S. 3064: Relief of Chronic Pain Act of 2025

This bill, titled the Relief of Chronic Pain Act of 2025, aims to improve access to non-opioid pain management drugs for individuals with chronic pain under Medicare Part D. Here’s a simplified overview of its key provisions:

1. Amendments to Medicare Part D

The bill proposes amendments to Section 1860D–2 of the Social Security Act, which governs Medicare Part D coverage of prescription drugs. The main changes would include:

• Cost-Sharing for Non-Opioid Drugs: Beginning January 1, 2026, qualifying non-opioid chronic pain management drugs will not be subject to the usual deductible, meaning patients will not have to pay this amount before their medication coverage kicks in. Additionally, these qualifying drugs will be placed in the lowest cost-sharing tier, reducing out-of-pocket costs for patients.

2. Definition of Qualifying Drugs

The bill defines qualifying non-opioid chronic pain management drugs as medications that:

• Have been approved by the Food and Drug Administration (FDA) specifically for the treatment of chronic pain or a chronic pain condition.
• Do not act on the body's opioid receptors.
• Are not therapeutically equivalent to any other product currently sold or marketed in the U.S.
• Have a wholesale acquisition cost for a monthly supply that does not exceed the established specialty tier cost threshold.

3. Definition of Chronic Pain Conditions

The chronic pain conditions eligible for treatment with these non-opioid drugs include:

• Diabetic peripheral neuropathic pain
• Endometriosis
• Fibromyalgia
• Musculoskeletal pain
• Neuropathic pain
• Post-herpetic neuralgia
• Trigeminal neuralgia

4. Changes to Cost-Sharing for Low-Income Individuals

The bill also includes provisions for low-income beneficiaries under Medicare, ensuring that these individuals also benefit from the new cost-sharing rules for qualifying non-opioid chronic pain management drugs, similar to other Medicare recipients.

5. Prohibition on Step Therapy and Prior Authorization

Starting January 1, 2026, the bill prohibits Medicare prescription drug plans from requiring step therapy or prior authorization for the qualifying non-opioid chronic pain management drugs. This means that patients will not be required to try opioids first before receiving their non-opioid prescriptions, simplifying access to these medications.

Summary of Impact

The overall intent of the Relief of Chronic Pain Act of 2025 is to expand access to non-opioid treatments for chronic pain patients, reduce the financial barriers associated with these medications, and simplify the process for obtaining necessary prescriptions.

Relevant Companies

• PFE - Pfizer Inc.: Pfizer produces various non-opioid pain management medications that may see an increase in prescription volumes.
• AMGN - Amgen Inc.: Amgen manufactures medications for chronic pain management that align with the provisions of this bill.
• REGN - Regeneron Pharmaceuticals: Regeneron produces drugs that could be classified as qualifying non-opioid pain management options.