II 

118TH CONGRESS 

2D SESSION S. 3832 

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 SENATE OF THE UNITED STATES 

FEBRUARY 29, 2024 

Mr. TILLIS (for himself and Mr. KELLY) introduced the following bill; which 

was read twice and referred to the Committee on Finance 

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. 

4 This Act may be cited as the ‘‘Alternatives to Prevent 

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

6 PAIN Act’’. 


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1 SEC. 2. APPROPRIATE COST-SHARING FOR QUALIFYING 

2 NON-OPIOID PAIN MANAGEMENT DRUGS 

3 UNDER MEDICARE PART D. 

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

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

6 (1) in subsection (b)— 

7 (A) in paragraph (1)(A), in the matter 

8 preceding clause (i), by striking ‘‘paragraphs 

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

10 (9), and (10)’’; 

11 (B) in paragraph (2)(A), in the matter 

12 preceding clause (i), by striking ‘‘paragraphs 

13 (8) and (9)’’ and inserting ‘‘paragraphs (8), 

14 (9), and (10)’’; and 

15 (C) by adding at the end the following new 

16 paragraph: 

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

18 QUALIFYING NON-OPIOID PAIN MANAGEMENT

19 DRUGS.— 

20 ‘‘(A) IN GENERAL.—For plan years begin21 ning on or after January 1, 2025, with respect 

22 to a covered part D drug that is a qualifying 

23 non-opioid pain management drug (as defined 

24 in subparagraph (B))— 

25 ‘‘(i) the deductible under paragraph 

26 (1) shall not apply; and 


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

2 lowest cost-sharing tier, if any, for pur3 poses of determining the maximum co-in4 surance or other cost-sharing for such 

5 drug. 

6 ‘‘(B) QUALIFYING NON-OPIOID PAIN MAN7 AGEMENT DRUGS.—In this paragraph, the term 

8 ‘qualifying non-opioid pain management drug’ 

9 means a drug or biological product— 

10 ‘‘(i) that has a label indication ap11 proved by the Food and Drug Administra12 tion to reduce postoperative pain or any 

13 other form of acute pain; 

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

15 opioid receptors; 

16 ‘‘(iii) for which there is no other drug 

17 or product that is— 

18 ‘‘(I) rated as therapeutically 

19 equivalent (under the Food and Drug 

20 Administration’s most recent publica21 tion of ‘Approved Drug Products with 

22 Therapeutic Equivalence Evalua23 tions’); and 

24 ‘‘(II) sold or marketed in the 

25 United States; and 


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1 ‘‘(iv) for which the wholesale acquisi2 tion cost (as defined in section 

3 1847A(c)(6)(B)), for a monthly supply 

4 does not exceed the monthly specialty-tier 

5 cost threshold as determined by the Sec6 retary from time to time.’’; and 

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

8 following new paragraph: 

9 ‘‘(7) TREATMENT OF COST-SHARING FOR

10 QUALIFYING NON-OPIOID PAIN MANAGEMENT

11 DRUGS.—The coverage is provided in accordance 

12 with subsection (b)(10).’’. 

13 (b) CONFORMING AMENDMENTS TO COST-SHARING

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

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

16 amended— 

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

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

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

20 and 

21 (2) by adding at the end the following new 

22 paragraph: 

23 ‘‘(7) TREATMENT OF COST-SHARING OR DE24 DUCTIBLE FOR QUALIFYING NON-OPIOID PAIN MAN25 AGEMENT DRUGS.—For plan years beginning on or 


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

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

3 management drug (as defined in section 1860D– 

4 2(b)(10)(B))— 

5 ‘‘(A) the deductible under section 1860D– 

6 2(b)(1) shall not apply; and 

7 ‘‘(B) such drug shall be placed on the low8 est cost-sharing tier, if any, for purposes of de9 termining the maximum co-insurance or other 

10 cost-sharing for such drug.’’. 

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

12 PRIOR AUTHORIZATION FOR QUALIFYING 

13 NON-OPIOID PAIN MANAGEMENT DRUGS 

14 UNDER MEDICARE PART D. 

15 Section 1860D–4(c) of the Social Security Act (42 

16 U.S.C. 1395w–104) is amended— 

17 (1) by redesignating paragraph (6), as added by 

18 section 50354 of division E of the Bipartisan Budg19 et Act of 2018 (Public Law 115–123), as paragraph 

20 (7); and 

21 (2) by adding at the end the following para22 graph: 

23 ‘‘(8) 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.—For plan years begin2 ning on or after January 1, 2025, a prescrip3 tion drug plan or an MA–PD plan may not, 

4 with respect to a qualifying non-opioid pain 

5 management drug (as defined in section 

6 1860D–2(b)(10)(B)) for which coverage is pro7 vided under such plan, impose any— 

8 ‘‘(i) step therapy requirement under 

9 which an individual enrolled under such 

10 plan is required to use an opioid prior to 

11 receiving such drug; or 

12 ‘‘(ii) prior authorization requirement. 

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

14 the term ‘step therapy’ means a drug therapy 

15 utilization management protocol or program 

16 that requires use of an alternative, preferred 

17 prescription drug or drugs before the plan ap18 proves coverage for the non-preferred drug 

19 therapy prescribed. 

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

21 paragraph, the term ‘prior authorization’ means 

22 any requirement to obtain approval from a plan 

23 prior to the furnishing of a drug.’’. 

Æ 


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