He previously served as HHS general counsel and deputy secretary for President George W. Bush. Following his time with the administration, he worked for pharmaceutical giant Eli Lilly & Co. and became president of Lilly USA in 2012. As part of his role at Lilly USA, Azar was on the board of directors for the Boards of the Biotechnology Industry Organization (BIO), a drug lobbying group. He left Lilly USA and BIO in January.

During Azar's tenure leading Lilly, the company was accused of routinely increasing drug prices.

In an October letter, Reps. Raul Grijalva, D-Arizona, Mark Pocan, D-Wisconsin, and Jan Schakowsky, D-Illinois, wrote that under his leadership, Azar's company fought "against federal and state legislation to increase drug pricing transparency." And a lawsuit filed in Massachusetts in early 2017 alleges that the company shot up prices on insulin "in near lock step" with two other pharmaceutical manufacturers, according to The New York Times.
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Following Yale Law School, Azar clerked for Supreme Court Justice Antonin Scalia, and later joined the Whitewater independent counsel headed by his "mentor" Ken Starr. He also worked on Bush's 2000 presidential campaign before his first stint at HHS.