Alternatives to PAIN Act Raises Access and Market Stability Concerns: Adam Colborn, JD

The Academy of Managed Care Pharmacy (AMCP) annual meeting covered a wide range of health coverage topics, from novel therapies to clinical pathways to updating policy. One policy currently under consideration is the Alternatives to PAIN Act. Although aimed to broaden coverage for pain medications, “its feasibility may reveal more difficulty upon implementation than expected,” Adam Colborn, JD, vice president of congressional affairs at AMCP, said in an interview with The American Journal of Managed Care^®.

The Alternatives to PAIN Act would essentially reduce cost-sharing and prohibit specific utilization requirements under the Medicare prescription drug benefit for certain nonopioid pain management drugs.¹ However, Colborn emphasized that mandates such as these create instability within the Medicare Part D marketplace, with the rising prices of these drugs.

“Plans [are] either reducing what they cover or withdrawing from markets entirely,” he said. “And there's a balance maybe that isn't being perfectly managed. What does ‘access’ mean beyond simply ordering that a drug is covered?”

He then explained that the Medicaid VBPs for Patient Act, the Access to Prescription Digital Therapeutics Act, and the Equitable Community Access to Pharmacist Services Act do a better job of balancing access with specific health coverages. These 3 bills collectively aim to expand access to high-cost therapies, create new statutory benefit categories, and reimburse pharmacists for their time, which overall can help save patients from high health care costs.

Additionally, Colborn noted that meetings such as AMCP bring together clinicians and pharmacists to address access gaps and ways to improve them.

“We're seeing a lot more collaboration between payers and pharmaceutical manufacturers and figuring out how to facilitate patient access in a way that works for everyone, and how do we do that in a value-based way that ties compensation to patient outcomes and can effectively monitor patient outcomes?” he said.

Reference

Alternatives to PAIN Act, HR 1227, 119th Cong (2025-2026). Accessed April 17, 2026. https://www.congress.gov/bill/119th-congress/house-bill/1227