In a Congress that struggles to agree on much of anything, Rep. Miller-Meeks has done something very rare. She authored a bipartisan bill that now has 82 cosponsors, half Republicans and half Democrats. This kind of bipartisan momentum does not happen by accident. It happens when someone identifies a real problem, crafts a commonsense solution, and keeps pushing.
The Alternatives to PAIN Act is that commonsense piece of legislation, and Iowa should be proud that one of our own is leading the charge.
As a doctor, I’ve seen how cost can shape the decisions patients make. When Medicare Part D makes generic opioids cheaper and charges significantly more for non-opioid alternatives, patients notice. Patients often end up taking the cheaper opioid medication even if it’s not what they intended on purchasing. That is not a failure of patients. It is a failure of policy.
But the pricing problem is only half of it. Patients must go through prior authorization requirements for non-opioid alternatives, meaning a pharmacy has to stop, contact the insurer, and wait for approval before a patient can even get their medication. That process can take days. In the meantime, a patient can go ahead and get an opioid that requires no hoops to jump through at all.
Fail-first policies can make this issue worse. Under these rules, an insurance plan can require that a patient try an opioid and demonstrate it did not work before the plan will cover the non-opioid their doctor prescribed. This can be demoralizing for those susceptible to or with a history of opioid addiction. The point of having non-addictive options is to use them instead of an opioid, not after.
Rep. Miller-Meeks understands the need to give Medicare recipients the option when she wrote this bill. It would ensure that beneficiaries never pay more for a non-opioid pain medication than for an opioid, and it would end prior authorization and step therapy requirements for non-opioid alternatives.
What makes the cosponsor count so significant is not just the number but the balance. It reflects the fact that the opioid epidemic does not sort itself by party, and neither does the case for fixing a Medicare pricing structure that has been working against patients for years.
Any health professional will tell you that prevention is cheaper than treatment. This bill puts that principle into practice. The savings from expanding the options for seniors are real – fewer hospitalizations, less emergency care, and lower long-term treatment costs. Good healthcare and sound fiscal policy, at the same time.
Rep. Miller-Meeks said it right in her most recent hearing on the issue on March 26, “We were pushed into an opioid-centric pain management system by design. Expanding access to alternatives improves outcomes and lowers long-term costs.” It is only fair that we grant seniors the option to access these non-opioid alternatives.
As a healthcare professional and longtime supporter of hers, it has been remarkable seeing her fight for improving the quality and options of care for Iowans. I want to say clearly – thank you Rep. Miller-Meeks. Now it’s time to get this bill passed.
Sharon Bertroche, MD
Des Moines
