Forms & Resources
Enrollment unlocks 1-on-1 support and resources

Enrolling in YourBlueprint® is simple: complete the enrollment form and make sure your patient provides their consent and authorization
Enrollment form
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:
Dose exchange program
Complete the AYVAKIT dose exchange form to allow patients for whom
you prescribe a change in their dose of AYVAKIT to exchange remaining
medication for the new dose.

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 a formulary exception request to an insurer and suggested documents to include.
