Most pharma and healthcare marketing teams have already done the hard governance work. They have a RACI chart, content tiers, and SLAs on paper for how long Medical, Legal, and Regulatory get to review a piece before it escalates. And MLR review still takes weeks.
That gap is worth sitting with, because it’s not what most advice on this topic assumes. A 2024 review of MLR practices from consultant Alana Goodman put it plainly: the same complaints she heard from marketing teams in 2011, missed deadlines, reviewer turnover, cumbersome technology, lack of visibility into what’s in the queue, are the same ones she still hears now, “despite the incredible advancements in technology.” The policies got better. The day-to-day experience didn’t move.
If your governance is solid and review still crawls, the problem usually isn’t in the framework. It’s in what happens to that framework once real work hits it.
The Bottleneck Isn’t the Policy. It’s What Happens to the Policy in Practice.
A RACI chart says who’s accountable for what. A tiering system says which materials need a full review and which can move faster. An SLA says a reviewer has three business days. None of that means anything if the actual submission still moves through email threads, shared drives, and file names that read like an apology.
That’s not a hypothetical. A March 2026 breakdown of the problem from InformaIT described exactly this: “Most companies haven’t changed a thing about how they work. Email routing. Spreadsheet tracking. Version names like ‘Finalv3UPDATED_USE THIS ONE.’ That’s still how big organizations operate… Reviewers waste time figuring out where a claim came from instead of actually reviewing it.”
Pharma regulatory attorney Darshan Kulkarni has described the resulting dynamic between brand and MLR teams as “us versus them,” with MLR cast as the enforcer instead of a partner in getting content out the door. Reviewers aren’t slow because they’re careless. They’re slow because they’re spending part of every review figuring out what they’re even looking at.
Here are the three places that gap shows up most often.
1. Version Confusion Costs More Time Than Slow Reviewers Do
When a submission goes out over email, “final” doesn’t mean final. It means final until the next round of comments comes back, at which point someone renames the file and sends it again. Multiply that across three reviewer functions and several rounds, and reviewers routinely comment on a version that’s already been superseded, or two reviewers leave conflicting notes on different files without realizing it.
This is the single most consistently named pain point in how practitioners describe MLR review, more than reviewer bandwidth, more than committee scheduling. It’s not a training issue. It’s what happens when the definitive version of a file lives in whoever’s inbox got it last, instead of in one place everyone can check.
2. No One Can Answer “Where Is This Right Now?” Without Asking Around
Goodman’s list of chronic MLR complaints includes “lack of visibility into the number, types of materials, and when submissions will occur” and “lack of accountability.” Put together, that means a marketing director asking “where’s the Q3 campaign in review?” often gets answered with a Slack message to three different people, not a status they can see themselves.
That visibility gap is also where accountability quietly disappears. If nobody can see that a submission has sat with one reviewer for eight days past the SLA, nobody escalates it. The SLA exists. It’s just not being enforced by anything.
3. Conflicting Feedback Has No Built-In Tie-Breaker
Medical, Legal, and Regulatory don’t always agree, and when they don’t, someone has to decide which note wins. In a well-instrumented process, that’s a defined escalation path with an owner. In an email-based process, it’s usually whoever replies last, or a meeting that gets scheduled a week out because that’s when everyone’s free.
Kulkarni’s description of the “feast or famine” submission cycle makes this worse: review volume swings from quiet stretches to launch-mode pileups, and a resolution process that barely works at low volume falls apart when everything shows up at once.
A Diagnostic: Is Your Bottleneck Governance, Capacity, or Execution?
Before fixing anything, it’s worth figuring out which of the three you actually have. These aren’t mutually exclusive, most teams have some mix, but the fix looks different depending on which one dominates.
- Can you name, right now, exactly where every piece of content currently in review sits, and who has it? If not, this is a visibility problem.
- When Medical and Legal disagree, is there a defined person or committee who resolves it, and does that happen in days or in weeks? If there’s no clear answer, that’s a tie-breaker gap, not a staffing gap.
- Do reviewers ever comment on a version that’s already been revised? If yes, that’s lost time nobody’s tracking, and it compounds every round.
- Could you produce an audit trail today showing who approved a specific claim, when, and on which version, if Legal asked for it tomorrow? If that takes more than a few minutes to assemble, your compliance risk is higher than your review-time metrics suggest.
- Is your SLA enforced by a system, or by someone remembering to follow up? If it’s the second one, the SLA is a suggestion.
If most of your “no” answers cluster around visibility, versioning, and enforcement rather than policy or headcount, the fix lives directly in your governance framework.
What It Looks Like When Governance Gets Enforced Instead of Just Documented
The RACI chart, the tiers, and the SLAs don’t need to be replaced. They need a system underneath them that does three things automatically instead of relying on someone to remember: route each submission to the right reviewers in the right order, keep every version and comment attached to the file itself instead of scattered across email, and log every approval with a timestamp and a name attached.
That’s the operational layer most MLR advice skips past, because governance frameworks are the more interesting thing to write about. But it’s the layer where the actual delay lives. RoboHead’s feedback and review tools were built around exactly this: reviewers annotate directly on the asset, every version stays visible for comparison instead of getting overwritten, and every approval is recorded with who signed off and when, so the audit trail already exists instead of getting assembled after the fact under pressure.
Healthcare marketing teams running this at scale, like Lehigh Valley Health Network, close out close to 4,000 projects a year with a requester base of more than 20,000 employees. That volume doesn’t work with an email-based review process. It works because the routing, the version history, and the sign-off record aren’t things anyone has to manually maintain.
The Real Fix Is Making the Policy Enforce Itself
Two data points are worth naming here, with the caveats attached. Veeva’s own analysis of customers who moved MLR workflows into a dedicated system reported a 57% reduction in review cycle times and a 55% drop in time spent in review meetings; that’s vendor-reported and from 2023, so treat it as directional rather than an independent benchmark. Separately, McKinsey’s 2025 research on pharma regulatory operations found that leading companies have compressed regulatory submission timelines by 50 to 65% through workflow redesign and AI, worth noting even though that research covers health-authority dossier submissions rather than MLR promotional review specifically. The pattern in both cases is the same: the gains come from redesigning how the work moves, not from writing a better policy on top of the same process.
If your MLR governance is already solid on paper and review still drags, you don’t need another framework. You need the one you have to actually run itself. See how RoboHead’s review and approval tools work, or look at how Lehigh Valley Health Network and other regulated teams run MLR-scale review without it living in email. Schedule a demo to see it against your own workflow.
