HR 1227
Alternatives to PAIN Act
Take action
Record your position on this measure.
Sign in to record your position, submit testimony, or contact your legislator.
Sign in to take action- Introduced
- Passed House
- Passed Senate
- To President
- Became Law
Bill overview
The Alternatives to Prevent Addiction In the Nation Act, or the Alternatives to PAIN Act, aims to improve access to non-opioid pain medications for Medicare recipients. It reduces or eliminates cost-sharing for these drugs, ensuring they are placed on the lowest cost-sharing tier. Furthermore, the bill prohibits plans from requiring step therapy or prior authorization for these medications, making them more readily available to patients.
Sponsors
Official sponsors from legislative records.
Primary sponsor
Cosponsors
Arguments in favor
Reasons to support this legislation.
No arguments in favor have been submitted.
Submit yoursArguments opposed
Reasons to oppose this legislation.
No arguments opposed have been submitted.
Submit yoursRead the latest version inline or switch to a previous version.
119th CONGRESS — 1st Session
H. R. 1227
IN THE HOUSE OF REPRESENTATIVES
A BILL
To amend title XVIII of the Social Security Act to ensure appropriate access to non-opioid pain management drugs under part D of the Medicare program.
This Act may be cited as the Alternatives to Prevent Addiction In the Nation Act Alternatives to PAIN Act
or the
.
Section 1860D–2 of the Social Security Act (42 U.S.C. 1395w–102) is amended—
in subsection (b)—
in paragraph (1)(A), in the matter preceding clause (i), by striking paragraphs (8) and (9)
and inserting paragraphs (8), (9), and (10)
;
paragraphs (8) and (9)and inserting
paragraphs (8), (9), and (10); and
by adding at the end the following new paragraph:
For plan years beginning on or after January 1, 2026, with respect to a covered part D drug that is a qualifying non-opioid pain management drug (as defined in subparagraph (B))—
the deductible under paragraph (1) shall not apply; and
such drug shall be placed on the lowest cost-sharing tier, if any, for purposes of determining the maximum co-insurance or other cost-sharing for such drug.
In this paragraph, the term qualifying non-opioid pain management drug
means a drug or biological product—
that has a label indication approved by the Food and Drug Administration to reduce postoperative pain or any other form of acute pain;
that does not act upon the body’s opioid receptors;
for which there is no other drug or product that is—
rated as therapeutically equivalent (under the Food and Drug Administration’s most recent publication of Approved Drug Products with Therapeutic Equivalence Evaluations
); and
sold or marketed in the United States; and
for which the wholesale acquisition cost (as defined in section 1847A(c)(6)(B)), for a monthly supply does not exceed the monthly specialty-tier cost threshold as determined by the Secretary from time to time.
in subsection (c), by adding at the end the following new paragraph:
The coverage is provided in accordance with subsection (b)(10).
Section 1860D–14(a) of the Social Security Act (42 U.S.C. 1395w–114(a)) is amended—
in paragraph (1)(D), in each of the clauses (ii) and (iii), by striking Subject to paragraph (6)
and inserting Subject to paragraphs (6) and (7)
; and
by adding at the end the following new paragraph:
For plan years beginning on or after January 1, 2026, with respect to a covered part D drug that is a qualifying non-opioid pain management drug (as defined in section 1860D–2(b)(10)(B))—
the deductible under section 1860D-2(b)(1) shall not apply; and
such drug shall be placed on the lowest cost-sharing tier, if any, for purposes of determining the maximum co-insurance or other cost-sharing for such drug.
Section 1860D–4(c) of the Social Security Act (42 U.S.C. 1395w–104(c)) is amended—
by redesignating paragraph (6), as added by section 50354 of division E of the Bipartisan Budget Act of 2018 (Public Law 115–123), as paragraph (7); and
by adding at the end the following new paragraph:
For plan years beginning on or after January 1, 2026, a prescription drug plan or an MA–PD plan may not, with respect to a qualifying non-opioid pain management drug (as defined in section 1860D–2(b)(10)(B)) for which coverage is provided under such plan, impose any—
step therapy requirement under which an individual enrolled under such plan is required to use an opioid prior to receiving such drug; or
prior authorization requirement.
In this paragraph, the term step therapy
means a drug therapy utilization management protocol or program that requires use of an alternative, preferred prescription drug or drugs before the plan approves coverage for the non-preferred drug therapy prescribed.
In this paragraph, the term prior authorization
means any requirement to obtain approval from a prescription drug plan prior to the furnishing of a drug.