Transforming Healthcare
with Proven Innovation

Industry-leading utilization management solutions built on decades of expertise—empowering health plans, PBMs, and healthcare organizations with advanced automation, efficiency, and compliance.

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WHY AGADIA

Next-Gen Utilization Management Solutions:
AI-Powered, Expert-Driven

Pharmacy & Medical Benefit Prior Authorization Technology for Health Plans & PBMs

Electronic Prior Authorization for Hubs, Specialty Pharmacies, & Drug Manufacturers

Part D Star Ratings & Adherence

Health Plan, PBM & TPA Customers

Covering Nearly

Million Lives

Backed By

Years in Business

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Why Choose Agadia?

Beyond a Vendor: Your Trusted Business Partner in Healthcare Innovation

We proudly go beyond traditional vendor relationships by continuously investing in the evolution of our solutions. We proactively implement global enhancements driven by new CMS regulations, industry requirements, and emerging technological trends, ensuring our clients stay ahead in an ever-changing healthcare landscape.

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Increased Processing Speed by

133%

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%

Read the Case Study

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

199%

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

Read the Case Study

OUR MISSION

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, PBM

In the News

Navigating Opioid and Controlled Substance Programs in Healthcare

Dec 4, 2023 | Adherence, Opioid Overutilization

Addressing the opioid epidemic requires more than just awareness—it demands strategic and efficient solutions. Health Plans and PBMs play a crucial role in curbing this crisis, and Agadia's RxSentinel+ is at the forefront, empowering organizations to configure and...

Empowering Health Plans and PBMs to Address the Prior Authorization Burden: Insights from Medical Groups

Nov 21, 2023 | Electronic Prior Authorization, Healthcare Technology, Prior Authorization

In response to the recent report from the Medical Group Management Association (MGMA), it's evident that the prior authorization process remains a significant challenge for medical groups, impacting patient care and straining operational efficiency. The report...

Optimizing Electronic Medical Prior Authorizations: The Transformative Power of PAHub

Nov 15, 2023 | Electronic Prior Authorization, ePrescribing, Prior Authorization

Efficiently processing medical prior authorizations is crucial for Health Plans and Pharmacy Benefit Managers (PBMs) seeking to enhance operational efficiency and improve patient outcomes. In this blog post, we'll explore the importance of streamlined eMPA workflows...

Democrats Express Concerns About CMS’s Prior Authorization Requirements and the Use of AI-Driven tools

Nov 7, 2023 | Electronic Prior Authorization, Healthcare Technology, Prior Authorization

As per an article published last Friday, House Democrats are pressuring the Centers for Medicare & Medicaid Services (CMS) to better evaluate how artificial intelligence is utilized by Medicare Advantage (MA) plans, hoping to prevent eye-catching rates of denial....

Agadia Announces Game Changing Solution for Grievance Management

Nov 6, 2023 | Grievance Management

Agadia is delighted to introduce GrievancesHub - a cutting-edge web-based resolution system engineered to redefine Grievance Management for Health Plans and Pharmacy Benefit Managers (PBMs). Live demos will begin this December. We invite you to schedule a demo and...

The Human Touch in Healthcare Technology: Navigating the AI Revolution

Oct 30, 2023 | Healthcare Technology

Technological advancements in the Healthcare industry have become synonymous with progress. The surge of AI technology in healthcare is not only revolutionizing patient care but also reshaping how healthcare operations are conducted. While AI is indeed a powerful...