Commentary: Delaware opioid surcharge plan ‘misguided’

The Delaware State Senate voted to approve a surcharge on opioid prescriptions. At first glance, the motive behind the fee seems to be well-intentioned, but the fee is actually a misguided attempt and only further complicates the opioid crisis we are in.

I’ve been a pharmacist for seven years and there is nothing I want more than for all my patients to be pain and addiction free; this absurd fee is not the way to accomplish that goal.

Advocates will defend the relatively “low cost” of this imposed fee, dealing with fractions of cents. This quickly adds up for even the low doses. A 100-count bottle of 30-milligram generic oxycodone that may typically cost $20 now has a $11.25 (60%!) fee attached; this will most definitely get passed down to consumers. There is nothing in the bill that prevents this from happening now or in the future, as it was already deemed unconstitutional to prevent a business from raising their prices.

The bill attempts to seem fair by stating, “The fee is assessed on manufacturers who exceed a threshold of 100,000 MMEs dispensed each quarter.” However, simple math would show that that equals roughly 70 100-count bottles of oxycodone 10mg: hardly a difficult threshold for a manufacturer to fall into, considering there are over 70 pharmacies in Delaware. This creates a situation where manufacturers will simply stop supplying to Delaware to avoid the fee. This inevitably will create a catastrophic drug shortage. All people suffering from any degree of pain will be affected by a product shortage.

Yes, this bill excludes drugs administered in hospital or directly from hospice care. That is not where the majority of chronic pain patients are getting their medication; it will still be punishing the numerous cancer and chronic disease patients that get their prescriptions filled at retail pharmacies. Not every hospice patient gets medication directly from hospice. People can live at home with hospice care and get their medications at the retail pharmacy. Cancer patients as well rely on retail pharmacies for the majority of their pain medication. Punishing these patients with either increased price or lack of an availability is not fair or ethically acceptable.

Pain disproportionately affects people of lower socioeconomic status. According to a 2017 study from the University of Buffalo “Poorer and less-educated older Americans are more like to suffer from chronic pain than those with greater wealth and more education, but the disparity between the two groups is much greater than previously thought, climbing as high as 370 percent in some categories.”

Is this who you want to target with the imposed fee? Because that is who will be suffering. The under and uninsured will be hit the hardest by this fee that will surely increase prices.

This bill is nothing more than a feeble attempt by members of the Delaware government to look as if they are doing something to combat the opioid crisis. Their superficial feelings of victory over passing this bill will do nothing in the long run to combat the roots of the opioid crisis.

Insurance companies need to cover non-opioid interventions (physical therapy, massage therapy, cognitive behaviorally therapy). Employers need to offer adequate time off after injury regardless of the origin. Doctors must be more responsible prescribing medication.

Pharmacists must counsel their patients about the risks of opioid use. Nurses must explain to patients realistic pain treatment goals. People must educate themselves about goals and risks of pain management. An “impact fee” will not change the culture that has created this crisis.

EDITOR’S NOTE: Elizabeth Hauss is a resident of Dover.

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