Alternatives to PAIN Act
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Progress
Where this bill stands in the legislative process.
- Introduced
- Passed Senate
- Passed House
- To President
- Became Law
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 and prohibits plans from requiring step therapy or prior authorization before coverage is approved. The bill focuses on ensuring that these medications are readily available without significant financial barriers.
Key provisions
- Eliminates the deductible for qualifying non-opioid pain management drugs.
- Places qualifying non-opioid pain management drugs on the lowest cost-sharing tier.
- Prohibits step therapy requirements for qualifying non-opioid pain management drugs.
- Prohibits prior authorization requirements for qualifying non-opioid pain management drugs.
- Defines ‘qualifying non-opioid pain management drug’ based on FDA labeling, lack of opioid receptor activity, and wholesale acquisition cost.
- Applies these changes starting January 1, 2026.
- Modifies cost-sharing rules for low-income Medicare beneficiaries.
- Reclassifies a previous provision regarding step therapy to align with the new prohibitions.
Who is affected
- Medicare beneficiaries
- Pharmaceutical companies
- Medicare prescription drug plans (Part D)
- Managed care organizations
Notable changes
Bill text
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Sponsors
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37 on record
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