When Pres. Donald Trump announced he was nominating Alex Michael Azar II to be the next secretary of health and human services, Trump called him a “star for better healthcare and lower drug prices.” The catch is that Azar, who served as president of pharmaceutical giant Lilly USA until January, has been widely criticized for raising medication costs. During his decade at Lilly, the company tripled the price of its insulin and was fined for colluding to keep its prices high in Mexico.

Democrats say that the issue will likely dominate Azar’s confirmation hearing Wednesday before the Senate Health, Education, Labor and Pensions (HELP) committee. “Given his professional background, Sen. Murray will definitely want to focus on whether or not he will be able to make any effort to lower drug prices for patients,” says Mairead Lynn, spokesperson for ranking HELP Committee member Sen. Patty Murray (D-Washington).

Sen. Bernie Sanders (I-Vermont), who is also on that committee, expressed concerns in a press statement. “The nomination of Alex Azar, the former head of Eli Lilly’s U.S. operations, shows that Trump was never serious about his promise to stop the pharmaceutical industry from ‘getting away with murder,’” Sanders said. “The last thing we need is to put a pharmaceutical executive in charge of the Department of Health and Human Services.”

On the campaign trail Trump had called for action to lower drug prices, such as boosting medication imports and granting the government more negotiating powers to lower prescription costs. But in the White House those actions have not yet gained ground. Based on Azar’s track record, Democrats question if that is likely to change with him as HHS secretary.   

Still, Democratic lawmakers may find other things to like about an Azar-led HHS. Like Trump’s current head of the Food and Drug Administration, Scott Gottlieb, Azar is already familiar with the inner workings of the agency he would run. Azar’s bona fides include serving as the number two official at HHS during the George W. Bush administration, and previously serving as its general counsel. But potential conflicts of interest will also be at the forefront of Wednesday’s discussions, Democrats say. Committee members will ask if Azar will commit to recusing himself from decisions related to his private-sector work. In addition to his tenure at Lilly, he also consulted for various biopharmaceutical and health insurance companies on federal and state policy, sales, marketing, pricing, reimbursement, access and distribution.

Republicans including Tennessee Sen. Lamar Alexander, the chairman of the HELP committee, have already endorsed Azar. Many GOP lawmakers have wanted to quickly fill the role since Trump-appointed Secretary Tom Price resigned in September, after Politico reported that he was using private jets and military aircraft for government business, running up a massive travel tab at taxpayers’ expense. (Since then, Acting Secretary Eric Hargan has been running the agency.)

Azar was easily confirmed for his prior stints at HHS. But the road ahead may not be as smooth as it was under Bush’s tenure, largely due to partisan tensions over Obamacare that could roil the process. Moreover, Democrats wary of the HHS record under Tom Price will likely press Azar on his plans for reproductive medicine policy and the opioid crisis.

Some committee members are already familiar with Azar. Murray and Alexander both met with him in the two weeks between his November 13 nomination and the HELP hearing. Murray’s office says she and Azar discussed issues she plans to bring up in the hearing, including the health care system, drug pricing and the opioid epidemic. And Alexander said in a statement after their meeting that Azar had impressive knowledge and experience, as well as the “qualifications to get results.”

Before the full Senate votes on Azar there will be one additional hurdle after Wednesday—another hearing, which has not yet been scheduled, before the Senate Finance Committee. Sen. Orrin Hatch (R-Utah), chairman of that committee, supports the nominee. “The leader of HHS will be at the tip of the spear, working to not only right the wrongs of this deeply flawed [Affordable Care Act] law, but also ensure the long-term sustainability of both Medicare and Medicaid,” Hatch said in a press release. “Mr. Azar has the experience, knowledge and fortitude to take on these daunting challenges.”