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Congress·In Committee·S. 475

Congress targets lower Medicare drug costs and fewer plan barriers for certain non-opioid pain medicines

Alternatives to PAIN Act

about 1 year ago·View on Congress.gov
Part of: Congress Proposes Expanded Medicare Access to Non-Opioid Pain Medications
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Stalled

No legislative action in over 90 days.

Legislative Progress

Senate
House
President
Law

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.
HealthcareMedicare MedicaidPrescription DrugsDrug Policy

Impact Analysis

Personal Impact

How this policy affects specific groups of people

Positive Impacts(2)
Medicare
Helps
Chronic Illness
Helps

Milestones

2 milestones2 actions
Feb 6, 2025Senate

Read twice and referred to the Committee on Finance.

Feb 6, 2025

Introduced in Senate

Source Information

Document Type

Congressional Bill

Official Title

Alternatives to PAIN Act

Bill NumberS 475
Congress119th Congress
ChamberSenate
Latest ActionRead twice and referred to the Committee on Finance.

Sponsor

Cosponsors

(32)
D: 16R: 15I: 1

Analysis generated by AI. Always verify with official sources.