Oregon bill would force health insurers to cover non-opioid pain treatment

The Oregon Senate on Monday voted to pass a bill aimed at making non-opioid pain treatments more accessible and affordable for patients.

Senate Bill 598, which cleared the chamber 23-6, would require health insurers to cover at least one non-opioid alternative for every opioid they cover — and bar them from placing stricter approval processes or higher out-of-pocket costs on those alternatives. The measure now heads to the Oregon House with only a few days left in the legislative session.

The bill’s requirements would apply not only to commercial health plans but also to public insurance programs such as the Public Employees’ Benefit Board and the Oregon Educators Benefit Board, both administered by the Oregon Health Authority. The agency estimates the change will cost approximately $800,000 in the upcoming two-year budget cycle, largely due to modest increases in insurance premiums.

Opioid medications are often prescribed to treat acute and chronic pain, but they also carry a risk of addiction and misuse. According to the Centers for Disease Control and Prevention, nearly 8.6 million Americans age 12 and older reported misusing prescription opioids in 2023, and more than five million had a prescription use disorder. The agency found that the majority of people who misused opioids did so to relieve physical pain.

In response to the ongoing opioid crisis, the CDC issued new guidelines recommending that doctors prioritize non-opioid and non-drug treatments for pain when appropriate. These alternatives include medications like ibuprofen, acetaminophen and certain drugs used to treat migraines.

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The Food and Drug Administration also recently approved a new class of non-opioid pain reliever, though newer treatments can be more expensive than generic opioids.

Supporters of the bill argue that insurance barriers — like higher copays or stricter approval rules — can make non-opioid options harder to access. They say that the bill would help level the playing field by requiring insurers to treat non-opioid pain medications no differently than opioids in terms of coverage and cost to the patient.

Aimee Adelmann, Portland resident who testified in support of the bill, told lawmakers about how current insurance policies made it difficult for her to choose non-opioid pain medications after surgeries. She said the bill would reduce administrative and support patients to make decisions on which drugs best fit their needs.

“People living with chronic pain or recovering from surgery should not have to jump through extra hoops just to access safe and appropriate treatment,” Adelmann said.

Opponents of the bill include health insurers, who argue that the bill could drive up health care costs without improving patient outcomes.

Regence BlueCross BlueShield of Oregon, for example, testified that the SB 598 would require coverage of expensive non-opioid drugs even when cheaper, equally effective generics are available. The insurer also pointed out that some non-opioid pain medications — such as ketorolac, under the name Toradol — also come with serious health risks if not closely monitored.

While Regence agreed with making non-opioid treatments more accessible, the insurer warned the bill could raise insurance premiums for consumers and employers, and open the door for pharmaceutical companies to push expensive drugs that offer little added benefit.