AI-Powered Automation for Modern Utilization Management
A unified suite of intelligent utilization management solutions, spanning prior authorization, formulary management, MTM, Star Ratings and Grievances/Appeals — designed to simplify compliance, accelerate decisions, and help health plans, PBMs, and healthcare organizations scale with confidence.
Next-Gen Utilization Management Solutions:
AI-Powered, Expert-Driven. Keeping Humans in the Loop.
Automate Prior Authorization
A seamless enterprise platform leveraging AI & automation for medical & pharmacy prior authorizations. HL7 & FHIR ready.
Formulary Benefit Management
Control the creation, implementation and maintenance of custom and standard formularies.
Grievances & Appeals
Manage and resolve member grievances efficiently, while also ensuring compliance with CMS requirements.
Part D Star Ratings & Adherence
Design and manage clinical programs to achieve higher clinical & formulary compliance
Medication Therapy Management
Efficiently Manage & Implement MTM Programs to Meet these CMS Requirements
Hub Services
Enabling Hubs, Specialty Pharmacies, and Drug Manufacturers to access APIs or an ePA portal to streamline the prior authorization process.
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.
Agadia partners closely with each customer to understand their operational goals, compliance priorities, and evolving business needs. Through dedicated account support, ongoing collaboration, and customer-driven product enhancements, we help organizations optimize utilization management performance while adapting to new regulations, market demands, and opportunities for automation.
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%
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
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
Setting the Course for Success in 2024: Enhancing Medication Therapy Management Programs
As we approach 2024, it's an ideal time to set new goals and strategies for your Medication Therapy Management (MTM) programs. In this blog post, we'll explore key considerations for enhancing your MTM programs to meet the needs of your members, fulfill CMS...
What Is Utilization Management In-House? How Health Plans Benefit
Health plans continually face the challenge of delivering high-quality care while managing costs and ensuring regulatory compliance. One crucial area where they can make a significant impact is in the realm of utilization management programs. It's led many health...
Medication Therapy Management Solution, RxMTM+: Unveiling the Agadia Advantage
Medication Therapy Management (MTM) solutions have become a crucial component of ensuring patient well-being. For Health Plans and Pharmacy Benefit Managers (PBMs), it's not just about offering MTM services; it's about delivering them effectively, efficiently, and...
Enhancing Healthcare Utilization Management: Agadia’s Suite of Comprehensive Solutions for Health Plans and PBMs
In an ever-evolving healthcare landscape, Health Plans and Pharmacy Benefit Managers (PBMs) face the intricate challenge of utilization management efficiency while ensuring optimal care for their members. Agadia, a trusted partner with a decade-long track record,...
How a Prior Authorization Solution Supercharged This PBM’s Efficiency
Pharmacy Benefit Managers (PBMs) play a pivotal role in ensuring access to cost-effective, quality treatments for self-funded employers and their members. One PBM stood out for its commitment to transparency and advanced clinical management, but they faced a challenge...
Transforming Electronic Prior Authorization for Drugs Under the Medical Benefit with Agadia’s eMPA Solution: PAHub
In the ever-evolving landscape of healthcare, streamlining processes while ensuring compliance is crucial to delivering efficient patient care. One significant challenge that has long plagued the healthcare industry is the manual and time-consuming process of...
