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

YourBlueprint for 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 for AYVAKIT Patient Support Program Enrollment Form

YourBlueprint Patient Support Program Consent and Authorization Form (AYVAKIT)

YourBlueprint Patient Support Program Overview Brochure (AYVAKIT)

 

Medications

  • avapritnib tablet (Ayvakit) Tablet
 

Eligibility Requirements   

Insurance Status May have insurance
Those with Part D Eligible? Determined case by case
Income Not disclosed
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 Email, fax or mail
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 Varies
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.

Updated September 09, 2020