Prescription Drug Coverage

Important Information

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.

You can access our 2024 formulary of covered prescription drugs here.

For 2023 covered prescription drugs, please click here.

As a Solis member, you can go to any of the pharmacies in our network. You can download our 2023 pharmacy directory here.

Real Time Benefit Guide

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. You can find information on how to use the RTBC here.

To access to the Real-Time Benefit Tool, click here.

Prior Authorization Criteria

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. You can find that criteria here:

2024 Part D Prior Authorization Criteria .

2023 Part D Prior Authorization Criteria .

Step Therapy

This program encourages you first try certain drugs to treat your medical condition before we cover another drug for that condition.

2024 Part D Step Therapy Criteria.

2023 Part D Step Therapy Criteria.

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. Please access our transition policy for more information:

Part D Formulary Transition Policy (2023)

Part D Formulary Transition Policy (2024)

Member Direct Reimbursement Form

You can download your Part D Member Direct Reimbursement Form here.

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 1-833-615-9259 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 1-855-668-8552. 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.

Download the Coverage Determination Request Form (Prescription Coverage) here

Note: You can also access the Drug Determination Request Form at the CMS part D webpage link here: Part D Coverage Determination Request Form

Request for Redetermination (Appeal) of Medicare Prescription Drug Denial

For the Request for Redetermination (Appeal) of Medicare Prescription Drug Denial Form click here .

2023 Medication Therapy Management Program

If you’re in a Medicare drug plan and you have complex health needs, you may be able to participate in a Medication Therapy Management (MTM) program. MTM is a service offered by Solis Health Plans 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, we will send you a letter inviting you to participate in the program and information about the program, including how to access the program. 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:

  1. Have at least 3 of the following conditions or diseases:
    1. Alzheimer's Disease.
    2. Bone Disease-Arthritis-Osteoporosis.
    3. Chronic Heart Failure (CHF).
    4. Diabetes.
    5. Dyslipidemia.
    6. Hypertension.
    7. Mental Health-Depression.
    8. Asthma.
    9. Chronic Obstructive Pulmonary Disease (COPD).
  2. Take at least 8 covered Part D medications.
  3. Are likely to have medication costs of covered Part D medications greater than $4,935 per year.

To help reduce the risk of possible medication problems, the MTM program offers two types of clinical review of your medications:

  1. Targeted medication review: at least quarterly, we will review all your prescription medications and contact you, by phone or mail, and/or your doctor if we detect a potential problem.
  2. Comprehensive medication review: at least once per year, we offer a free discussion and review of all of your medications by a clinician 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 via telephone by our Clinical Engagement Center. The CMR may also be provided in person at your provider’s office, pharmacy, or long-term care facility.

This review requires about 30 minutes of your time. Following the review, you will get a written summary of this call, 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.
  • Personal Medication List (PML): The medication list will help you keep track of your medications and how to use them the right way.

Click here to download a blank copy of the Medication Action Plan (MAP) to help you get the best results from your medications.

Click here to download 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.

To learn more about Medication Therapy Management, Click here.

If you take many medications for more than one chronic health condition contact your drug plan to see if you’re eligible for MTM, or for more information, call the Nativus Medication Therapy Management (MTM) program team 1-888-913-7885, Monday through Thursday 9 a.m. to 8 p.m. Eastern Time and on Friday 9 a.m. to 6p.m. Eastern Time. TTY users can reach our program team through the National Relay Service 711, during the same hours as show above. You may also learn more by visiting our website http://www.navitus.com/clinical-engagement-center.