S.475 - Alternatives to Prevent Addiction In the Nation Act; Alternatives to PAIN Act (119th Congress)
Summary
S.475, 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 seeks to ensure appropriate cost-sharing for these drugs and prohibits the use of step therapy and prior authorization requirements. This legislation is intended to reduce opioid addiction by promoting alternative pain management options.
Expected Effects
The bill, if enacted, will likely lead to increased utilization of non-opioid pain management drugs among Medicare Part D beneficiaries. This would be achieved through lower cost-sharing and the removal of administrative hurdles like step therapy and prior authorization. The changes are slated to take effect for plan years beginning on or after January 1, 2026.
Potential Benefits
- Reduced financial burden on patients needing non-opioid pain management.
- Decreased reliance on opioids, potentially lowering addiction rates.
- Streamlined access to alternative pain relief options through the elimination of step therapy and prior authorization.
- Improved patient choice and provider flexibility in pain management.
- Better alignment of Medicare Part D coverage with current pain management best practices.
Potential Disadvantages
- Potential increase in Medicare Part D costs due to higher utilization of non-opioid drugs.
- Possible unintended consequences if non-opioid drugs are not appropriately managed or prescribed.
- The definition of 'qualifying non-opioid pain management drugs' may limit the scope of the bill's impact.
- Pharmaceutical companies may increase the price of qualifying non-opioid drugs, offsetting the cost-sharing benefits.
- Potential administrative burden for Medicare Part D plans to implement these changes.
Constitutional Alignment
The bill appears to align with the general welfare clause of the US Constitution, as it aims to improve public health by addressing opioid addiction and promoting access to alternative pain management options. Specifically, the preamble states the Constitution is intended to "promote the general Welfare". The bill does not appear to infringe upon any specific individual rights or freedoms enumerated in the Bill of Rights. Congress has the power to legislate on matters related to Medicare under its constitutional authority.
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).