Understanding the NOPAIN Act: Expanding Access to Non-Opioid Pain Management

The Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act expands Medicare coverage to non-opioid alternatives used during outpatient surgical procedures, which gives patients options for pain management outside of opioids.¹ For healthcare providers, this law presents both opportunities and responsibilities in patient care.

Why the NOPAIN Act Matters

Pain continues to rank as the top arthritis-related challenge in the Arthritis Foundation’s annual Advocate Priorities Survey. As the landscape of pain management evolves, the Foundation continues to call for patient-centered and individualized care decision-making.

Historically, opioids have played a significant role in post-surgical pain relief. However, many patients—especially those living with chronic conditions like arthritis—need additional options that are safe, effective, and accessible. The NOPAIN Act was designed to bridge this gap by reducing financial barriers and ensuring Medicare reimbursement for qualifying non-opioid pain management options when used in outpatient surgical settings, including the hospital outpatient department (HOPD) and ambulatory surgical center (ASC)¹.

What Healthcare Providers Need to Know

• Effective Date: January 1, 2025.
• Coverage Expansion: Medicare now provides additional reimbursement for branded, FDA-approved non-opioid pain management therapies including drugs, biologics, or devices when used to reduce or manage post-surgical pain.
• Scope of Use: Currently, there are 20 qualifying products eligible for separate reimbursement.² The NOPAIN Act creates room for innovation and broader adoption of these alternatives across outpatient surgical care.   
• Clinical Implication: Providers are able to recommend and prescribe non-opioid options without concern that Medicare patients will face cost-related barriers. This is a significant step toward integrating multimodal pain management strategies into routine care.

Anticipated Impact

• Reduced Opioid Exposure: By making non-opioid options financially accessible, the NOPAIN Act is expected to reduce the volume of initial opioid prescriptions.
• Expanded Treatment Choices: Providers gain greater flexibility in tailoring pain management to individual patients, particularly those at higher risk for opioid-related side effects.
• Policy Momentum: The law underscores a broader shift toward patient-centered, safer pain management practices and may influence private insurers to adopt similar reimbursement policies.

What You Can Do

Healthcare providers can prepare by:

1. Staying Informed: Familiarize yourself with FDA-approved non-opioid options available for your patient population.
2. Educating Patients: Communicate with patients about the risks of opioids and the availability of effective non-opioid alternatives.
3. Collaborating Across Care Teams: Engage anesthesiologists, surgeons, pharmacists, and nursing staff in planning multimodal pain management pathways.
4. Tracking Outcomes: As adoption increases, documenting patient outcomes with non-opioid therapies will help refine best practices.

Qualifying Products Include²:

• EXPAREL®
• Omidria
• Dextenza
• Zynrelef
• Journavx
• Caldolor
• Ketorolac tromethamine injection
• ON-Q Pump
• SPRINT Peripheral Nerve Stimulator System
• Cryo Nerve Block Therapy
• ambIT Electronic Infusion Pump
• iovera˚ System
• IceMan
• Sapphire Pump
• Echogenic and/or nerve stimulator-guided nerve block needles (SonoPlex, SonoBlock, SonoTap, Stimuplex)
• Perforated continuous infusion catheter set (InfiltraLong)
• Continuous anesthesia conduction catheter sets (SonoLong, E-Cath)
• CADD-Solis ambulatory infusion pump
• ambIT Electronic Infusion Pump (Reusable)
• Game Ready System GRPro 2.1

Download the full list of qualifying products.

Looking Ahead

The NOPAIN Act represents a pivotal step in balancing effective pain relief with the urgent need to curb opioid overuse. For healthcare providers, it is both a policy change and a call to reimagine pain management strategies that prioritize safety, efficacy, and accessibility.

For more information and updates, visit nonopioidchoices.org.

Thank you to Pacira BioSciences for supporting the arthritis community.

References

1. Consolidated Appropriations Act, 2023 (Public Law 117-328), Section 4135 – Accessed Sept 14, 2026. https://www.congress.gov/117/plaws/publ328/PLAW-117publ328.pdf
2. Centers for Medicare & Medicaid Services (CMS). Non-Opioid Treatments for Pain Relief. Updated Sept 1, 2026. https://www.cms.gov/medicare/payment/prospective-payment-systems/hospital-outpatient-pps/non-opioid-treatments-pain-relief. Accessed Sept 14, 2026.