Feb 29 2024

WASHINGTON, D.C. – Today, Senators Thom Tillis (R-NC) and Mark Kelly (D-AZ) introduced the Alternatives to Prevent Addiction in the Nation (Alternatives to PAIN) Act, bipartisan legislation that would provide greater access to non-opioid treatments for pain management for seniors.

“The opioid crisis continues to wreak havoc on families and communities across the country, including in North Carolina,”said Senator Tillis. “This bipartisan, pragmatic legislation will help prevent opioid addiction before it starts by leveling the playing field for non-opioid alternatives, ensuring seniors have uninterrupted access to non-opioid, non-addictive alternatives.” 

“Opioid addiction doesn’t discriminate by age and, sadly, Medicare beneficiaries are at particular risk,” said Senator Kelly.“Too often, Medicare Part D makes it unaffordable for seniors to get non-opioid pain relievers and forces them to settle for a prescription with a higher risk of addiction and overdose. Our bill would remove these barriers so that seniors are able to choose the treatment that is best for them.” 

“The federal government’s rinse-and-repeat approach to the opioid addiction crisis has not worked,” said Chris Fox, Executive Director of Voices for Non-Opioid Choices. “In addition to ensuring people have access to treatment, we should focus on opportunities to prevent opioid addiction where we can, including increasing access to non-addictive pain management approaches. The Alternatives to PAIN Act will ensure that all Americans can readily access non-opioid pain options.” 

The Alternatives to Prevent Addiction in the Nation (Alternatives to PAIN) Act is supported by the following organizations: Voices for Non-Opioid Choices, Ambulatory Surgery Center Association, American Association of Oral and Maxillofacial Surgeons, American Psychological Association Services, Asheville Equine Therapy, A Voice in the Wilderness Empowerment Center, CA Black Health Network, Center of Addiction & Faith, Chatham Drug Free, Clean Living Exceptional Alternative Recovery Residences (CLEARR), Hawaii Health and Harm Reduction Center, Healing On The Fly Inc, Hep Free Hawaii, Herren Project, Journey House Foundation, Medicare Rights Center,Mental Health America of Illinois, Michigan Women Veterans Empowerment, National Association of Social Workers, National Certification Commission for Acupuncture and Oriental Medicine, National Hispanic Medical Association, National Rural Health Association, National Safety Council, National Transitions of Care Coalition, Partnership to End Addiction, Pledge for Life Partnership, Prevention Action Alliance, PTSD Awareness Summit, Operation First Response, Inc, Overdose Lifeline, Real Life Program, RetireSafe, Salvage USA, Shatterproof, She Recovers Foundation, Society for Opioid-Free Anesthesia, Society of Behavioral Medicine, South End – Roxbury, Community Partnership, Team Sharing, Inc., The Battle Within, The Zellner Foundation for Military Vets, U.S. VETS, VetPark, Veterans National Recovery Center, Voices For Awareness, Warren Coalition, Warrior Path Home, West Warwick Prevention Coalition, Will Bright Foundation, and Young People in Recovery. 


The United States is facing a public health crisis caused by prescription drug addiction. Unfortunately, our country’s seniors are not immune to the worsening opioid epidemic. In 2021, 1.1 million seniors were diagnosed with an opioid use disorder, and 50,000 seniors experienced an opioid overdose-from prescription opioids, illicit opioids, or both. Tragically, the number of Americans aged 65 and older who died as the result of a natural or semisynthetic opioid overdose increased 63 percent between 2012 and 2020.

Now, more than ever, we must prevent unnecessary opioids from becoming prevalent in medicine cabinets, homes, and communities. We can do this by increasing the use of non-opioids for pain management. Non-opioid treatments and therapies can be successful in replacing, delaying, or reducing the use of opioids which is why we believe it is necessary for Congress to advance policies that give practitioners and patients more access to these non-addictive treatments.

The opioid epidemic is estimated to cost U.S. taxpayers $1.5 trillion every year. Too often, cost considerations incentivize Medicare Part D sponsors to employ utilization management practices intended to steer patients towards lowest cost options, which typically end up being generic opioids. 

This has resulted in opioid prescribing in Medicare Part D increasing over the past decade. In fact, Medicare Part D’s share of overall opioid prescriptions dispensed in the United States has increased 75 percent just since 2011. With several new opioid alternatives in the pipeline and others currently on the market, it is essential we encourage robust access to these therapies for Medicare Part D beneficiaries. 

This bipartisan legislation would: 

  • Limit patient cost-sharing for patients receiving non-opioid based pain relief under Medicare Part D plans;
  • Prohibit the utilization of step therapy and prior authorization for these drugs; and
  • Encourage the continued dialogue between patients and their healthcare professionals about preferences in pain management choices. 

This legislation builds on the Non-Opioids Prevent Addiction in the Nation (NO PAIN) Act, legislation supported by Senator Tillis that was signed into law in December 2022. The NO PAIN Act directed the Centers for Medicare & Medicaid Services (CMS) to provide separate Medicare reimbursement for non-opioid treatments used to manage pain in both the hospital outpatient department (HOPD) and the ambulatory surgery center (ASC) settings. Prior to the NO PAIN Act being signed into law, hospitals received the same payment from Medicare regardless of whether a physician prescribed an opioid or a non-opioid. As a result, hospitals relied on opioids, which are typically dispensed by a pharmacy after discharge at little or no cost to the hospital. 

Full text of the bill is available HERE.