Blueprint Patient Assistance Program

Funded

About

The Blueprint Patient Assistance Program offers exceptional support for patients prescribed Ayvakit, ensuring access to necessary medication even for those with little or no insurance coverage. This program provides the drug Ayvakit at no cost to eligible individuals, with personalized assistance from a Case Manager to guide them through the process. The Blueprint Patient Assistance Program is committed to helping patients manage their treatment costs effectively.

Insurance requirements: Underinsured, Uninsured

Enrollment Forms

Enrollment Form

Program Requirements

•Valid only for residents in the US and Puerto Rico

•Enrollment Required: Yes

•Coverage Required: No

•Needs Based: Yes

•Activation Required: No

Program Details

•If patient does not have insurance or if coverage is limited, they may be eligible to receive medication at no cost through this program

•For additional information including eligibility requirements, patient must speak with a dedicated Case Manager to learn more

•Patient and prescriber must complete the enrollment form, sign and fax it to YourBlueprint® at 18663703082

•To complete enrollment, patient will need to provide consent inoffice, online, or in writing via:

•Email: info@yourblueprint.com, or

•Fax: 18663703082, or

•Mail: PO Box 15590, Pittsburgh, PA 15244

•Once enrolled, patient will be contacted by a dedicated Case Manager who will provide ongoing support throughout treatment depending on specific needs

•If you have any questions, please contact customer support at 1888BLUPRNT (18882587768) MondayFriday 8 am8 pm ET

Enrollment Forms

Enrollment Form