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

Enrollment forms

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

Additional ways to obtain patient consent

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 services and 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.

 
 
 
 
 
 
 

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.

 
 
 
 
 
 
 
 

This comprehensive guide provides detailed information about product ordering, distribution, patient support, coverage, and access for GAVRETO. 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 indications for GAVRETO. These codes are provided for information only.

 
 
 
 
 
 
 
 
 
 
 
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YourBlueprint: Our priority is your patient