Relief of Chronic Pain Act of 2025
Sponsored By: Senator Steve Daines
Introduced
Summary
Expands and standardizes access to certain FDA‑labeled non‑opioid drugs for chronic pain in Medicare Part D and bans prior authorization and step therapy for those medicines. It removes the Part D deductible and requires qualifying drugs to be placed on the lowest cost-sharing tier for plan years beginning on or after January 1, 2026.
Show full summary
- People with chronic pain: Qualifying non-opioid drugs for seven chronic pain conditions are defined by FDA label and must not act on opioid receptors. These drugs have no Part D deductible and go on the lowest cost-sharing tier, covering conditions such as fibromyalgia and diabetic peripheral neuropathic pain.
- Low-income Medicare enrollees: Conforming amendments ensure the same deductible relief and lowest-tier placement apply under low-income cost-sharing rules for plan years beginning January 1, 2026.
- Plans and prescribers: Prescription drug plans and Medicare Advantage prescription drug plans cannot impose step therapy that requires prior opioid use or require prior authorization for qualifying drugs. The Secretary sets a monthly specialty-tier cost threshold and uses FDA therapeutic equivalence listings to determine which drugs qualify.
Your PRIA Score
Personalized for You
How does this bill affect your finances?
Sign up for a PRIA Policy Scan to see your personalized alignment score for this bill and every other piece of legislation we track. We analyze your financial profile against policy provisions to show you exactly what matters to your wallet.
Bill Overview
Analyzed Economic Effects
3 provisions identified: 3 benefits, 0 costs, 0 mixed.
Lower Part D costs for non-opioids
If enacted, for plan years beginning January 1, 2026, Part D plans would waive the Part D deductible for qualifying non-opioid chronic pain drugs. Plans would place those drugs on the lowest cost-sharing tier when calculating your coinsurance or other cost-sharing. If you get the low-income subsidy, you would get the same deductible waiver and tier placement. These rules apply when your prescription drug plan or Medicare Advantage prescription drug plan covers the qualifying drug.
No prior authorization for non-opioids
If enacted, for plan years beginning January 1, 2026, prescription drug plans and MA-PD plans could not require you to try an opioid before a qualifying non-opioid chronic pain drug. Plans also could not require prior authorization for those qualifying non-opioid drugs. The ban applies when the plan covers the qualifying drug.
Definition of qualifying non-opioid drugs
If enacted, the bill would define a "qualifying non-opioid chronic pain management drug" for Part D starting January 1, 2026. A drug would qualify if it has an FDA label for chronic pain or one of seven listed pain conditions that last over 3 months, does not act on opioid receptors, has no therapeutically equivalent product sold in the U.S., and has a monthly wholesale cost below a Secretary-set threshold. The Secretary would set the monthly specialty-tier cost threshold and the FDA list of therapeutic equivalents would control equivalence tests.
Sponsors & CoSponsors
Sponsor
Steve Daines
MT • R
Cosponsors
Maria Cantwell
WA • D
Sponsored 10/28/2025
Roll Call Votes
No roll call votes available for this bill.
View on Congress.govTake It Personal
Get Your Personalized Policy View
Start a Free Government Policy Watch to see how policy affects your household, then upgrade to PRIA Full Coverage for year-round monitoring.
Already have an account? Sign in