This legislation seeks to enhance beneficiary access to non-opioid pain management drugs under Medicare Part D. Starting January 1, 2026, for qualifying non-opioid pain management drugs, the standard deductible will not apply. Furthermore, these drugs will be placed on the lowest cost-sharing tier available within a Medicare Part D plan, significantly reducing out-of-pocket expenses for beneficiaries. A qualifying non-opioid pain management drug is defined as one approved by the FDA for acute pain, does not act on opioid receptors, has no therapeutically equivalent alternative sold in the U.S., and whose monthly wholesale acquisition cost does not exceed a specified threshold. To further ensure access, the bill prohibits Medicare Part D plans from imposing step therapy requirements that mandate opioid use first, or any prior authorization requirements for these qualifying non-opioid pain management drugs. These measures aim to remove barriers and encourage the use of non-addictive pain relief options.
Drug therapyHealth care costs and insuranceMedicarePrescription drugs
Alternatives to PAIN Act
USA119th CongressS-475| Senate
| Updated: 2/6/2025
This legislation seeks to enhance beneficiary access to non-opioid pain management drugs under Medicare Part D. Starting January 1, 2026, for qualifying non-opioid pain management drugs, the standard deductible will not apply. Furthermore, these drugs will be placed on the lowest cost-sharing tier available within a Medicare Part D plan, significantly reducing out-of-pocket expenses for beneficiaries. A qualifying non-opioid pain management drug is defined as one approved by the FDA for acute pain, does not act on opioid receptors, has no therapeutically equivalent alternative sold in the U.S., and whose monthly wholesale acquisition cost does not exceed a specified threshold. To further ensure access, the bill prohibits Medicare Part D plans from imposing step therapy requirements that mandate opioid use first, or any prior authorization requirements for these qualifying non-opioid pain management drugs. These measures aim to remove barriers and encourage the use of non-addictive pain relief options.