We Have Heard of Pay-for-Delay, Now We Hear about Pay for Pain

We have all read about the issue of pay-for-delay, where a generic company gets something in return for a patent settlement and agrees not to market a product for a period of time.  The Federal Trade Commission (FTC) is aggressively pursuing such cases as anticompetitive,but that is a topic for another day.  Now we may have a pay-for-pain proposition floating around Congress.  I just read the summary of the proposed Budgeting for Opioid Addiction Treatment Act (here)  introduced by Senator Joe Manchin of West Virginia. While I agree totally that more treatment services need to be made available and that there is an opioid abuse crisis in this country that must be addressed, the budgeting mechanism to support the billmay be  hard to swallow.

According to the document, the funds to support the proposed treatment will come from a fee on the opioids themselves. The manufacturer will be responsible for paying the tax.  That’s right-a tax on the drugs that people need to treat their pain.  “[T]his bill would establish a $0.01 (1 cent) fee on each milligram of active opioid ingredient in a prescription pain pill. Additional ingredients (acetaminophen, naloxone) also contained in the pain reliever will not be subject to the tax.”  (Good to know they won’t try to tax non-narcotic components.

Products used exclusively for addiction treatment will be exempt from the fee.  How the government plans to monitor that is a mystery since some of those same drugs are also used to treat pain?  The real kicker is the rebate for drugs used to treat cancer pain.  As further explained in the summary:

“The fee paid on opioid medications that are prescribed to treat cancer related pain or to patients participating in hospice care shall be subject to a rebate. The discount or rebate mechanism shall be determined by the Secretary of Health and Human Services with input from relevant stakeholders, including patient advocacy groups. The discount or rebate shall be designed to ensure that the patient or family faces does not face an economic burden from the tax.”

How the heck is the government going to determine which drugs are used for cancer pain and which are used for others in severe pain?  Given the complexity of this proposal, the fees collected for the entire program may well exceed the taxpayer’s cost to administer the waiver and rebate program of questionable effectiveness in terms of treating the underlying causes and effects. Certainly any excess costs above the tax borne by the manufacutrers in operating this program where the government seem to be putting a price on the type of pain a patient has, will be passed onto all patients.

In addition, why are patients that have other debilitating diseases that cause then severe, intractable pain not qualified for the rebate?  In an effort to try to fund treatment options for opioid addicted patients, this bill seems to penalize the millions of patients that don’t abuse drugs and aree in pain but for  other than cancer pain requiring opioid treatment. Most of these patients don’t abuse the drugs nor do they contribute to the opioid abuse problem. Thus, this program actually places a tax on other pain patients to fund treatment options while at the same time placing the extra financial burden on those patients!   The nature of the bill seems to place pain patients into two groups: those that are under addiction treatment and/or have cancer pain (and won’t theoretically have to pay the tax in the long run: and those patients that have pain judged severe enough by their health care provider.  Does this seen right to you?,   Watch out folks as another well-meaning program may become yet another example of unintended consequences of waste and abuse to be further picked up by the taxpayer. In the end, who knows how much of this will actually benefit the opioid-addicted population it is meant to treat. A copy of the text of the bill can be found here.