GBT Source Solutions®—helping your Oxbryta patients start and stay on treatment as prescribed

Enroll your Oxbryta patients in GBT Source Solutions today

How to enroll:

Complete Prescriber pages 1-2 of the GBT Source Enrollment Form, which includes a valid Oxbryta prescription. Have your patient (or their Authorized Caregiver*) complete and sign the Patient Authorization and Consent Form to receive support from GBT Source Solutions.

*An Authorized Caregiver is someone who is legally authorized to make decisions on behalf of the patient.

GBT Source® HCP Portal icon.

GBT Source HCP Portal

Streamline patient enrollment: enroll
patient into GBT Source.

Download icon.


Download the Prescription/
Enrollment Form

Fax the completed form to
(888) 418-4178

Enrollment into GBT SourceTM

  • HCP completes and sends all necessary enrollment information to GBT Source
  • Patient completes and signs Authorization Form, and form is sent to GBT Source

GBT Source reviews benefits and coverage requirements

  • Informs HCP of prior authorization requirements
  • Informs HCP of appeal requirements, if needed

GBT Source communicates benefit investigation findings to insured patients

  • Informs patient of out-of-pocket costs and potential support
  • Informs HCP of discussion with patient and next steps


  • GBT Source sends enrollment form (prescription) to specialty pharmacy
  • Specialty pharmacy contacts patient to schedule shipment

Ongoing refill and adherence services

  • Specialty pharmacy contacts patient on a regular basis to schedule and send refills
  • Specialty pharmacy and GBT Source continue ongoing contact with patient to help address access and adherence challenges

Helpful tips to streamline enrollment

Once you’ve talked to your patient about the benefits of enrolling in GBT Source:

Complete all sections of the Prescription/Enrollment Form and sign/enter the date in the appropriate boxes

Verify that patient’s contact and insurance information is correct (you may also include a copy of the front and back of your patient’s insurance card with the Prescription/Enrollment Form)

Provide your contact and alternative office contact details to GBT Source for quick and efficient communication

Make sure your patient (or their Authorized Caregiver) reads, signs, and dates the Patient Authorization and Consent Form

GBT Source Solutions is a resource for your patients that offers access and reimbursement support after Oxbryta has been prescribed

Support for your eligible patients throughout the treatment process

Financial Assistance icon.


Reimbursement Support icon.


Specialty Pharmacy icon.


Adherence Support icon.


Explore the access and support available to your patients

Visit the GBT Source
Solutions website

Enrolled patients must meet GBT Source eligibility criteria.

Oxbryta has widespread payer coverage nationwide

The GBT Source Commercial Copay Program may cover up to a maximum of $15,000 per calendar year of out-of-pocket expenses related to Oxbryta tablets

Patients who do not have health insurance may qualify for the GBT Source Solutions Patient Assistance Program (PAP) for Free Drug. Please call us at (833) 428-4968 for information about this program

For patients with government-funded insurance who need assistance, GBT Source can provide information on independent charitable patient assistance programs. GBT Source does not have any affiliation with these programs nor does GBT determine eligibility

For your practice/patients

Access Navigators icon.

Access Navigators

  • Answer questions and provide information on access requirements related to Oxbryta, including GBT Source resources, navigating the insurance process, and the Patient Assistance Program
  • Assist your practice with on-site, in-person support or with virtual, online support
  • Contact patients who opted in during enrollment to schedule an introductory session to provide an overview of the services provided by GBT Source

For your patients

Care Coordinator icon.

Care Coordinators provide reimbursement support

  • Discuss and verify insurance benefits
  • Determine if prior authorization is necessary
  • Inform you and your patients (or their Authorized Caregivers) about out-of-pocket costs
  • Provide information about appeals process if coverage is denied
Nurse Support icon.

A Nurse Support Team provides adherence support§

  • Help your patients start and stay on Oxbryta as prescribed
  • Provide resources and answer general questions about treatment with Oxbryta

§The Nurse Support team is available to support product adherence, and does not replace a patient’s treatment plan. They do not provide medical advice or case management services.

For your patients/practice

Specialty Pharmacy icon.

Specialty Pharmacy

  • Coordinates shipment of Oxbryta once prescribed
  • Follows up with patients (or their Authorized Caregivers) after shipments are delivered
  • Monitors prescription refills and requests refill authorization as needed
  • Notifies you and your patients of any treatment challenges or refill issues
  • Answers any questions your patients may have (pharmacist available by phone 24/7)
GBT Source Solutions® HCP Portal icon.

To learn more, call

(833) 428-4968


(833-GBT-4YOU) M-F, 8am–8pm ET

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