Alternatives to PAIN Act
Sponsored By: Representative Miller-Meeks
Introduced
Summary
Lowering cost and access barriers for qualifying non-opioid pain management drugs under Medicare Part D. This bill would make certain non-opioid pain drugs cheaper and easier to get for Medicare enrollees.
Show full summary
- Medicare Part D enrollees would pay less out of pocket because qualifying non-opioid pain drugs would not be subject to the Part D deductible and must be placed on the lowest cost-sharing tier when calculating maximum co-insurance or other cost-sharing. These changes apply for plan years beginning on or after January 1, 2026.
- Low-income Medicare enrollees who receive Part D subsidies would get the same deductible waiver and lowest-tier placement for qualifying drugs when calculating their maximum cost-sharing, for plan years beginning on or after January 1, 2026.
- Prescription drug plans and Medicare Advantage prescription drug plans would be barred from imposing step therapy or prior authorization for qualifying non-opioid pain drugs, reducing administrative hurdles for patients and providers beginning in 2026.
- A qualifying non-opioid pain drug must have an FDA-approved indication for acute or postoperative pain, not act on opioid receptors, lack a therapeutically equivalent U.S. product, and have a monthly wholesale acquisition cost below a specialty-tier cost threshold that the Secretary may set and update.
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Bill Overview
Analyzed Economic Effects
3 provisions identified: 3 benefits, 0 costs, 0 mixed.
Lower Medicare costs for non-opioid pain drugs
Starting with plan years on or after January 1, 2026, this would cut what you pay for certain non-opioid pain drugs under Medicare Part D. Plans would have to waive the Part D deductible for these drugs. Plans would also have to put them on the lowest cost-sharing tier when setting your copay or coinsurance. The same waiver and lowest-tier rule would apply when figuring costs for low-income subsidy enrollees. These changes would apply to stand‑alone Part D and Medicare Advantage plans that include Part D. The savings would apply only if the drug meets the bill’s definition of a qualifying non‑opioid pain drug.
Medicare: No prior authorization or step therapy
For plan years starting on or after January 1, 2026, Medicare drug plans would not be allowed to require prior authorization for qualifying non‑opioid pain drugs. Plans also could not make you try another drug, including an opioid, before covering the qualifying non‑opioid drug. This would apply to all Part D plans and Medicare Advantage plans with Part D.
Which pain drugs qualify under Medicare
The bill would set which drugs count as qualifying non‑opioid pain drugs. A drug would need an FDA‑approved use for post‑surgery or other acute pain and must not act on opioid receptors. It would need no therapeutically equivalent product sold in the U.S. Its monthly list price (wholesale acquisition cost) would have to be at or below Medicare’s specialty‑tier price threshold set by the Secretary. These rules would apply for plan years beginning on or after January 1, 2026.
Sponsors & CoSponsors
Sponsor
Miller-Meeks
IA • R
Cosponsors
Barragan
CA • D
Sponsored 2/12/2025
Kelly (PA)
PA • R
Sponsored 2/12/2025
Panetta
CA • D
Sponsored 2/12/2025
Miller (WV)
WV • R
Sponsored 2/24/2025
Larson (CT)
CT • D
Sponsored 2/24/2025
Malliotakis
NY • R
Sponsored 2/24/2025
Moulton
MA • D
Sponsored 2/24/2025
Balderson
OH • R
Sponsored 3/18/2025
Guest
MS • R
Sponsored 3/18/2025
Clarke (NY)
NY • D
Sponsored 3/18/2025
Budzinski
IL • D
Sponsored 3/18/2025
Lieu
CA • D
Sponsored 3/24/2025
Fleischmann
TN • R
Sponsored 3/24/2025
Tenney
NY • R
Sponsored 3/31/2025
Peters
CA • D
Sponsored 3/31/2025
Griffith
VA • R
Sponsored 4/7/2025
Auchincloss
MA • D
Sponsored 4/7/2025
Thompson (PA)
PA • R
Sponsored 4/28/2025
Cohen
TN • D
Sponsored 4/28/2025
Mann
KS • R
Sponsored 6/3/2025
Del. Norton, Eleanor Holmes [D-DC-At Large]
DC • D
Sponsored 6/3/2025
Womack
AR • R
Sponsored 6/3/2025
Salinas
OR • D
Sponsored 6/3/2025
Kiggans (VA)
VA • R
Sponsored 6/23/2025
Brownley
CA • D
Sponsored 6/23/2025
Dunn (FL)
FL • R
Sponsored 6/25/2025
Pocan
WI • D
Sponsored 6/25/2025
Scott, Austin
GA • R
Sponsored 6/26/2025
Tokuda
HI • D
Sponsored 6/26/2025
Moore (WI)
WI • D
Sponsored 6/26/2025
Aderholt
AL • R
Sponsored 6/26/2025
Bilirakis
FL • R
Sponsored 7/2/2025
Subramanyam
VA • D
Sponsored 7/2/2025
Costa
CA • D
Sponsored 7/10/2025
Carter (GA)
GA • R
Sponsored 8/1/2025
Khanna
CA • D
Sponsored 8/19/2025
McGovern
MA • D
Sponsored 8/19/2025
Kelly (IL)
IL • D
Sponsored 8/19/2025
Mast
FL • R
Sponsored 9/4/2025
Craig
MN • D
Sponsored 9/8/2025
Vindman
VA • D
Sponsored 9/11/2025
Vasquez
NM • D
Sponsored 9/30/2025
Bresnahan
PA • R
Sponsored 9/30/2025
McGarvey
KY • D
Sponsored 10/8/2025
Fitzpatrick
PA • R
Sponsored 10/10/2025
Davis (NC)
NC • D
Sponsored 10/31/2025
Pfluger
TX • R
Sponsored 11/20/2025
Garcia (CA)
CA • D
Sponsored 11/20/2025
Steube
FL • R
Sponsored 12/1/2025
Weber (TX)
TX • R
Sponsored 12/2/2025
Rutherford
FL • R
Sponsored 12/2/2025
Bean (FL)
FL • R
Sponsored 12/2/2025
Hudson
NC • R
Sponsored 12/3/2025
Joyce (PA)
PA • R
Sponsored 12/3/2025
Burchett
TN • R
Sponsored 12/3/2025
Ezell
MS • R
Sponsored 12/3/2025
Cammack
FL • R
Sponsored 12/4/2025
Randall
WA • D
Sponsored 12/5/2025
Sewell
AL • D
Sponsored 12/9/2025
Pappas
NH • D
Sponsored 12/9/2025
Bentz
OR • R
Sponsored 12/9/2025
Cherfilus-McCormick
FL • D
Sponsored 12/9/2025
Mackenzie
PA • R
Sponsored 12/9/2025
Nehls
TX • R
Sponsored 12/9/2025
Garcia (TX)
TX • D
Sponsored 12/9/2025
Pettersen
CO • D
Sponsored 12/9/2025
Dean (PA)
PA • D
Sponsored 12/9/2025
Harrigan
NC • R
Sponsored 12/10/2025
Cleaver
MO • D
Sponsored 12/18/2025
Amo
RI • D
Sponsored 12/18/2025
Schmidt
KS • R
Sponsored 12/19/2025
McBath
GA • D
Sponsored 12/19/2025
Barrett
MI • R
Sponsored 12/19/2025
McGuire
VA • R
Sponsored 1/7/2026
Lawler
NY • R
Sponsored 1/13/2026
Thanedar
MI • D
Sponsored 1/23/2026
Lofgren
CA • D
Sponsored 2/9/2026
Grijalva
AZ • D
Sponsored 2/17/2026
Van Orden
WI • R
Sponsored 2/20/2026
Garbarino
NY • R
Sponsored 3/4/2026
Carbajal
CA • D
Sponsored 3/16/2026
Trahan
MA • D
Sponsored 3/25/2026
Roll Call Votes
No roll call votes available for this bill.
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