I 

118TH CONGRESS 

2D SESSION H. R. 7142 

To amend title XVIII of the Social Security Act to ensure appropriate 

access to non-opioid pain management drugs under part D of the Medicare program. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 30, 2024 

Mrs. MILLER-MEEKS (for herself and Mr. CA ́RDENAS) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend title XVIII of the Social Security Act to ensure 

appropriate access to non-opioid pain management drugs 

under part D of the Medicare program. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; FINDINGS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Alternatives to Prevent Addiction In the Nation Act’’ or 

6 the ‘‘Alternatives to PAIN Act’’. 

7 (b) FINDINGS.—Congress finds the following: 


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1 (1) In 2019, approximately 10 million people 

2 misused prescription opioids. 

3 (2) 3 million U.S. citizens and 16 million indi4 viduals worldwide have had or currently suffer from 

5 opioid use disorder (OUD). 

6 (3) In 2021, the number of overdose deaths in7 volving opioids was 10 times the number in 1999, 

8 and overdoses involving opioids killed more than 

9 80,000 people in 2021 alone. 

10 (4) Most Medicare beneficiaries are prescribed 

11 opioids to manage post-surgical pain. 

12 (5) Data from 2017 indicates that, of those 

13 prescribed an abundance of opioids, 90% did not 

14 properly dispose of the extra. 

15 (6) A combination of opioid overreliance, im16 proper storage, and easy access to opioids can wors17 en the addiction crisis. 

18 (7) 1 study from 2019 found that among young 

19 people misusing opioids, over 55% obtained them 

20 from friends or relatives. 

21 (8) Some individuals require opioids to manage 

22 their condition including for chronic pain and pallia23 tive care. 


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1 (9) Nothing should interfere with the ability of 

2 a health care provider to prescribe or administer a 

3 course of treatment that is medically appropriate. 

4 SEC. 2. APPROPRIATE COST-SHARING FOR QUALIFYING 

5 NON-OPIOID PAIN MANAGEMENT DRUGS 

6 UNDER MEDICARE PART D. 

7 (a) MEDICARE PART D.—Section 1860D–2 of the 

8 Social Security Act (42 U.S.C. 1395w–102) is amended— 

9 (1) in subsection (b)— 

10 (A) in paragraph (1)(A), by striking 

11 ‘‘paragraphs (8) and (9)’’ and inserting ‘‘para12 graphs (8), (9), and (10)’’; 

13 (B) in paragraph (2)— 

14 (i) in subparagraph (A), by striking 

15 ‘‘paragraphs (8) and (9)’’ and inserting 

16 ‘‘paragraphs (8), (9), and (10)’’; 

17 (ii) in subparagraph (C)(i), in the 

18 matter preceding subclause (I), by striking 

19 ‘‘and (9)’’ and inserting ‘‘, (9), and (10)’’; 

20 and 

21 (iii) in subparagraph (D)(i), in the 

22 matter preceding subclause (I), by striking 

23 ‘‘and (9)’’ and inserting ‘‘, (9), and (10)’’; 


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1 (C) in paragraph (3)(A), in the matter 

2 preceding clause (i), by striking ‘‘and (9)’’ and 

3 inserting ‘‘(9), and (10)’’; 

4 (D) in paragraph (4)(A)(i), by striking 

5 ‘‘paragraphs (8) and (9),’’ and inserting ‘‘para6 graphs (8), (9), and (10),’’; and 

7 (E) by adding at the end the following new 

8 paragraph: 

9 ‘‘(10) TREATMENT OF COST-SHARING FOR

10 QUALIFYING NON-OPIOID PAIN MANAGEMENT

11 DRUGS.— 

12 ‘‘(A) IN GENERAL.—For plan years begin13 ning on or after January 1, 2025, with respect 

14 to a covered part D drug that is a qualifying 

15 non-opioid pain management drug (as defined 

16 in subparagraph (B))— 

17 ‘‘(i) the deductible under paragraph 

18 (1) shall not apply; and 

19 ‘‘(ii) such drug shall be placed on the 

20 lowest cost-sharing tier, if any, for pur21 poses of determining the maximum co-in22 surance or other cost-sharing for such 

23 drug. 

24 ‘‘(B) QUALIFYING NON-OPIOID PAIN MAN25 AGEMENT DRUGS.—In this paragraph, the term 


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1 ‘qualifying non-opioid pain management drug’ 

2 means a drug or biological product— 

3 ‘‘(i) that has a label indication ap4 proved by the Food and Drug Administra5 tion to reduce postoperative pain or any 

6 other form of acute pain; 

7 ‘‘(ii) that does not act upon the body’s 

8 opioid receptors; 

9 ‘‘(iii) that is not a schedule I, II, or 

10 III controlled substance; 

11 ‘‘(iv) for which there is no other drug 

12 or product that is— 

13 ‘‘(I) rated as therapeutically 

14 equivalent (under the Food and Drug 

15 Administration’s most recent publica16 tion of ‘Approved Drug Products with 

17 Therapeutic Equivalence Evalua18 tions’); and 

19 ‘‘(II) which is sold or marketed 

20 in the United States; and 

21 ‘‘(v) for which the wholesale acquisi22 tion cost (as defined in section 

23 1847A(c)(6)(B)), for a monthly supply 

24 does not exceed the monthly specialty-tier 


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1 cost threshold as determined by the Sec2 retary from time to time.’’; and 

3 (2) in subsection (c), by adding at the end the 

4 following new paragraph: 

5 ‘‘(7) TREATMENT OF COST-SHARING FOR

6 QUALIFYING NON-OPIOID PAIN MANAGEMENT

7 DRUGS.—The coverage is provided in accordance 

8 with subsection (b)(10).’’. 

9 (b) CONFORMING AMENDMENTS TO COST-SHARING

10 FOR LOW-INCOME INDIVIDUALS.—Section 1860D–14(a) 

11 of the Social Security Act (42 U.S.C. 1395w–114(a)) is 

12 amended— 

13 (1) in paragraph (1)(D), in each of the clauses 

14 (ii) and (iii), by striking ‘‘Subject to paragraph (6)’’ 

15 and inserting ‘‘Subject to paragraphs (6) and (7)’’; 

16 (2) in paragraph (2)— 

17 (A) in subparagraph (B), by striking 

18 ‘‘Subject to paragraphs (8) and (9)’’ and insert19 ing ‘‘Subject to paragraphs (8), (9), and (10)’’; 

20 (B) in subparagraph (D), by striking 

21 ‘‘Subject to paragraph (6)’’ and inserting ‘‘Sub22 ject to paragraphs (6) and (7)’’; and 

23 (C) in subparagraph (E), by striking ‘‘Sub24 ject to paragraph (6)’’ and inserting ‘‘Subject 

25 to paragraphs (6) and (7)’’; and 


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1 (3) by adding at the end the following new 

2 paragraph: 

3 ‘‘(7) NO APPLICATION OF COST-SHARING OR

4 DEDUCTIBLE FOR QUALIFYING NON-OPIOID PAIN

5 MANAGEMENT DRUGS.—For plan years beginning on 

6 or after January 1, 2025, with respect to a covered 

7 part D drug that is a qualifying non-opioid pain 

8 management drug (as defined in section 1860D– 

9 2(b)(10)(B))— 

10 ‘‘(A) the deductible under section 1860D11 2(b)(1) shall not apply; and 

12 ‘‘(B) such drug shall be placed on the low13 est cost-sharing tier, if any, for purposes of de14 termining the maximum co-insurance or other 

15 cost-sharing for such drug.’’. 

16 SEC. 3. PROHIBITION ON THE USE OF STEP THERAPY AND 

17 PRIOR AUTHORIZATION FOR QUALIFYING 

18 NON-OPIOID PAIN MANAGEMENT DRUGS 

19 UNDER MEDICARE PART D. 

20 Section 1860D–4 of the Social Security Act (42 

21 U.S.C. 1395w–104) is amended in subsection (c) by add22 ing at the end the following paragraph: 

23 ‘‘(7) PROHIBITION ON USE OF STEP THERAPY

24 AND PRIOR AUTHORIZATION FOR QUALIFYING NON25 OPIOID PAIN MANAGEMENT DRUGS.— 


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1 ‘‘(A) IN GENERAL.—A prescription drug 

2 plan may not, with respect to a qualifying non3 opioid pain management drug for which cov4 erage is provided under such plan, impose 

5 any— 

6 ‘‘(i) step therapy requirement under 

7 which an individual enrolled under such 

8 plan is required to use an opioid prior to 

9 receiving such drug; or 

10 ‘‘(ii) prior authorization requirement. 

11 ‘‘(B) STEP THERAPY.—In this paragraph, 

12 the term ‘step therapy’ means a drug therapy 

13 utilization management protocol or program 

14 that requires use of an alternative, preferred 

15 prescription drug or drugs before the plan ap16 proves coverage for the non-preferred drug 

17 therapy prescribed. 

18 ‘‘(C) PRIOR AUTHORIZATION.—In this 

19 paragraph, the term ‘prior authorization’ means 

20 any requirement to obtain approval from a pre21 scription drug plan prior to the furnishing of a 

22 drug. 

23 ‘‘(D) QUALIFYING NON-OPIOID PAIN MAN24 AGEMENT DRUGS.—In this paragraph, the term 

25 ‘qualifying non-opioid pain management drug’ 


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1 has the meaning given that term in section 

2 1860D–2(b)(10)(B).’’. 

3 SEC. 4. RULE OF CONSTRUCTION. 

4 Nothing in the amendments made by this Act may 

5 be construed to limit or interfere with the authority of a 

6 health care provider to prescribe or administer any legally 

7 marketed drug to a patient for any condition or disease 

8 within a legitimate health care practitioner-patient rela9 tionship. 

Æ 


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