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Providers and Prescribers
Looking for the CAREAssist Formulary?

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 health insurance by paying for insurance premiums, doctor visit copays and medication copays. It is our hope that by providing CAREAssist services, Oregonians living with HIV/AIDS are empowered to effectively manage their HIV disease and improve their overall health and quality of life.


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 located on the Ramsell website includes both in and out of network pharmacies which can process a claim through the Ramsell system. CAREAssist clients who have OHP coverage may use any pharmacy that OHP approves. For OHP clients, CAREAssist will pay the prescription copays if the pharmacy is also signed up with Ramsell.

Pharmacy related forms can be found on the Ramsell website.


Formulary

While CAREAssist will pay a co-pay for almost any medication prescribed by a doctor, there are several HIV specific medications that CAREAssist will cover at full cost should insurance not cover the medication. The formulary is updated when a new FDA approved medication is recommended for HIV treatment. A current CAREAssist program formulary  is available.

Prescriber Information

CAREAssist as Primary Payer of services

If a CAREAssist client has no insurance or when these services are not covered due to a pre-existing exclusion imposed by 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 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 to patients through direct adherence counseling 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. After the first interview, 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 clinical providers referral form  to refer a CAREAssist client to the MTM program.


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 this document.


Forms and Applications

Necessary CAREAssist documents are available on the Forms & 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 at 971-673-0144.


Treatment Guidelines

Information for providers on HIV Treatment Guidelines can be found at the following links:

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. 

Guidance for Non-HIV Specialized Providers Caring for HIV Infected Residents Displaced from Disaster Areas

  • In the event of an emergency, you might want to consider this document which provides guidance to health care providers attending to the medical needs of HIV infected adults and children who are displaced as a result of a disaster.

Northwest AIDS Education and Training Center

Looking to increase your capacity in treatment of your patients living with HIV? The Northwest AIDS Education and Training Center (NW AETC) offers HIV treatment education, clinical consultation, capacity building, and technical assistance to health care professionals and agencies in Washington, Alaska, Montana, Idaho, and Oregon. For more information visit the NW 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, or to contact a DIS worker nearest you, visit the Public Health website.


Administrative Rule

CAREAssist is governed by Oregon Administrative Rule, 410-121-3000