Our History

Introduced AI-based clinical criteria automation capabilities to enhance prior authorization decision support.

• Covering over 100 million lives, approximately one-third of the US population
• Integrated with nearly all claims adjudication systems
• Used by over 50 health plans, PBMs, and healthcare organizations across all lines of business and all 50 states.

Launched first of its kind ePA portal for drugs under both the pharmacy and medical benefit for Hubs, Specialty Pharmacies and Drug Manufacturers.

• Processed around 12 million prior authorizations annually under both the pharmacy and medical benefit.

Launched Formulary Benefit Solution, FormularyHub & Grievance Management Solution, GrievancesHub

• Rolled out QuickPA, an enhancement to streamline the PA process, and PAHub Insights, a reporting tool powered by Microsoft Power BI.

Built the industry’s first electronic medical prior authorization (eMPA) API

• Began processing prior authorizations for drugs and procedures under the medical benefit.

Case Study conducted where Agadia helped a health plan client achieve:

• 44% reduction in fax volume.
• 50% decrease in phone volume.
• 20% increase in case volume with fewer FTEs
• 1.43 ROI on implementation

Achieved HITRUST Certification for Agadia’s Solutions

Implemented the Automation of Non-formulary PAs

• Case study conducted where Agadia delivered a 199% IRR in the first year of PAHub implementation for a health plan client.

Launched RxMTM+ and RxSentinel+

• Launched Agadia’s Medication Therapy Management platform, RxMTM+, enabling clinical interventions to improve patient outcomes.
• Launched Agadia’s Part D Star Ratings & Medication Adherence solution, RxSentinel+

Implemented our first ePA integration with a customer 

Launched the PromptPA Portal for Providers, Prescribers & Members

Agadia contributed to the draft for the electronic prior authorization (ePA) workflow as part of the NCPDP task group.

• First Medicare implementations with national health plans

First Medicaid and Commercial implementations in PAHub with a national PBM and regional health plan that are still partnering with Agadia today.

Agadia Founded in Parsippany, NJ.

• Introduced PAHub, Agadia’s flagship solution for automating prior authorization workflows.