Forms & Resources

Forms and resources

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If you are looking for forms and information, you are in the right place

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.

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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:

Once you enroll in YourBlueprint, you will be contacted by your dedicated Case Manager who will provide ongoing support to you throughout treatment depending on your specific needs. Please be on the lookout for a call from 1-888-BLUPRNT (1-888-258-7768).

YourBlueprint is a free resource for patients who have been prescribed AYVAKIT.

YourBlueprint can help you figure out what help is available for you. Contact YourBlueprint at 1-888-BLUPRNT (1-888-258-7768) to learn about your options.

Patients with government insurance are not eligible for the Co-Pay Assistance Program. Contact YourBlueprint at 1-888-BLUPRNT (1-888-258-7768) to learn about other potential options.

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.

You should contact your healthcare provider immediately if you are having any side effects. You may also contact Blueprint Medicines at 1-888-BLUPRNT (1-888-258-7768) or the Food and Drug Administration (FDA) at 1-800-332-1088 to report any side effects.

If you no longer wish to receive support from YourBlueprint, you can call 1-888-BLUPRNT (1-888-258-7768) to opt out.

Connect with YourBlueprint today. Call us at 1-888-BLUPRNT (1-888-258-7768) Monday-Friday, 8 AM-8 PM Eastern Time (ET)

This website does not provide medical advice. The information provided on this website is for educational purposes only and is not intended to replace discussions with a healthcare provider, including questions related to your condition or care. All decisions regarding patient care must be made with  a healthcare provider, considering the unique characteristics of the patient. Please see our Terms of Use for more information.

AYVAKIT, Blueprint Medicines, YourBlueprint and associated logos are trademarks of Blueprint Medicines Corporation.
© 2020 Blueprint Medicines Corporation.
01/2020     USBP-PSP-19.041.1