H.R. 4509 (119th Congress) – “NOPAIN for Veterans Act” is a bipartisan bill to make sure VA covers certain FDA-authorized non-opioid pain drugs/biologics by putting them on the VA National Formulary (and VA’s drug standardization list).

Where it stands (as of Jan 7, 2026)

• Introduced: July 17, 2025 (Rep. Greg Landsman)
  
   
• Committee: House Veterans’ Affairs; referred to Subcommittee on Health: Dec. 19, 2025
  
   
• Status: Still introduced (has not passed the House).
  
   

What it would change (plain English)

The bill amends 38 U.S.C. § 8125 to:

1. Define a “non-opioid pain management drug or biological product” as an FDA-approved/granted/cleared product used to reduce post-op pain or provide post-surgical/regional analgesia without acting on opioid receptors.
   
    
2. Require VA to add any such drug/biologic to the VA national formulary within 1 year after it becomes eligible for certain Medicare payment categories (explained below).
   
    
3. Also include it in VA’s drug standardization list.
   
    

The trigger it uses: Medicare “eligibility”

VA’s 1-year clock starts when the drug/biologic becomes eligible for either:

• Medicare’s temporary additional payment for non-opioid pain treatments under 42 U.S.C. § 1395l(t)(16)(G)
  
   
• OR “separate payment” in ambulatory surgery centers under 42 C.F.R. § 416.174
  
   

(Those Medicare policies generally cover non-opioid drugs/biologics/devices tied to post-surgical pain relief and run in the 2025–2027 window.)

Implementation + funding guardrail

• VA must implement within 90 days of enactment (i.e., once/if it becomes law).
  
   
• It cannot use the Cost of War Toxic Exposures Fund to carry out this change.
  
   

Why it matters for veterans

• The bill is designed to speed VA coverage of newer non-opioid post-surgical pain options once Medicare has recognized them for special payment treatment—helping reduce default reliance on opioids after procedures.