I 
116TH CONGRESS 
1ST SESSION H. R. 4793 
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 HOUSE OF REPRESENTATIVES 
OCTOBER 22, 2019 
Mr. NORCROSS (for himself and Mr. LARSON of Connecticut) introduced the 
following bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
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-
tives 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’’. 
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SEC. 2. STEWARDSHIP FEE ON OPIOID PAIN RELIEVERS. 
(a) IN GENERAL.—Subchapter E of chapter 32 of the 
Internal Revenue Code of 1986 is amended by adding at 
the end the following new section: 
‘‘SEC. 4192. 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 sec-
tion 102 of the Controlled Substances Act, as in ef-
fect 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 AMENDMENTS.— 
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(1) The heading of subchapter E of chapter 32 
of the Internal Revenue Code of 1986 is amended by 
striking 
‘‘Medical 
Devices’’ 
and 
inserting 
‘‘Other Medical Products’’. 
(2) The table of subchapters for chapter 32 of 
such Code is amended by striking the item relating 
to subchapter E and inserting the following new 
item: 
‘‘SUBCHAPTER E. OTHER MEDICAL PRODUCTS’’. 
(3) The table of sections for subchapter E of 
chapter 32 of such Code is amended by adding at 
the end the following new item: 
‘‘Sec. 4192. Opioid pain relievers.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to sales on or after the date that 
is 1 year after the date of the enactment of this Act. 
(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 advo-
cacy groups and other relevant stakeholders as de-
termined by such Secretary, shall establish a mecha-
nism by which— 
(A) any amount paid by an eligible patient 
in connection with the stewardship fee under 
section 4192 of the Internal Revenue Code of 
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1986 (as added by this section) shall be rebated 
to such patient in as timely a manner as pos-
sible; or 
(B) amounts paid by an eligible patient for 
active opioids (as defined in section 4192(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 de-
scribed in subparagraph (A) or (B) is, in the Sec-
retary’s determination, most effective and efficient 
in ensuring eligible patients face no economic burden 
from such fee. 
(2) ELIGIBLE PATIENT.—For purposes of this 
section, the term ‘‘eligible patient’’ means— 
(A) a patient for whom any active opioid 
(as so defined) is prescribed to treat pain relat-
ing to cancer or cancer treatment; 
(B) a patient participating in hospice care; 
and 
(C) in the case of the death or incapacity 
of a patient described in subparagraph (A) or 
(B) or any similar situation as determined by 
the Secretary of Health and Human Services, 
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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 in-
serting ‘‘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 sec-
tion 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 Treas-
ury in the previous fiscal year resulting from the enact-
ment of section 4192 of the Internal Revenue Code of 
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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 reimburse-
ment for certified mental health providers pro-
viding substance abuse treatment in medically 
underserved communities or communities with 
high rates of prescription drug abuse; 
‘‘(D) expanding access to long-term, resi-
dential treatment programs for opioid addicts 
(including 30-, 60-, and 90-day programs); 
‘‘(E) establishing or operating support pro-
grams 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 sub-
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stance abuse treatment programs, including 
capital costs; 
‘‘(G) establishing or operating facilities to 
provide care for babies born with neonatal ab-
stinence 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 pre-
vious fiscal year resulting from the enactment of section 
4192 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’’ be-
fore the period. 
SEC. 4. REPORT. 
Not later than 2 years after the date described in sec-
tion 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— 
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(1) the retail cost of active opioids (as defined 
in section 4192 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 4192 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 hos-
pice patients; and 
(B) substance abuse treatment efforts 
under such section 1923A. 
Æ 
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