Congress Targets Lower Medicare Part D Costs and Fewer Barriers for Certain Non-Opioid Pain Drugs

Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

Introduced in House

Medicare Part D plans must treat qualifying non-opioid pain drugs as no-deductible drugs.

If you’re prescribed one of these qualifying drugs, the plan can’t make you “pay the deductible first” for that medicine starting with 2026 coverage.

Qualifying non-opioid pain drugs must be placed on the plan’s lowest cost-sharing tier (if the plan uses tiers).

Your copay/coinsurance for these drugs should be closer to the cheapest covered drugs on your plan, not specialty or high tiers, starting in 2026.

Plans are prohibited from requiring an opioid first (step therapy) for qualifying non-opioid pain drugs.

If your doctor prescribes a qualifying non-opioid drug, the plan can’t tell you to try an opioid before it will cover the non-opioid option starting in 2026.

Plans are prohibited from using prior authorization for qualifying non-opioid pain drugs.

You should face fewer delays and less paperwork waiting for plan approval before the pharmacy can fill a qualifying drug starting in 2026.