Navigating Coverage

We’re Here To Help With Access

At YourBlueprint®, we work together with your staff and your patient’s pharmacy to help your patient obtain the medication needed.

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Coverage approval process

Your patient's Case Manager can help facilitate access to therapy.

Prior authorization resources

Approval process requirements vary by payer. These resources are provided to help you navigate the process.

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Prior authorization checklist

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Sample letter of medical necessity

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Denials & appeals

In the event of a prior authorization denial, you can request reconsideration by providing additional guidance, a documentation checklist or a sample letter of medical necessity or appeal.

Common reasons for claim denials

Here are a few reasons for denials that may be resolvable through the appeals or formulary exception request process.

Appeals process

If a request for coverage of your patient’s Blueprint Medicines therapy is denied, it may be resolvable through the standard appeals process, which consists of three levels:


1st level appeal

Contact payer to request a consideration of the denial. This may include a “peer-to-peer” discussion with the medical reviewer.


2nd level appeal

At this step, the appeal is typically reviewed by the plan’s medical director to determine if the request should be accepted within the coverage guidelines.


Independent external review

If appeals have not been successful, an external review can be conducted by an independent third party to make a binding decision.

Patients may also assist with the appeals process

If a request for coverage is denied, patients can contact their employer’s benefits administrator or their health plan for additional information on how to appeal the payer’s decision or to request an external review. In some cases, it may be necessary to submit a formulary exception request to the payer. Download the Appeals Request Checklist for more information.

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Appeals request checklist

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Sample letter of appeal

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Sample formulary exception request

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