets on the taxpayer dime.

If confirmed by the U.S. Senate, Azar would oversee one of the most sprawling and powerful federal agencies in America. HHS houses everything from the Centers for Medicare & Medicaid Services (CMS)—which is tasked with running major national health care programs like Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and Obamacare—to the Food and Drug Administration (FDA), the Centers for Disease Control (CDC), the National Institutes for Health (NIH), the Indian Health Service (IHS), and the Substance Abuse and Mental Health Services Administration (SAMHSA).

One striking aspect of the nomination is Azar’s history as a prominent executive in the drug industry—a sector that Trump hasn’t been shy about criticizing over high drug prices and lavish price increases. After serving in the George W. Bush administration’s HHS, first as general counsel and then as a deputy HHS Secretary from 2005 to 2007, Azar moved on to several high-level posts at Eli Lilly—including as the president of Lilly USA, the drug maker’s main U.S. arm. Azar left the company at the beginning of 2017 to “pursue other career opportunities.”

Trump announces his nomination of Alex Azar for HHS Secretary on Twitter Monday

The Trump White House says Azar’s combination of public and private sector experience will serve him well at a time when the administration is seeking big changes to Obamacare and regulatory agencies like the FDA. “He will be a star for better healthcare and lower drug prices!” wrote Trump in a tweet on Monday morning.

There’s a chance Azar may not face the same level of grilling and controversy that previous HHS Secretary Price did during his own Senate confirmation hearings (although Azar’s drug industry ties may prompt some scrutiny). Azar was confirmed unanimously in a Senate voice vote to his role as Deputy Secretary under the Bush administration in 2005.

This is at least the third industry insider that Trump has tapped to run a major federal health care entity (after Price and FDA Commissioner Dr. Scott Gottlieb). Both Price and Gottlieb were questioned on their intimate involvement with biopharmaceutical and health care companies by lawmakers; Price specifically was the subject of sharp ethics questions about his financial investments in medical firms that would also benefit from legislation he was pushing while serving in the House of Representatives. Gottlieb stated during his confirmation hearing that he would recuse himself from any FDA decisions involving 20-plus drug, device, and other health care companies from which he’s either received money or invested in.

A version of this essay appears in today’s edition of the Fortune Brainstorm Health Daily. Get it delivered straight to your inbox.

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