Bill > S475

This bill, known as the Alternatives to PAIN Act, aims to improve access to non-opioid pain management drugs under Medicare Part D by introducing several key provisions. Starting in 2026, the bill mandates that qualifying non-opioid pain management drugs will be exempt from the standard deductible and placed on the lowest cost-sharing tier of Medicare Part D prescription drug plans. These qualifying drugs must have FDA-approved label indications for pain management, not act on opioid receptors, have no therapeutic equivalents in the market, and meet specific cost thresholds. Additionally, the bill prohibits Medicare prescription drug plans from requiring step therapy (forcing patients to try opioids first) or obtaining prior authorization for these specific non-opioid pain management drugs. The legislation also ensures that these provisions apply to low-income Medicare beneficiaries, effectively reducing financial barriers and administrative hurdles for patients seeking alternative pain management solutions that do not involve opioids. By targeting the cost and accessibility of non-opioid pain medications, the bill seeks to provide more treatment options and potentially help address opioid addiction concerns.

Budget and Finance

https://www.congress.gov/bill/119th-congress/senate-bill/475/all-info