by Karen Apwah | Sep 11, 2024 | Opioid Overutilization, Part D Star Ratings
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...
by Karen Apwah | Jul 17, 2024 | CMS, Electronic Prior Authorization, Healthcare Technology, 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...
by Karen Apwah | Jun 6, 2024 | Grievance Management, Healthcare Technology
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...
by Karen Apwah | May 6, 2024 | Formulary Benefit Design
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...
by Karen Apwah | Apr 15, 2024 | Adherence, CMS, Medication Therapy Management
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...
by Karen Apwah | Apr 2, 2024 | Grievance Management, Healthcare Technology
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...
by Karen Apwah | Mar 18, 2024 | Adherence, Formulary Benefit Design, Grievance Management, Healthcare Technology, Medication Therapy Management, Part D Star Ratings, Prior Authorization
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,...
by Karen Apwah | Mar 8, 2024 | Electronic Prior Authorization, Prior Authorization
The need for effective Prior Authorization (PA) management for health plans, Pharmacy Benefit Managers (PBMs), and Third-Party Administrators (TPAs) continues to evolve. To propel your organization to new heights, it’s not just about managing authorizations but...
by Karen Apwah | Feb 26, 2024 | Healthcare Technology, Prior Authorization
Planning for the Future of Healthcare Legislation: Agadia’s Response to Colorado Revised Statutes When it comes to healthcare legislation, staying ahead is not just a necessity; it’s our commitment at Agadia. As of February 20, 2024, the Colorado Revised...
by Karen Apwah | Feb 13, 2024 | Electronic Prior Authorization, Prior Authorization
In response to escalating concerns voiced by providers and patients regarding delayed and denied care, an increasing number of states are taking decisive steps to impose limitations on prior authorization (PA) requirements. These legislative efforts, reaching beyond...
