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
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.
Trusted By Over
Health Plan, PBM & TPA Customers
Covering Over
Million Lives
Backed by
Years in Business
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.
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
Doing More With Less: How Health Plans and PBMs Can Reduce Costs Without Burning Out Their Teams
Health plans and PBMs are being asked to do something that feels increasingly difficult: reduce costs, improve outcomes, and keep operations moving forward while working with smaller teams and tighter budgets. At the same time, administrative workloads continue to...
Agadia’s Solution, PAHub, Takes the Pain out of Prior Authorizations
As noted in the following article posted on AMJC.com by Kelly Davio, prior authorizations are having a significant negative impact on clinical outcomes and causing a delay in care. This challenge is the driving force behind Agadia's prior authorization solution,...
Agadia Relocating to Morris Plains, NJ to Support Continued Growth
Agadia Relocating to Morris Plains, NJ to Support Continued Growth We are thrilled to announce that Agadia’s corporate headquarters will be relocating to 201 Littleton Road in Morris Plains, New Jersey, with the move planned for early 2026. “This move...
Regulatory Readiness: How Case Work Automation Strengthens Oversight & Auditing
In healthcare, regulatory oversight is constant. Organizations must demonstrate that grievance cases are resolved within mandated timelines, tracked appropriately, and documented with accuracy. The Centers for Medicare & Medicaid Services (CMS), for example,...
Tackling GLP-1 Medication Growth with Smarter Prior Authorization Strategies
GLP-1 medications are creating new challenges for health plans due to rising demand and costs. Originally developed for type 2 diabetes, these drugs are now widely prescribed for weight management, sleep apnea, and other clinical uses. As this surge continues,...
Streamlining Prior Authorization: The Role of Interoperability, Automation and AI in Improving Efficiency and Patient Care
The healthcare industry is facing unprecedented challenges in streamlining prior authorization (PA) processes effectively. According to a report by the Arthritis Foundation, the average wait time for medical procedure PAs ranges from a few days to several weeks,...
Ready to Get Started?
Contact Us Today
NOTE FOR PATIENTS: We are a software company. Please contact your physician or pharmacy for any drug related questions.
