S. 3064 — Relief of Chronic Pain Act of 2025

This section amends the Medicare Part D benefit definition (SSA sec. 1860D-2) to waive, for plan years beginning on or after January 1, 2026, the deductible and to place qualifying non-opioid chronic pain management drugs on the lowest cost-sharing tier (if any). Qualifying drugs are non-opioid products with FDA-approved labeling for chronic pain conditions (i.e., diabetic peripheral neuropathic pain, endometriosis, fibromyalgia, musculoskeletal pain, neuropathic pain, post-herpetic neuralgia, or trigeminal neuralgia persisting more than three months), that do not act on opioid receptors, lack therapeutically equivalent alternatives available in the U.S., and have a monthly wholesale acquisition cost not exceeding the Secretary-determined monthly specialty-tier threshold. The section makes conforming amendments to apply these rules to low-income subsidy cost-sharing (SSA sec. 1860D-14(a)).

This section prohibits Medicare prescription drug plans and Medicare Advantage prescription drug (MA-PD) plans from imposing, for plan years beginning on or after January 1, 2026, (1) step therapy requirements that mandate prior use of an opioid or (2) any prior authorization requirements on qualifying non-opioid chronic pain management drugs covered under the plan. Step therapy means a utilization management protocol requiring use of a preferred prescription drug before approving coverage for a non-preferred drug; prior authorization means any predrug approval requirement from the plan.