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
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 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 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 indication for GAVRETO. These codes are provided for information only.
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.