Clients

AIDS Drug Assistance Program (ADAP)

ADAP provides access to medications for people living with HIV.

CAREAssist is Oregon's version of ADAP. CAREAssist helps people living with HIV or AIDS pay for medication and other medical care expenses. We are not health insurance, but we help individuals maintain and utilize health insurance by paying for insurance premiums, doctor visit copays and medication copays.

Handbook

The CAREAssist Client Handbook describes the services and expectations of the program. Please contact CAREAssist if you have questions related to this resource.

CAREAssist Client Handbook (English)

CAREAssist Client Handbook (en español)

Am I eligible

To become a member of CAREAssist, you must:

1. Have a confirmed HIV status
   
2. Reside in Oregon
3. Currently have medical insurance or be in the process of applying for medical insurance. We can help you with this.
4. Have income below 550% of the Federal Poverty Level (FPL). CAREAssist uses the Federal Poverty Level to determine eligibility based on income. The FPL is based on income and household size. To determine FPL, CAREAssist includes almost all forms of income, including work income/wages/salaries, disability, self-employment income, pension/retirement income, child support and unemployment.
   
   

What if I can't get health insurance outside of open enrollment

For persons who are unable to secure health insurance outside of an open enrollment period, CAREAssist can assist with payments for a limited number of medical services and medications (indicated by a "C" in the left hand column) through the Uninsured Persons Program (UPP). Persons enrolled in this program must also be enrolled in community-based Ryan White HIV case management, and stay closely connected to the CAREAssist program to ensure that ongoing health insurance is secured as soon as it becomes available. To see if you are eligible, please contact the program or complete a CAREAssist application.

How do I apply

All CAREAssist forms and instructions, including the application and a Client Eligibility Review (CER) form are available on the Forms and Applications page.

If you need immediate assistance with medications, the Bridge Program provides assistance to help individuals obtain HIV medications for up to 30 days. Assistance provided under this program is intended to help persons meet their medication needs while applying and enrolling in health insurance and CAREAssist.

What medications are covered

If you're using an In-Network Pharmacy, CAREAssist can help with out-of-pocket expenses on most drugs, not just medications that treat HIV. There is no annual dollar limit to prescription help.

If you're insured: CAREAssist will pay copays, deductibles and coinsurance on medications covered by your insurance. If your insurance denied coverage, CAREAssist can pay for the full cost of any non-excluded items (See What medications do I have to pay for).

If you are uninsured: Call your CAREAssist Case Worker or HIV Case Manager immediately. You may be eligible for insurance and help with out-of-pocket expenses. If we can't get you insurance, CAREAssist will pay full cost for any non-excluded items.

Important Note: If you use a non-network pharmacy (including Kaiser), and you need help with a prescription not covered by your insurance, you must transfer the prescription to an In-Network Pharmacy.

View the Open Formulary Notice sent to clients May 2016

What medications do I have to pay for (Excluded Items)

CAREAssist cannot pay full cost for medications prescribed for:

1. Anorexia, weight loss, weight gain
2. Fertility purposes
3. Hair growth or cosmetic purposes
4. Non-prescription drugs
5. Nutritional/Dietary Supplements (including Herbal supplements)
6. Prescription vitamins and mineral products
• Note: Fluoride, Niacin, Vitamin D analogs, Prenatal & B vitamins are not excluded
7. Durable Medical Equipment
• Note: Diabetic Supplies are not excluded
8. Sexual/Erectile Dysfunction
• Note: Allowed for Benign Prostatic Hyperplasia (BPH) only. Call CAREAssist for more information

What pharmacies can I use

Please choose one of our In-Network pharmacies. You can view the list of CAREAssist in-network pharmacies, or to find the closest CAREAssist network pharmacy nearest you, use the Pharmacy Locator on the left side of the Ramsell webpage. Fill in your city, zip code and county, and hit the locate button. In-Network Pharmacies will be highlighted in red. For an urgently needed medication (like a short-term antibiotic), you may be able to use an Out of Network pharmacy that is closer to you.

In the event of a state declared emergency, you will be able to pick up medications at almost any pharmacy in the state. Please see the Emergency Preparedness Fact Sheet (en español) for more information.

Who will be my health insurance

CAREAssist is happy to help pay premiums for most health care insurance plans, Medicare, OHP, employee based insurance programs, and all Silver Level plans through the Federal Exchange.

What other services are available

Some CAREAssist members may also have an HIV case manager. HIV case managers are located throughout the state. They know about the services and programs available in your area to help HIV-positive Oregonians and their families. They can help with information and referrals, adherence to HIV medications, and coordination between your health care providers. Case managers can help determine eligibility for various programs that can assist you. HIV case managers are found at community based organizations, health departments and health clinics.

You may qualify for help with:

• HIV case management
• Dental care
• Mental health therapy/counseling
• Drug and alcohol treatment/counseling
• Housing related assistance
• Transportation
• Food
• Utilities
• Other supportive services

All available services depend on current funding levels. They may vary from county to county. To find the HIV case manager nearest you, call the Oregon HIV/STD Hotline at 800-777-2437

Grievance Procedure

English
Spanish

How do I get involved

Make your voice heard. Check out the CAREAssist Advisory Group or join us on Facebook and Twitter for HIV related information, events and discussion. Tell us what you think!