首页 > 资讯 > 患者需为疼痛治疗支付更多费用？

出自识林

2016-06-04 Lachman CONSULTANTS

我们都了解有偿延迟（pay-for-delay），即仿制药企业达成专利和解并同意一段时间内不上市销售产品而获得一些回报。美国联邦贸易委员会（FTC）正积极追踪这类案件作为反竞争行为，但这并不是今天的主题。现在有一个“有偿疼痛”（pay-for-pain）的提案在国会流传。我阅读了由西弗吉尼亚州参议员Joe Manchin推出的阿片类药物成瘾治疗法案预算提案概要。虽然我完全同意需要提供更多的治疗服务，并且这个国家存在必须解决的阿片类滥用危机，但用以支持议案的预算编制机制恐怕难以接受。（议案全文；概要）

根据该文件，用以支持治疗拟议的资金将来自于阿片类药物本身的费用。制造商将负责支付税款。是的，对人们需要使用以治疗疼痛的药品征税。“这项法案将对每张止疼片处方的中每毫克阿片类药物活性成分制定$0.01（1美分）的费用。包含在止疼药中的附加成分（对乙酰氨基酚、纳洛酮）将不会被征税。”（幸好知道他们将不会试图对非麻醉性镇痛成分征税）。

专门用于戒毒治疗的产品将豁免这一费用。政府计划如何监测是个谜，因为其中一些相同的药品也可用于治疗疼痛？真正的意外是用于治疗癌症疼痛的药品的退税。正如概要中进一步解释的那样：

“被指定用于治疗癌症相关疼痛或参加临终关怀患者的阿片类药品支付的费用应得到退税。折扣或退税机制应由卫生和人类服务部部长根据相关利益攸关方（包括患者倡导团体）的建议来决定。折扣或退税应经过设计以确保患者或家庭不会面对来自税务的经济负担。”

问题是政府将如何决定哪些药品用于癌症疼痛，哪些用于其它严重疼痛？鉴于该提案的复杂性，整个计划收到的费用可能远远超出纳税人根据治疗的根本原因和效果对有疑问的有效性实施豁免和退税计划的费用。当然，制造商在执行该计划中负担的任何超出税费以上的费用（政府似乎希望仅对疼痛患者征收的费用）将被传递给所有患者。

此外，为什么患有引起严重、顽固性疼痛的其它致命疾病的患者不符合退税资格？为了努力设法资助阿片类药物成瘾患者，该法案似乎惩罚了数百万没有滥用药品并处于除癌症疼痛之外的需要阿片类药物治疗的患者。这些患者大多数不滥用药品，也不造成阿片类滥用问题。因此，这一计划实际上将税负置于其它疼痛患者身上以资助成瘾治疗，而同时给这些患者增加了额外的财务负担！议案的本质似乎是将疼痛患者分为两组：接受成瘾治疗的患者和/或有癌症疼痛的患者（从长远来看理论上不需要缴税），以及那些由他们的医疗保健提供者判断患有足够严重的疼痛的患者。这看起来对吗？诸位请当心另一个善意的计划可能成为需要由纳税人来收拾的浪费和滥用的意向外后果的又一例证。最后，谁又知道需要治疗的阿片类药物成瘾人群的实际受益将是多少呢。

Lachman CONSULTANTS - Bob Pollock先生
编译：识林-椒
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We Have Heard of Pay-for-Delay, Now We Hear about Pay for Pain
By Bob Pollock | May 30, 2016

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.