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 an Enrollment Form to prescribe Oxbryta. Your patient must also complete and sign the Patient Authorization Form in order to receive support from GBT Source Solutions.

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Fax

(888) 418-4178

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GBT Source Portal

Enroll patients online at HCP.GBTsource.com

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

Fulfillment

  • 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

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Financial
assistance*

Reimbursement Support Icon

Reimbursement
support*

Specialty Pharmacy Icon

Specialty
pharmacy

Adherence Support Icon

Adherence
support

*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)

For your patients

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Care Coordinators

Available for your patients by phone to discuss insurance benefits and review financial assistance programs for eligible patients

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Nurse Support§

Offers educational 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

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Patient Navigators

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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