Prescription Drug Coverage Determination

Some Prescription Drugs Require Authorization

A coverage determination is needed when SOLIS applies rules to certain medications. If you or your prescriber want to waive these rules, you may request an exception to our rules. If your medication requires this action, you, your appointed representative, your prescribing physician or other prescriber will need to request a coverage determination or exception and receive approval in order for SOLIS Health Plans (HMO) to cover your drug.

How do I request a Coverage Determination or Exception?

You, your appointed representative, your prescribing physician or other prescriber can contact SOLIS in one of the following ways:

• Mail

  SOLIS Health Plans

  Attention: Pharmacy coverage determination review team

  PO Box 1039

  Appleton, WI 54912-1039

• Fax

  1-855-668-8552

• Phone

  1-833-615-9259

• Or using a secure link

  Click here to be redirected to the secure coverage determination process

Note:You can also access the Part D Coverage Determination Request Form from the CMS part D webpage by clicking this link: Click here (for use by enrollees and providers)

If you have any questions or concerns, please contact our Member Services department at 1-844-447-6547, TTY 711, from 8 a.m. to 8 p.m. seven days a week from Oct. 1 – March 31 and 8 a.m. to 8 p.m. Monday-Friday from April 1 - Sept. 30. You may always leave a voicemail message after hours, Saturdays, Sundays, and holidays and we will return your call within 1 business day.