Prior Authorization Framework and Accreditation Program (PAFA) logo
Prior Authorization Framework and Accreditation Program (PAFA) logo

Payer Member Application

All private and public payers can apply for membership. Private payers include insurers, pharmacy benefit managers (PBM), or other third parties that make reimbursement decisions for drugs that require prior or special authorization. Public payers include provincial and territorial drug benefit programs.

The annual membership fees for payers are $10,000 plus HST annually for the silver level and $15,000 plus HST annually for the gold level. The gold level is a requirement for those organizations who successfully apply for a seat on the Framework and Accreditation Advisory Board. A full list of payer member benefits can be found in Section 4 of the PAFA Program Guide.

To qualify for membership, payers are required to make a written commitment to the PAFA Program’s Guiding Principles. Internally, payers are required to communicate the commitment to employees responsible for prior/special authorization claims review and adjudication. Externally, payers are required to post their commitment to patients and other stakeholders in a prominent position on the prior/special authorization section of their website.

You can complete and submit this form electronically. Once your application is approved you will be notified, and an invoice will be sent via email to the contact listed below from PAFA. If you have any questions about this application, contact Denise Balch denisebalch@priorauthframework.ca, admin@priorauthframework.ca or call 905 220 4260.

This field is for validation purposes and should be left unchanged.
Business Address(Required)
Payer Type(Required)
Please provide more information if your organization doesn't match one of the above categories.
Contact Person Name(Required)
Email Address(Required)
*plus applicable taxes
Acknowledgement(Required)

Please attach a copy of your organization’s written internal commitment to the PAFA Program’s Guiding Principles as part of this application and the communication that was sent to employees responsible for claims review and adjudication.

Your internal statement of commitment to the PAFA Program’s Guiding Principles must:

  • Be on your organization’s letterhead, dated, and with your organization’s logo
  • Be signed by your President, COO, Vice President or Director, including their phone and email address. For the public sector, this could be the Deputy Minister of Health or another appropriate senior ministry or drug programs official.
  • Confirm your organization’s commitment and list the Guiding Principles, found in Section 2 of the PAFA Program Guide.
  • Include the location that employees can find a hard copy of your commitment in the workplace as a reminder/reference to your employees. Please include a copy in your application.

View and download a sample commitment here.

All documents must be uploaded as part of your application and combined in one PDF file.

Accepted file types: pdf, doc, docx, png, jpg, Max. file size: 10 MB.

Please attach a copy of your organization’s written external commitment to the PAFA Program’s Guiding Principles as part of this application. The document you upload with your application must include the link to the web page and the actual web page wording where your organization’s commitment is posted. The wording on your website must:

  • Include your organization’s external commitment to the PAFA Program’s Guiding Principles and list the principles, found in Section 2 of the PAFA Program Guide.
  • The commitment must be prominently posted in the specialty drug/prior or special authorization section of your website available to patients, and be accessible by patient support, drug access navigators and health care practitioners (HCP). HCP in this case includes physicians and pharmacists.

View and download a sample commitment here.

Accepted file types: pdf, doc, docx, png, jpg, Max. file size: 10 MB.

Date(Required)
Any additional notes, contact details or invoicing instructions can be entered below. Or you can contact denisebalch@priorauthframework.ca, info@priorauthframework.ca or call 905 220 4260.