Agadia Expands Market Reach with a New Electronic Prior Authorization Portal for Specialty Drugs

Empowering Specialty Pharmacies, Hub Service Companies, and Drug Manufacturers to Expedite Patient Access

PARSIPPANY, N.J., Feb. 19, 2025 /PRNewswire/ -- Agadia, a leader in Utilization Management automation, is proud to announce the expansion of its electronic prior authorization (ePA) capabilities to support specialty pharmacies, hub service companies, drug manufacturers, and other healthcare organizations. With the introduction of its PromptPA portal for specialty drugs, Agadia is making the prior authorization process more efficient, reducing administrative burdens, and accelerating patient access to life-changing medications.

Specialty medications often require complex approval processes that can delay treatment and increase administrative workload. PromptPA directly connects Hub Service Companies, Drug Manufacturers, and Specialty Pharmacies to a network of 45+ health plans and PBMs, covering nearly 100 million lives, streamlining prior authorizations for both pharmacy and medical benefit drugs.

Navigating the Industry's Biggest Prior Authorization Challenges

The prior authorization (PA) process is one of the biggest obstacles to timely patient care, often causing delays, administrative burdens, and frustrations for patients, providers, and payers. Agadia is tackling these challenges head-on with PromptPA, an innovative electronic prior authorization portal designed to bring efficiency, transparency, and compliance to the prior authorization process.

Here's how PromptPA addresses key industry challenges:

1. Complexity and Variability in Payer Requirements

The Challenge: Every payer has unique PA criteria, documentation requirements, and workflows, making it difficult for hub service companies, specialty pharmacies, and drug manufacturers to standardize their processes. This complexity often leads to confusion, inefficiencies, and prolonged approval times.

How PromptPA Helps:

• Real-time access to clinical criteria and question sets configured by 45+ health plans and PBMs, ensuring accuracy and reducing manual guesswork.
• Seamless integration with PAHub, the industry-leading utilization management platform where payers configure their decision trees, workflows, turnaround times, and letter templates—so users always have access to the latest PA requirements.
• Eliminates the back-and-forth of faxed requests and phone calls by directly connecting users with the right payer criteria upfront.

2. Limited Visibility into PA Status

The Challenge: Many prior authorization requests get stuck in black-box workflows with little to no visibility into where they stand in the review process. This lack of transparency causes delays, provider frustration, and unnecessary follow-up calls to check PA statuses.

How PromptPA Helps:

• Real-time PA tracking shows exactly where a request is in the process, whether it's pending, approved, denied, or requires additional information.
• If a PA is denied, users can view the exact reason and access denial explanations, eliminating guesswork and reducing the need for appeals.
• Enhanced communication tools reduce unnecessary back-and-forth between stakeholders, ensuring faster resolutions and fewer administrative burdens.

3. Delays and Inefficiencies in PA Processing

The Challenge: Incomplete or incorrect PA submissions create bottlenecks, forcing providers and hub services to resubmit documentation multiple times, delaying patient access to treatment.

How PromptPA Helps:

• Ensures that only the correct clinical criteria are used, reducing errors that lead to rejections.
• Prevents submission until all mandatory fields are completed and supporting documents are uploaded, reducing avoidable denials.
• Provides visibility if more information is needed.

4. Evolving Compliance and Regulatory Requirements

The Challenge: Frequent regulatory changes require constant updates to PA processes and clinical criteria, creating challenges for hubs, specialty pharmacies, and drug manufacturers trying to stay compliant.

How PromptPA Helps:

• Real-time connectivity to PAHub ensures that users always have access to the latest payer requirements and regulatory updates.
• Provides a scalable solution that adapts to changing regulations, keeping stakeholders ahead of policy shifts.

Unlock Access, Streamline Care

With the growing demand for specialty medications, Agadia's PromptPA portal provides a scalable and efficient solution for healthcare organizations looking to optimize their market access strategy while reducing administrative burden.

Experience the PromptPA Advantage:

• Immediate Market Access: Connect with a network of 45+ health plans and PBMs representing nearly 100 million lives.
• Real-Time Decisions: Eliminates manual faxing and provides direct access to payer-configured question sets.
• Efficient Prior Authorizations: Supports medical and pharmacy benefit PAs to streamline specialty drug approvals.

How PromptPA Benefits Health Plans and PBMs:

The PromptPA portal not only benefits specialty pharmacies, hubs and drug manufacturers, but it also offers significant advantages for health plans and PBMs by reducing manual processes, increasing efficiency, and improving patient outcomes. Health plans and PBMs will experience:

• Increased complete ePA Submissions: PromptPA significantly reduces fax volume by facilitating more complete electronic prior authorization submissions, particularly for specialty drugs covered under medical benefits.
• Real-Time Visibility: Hub service companies and specialty providers will have access to the appropriate clinical criteria forms, ensuring accurate submissions to payers and reducing administrative delays.
• Operational Efficiencies: This enhanced ePA process will result in decreased touch times, smoother workflows, and ultimately improved patient satisfaction and care.

"We recognize the challenges that specialty pharmacies, hub services, and drug manufacturers face in navigating the prior authorization process," said Nishi Goel, VP of Customer Experience at Agadia. "With PromptPA, we are providing a direct, efficient, and technology-driven solution that improves market access and accelerates patient care."

To learn more about how PromptPA can transform your specialty drug prior authorization process, visit www.Agadia.com or schedule a demo today.

About Agadia
Founded in 2007, Agadia is a leading provider of utilization management solutions for the healthcare industry. Agadia's flagship product, PAHub, is trusted by over 45 health plans and PBMs, covering approximately 100 million lives. The company's innovative solutions continue to bring efficiency, compliance, and savings to the healthcare market.

For media inquiries or partnership opportunities, please contact:

Karen Apwah
Associate Director, Marketing & Business Development
Agadia
973-540-8400
[email protected]

SOURCE Agadia Systems, Inc.