CAREAssist has contracted with Ramsell as the PBA/PBM (Pharmacy Benefits Administrator / Pharmacy Benefits Manager).
Most clients will be required to use aCAREAssist 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.
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.
Authorization request form
Treatment exception form
Compounded drug attachment form
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.
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.
Help your Clients Quit Tobacco
CAREAssist provides a variety of free resources for clients who want to quit tobacco, including:
- Free nicotine replacement therapy (patches, gum, lozenges) through a preferred pharmacy
- Prescription medications.
Factsheet: Tobacco cessation services for people living with HIV.
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.
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 clinical providers referral form to refer a CAREAssist client to the MTM program.
Forms and Applications
CAREAssist documents are available on the Forms and Applications page.
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:
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.
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.
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.
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.
CAREAssist is governed by Oregon Administrative Rule, 333-022-1000.