In “A chance to fix 2018 opioid inaction” (March 24), the Star Tribune Editorial Board urged swift passage of legislation that would impose additional fees on certain stakeholders in Minnesota’s health care delivery system.
Both of the legislative proposals for which the Editorial Board advocates, however, would create unsustainable pressure on the manufacturers of low-cost generic medicines. Neither of the bills creates long-term, sustainable solutions to the opioid-related challenges facing Minnesotans. Those who need prescription opioids (e.g., cancer patients and those with long-term pain) could lose access to the affordable medications on which they depend.
The most effective programs enacted by states to combat opioid addiction harness the input of all stakeholders — from government, to manufacturers, to doctors, to patient groups — in developing comprehensive solutions. Laws that mandate doctor education, prescription limits, increased insurance coverage of alternative treatments for pain, real-time and mandatory use of state prescription drug monitoring programs, and busting pill mills have made a quantifiable difference in other states. Opioid prescriptions have dropped more than 25 percent since 2012.
The funding of Minnesota’s opioid abuse prevention and treatment programs is now before the Legislature. The strategies currently being debated could force generic drugmakers to leave Minnesota, reducing patient access to affordable medicines while simultaneously increasing the risk of shortages of critical pain medications.
We recently conducted a survey of our member companies, asking them what effect the proposed legislation would have on their ability to deliver low-cost medicines. The results of that survey should give lawmakers pause.
The proposed fee increases would exceed the average opioid-related revenue from the state of Minnesota. In other words, it would cost the average company more money to do business in the state than it makes here. The results are predictable: Cancer patients, postoperative patients and those with long-term pain could soon find that affordable generic versions of the medicines they rely on will no longer be available in Minnesota.
Fortunately, there is a practical solution to provide funding for the state to address this crisis: Expand registration of all parties involved in prescribing and delivering opioids to patients in Minnesota — from doctors to hospitals to pharmacists, insurers, distributors, wholesalers and beyond. All parties who prescribe, manufacture or deliver opioids should be subject to an increase in their annual licensing fee. The best way to ensure a robust and sustainable pool of funds to pay for opioid remediation programs is to equitably distribute the costs across all responsible groups.
This funding method avoids some of the pitfalls that have vexed other states that failed to adopt a comprehensive and equitable plan. New York passed a law in 2018 that placed a tax only on manufacturers and wholesalers. The law was later found unconstitutional. One critical factor in the court’s consideration of that law was a declaration by one generic drugmaker explaining how the tax being levied upon it for its opioid sales would surpass the total revenue generated from those sales within the state.
This same upside-down dynamic holds true for many of the generic drugmakers who currently serve the needs of patients in Minnesota. Clearly, this makes no economic sense. Why would any company operate in a state where it is taxed more than it earns? The federal court in New York recognized that “the perhaps-unforeseen consequence that the [New York opioid tax] could well reduce the availability of opioid medications for those who need them also runs counter to the public interest.” A consequence of manufacturers exiting any market is less competition, leading to higher prices and shortages.
It is critical that we all work together to address the opioid crisis in Minnesota. Yet we must do so in a way that does not harm patients with legitimate pain needs.
In Minnesota each year, roughly 26,000 patients are diagnosed with cancer. For those patients, we must protect access to the medicines that can ease the debilitating pain that is caused by tumors and by some of the treatments themselves. Kate Nicholson, a civil rights and health policy attorney who speaks and writes publicly about her own battle with pain, recently wrote, “Tackling the overdose crisis is a vital public policy goal. But chronic pain patients should not become casualties in that fight.”
Chip Davis is CEO of the Association for Accessible Medicines.