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
Tips to streamline enrollment
After talking to your patient about the benefits of enrolling into GBT Source Solutions:
Complete all sections of the Enrollment Form and sign/enter the date in the appropriate boxes
Verify that the patient’s contact and insurance information is correct (or include a copy of the patient’s insurance cards with the Enrollment Form)
Make sure your patient reads, signs, and dates the Patient Authorization Form
Provide an office contact to GBT Source Solutions for quick and efficient communication
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
*Enrolled patients must meet GBT Source eligibility criteria.
Financial assistance programs available for eligible patients
For eligible, commercially insured patients
GBT Source Solutions Commercial Co-pay Program helps cover out-of-pocket expenses related to Oxbryta†
For patients with government insurance
Referrals to independent charitable patient assistance programs‡
For eligible uninsured patients
Please call (833) GBT-4YOU for details about the GBT Source Solutions Patient Assistance Program (PAP)
†Up to a maximum of $15,000 per year, subject to certain term and conditions.
‡Resources include referrals to independent nonprofit patient assistance programs. Eligibility for resources provided by independent nonprofit patients assistance programs is based on the nonprofits’ criteria. GBT has no control over these programs and provides referrals as a courtesy only.
Our team is here to offer assistance to you and your patients
For your patients
Available for your patients by phone to discuss insurance benefits and review financial assistance programs for eligible patients
resources and personalized support for patients
§The Nurse Support team is there to support product adherence, and not replace a patient’s treatment plan. They do not provide medical advice or case management services.
For your practice
Assist your practice with onsite,
in-person support providing information on GBT Source resources and help with navigating insurance and access requirements for your patients prescribed Oxbryta
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A message from Dr. Ted W. Love
President and CEO, Global Blood Therapeutics, Inc.
Thank you for visiting the NMA 2020 Virtual Conference!
We are proud to participate in this important meeting and appreciate your interest in learning more about GBT and Oxbryta® (voxelotor) tablets. We at GBT share your passion and commitment to improving the lives of patients. Together, we can make a difference.
I encourage you to explore our website to learn more about Oxbryta.
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