When your organization becomes a PAFA member or associate member you will be supporting improvements in prior authorization that will benefit all stakeholders in the process. Payers and non-payers can become members, get involved, and be recognized for their support. Have your say and get involved. All are welcome!
Our latest member is AGA Benefit Solutions, a benefits consultant and third-party payer that also adjudicates prior authorization claims.
So what is PAFA? The PAFA Program is a Canadian non-profit launched in November 2024. The Program consists of three parts:
- Membership – this is open to payers and non-payers. Payers must be members before they can apply for accreditation
- The Framework – which lists practices and processes that improve the efficiency of prior authorization for those payers that adopt them
- Accreditation – which recognizes payers that meet the Framework, those who follow the Framework to achieve administration efficiencies and those who follow the Framework and adopt electronic prior authorization.
PAFA is managed by an Executive Director, Board of Directors, and Advisory Board. An independent Accreditation Panel evaluates accreditation applications.
The first step in supporting this exciting initiative or becoming accredited is to become a member. Your organization can join online at our website at www.priorauthframework.ca and you can also find out more about PAFA, a list of our members, and how you can get involved. You can also contact Denise Balch, Executive Director, PAFA at denisebalch@priorauthframework.ca for more information.
At our September 23, 2025 webinar, Denise Balch, Executive Director, launched the new PAFA Accreditation Applications and Companion Guide and reviewed the accreditation process.
Presenters include Denise Balch, PAFA’s Executive Director, and guest presenter and advisory board member Dr. Imtiaz Khan, Rheumatologist, and Chair of the Private Payers committee for the Ontario Rheumatology Association. PAFA advisory board members Abigail O’Neill, VP at Mosey & Mosey and John Anacleto, Anacleto Consulting joined presenters for a panel discussion.
Did you miss our earlier webinars? Here are just some of the takeaways from the webinars the PAFA Program has already delivered in 2025:
- PAFA is managed by a Board of Directors, Framework and Accreditation Advisory Board of 9 non-payer and 2 payers, and an Accreditation Panel of 5 non-payer representatives. Each of those on the Advisory Board or Accreditation Panel must have an interest in or have direct experience with prior authorization to become involved. Advisors, patients, physicians, pharmacists, and patient groups are all represented.
- The goal of PAFA is to improve prior authorization processes and practices, create more standardization, administration efficiencies and more clarity for patients and other stakeholders. It also encourages and recognizes the adoption of ePA.
- There are four fundamental PAFA values: to be fair, current, relevant and achievable.
- The four guiding principles of PAFA are: communication, consistency, efficiency, transparency and fairness.
- Payers that follow the Framework will have a clearer and transparent claims process for prior authorization so that patients and their healthcare team will know what to expect from their provider, including response times, the appeal process, and what happens if there is a change in carrier or temporary medication switch. This clarity will result in less administrative delays.
- Payers who become accredited because they follow the Framework will be recognized by PAFA, can use the PAFA Accreditation branding, and will be recognized by advisors and their clients for excellence in prior authorization claims administration. Payers gain a competitive advantage over those who are not accredited.
- Reporting will be a requirement of accreditation, and the PAFA will monitor the results of payer reporting. Payers who are accredited agree to conduct regular patient evaluations so that they know how their processes and practices are impacting patients. Accredited payers will also be required to provide high level results on prior authorization claims activity back to PAFA who will develop an aggregate non identifying annual report on prior authorization in Canada.
The world is changing and so is prior authorization. Apply for membership and get involved in improving the prior authorization environment.
Contact Denise Balch, Executive Director, PAFA at denisebalch@priorauthframework.ca to find out more.