Forms & Resources
Forms and resources
If you have not yet finalized your enrollment in YourBlueprint™ with your healthcare provider, complete the process today by providing your consent online.
If you would prefer not to provide your consent online, you can simply complete this form and send it to the email, fax, or mailing address provided on the consent form.
Tell a family member or friend about YourBlueprint: print an overview of the services and support we offer.
YourBlueprint is just a call away. Take a look at some of the questions we are most frequently asked:
Once you have been prescribed AYVAKIT™ (avapritinib), your healthcare provider can enroll you into the program. To complete your enrollment, you will need to provide your consent in-office, online, or in writing. If you choose to provide your consent in writing, you can send your completed form via:
- – Email: firstname.lastname@example.org, or
- – Fax: 1-866-370-3082, or
- – Mail: PO Box 15590, Pittsburgh, PA 15244
YourBlueprint is a free resource for patients who have been prescribed AYVAKIT.
Your specialty pharmacy will work with your insurance provider to check your coverage and determine your costs, then will follow up with you to talk about your options.
AYVAKIT, Blueprint Medicines, YourBlueprint and associated logos are trademarks of Blueprint Medicines Corporation.
© 2020 Blueprint Medicines Corporation.