For U.S. healthcare providers only

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Forms & Resources

Enrollment unlocks 1⁠-⁠on⁠-⁠1 support and resources

Enrollment Form Icon

Enrolling in YourBlueprint™ is simple: complete the enrollment form and make sure your patient provides their consent and authorization

Enrollment form

To initiate enrollment, print and complete the enrollment form with your patient and fax it to 1-866-370-3082.

Enroll your patients through CoverMyMeds*

Log on and access your user account

Additional ways to obtain patient consent and authorization

Regardless of which product is being prescribed, if your patient did not provide consent in person, they can provide it either:

Additional tools to help start your patients on a Blueprint Medicines therapy

Download a patient program overview to inform your patients about the support YourBlueprint provides.

Inform your office and others about YourBlueprint with the program overview for providers.

 

Download a sample letter to provide in case you need to confirm the medical necessity and appropriateness of a Blueprint Medicines therapy for your patient. Once appropriately modified and completed, submit it to your patient’s insurer.

 
 

Download a sample letter of appeal to use in the event your patient is denied coverage for a Blueprint Medicines therapy. Once appropriately modified and completed, submit it to your patient’s insurer.

 
 
 

Download this sample letter to use as a guide to request a formulary exemption for a Blueprint Medicines therapy for your patient. Once appropriately modified and completed, submit it to your patient’s insurer.

 
 
 
 

This comprehensive checklist provides guidance on submitting a prior authorization to an insurer and suggested documents to include.

 
 
 
 
 
This comprehensive checklist provides guidance on submitting an appeal to an insurer and suggested documents to include.

This comprehensive checklist provides guidance on submitting a formulary exception request to an insurer and suggested documents to include.

 
 
 
 
 
 
 
Follow these simple instructions to ensure your practice pharmacy is contracted with our claims processor and can receive reimbursement for the Co⁠-⁠Pay Assistance Program.
Download this comprehensive guide for a detailed overview and instructions on utilization of the YourBlueprint patient support program—assisting your patients with access to their prescribed medication.
This comprehensive guide provides detailed information about product ordering, distribution, YourBlueprint patient support, coverage, and access for AYVAKIT. It includes helpful resources such as documentation checklists for prior authorizations and appeals, sample letters for appeals, medical necessity and formulary exceptions, and a diagnostic testing, billing, and coding guide.
This comprehensive guide provides examples of diagnosis codes that may be appropriate for the FDA-approved indication for AYVAKIT. These codes are provided for information only.

Complete the AYVAKIT dose exchange form to allow patients who have a change in their dose of AYVAKIT to exchange remaining medication for the new dose.

 
 
 
 
 
 
 
 
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YourBlueprint: Our priority is your patient

Forms & Resources

Forms and resources

Enrollment Initiation Icon
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 and HIPPA authorization online (facilitated through DocuSign).
If you would prefer not to provide your consent and HIPPA authorization 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 a Blueprint Medicines therapy, your healthcare provider can enroll you into the program. To complete your enrollment, you will need to provide your consent and HIPPA authorization in-office, online (facilitated through DocuSign), 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).

Your dedicated team includes a Case Manager and Patient Navigator, who are here to provide support with getting on your prescribed therapy and ongoing support once you are on therapy. Meet your team to learn more about how they can help throughout your treatment journey.

YourBlueprint is a free resource for patients who have been prescribed a Blueprint Medicines therapy.

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.

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 opt out by calling 1-888-BLUPRNT (1-888-258-7768), emailing info@yourblueprint.com, or sending a letter to PO Box 15590, Pittsburgh, PA 15244.

Beyond YourBlueprint, take a look at outside resources that support people with cancer and their families:

These advocacy groups are included as a reference for patients, and do not imply endorsement of the company or its products by the groups listed. Blueprint Medicines is not affiliated with and does not endorse any particular advocacy group. We make no guarantees about the accuracy of the information provided on advocacy groups’ websites or the quality of support provided. Descriptions of advocacy group resources and activities have been provided by the independent advocacy groups.

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The information contained in this site is intended for U.S. healthcare providers only

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You will enter a website that is not owned or controlled by Blueprint Medicines. Blueprint Medicines is not responsible for any information, statements, or other content you may encounter on third-party websites and makes no representation as to the accuracy of information contained on websites we do not own or control. Further, Blueprint Medicines does not recommend nor endorse any third-party website. Your use of a third-party website is subject of the terms and conditions of use for such sites.

TERMS AND CONDITIONS

The value of this program is exclusively for the benefit of enrolled patients and is intended to be credited toward patient out-of-pocket obligations, including applicable co-payments, co-insurance, and deductibles. Patient may not seek reimbursement for the value received from this program from other parties, including any health insurance program or plan, flexible spending account, or health care savings account. Patient is responsible for complying with any applicable limitations and requirements of his/her health plan related to the use of the program. Program is not valid where prohibited by law. Valid only in the United States and U.S. Territories. This program is not health insurance. This program may not be combined with any third-party rebate, coupon, or offer. Offer is not available to patients whose prescription claims are eligible to be reimbursed, in whole or in part, by any governmental program, such as patients enrolled in Medicare Part D and patients whose prescription is paid for by Medicare, Medicaid, Medigap, CHAMPUS, Department of Defense (DoD), TRICARE, Veterans Affairs (VA), Children’s Heath Insurance Program (CHIP), the Indian Health Service, or a state pharmaceutical assistance program. Blueprint Medicines reserves the right to rescind, revoke, or amend the program and discontinue support at any time without notice. Offer is not valid if the patient is uninsured or paying cash for the prescription. If you have any questions, please contact customer support at 1-888-BLUPRNT (1-888-258-7768).