When the Senate Finance Committee put out a Request for Information asking stakeholders to weigh in on health coverage, we knew we couldn’t sit this one out.
Because the issues they’re asking about? Our members aren’t reading about them in policy briefs. They’re living them. It’s one of the most talked about issues among our members and those who attend our live events. Every single day, our RNs and NPs are in the trenches, fighting prior authorizations, navigating step therapy hurdles, and watching patients get caught in a system that too often puts administrative process ahead of patient care.
That’s exactly why RNS submitted a formal response. Our members’ voices belong in this conversation.
Prior Authorization — The data speaks for itself: 96% of prior authorization requests are ultimately approved. So why are our nurses spending hours documenting, appealing, and waiting while patients sit in limbo? We told the Committee that prior authorization, as it currently operates, too often delays care that’s already been deemed medically appropriate. That’s not a system working for patients. That’s a system working against them.
What We Weighed In On
Step Therapy — “Fail first” is exactly what it sounds like. Patients are required to try insurer-preferred medications before they can access what their own clinician prescribed. For someone living with rheumatoid arthritis or another complex rheumatologic condition, that delay can mean a flare, lost function, and real suffering. Of course you know that – you’re the one who has to explain this to your patients while they are in pain. We urged Congress to support the Safe Step Act (S.2903/H.R.5509), which would create a meaningful exception process, one that respects clinical judgment.
PBM Reform — Three pharmacy benefit managers now control nearly 80% of U.S. prescriptions. We raised serious concerns about the lack of transparency in how PBMs are compensated and how those incentives shape formulary decisions. Patients deserve to know that the system managing their medications is working for them and not for profit margins.
What This Letter Means
A Request for Information is one of the ways Congress actually listens. When the Senate Finance Committee opens that door, the organizations that walk through it have a real opportunity to shape how lawmakers understand an issue: what’s broken, what’s at stake, and what solutions are worth pursuing.
For RNS, submitting this response means we have a seat at the table. It means that when the Committee sits down to draft legislation, our members’ daily reality is part of the record. That matters. Rheumatology nurses and nurse practitioners bring a perspective that no insurance executive or policy analyst can replicate. They know what it actually looks like when the system fails a patient.
We don’t just want to be heard once. We want to be a resource. If the Committee has questions about how these policies play out at the bedside, we want to be the organization they call. That’s the relationship we’re working to build, and this letter is a step in that direction.
Why This Matters
Advocacy has always been part of the RNS mission. But I want to be honest: this felt personal. When I hear from our members about the barriers they face, the phone calls, the appeals, the patients who give up, I feel a responsibility to make sure those stories reach the people making decisions.
This letter is one way we do that. And we’re just getting started.
You can read our full response attached to this post.
If you want to get more involved in RNS advocacy, or if you have a story you think Congress should hear, I’d love to connect. Reach out at info@RNSnurse.org.
Sadie Larson
Executive Director, Rheumatology Nurses Society