Budgeting for Opioid Addiction Treatment Act

II 116TH CONGRESS 1ST SESSION S. 425 To amend the Internal Revenue Code of 1986 to establish a stewardship fee on the production and importation of opioid pain relievers, and for other purposes. IN THE SENATE OF THE UNITED STATES FEBRUARY 7, 2019 Mr. MANCHIN (for himself, Ms. KLOBUCHAR, Ms. BALDWIN, Mr. KING, Mr. WHITEHOUSE, Ms. WARREN, Mrs. SHAHEEN, Ms. HASSAN, Mr. BLUMENTHAL, and Ms. SMITH) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend the Internal Revenue Code of 1986 to establish a stewardship fee on the production and importation of opioid pain relievers, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Budgeting for Opioid 4 Addiction Treatment Act’’. 5 VerDate Sep 11 2014 18:48 Feb 19, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S425.IS S425 pamtmann on DSKBFK8HB2PROD with BILLS 2 •S 425 IS SEC. 2. STEWARDSHIP FEE ON OPIOID PAIN RELIEVERS. 1 (a) IN GENERAL.—Subchapter E of chapter 32 of the 2 Internal Revenue Code of 1986 is amended by adding at 3 the end the following new section: 4 ‘‘SEC. 4192. OPIOID PAIN RELIEVERS. 5 ‘‘(a) IN GENERAL.—There is hereby imposed on the 6 sale of any active opioid by the manufacturer, producer, 7 or importer a fee equal to 1 cent per milligram so sold. 8 ‘‘(b) ACTIVE OPIOID.—For purposes of this section— 9 ‘‘(1) IN GENERAL.—The term ‘active opioid’ 10 means any controlled substance (as defined in sec- 11 tion 102 of the Controlled Substances Act, as in ef- 12 fect on the date of the enactment of this section) 13 which is opium, an opiate, or any derivative thereof. 14 ‘‘(2) EXCLUSION FOR CERTAIN PRESCRIPTION 15 MEDICATIONS.—Such term shall not include any 16 prescribed drug which is used exclusively for the 17 treatment of opioid addiction as part of a medically 18 assisted treatment effort. 19 ‘‘(3) EXCLUSION OF OTHER INGREDIENTS.—In 20 the case of a product that includes an active opioid 21 and another ingredient, subsection (a) shall apply 22 only to the portion of such product that is an active 23 opioid.’’. 24 (b) CLERICAL AMENDMENTS.— 25 VerDate Sep 11 2014 18:48 Feb 19, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S425.IS S425 pamtmann on DSKBFK8HB2PROD with BILLS 3 •S 425 IS (1) The heading of subchapter E of chapter 32 1 of the Internal Revenue Code of 1986 is amended by 2 striking ‘‘Medical Devices’’ and inserting 3 ‘‘Other Medical Products’’. 4 (2) The table of subchapters for chapter 32 of 5 such Code is amended by striking the item relating 6 to subchapter E and inserting the following new 7 item: 8 ‘‘SUBCHAPTER E. OTHER MEDICAL PRODUCTS’’. (3) The table of sections for subchapter E of 9 chapter 32 of such Code is amended by adding at 10 the end the following new item: 11 ‘‘Sec. 4192. Opioid pain relievers.’’. (c) EFFECTIVE DATE.—The amendments made by 12 this section shall apply to sales on or after the date that 13 is 1 year after the date of the enactment of this Act. 14 (d) REBATE OR DISCOUNT PROGRAM FOR CERTAIN 15 CANCER AND HOSPICE PATIENTS.— 16 (1) IN GENERAL.—The Secretary of Health and 17 Human Services, in consultation with patient advo- 18 cacy groups and other relevant stakeholders as de- 19 termined by such Secretary, shall establish a mecha- 20 nism by which— 21 (A) any amount paid by an eligible patient 22 in connection with the stewardship fee under 23 section 4192 of the Internal Revenue Code of 24 VerDate Sep 11 2014 18:48 Feb 19, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S425.IS S425 pamtmann on DSKBFK8HB2PROD with BILLS 4 •S 425 IS 1986 (as added by this section) shall be rebated 1 to such patient in as timely a manner as pos- 2 sible; or 3 (B) amounts paid by an eligible patient for 4 active opioids (as defined in section 4192(b) of 5 such Code) are discounted at time of payment 6 or purchase to ensure that such patient does 7 not pay any amount attributable to such fee, 8 with as little burden on the patient as possible. The 9 Secretary shall choose whichever of the options de- 10 scribed in subparagraph (A) or (B) is, in the Sec- 11 retary’s determination, most effective and efficient 12 in ensuring eligible patients face no economic burden 13 from such fee. 14 (2) ELIGIBLE PATIENT.—For purposes of this 15 section, the term ‘‘eligible patient’’ means— 16 (A) a patient for whom any active opioid 17 (as so defined) is prescribed to treat pain relat- 18 ing to cancer or cancer treatment; 19 (B) a patient participating in hospice care; 20 and 21 (C) in the case of the death or incapacity 22 of a patient described in subparagraph (A) or 23 (B) or any similar situation as determined by 24 the Secretary of Health and Human Services, 25 VerDate Sep 11 2014 18:48 Feb 19, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S425.IS S425 pamtmann on DSKBFK8HB2PROD with BILLS 5 •S 425 IS the appropriate family member, medical proxy, 1 or similar representative or the estate of such 2 patient. 3 SEC. 3. BLOCK GRANTS FOR PREVENTION AND TREATMENT 4 OF SUBSTANCE ABUSE. 5 (a) GRANTS TO STATES.—Section 1921(b) of the 6 Public Health Service Act (42 U.S.C. 300x–21(b)) is 7 amended by inserting ‘‘, and, as applicable, for carrying 8 out section 1923A’’ before the period. 9 (b) NONAPPLICABILITY OF PREVENTION PROGRAM 10 PROVISION.—Section 1922(a)(1) of the Public Health 11 Service Act (42 U.S.C. 300x–22(a)(1)) is amended by in- 12 serting ‘‘except with respect to amounts made available 13 as described in section 1923A,’’ before ‘‘will expend’’. 14 (c) OPIOID TREATMENT PROGRAMS.—Subpart II of 15 part B of title XIX of the Public Health Service Act (42 16 U.S.C. 300x–21 et seq.) is amended by inserting after sec- 17 tion 1923 the following: 18 ‘‘SEC. 1923A. ADDITIONAL SUBSTANCE ABUSE TREATMENT 19 PROGRAMS. 20 ‘‘A funding agreement for a grant under section 1921 21 is that the State involved shall provide that any amounts 22 made available by any increase in revenues to the Treas- 23 ury in the previous fiscal year resulting from the enact- 24 ment of section 4192 of the Internal Revenue Code of 25 VerDate Sep 11 2014 18:48 Feb 19, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S425.IS S425 pamtmann on DSKBFK8HB2PROD with BILLS 6 •S 425 IS 1986, reduced by any amounts rebated or discounted 1 under section 2(d) of the Budgeting for Opioid Addiction 2 Treatment Act (as described in section 1933(a)(1)(B)(i)) 3 be used exclusively for substance abuse (including opioid 4 abuse) treatment efforts in the State, including— 5 ‘‘(1) treatment programs— 6 ‘‘(A) establishing new addiction treatment 7 facilities, residential and outpatient, including 8 covering capital costs; 9 ‘‘(B) establishing sober living facilities; 10 ‘‘(C) recruiting and increasing reimburse- 11 ment for certified mental health providers pro- 12 viding substance abuse treatment in medically 13 underserved communities or communities with 14 high rates of prescription drug abuse; 15 ‘‘(D) expanding access to long-term, resi- 16 dential treatment programs for opioid addicts 17 (including 30-, 60-, and 90-day programs); 18 ‘‘(E) establishing or operating support pro- 19 grams that offer employment services, housing, 20 and other support services to help recovering 21 addicts transition back into society; 22 ‘‘(F) establishing or operating housing for 23 children whose parents are participating in sub- 24 VerDate Sep 11 2014 18:48 Feb 19, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S425.IS S425 pamtmann on DSKBFK8HB2PROD with BILLS 7 •S 425 IS stance abuse treatment programs, including 1 capital costs; 2 ‘‘(G) establishing or operating facilities to 3 provide care for babies born with neonatal ab- 4 stinence syndrome, including capital costs; and 5 ‘‘(H) other treatment programs, as the 6 Secretary determines appropriate; and 7 ‘‘(2) recruitment and training of substance use 8 disorder professionals to work in rural and medically 9 underserved communities.’’. 10 (d) ADDITIONAL FUNDING.—Section 11 1933(a)(1)(B)(i) of the Public Health Service Act (42 12 U.S.C. 300x–33(a)(1)(B)(i)) is amended by inserting ‘‘, 13 plus any increase in revenues to the Treasury in the pre- 14 vious fiscal year resulting from the enactment of section 15 4192 of the Internal Revenue Code of 1986, reduced by 16 any amounts rebated or discounted under section 2(d) of 17 the Budgeting for Opioid Addiction Treatment Act’’ be- 18 fore the period. 19 SEC. 4. REPORT. 20 Not later than 2 years after the date described in sec- 21 tion 2(c), the Secretary of Health and Human Services 22 shall submit to Congress a report on the impact of the 23 amendments made by sections 2 and 3 on— 24 VerDate Sep 11 2014 18:48 Feb 19, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S425.IS S425 pamtmann on DSKBFK8HB2PROD with BILLS 8 •S 425 IS (1) the retail cost of active opioids (as defined 1 in section 4192 of the Internal Revenue Code of 2 1986, as added by section 2); 3 (2) patient access to such opioids, particularly 4 cancer and hospice patients, including the effect of 5 the discount or rebate on such opioids for cancer 6 and hospice patients under section 2(d); 7 (3) how the increase in revenue to the Treasury 8 resulting from the enactment of section 4192 of the 9 Internal Revenue Code of 1986 is used to improve 10 substance abuse treatment efforts in accordance 11 with section 1923A of the Public Health Service Act 12 (as added by section 3); and 13 (4) suggestions for improving— 14 (A) access to opioids for cancer and hos- 15 pice patients; and 16 (B) substance abuse treatment efforts 17 under such section 1923A. 18 Æ VerDate Sep 11 2014 18:48 Feb 19, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6301 E:\BILLS\S425.IS S425 pamtmann on DSKBFK8HB2PROD with BILLS