In December 2022, the "Non-Opioids Prevent Addiction in the Nation," or "NOPAIN," Act was signed into law.
Effective January 2025, the law prioritizes non-opioid pain treatment options in the outpatient setting, including several alternatives offered by orthopedic and spine surgeons. Here are 10 things for spine and orthopedic surgeons to know about the new law:
- The bipartisan legislation was championed by Shelley Moore Capito (R-W.Va.), Jeanne Shaheen (D-N.H.), Terri Sewell (D-Ala.), David McKinley (R-W.Va.), Rob Portman (R-Ohio), Joe Manchin (D-W.Va.), Ann Kuster (D-N.H.) and Brian Fitzpatrick (R-Pa.). Over 160 members of Congress have co-sponsored the legislation.
- The law aims to prevent unnecessary exposure to opioids and open up access to innovative pain-management therapies for American seniors.
- The law establishes patient cost-sharing no greater than generic tier for patients receiving non-opioid based pain relief under Medicare Part D plans, and prohibits the utilization of step therapy and prior authorization for non-opioid pain management drugs for Medicare Part D beneficiaries.
- The law expands patient and provider access to FDA-approved non-opioid pain management approaches in outpatient surgical settings beginning in 2025.
- Nearly 100 organizations across multiple communities support the law to prevent addiction before it starts.
- The law requires HSS to report to Congress on limitations, gaps, barriers to access, or deficits in Medicare coverage or reimbursement for therapeutic services.
- Starting Jan. 1, 2025, the Medicare must provide reimbursement for the average sale price, plus 6%, for qualified non-opioid options used in all outpatient surgeries.
- The law expands access across both ASC and HOPD settings.
- CMS published its proposed ruling July 10, 2024, to ensure swift implementation of the law in January.
- Here is a list of non-opioid medications and treatments that will be covered.