Health plans and pharmacy benefit managers (PBMs) that want software to run prior authorization often compare Agadia and Banjo Health. Prior authorization is the review a plan does before it agrees to cover a drug or procedure. Agadia sells PAHub, a utilization management suite that handles prior authorization for both medical and pharmacy benefits, along with formulary and grievance work. Banjo Health, an earlier-stage company in Washington, DC, sells BanjoPA, which uses AI and a no-code criteria builder to move authorization cases and appeals faster.
Health plans and pharmacy benefit managers that want medical and pharmacy prior authorization on one platform
Plans with no utilization management team to configure criteria and run the work
Health plans and pharmacy benefit managers that want AI help on prior authorization cases, appeals, and clinical criteria
Provider groups that only need a tool to submit prior authorization requests to payers
| Axis | Agadia | Banjo Health |
|---|---|---|
| Breadth of the suite | Stronger PAHub covers medical and pharmacy prior authorization plus formulary, medication therapy management, and grievance modules. |
BanjoPA covers prior authorization cases, appeals, and grievances. |
| Building clinical criteria | Plan staff configure criteria as part of a larger payer-operations rollout. | Stronger A no-code composer lets utilization management staff turn clinical criteria into decision trees. |
| AI on case review | Automation is measured in turnaround time and the share of requests decided automatically. | Stronger AI assistance on authorization cases and appeals is the center of Banjo Health's pitch to plans. |
| Track record | Stronger Agadia is an established vendor to health plans and PBMs, and it scores 7.8 on turnaround and automation outcomes. |
Banjo Health has revenue estimated near $3-4M and fewer than 50 employees, and it scores 7.3 on plan-side outcomes. |
| Getting it live | Stronger Going live means building criteria and integrations inside a payer-operations program. |
Going live is a utilization management project that includes coding the plan's clinical criteria. |
| Knowing what you will pay | Similar Enterprise quote based on covered lives, medical or pharmacy modules, and interface scope. |
Similar Enterprise quote based on authorization volume, modules, and integration scope. |
Agadia is for a health plan or PBM that wants one established suite for medical and pharmacy prior authorization, with formulary and grievance work in the same place. Banjo Health is for a plan that wants AI help on authorization cases and appeals, wants its own staff to write criteria as decision trees, and is comfortable buying from a smaller, earlier-stage company.
Walk away from both if you are a provider group that needs to send prior authorization requests to payers, because both sell to the plan that makes the decision. Walk away from both if no one on your team will own criteria setup and the daily review work. Walk away from Banjo Health if you need a vendor with a long record at large plans.