Let's Rally Around Your Patients

This site is intended only for healthcare professionals of the United States and Puerto Rico.

DIANA

Part of YourSource care team

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To learn more, call (833) 428-4968
OPTION 1 TO SPEAK WITH A REPRESENTATIVE | M-F, 8am-8pm ET

ABOUT YourSource

YourSource ONGOING PATIENT ASSISTANCE

Meet the dedicated YourSource Care Team.

Click/tap below to select and learn more.

Care Coordinators icon
YourSource Care Coordinators
  • Provide reimbursement support to eligible patients
  • Discuss and verify insurance benefits
  • Communicate if prior authorization is necessary
  • Inform you and your patients (or their Authorized Caregivers) about out-of-pocket costs
  • Provide information about the appeals process if coverage is denied
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YourSource Access Navigators
  • Your regionally aligned Access Navigator can answer general questions and provide information on access requirements related to Oxbryta, including YourSource resources, navigating the insurance process, and the Pfizer Patient Assistance Programb
  • Access Navigators also contact patients who opted in during enrollment to schedule and provide an introductory session about the services provided by YourSource
bThe Pfizer Patient Assistance Program is a joint program of Pfizer Inc. and the Pfizer Patient Assistance Foundation. Free medications from Pfizer are provided through the Pfizer Patient Assistance Foundation. The Pfizer Patient Assistance Foundation is a separate legal entity from Pfizer Inc. with distinct legal restrictions. If patient has a Medicare Part D plan and is eligible for the Pfizer Patient Assistance Program, YourSource will notify patient’s Part D plan of their enrollment in the Pfizer Patient Assistance Program.
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YourSource Nurse Support Team
  • Provides adherence education
  • Answers general questions about treatment with Oxbryta
  • NOTE: The Nurse Support Team does not provide medical advice or case-management services. Patients should always talk with you, their healthcare provider, if they need guidance about their specific condition or overall health
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Your Patients’ Specialty Pharmacyc
  • 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 general questions your patients (or their Authorized Caregivers) may have (pharmacist available by phone 24/7)
c

The Specialty Pharmacy does not replace the role of a patient's healthcare provider. Patients should talk with their doctor if they need guidance about their specific condition or overall health.

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Hear Directly From YourSource
Portrait of Diana, a nurse on the YourSource Care Team, outdoors
Hear Directly From YourSource

Listen to a member of our Nurse Support Team discuss what it means to provide patients like yours with support from YourSource.

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YourSource HCP Brochure
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YourSource HCP Brochure

Your guide to helping your patients start and continue treatment as prescribed.

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The Care Team

FREQUENTLY ASKED QUESTIONS

QUICK INFORMATION ABOUT YourSource

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Enroll your patients in YourSource either using the Prescription/Enrollment Form, or through the YourSource HCP Portal.

Each insurer has their own Prior Authorization process, and timelines may differ; however, many patients receive approval within 2-4 days for Oxbryta prescriptions.

Contact YourSource at (833) 428-4968, M-F, 8am-8pm ET, with general questions regarding the Prior Authorization process.

YourSource provides a Sample Appeal Template and a Sample Letter of Medical Necessity Template. If you have general questions while completing the templates, reach out to a YourSource Care Coordinator at (833) 428-4968, M-F, 8am-8pm ET.

YourSource can provide guidance to your patients about available financial assistance programs, dependent upon insurance status and other eligibility criteria.

YourSource Access Navigators are here to help. If you are unsure who your Access Navigator is, contact YourSource at (833) 428-4968, M-F, 8am-8pm ET.

ENROLLMENT

CONNECT YOUR PATIENTS WITH YourSource

Let's work together to help your patients receive additional treatment support. Get started by completing all Prescriber pages of the YourSource Enrollment Formd and have your patient (or Authorized Caregiver) complete and sign the Patient Authorization and Consent Form.

d

Enrollment Form includes valid Oxbryta prescription.

MARKUS

Family man, entertainer, sports enthusiast, and enrolled YourSource member

Pink checkmark on laptop screen Portrait of Markus, a nurse on the YourSource Care Team, outdoors
YourSource HCP Portal

The HCP Portal is a resource to enroll patients in YourSource. Visit YourSourcePortal.com to get started.

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Download/print/fax

Download the Prescription/Enrollment Form. Fax the completed Form to (888) 418-4178.


TIPS TO ENROLL PATIENTS IN YourSource

Once you’ve talked to your patient about enrolling in YourSource:

  • Complete all sections of the Prescription/Enrollment Form and sign/enter 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 Prescription/Enrollment Form)
  • Provide all requested contact information for quick and efficient communication
  • Make sure your patient (or their Authorized Caregiver) reads, signs, and dates the Patient Authorization and Consent Form

YourSource ENROLLMENT PROCESSe

eProcess is subject to variability per patient's coverage type.

Click/tap on the cards below to reveal more information about each step.

STEP 1
Enrolling your patients
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STEP 1
  • Your office will complete and send all necessary prescription/enrollment information to YourSource
  • Patient (or Authorized Caregiver) completes and signs Patient Authorization and Consent Form, and Form is sent to YourSource
  • NOTE: You can complete the enrollment process with the HCP Portal. Click here to visit
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STEP 2
YourSource reviews benefits and coverage requirements
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STEP 2
  • YourSource informs your office of any prior authorization requirements
  • YourSource informs your office of appeal requirements, if needed
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STEP 3
YourSource communicates benefit investigation findings to insured patients
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STEP 3
  • YourSource will call patient (or Authorized Caregiver) to inform them of out-of-pocket costs and potential financial assistance programs and eligibility requirements based on certain terms and conditions
  • YourSource informs your office of discussion with patient and next steps
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STEP 4
Specialty Pharmacy fulfillment
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STEP 4
  • YourSource sends Prescription/Enrollment Form to Oxbryta Specialty Pharmacy Network
  • Specialty Pharmacy contacts patient (or Authorized Caregiver) to schedule Oxbryta prescription delivery
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STEP 5
Ongoing refill and adherence services
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STEP 5
  • Specialty Pharmacy contacts patient (or Authorized Caregiver) on a monthly basis to refill Oxbryta and schedule prescription delivery
  • After patient consent has been obtained, YourSource will continue ongoing contact with patient (or Authorized Caregiver) to provide education on access and adherence
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SUBMITTING AN APPEAL

If your patient’s coverage for Oxbryta is denied, Care Coordinators can provide information about the appeals process. You can submit an Appeal and a Letter of Medical Necessity on behalf of your patient. If your patient is eligible and approved for the Pfizer Patient Assistance Program (PAP), your patient will receive approval for free product.

Sample Appeal Template

Sample Letter of Medical Necessity

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To learn more, call (833) 428-4968
OPTION 1 TO SPEAK WITH A REPRESENTATIVE | M-F, 8am-8pm ET

Contact a Care Coordinator if you have questions when completing these templates.

FINANCIAL ASSISTANCE

YOUR PATIENTS' WAY TO FINANCIAL ASSISTANCE OPTIONS

We know at times patients may worry about paying for treatment. YourSource will work with your patients and their Authorized Caregivers to help explain their insurance benefits and determine which financial assistance options they may qualify for.

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Maya(not an actual patient)

If your patient has commercial, private, employer, or state health insurance marketplace coverage, they could pay as little as $0 per month for Oxbryta, with a maximum benefit of $15,000 per calendar year.f

The YourSource Commercial Copay Program provides financial assistance with out-of-pocket deductibles, copay, or coinsurance costs for eligible patients.f,g

Maya represents an eligible patient who is covered under her parents’ commercial insurance, with a copay of $80. Like more than 90% of commercially insured patients who use YourSource Commercial Copay Program, her parents pay $0 for her Oxbryta treatment.f,g,h

Image of Joshua
Joshua(not an actual patient)

If your patient does not have health insurance, YourSource may be able to help them find programs that provide assistance. We’ll check to see if your patient is eligible for a government program that can help pay for prescription medicines through Medicaid. If your patient appears to be eligible, we’ll guide them on how to apply. We’ll see if they're eligible to receive up to a 90-day supply of Oxbryta for free while applying for Medicaid.

If they do not qualify for Medicaid, they may be able to receive their medication for free for up to 1 year through the Pfizer Patient Assistance Program (PAP).f,i

Joshua is an example of an eligible patient who is uninsured. He applied to and was approved for the Pfizer PAP for eligible patients and receives his Oxbryta treatment for free.f,i

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Kevin(not an actual patient)

If your patient has Medicare/Medicare Part D, Medicaid, TRICARE, or another government insurance plan, YourSource may be able to help identify financial support resources. We can assist them with searching for financial support from alternate funding resources, which may include financial assistance through Extra Help, a Medicare Part D Low-Income Subsidy (LIS) program. If support from alternate funding resources or Medicare Extra Help is not available, we’ll see if your patient is eligible for the Pfizer Patient Assistance Program (PAP) for Free Drug.f,g,i

Kevin represents an eligible patient who has a government-funded insurance plan. He applied to and was approved for the Pfizer PAP for eligible patients and receives his Oxbryta treatment for free.f,g,i

f Subject to eligibility and certain limits, terms and conditions, and annual reenrollment requirements.
g Patients will receive a maximum benefit of $15,000 per calendar year. Patients are not eligible for the YourSource Commercial Copay Program if they are enrolled in a state- or federally funded insurance program, including but not limited to Medicare, Medicaid, TRICARE, Veterans Affairs healthcare, a state prescription drug assistance program, or the Government Health Insurance Plan available in Puerto Rico. For full terms and conditions, call YourSource at (833) 428-4968.
h This is an example representative of YourSource data (November 2019-September 2022). Your patient may have a different experience based on their insurance coverage.
i The Pfizer Patient Assistance Program is a joint program of Pfizer Inc. and the Pfizer Patient Assistance Foundation. Free medications from Pfizer are provided through the Pfizer Patient Assistance Foundation. The Pfizer Patient Assistance Foundation is a separate legal entity from Pfizer Inc. with distinct legal restrictions. If you have a Medicare Part D plan and are eligible for the Pfizer Patient Assistance Program, YourSource will notify your Part D plan of your enrollment in the Pfizer Patient Assistance Program.
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Financial Assistance for Your Patients
Potrait of Markus, Oxbryta patient enrolled in YourSource
Financial Assistance for Your Patients

Hear how our financial assistance has helped Markus, a real patient, continue his Oxbryta treatment as prescribed by his healthcare provider.

Watch now

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FinaNcial Assistance

RESOURCES

RESOURCES TO NAVIGATE A SPECIALTY MEDICATION

Use the resources below to learn more about the support services and coverage options YourSource can provide for your patients.

YourSource HCP Portal

Complete the enrollment process virtually using the YourSource HCP Portal at YourSourcePortal.com.

YourSource Prescription/Enrollment Form

Enroll patients in YourSource by downloading, printing, completing, and faxing the Prescription/Enrollment Form.

YourSource HCP Brochure

Your guide to helping your patients start and continue treatment as prescribed.

Sample Appeal Template

Submit if your patient’s Oxbryta coverage is denied.

Sample Letter of Medical Necessity

Submit if your patient requires treatment with Oxbryta.

Hear From Our Community

Watch videos from a member of our Nurse Support Team and enrolled patients about how YourSource can provide assistance.

Watch now:

YourSource Patient Brochure

Your patient’s guide to Oxbryta access support and getting started with YourSource

YourSource Digital Wallet Card

This convenient Wallet Card provides patients with important YourSource and Specialty Pharmacy phone numbers.

Find Support Organizations

Use our Locator Tool to connect your patients with community-based and national organizations that may offer additional support in their area.j

jThese resources are meant to be informational only and are not intended to replace medical advice.

Learn more about Oxbryta

If you have additional questions or want more information about Oxbryta, explore the website.

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MARKUS

Family man, entertainer, sports enthusiast, and enrolled YourSource member

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