Alternatives to PAIN Act
Congress Targets Lower Medicare Part D Costs and Fewer Barriers for Certain Non-Opioid Pain Drugs
Stalled
No legislative action in over 90 days.
Legislative Progress
Key Points
- Starting in 2026, Medicare Part D plans would have to cover certain non-opioid pain drugs with no deductible and the lowest cost-sharing tier.
- The bill targets drugs used for post-surgery or other acute pain that do not work on opioid receptors, aiming to make non-opioid options easier to get.
- It mainly applies to newer drugs with no therapeutically equivalent version sold in the U.S., and only if the monthly price stays under Medicare’s specialty-tier threshold.
- Part D plans could not require “step therapy” that makes a patient try an opioid first before getting the non-opioid drug.
- Part D plans also could not require prior authorization for these qualifying non-opioid pain drugs, which could speed up access at the pharmacy.
Impact Analysis
Personal Impact
How this policy affects specific groups of people
Milestones
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.
Sent to a congressional committee for expert review. The committee decides whether this bill moves forward.
Introduced in House
The bill was officially filed and given a number. It now enters the legislative queue.
Votes
No votes have been recorded for this legislation yet.
Source Information
Document Type
Congressional Bill
Official Title
Alternatives to PAIN Act
Data Sources
Sponsor
Cosponsors
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