Healthcare Utilization Management Solutions for Health Plans, PBMs & TPAs

Discover Why the Nation’s Leading Health Plans & PBMs Choose Our Solutions To Streamline Their Utilization Management Processes

All Lines of Business

Commercial, Medicare, Medicaid

All Channels

Phone, fax, ePA, e-prescribing, etc.

All Healthcare Services

Pharmacy & Medical

Electronic Prior Authorization

PAHub™, is a HITRUST certified solution that puts the tools at your fingertips to streamline and control all clinical, compliance and administrative aspects of Prior Authorization to improve compliance, automation, reduce turn-around times and costs.

Medication Therapy Management

RxMTM+™ is a web-based solution leveraged by Health Plans & PBMs to streamline their workflow and clinical modules, increase staff productivity, consult patients in a quick and efficient manner, and ultimately improve the quality of care.

Formulary Benefit Design

FormularyHub simplifies formulary management by enabling Health Plans and PBMs to create, administer, manage and publish both pharmacy and medical benefit formularies through a centralized solution in an automated fashion.

Grievance Management

GrievancesHub is a cutting-edge web-based solution designed to streamline Grievance Management.  Discover how Health Plans and PBMs can efficiently capture, track, and resolve member grievances, ensuring compliance with regulatory requirements and enhancing customer satisfaction.

Part D Star Ratings & Adherence

Our Part D Star Ratings & Medication Adherence software, RxSentinel+, allows Health Plans and PBMs to customize programs leading to better patient outcomes, higher levels of adherence and improved CMS Star Ratings.

Why Choose Agadia?

Trusted by over 50 Health Plans, PBMs & TPAs

Our Mission is to improve the quality of care and expedite the delivery of critical health care services by advancing and automating utilization management processes

Increased Processing Speed by


For Prior Authorizations Using PAHub

Explore How a Health Plan
Specializing in State Medicaid

Doubled Their Prior Authorization Volume

with an actual reduction in staff, and increased their processing speed by more than 133%

What our clients are saying

Trusted By Leading Health Plans & PBMs

“Agadia has been pivotal in our go-to-market strategy—both from a product stand-point as well as strategic leadership demonstrated by their team.” — VP, IT

First Year IRR of


While Using PAHub

Learn how a Health Plan with both commercial and medicare business

Saw an Internal Rate of Return of 199%

within one year of using PAHub


Agadia is dedicated to

improving the quality of care and expediting the delivery of health care services by advancing and automating utilization management processes.

What Our Clients Are Saying

"“Agadia has been a fantastic partner for several years. As MedOne has grown as a market leader in medication stewardship, we have directly benefited from the efficiencies afforded through the PAHub platform. We would not have been able to enhance the level of care we provide to our members while scaling our operations without the support of the Agadia software and team.” " - Dr. Nathan Harold, RPh, PharmD., MedOne

"I wanted to pass along that the CDAG portion of our CMS audit last week went well and complement Agadia on the PAHub systems display. The ease of navigation through the full report helped us display the information very smoothly and precisely which is often half the battle in a CMS audit." - Manager - PBM

"I just wanted to drop a quick note letting you know how well PAHub has worked out for us. It has been instrumental in ensuring compliance with various regulations and increased the overall productivity of the Clinical staff. This is a terrific product that has allowed CMS audit events to go very smoothly. Thank you for helping us be successful!" - A.P.; SVP PBM

"Agadia has consistently lead product development with out-of-the-box thinking focusing on a replicable feature-sets to reduce our overall cost of ownership. Their commitment to project management best practices has allowed us to prioritize tactically and avoid potential budget escalations. Agadia’s growing market foot-print clearly demonstrates their commitment to innovation in the healthcare IT space and have been phenomenal to work with." - VP, Genetic Benefit Manager

In the News
Improving Operational Efficiencies with Utilization Management Solutions

Improving Operational Efficiencies with Utilization Management Solutions

As our industry continues to evolve, efficiency, security, and adaptability are non-negotiables. Health plans, Pharmacy Benefit Managers (PBMs), and Third-Party Administrators (TPAs) need robust solutions that not only streamline operations but also ensure compliance,...

Ready to Get Started?

Contact Us Today

NOTE FOR PATIENTS: We are a software company. Please contact your physician or pharmacy for any drug related questions.





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