Doctors voice objections to DEA fee increase

Medical associations and individual physicians offer alternatives to the proposed 87% hike.

By Andis Robeznieks, amednews staff. May 12, 2003.

The public comment period for the U.S. Drug Enforcement Administration's proposed physician registration fee increase ended April 21, and agency representatives said they would review comments before taking any further steps.

The agency received 27 letters from individuals and organizations regarding its proposal to increase from $70 to $131 the annual fee physicians must pay to write prescriptions for controlled substances.

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"Most physicians probably feel there's nothing they can do, but I don't think any of them are saying, 'Yeah, it should definitely be increased,' " said John P. DuMoulin, the American College of Physicians' director of practice advocacy. "But by the same token, we had enough complaints from members to merit writing a letter."

The fee helps fund the agency's prescription drug anti-diversion program. In its comment letter, the ACP suggested other ways the DEA could find money for this.

"Physicians are in partnership with the DEA in keeping controlled substances out of the wrong hands," DuMoulin said. "Instead of charging them a fee, we suggest putting the cost back on people who use the DEA number improperly as a unique identifier. ... That kills two birds with one stone: It reduces the number of people doing that, and it would also put more money in the program."

Family physician Peter Bidwell, MD, of Jasper, Texas, agrees. He was one of the letter writers, and he suggested increasing fines for people who fraudulently obtain prescriptions and then using those fines to finance the program.

"If they find a Hummer full of cocaine, they get to sell the Hummer," Dr. Bidwell said. "They don't tax the people who made the vehicle."

He also suggested higher fees for pharmaceutical companies.

"They make all kinds of money," he said. "They must, because I know I can't afford to advertise during the Super Bowl."

Organized medicine weighs in

In an AMA comment letter, the Association's main point is that the fee is a tax on doctors. And, while the anti-diversion program has laudable goals, it should be paid for from general revenue funds.

AMA Executive Vice President Michael Maves, MD, wrote that the DEA had not demonstrated the rationale behind the larger budgets that the fee increase would fund, and that "there must also be significantly more transparency ... before the legitimacy of these increases can be established."

DEA spokeswoman Rogene Waite countered that Congress, not the DEA, initiated the registration fee and mandated that it be used to pay for the anti-diversion program.

"If anyone wants to address it, they have to do it through [legislative] channels -- not through the DEA," she said.

Waite said a decision would be made on the proposed fee hike this year. "We don't put a time frame on these things," she said. "The most important thing is that everything that needs to be considered is."

Dr. Bidwell said he didn't know if he would continue to protest, but -- even though he doesn't like it -- he will continue to pay a fee to the Drug Enforcement Administration (and also to the state of Texas) so that he can continue to prescribe controlled substances.

"It would be impossible to do without [DEA registration]," Dr. Bidwell said. "But it's just wrong. I don't have to pay a tax to write a prescription for Nexium or an antibiotic."

ADDITIONAL INFORMATION:

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Drug Enforcement Administration's controlled substances registration and reregistration application fee request (www.deadiversion.usdoj.gov/fed_regs/rules/2003/fr0218.htm)

American College of Physicians letter objecting to DEA proposal to raise registration fee (www.acponline.org/hpp/dea_letter.htm?hp)