,i #aahth ,,congress #b;d ,session ,h4 ,r4 #gadb ,,in ,,the ,,house ,,of ,,representatives ,january #cj1 #bjbd ,mrs4 ,miller-,meeks 7for herself and ,mr4 ,crdenas7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,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 program4 #a4 ,short title2 findings 7a7 ,short title ,this ,act may be cited as the ,alternatives to ,prevent ,addiction ,in the ,nation ,act or the ,alternatives to ,,pain ,act4 7b7 ,findings ,congress finds the following3 7#a7 ,in #bjai1 approximately #aj million people misused prescription opioids4 7#b7 #c million ,u4,s4 citizens and #af million individuals worldwide have had or currently suffer from opioid use disorder 7,,oud74 7#c7 ,in #bjba1 the number of overdose deaths involving opioids was #aj times the number in #aiii1 and overdoses involving opioids killed more than #hj1jjj people in #bjba alone4 7#d7 ,most ,medicare beneficiaries are prescribed opioids to manage post-surgical pain4 7#e7 ,data from #bjag indicates that1 of those prescribed an abundance of opioids1 #ij did not properly dispose of the extra4 7#f7 ,a combination of opioid overreliance1 improper storage1 and easy access to opioids can worsen the addiction crisis4 7#g7 #a study from #bjai found that among young people misusing opioids1 over #ee obtained them from friends or relatives4 7#h7 ,some individuals require opioids to manage their condition including for chronic pain and palliative care4 7#i7 ,nothing should interfere with the ability of a health care provider to prescribe or administer a course of treatment that is medically appropriate4 #b4 ,appropriate cost-sharing for qualifying non-opioid pain management drugs under medicare part ,d 7a7 ,medicare part d ,section #ahfj;,d-#b of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajb7 is amended-- 7#a7 in subsection 7b7-- 7,a7 in paragraph 7#a77;,a71 by striking paragraphs 7#h7 and 7#i7 and inserting paragraphs 7#h71 7#i71 and 7#aj72 7,b7 in paragraph 7#b7-- 7i7 in subparagraph 7,a71 by striking paragraphs 7#h7 and 7#i7 and inserting paragraphs 7#h71 7#i71 and 7#aj72 7ii7 in subparagraph 7,c77i71 in the matter preceding subclause 7,i71 by striking and 7#i7 and inserting 1 7#i71 and 7#aj72 and 7iii7 in subparagraph 7,d77i71 in the matter preceding subclause 7,i71 by striking and 7#i7 and inserting 1 7#i71 and 7#aj72 7,c7 in paragraph 7#c77;,a71 in the matter preceding clause 7i71 by striking and 7#i7 and inserting 7#i71 and 7#aj72 7,d7 in paragraph 7#d77;,a77i71 by striking paragraphs 7#h7 and 7#i71 and inserting paragraphs 7#h71 7#i71 and 7#aj712 and 7,e7 by adding at the end the following new paragraph3 7#aj7 ,treatment of cost-sharing for qualifying non-opioid pain management drugs 7,a7 ,in general ,for plan years beginning on or after ,january #a1 #bjbe1 with respect to a covered part ,d drug that is a qualifying non-opioid pain management drug 7as defined in subparagraph 7,b77-- 7i7 the deductible under paragraph 7#a7 shall not apply2 and 7ii7 such drug shall be placed on the lowest cost-sharing tier1 if any1 for purposes of determining the maximum co-insurance or other cost-sharing for such drug4 7,b7 ,qualifying non-opioid pain management drugs ,in this paragraph1 the term qualifying non-opioid pain management drug means a drug or biological product-- 7i7 that has a label indication approved by the ,food and ,drug ,administration to reduce postoperative pain or any other form of acute pain2 7ii7 that does not act upon the body's opioid receptors2 7iii7 that is not a schedule ,i1 ,,ii1 or ,,iii controlled substance2 7iv7 for which there is no other drug or product that is-- 7,i7 rated as therapeutically equivalent 7under the ,food and ,drug ,administration's most recent publication of ,approved ,drug ,products with ,therapeutic ,equivalence ,evaluations72 and 7,,ii7 which is sold or marketed in the ,united ,states2 and 7v7 for which the wholesale acquisition cost 7as defined in section #ahdg;,a7c77#f77;,b771 for a monthly supply does not exceed the monthly specialty-tier cost threshold as determined by the ,secretary from time to time4 2 and 7#b7 in subsection 7c71 by adding at the end the following new paragraph3 7#g7 ,treatment of cost-sharing for qualifying non-opioid pain management drugs ,the coverage is provided in accordance with subsection 7b77#aj74 4 7b7 ,conforming amendments to cost-sharing for low-income individuals ,section #ahfj;,d-#ad7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7;a77 is amended-- 7#a7 in paragraph 7#a77;,d71 in each of the clauses 7ii7 and 7iii71 by striking ,subject to paragraph 7#f7 and inserting ,subject to paragraphs 7#f7 and 7#g72 7#b7 in paragraph 7#b7-- 7,a7 in subparagraph 7,b71 by striking ,subject to paragraphs 7#h7 and 7#i7 and inserting ,subject to paragraphs 7#h71 7#i71 and 7#aj72 7,b7 in subparagraph 7,d71 by striking ,subject to paragraph 7#f7 and inserting ,subject to paragraphs 7#f7 and 7#g72 and 7,c7 in subparagraph 7,e71 by striking ,subject to paragraph 7#f7 and inserting ,subject to paragraphs 7#f7 and 7#g72 and 7#c7 by adding at the end the following new paragraph3 7#g7 ,no application of cost-sharing or deductible for qualifying non-opioid pain management drugs ,for plan years beginning on or after ,january #a1 #bjbe1 with respect to a covered part ,d drug that is a qualifying non-opioid pain management drug 7as defined in section #ahfj;,d-#b7;b77#aj77;,b77-- 7,a7 the deductible under section #ahfj;,d-#b7;b77#a7 shall not apply2 and 7,b7 such drug shall be placed on the lowest cost-sharing tier1 if any1 for purposes of determining the maximum co-insurance or other cost-sharing for such drug4 4 #c4 ,prohibition on the use of step therapy and prior authorization for qualifying non-opioid pain management drugs under medicare part d ,section #ahfj;,d-#d of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7 is amended in subsection 7c7 by adding at the end the following paragraph3 7#g7 ,prohibition on use of step therapy and prior authorization for qualifying non-opioid pain management drugs 7,a7 ,in general ,a prescription drug plan may not1 with respect to a qualifying non-opioid pain management drug for which coverage is provided under such plan1 impose any-- 7i7 step therapy requirement under which an individual enrolled under such plan is required to use an opioid prior to receiving such drug2 or 7ii7 prior authorization requirement4 7,b7 ,step therapy ,in this paragraph1 the term step therapy means a drug therapy utilization management protocol or program that requires use of an alternative1 preferred prescription drug or drugs before the plan approves coverage for the non-preferred drug therapy prescribed4 7,c7 ,prior authorization ,in this paragraph1 the term prior authorization means any requirement to obtain approval from a prescription drug plan prior to the furnishing of a drug4 7,d7 ,qualifying non-opioid pain management drugs ,in this paragraph1 the term qualifying non-opioid pain management drug has the meaning given that term in section #ahfj;,d-#b7;b77#aj77;,b74 4 #d4 ,rule of construction ,nothing in the amendments made by this ,act may be construed to limit or interfere with the authority of a health care provider to prescribe or administer any legally marketed drug to a patient for any condition or disease within a legitimate health care practitioner-patient relationship4