H.R.1227 - Alternatives to Prevent Addiction In the Nation Act; Alternatives to PAIN Act (119th Congress)
Summary
H.R.1227, also known as the Alternatives to PAIN Act, aims to amend Title XVIII of the Social Security Act to improve access to non-opioid pain management drugs under Medicare Part D. The bill focuses on reducing cost-sharing for qualifying non-opioid pain management drugs and prohibits the use of step therapy and prior authorization for these drugs. This is intended to provide Medicare beneficiaries with more accessible and less restrictive alternatives to opioids for pain management.
Expected Effects
If enacted, H.R.1227 would likely lead to increased utilization of non-opioid pain management drugs among Medicare Part D beneficiaries starting in 2026. This could reduce opioid dependence and related health issues within this population. The changes would affect cost-sharing, deductibles, and utilization management protocols related to pain management medications covered under Medicare Part D.
Potential Benefits
- Reduced financial burden for Medicare beneficiaries needing non-opioid pain management.
- Increased access to alternative pain relief options, potentially decreasing opioid use and addiction.
- Streamlined access to non-opioid drugs by removing step therapy and prior authorization requirements.
- Improved health outcomes by promoting safer pain management practices.
- Potential for reduced healthcare costs associated with opioid-related complications.
Potential Disadvantages
- Potential increase in overall Medicare Part D costs due to increased utilization of non-opioid drugs.
- Possible administrative challenges in defining and identifying 'qualifying non-opioid pain management drugs'.
- Risk that pharmaceutical companies may increase prices of non-opioid drugs, offsetting cost-saving measures.
- Limited impact on pain management for conditions not covered by the specific criteria in the bill.
- Potential for unintended consequences if non-opioid alternatives are not as effective for some patients, leading to inadequate pain relief.
Constitutional Alignment
The bill appears to align with the general welfare clause of the US Constitution, as it aims to improve healthcare access and outcomes for Medicare beneficiaries. Specifically, it falls under Congress's power to legislate on matters related to healthcare and Social Security, as outlined in Article I, Section 8. The bill does not appear to infringe on any specific constitutional rights or freedoms.
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).