Before using the HID website and the online prior authorization form, please read and accept an agreement to abide by the following terms of use regarding the information you find within this site.

The online prior authorization form that is posted on the HID website is designed for use by health care professionals only. 

This form is to be filled out solely by a licensed healthcare provider or a representative thereof.  The information transmitted via this website is confidential and contains protected health information. 

This form can not be used to request a prior authorization for biological injectibles, Xolair, or erectile dysfunction drugs. If you require a prior authorization for one of these drugs a manual request is required.

Please contact HID at 1-800-748-0130 with questions or concerns about terms of use.

Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking below on the button labeled “Accept”.


Accept and Proceed to PA Request
Accept and Proceed to Override Request