Access & Reimbursement
YourBlueprint™ aims to simplify access
You choose the dispensing method, we’ll provide the support
Your patients can receive their Blueprint Medicines therapy either through a qualified medically integrated dispenser (MID), or one of our network specialty pharmacies. Once a dispensing method is selected, patients will need to enroll with YourBlueprint. From there, we’ll help coordinate the process and can answer any questions you may have along the way.
Submit the prescription to your MID.
MID conducts benefits investigation, prior authorization, and appeal when required:
- If insurer requires use of a Blueprint Medicines specialty pharmacy, follow the steps to route the prescription to the specified specialty pharmacy
- If your MID needs assistance with reimbursement support, YourBlueprint can help
- Patient receives medication
Complete the prescription and send to your preferred Blueprint Medicines specialty pharmacy via fax or eRx.
Specialty pharmacy:
- Conducts benefits investigation and routes patient to an alternate pharmacy if required
- Assists your office with prior authorization and appeals support
- Coordinates with YourBlueprint and your office staff to enroll eligible patients in support programs
- Delivers medication to your patient’s home
YourBlueprint can conduct benefits verifications
Your patient’s Case Manager can conduct a benefits verification to determine a patient’s health insurance coverage and out-of-pocket costs. After verifying coverage, we’ll provide a summary of benefits to you over the phone as well as fax. For the patient, we can call to review the summary of benefits verbally, and upon request, we can mail a copy to the patient.
Prior authorization requirement? We can help.
Our Case Managers can support your patient through the process of managing a prior authorization requirement. Here is what you can expect:
- First, we will coordinate with your patient’s insurer to gather the prior authorization requirements, including the payer specific documents.
- Your patient’s Case Manager will then contact you to help guide you through the submission process and provide you the necessary documents, including a documentation checklist.
- After your office submits the prior authorization request, upon your request, we can track the progress and communicate the status of a prior authorization to you.
Ask us about appeals support
In the event of a prior authorization denial, your patient’s Case Manager can assist with an appeal of the payer’s decision via a request for reconsideration by providing:
- Additional guidance on types of information to include
- A documentation checklist
- A sample letter of medical necessity and/or a sample letter of appeal
Formulary Exceptions Requests
Your patient’s Case Manager can help you understand the formulary exception requests process by providing:
- Background information
- Payer processes
- Documentation checklist
- Sample formulary exception request letter
Uninterrupted access is our goal
YourBlueprint offers the following no cost options to eligible patients who need assistance accessing their Blueprint Medicines therapy while awaiting an insurance coverage determination or while transitioning between doses. Take a look at the following situations to see which programs we offer.
- Eligible patients may receive 3 refills pending insurance coverage
- Available to patients with private/commercial or government insurance experiencing delays in coverage
- Patients must be new to therapy
- Enrollment in YourBlueprint is required
*Please ensure to include the QuickStart prescription selections on the enrollment form for faster processing.
Upon receipt of enrollment form, your patient’s Case Manager will communicate your patient’s program eligibility determination by fax and phone. If approved, we will contact your patient by phone to arrange shipment of their medication.
- Eligible patients may receive 3 refills pending insurance coverage
- Patients must be on therapy
- Enrollment in YourBlueprint is required
*Please be sure to include the Coverage Interruption prescription selections on the enrollment form for faster processing.
Upon receipt of enrollment form, your patient’s Case Manager will communicate your patient’s program eligibility determination by fax and phone. If approved, we will contact your patient by phone to arrange shipment of their medication.
The AYVAKIT Dose Exchange Program allows patients who have a change in their dose of AYVAKIT to exchange remaining medication for the new dose.
