I 
119TH CONGRESS 
1ST SESSION H. R. 1227 
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 
FEBRUARY 12, 2025 
Mrs. MILLER-MEEKS (for herself, Ms. BARRAGA´N, Mr. KELLY of Pennsyl-
vania, and Mr. PANETTA) introduced the following bill; which was re-
ferred to the Committee on Energy and Commerce, and in addition to 
the Committee on Ways and Means, for a period to be subsequently de-
termined 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Alternatives to Prevent 
Addiction In the Nation Act’’ or the ‘‘Alternatives to 
PAIN Act’’. 
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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), in the matter 
preceding clause (i), by striking ‘‘paragraphs 
(8) and (9)’’ and inserting ‘‘paragraphs (8), 
(9), and (10)’’; 
(B) in paragraph (2)(A), in the matter 
preceding clause (i), in subparagraph (A), by 
striking ‘‘paragraphs (8) and (9)’’ and inserting 
‘‘paragraphs (8), (9), and (10)’’; and 
(C) 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, 2026, 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 
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‘‘(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 
‘qualifying non-opioid pain management drug’ 
means a drug or biological product— 
‘‘(i) that has a label indication ap-
proved by the Food and Drug Administra-
tion to reduce postoperative pain or any 
other form of acute pain; 
‘‘(ii) that does not act upon the body’s 
opioid receptors; 
‘‘(iii) for which there is no other drug 
or product that is— 
‘‘(I) 
rated 
as 
therapeutically 
equivalent (under the Food and Drug 
Administration’s most recent publica-
tion of ‘Approved Drug Products with 
Therapeutic 
Equivalence 
Evalua-
tions’); and 
‘‘(II) sold or marketed in the 
United States; and 
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‘‘(iv) for which the wholesale acquisi-
tion 
cost 
(as 
defined 
in 
section 
1847A(c)(6)(B)), for a monthly supply 
does not exceed the monthly specialty-tier 
cost threshold as determined by the Sec-
retary from time to time.’’; and 
(2) in subsection (c), by adding at the end the 
following new paragraph: 
‘‘(7) 
TREATMENT
OF
COST-SHARING
FOR 
QUALIFYING
NON-OPIOID
PAIN
MANAGEMENT 
DRUGS.—The coverage is provided in accordance 
with subsection (b)(10).’’. 
(b) CONFORMING AMENDMENTS TO COST-SHARING 
FOR LOW-INCOME INDIVIDUALS.—Section 1860D–14(a) 
of the Social Security Act (42 U.S.C. 1395w–114(a)) is 
amended— 
(1) in paragraph (1)(D), in each of the clauses 
(ii) and (iii), by striking ‘‘Subject to paragraph (6)’’ 
and inserting ‘‘Subject to paragraphs (6) and (7)’’; 
and 
(2) by adding at the end the following new 
paragraph: 
‘‘(7) TREATMENT
OF
COST-SHARING
OR
DE-
DUCTIBLE FOR QUALIFYING NON-OPIOID PAIN MAN-
AGEMENT DRUGS.—For plan years beginning on or 
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after January 1, 2026, 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(c) of the Social Security Act (42 
U.S.C. 1395w–104(c)) is amended— 
(1) by redesignating paragraph (6), as added by 
section 50354 of division E of the Bipartisan Budg-
et Act of 2018 (Public Law 115–123), as paragraph 
(7); and 
(2) by adding at the end the following new 
paragraph: 
‘‘(8) PROHIBITION ON USE OF STEP THERAPY 
AND PRIOR AUTHORIZATION FOR QUALIFYING NON- 
OPIOID PAIN MANAGEMENT DRUGS.— 
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‘‘(A) IN GENERAL.—For plan years begin-
ning on or after January 1, 2026, a prescrip-
tion drug plan or an MA–PD plan may not, 
with respect to a qualifying non-opioid pain 
management drug (as defined in section 
1860D–2(b)(10)(B)) for which coverage is pro-
vided 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.’’. 
Æ 
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