# 119-hr-1227: Alternatives to PAIN Act

119-hr-1227, Alternatives to PAIN Act, is a 119th Congress bill sponsored by Rep. Miller-Meeks, Mariannette [R-IA-1] (R-IA); status introduced; PRIA reads it as touching household money (as of 2026-10-21).

- Canonical: https://policyrisk.com/legislation/119-hr-1227
- As of: 2026-10-21
- Plain-text twin of the page above; the HTML and this file carry the same facts.

## Facts
- Bill: 119-hr-1227
- Congress: 119
- Title: Alternatives to PAIN Act
- Status: introduced
- Introduced: 2025-02-12
- Sponsor: Rep. Miller-Meeks, Mariannette [R-IA-1] (R-IA)
- Cosponsors: 116
- Policy area: Health
- Touches household money: yes
- Last recorded action: 2026-10-21

## 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. - 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.

## Cosponsors (116)

- Rep. McClellan, Jennifer L. [D-VA-4] (D-VA), 2026-09-28T00:00:00.000Z
- Rep. Barragán, Nanette Diaz [D-CA-44] (D-CA), 2025-02-12T00:00:00.000Z
- Rep. Kelly, Mike [R-PA-16] (R-PA), 2025-02-12T00:00:00.000Z
- Rep. Panetta, Jimmy [D-CA-19] (D-CA), 2025-02-12T00:00:00.000Z
- Rep. Miller, Carol D. [R-WV-1] (R-WV), 2025-02-24T00:00:00.000Z
- Rep. Larson, John B. [D-CT-1] (D-CT), 2025-02-24T00:00:00.000Z
- Rep. Malliotakis, Nicole [R-NY-11] (R-NY), 2025-02-24T00:00:00.000Z
- Rep. Moulton, Seth [D-MA-6] (D-MA), 2025-02-24T00:00:00.000Z
- Rep. Balderson, Troy [R-OH-12] (R-OH), 2025-03-18T00:00:00.000Z
- Rep. Guest, Michael [R-MS-3] (R-MS), 2025-03-18T00:00:00.000Z
- Rep. Clarke, Yvette D. [D-NY-9] (D-NY), 2025-03-18T00:00:00.000Z
- Rep. Budzinski, Nikki [D-IL-13] (D-IL), 2025-03-18T00:00:00.000Z
- Rep. Lieu, Ted [D-CA-36] (D-CA), 2025-03-24T00:00:00.000Z
- Rep. Fleischmann, Charles J. "Chuck" [R-TN-3] (R-TN), 2025-03-24T00:00:00.000Z
- Rep. Tenney, Claudia [R-NY-24] (R-NY), 2025-03-31T00:00:00.000Z
- Rep. Peters, Scott H. [D-CA-50] (D-CA), 2025-03-31T00:00:00.000Z
- Rep. Griffith, H. Morgan [R-VA-9] (R-VA), 2025-04-07T00:00:00.000Z
- Rep. Auchincloss, Jake [D-MA-4] (D-MA), 2025-04-07T00:00:00.000Z
- Rep. Thompson, Glenn [R-PA-15] (R-PA), 2025-04-28T00:00:00.000Z
- Rep. Cohen, Steve [D-TN-9] (D-TN), 2025-04-28T00:00:00.000Z
- Rep. Mann, Tracey [R-KS-1] (R-KS), 2025-06-03T00:00:00.000Z
- Del. Norton, Eleanor Holmes [D-DC-At Large] (D-DC), 2025-06-03T00:00:00.000Z
- Rep. Womack, Steve [R-AR-3] (R-AR), 2025-06-03T00:00:00.000Z
- Rep. Salinas, Andrea [D-OR-6] (D-OR), 2025-06-03T00:00:00.000Z
- Rep. Kiggans, Jennifer A. [R-VA-2] (R-VA), 2025-06-23T00:00:00.000Z
- Rep. Brownley, Julia [D-CA-26] (D-CA), 2025-06-23T00:00:00.000Z
- Rep. Dunn, Neal P. [R-FL-2] (R-FL), 2025-06-25T00:00:00.000Z
- Rep. Pocan, Mark [D-WI-2] (D-WI), 2025-06-25T00:00:00.000Z
- Rep. Scott, Austin [R-GA-8] (R-GA), 2025-06-26T00:00:00.000Z
- Rep. Tokuda, Jill N. [D-HI-2] (D-HI), 2025-06-26T00:00:00.000Z
- Rep. Moore, Gwen [D-WI-4] (D-WI), 2025-06-26T00:00:00.000Z
- Rep. Aderholt, Robert B. [R-AL-4] (R-AL), 2025-06-26T00:00:00.000Z
- Rep. Bilirakis, Gus M. [R-FL-12] (R-FL), 2025-07-02T00:00:00.000Z
- Rep. Subramanyam, Suhas [D-VA-10] (D-VA), 2025-07-02T00:00:00.000Z
- Rep. Costa, Jim [D-CA-21] (D-CA), 2025-07-10T00:00:00.000Z
- Rep. Carter, Earl L. "Buddy" [R-GA-1] (R-GA), 2025-08-01T00:00:00.000Z
- Rep. Khanna, Ro [D-CA-17] (D-CA), 2025-08-19T00:00:00.000Z
- Rep. McGovern, James P. [D-MA-2] (D-MA), 2025-08-19T00:00:00.000Z
- Rep. Kelly, Robin L. [D-IL-2] (D-IL), 2025-08-19T00:00:00.000Z
- Rep. Mast, Brian J. [R-FL-21] (R-FL), 2025-09-04T00:00:00.000Z
- Rep. Craig, Angie [D-MN-2] (D-MN), 2025-09-08T00:00:00.000Z
- Rep. Vindman, Eugene Simon [D-VA-7] (D-VA), 2025-09-11T00:00:00.000Z
- Rep. Vasquez, Gabe [D-NM-2] (D-NM), 2025-09-30T00:00:00.000Z
- Rep. Bresnahan, Robert P. [R-PA-8] (R-PA), 2025-09-30T00:00:00.000Z
- Rep. McGarvey, Morgan [D-KY-3] (D-KY), 2025-10-08T00:00:00.000Z
- Rep. Fitzpatrick, Brian K. [R-PA-1] (R-PA), 2025-10-10T00:00:00.000Z
- Rep. Nunn, Zachary [R-IA-3] (R-IA), 2026-10-19T00:00:00.000Z
- Rep. Soto, Darren [D-FL-9] (D-FL), 2026-10-19T00:00:00.000Z
- Rep. Davis, Donald G. [D-NC-1] (D-NC), 2025-10-31T00:00:00.000Z
- Rep. Pfluger, August [R-TX-11] (R-TX), 2025-11-20T00:00:00.000Z
- Rep. Garcia, Robert [D-CA-42] (D-CA), 2025-11-20T00:00:00.000Z
- Rep. Steube, W. Gregory [R-FL-17] (R-FL), 2025-12-01T00:00:00.000Z
- Rep. Weber, Randy K. Sr. [R-TX-14] (R-TX), 2025-12-02T00:00:00.000Z
- Rep. Rutherford, John H. [R-FL-5] (R-FL), 2025-12-02T00:00:00.000Z
- Rep. Bean, Aaron [R-FL-4] (R-FL), 2025-12-02T00:00:00.000Z
- Rep. Hudson, Richard [R-NC-9] (R-NC), 2025-12-03T00:00:00.000Z
- Rep. Joyce, John [R-PA-13] (R-PA), 2025-12-03T00:00:00.000Z
- Rep. Burchett, Tim [R-TN-2] (R-TN), 2025-12-03T00:00:00.000Z
- Rep. Ezell, Mike [R-MS-4] (R-MS), 2025-12-03T00:00:00.000Z
- Rep. Cammack, Kat [R-FL-3] (R-FL), 2025-12-04T00:00:00.000Z
- Rep. Randall, Emily [D-WA-6] (D-WA), 2025-12-05T00:00:00.000Z
- Rep. Sewell, Terri A. [D-AL-7] (D-AL), 2025-12-09T00:00:00.000Z
- Rep. Pappas, Chris [D-NH-1] (D-NH), 2025-12-09T00:00:00.000Z
- Rep. Bentz, Cliff [R-OR-2] (R-OR), 2025-12-09T00:00:00.000Z
- Rep. Cherfilus-McCormick, Sheila [D-FL-20] (D-FL), 2025-12-09T00:00:00.000Z
- Rep. Mackenzie, Ryan [R-PA-7] (R-PA), 2025-12-09T00:00:00.000Z
- Rep. Nehls, Troy E. [R-TX-22] (R-TX), 2025-12-09T00:00:00.000Z
- Rep. Garcia, Sylvia R. [D-TX-29] (D-TX), 2025-12-09T00:00:00.000Z
- Rep. Pettersen, Brittany [D-CO-7] (D-CO), 2025-12-09T00:00:00.000Z
- Rep. Dean, Madeleine [D-PA-4] (D-PA), 2025-12-09T00:00:00.000Z
- Rep. Harrigan, Pat [R-NC-10] (R-NC), 2025-12-10T00:00:00.000Z
- Rep. Cleaver, Emanuel [D-MO-5] (D-MO), 2025-12-18T00:00:00.000Z
- Rep. Amo, Gabe [D-RI-1] (D-RI), 2025-12-18T00:00:00.000Z
- Rep. Schmidt, Derek [R-KS-2] (R-KS), 2025-12-19T00:00:00.000Z
- Rep. McBath, Lucy [D-GA-6] (D-GA), 2025-12-19T00:00:00.000Z
- Rep. Barrett, Tom [R-MI-7] (R-MI), 2025-12-19T00:00:00.000Z
- Rep. McGuire, John J. [R-VA-5] (R-VA), 2026-01-07T00:00:00.000Z
- Rep. Lawler, Michael [R-NY-17] (R-NY), 2026-01-13T00:00:00.000Z
- Rep. Thanedar, Shri [D-MI-13] (D-MI), 2026-01-23T00:00:00.000Z
- Rep. Lofgren, Zoe [D-CA-18] (D-CA), 2026-02-09T00:00:00.000Z
- Rep. Grijalva, Adelita S. [D-AZ-7] (D-AZ), 2026-02-17T00:00:00.000Z
- Rep. Van Orden, Derrick [R-WI-3] (R-WI), 2026-02-20T00:00:00.000Z
- Rep. Garbarino, Andrew R. [R-NY-2] (R-NY), 2026-03-04T00:00:00.000Z
- Rep. Carbajal, Salud O. [D-CA-24] (D-CA), 2026-03-16T00:00:00.000Z
- Rep. Trahan, Lori [D-MA-3] (D-MA), 2026-03-25T00:00:00.000Z
- Rep. Garamendi, John [D-CA-8] (D-CA), 2026-04-13T00:00:00.000Z
- Rep. Correa, J. Luis [D-CA-46] (D-CA), 2026-04-13T00:00:00.000Z
- Rep. Mullin, Kevin [D-CA-15] (D-CA), 2026-04-20T00:00:00.000Z
- Rep. Owens, Burgess [R-UT-4] (R-UT), 2026-04-16T00:00:00.000Z
- Rep. Thompson, Mike [D-CA-4] (D-CA), 2026-04-27T00:00:00.000Z
- Rep. Whitesides, George [D-CA-27] (D-CA), 2026-04-27T00:00:00.000Z
- Rep. Cline, Ben [R-VA-6] (R-VA), 2026-04-30T00:00:00.000Z
- Rep. Menendez, Robert [D-NJ-8] (D-NJ), 2026-05-13T00:00:00.000Z
- Rep. Keating, William R. [D-MA-9] (D-MA), 2026-05-20T00:00:00.000Z
- Rep. Gottheimer, Josh [D-NJ-5] (D-NJ), 2026-06-02T00:00:00.000Z
- Rep. Balint, Becca [D-VT-At Large] (D-VT), 2026-06-03T00:00:00.000Z
- Rep. Biggs, Sheri [R-SC-3] (R-SC), 2026-06-04T00:00:00.000Z
- Rep. Hinson, Ashley [R-IA-2] (R-IA), 2026-06-04T00:00:00.000Z
- Rep. Landsman, Greg [D-OH-1] (D-OH), 2026-06-18T00:00:00.000Z
- Rep. Morelle, Joseph D. [D-NY-25] (D-NY), 2026-06-18T00:00:00.000Z
- Rep. DeSaulnier, Mark [D-CA-10] (D-CA), 2026-06-18T00:00:00.000Z
- Rep. Williams, Nikema [D-GA-5] (D-GA), 2026-06-18T00:00:00.000Z
- Rep. Mills, Cory [R-FL-7] (R-FL), 2026-06-29T00:00:00.000Z
- Rep. Bacon, Don [R-NE-2] (R-NE), 2026-06-29T00:00:00.000Z
- Rep. Moore, Tim [R-NC-14] (R-NC), 2026-06-29T00:00:00.000Z
- Rep. Suozzi, Thomas R. [D-NY-3] (D-NY), 2026-06-30T00:00:00.000Z
- Rep. Langworthy, Nicholas A. [R-NY-23] (R-NY), 2026-07-06T00:00:00.000Z
- Rep. Carey, Mike [R-OH-15] (R-OH), 2026-07-06T00:00:00.000Z
- Rep. Himes, James A. [D-CT-4] (D-CT), 2026-07-09T00:00:00.000Z
- Rep. Rulli, Michael A. [R-OH-6] (R-OH), 2026-07-09T00:00:00.000Z
- Rep. Raskin, Jamie [D-MD-8] (D-MD), 2026-08-10T00:00:00.000Z
- Rep. Stanton, Greg [D-AZ-4] (D-AZ), 2026-08-10T00:00:00.000Z
- Rep. McBride, Sarah [D-DE-At Large] (D-DE), 2026-08-17T00:00:00.000Z
- Rep. Kennedy, Mike [R-UT-3] (R-UT), 2026-09-02T00:00:00.000Z
- Rep. Neguse, Joe [D-CO-2] (D-CO), 2026-09-02T00:00:00.000Z
- Rep. Strickland, Marilyn [D-WA-10] (D-WA), 2026-09-10T00:00:00.000Z

## Provisions PRIA read

- Lower Medicare costs for non-opioid pain drugs: benefit, medium. 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 co…
- Medicare: No prior authorization or step therapy: benefit, medium. 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…
- Which pain drugs qualify under Medicare: benefit, low. 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 acquisiti…

## Related bills

- 119-hr-842: Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage Act
- 119-hr-3514: Improving Seniors’ Timely Access to Care Act of 2025
- 119-hr-1262: Mikaela Naylon Give Kids a Chance Act
- 119-hr-909: Crime Victims Fund Stabilization Act of 2025
- 119-hr-2102: Major Richard Star Act
- 119-hr-1993: 25th Anniversary of 9/11 Commemorative Coin Act

## Sources
- [119-hr-1227 on Congress.gov](https://www.congress.gov/bill/119th-congress/house-bill/1227)

## Related
- [119-hr-842: Nancy Gardner Sewell Medicare Multi-Cancer Early Detection Screening Coverage A…](https://policyrisk.com/legislation/119-hr-842)
- [119-hr-3514: Improving Seniors’ Timely Access to Care Act of 2025](https://policyrisk.com/legislation/119-hr-3514)
- [119-hr-1262: Mikaela Naylon Give Kids a Chance Act](https://policyrisk.com/legislation/119-hr-1262)
- [119-hr-909: Crime Victims Fund Stabilization Act of 2025](https://policyrisk.com/legislation/119-hr-909)
- [119-hr-2102: Major Richard Star Act](https://policyrisk.com/legislation/119-hr-2102)
- [119-hr-1993: 25th Anniversary of 9/11 Commemorative Coin Act](https://policyrisk.com/legislation/119-hr-1993)
- [All bills in Congress](https://policyrisk.com/legislation)

Source: PRIA, https://policyrisk.com/legislation/119-hr-1227 (as of 2026-10-21).