Alternatives to PAIN Act
Alternatives to PAIN Act
Plain Language Summary
# Alternatives to PAIN Act Summary **What the Bill Would Do** The Alternatives to PAIN Act would make non-opioid pain management drugs more affordable and accessible for Medicare patients. Specifically, it would require Medicare prescription drug plans to cover these medications without requiring patients to pay a deductible and place them in the lowest cost-sharing tier. The bill would also eliminate two common insurance barriers: prior authorization (where insurance companies require advance approval before covering a drug) and step therapy (where patients must try cheaper or alternative drugs first before their preferred medication is covered). **Who It Affects and Current Status** This bill primarily affects Medicare beneficiaries who use non-opioid pain medications, as well as healthcare providers prescribing these drugs.
The legislation reflects a push to provide alternatives to opioids—which carry addiction risks—by making non-opioid options more accessible and affordable. As of now, the bill is in committee and has not been voted on by the full Senate. It was introduced by Senator Thomas Tillis (R-NC) in the 119th Congress.
CRS Official Summary
Alternatives to Prevent Addiction In the Nation Act or the Alternatives to PAIN ActThis 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
Read twice and referred to the Committee on Finance.