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. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Budgeting for Opioid 

5 Addiction Treatment Act’’. 


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1 SEC. 2. STEWARDSHIP FEE ON OPIOID PAIN RELIEVERS. 

2 (a) IN GENERAL.—Subchapter E of chapter 32 of the 

3 Internal Revenue Code of 1986 is amended by adding at 

4 the end the following new section: 

5 ‘‘SEC. 4192. OPIOID PAIN RELIEVERS. 

6 ‘‘(a) IN GENERAL.—There is hereby imposed on the 

7 sale of any active opioid by the manufacturer, producer, 

8 or importer a fee equal to 1 cent per milligram so sold. 

9 ‘‘(b) ACTIVE OPIOID.—For purposes of this section— 

10 ‘‘(1) IN GENERAL.—The term ‘active opioid’ 

11 means any controlled substance (as defined in sec12 tion 102 of the Controlled Substances Act, as in ef13 fect on the date of the enactment of this section) 

14 which is opium, an opiate, or any derivative thereof. 

15 ‘‘(2) EXCLUSION FOR CERTAIN PRESCRIPTION

16 MEDICATIONS.—Such term shall not include any 

17 prescribed drug which is used exclusively for the 

18 treatment of opioid addiction as part of a medically 

19 assisted treatment effort. 

20 ‘‘(3) EXCLUSION OF OTHER INGREDIENTS.—In 

21 the case of a product that includes an active opioid 

22 and another ingredient, subsection (a) shall apply 

23 only to the portion of such product that is an active 

24 opioid.’’. 

25 (b) CLERICAL AMENDMENTS.— 


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1 (1) The heading of subchapter E of chapter 32 

2 of the Internal Revenue Code of 1986 is amended by 

3 striking ‘‘Medical Devices’’ and inserting 

4 ‘‘Other Medical Products’’. 

5 (2) The table of subchapters for chapter 32 of 

6 such Code is amended by striking the item relating 

7 to subchapter E and inserting the following new 

8 item: 

‘‘SUBCHAPTER E. OTHER MEDICAL PRODUCTS’’. 

9 (3) The table of sections for subchapter E of 

10 chapter 32 of such Code is amended by adding at 

11 the end the following new item: 

‘‘Sec. 4192. Opioid pain relievers.’’. 

12 (c) EFFECTIVE DATE.—The amendments made by 

13 this section shall apply to sales on or after the date that 

14 is 1 year after the date of the enactment of this Act. 

15 (d) REBATE OR DISCOUNT PROGRAM FOR CERTAIN

16 CANCER AND HOSPICE PATIENTS.— 

17 (1) IN GENERAL.—The Secretary of Health and 

18 Human Services, in consultation with patient advo19 cacy groups and other relevant stakeholders as de20 termined by such Secretary, shall establish a mecha21 nism by which— 

22 (A) any amount paid by an eligible patient 

23 in connection with the stewardship fee under 

24 section 4192 of the Internal Revenue Code of 


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1 1986 (as added by this section) shall be rebated 

2 to such patient in as timely a manner as pos3 sible; or 

4 (B) amounts paid by an eligible patient for 

5 active opioids (as defined in section 4192(b) of 

6 such Code) are discounted at time of payment 

7 or purchase to ensure that such patient does 

8 not pay any amount attributable to such fee, 

9 with as little burden on the patient as possible. The 

10 Secretary shall choose whichever of the options de11 scribed in subparagraph (A) or (B) is, in the Sec12 retary’s determination, most effective and efficient 

13 in ensuring eligible patients face no economic burden 

14 from such fee. 

15 (2) ELIGIBLE PATIENT.—For purposes of this 

16 section, the term ‘‘eligible patient’’ means— 

17 (A) a patient for whom any active opioid 

18 (as so defined) is prescribed to treat pain relat19 ing to cancer or cancer treatment; 

20 (B) a patient participating in hospice care; 

21 and 

22 (C) in the case of the death or incapacity 

23 of a patient described in subparagraph (A) or 

24 (B) or any similar situation as determined by 

25 the Secretary of Health and Human Services, 


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1 the appropriate family member, medical proxy, 

2 or similar representative or the estate of such 

3 patient. 

4 SEC. 3. BLOCK GRANTS FOR PREVENTION AND TREATMENT 

5 OF SUBSTANCE ABUSE. 

6 (a) GRANTS TO STATES.—Section 1921(b) of the 

7 Public Health Service Act (42 U.S.C. 300x–21(b)) is 

8 amended by inserting ‘‘, and, as applicable, for carrying 

9 out section 1923A’’ before the period. 

10 (b) NONAPPLICABILITY OF PREVENTION PROGRAM

11 PROVISION.—Section 1922(a)(1) of the Public Health 

12 Service Act (42 U.S.C. 300x–22(a)(1)) is amended by in13 serting ‘‘except with respect to amounts made available 

14 as described in section 1923A,’’ before ‘‘will expend’’. 

15 (c) OPIOID TREATMENT PROGRAMS.—Subpart II of 

16 part B of title XIX of the Public Health Service Act (42 

17 U.S.C. 300x–21 et seq.) is amended by inserting after sec18 tion 1923 the following: 

19 ‘‘SEC. 1923A. ADDITIONAL SUBSTANCE ABUSE TREATMENT 

20 PROGRAMS. 

21 ‘‘A funding agreement for a grant under section 1921 

22 is that the State involved shall provide that any amounts 

23 made available by any increase in revenues to the Treas24 ury in the previous fiscal year resulting from the enact25 ment of section 4192 of the Internal Revenue Code of 


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1 1986, reduced by any amounts rebated or discounted 

2 under section 2(d) of the Budgeting for Opioid Addiction 

3 Treatment Act (as described in section 1933(a)(1)(B)(i)) 

4 be used exclusively for substance abuse (including opioid 

5 abuse) treatment efforts in the State, including— 

6 ‘‘(1) treatment programs— 

7 ‘‘(A) establishing new addiction treatment 

8 facilities, residential and outpatient, including 

9 covering capital costs; 

10 ‘‘(B) establishing sober living facilities; 

11 ‘‘(C) recruiting and increasing reimburse12 ment for certified mental health providers pro13 viding substance abuse treatment in medically 

14 underserved communities or communities with 

15 high rates of prescription drug abuse; 

16 ‘‘(D) expanding access to long-term, resi17 dential treatment programs for opioid addicts 

18 (including 30-, 60-, and 90-day programs); 

19 ‘‘(E) establishing or operating support pro20 grams that offer employment services, housing, 

21 and other support services to help recovering 

22 addicts transition back into society; 

23 ‘‘(F) establishing or operating housing for 

24 children whose parents are participating in subVerDate Sep 11 2014 18:48 Feb 19, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S425.IS S425

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1 stance abuse treatment programs, including 

2 capital costs; 

3 ‘‘(G) establishing or operating facilities to 

4 provide care for babies born with neonatal ab5 stinence syndrome, including capital costs; and 

6 ‘‘(H) other treatment programs, as the 

7 Secretary determines appropriate; and 

8 ‘‘(2) recruitment and training of substance use 

9 disorder professionals to work in rural and medically 

10 underserved communities.’’. 

11 (d) ADDITIONAL FUNDING.—Section 

12 1933(a)(1)(B)(i) of the Public Health Service Act (42 

13 U.S.C. 300x–33(a)(1)(B)(i)) is amended by inserting ‘‘, 

14 plus any increase in revenues to the Treasury in the pre15 vious fiscal year resulting from the enactment of section 

16 4192 of the Internal Revenue Code of 1986, reduced by 

17 any amounts rebated or discounted under section 2(d) of 

18 the Budgeting for Opioid Addiction Treatment Act’’ be19 fore the period. 

20 SEC. 4. REPORT. 

21 Not later than 2 years after the date described in sec22 tion 2(c), the Secretary of Health and Human Services 

23 shall submit to Congress a report on the impact of the 

24 amendments made by sections 2 and 3 on— 


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1 (1) the retail cost of active opioids (as defined 

2 in section 4192 of the Internal Revenue Code of 

3 1986, as added by section 2); 

4 (2) patient access to such opioids, particularly 

5 cancer and hospice patients, including the effect of 

6 the discount or rebate on such opioids for cancer 

7 and hospice patients under section 2(d); 

8 (3) how the increase in revenue to the Treasury 

9 resulting from the enactment of section 4192 of the 

10 Internal Revenue Code of 1986 is used to improve 

11 substance abuse treatment efforts in accordance 

12 with section 1923A of the Public Health Service Act 

13 (as added by section 3); and 

14 (4) suggestions for improving— 

15 (A) access to opioids for cancer and hos16 pice patients; and 

17 (B) substance abuse treatment efforts 

18 under such section 1923A. 

Æ 


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