,,ii #aaith ,,congress #ast ,session ,s4 #dge ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,february #f 7legislative day1 ,february #e71 #bjbe,mr4 ,tillis 7for himself1 ,mr4 ,kelly1 ,mrs4 ,capito1 ,mr4 ,kaine1 ,mrs4 ,britt1 ,mrs4 ,shaheen1 ,mr4 ,budd1 ,mr4 ,coons1 ,mr4 ,cornyn1 ,mr4 ,booker1 ,mr4 ,moran1 ,mr4 ,bennet1 ,mr4 ,banks1 ,mr4 ,padilla1 ,mr4 ,daines1 ,mr4 ,warner1 and ,mrs4 ,hyde-,smith7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,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 title ,this ,act may be cited as the ,alternatives to ,prevent ,addiction ,in the ,nation ,act or the ,alternatives to ,,pain ,act4 #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 in the matter preceding clause 7i71 by striking paragraphs 7#h7 and 7#i7 and inserting paragraphs 7#h71 7#i71 and 7#aj72 7,b7 in paragraph 7#b77;,a71 in the matter preceding clause 7i71 by striking paragraphs 7#h7 and 7#i7 and inserting paragraphs 7#h71 7#i71 and 7#aj72 and 7,c7 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 #bjbf1 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 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 sold or marketed in the ,united ,states2 and 7iv7 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 and 7#b7 by adding at the end the following new paragraph3 7#g7 ,treatment of cost-sharing or deductible for qualifying non-opioid pain management drugs ,for plan years beginning on or after ,january #a1 #bjbf1 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-#d7;c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7 is amended-- 7#a7 by redesignating paragraph 7#f71 as added by section #ejced of division ,e of the ,bipartisan ,budget ,act of #bjah 7,public ,law #aae-abc71 as paragraph 7#g72 and 7#b7 by adding at the end the following paragraph3 7#h7 ,prohibition on use of step therapy and prior authorization for qualifying non-opioid pain management drugs 7,a7 ,in general ,for plan years beginning on or after ,january #a1 #bjbf1 a prescription drug plan or an ,,ma-,,pd plan may not1 with respect to a qualifying non-opioid pain management drug 7as defined in section #ahfj;,d-#b7;b77#aj77;,b77 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 plan prior to the furnishing of a drug4 4