Prescription Drug Coverage
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Our goal is to make a difference through personal service. As a Solis Health Plans member, you get prescription drug coverage (Part D) and must get your prescription drugs through our network of pharmacies.
As a Solis member, you can go to any of the pharmacies in our network.
Solis Health Plans covers the diabetic supplies that may fit your needs and make managing your condition easier. Below is our list of preferred supplies:
The Real-Time Benefit Check (RTBC) helps you and your doctor search for the lowest-cost pharmacy and medication available and find your participating pharmacy.
Access the Real-Time Benefit Check Tool
This program requests prior approval before receiving your medication to make sure you’re getting a prescription drug that is suitable for the intended use and covered by the prescription benefit.
Step Therapy: This program encourages you first try certain drugs to treat your medical condition before we cover another drug for that condition.
PRESCRIPTION DRUG TRANSITION POLICY
When entering a new plan, getting used to all of the changes can be confusing. At Solis, we want to make the transition for our members easy. If you are unable to get your prescription medications due to it not being covered or because it requires a prior authorization, we have the tools to help.
You can get prescription medications directly to your doorstep though Birdi. Download the forms attached to set up home delivery on your prescription medications.
Download your Part D Member Direct Reimbursement Form:
Coverage Determination Request Form / EXCEPTION REQUEST
To request a drug coverage determination, you, your appointed representative, or your prescribing physician/other prescriber can contact Solis in one of the following ways:
Ask your prescribing physician or other prescriber to submit the request for you. Your prescribing physician or other prescriber may call our Pharmacy Coverage Determination Review team at 833-615-9259 and request a coverage determination request over the phone. We are available to take your prescriber’s call Monday to Friday, 8 a.m. to 5p.m.
Alternatively, your prescribing physician or other prescriber can submit a coverage determination request form for you. Your prescriber may call the Pharmacy Coverage Determination Review team at the number provided above and request a coverage determination form specifically designed for the drug that is being requested and submit the completed form to us by fax at 1-844-268-9789. This form will include specific questions to ensure all required information is obtained for the review. Your physician can also submit the request for you online by filling out the Coverage Determination Request Form, which is a general form. This form may require the Pharmacy Coverage Determination Review team to contact your prescriber to obtain additional information specific to the drug being requested.
Note: You can also access the Drug Determination Request Form at the CMS part D webpage
Request for Redetermination (Appeal) of Medicare Prescription Drug Denial
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Medication Therapy Management Program
Beginning in January 2024, Solis will be partnering with Aprexis Health Solutions to deliver Medication Therapy Management (MTM) to our qualified members. If you’re in a Medicare drug plan and you have complex health needs, you may be eligible to participate in the Solis MTM Program at no additional cost to you.
The MTM program is required by the Centers for Medicare and Medicaid Services (CMS) and is not considered a benefit. This program helps you and your doctor make sure that your medications are working. It also helps us identify and reduce possible medication problems.
To take part in this program, you must meet certain criteria set forth in part by CMS. These criteria are used to identify people who have multiple chronic diseases and are at risk for medication-related problems. If you meet these criteria, you will receive a letter in the mail from Aprexis and Solis with details on the program and information on how to get started. Your enrollment in MTM is voluntary and does not affect Medicare coverage for drugs covered under Medicare.
To qualify for Solis’ MTM program, you must meet ALL of the following criteria:
Have at least 3 of the following conditions or diseases:
Chronic Heart Failure (CHF)
Diabetes
Dyslipidemia
Hypertension
Asthma
Chronic Obstructive Pulmonary Disease (COPD)
Take at least 8 covered Part D medications, and
Are likely to have medication costs of covered Part D medications greater than $5,330 per year.
To help reduce the risk of possible medication problems, the MTM program offers two types of clinical review of your medications:
Targeted Medication Review: at least quarterly, we will review all your prescription medications and contact you and/or your doctor if we detect a potential problem.
Comprehensive Medication Review: at least once per year, we offer a free discussion and review of all of your medications by a pharmacist or other health professional to help you use your medications safely. This review, or CMR, is provided to you confidentially on behalf of Solis Health Plans and Aprexis and will be provided via telephone or in-person at the assigned pharmacy.
The review requires about 30 minutes of your time. Following the review, you will get a written summary of the discussion, which you can take with you when you talk with your doctors. This summary includes:
Medication Action Plan (MAP): The action plan has steps you should take to help you get the best results from your medications. To obtain a blank copy of the Medication Action Plan (MAP) to help you get the best results from your medications.
Personal Medication List (PML): The medication list will help you keep track of your medications and how to use them the right way. To obtain a blank copy of the Personal Medication List (PML) that can help you and your health care providers keep track of the medications you are taking.
Learn more about the Solis MTM Program powered by Aprexis
If you take many medications for more than one chronic health condition, contact your drug plan to see if you’re eligible for MTM. If you know that you qualify for the MTM Program and would like to get started, call the Solis MTM Program at 866-793-1690 (available 24/7) to schedule your first consult. For Spanish interpretation, call 877-253-7244 and request to be connected to 866-793-1690. TTY users can reach our program team through the National Relay Service at 711 from a TTY device.
Safe Disposal of Medications
Solis Health Plans MTM Program is dedicated to providing you with information about safe medication disposal. Medications that are safe for you may not be safe for someone else. Unneeded medications should be disposed of as soon as possible. You can discard your unneeded medications through a local safe disposal program or at home for some medications.
Locating a community safe drug disposal site
A drug collection site is the best way to safely dispose of medications. Find drug collection sites near you:
Some pharmacies and police stations offer on-site drop-off boxes, mail-back programs, and other ways for safe disposal. Call your pharmacy or local police department (non-emergency number) for disposal options near you.
Safe at-home medication disposal
You can safely dispose of many medications through the trash or by flushing them down the toilet.
You can also dispose of medications in the trash fisrts by removing medication labels to protect your personal information, mixing the medications with undesirable substances, such as dirt or used coffee grounds, and placing the mixture in a sealed container, such as an empty margarine tub.
