US SB475

Amends Medicare Part D to eliminate deductibles and require lowest cost-sharing tier placement for qualifying non-opioid pain management drugs, effective January 1, 2026

Defines qualifying non-opioid drugs as those FDA-approved to reduce postoperative or acute pain, that do not act on opioid receptors, have no therapeutically equivalent alternative on the U.S. market, and cost below the specialty-tier threshold

Prohibits Medicare Part D and MA-PD plans from requiring step therapy that mandates opioid use before accessing non-opioid alternatives

Bans prior authorization requirements for qualifying non-opioid pain management drugs under Medicare Part D

Extends the same cost-sharing protections to low-income Medicare beneficiaries enrolled in Part D subsidized coverage