[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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