Relief of Chronic Pain Act of 2025
Summary
The Relief of Chronic Pain Act of 2025 aims to improve access to non-opioid pain management drugs under Medicare Part D. It amends Title XVIII of the Social Security Act to ensure appropriate cost-sharing and prohibits step therapy and prior authorization for qualifying non-opioid chronic pain management drugs. The bill focuses on specific chronic pain conditions and sets criteria for drugs to qualify under the new provisions.
Expected Effects
This act will likely reduce the financial burden on Medicare beneficiaries who require non-opioid pain management for chronic conditions. It will also streamline access to these medications by removing barriers like deductibles, step therapy, and prior authorization. The changes are set to take effect for plan years beginning on or after January 1, 2026.
Potential Benefits
- Reduced out-of-pocket costs for non-opioid chronic pain management drugs under Medicare Part D.
- Streamlined access to necessary medications by eliminating deductibles and prior authorization requirements.
- Encourages the use of non-opioid alternatives for pain management, potentially reducing opioid dependence.
- Specifically addresses cost-sharing for low-income individuals, providing additional relief.
- May improve the quality of life for individuals suffering from chronic pain conditions.
Potential Disadvantages
- The definition of 'qualifying non-opioid chronic pain management drug' is restrictive, potentially excluding some beneficial treatments.
- The cost threshold based on wholesale acquisition cost may need adjustment over time to remain effective.
- Increased utilization of non-opioid drugs could lead to higher overall Medicare Part D costs.
- The act's focus on specific chronic pain conditions may leave out other valid pain management needs.
- Potential for pharmaceutical companies to exploit the provisions by increasing prices of qualifying drugs.
Constitutional Alignment
The Relief of Chronic Pain Act appears to align with the general welfare clause of the US Constitution, as it aims to improve healthcare access for individuals with chronic pain. Article I, Section 8, Clause 1 grants Congress the power to lay and collect taxes, duties, imposts and excises, to pay the debts and provide for the common defense and general welfare of the United States. By amending Medicare Part D to improve access to pain management, the act can be argued to be promoting the general welfare.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).