Agadia Blog
Company and Industry News
What is Prior Authorization and Why is it Important?
One of the most common and often misunderstood components of insurance plans is prior authorization (PA). While it might seem like an extra hurdle, PA plays a significant role in healthcare cost management and patient safety. Key Takeaways: Prior authorization ensures...
Navigating the Evolving CMS Medication Therapy Management Landscape in 2025
The Centers for Medicare & Medicaid Services (CMS) recently released updated guidelines for the Medication Therapy Management (MTM) program, effective January 1, 2025. These changes significantly impact how health plans and PBMs can participate and deliver...
Streamlining Prior Authorization: Insights on the Improving Seniors’ Timely Access to Care Act of 2024
The bipartisan momentum behind the Improving Seniors’ Timely Access to Care Act of 2024 marks a critical step forward in addressing a longstanding issue in healthcare: the inefficiencies of prior authorization. With broad support in both the House and Senate, this...
Medicare Part D Star Ratings: Understanding the 2024 Changes and Their Implications
The Centers for Medicare & Medicaid Services (CMS) recently finalized changes to the Medicare Part D Star Ratings for 2024, introducing several new initiatives aimed at improving the quality of care and enhancing patient outcomes. These changes not only affect how...
Staying Compliant: Preparing for New AI Guidelines in Prior Authorization
Are you prepared for potential upcoming AI Guidelines in Prior Authorization? As AI continues to revolutionize various aspects of healthcare, including prior authorization (PA) management, it’s crucial for Health Plans and Pharmacy Benefit Managers (PBMs) to stay...
Streamlining Grievance Management: A Critical Tool for Health Plans & PBMs
With ongoing challenges such as the COVID-19 pandemic, rising healthcare costs, and changing regulatory requirements, healthcare organizations face increasing pressure to ensure efficient resolution of member grievances while maintaining compliance with industry...
Driving Efficiency & Compliance in Formulary Benefit Management
For Health Plans, PBMs, and TPAs, formulary management stands as a critical pillar in ensuring optimal patient care while managing costs effectively. As complexities surrounding formularies continue to mount, traditional approaches lack efficiency and are proving...
Enhancing MTM Programs: Impact of CMS’s 2025 Final Rule for Health Plans and PBMs
The recent final rule for the 2025 contract year issued by the Centers for Medicare & Medicaid Services (CMS) carries significant implications for Health Plans and Pharmacy Benefit Managers (PBMs) managing Medication Therapy Management (MTM) programs. This change...
Agadia Expands Suite of Healthcare Technology Solutions with the Launch of GrievancesHub
Parsippany NJ, April 2, 2024– Agadia, a leading provider of healthcare technology solutions, is pleased to announce the launch of GrievancesHub, a web-based Grievance Management solution designed to empower Health Plans and Pharmacy Benefit Managers (PBMs) in...
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,...
