Prior approval is required for the use of certain drugs and/or exceptions to how drugs are dispensed. Requests for prior authorization must be certified as medically necessary by the physician and submitted to Health Information Designs (HID) for approval. Only HID can issue prior authorizations (PAs). HID may be contacted at 1-800-748-0130. 

• Synagis® - Important information for the 2009-2010 season

• Prior Authorization Form 369 - Fillable  - Updated 7-24-09

• Criteria/Instruction Booklet for Prior Authorization Forms - Effective 10-1-09

• Online Prior Authorization Form - New online form for use by health professionals only

• Pharmacy Override Form 409 - Fillable- Updated 4-25-08

• Criteria/Instruction Booklet for Form 409 - Effective 5-1-08

• PA Form 410– Growth Hormone/Child- Updated 1-30-08

• PA Form 411– Growth Hormone/Adult - Updated 1-30-08

• PA Form 366– Growth Hormone/AIDS Wasting - Updated 1-30-08

• PA Form 390– Miscellaneous Drugs - Updated 2-23-08

• Emergency Prior Authorization Number - Available to pharmacy providers when emergency or extenuating circumstances exist and after-hours PA assistance is unavailable.  Click here to view Provider Manual Chapter 27.3.

• Pharmacy Denial Information Form - Fillable

• Synagis® Prior Authorization Form - Updated 7/27/09

• Synagis® Prior Authorization Criteria - Updated 9/23/09

• Synagis® Appendix A - Updated 7/27/09

• Synagis® Instruction Worksheet - Updated 9/23/09

• Synagis® 2009-2010 ALERT - Updated 7/27/09

Note: Some documents are in PDF format. To view PDFs, please ensure you have the free Adobe Reader installed. If not, download the reader by clicking on the Adobe Reader icon.