The Florida Silver Haired Legislature exists to make sure the voices of older Floridians are heard where decisions get made. When we see a policy that is quietly putting seniors at unnecessary risk, speaking up is what we are here to do. The way Medicare currently handles pain medication is one of those policies — and a hearing last week before the House Energy and Commerce Committee focused on a bill that presents an opportunity to fix it. In that hearing, our own Seminole County Sheriff Dennis Lemma expressed the seriousness of the opioid epidemic by saying, “The best thing they can do is never start.”
When a senior in Florida needs pain management after a surgery, procedure, or an acute injury, that conversation with their doctor should be guided by medicine alone. But Medicare’s own rules too often make that call before the doctor can. Generic opioids are routinely placed on lower, cheaper tiers, whereas FDA-approved non-opioid alternatives, many developed specifically to eliminate the threat of addiction, sit on higher tiers with steeper copays. In practice, the math steers patients toward opioids — not because anyone designed it that way, but because no one has fixed it.
And when a patient or physician tries to choose an alternative anyway, the system frequently blocks that too. Prior authorization rules and fail-first requirements demand that patients show opioids have not worked for them before their insurance plan will cover a non-opioid option. That means people who come to their doctor specifically hoping to avoid opioids are told to try them first. It is a policy that made little sense when it was written and makes none today.
The Alternatives to PAIN Act will make two practical corrections: it would ensure that Medicare beneficiaries never pay more for a non-opioid pain medication than for an opioid, and it would prohibit plans from requiring opioid use as a precondition for covering non-opioid alternatives. Doctors and patients would be free to make decisions based on medicine, not on administrative cost structures from another era.
Florida’s congressional delegation already understands the urgency. Eight members have signed on as cosponsors of this bill — a remarkable show of bipartisan support that reflects just how clearly our representatives have heard from constituents about what is at stake. That foundation of support makes the path forward clear: the Energy and Commerce Committee should move this bill so the full House can act on it.
The stakes are real. Seniors who are steered toward opioids unnecessarily face genuine risks of dependence, hospitalization, and a difficult recovery cycle that no one should have to navigate. Preventing that from happening in the first place is better for patients, better for families, and better for a Medicare program already under financial pressure. The cost savings that come from avoiding addiction and its downstream consequences are predictable and significant.
Ernie Bach is CEO-President of the Florida Silver Haired Legislature.
