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 Medi-
care program. 
IN THE HOUSE OF REPRESENTATIVES 
JANUARY 30, 2024 
Mrs. MILLER-MEEKS (for herself and Mr. CA´RDENAS) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; FINDINGS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Alternatives to Prevent Addiction In the Nation Act’’ or 
the ‘‘Alternatives to PAIN Act’’. 
(b) FINDINGS.—Congress finds the following: 
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(1) In 2019, approximately 10 million people 
misused prescription opioids. 
(2) 3 million U.S. citizens and 16 million indi-
viduals worldwide have had or currently suffer from 
opioid use disorder (OUD). 
(3) In 2021, the number of overdose deaths in-
volving opioids was 10 times the number in 1999, 
and overdoses involving opioids killed more than 
80,000 people in 2021 alone. 
(4) Most Medicare beneficiaries are prescribed 
opioids to manage post-surgical pain. 
(5) Data from 2017 indicates that, of those 
prescribed an abundance of opioids, 90% did not 
properly dispose of the extra. 
(6) A combination of opioid overreliance, im-
proper storage, and easy access to opioids can wors-
en the addiction crisis. 
(7) 1 study from 2019 found that among young 
people misusing opioids, over 55% obtained them 
from friends or relatives. 
(8) Some individuals require opioids to manage 
their condition including for chronic pain and pallia-
tive care. 
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(9) Nothing should interfere with the ability of 
a health care provider to prescribe or administer a 
course of treatment that is medically appropriate. 
SEC. 2. APPROPRIATE COST-SHARING FOR QUALIFYING 
NON-OPIOID 
PAIN 
MANAGEMENT 
DRUGS 
UNDER MEDICARE PART D. 
(a) MEDICARE PART D.—Section 1860D–2 of the 
Social Security Act (42 U.S.C. 1395w–102) is amended— 
(1) in subsection (b)— 
(A) in paragraph (1)(A), by striking 
‘‘paragraphs (8) and (9)’’ and inserting ‘‘para-
graphs (8), (9), and (10)’’; 
(B) in paragraph (2)— 
(i) in subparagraph (A), by striking 
‘‘paragraphs (8) and (9)’’ and inserting 
‘‘paragraphs (8), (9), and (10)’’; 
(ii) in subparagraph (C)(i), in the 
matter preceding subclause (I), by striking 
‘‘and (9)’’ and inserting ‘‘, (9), and (10)’’; 
and 
(iii) in subparagraph (D)(i), in the 
matter preceding subclause (I), by striking 
‘‘and (9)’’ and inserting ‘‘, (9), and (10)’’; 
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(C) in paragraph (3)(A), in the matter 
preceding clause (i), by striking ‘‘and (9)’’ and 
inserting ‘‘(9), and (10)’’; 
(D) in paragraph (4)(A)(i), by striking 
‘‘paragraphs (8) and (9),’’ and inserting ‘‘para-
graphs (8), (9), and (10),’’; and 
(E) by adding at the end the following new 
paragraph: 
‘‘(10) TREATMENT
OF
COST-SHARING
FOR 
QUALIFYING
NON-OPIOID
PAIN
MANAGEMENT 
DRUGS.— 
‘‘(A) IN GENERAL.—For plan years begin-
ning on or after January 1, 2025, with respect 
to a covered part D drug that is a qualifying 
non-opioid pain management drug (as defined 
in subparagraph (B))— 
‘‘(i) the deductible under paragraph 
(1) shall not apply; and 
‘‘(ii) such drug shall be placed on the 
lowest cost-sharing tier, if any, for pur-
poses of determining the maximum co-in-
surance or other cost-sharing for such 
drug. 
‘‘(B) QUALIFYING NON-OPIOID PAIN MAN-
AGEMENT DRUGS.—In this paragraph, the term 
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(3) by adding at the end the following new 
paragraph: 
‘‘(7) NO
APPLICATION
OF
COST-SHARING
OR 
DEDUCTIBLE
FOR
QUALIFYING
NON-OPIOID
PAIN 
MANAGEMENT DRUGS.—For plan years beginning on 
or after January 1, 2025, with respect to a covered 
part D drug that is a qualifying non-opioid pain 
management drug (as defined in section 1860D– 
2(b)(10)(B))— 
‘‘(A) the deductible under section 1860D- 
2(b)(1) shall not apply; and 
‘‘(B) such drug shall be placed on the low-
est cost-sharing tier, if any, for purposes of de-
termining the maximum co-insurance or other 
cost-sharing for such drug.’’. 
SEC. 3. PROHIBITION ON THE USE OF STEP THERAPY AND 
PRIOR 
AUTHORIZATION 
FOR 
QUALIFYING 
NON-OPIOID 
PAIN 
MANAGEMENT 
DRUGS 
UNDER MEDICARE PART D. 
Section 1860D–4 of the Social Security Act (42 
U.S.C. 1395w–104) is amended in subsection (c) by add-
ing at the end the following paragraph: 
‘‘(7) PROHIBITION ON USE OF STEP THERAPY 
AND PRIOR AUTHORIZATION FOR QUALIFYING NON- 
OPIOID PAIN MANAGEMENT DRUGS.— 
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‘‘(A) IN
GENERAL.—A prescription drug 
plan may not, with respect to a qualifying non- 
opioid pain management drug for which cov-
erage is provided under such plan, impose 
any— 
‘‘(i) step therapy requirement under 
which an individual enrolled under such 
plan is required to use an opioid prior to 
receiving such drug; or 
‘‘(ii) prior authorization requirement. 
‘‘(B) STEP THERAPY.—In this paragraph, 
the term ‘step therapy’ means a drug therapy 
utilization management protocol or program 
that requires use of an alternative, preferred 
prescription drug or drugs before the plan ap-
proves coverage for the non-preferred drug 
therapy prescribed. 
‘‘(C) PRIOR
AUTHORIZATION.—In this 
paragraph, the term ‘prior authorization’ means 
any requirement to obtain approval from a pre-
scription drug plan prior to the furnishing of a 
drug. 
‘‘(D) QUALIFYING NON-OPIOID PAIN MAN-
AGEMENT DRUGS.—In this paragraph, the term 
‘qualifying non-opioid pain management drug’ 
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has the meaning given that term in section 
1860D–2(b)(10)(B).’’. 
SEC. 4. RULE OF CONSTRUCTION. 
Nothing in the amendments made by this Act may 
be construed to limit or interfere with the authority of a 
health care provider to prescribe or administer any legally 
marketed drug to a patient for any condition or disease 
within a legitimate health care practitioner-patient rela-
tionship. 
Æ 
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