At Solis, our goal is to make a difference through personal service. As a valued Solis Health Plans provider, we aim to have all the pharmacy information you need in one place. Below you will find important documents and forms relating to Part D coverage.

2024 Formulary

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

Real Time Benefit Guide

The Real Time Benefit Check helps you, as a physician, search for the lowest-cost pharmacy and medication available. You can find information on how to use the RTBC here

To access the Real Time Benefit Tool click here.

Prescription Drug Transition Policy

When entering a new plan, getting used to all of the changes can be confusing for members. 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 (2024)

Coverage Determination Request Form/ Exception Request

To request a drug coverage determination, the member, an appointed representative, or you, as the prescribing physician can contact Solis in one of the following ways:

  • The member can ask their prescribing physician or other prescriber to submit the request for you. You 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, the prescribing physician or other prescriber can submit a coverage determination request form for the member. The 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. The 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.

Request for Redetermination (Appeal) of Medicare Prescription Drug Denial

Download the Redetermination (Appeal) Request Form here

2024 Medication Therapy Management Program

As of January 2024, Solis will be partnering with Aprexis Health Solutions to deliver Medication Therapy Management (MTM) to our qualified members.

If a Solis member has complex health needs, they 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 members and their doctors doctor make sure that 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, members must meet ALL the following criteria:

  1. Have at least 3 of the following conditions or diseases:
    1. Chronic Heart Failure (CHF)
    2. Diabetes
    3. Dyslipidemia
    4. Hypertension
    5. Asthma
    6. Chronic Obstructive Pulmonary Disease (COPD)
  2. Take at least 8 covered Part D medications, and
  3. 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 for medications:

  1. Targeted Medication Review: at least quarterly, we will review all the member’s prescription medications and contact the member and/or doctor if we detect a potential problem.
  2. Comprehensive Medication Review (CMR): at least once per year, we offer a free discussion and review of all the member’s medications by a pharmacist or other health professional to help you use your medications safely. This review is provided to the member confidentially on behalf of Solis Health Plans and Aprexis and will be provided via telephone or in-person at the assigned pharmacy.

Following the review, members will get a written summary of the discussion, which they can take with them to their appointments. This summary includes:

  • Medication Action Plan (MAP): The action plan has steps that a member can take to ensure they get the best results from their medications. To obtain a blank copy of the Medication Action Plan (MAP), click here and download the attached form.
  • Personal Medication List (PML): This medication list will help members track their medications and how they can use them the right way. To obtain a blank copy of the Personal Medication List (PML), click here and download the attached form.

To learn more about our MTM program or get started, call our Solis MTM Program at 1-866-793-1690 (TTY: 711). To learn more about Aprexis, visit them at

Important Pharmacy Documents and Forms: