Alternatives to PAIN Act

Senate Bill

S. 475

119th Congress

Alternatives to PAIN Act

In Committee

Introduced:Feb 6, 2025

Primary Sponsor

Martin Heinrich

Senator

Democratic

NM

Cosponsors

30

Quick Stats

Policy Area

Health

Summary

This bill improves Medicare coverage for non-opioid pain management drugs by eliminating deductibles, placing them on the lowest cost-sharing tier, and prohibiting prior authorization and step therapy requirements that could delay access to these alternatives.

Latest Action

Read twice and referred to the Committee on Finance.

SponsorMartin Heinrich (D-NM)

Introduced2/6/2025

StatusRead twice and referred to the Committee on Finance.

ChamberSenate

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Vote Prediction

Alternatives to PAIN Act

This bill improves Medicare coverage for non-opioid pain management drugs by eliminating deductibles, placing them on the lowest cost-sharing tier, and prohibiting prior authorization and step therapy requirements that could delay access to these alternatives.

Community Breakdown

Pass

0%

Fail

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0 predictions

This bill improves Medicare coverage for non-opioid pain management drugs by eliminating deductibles, placing them on the lowest cost-sharing tier, and prohibiting prior authorization and step therapy requirements that could delay access to these alternatives.

Bill Number: 475
Sponsor: Martin Heinrich (D-NM)
Introduced: 2/6/2025
Status: Read twice and referred to the Committee on Finance.
Policy Area: Health

Data from Congress.gov

AI-generated summary

Fact Sheet

Title: Alternatives to PAIN Act
Bill Number: 475
Sponsor: Martin Heinrich (D-NM)
Status: Read twice and referred to the Committee on Finance.
Introduced: 2/6/2025
Summary: This bill improves Medicare coverage for non-opioid pain management drugs by eliminating deductibles, placing them on the lowest cost-sharing tier, and prohibiting prior authorization and step therapy requirements that could delay access to these alternatives.

Data from Congress.gov

AI Summary

Plain-English explanation of this bill

This bill improves Medicare coverage for non-opioid pain management drugs by eliminating deductibles, placing them on the lowest cost-sharing tier, and prohibiting prior authorization and step therapy requirements that could delay access to these alternatives.

Last updated: 1/5/2026

Official Summary

Congressional Research Service summary

Alternatives to Prevent Addiction In the Nation Act or the Alternatives to PAIN ActThis bill reduces cost-sharing and prohibits the imposition of certain utilization requirements under the Medicare prescription drug benefit for certain non-opioid pain management drugs.Specifically, the bill requires such drugs to be covered without a deductible and to be placed on the lowest cost-sharing tier (if any). The bill also prohibits the imposition of prior authorization requirements (i.e., requiring prior approval from a plan) or step therapy requirements (i.e., requiring the use of alternative drugs before a drug is covered under a plan) with respect to such drugs.

Key Points

Main provisions of the bill

Eliminates Medicare deductibles for non-opioid pain drugs
Places non-opioid pain medications on lowest cost-sharing tier
Prohibits prior authorization requirements for these drugs
Bans step therapy requirements for non-opioid alternatives
Aims to reduce reliance on opioids for pain management

How This Impacts Americans

Potential effects on citizens and communities

Medicare beneficiaries would have easier and more affordable access to non-opioid pain medications, potentially reducing dependence on opioid painkillers. Removing prior authorization barriers could help patients get these alternatives faster.

Policy Areas

Primary Policy Area

Health

Related Subjects

Drug therapy

Health care costs and insurance

Medicare

Prescription drugs

Scope & Jurisdiction

Jurisdiction Level

federal

Congressional Session

119th Congress

Citation Reference

475, 119th Congress (2025). "Alternatives to PAIN Act". Source: Voter's Right Platform. https://votersright.org/bills/118-s-475

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