Alternatives to PAIN Act is the right fix for Medicare

The Florida Silver Haired Legislature exists to make sure the voices of older Floridians are heard where decisions are made. When we see a policy that is quietly putting seniors at unnecessary risk, speaking up is what we are here to do.

The way Medicare currently manages pain medication is one of those policies — and a hearing last week before the House Energy and Commerce Committee focused on a bill that presents an opportunity to fix it.

In that hearing, Seminole County Sheriff Dennis Lemma expressed the seriousness of the opioid epidemic, saying, “The best thing they can do is never start.”

When a senior in Florida needs pain management after surgery, a procedure or an acute injury, that conversation with their doctor should be guided solely by medicine. But Medicare’s rules too often make that call before the doctor can.

Generic opioids are routinely placed on lower, cheaper tiers, while FDA-approved non-opioid alternatives — many developed specifically to eliminate the threat of addiction — sit on higher tiers with steeper copays. In practice, the math steers patients toward opioids, not because anyone designed it that way, but because no one has fixed it.

And when a patient or physician tries to choose an alternative anyway, the system frequently blocks that, too. Prior authorization rules and fail-first requirements demand that patients show opioids have not worked before their insurance plan will cover a non-opioid option.

That means people who come to their doctor hoping to avoid opioids are told to try them first. It is a policy that made little sense when it was written and makes none today.

The Alternatives to PAIN Act would make two practical corrections: It would ensure that Medicare beneficiaries never pay more for non-opioid pain medication than for an opioid, and it would prohibit plans from requiring opioid use as a precondition for covering non-opioid alternatives.

Doctors and patients would be free to make decisions based on medicine, not on administrative cost structures from another era.

Florida’s congressional delegation already understands the urgency. Eight members have signed on as cosponsors of the bill — a remarkable show of bipartisan support that reflects how clearly representatives have heard from constituents about what is at stake. That foundation of support makes the path forward clear: The Energy and Commerce Committee should move the bill so the full House can act on it.

The stakes are real.

Seniors who are steered toward opioids unnecessarily face genuine risks of dependence, hospitalization and a difficult recovery cycle that no one should have to navigate. Preventing that from happening in the first place is better for patients, better for families and better for a Medicare program already under financial pressure. The cost savings that come from avoiding addiction and its downstream consequences are predictable and significant.

More than 100 organizations nationwide have endorsed the bill — physician associations, patient advocates, veterans’ groups and elder care organizations reaching the same conclusion from different directions.

The current system creates unnecessary risks, and this legislation corrects it. Florida’s seniors deserve better.

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Ernie Bach is the CEO-president of the Florida Silver Haired Legislature.