by Karen Apwah | May 6, 2024 | Formulary Benefit Design
For Health Plans, PBMs, and TPAs, formulary management stands as a critical pillar in ensuring optimal patient care while managing costs effectively. As complexities surrounding formularies continue to mount, traditional approaches lack efficiency and are proving...
by Karen Apwah | Apr 15, 2024 | Adherence, CMS, Medication Therapy Management
The recent final rule for the 2025 contract year issued by the Centers for Medicare & Medicaid Services (CMS) carries significant implications for Health Plans and Pharmacy Benefit Managers (PBMs) managing Medication Therapy Management (MTM) programs. This change...
by Karen Apwah | Apr 2, 2024 | Grievance Management, Healthcare Technology
Parsippany NJ, April 2, 2024– Agadia, a leading provider of healthcare technology solutions, is pleased to announce the launch of GrievancesHub, a web-based Grievance Management solution designed to empower Health Plans and Pharmacy Benefit Managers (PBMs) in...
by Karen Apwah | Mar 18, 2024 | Adherence, Formulary Benefit Design, Grievance Management, Healthcare Technology, Medication Therapy Management, Part D Star Ratings, Prior Authorization
As our industry continues to evolve, efficiency, security, and adaptability are non-negotiables. Health plans, Pharmacy Benefit Managers (PBMs), and Third-Party Administrators (TPAs) need robust solutions that not only streamline operations but also ensure compliance,...
by Karen Apwah | Mar 8, 2024 | Electronic Prior Authorization, Prior Authorization
The need for effective Prior Authorization (PA) management for health plans, Pharmacy Benefit Managers (PBMs), and Third-Party Administrators (TPAs) continues to evolve. To propel your organization to new heights, it’s not just about managing authorizations but...
by Karen Apwah | Feb 26, 2024 | Healthcare Technology, Prior Authorization
Planning for the Future of Healthcare Legislation: Agadia’s Response to Colorado Revised Statutes When it comes to healthcare legislation, staying ahead is not just a necessity; it’s our commitment at Agadia. As of February 20, 2024, the Colorado Revised...
by Karen Apwah | Feb 13, 2024 | Electronic Prior Authorization, Prior Authorization
In response to escalating concerns voiced by providers and patients regarding delayed and denied care, an increasing number of states are taking decisive steps to impose limitations on prior authorization (PA) requirements. These legislative efforts, reaching beyond...
by Karen Apwah | Jan 31, 2024 | CMS, Electronic Prior Authorization, Healthcare Technology, Prior Authorization
The healthcare landscape is undergoing a transformative shift with the introduction of the Centers for Medicare & Medicaid Services (CMS) Interoperability and Prior Authorization Final Rule (CMS-0057-F). This comprehensive regulation sets forth a series of...
by Karen Apwah | Jan 29, 2024 | Healthcare Technology, Prior Authorization
The Biden-Harris Administration’s recent announcement on promoting competition in healthcare includes a significant focus on increasing transparency in the Medicare Advantage (MA) insurance market. The U.S. Department of Health and Human Services (HHS) and the...
by Karen Apwah | Jan 4, 2024 | Healthcare Technology, HITRUST & Security
Ensuring the security and confidentiality of patient data is paramount. Healthcare vendors play a crucial role in maintaining the integrity of sensitive information. One key aspect that highlights a commitment to robust security practices is achieving HITRUST...
