[Congressional Record Volume 167, Number 191 (Monday, November 1, 2021)]
[Senate]
[Pages S7560-S7561]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
SA 4115. Mr. MANCHIN submitted an amendment intended to be proposed
to amendment SA 3867 submitted by Mr. Reed and intended to be proposed
to the bill H.R. 4350, to authorize appropriations for fiscal year 2022
for military activities of the Department of Defense, for military
construction, and for defense activities of the Department of Energy,
to prescribe military personnel strengths for such fiscal year, and for
other purposes; which was ordered to lie on the table; as follows:
At the appropriate place, insert the following:
SEC. ____. OPIOID SUBSTANCE ABUSE REDUCTION.
(a) Stewardship Fee on Opioid Pain Relievers.--
(1) 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.
``(c) 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 subsection (a) shall be
rebated to such patient in as timely a manner as possible, or
``(B) amounts paid by an eligible patient for active
opioids 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 of Health and Human Services shall choose whichever
of the options described in subparagraph (A) or (B) is, in
such 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 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.''.
(2) 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''.
(3) Effective date.--The amendments made by this subsection
shall apply to sales on or after the later of--
(A) the date which is 1 year after the date of the
enactment of this Act; or
(B) the date on which the Secretary of Health and Human
Services establishes the mechanism described in subsection
(c)(1) of section 4191 of the Internal Revenue Code of 1986,
as added by this section.
(b) Block Grants for Prevention and Treatment of Substance
Abuse.--
(1) Grants to states.--Section 1921(b) of the Public Health
Service Act (42 U.S.C.
[[Page S7561]]
300x-21(b)) is amended by inserting ``, and, as applicable,
for carrying out section 1923A'' before the period.
(2) 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''.
(3) 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 (determined by
taking into account any outlays for amounts rebated or
discounted under subsection (c)(1) thereof (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.''.
(4) 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 (determined by taking into account any outlays for
amounts rebated or discounted under subsection (c)(1)
thereof)'' before the period.
(c) Report.--Not later than 2 years after the date
described in subsection (a)(3), the Secretary of Health and
Human Services shall submit to Congress a report on the
impact of the amendments made by subsections (a) and (b) on--
(1) the retail cost of active opioids (as defined in
section 4191 of the Internal Revenue Code of 1986, as added
by subsection (a));
(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 4191(c)(1) of such Code, as so added;
(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 subsection (b)); 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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