One form unlocks a host of access solutions

Enroll your patients in Deciphera AccessPoint to get them started right away.

Enroll a patient in Deciphera AccessPoint

It's quick and easy to get started. Simply fill out and submit the enrollment form and we do the rest.

Fax a completed enrollment form to 1‑833‑DCPH‑FAX.

Be sure to include:

  • Prescription
  • Prescriber signatures
  • Patient signatures
  • Optional/recommended: A request for a temporary 10‑day supply of free medication, in case the patient faces an insurance delay or interruption

Deciphera AccessPoint assesses coverage and helps identify financial assistance options

Specialty pharmacy delivers the prescription directly to the patient, or eligible offices may dispense via an in‑office pharmacy

Enrollment form

The enrollment form is available in your Deciphera AccessPoint Office Toolkit or for download here:

Download form


Download form


Enrollment form instructions

This guide explains how to obtain, fill out, and submit the form to help patients access services quickly:
Download guide

Enroll a patient in the Commercial Copay Program

Patients eligible for the Qinlock® (ripretinib) Commercial Copay Program can be enrolled via the link below. NOTE: You will be redirected to a new page to complete enrollment.

Go to Copay enrollment

Patients may also be enrolled in the Commercial Copay Program via their specialty pharmacy provider or through Deciphera AccessPoint.

Questions about enrollment?

Call our dedicated Case Managers at 1‑833‑4DACCES (1‑833‑432‑2237), Monday–Friday 8AM–8PM ET

Or email to schedule a call back

Insurance & financial support

We provide solutions to help you get patients started faster.

See our services

Ordering information

Qinlock is available through a limited network of specialty pharmacies and distributors.

How to order

Forms & resources

A host of tools and resources to help you gain fast access to Qinlock, right at your fingertips.

Explore resources