Author: nathansmofsky@connexhc.com

The Prior Authorization Framework and Accreditation (PAFA) Program is pleased to announce the launch of the Accreditation Application Companion and Checklist for payers with an interest in learning more about the accreditation process before they apply for accreditation. The PAFA’s September 23, 2025, webinar on Navigating the Changing Prior Authorization Landscape included an overview of the Companion and can be viewed here. 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.

What is PAFA Accreditation?

PAFA accreditation recognizes those payers, both public and private, who have implemented administration efficiencies in the processing of prior authorization claims. There are three accreditation levels:

1. Administration Efficiencies
2. Electronic Prior Authorization (ePA) – Parts A and B
3. Gold Accreditation (for those who have achieved levels 1 and 2)

The Accreditation Application Companion

The Accreditation Application Companion provides valuable information for any payer with an interest in pursuing accreditation and who wants to evaluate their readiness to apply.

The Companion reviews the three levels of accreditation, and it also addresses the benefits of membership and accreditation, details of the application process, privacy and confidentiality, and frequently asked questions. Included is an Accreditation Checklist for payers to evaluate their readiness to apply for accreditation.

Membership First

Whether a payer is ready or not to apply for accreditation, they are encouraged to become a member and get involved. Once they are members, payers can not only apply for accreditation, they can also apply for one of two payer seats on PAFA’s advisory board. Plus, all payer members receive regular updates and have input into the annual PAFA report and in PA in Canada surveys.

The PAFA’s payer membership form is available online at the PAFA website.

When a payer member is ready to apply for accreditation, they should contact denisebalch@priorauthframework.ca for their unique secure link and access code to online accreditation forms.

Accredited payers will be recognized on the PAFA website, in promotional communications, and at PAFA’s online and in-person events, including in-person accreditation awards.

Is There a Role for Non-Payers?

Yes. Non-payers are encouraged to become associate members of PAFA. Associate members will receive regular updates, are eligible to apply for one of seven non-payer seats on PAFA’s advisory board and may be eligible to apply for one of five seats on the accreditation panel.

The associate membership form is available online at www.priorauthframework.ca/#membership.

What is PAFA?

PAFA is a Canadian non-profit in operation since 2024. The primary goals of the PAFA Program are to:

• Grow a membership of payer and non-payer stakeholders to support change in prior authorization,
• Motivate payers to review and if necessary, improve their prior authorization claims processes and practices to introduce efficiencies that benefit all stakeholders,
• Recognize payers who achieve the processes and practices in the Prior Authorization Framework and Accreditation Program through accreditation and recognition.

PAFA will also release an annual report on prior authorization. Look out for the 2025 Prior Authorization Survey in Canada which will be launched this Fall.

PAFA is managed by a Board of Directors, a Framework and Accreditation Advisory Board (Advisory Board) that is made up of a cross section of seven industry stakeholders and two payer members, and an Accreditation Panel made up of five members who are non-payer industry leaders. A list of those who are part of PAFA’s management and government structure can be found on the PAFA website.

Questions? Contact denisebalch@priorauthframework.ca.

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:

1. Membership – this is open to payers and non-payers. Payers must be members before they can apply for accreditation
2. The Framework – which lists practices and processes that improve the efficiency of prior authorization for those payers that adopt them
3. 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.

Support for improving prior authorization is trending and the PAFA Program continues to build.

We are pleased to welcome AGA Benefit Solutions, also a third-party payer, as PAFA’s newest member.

Thank you to all our associate members for their support to improve prior authorization and PAFA’s Framework. Every associate member has made a commitment to PAFA’s Guiding Principles and to support improvements in prior authorization.

The interest in prior authorization is growing, which is driving more interest in reforming current practices and policies to create efficiencies. This will improve communication, reduce time-consuming claims process and lower administration costs. Simplify Prior Authorization (SPA) and Prior Authorization Framework and Accreditation (PAFA) Program are helping to shape the prior authorization environment. The SPA and PAFA team are often asked how these two initiatives are different and what their role is. This blog will answer some of the questions you may have. If we don’t answer them all, then just email us at denisebalch@priorauthframework.ca.

Mosey & Mosey, Abbvie, Amgen and Gilead have all joined PAFA as associate members. These leaders are supporting the PAFA Program and the administration framework that everyone can reference to evaluate their payer. Payers can become members and adopt the PAFA Framework to become accredited. Adopting the Framework will result in a faster, more accurate process and lower costs to clients.

Whether you are a payer, advisor, patient support program, pharmacy or pharma, or another organization or association you can join PAFA. You should join if you believe change in prior authorization practices and the process are necessary. Join us as we work to improve the prior authorization landscape.

What are the benefits of membership and associate membership?

• Recognition – We’ll regularly recognize our members in our communications, and on the PAFA website priorauthframework.ca. You can use the PAFA associate member or member branding on your communications and on your website.
• Input and Involvement – Members and associate members can:
  • Participate in governance on PAFA’s framework and accreditation advisory board
  • Contribute and have your say in shaping the future of the Framework at regular member meetings.
• Participate on the Accreditation Panel – associate members are eligible to apply.
• Becoming Accredited – Payer members who follow the Framework and become accredited will be acknowledged and can use the PAFA accreditation branding.
• Annual Reporting – All members can contribute to our annual survey and report on prior authorization in Canada.

Why is supporting the PAFA through membership and associate membership important?

PAFA has created the only publicly available guide to best practices for the prior authorization claims process. In the Guide, you will learn what to expect from private and public payers that are adjudicating prior authorization claims. Without the Guide, you won’t know what to expect from payers and you cannot objectively evaluate a payers prior authorization process.

What Joining PAFA Says About Your Organization

Becoming a member of the PAFA program is more than just joining an organization—it’s a bold commitment to driving meaningful change in Canada’s prior authorization landscape. By aligning with PAFA’s vision, your organization positions itself as a leader in improving communication and workflow for PA claims. You’ll join us in working towards administrative efficiencies in the PA process, quicker approvals and ultimately better health outcomes for plan members. That means plan members can stay at work or return to work more quickly in the case of a serious illness.

Together, we can create a more efficient, patient-focused healthcare system.

Take the next step in transforming prior authorization — join PAFA today and be part of a brighter future for healthcare in Canada.

Join online:

• Payer Membership Application
• Associate Membership Application

If you are a not-for-profit association, contact us for membership details. If you have questions or need assistance with the application process, contact Denise Balch at denisebalch@priorauthframework.ca or call 905-220-4260.

At the Prior Authorization Framework and Accreditation (PAFA) Program, collaboration is at the heart of our mission to improve prior authorization (PA) for everyone. If you’ve attended our Q1 webinars, you’ll know that we are committed to bringing all PA stakeholders together to foster meaningful change. As part of this commitment, we are excited to introduce the Framework and Accreditation Advisory Board (FAAB).

The FAAB plays a key role in guiding our work and ensuring transparency, balance, and accountability across all aspects of our Framework and Accreditation program. We are incredibly proud of the caliber of experts who have joined the FAAB. These individuals bring a wealth of experience and diverse perspectives from across the prior authorization landscape—including clinicians, patient advocates, and industry leaders. Their guidance will be instrumental in ensuring that PAFA’s work is credible, inclusive, and grounded in real-world expertise. With their leadership, PAFA continues to grow as a trusted, balanced voice in improving PA in Canada.

The FAAB will comprise nine members, two of whom will be representatives from payers of prior authorization claims. Please join us in welcoming the following members:

We are thrilled to see the new Prior Authorization and Accreditation (PAFA) Program, a Canadian non-profit, gain recognition in the February 4th, 2025 online article from Josh Welsh at Benefits and Pensions Monitor. The article is based on the January 23, 2025 PAFA webinar – What’s New in Prior Authorization: Making it Better.

The conversation around prior authorization (PA) reform is shifting—and that’s something to celebrate. Patients, physicians, patient support programs, specialty pharmacy, and payers continue to struggle with lengthy administration and approval processes, which mean delays in access to life changing and sometimes life saving specialty medications.

In their article, Benefits and Pensions Monitor highlights the significant progress being made by PAFA and others to encourage payers to adopt more efficient processes and recognize those who do through PAFA.

Industry Recognition: A Step Toward Meaningful Change

Just a few years ago, discussions about digitizing and standardizing PA processes were met with skepticism. Now insurers and stakeholders alike recognize the need for change. The shift in attitude is undeniable, and we’re proud to be part of the movement making this a reality.

At PAFA we are committed to working collaboratively with payers to encourage improvements in prior authorization processes and provide recognition to those who do adopt change through our accreditation program.

Want to know more about PAFA? You can learn more and register for upcoming webinars through our Events page.

To read the full article and learn more about how PA improvements are shaping the future of healthcare, take the time to read Benefits and Pensions Monitor’s coverage through the link below:

Do you pay or adjudicate prior/special authorization claims? Do you want to be recognized for your prior authorization (PA) processes, or do you plan to make changes to improve them?

If yes, then your organization should consider membership with a view to applying for accreditation with the new Prior Authorization Framework and Accreditation (PAFA) Program.

Established in Fall 2024, with input from a wide group of PA stakeholders, PAFA is a Canadian non-profit dedicated to recognizing those organizations, both public and private, who are committed to improving the PA process for specialty and high-volume medications. PAFA offers membership to payers, associate membership to non-payers, and accreditation to public or private payer members who implement efficiencies in their PA practices.

Understanding PAFA Accreditation

The first step to payer accreditation is joining PAFA as a member. To become a member public and private payers must commit to PAFA’s four Guiding Principles:

1. Communication: Ensuring PA information is patient-centric, using plain language that is easy to understand and meets accessibility standards.
2. Transparency and Fairness: Building transparency into all non-proprietary aspects of PA to improve stakeholder understanding and ensure timely information on claim status.
3. Consistency: Developing evidence-based, informed, and consistent guidelines, practices, and decision-making that promote equitable and reliable access to positive patient outcomes.
4. Efficiency: Striving for continuous improvement by adopting new technologies, including electronic prior authorization (ePA), to enhance the patient and stakeholder experience.

Not a payer? Did you know that non-payers are also encouraged to join PAFA as an associate member to support improvements in prior authorization and to get involved.

Accreditation Levels

The PAFA Program offers three levels of accreditation for payer members:

1. Administration Efficiencies (AE): Recognizes payers who have adopted efficient PA claims administration practices and processes that are outlined in the PAFA Program Guide.
2. Electronic Prior Authorization (ePA): Acknowledges payers who have implemented electronic systems to streamline the PA process.
3. Gold Certification: Awarded to payers who achieve both AE and ePA accreditations, demonstrating a comprehensive commitment to PA excellence.

Details of the requirements for accreditation are in Section 3 of the PAFA Program Guide, which is available for download from the PAFA website.

Accreditation recognizes a payer’s dedication to improving the prior authorization claims process by improving communication, reducing the administrative burden, reducing claim processing times, and ensuring that patients receive the timeliest access to prescribed medications.

Benefits of PAFA Accreditation

• Competitive Advantage: Accredited payers can differentiate themselves in the marketplace by showcasing their commitment to superior PA practices.
• Stakeholder Trust: Demonstrating adherence to established standards fosters trust among patients, healthcare providers, and other stakeholders.
• Operational Efficiency: Implementing the PAFA Framework can lead to streamlined processes, reducing costs and improving service to patients and other PA stakeholders.

How to Apply for Accreditation

Payers interested in pursuing PAFA accreditation should first become a PAFA member. Membership details, including benefits and application procedures, are outlined in Section 4 of the PAFA Program Guide. Membership forms can be completed online at www.priorauthframework.ca/payer-membership/.

Members can apply for any one or more accreditation levels by completing an accreditation application and providing the required supporting documentation. Applications will be available in Q2 2025 by contacting denisebalch@priorauthframework.ca.

Join the Movement Towards Better PA Practices

Public and private payers are encouraged to explore membership and accreditation. Those who become members can be active participants in the operations and the future of the PAFA Program. Those who become accredited not only commit to improving PA processes but are also supporting a broader effort to improve healthcare delivery to patients in Canada.

Embrace the opportunity to lead in PA innovation and make a tangible difference in patient care. For more information on accreditation and membership, explore the PAFA website or contact Denise Balch at denisebalch@priorauthframework.ca or call 905-220-4260.