Both sides have signed this (Bill Ranking)
H.R. 1227 · 119th Congress (2025-2026)
111 members · Left 48 · Center 15 · Right 48 (Bill Ranking)
| Sponsor | Rep. Miller-Meeks, Mariannette (R-IA) (Introduced 02/12/2025) |
|---|---|
| Sponsor Voting Record | Lean right · DW-NOMINATE +0.34 · measured from every roll-call vote this member has cast (voteview.com) (Sponsor Ranking) |
| Support |
LLLCLRR support across the spectrum: 111 members signed on (Bill Ranking) this bill: sponsor + current cosponsors, each once |
| Committees | House - Ways and Means Committee; House - Energy and Commerce Committee |
| Latest Action | 02/12/2025 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. |
| Roll Call Votes | There have been no roll call votes |
| Source | view on congress.gov → |
Introduced in House (02/12/2025)
Alternatives to Prevent Addiction In the Nation Act or the Alternatives to PAIN Act
This 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.
115 HR 1227 IH: Alternatives to Prevent Addiction In the Nation Act U.S. House of Representatives 2025-02-12 text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain. I119th CONGRESS1st SessionH. R. 1227IN THE HOUSE OF REPRESENTATIVESFebruary 12, 2025Mrs. Miller-Meeks (for herself, Ms. Barragán, Mr. Kelly of Pennsylvania, and Mr. Panetta) 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 concernedA BILLTo 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.Short titleThis Act may be cited as the Alternatives to Prevent Addiction In the Nation Act or the Alternatives to PAIN Act.
2.Appropriate cost-sharing for qualifying non-opioid pain management drugs under medicare part D(a)Medicare part dSection 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 generalFor plan years beginning 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(ii)such drug shall be placed on the lowest cost-sharing tier, if any, for purposes of determining the maximum co-insurance or other cost-sharing for such drug.(B)Qualifying non-opioid pain management drugsIn this paragraph, the term qualifying non-opioid pain management drug means a drug or biological product—(i)that has a label indication approved by the Food and Drug Administration 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 publication of Approved Drug Products with Therapeutic Equivalence Evaluations); and(II)sold or marketed in the United States; and(iv)for which the wholesale acquisition 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 Secretary 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 drugsThe coverage is provided in accordance with subsection (b)(10)..(b)Conforming amendments to cost-Sharing for low-Income individualsSection 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 deductible for qualifying non-opioid pain management drugsFor plan years beginning 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 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 lowest cost-sharing tier, if any, for purposes of determining the maximum co-insurance or other cost-sharing for such drug..3.Prohibition on the use of step therapy and prior authorization for qualifying non-opioid pain management drugs under medicare part dSection 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 Budget 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(A)In generalFor plan years beginning on or after January 1, 2026, a prescription 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 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 therapyIn 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 approves coverage for the non-preferred drug therapy prescribed.(C)Prior authorizationIn this paragraph, the term prior authorization means any requirement to obtain approval from a prescription drug plan prior to the furnishing of a drug..
The bill's own words, from our database (synced from the GPO BILLS XML); paragraph breaks added at the bill's section boundaries, nothing else changed.
| Date | Chamber | All Actions |
|---|---|---|
| 02/12/2025 | Library of Congress | Introduced in House |
| 02/12/2025 | Library of Congress | Introduced in House |
| 02/12/2025 | House floor actions | 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. |
| 02/12/2025 | House floor actions | 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. |
| Title Type | Title |
|---|---|
| Display Title | Alternatives to PAIN Act |
| Short Title(s) as Introduced | Alternatives to PAIN Act |
| Short Title(s) as Introduced | Alternatives to Prevent Addiction In the Nation Act |
| Official Title as Introduced | 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. |
There are no amendments to this bill.
* = Original cosponsor
| Committee | Activity |
|---|---|
| House - Ways and Means Committee | 02/12/2025 Referred To |
| House - Energy and Commerce Committee | 02/12/2025 Referred To |
Policy Area: Health
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