For Care Coordinators
You check formulary coverage dozens of times a day. Each lookup means a different MCO portal, a different login, a different PDF. FormCheckRx checks every plan in your state simultaneously.
The Problem You Live Every Day
92% of medical practices have hired or reassigned staff solely to handle the growing volume of prior authorization requests (MGMA, 2025). The first step in every PA workflow is the same: check whether the drug is on the plan's formulary.
For Medicaid patients enrolled in managed care, that means checking each MCO's formulary separately. In Michigan alone, that is 11 plans. In New York, 7. In Florida, 9. Each plan has its own portal, its own PDL format, and its own PA criteria. There is no unified lookup. There is no shared system. There is just you, cycling through browser tabs.
At 8 formulary lookups per day — a conservative estimate for most coordination roles — manual lookup consumes over an hour of skilled clinical time. Every day. Across a five-person care coordination team, that is more than a full-time equivalent position lost to portal navigation.
The stakes of getting it wrong are documented. A HHS Office of Inspector General review of 115 Medicaid MCOs found an overall PA denial rate of 12.5% — more than double the Medicare Advantage denial rate of 5.7%. Twelve of those 115 MCOs had denial rates above 25%. Yet 89% of Medicaid enrollees never appeal a denial (HHS OIG, 2023). When a formulary lookup produces the wrong answer — or no answer at all — patients are the ones who absorb that error.
A 2025 study in the American Journal of Managed Care surveyed 322 Virginia Medicaid MCO care coordinators and found that between 49% and 82% reported each of the 15 measured barriers as a "major problem" or "somewhat of a problem." The barrier most strongly associated with both burnout and reduced job satisfaction was administrative and regulatory burden — not caseload size, not clinical complexity, but paperwork (AJMC, 2025).
Workflow Comparison
The same formulary lookup. One way takes up to 30 minutes. The other takes under 5 seconds.
Search Results
Every query returns a complete clinical reference card. No follow-up lookups required.
Drug Identity
Drug name normalized across 150+ brand aliases. Generic availability, drug class, and therapeutic category shown upfront so you know what you are working with before checking coverage.
Coverage Status
Coverage status badge for every MCO in your state shown side by side. Preferred, Non-Preferred, Carve-Out, and Not Covered — all in one view, no plan-switching required.
Plan Breakdown
A row for each managed care plan showing coverage status, PA requirements, quantity limits, and step therapy requirements. If a patient switches plans, you see the new plan's status without leaving the page.
Prior Authorization
When PA is required, the clinical criteria are shown in the result — diagnosis requirements, step therapy conditions, duration limits, and renewal timelines. No separate lookup for the criteria document.
Carve-Out Detection
Carve-out drugs are automatically flagged with the correct billing pathway — FFS Prime, FFS Magellan, OTP, or ADAP. Prevents billing the MCO for a drug that routes through fee-for-service.
Alternatives
If the requested drug is not covered or requires PA, covered alternatives in the same therapeutic class are shown with their coverage status — so you can suggest a clinically appropriate switch immediately.
Federal Safety
All five federal safety databases are integrated into every result. Safety flags appear automatically — you do not need to check a separate list. Beers Criteria (65+), ISMP High-Alert, NIOSH Hazardous, NTI, and REMS status.
Dual-Eligible
Dual-eligible beneficiaries enrolled in both Medicare and Medicaid have complex coverage rules. Results include dual-eligibility guidance to help coordinators identify when Medicare Part D is the primary payer.
Documentation
Every result can be exported as a timestamped PDF with plan contact information included. Serves as a point-in-time record of formulary status at the time of the lookup — useful for PA appeals.
Real Numbers
Pricing
FormCheckRx recovers hours of your week. It costs less than a cup of coffee per day.
Recommended for Individual Coordinators
Professional
$29.99/mo
Less than $1 per day
Need team access? The Clinic plan includes 5 seats for $99/month. See all plans →