SpringWorks CareConnections®
Resources & Forms

Additional Resources to Support Your Patients

We provide information you need, when you need it, so you can support your patients on their treatment journey with GOMEKLI® (mirdametinib).

Downloadable Resources

Explore our resources below and visit GOMEKLI.com for more about GOMEKLI.

Enrollment Form

Enrollment Form

SpringWorks CareConnections®
Enrollment Form

Complete this form to get your patients started with SpringWorks CareConnections today.

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SpringWorks CareConnections Brochures

HCP Brochure

SpringWorks CareConnections HCP Brochure

Discover the resources available for you and your office staff through SpringWorks CareConnections to help facilitate patient access to GOMEKLI.

Download

Patient Brochure

SpringWorks CareConnections
Patient Brochure

Share this helpful overview of SpringWorks CareConnections with your patients.

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Sample Letters and Checklists

Sample Letter of Medical Necessity or Medical Exception for GOMEKLI

Sample Letter of Medical Necessity or Medical Exception for GOMEKLI

Refer to this example when a letter of medical necessity or medical exception is appropriate.

Download

Sample Letter of Appeal for GOMEKLI

Sample Letter of Appeal for GOMEKLI

Refer to this example when a letter of appeal of a PA denial is appropriate.

Download

Alternative Funding Program (AFP) Sample Letter

Alternative Funding Program (AFP) Sample Letter

Refer to this example when contacting a patient’s insurance provider to request coverage for GOMEKLI where an AFP is involved.

Download

GOMEKLI Prior Authorization (PA) Tips and Checklist

GOMEKLI Prior Authorization (PA) Tips and Checklist

This checklist can serve as a guide through the PA process.

Download

GOMEKLI Appeals Tips and Checklist

GOMEKLI Appeals Tips and Checklist

This checklist can serve as a guide through the appeals process.

Download

Peer-to-Peer Checklist

Peer-to-Peer Checklist

This resource provides a checklist and relevant tips to help you prepare for and engage in a peer-to-peer discussion.

Download

Additional Resources

GOMEKLI Treatment Access Guide

GOMEKLI Treatment Access Guide

This guide outlines the process for prescribing GOMEKLI and the support services offered by SpringWorks CareConnections that may help address access barriers.

Download

GOMEKLI Coverage Tool Kit

GOMEKLI Coverage Tool Kit

This guide provides information and resources to help HCPs and office staff navigate potential access challenges when prescribing GOMEKLI.

Download

GOMEKLI Product Fact Sheet and Ordering Guide

GOMEKLI Product Fact Sheet and Ordering Guide

Find out about GOMEKLI and how to prescribe through our limited network of Specialty Pharmacies or order directly through our Specialty Distributor partners.*

Download

Evidence Compendium

Evidence Compendium

This resource provides a library of articles that support why GOMEKLI may be medically necessary and should be covered by a patient’s health plan.

Download

ICD-10 Code Guide

ICD-10 Code Guide

Discover location-specific ICD-10 codes and learn about a reporting tool that supports clinical decisions.

Download

Navigating Health Insurance Brochure

Navigating Health Insurance Brochure

Share with patients to help them learn about some of the different types of health insurance as well as select terms related to obtaining coverage.

Download

Navigating Health Insurance as a Young Adult Brochure

Navigating Health Insurance as a Young Adult Brochure

Share with young adult patients to help them learn about health insurance and transitioning onto their own health insurance plan.

Download

GOMEKLI Electronic Health Record (EHR) Flashcard

GOMEKLI Electronic Health Record (EHR) Flashcard

Learn more about how to add GOMEKLI to your EHR system.

Download

How Health Insurance Changes May Impact You Brochure

How Health Insurance Changes May Impact You Brochure

Share with patients to help them understand their insurance plan and make informed decisions when selecting a new insurance plan.

Download

Alternative Funding Program Information for Providers

Alternative Funding Program Information for Providers

This guide provides information on the impact of AFPs on patient care and offers guidance to HCPs and office staff on helping patients navigate AFPs.

Download

*May not be available for all practices or organizations.

Resources and Forms

Staying on track with GOMEKLI support is always within reach! SpringWorks has partnered with Medisafe, the #1 medication management app to give GOMEKLI patients a free resource in the GOMEKLI Digital Companion

Click here to learn more

Stay Connected About GOMEKLI

Click here to receive information, updates, and resources for GOMEKLI.

Starting the SpringWorks CareConnections Enrollment Process is simple

Begin Enrollment

Have Questions?

Call SpringWorks
CareConnections today

844-CARES-55

(844-227-3755)

Monday-Friday
8 AM-8 PM ET

Field Access
Manager (FAM) Support

For questions about patient access to
GOMEKLI, click to connect with a FAM

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© 2026 Merck KGaA, Darmstadt, Germany and/or its affiliates. All rights reserved.

OGSIVEO, GOMEKLI, PIMJETMI, and SpringWorks CareConnections are registered trademarks of Merck KGaA, Darmstadt, Germany and/or its affiliates. All other trademarks are the property of their respective owners.

EMD Serono, Inc. and SpringWorks Therapeutics, Inc. are healthcare companies of Merck KGaA, Darmstadt, Germany.

US-GOM-01397  11/26

This site is intended for U.S. audiences only.

This site is intended for U.S. audiences only.

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