How Long Does a Formulary Lookup Actually Take? Measuring the Hidden Cost

Most healthcare practices have never put a number on the time their staff spends on formulary lookups. It does not show up as a line item in a budget. It does not appear in a staffing report. It accumulates in two-minute increments — a tab opened here, a login entered there, a PDF scrolled through while a patient waits — until it becomes hours per day that no one has measured.

Surescripts, which processes the majority of electronic prior authorization transactions in the United States, estimates 20 minutes of care team time per PA request. That estimate covers the full PA workflow. What it does not isolate is the first step that precedes every PA submission: verifying that the drug is on the formulary, and at what tier, for the patient's specific plan.

The Manual Lookup Sequence

A manual formulary lookup is not a single task. It is a sequence of steps, each of which takes time and each of which depends on information that may need to be retrieved separately.

A straightforward lookup — right MCO, drug on formulary, result clear — takes approximately 7 to 16 minutes for a single plan. When the drug is not on the formulary or the result is ambiguous, the process repeats. When the practice needs to check multiple MCOs for the same patient — because the patient may have recently switched plans, or because the coordinator is not certain which MCO is current — the time multiplies accordingly.

Multiplied Across a State's MCO Landscape

Michigan has 11 Medicaid managed care organizations. New York has 7. Florida has 9. California has dozens, depending on the county and enrollment category. A practice treating Medicaid patients is not checking one formulary — it is navigating an entire ecosystem of plans, each with its own portal and its own PDL.

For a care coordinator handling eight formulary lookups per day — a conservative estimate for practices with significant Medicaid volume — the math at 10 minutes per lookup is 80 minutes of staff time. At $25 per hour, that is approximately $33 in labor cost per day, $165 per week, and roughly $8,580 per year for a single coordinator. At a practice with three coordinators, that is $25,740 annually — and that is before accounting for the PA submissions that follow from the lookups that confirmed coverage.

What the Research Shows About Staff Involvement

The time cost compounds because formulary lookups and PA submissions are rarely single-person tasks. MGMA survey data shows that in 60% of medical practices, three or more employees are involved in a single prior authorization from initiation to approval. The formulary lookup is often performed by a front-office coordinator, the PA form is completed by a clinical staff member, and the follow-up calls are handled by whoever picks up the phone.

Surescripts' 2025 pharmacy survey data found that 87% of pharmacists identify prior authorization as the single biggest impediment to getting patients their medications on time — and 47% report that PA denial rates have increased in the past year. The lookup problem is not static. As formularies become more complex and PA requirements expand, the time cost of doing this manually grows.

The Upstream Effect of Getting the Lookup Right

The most significant efficiency gain from accurate formulary lookup is not the time saved on the lookup itself. It is the downstream work that is eliminated when the lookup produces a correct answer before a prescription is written.

A prescription written for a drug that turns out to require PA — information that was available but not checked — initiates a callback from the pharmacy, a PA submission, clinical documentation gathering, insurer review, and potentially a denial and appeal. That cascade can consume 60 to 90 minutes of staff and prescriber time across multiple people. A five-second formulary check that produces the answer before the prescription leaves the office eliminates the entire cascade.

This is the operational case for simultaneous multi-plan search: not just that it is faster than checking one plan at a time, but that the answer it returns — coverage status across all plans simultaneously — enables a clinical decision that is already optimized for coverage before it reaches the pharmacy. The time savings show up not in the lookup itself but in every workflow step that follows.