Prevent Addiction in the Nation (NOPAIN) Act in 2022. Signed into law by President Joe Biden, the NOPAIN Act, beginning in 2025, expanded access to nonopioid pain treatments by establishing separate reimbursement for nonopioid pain medication for outpatient surgical procedures covered by Medicare Part B. In an effort to build on the success of the NOPAIN Act, the Alternatives to Prevent Addiction in the Nation (Alternatives to PAIN) Act proposes to (i) establish patient cost-sharing no greater than generic tier for patients receiving nonopioid pain relief under Medicare Part D plans, and (ii) prohibit the utilization of step therapy and prior authorization for nonopioid pain management drugs for Medicare Part D beneficiaries. It is a separate, newer proposal from the previously passed 2022 NOPAIN Act, which focused on surgical settings. Now, advocates are urging Congress to pass the NOPAIN for Veterans Act. The bipartisan bill, led by Sen. Shelley Moore Capito (R-WV) and Sen. Jeanne Shaheen (D-NH) in the Senate and Rep. Greg Landsman (D-OH), Rep. Derrick Van Orden (R-WI), Rep Chris Pappas (D-NH), Rep. Jack Bergman (R-MI), Rep. Terri Sewell (D-AL) and Rep. Abraham Hamadeh (R-AZ) in the House of Representatives, would expand the Veterans’ Affairs formulary to include all qualified nonopioid treatments and ensure veterans have every option when it comes to safe, effective pain care. The NOPAIN for Veterans Act would require the U.S. Department of Veterans Affairs to furnish and cover non-opioid pain management drugs under VA pharmacy benefits if those drugs are covered by Medicare. “Our veterans deserve the very best care, which includes access to safer options for managing pain,” Landsman argued. “Our bipartisan bill is a common- sense step to make nonopioid treatments more affordable and available to those who’ve served our country and a way to prevent addiction before it starts. We can protect our veterans’ health and keep pushing forward in the fight to end the opioid epidemic.” Capito added, “Our veterans deserve the very best care we can provide, including safe and effective options to manage pain without exposing them to unnecessary risk. By ensuring FDA-approved nonopioid treatments are included on the VA National Formulary, our legislation will make these alternatives easier to prescribe and easier for veterans to access.” Those include centrally acting nonopioid analgesics (CANOAs), which are pain medications that modulate pain perception within the central nervous system without using opioid receptors. That means they have a lower risk of addiction and dependence. Examples include acetaminophen, nefopam, flupirtine and newer sodium channel blockers like suzetrigine, which are useful for acute and neuropathic pain. “Centrally acting non-opioid analgesics (CANOAs) were launched as alternative agents to opioids,” according to the authors of a recent review in Current Pharmaceutical Design. “CANOAs modulate pain perception at the central level without interacting with opioid receptors, making them particularly valuable in multimodal analgesia strategies. CANOAs generally have a rapid onset and sustained duration of action. Their unique mechanisms of action enable them to alleviate both nociceptive and neuropathic pain components.”2 They advised clinicians to consider the specific characteristics, indications and drawbacks of each agent in different clinical situations, adding that most professional organizations “have issued algorithms and guidelines to guide clinicians on the uses, limitations, and drawbacks of these agents.” The study added that, though “CANOAs may be used as effective agents in pain treatment in various clinical settings, more population-based, controlled studies will further enlighten their role in the evolving management of pain.” CANOAs are used for managing acute pain (e.g., surgical, traumatic) and sometimes for neuropathic pain or chronic pain syndromes. While they are effective for moderate pain, they might be less potent than strong opioids for severe cases, according to the review. One of the most promising, according to another review from the University of California San Diego Health and the La Jolla, CA, VAMC, is suzetrigine, a selective NaV1.8 inhibitor in acute and chronic pain. Writing in Current Opinion in Anesthesiology in April this year, the authors noted, “The opioid epidemic and limitations of current nonopioid analgesics have created a need for safer, effective pain therapies. Suzetrigine, a first-in-class selective NaV1.8 inhibitor, was approved by the Food and Drug Administration in 2025 for the treatment of moderate to severe acute pain. The pur- pose of this review is to discuss the mechanism and clin- ical efficacy of suzetrigine and its potential for address- ing existing therapeutic gaps in pain management.”3 Vertex Pharmaceuticals Inc. announced in January 2025 that the U.S. Food and Drug Administration (FDA) had approved suzetrigine, marketed as Journavx, an oral, nonopioid, highly selective NaV1.8 pain signal 2 0 2 6 C O M P E N D I U M O F F E D E R A L M E D I C I N E 5 7
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