By: David Ostrowsky

Every year, tens of millions of opioid prescriptions are written for Americans experiencing searing pain caused by broken bones, burns, procedures, and wounds. In most cases, the medications produce efficacious results without causing patients to become overly dependent and ultimately addicted. Still, there is a relatively small percentage of users (numbering in the tens of thousands) who develop severe – and sometimes fatal – addictions, hence the well-chronicled national opioid crisis that has descended on humanity this century.

Though health insurers and healthcare providers may continue steering patients toward these affordable, generally effective opioid prescriptions, an intriguing and potentially game-changing alternative has just emerged: Journavx (suzetrigine), a nonaddictive non-opioid analgesic designed to treat moderate to severe acute pain in adults, which was produced by Boston-based Vertex (the company most famous for generating cystic fibrosis treatments like the blockbuster Trikafta) and recently greenlighted by the FDA. Journavx has been hailed as a potential groundbreaking scientific development because it alleviates discomfort by working on nerve cells outside the brain – it never actually enters the brain -- thus lowering the risk of addiction and dependence that can cause some patients to consume dangerously high doses. Furthermore, Vertex’s new medication has not been reported to have opioids’ notoriously unpleasant side effects, namely nausea and drowsiness.

While Journavx presents as an FDA-backed, more salubrious alternative to traditional opioid drugs -- “an important public health milestone in acute pain management” according to Dr. Jacqueline Corrigan-Curay, the acting director of the FDA's Center for Drug Evaluation and Research --  questions remain as to how accessible it will be to healthcare consumers. More specifically, from a financial standpoint, Journavx is undeniably expensive, with each 50-milligram oral tablet costing $15.50. With patients expected to take two pills a day, the daily total cost would amount to $31. In contrast, comparable doses of the hydrocodone and acetaminophen combination retail for approximately $7 per day. Thus, without the availability of patient assistance programs or robust insurance coverage, the daily price of Journavx may prove to be prohibitively expensive for many Americans.

Fortunately, there may be some government-sponsored relief available, courtesy of the No Pain Act, which, effective this past January 1, mandates that Medicare provide additional reimbursement for non-opioid pain management in ambulatory surgical centers and hospital outpatient departments. Prior to 2025, hospitals were paid by Medicare at the same rate, irrespective of whether a doctor prescribed an opioid or a non-opioid medication; consequently, hospital providers have steered patients toward opioids, which are dispensed by a pharmacy upon a patient’s discharge at little or no cost to the facility. However, should Journavx be included among the list of non-opioid pharmaceuticals subject to the Act’s provisions, Vertex’s new pain drug would be more accessible in the aforementioned settings. Nevertheless, there is still the likelihood that commercial and Medicaid insurer challenges will ensue as the Act’s provisions are not applicable to these payers. Furthermore, even in the realm of Medicare, health plans have the ability to pursue coverage restrictions in the form of utilization management practices.  

Yet there may be an alternative means for patients on Medicare plans to acquire non-opioid medications more affordably. In an effort to augment the No Pain Act amidst overdose deaths of seniors having soared over the past decade, Senators Thom Tillis (R-NC) and Mark Kelly (D-AZ) last year introduced the Alternatives to Pain Act to provide elderly Americans and those with disabilities easier access to non-opioid treatments at the pharmacy counter. If enacted, this law would reduce cost-sharing for patients receiving non-opioid pain medication under Medicare plans that cover outpatient therapeutics; eliminate the utilization of step edits that require patients to try a lower-priced prescription drug before “stepping up” to a costlier medication like a non-opioid alternative; and advocate for shared decision-making between patients and their healthcare providers pertaining to preferences for pain management medications.

Of course, the emergence of Journavx won’t be a panacea for the devastating opioid crisis. But, if Big Pharma, commercial insurers, and legislators can work towards a viable solution for ensuring broader accessibility, Vertex’s new creation could be a tremendous boon to humanity.