Pharmacy
Important Information
As a key member of our provider network, you can guide your patients to receive their prescription medications that are covered under Part D through any participating network pharmacy. Our goal is to ensure access to cost-effective and clinically appropriate therapies.
Formulary
The Solis Health Plans Formulary, also known as the Drug List, outlines covered medications—both generics and brand-name—selected based on their clinical effectiveness and value. As a provider, you can reference, download, and share this resource to support your prescribing decisions.
Provider/Pharmacy Directories
Solis members must go to any of the pharmacies in our network.
Solis Health Plans covers the diabetic supplies that may fit the needs of our members and make managing conditions easier. Below is our list of preferred supplies:
Real Time Benefit Guide
Enables you and your care team to view real-time medication pricing, alternatives, and in-network pharmacy options.
Prior Authorization Criteria
Required for certain medications to ensure clinical appropriateness and plan coverage.
NEW! Each drug that requires a Prior Authorization (PA) has a dedicated PA fax form that can be faxed in for review.
Step Therapy
Members may be required to try preferred therapies before accessing alternative treatments.
Prescription Drug Transition Policy
Supports members whose existing therapies may require approval or exception during plan enrollment transitions.
Prescription Medications – Home Delivery
Members can have prescriptions delivered to their home through our Mail Order Pharmacy options: Express Scripts, Walgreens Mail, and
Amazon Pharmacy.
Coverage Determinations
Prior Authorization, Formulary Exception, Step Therapy, Quantity Limit Exception
When your patient needs an exception or change to their medication coverage, you can submit a coverage determination on their behalf. You can:
Download the Coverage Determination form below and fax it to 855-212-8110. Please attached all pertinent clinical documentation to support the request.
Alternatively, you can complete a general Coverage Determination Request Form online, though additional follow-up may be needed to gather drug-specific details which may delay the process.
Use Cover My Meds through your Electronic Health Record (EHR) software system to request the Prior Authorization. For general support, you can call: 1-866-452-5017 Monday to Friday, 8am to 8pm (EST)For any issues, please contact our Member Services department at 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.
Request for Redetermination (Appeal) of Medicare Prescription Drug Denial
Medicare's Medication Prescription Payment Plan
Medicare's Medication Prescription Payment Plan helps make paying for prescription drugs easier.
This allows members to spread out the cost of their medications over 12 months, so they don’t have to pay everything all at once. The plan also puts a $2,000 limit on how much members pay out-of-pocket each year for prescriptions. This means members can better plan for their medication costs and avoid big, unexpected bills. It's a helpful way to manage prescription expenses and make sure members can afford the medicines they need.
Medication Therapy Management Program
In 2026, Solis continues its partnership 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 one of the two following sets of criteria:
A) Have at least 3 of the following conditions or diseases:
Alzheimer’s Disease
Bone disease-arthritis (including osteoporosis, osteoarthritis, and rheumatoid arthritis)
Chronic congestive heart failure (CHF)
Diabetes
Dyslipidemia
End-stage renal disease (ESRD)
Human immunodeficiency virus/Acquired immunodeficiency syndrome (HIV/AIDS)
Hypertension
Mental health (including depression, schizophrenia, bipolar disorder, and other chronic/disabling mental health conditions)
Respiratory Disease (including asthma, chronic obstructive pulmonary disease (COPD), and other chronic lung disorders)
AND
B) Take at least 8 (eight) covered Part D medications,
ANDC) Are likely to have medication costs of covered Part D medications greater than or equal to $1,276 per year.
ORAre an at-risk beneficiary with an active coverage limitation under a drug management program (DMP).
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 1-866-793-1690 (available 24/7) to schedule your first consult. For Spanish interpretation, call 1-877-253-7244 and request to be connected to 1-866-793-1690. 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. To 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.
Follow these steps for medication disposal in the trash
Remove medication labels to protect your personal information.
Mix medications with undesirable substances, such as dirt or used coffee grounds.
Place mixture in a sealed container, such as an empty margarine tub.
