[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[S. 1723 Introduced in Senate (IS)]

<DOC>






117th CONGRESS
  1st Session
                                S. 1723

 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

                              May 20, 2021

 Mr. Manchin (for himself, Mr. Romney, Ms. Klobuchar, Ms. Baldwin, Mr. 
King, Ms. Warren, Mrs. Shaheen, Ms. Hassan, Mr. Blumenthal, Ms. Smith, 
and Mr. Whitehouse) 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 Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Budgeting for Opioid Addiction 
Treatment Act''.

SEC. 2. STEWARDSHIP FEE ON OPIOID PAIN RELIEVERS.

    (a) In General.--Chapter 32 of the Internal Revenue Code of 1986 is 
amended by inserting after subchapter D the following new subchapter:

             ``Subchapter E--Certain Opioid Pain Relievers

``Sec. 4191. Opioid pain relievers.

``SEC. 4191. OPIOID PAIN RELIEVERS.

    ``(a) In General.--There is hereby imposed on the sale of any 
active opioid by the manufacturer, producer, or importer a fee equal to 
1 cent per milligram so sold.
    ``(b) Active Opioid.--For purposes of this section--
            ``(1) In general.--The term `active opioid' means any 
        controlled substance (as defined in section 102 of the 
        Controlled Substances Act, as in effect on the date of the 
        enactment of this section) which is opium, an opiate, or any 
        derivative thereof.
            ``(2) Exclusion for certain prescription medications.--Such 
        term shall not include any prescribed drug which is used 
        exclusively for the treatment of opioid addiction as part of a 
        medically assisted treatment effort.
            ``(3) Exclusion of other ingredients.--In the case of a 
        product that includes an active opioid and another ingredient, 
        subsection (a) shall apply only to the portion of such product 
        that is an active opioid.''.
    (b) Clerical Amendment.--The table of subchapters for chapter 32 of 
the Internal Revenue Code of 1986 is amended by inserting after the 
item relating to subchapter D the following new item:

            ``subchapter e. certain opioid pain relievers''.

    (c) Effective Date.--The amendments made by this section shall 
apply to sales on or after the later of--
            (1) the date which is 1 year after the date of the 
        enactment of this Act; or
            (2) the date on which the Secretary of Health and Human 
        Services establishes the mechanism described in subsection 
        (d)(1).
    (d) Rebate or Discount Program for Certain Cancer and Hospice 
Patients.--
            (1) In general.--The Secretary of Health and Human 
        Services, in consultation with patient advocacy groups and 
        other relevant stakeholders as determined by such Secretary, 
        shall establish a mechanism by which--
                    (A) any amount paid by an eligible patient in 
                connection with the stewardship fee under section 4191 
                of the Internal Revenue Code of 1986 (as added by this 
                section) shall be rebated to such patient in as timely 
                a manner as possible, or
                    (B) amounts paid by an eligible patient for active 
                opioids (as defined in section 4191(b) of such Code) 
                are discounted at time of payment or purchase to ensure 
                that such patient does not pay any amount attributable 
                to such fee,
        with as little burden on the patient as possible. The Secretary 
        shall choose whichever of the options described in subparagraph 
        (A) or (B) is, in the Secretary's determination, most effective 
        and efficient in ensuring eligible patients face no economic 
        burden from such fee.
            (2) Eligible patient.--For purposes of this subsection, the 
        term ``eligible patient'' means--
                    (A) a patient for whom any active opioid (as so 
                defined) is prescribed to treat pain relating to cancer 
                or cancer treatment;
                    (B) a patient participating in hospice care;
                    (C) a patient with respect to whom the prescriber 
                of the applicable opioid determines that other non-
                opioid pain management treatments are inadequate or 
                inappropriate; and
                    (D) in the case of the death or incapacity of a 
                patient described in subparagraph (A), (B), or (C), or 
                any similar situation as determined by the Secretary of 
                Health and Human Services, the appropriate family 
                member, medical proxy, or similar representative or the 
                estate of such patient.

SEC. 3. BLOCK GRANTS FOR PREVENTION AND TREATMENT OF SUBSTANCE ABUSE.

    (a) Grants to States.--Section 1921(b) of the Public Health Service 
Act (42 U.S.C. 300x-21(b)) is amended by inserting ``, and, as 
applicable, for carrying out section 1923A'' before the period.
    (b) Nonapplicability of Prevention Program Provision.--Section 
1922(a)(1) of the Public Health Service Act (42 U.S.C. 300x-22(a)(1)) 
is amended by inserting ``except with respect to amounts made available 
as described in section 1923A,'' before ``will expend''.
    (c) Opioid Treatment Programs.--Subpart II of part B of title XIX 
of the Public Health Service Act (42 U.S.C. 300x-21 et seq.) is amended 
by inserting after section 1923 the following:

``SEC. 1923A. ADDITIONAL SUBSTANCE ABUSE TREATMENT PROGRAMS.

    ``A funding agreement for a grant under section 1921 is that the 
State involved shall provide that any amounts made available by any 
increase in revenues to the Treasury in the previous fiscal year 
resulting from the enactment of section 4191 of the Internal Revenue 
Code of 1986, reduced by any amounts rebated or discounted under 
section 2(d) of the Budgeting for Opioid Addiction Treatment Act (as 
described in section 1933(a)(1)(B)(i)) be used exclusively for 
substance abuse (including opioid abuse) treatment efforts in the 
State, including--
            ``(1) treatment programs--
                    ``(A) establishing new addiction treatment 
                facilities, residential and outpatient, including 
                covering capital costs;
                    ``(B) establishing sober living facilities;
                    ``(C) recruiting and increasing reimbursement for 
                certified mental health providers providing substance 
                abuse treatment in medically underserved communities or 
                communities with high rates of prescription drug abuse;
                    ``(D) expanding access to long-term, residential 
                treatment programs for opioid addicts (including 30-, 
                60-, and 90-day programs);
                    ``(E) establishing or operating support programs 
                that offer employment services, housing, and other 
                support services to help recovering addicts transition 
                back into society;
                    ``(F) establishing or operating housing for 
                children whose parents are participating in substance 
                abuse treatment programs, including capital costs;
                    ``(G) establishing or operating facilities to 
                provide care for babies born with neonatal abstinence 
                syndrome, including capital costs; and
                    ``(H) other treatment programs, as the Secretary 
                determines appropriate; and
            ``(2) recruitment and training of substance use disorder 
        professionals to work in rural and medically underserved 
        communities.''.
    (d) Additional Funding.--Section 1933(a)(1)(B)(i) of the Public 
Health Service Act (42 U.S.C. 300x-33(a)(1)(B)(i)) is amended by 
inserting ``, plus any increase in revenues to the Treasury in the 
previous fiscal year resulting from the enactment of section 4191 of 
the Internal Revenue Code of 1986, reduced by any amounts rebated or 
discounted under section 2(d) of the Budgeting for Opioid Addiction 
Treatment Act'' before the period.

SEC. 4. REPORT.

    Not later than 2 years after the date described in section 2(c), 
the Secretary of Health and Human Services shall submit to Congress a 
report on the impact of the amendments made by sections 2 and 3 on--
            (1) the retail cost of active opioids (as defined in 
        section 4191 of the Internal Revenue Code of 1986, as added by 
        section 2);
            (2) patient access to such opioids, particularly cancer and 
        hospice patients, including the effect of the discount or 
        rebate on such opioids for cancer and hospice patients under 
        section 2(d);
            (3) how the increase in revenue to the Treasury resulting 
        from the enactment of section 4191 of the Internal Revenue Code 
        of 1986 is used to improve substance abuse treatment efforts in 
        accordance with section 1923A of the Public Health Service Act 
        (as added by section 3); and
            (4) suggestions for improving--
                    (A) access to opioids for cancer and hospice 
                patients; and
                    (B) substance abuse treatment efforts under such 
                section 1923A.
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