What does Preamble of Relief of Chronic Pain Act of 2025 do?

This bill aims to amend title XVIII of the Social Security Act. The proposed amendment seeks to ensure appropriate access to non-opioid pain management drugs. The focus is on individuals with chronic pain conditions. The changes would apply under part D of the Medicare program.

What does SHORT TITLE. of Relief of Chronic Pain Act of 2025 do?

This bill is formally titled the Relief of Chronic Pain Act of 2025.

What does APPROPRIATE COST-SHARING FOR QUALIFYING NON-OPIOID CHRONIC PAIN of Relief of Chronic Pain Act of 2025 do?

This section amends Section 1860D-2 of the Social Security Act (Medicare Part D) to address cost-sharing for qualifying non-opioid chronic pain management drugs. Beginning January 1, 2026, these drugs will be exempt from the deductible and placed on the lowest cost-sharing tier under Medicare Part D. A 'qualifying non-opioid chronic pain management drug' is defined as a non-opioid drug with FDA approval for chronic pain, not acting upon opioid receptors, lacking therapeutically equivalent alternatives, and with a wholesale acquisition cost not exceeding a monthly specialty-tier cost threshold determined by the Secretary. The term 'chronic pain condition' includes conditions like diabetic peripheral neuropathic pain, endometriosis, fibromyalgia, musculoskeletal pain, neuropathic pain, post-herpetic neuralgia, and trigeminal neuralgia. Section 1860D-14(a) of the Social Security Act is also amended to include conforming changes related to cost-sharing for low-income individuals, referencing the new provisions for qualifying non-opioid pain management drugs.

What does PROHIBITION ON THE USE OF STEP THERAPY AND PRIOR AUTHORIZATION of Relief of Chronic Pain Act of 2025 do?

This section amends Section 1860D-4(c) of the Social Security Act. It adds a new paragraph (8) to prohibit prescription drug plans and MA-PD plans from imposing certain requirements for qualifying non-opioid chronic pain management drugs. Starting January 1, 2026, plans may not require individuals to use an opioid before receiving a qualifying non-opioid drug, nor may they require prior authorization. The term 'step therapy' is defined as a drug therapy utilization management protocol requiring use of an alternative drug before coverage for a non-preferred drug. The term 'prior authorization' is defined as any requirement to obtain approval from a plan before a drug is furnished.

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Relief of Chronic Pain Act of 2025

Last updated: 10/28/2025 · Introduced: 10/28/2025

Author: Steve Daines (R-MT)

TL;DR (AI)

The bill requires Medicare Part D to exempt qualifying non-opioid chronic pain management drugs from deductibles and place them on the lowest cost-sharing tier, starting January 1, 2026.
Beginning January 1, 2026, Medicare prescription drug plans and Medicare Advantage plans will be prohibited from requiring patients to try opioids before accessing non-opioid pain medications or requiring prior authorization.
The bill defines 'qualifying non-opioid chronic pain management drug' as a non-opioid drug approved for chronic pain, lacking therapeutically equivalent alternatives, and meeting specific cost criteria.

119th Congressin committeeOfficial page

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Includes provisions on preamble, short title., and 2 more.

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