Alternatives to PAIN Act
Key claim: The Alternatives to PAIN Act would require Medicare Part D plans to cover non-opioid pain management drugs without a deductible, place them on the lowest cost-sharing tier, and prohibit prior authorization and step therapy requirements for such drugs.
Abstract
(S475 · 119th Congress) Alternatives to Prevent Addiction In the Nation Act or the Alternatives to PAIN Act This bill reduces cost-sharing and prohibits the imposition of certain utilization requirements under the Medicare prescription drug benefit for certain non-opioid pain management drugs. Specifically, the bill requires such drugs to be covered without a deductible and to be placed on the lowest cost-sharing tier (if any). The bill also prohibits the imposition of prior authorization requirements (i.e., requiring prior approval from a plan) or step therapy requirements (i.e., requiring the use of alternative drugs before a drug is covered under a plan) with respect to such drugs. Latest action (2025-02-06): Read twice and referred to the Committee on Finance.
Why this matters
The bill would directly change what Medicare Part D beneficiaries pay for non-opioid pain drugs by eliminating deductibles and requiring lowest-tier placement, while removing common utilization management tools (prior authorization, step therapy) that currently gate access. For insurers and PBMs administering Part D, it would constrain formulary design for an entire drug class; for providers and patients, it would ease access to non-opioid alternatives amid ongoing federal focus on reducing opioid reliance.