About
FormCheckRx was created because the formulary lookup process is broken — and the people doing it deserve better tools.
Our Mission
FormCheckRx exists to eliminate the hours of manual formulary research that care coordinators, pharmacists, and clinical staff perform every day.
Medical practices complete 39 prior authorizations per physician per week, consuming 13 hours of staff time (AMA, 2024). Prior authorization staffing costs have increased 43% since 2019 (MGMA). Forty percent of physician practices now employ staff whose sole function is managing prior authorizations. The first step in every prior authorization is checking formulary status — and most staff do it by logging into each MCO portal individually, one plan at a time.
The insurance industry's own trade group acknowledged the scale of the problem. Mike Tuffin, CEO of AHIP, stated that the healthcare system "remains fragmented and burdened by outdated manual processes, resulting in frustration for patients and providers alike." When the payers themselves describe their own administrative systems this way, the problem is structural — not fixable by adding more staff.
FormCheckRx searches every Medicaid managed care plan in a state simultaneously. One query. Every plan. Seconds instead of minutes. Knowing a drug's formulary status before prescribing prevents unnecessary prior authorizations at the source — not after a claim rejection that has already delayed patient care.
We are not a claims adjudication system. We are not an EHR. We are not a prescribing tool. We are a professional reference instrument that gives clinical staff the formulary intelligence they need to do their jobs faster, with fewer rejected claims, and with less preventable harm to patients.
The Data
PATIENT IMPACT
93% of physicians say prior authorization delays patient care. 82% report patients abandon recommended treatment because of PA barriers. 29% say a PA delay caused a serious adverse event — including hospitalization or permanent impairment (AMA, 2024). Gastroenterologist Dr. Jessica Korman, MD, told the New York Times: "When I prescribe a medication, I would say 95% of the time, I have to obtain a prior authorization. We have four full-time employees whose sole focus is obtaining prior authorization — and that's for just one disease state."
ADMINISTRATIVE BURDEN
89% of physicians say prior authorization significantly contributes to burnout (AMA, 2024). In 2024, more than 1 in 4 medical groups saw a physician leave or retire early because of it (Surescripts, 2025). Administrative waste totals $285–$570 billion annually in U.S. healthcare — spending that does not contribute to health outcomes (Health Affairs, 2022). The U.S. spends five times more on healthcare administrative functions than comparable wealthy nations (California Health Care Foundation).
SPEED TO THERAPY
95% of prescribers say patients should be able to start a new therapy within 6 days. In practice, 18% of prescribers report it typically takes a week or more — and 51% report PA denials have increased over the past year (Surescripts, 2025). Every day of delay represents a patient without their medication.
Regulatory Context
In January 2024, the Centers for Medicare & Medicaid Services finalized the CMS Interoperability and Prior Authorization Rule (CMS-0057-F). Effective January 1, 2026, Medicaid managed care plans must respond to standard prior authorization requests within 7 calendar days and urgent requests within 72 hours — cutting current standard timeframes in half for many payers. Payers must also publish their PA approval and denial metrics publicly beginning March 31, 2026.
This rule creates immediate operational pressure on state Medicaid agencies, MCOs, and the care coordination teams that manage prior authorizations. Knowing formulary status before submitting a PA request is the first step in meeting these new timelines — submitting a PA for a non-covered drug wastes days that plans and providers can no longer afford.
FormCheckRx was built for exactly this environment: instant formulary verification across all Medicaid managed care plans in a state, before the PA process begins.
Data Integrity
01 — SOURCE
Every verified state's data is sourced exclusively from the official Medicaid Preferred Drug List published by the state's Medicaid authority. We do not use third-party data aggregators or secondary sources for verified state data.
02 — VERIFY
A licensed PharmD reviews every verified state's formulary data against the official PDL before it goes live. No drug status is published as "verified" without pharmacist sign-off. Verification includes spot-checking PA criteria, quantity limits, and carve-out classifications.
03 — MONITOR
Our system checks state PDL sources every 6 hours for changes. When a change is detected, affected entries are flagged for pharmacist review and users are notified. Off-cycle PDL updates — which states issue for urgent changes — are captured and reflected promptly.
Patient Safety
FormCheckRx integrates five federal safety databases into every search result automatically. Clinical staff should not have to remember which safety list each drug belongs to — the system handles it.
Safety flags appear on every search result regardless of state, plan, or formulary status.
Architecture
FormCheckRx was architecturally designed to never receive, store, or transmit patient information. This is not a limitation — it is a deliberate design decision that eliminates an entire category of risk.
Healthcare data breaches cost an average of $10.22 million per incident and take 279 days to identify (IBM, 2025). Every vendor that handles patient data requires a Business Associate Agreement, HIPAA compliance infrastructure, and breach liability coverage. FormCheckRx requires none of these because patient data never enters the system.
This means procurement teams at hospital systems, health plans, and state agencies can approve FormCheckRx in days — not the months typically required for PHI-handling vendors.
The Company
FormCheckRx is a product of Information Pharm Corporation. The platform was conceived and built to solve a specific operational problem in Medicaid pharmacy workflows — the inefficiency of checking formulary coverage across multiple managed care plans when every prior authorization starts with that same lookup.
The founding team combines healthcare technology expertise with clinical pharmacy practice. Our pharmacist co-founder holds a Doctor of Pharmacy (PharmD) degree and is responsible for all clinical data validation, state verification, and formulary accuracy review. No drug status is published without pharmacist sign-off.
FormCheckRx currently covers all 50 states and DC, with Michigan fully PharmD-verified against the 2025–2026 Single Preferred Drug List. Additional states are verified on a rolling basis.
FormCheckRx is a professional Medicaid formulary reference tool for trained healthcare staff. Results are based on each state's official Medicaid managed care formulary. Not medical advice.