September 23, 2018
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The opioid crisis has outrun Maine. Time to catch up with a tax.

Mark Lennihan | AP
Mark Lennihan | AP
This Wednesday, Aug. 29, 2018, photo shows an arrangement of Oxycodone pills in New York.

Maine is among a dozen states considering a new approach to fighting the opioid crisis: taxing drug makers.

New York has led the way in the effort to use taxes to hold drug manufacturers accountable for a crisis they helped create. That state’s law, which levies a fee on drug makers and distributors based on an opioid medication’s strength, took effect July 1 and is expected to generate $100 million a year, according to a Sept. 6 Kaiser Health News report.

The proceeds would largely benefit addiction treatment and prevention programs, an indispensable but underfunded piece of the puzzle of reducing the grave toll addiction exacts on our communities.

Maine lawmakers considered a similar bill last year, which would have taxed drug makers at a rate of 0.1 cent per morphine milligram equivalent sold in Maine. It faced opposition from the Healthcare Distribution Alliance, a lobbying group for wholesale pharmaceutical distributors that’s now suing to halt the implementation of New York’s law. The Maine bill, sponsored by Rep. Margaret O’Neil, D-Saco, was subsequently amended to exempt wholesalers, as well as to redirect proceeds from the tax to the state Department of Health and Human Services’ Opioid Health Home program.

That program is designed to boost access to medication-assisted treatment and addiction services through primary care offices. But it has barely made a dent, with only a single health provider enrolling in it by February, a year after its launch.

Maine’s bill ultimately died in committee. But the next Legislature should give the approach another look, this time through legislation that directs the tax funds to more promising efforts, such as encouraging more health providers to prescribe buprenorphine, boosting the availability of overdose-reversing naloxone and increasing Medicaid reimbursement rates for methadone treatment.

The Legislature should also consider how best to structure the tax. A lobbying group for generic drug makers, while opposing all opioid taxes, argued that New York’s law unfairly targets generic manufacturers by taxing on a per-pill basis, rather than by revenue. Nearly 90 percent of all drugs dispensed last year were generics. The law largely spares brand-name drug makers, which were responsible for much of the marketing that contributed to the drug crisis, a group spokeswoman told Kaiser.

While cities across the country, including Portland and Bangor, have sued opioid makers over their role in the crisis, those cases could linger in the courts for years. Taxing opioid manufacturers could make funding for anti-addiction efforts available more quickly and independent of unpredictable federal funding, Kaiser points out.

Structuring the tax by revenue would also address criticism that tying the fee to medication strength inappropriately incentivizes lower prescribing levels, a decision best made by medical professionals.

Finally, the legislation should include provisions that prevent drug makers from passing the burden of the tax on to consumers, protecting patients who legitimately need the medications from higher prices.

With one Mainer a day dying from a drug overdose, the opioid crisis has outrun us. So far, other state and federal efforts to increase funding for treatment and prevention have fallen far short of the need. It’s time to catch up.

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