Alternatives to PAIN Act

Sponsored by Sen. Thomas Tillis (R-NC) · 36 active : 17 Republicans, 18 Democrats, 1 Independent

Latest action: Read twice and referred to the Committee on Finance.

Read the summary

Where it standsBefore the Senate

Hasn’t passed either chamber

Senate: next
House: not yet
President: not yet

5 senators score as swing votes

Summary

, via Congress.gov

Summary on Congress.gov

Alternatives to Prevent Addiction In the Nation Act or the Alternatives to PAIN Act

This bill reduces cost-sharing and prohibits the imposition of certain utilization requirements under the Medicare prescription drug benefit for certain non-opioid pain management drugs.

Read full summary

Specifically, the bill requires such drugs to be covered without a deductible and to be placed on the lowest cost-sharing tier (if any). The bill also prohibits the imposition of prior authorization requirements (i.e., requiring prior approval from a plan) or step therapy requirements (i.e., requiring the use of alternative drugs before a drug is covered under a plan) with respect to such drugs.

Committees and subjects

Committees

Senate Committee on Finance · SenateReferred to

Subjects

Drug therapy
Health care costs and insurance
Medicare
Prescription drugs

Senate · 100 House · 433

Model

v3defaultv2

Directional: count only breaks toward the other party Why do scores change?

How the House breaks down

45Swing 70–100
206Middle 30–70
180Entrenched 0–30
2Insufficient data not ranked

Members fall into . 2 representatives don’t have enough data yet and are marked “insufficient data”. Non-voting delegates are not counted. The bill is not before the House right now; these scores show where members would stand.

Key players in the House

Ranked by swing score, 0–100 · swing-v2, directional

: only movement toward the other party counts, so members who sit further from the center than their party no longer score as swing votes.

Bars show each input from 0 to 100: ideology gap, scorecard gap, . is the seat’s partisan lean, and shows how much of the input data a score has.

Similar past votes, House

Earlier behind swing-v3’s input

Similar votes count toward swing-v3 in the House: total similarity weight 8.5 (needs 5.0).

H.R. 498 · Dec 18, 2025 · Roll call 361On PassageDo No Harm in Medicaid Act
PassedSame policy area×0.5
H.R. 6703 · Dec 17, 2025 · Roll call 348On PassageLower Health Care Premiums for All Americans Act
PassedSame policy area×0.5
H.R. 2483 · Jun 4, 2025 · Roll call 150On PassageSUPPORT for Patients and Communities Reauthorization Act
PassedSame policy area×0.5
H.R. 2483 · Jun 4, 2025 · Roll call 149On Agreeing to the Amendment
FailedSame policy area×0.5
H.R. 8333 · Sep 9, 2024 · Roll call 1120On Motion to Suspend the Rules and Pass, as AmendedBIOSECURE Act
PassedSame policy area×0.5
H.R. 3843 · Mar 7, 2024 · Roll call 785On Motion to Suspend the Rules and PassAction for Dental Health Act
PassedSame policy area×0.5
H.R. 485 · Feb 7, 2024 · Roll call 758On PassageProtecting Health Care for All Patients Act
PassedSame policy area×0.5
H.R. 6918 · Jan 18, 2024 · Roll call 735On PassageSupporting Pregnant and Parenting Women and Families Act
PassedSame policy area×0.5

Show 9 more

H.R. 4531 · Dec 12, 2023 · Roll call 710On Motion to Suspend the Rules and Pass, as AmendedSupport for Patients and Communities Reauthorization Act
PassedSame policy area×0.5
H.R. 5378 · Dec 11, 2023 · Roll call 703On Motion to Suspend the Rules and Pass, as AmendedLower Costs, More Transparency Act
PassedSame policy area×0.5
H.R. 185 · Feb 8, 2023 · Roll call 115On PassageTo terminate the requirement imposed by the Director of the Centers for Disease Control and Prevention for proof of COVID-19 vaccination for foreign travelers, and for other purposes
PassedSame policy area×0.5
H.R. 185 · Feb 8, 2023 · Roll call 113On Agreeing to the Amendment

Cosponsors

36 active

Show all 36 cosponsors

How the swing score works

Ideology gapHow far a member’s DW-NOMINATE voting score sits from their party’s median in the same chamber.

Scorecard gapHow far their Heritage Action and LCV ratings stray from their party’s average, using the groups’ votes on similar bills where available.

Cross-pressureHow strongly their district or state leans toward the other party, from our own computed partisan lean.

Similar votesHow often they voted against their own party on earlier roll calls about this bill or similar ones.

Committee bonusMembers of the committees handling the bill decide whether it moves, so they get a boost.

Cosponsor checkThe sponsor and active cosponsors have already committed, so they drop toward entrenched.