Pharmacy Information
CAREAssist has contracted with Ramsell as the PBA/PBM (Pharmacy Benefits Administrator / Pharmacy Benefits Manager).
Most clients will be required to use a 
CAREAssist In-Network pharmacy. Some clients may be allowed to use an out of network pharmacy in some circumstances. The
Pharmacy Locator on the Ramsell website includes both in and out of network pharmacies which can process a claim through the Ramsell system. Click HERE to see a map of in-network pharmacy locations.
CAREAssist clients that have the Oregon Health Plan (OHP) as their primary insurance, may use any pharmacy that their Coordinated Care Organziation (CCO) allows when CAREAssist is not participating in the claim.
Pharmacy related forms can be found on the
Ramsell website.
Formularies (under the "What drugs are covered?" drop-down option in the FAQs section on the Ramsell page)
Authorization request form
Treatment exception form
Compounded drug attachment form
Formulary
CAREAssist will pay co-pays on most medication prescribed by a doctor. In the event that insurance will not cover the cost of a medication prescribed by your doctor, CAREAssist will pay full cost for all medications on their formulary at a CAREAssist preferred, in-network, pharmacy.
Prescriber Information
CAREAssist as Primary Payer of services
If a CAREAssist client has no insurance, CAREAssist will pay for out-patient service CPT codes. When CAREAssist acts as the primary payer, CAREAssist will pay providers at 125% of the Oregon Health Plan (Medicaid) reimbursement rate.
Review the
current OHP fee schedule for more information.
Bridge Program
The CAREAssist Bridge Program provides assistance to help individuals obtain HIV medications for up to 30 days. The Bridge Program will assist with payments for
limited medical services necessary to allow a primary care provider to prescribe HIV treatments. Assistance provided under this program is intended to help persons meet their medication needs while applying and enrolling in health insurance and CAREAssist. An application for the Bridge Program must be completed by an HIV provider.
See the
Bridge Program for an application and list of Bridge-approved pharmacies. All Bridge-approved medications are indicated by a "C" in the left-hand column of the
Oregon Formulary by Class.
Bridge Payments
CAREAssist will reimburse providers at 125% of the Oregon DMAP (Medicaid) rate for a limited number of service CPT codes. Review the
Bridge approved CPT codes for more information. Dispensing guidelines and the
Treatment exception form can be found on the
Ramsell website.
Medication Therapy Management (MTM)
In partnership with CAREAssist, Ramsell is pleased to offer Medication Therapy Management (MTM) to eligible clients who are having difficulty adhering to medication regimens. MTM provides phone-based support with an HIV pharmacist who will work with the patient to fit their medication regimen into their life. The HIV pharmacist will conduct a complete review of all medication. After each interaction, the patient and medical provider will receive a comprehensive list of all medications that a patient is currently taking and identified issues found in their medication regimens with specific recommendations and modifications for improvement. Patients will also be eligible to receive a free package of over the counter (OTC) medications that may be used to treat common adverse effects to HIV medications including loperamide, diphenhydramine, hydrocortisone cream, and ibuprofen.
Use the
MTM direct referral form to refer a CAREAssist client to the MTM program.
Sample Packs
The starting of antiretroviral treatment (ART) is a key strategy in ending the HIV epidemic. Early initiation of ART (defined as starting ART as soon as possible after diagnosis) improves linkage to and retention in care, reduces time to viral suppression, decreases viral transmission, and decreases morbidity and mortality for people with HIV.
Sample packs are a tool for prescribers that can be used with HIV Rapid Starts. A sample pack is 7 days of ART that providers can give at no cost while the patient applies for CAREAssist Rapid ART Bridge, CAREAssist full benefits, or other services that patients may be eligible for which will help them establish ongoing access to ART and lead to viral suppression.
This text is provided for informational purposes only. The distribution of sample packs is not administered by the Oregon Health Authority. CAREAssist is not responsible for nor does it specifically endorse any drug manufacturer or their products.
Providers and clinics interested in free ARV samples, click here: ARV Sample Contacts
Forms and Applications
CAREAssist documents are available on the
Forms and Applications page.
Billing Information
The CAREAssist Program is a federally funded program administered by the Oregon Health Authority. For billing purposes, please submit a Health Insurance Claim Form (HICF 1500) along with the primary insurance explanation of benefits (EOB) to:
CAREAssist Program/TPA
P.O. Box 14450
Portland, OR 97293
The Oregon Health Authority's method of payment is Electronic Funds Transfer (EFT) which allows providers to receive payment directly deposited into a bank account of their choice. For more information on how to set up the ability to receive payment, please refer to
Electronic Funds Transfer Information and FAQs. Click on the ACH/Direct Deposit links, available in .doc and .pdf formats. If EFT is a problem, contact the
CAREAssist Program.
Treatment Guidelines
Information for providers on
HIV Treatment Guidelines can be found at the following links:
Risk Reduction Messages
The program also encourages providers to provide risk reduction messages at every client visit. Best practices suggest that providers should spend 5 minutes of every patient visit discussing risk reduction with their client. After receiving a positive HIV test result, many people decrease behaviors that may transmit HIV to others. However, recent studies suggest that not all HIV-infected people maintain such behavioral changes over time and that some continue to engage in behaviors that place others at risk for HIV infection.
HIV Infected Adults and Children Displaced from Disaster Areas
In the event of an emergency, consider thisGuidance for non-HIV specialized providers caring for HIV infected residents displaced from disaster areas.
Oregon AIDS Education and Training Center
Looking to increase your capacity in treatment of your patients living with HIV The Oregon AIDS Education and Training Center (Oregon AETC) offers HIV treatment education, clinical consultation, capacity building, and technical assistance to health care professionals and agencies throughout Oregon. For more information visit the Oregon AETC website.
Partner Notification
Prevention messages and discussion should be a consistent part of every treatment plan. Partner notification services are available to help your patient notify sex and needle-sharing partners they may have put at risk. Disease Intervention Specialists (DIS) are available throughout the state to provide those at risk with education and referral. DIS can either coach your patient on how to inform their partners, or actually initiate confidential contact of a named person on behalf of your patient. For more information about partner notification services.
Administrative Rules
CAREAssist is governed by Oregon Administrative Rule,
333-022-1000.