Agadia Blog
Company and Industry News
The Impact of Prior Authorization on Patient Care: Pros and Cons
Prior authorization (PA) is a process used by health insurance companies to determine whether certain medications, procedures, or treatments are medically necessary before approving coverage. While the goal is to control costs and prevent unnecessary treatments, PA...
The Future of Grievance Management: Trends & Innovations
In today’s rapidly advancing healthcare industry, managing grievances has become more complex than ever. With rising regulatory scrutiny, evolving patient expectations, and a growing demand for efficiency, health plans and pharmacy benefit managers (PBMs) need...
Press Release: Agadia Expands Market Reach with a New ePA Portal for Specialty Drugs
Agadia Expands Market Reach with a ePA Portal for Specialty Drugs Empowering Specialty Pharmacies, Hub Service Companies, and Drug Manufacturers to Expedite Patient Access Agadia is proud to announce the expansion of its electronic prior authorization (ePA)...
Preparing for the CMS Interoperability and Prior Authorization Final Rule
Last year, the Centers for Medicare & Medicaid Services (CMS) finalized the CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F), a significant step toward improving healthcare efficiency, enhancing patient access to care, and reducing...
What is Prior Authorization and Why is it Important?
One of the most common and often misunderstood component of insurance plans is prior authorization (PA). While it might seem like an extra hurdle, PA plays a significant role in healthcare cost management and patient safety. What is Prior Authorization? Prior...
Navigating the Evolving CMS Medication Therapy Management Landscape in 2025
The Centers for Medicare & Medicaid Services (CMS) recently released updated guidelines for the Medication Therapy Management (MTM) program, effective January 1, 2025. These changes significantly impact how health plans and PBMs can participate and deliver...
Streamlining Prior Authorization: Insights on the Improving Seniors’ Timely Access to Care Act of 2024
Streamlining Prior Authorization: Insights on the Improving Seniors’ Timely Access to Care Act of 2024 The bipartisan momentum behind the Improving Seniors’ Timely Access to Care Act of 2024 marks a critical step forward in addressing a longstanding issue in...
Medicare Part D Star Ratings: Understanding the 2024 Changes and Their Implications
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...
Staying Compliant: Preparing for New AI Guidelines in 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...
Streamlining Grievance Management: A Critical Tool for Health Plans & PBMs
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...
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