Need immediate prescription coverage?

The Bridge Medication Program may be able to assist you while you are applying for CAREAssist.

CAREAssist Application and Instructions

The CAREAssist program is designed for HIV positive individuals who need financial help to pay for their HIV medications ongoing. CAREAssist can pay for medications and medical services for those who qualify.

Once you have downloaded the application, please take a minute to review the instructions. Most of the questions are easy to understand, but some may need an explanation. You may also have to gather information from your personal records.

If you need assistance with any part of the application, please call 971-673-0144 or 1-800-805-2313.

• Application  and Instructions 
• Affidavit of Zero Income Form  - you must complete this form and submit it with your application if you are reporting zero income.
• HIV Verification Form  - must be signed by a health care provider and submitted for a complete application. 
• Solicitud confidencial de CAREAssist & Instrucciones 
• Declaración de no ingresos 
• Formulario de confirmación VIH/Sida 

Residency Verification Forms

As of August 1st, 2012, proof of residency must be documented for every CAREAssist client. Clients are required to submit proof at the time of application and every six months when completing the Client Eligibility Review (CER) if their address has changed as of their last CER. Please see the list of acceptable residency documents. Documents must be current and have a residential address that matches the address provided on the CAREAssist application/CER. Options for providing proof of residency are as follows:

• Option 1. One Tier 1 document
• Option 2. Two Tier 2 documents
• Option 3. CAREAssist Residency Verification form (in English) PDF | Word or (Spanish) PDF | Word

The Residency Verification form should be used only when no Tier 1 or 2 documents exist.

CAREAssist Eligibility Review

A Client Eligibilty Review (CER) must be conducted every six months. Failure to complete and return the CER could delay or end your eligibility with the CAREAssist program.

• CER Form and Instructions.pdf

Cost Share Adjustment Request

If you are a CAREAssist member and your income changes by 25% or more, you may be eligible to apply for a cost share adjustment. Please complete the form and submit to the CAREAssist Program.

• Cost Share Adjustment Request form 
• Pedido de ajuste en la coparticipacion

CAREAssist Complaints and Grievances

It is the policy of the CAREAssist program to consistently respond with diligence to concerns voiced by clients about the administration of the CAREAssist program or policy issues regarding the program.

• CAREAssist Complaint and Grievance Policy  - Concerns and complaints will be resolved in the least formal manner using a variety of approaches while grievances must regard decisions, which affect a client's eligibility, amount, or length of time of assistance, and/or termination of assistance for program violations. 
  
• Grievance Policy and Form  - Grievances may only be filed for (1) denial of eligibility to participate in the CAREAssist program (2) denial of a request for CAREAssist program assistance (3) denial of a request for exception (4) termination of assistance for program violations. 
  
• Procesos de queja formal e informal 
• Programa de cuidado y tratamiento del VIH Politica y formulario de queja formal de CAREAssist

WellPartner Mail Order Enrollment

By using the mail order pharmacy, all of your medications (both HIV and non-HIV medications) will be mailed to your home or other location that you choose. If you use the mail-order pharmacy, you will still be able to use a local pharmacy to get urgently needed medication (like a short-term antibiotic). 
  
You can register for the mail order pharmacy by calling Wellpartner at 1-888-206-1605 or filling out a form:

1. WellPartner Order Form (English)
2. WellPartner Order Form (En Español)

Once you have gotten your first prescription, you can register for an online account and request refills online.

Medication Therapy Management

In partnership with Ramsell, CAREAssist is pleased to offer Medication Therapy Management (MTM) to eligible clients who are having difficulty adhering to medication regimens. MTM provides phone-based support to patients through direct adherence counseling with an HIV pharmacist. Both medical providers and Ryan White case managers can refer clients of concern to the MTM program.

For medical providers, use the MTM clinical providers referral form 

For Ryan White case managers, use the MTM case managers referral form