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

Enhancing Healthcare Utilization Management: Agadia’s Suite of Comprehensive Solutions for Health Plans and PBMs

Sep 26, 2023 | Adherence, Formulary Benefit Design, Medication Therapy Management, Part D Star Ratings, Prior Authorization

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

Sep 18, 2023 | Electronic Prior Authorization, Prior Authorization

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

Aug 31, 2023 | Electronic Prior Authorization, Prior Authorization

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...

The Vital Role of Flexibility and Control in Prior Authorization Management

Aug 8, 2023 | Electronic Prior Authorization, Prior Authorization

In the dynamic realm of healthcare, striking a balance between providing optimal care for members and maintaining operational efficiency is a constant challenge. For Health Plans and Pharmacy Benefit Managers (PBMs), the ability to exercise flexibility and control in...

Streamlining the Formulary Management Process for Health Plans & PBMs

Jul 31, 2023 | Formulary Benefit Design

In today's dynamic healthcare landscape, Health Plans and Pharmacy Benefit Managers (PBMs) play a pivotal role in ensuring that patients have access to safe, effective, and affordable medications. One of the essential tools in this process is the formulary—a list of...

Ensuring CMS Compliance for Medication Therapy Management Programs: How RxMTM+ Can Help

Jul 24, 2023 | Medication Therapy Management

For Health Plans and Pharmacy Benefit Managers (PBMs), ensuring CMS compliance is essential to the success and effectiveness of their Medication Therapy Management (MTM) programs. Meeting these guidelines not only guarantees the provision of quality care but also...