Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 1 of 2.
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YourBlueprint: AYVAKIT Patient Support Program

This program provides brand name medications at no or low cost

Provided by: Blueprint Medicines Corporation

PO Box 15590
Pittsburgh, PA 15244

TEL: 888-258-7768


FAX: 866-370-3082 		Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

YourBlueprint: AYVAKIT Patient Support Program Enrollment Form

YourBlueprint: AYVAKIT Patient Support Program Consent and Authorization Form

YourBlueprint: AYVAKIT Patient Support Program Overview Brochure
 

Medications
  • avapritnib tablet (Ayvakit) Tablet
 

Eligibility Requirements   
Insurance Status Must be uninsured or underinsured
Those with Part D Eligible? Determined case by case
Income Based on FPL
Diagnosis/Medical Criteria FDA-approved diagnosis
US Residency Required? Must be residing in the US or a US territory, and under the care of a US physician
   

Application
Obtaining Call or download
Receiving Downloaded from website
Returning Varies
Doctor's Action Complete section, sign, attach required documents
Applicant's Action Complete section, sign, attach required documents
Decision Communicated Not specified
Decision Timeframe Not specified
   

Medication
Amount/Supply As prescribed by Doctor
Sent To Doctor's office or patient's home
Delivery Time Varies
Refill Process Not specified
Limit Not specified
Re-application Contact program for details.
   

Additional Information
Co-payment assistance, and patient assistance programs are available for eligible patients.

Eligibility determined on a case-by-case basis. Contact program for details.

The QuickStart Program offers a no-cost 15-day supply of therapy to eligible newly prescribed patients who have an insurance delay.
Updated May 04, 2023


Don't qualify for this program? Visit the DBAs to look for financial assistance based on your diagnosis.  
Program 2 of 2.
 

Patient Access Network Foundation (PAN)

This is a copay assistance program

Provided by: Patient Access Network Foundation


TEL: 866-316-7263


FAX: 866-316-7261 		Languages Spoken:

English, Spanish, Others By Translation Service

Program Website

 

Program Applications and Forms

Patient Access Network Foundation (PAN) Application: Contact program
 

Medications
  • avapritnib tablet (Ayvakit) Tablet
 

Eligibility Requirements   
Insurance Status *See Additional Information section below
Those with Part D Eligible? Determined case by case
Income Between 400-500% of FPL
Diagnosis/Medical Criteria FDA Approved Diagnosis - See Program Website for Details
US Residency Required? Must reside and receive treatment in US
   

Application
Obtaining Call or complete online
Receiving Complete online or by phone
Returning Not applicable
Doctor's Action Varies
Applicant's Action Call for information or inform doctor that he/she is in need
Decision Communicated Patient and Doctor are notified
Decision Timeframe Within 48 hours
   

Medication
Amount/Supply Not applicable
Sent To Patient is sent savings card to be used at pharmacy
Delivery Time Once approved; shipped same day
Refill Process Patient presents voucher/card to pharmacy for each refill
Limit None
Re-application New application every 12 months
   

Additional Information
*Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance.

Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly.

Note: All new enrollment is now done electronically or over the phone. Contact program for details.
Updated May 30, 2023