Alternatives to PAIN Act

Key Points

• Starting in 2026, Medicare Part D plans would have to cover certain non-opioid pain drugs without applying the Part D deductible.
• These drugs would have to be put on the lowest cost-sharing tier, which is meant to reduce what people pay out of pocket at the pharmacy.
• Medicare drug plans could not require a patient to try an opioid first before getting these non-opioid pain drugs.
• Medicare drug plans also could not require prior approval (prior authorization) before filling these qualifying non-opioid pain prescriptions.
• The bill narrowly targets specific FDA-approved non-opioid pain drugs that don’t have an equivalent alternative on the market and that stay under Medicare’s specialty-tier monthly cost limit.