Bill > HR1227

This bill aims to improve access to non-opioid pain management drugs under Medicare Part D by introducing several key provisions effective January 1, 2026. Specifically, the bill requires that qualifying non-opioid pain management drugs (defined as FDA-approved drugs for acute or postoperative pain that do not interact with opioid receptors and have no therapeutic equivalents) be placed on the lowest cost-sharing tier and be exempt from Medicare Part D deductibles. The legislation also prohibits prescription drug plans from using step therapy (requiring patients to try other drugs first) or prior authorization for these specific non-opioid pain drugs. To qualify, the drugs must meet stringent criteria, including having a unique FDA label indication, not acting on opioid receptors, lacking therapeutic equivalents in the U.S. market, and having a monthly wholesale acquisition cost below a specific threshold. This bill represents an effort to provide Medicare beneficiaries with more affordable and accessible alternatives to opioid pain medications, potentially helping to address concerns about opioid addiction and pain management.

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https://www.congress.gov/bill/119th-congress/house-bill/1227/all-info