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ELMIRON® Savings Program

Eligible patients using commercial or private insurance can save on out-of-pocket costs for ELMIRON®. Eligible patients pay an initial $25 per fill at participating retail pharmacies and receive up to $300 off their out-of-pocket prescription costs, with a maximum program benefit of $3,600 or 12 fills per calendar year, whichever comes first. Not valid for patients using Medicare, Medicaid, or other government-funded programs to pay for their medications. Terms expire at the end of each calendar year and may change. There is no income requirement.

We provide cost support directly to patients through the Janssen CarePath Savings Program. This benefit is intended to help eligible patients afford their out-of-pocket obligations as set by their health plans. The cost support is meant solely for patients—not health plans and/or their partners.

See program requirements and visit the program site

State-Sponsored Programs

Some states sponsor prescription financial assistance programs, each with its own eligibility requirements. Find out if your state has a program that can help you.

Visit this program site

Additional Affordability Support from Janssen

Patient assistance is available if you have commercial, employer-sponsored, or government coverage that does not fully meet your needs. You may be eligible to receive your Janssen medication free of charge for up to one year. You must meet the eligibility and income requirements for the Janssen Patient Assistance Program. See terms and conditions at PatientAssistanceInfo.com or call 833-742-0791.

State-Sponsored Programs

Some states sponsor prescription financial assistance programs, each with its own eligibility requirements. Find out if your state has a program that can help you.

Visit this program site

Medicare Savings Program

Many states have programs for people with limited income and resources that pay some or all of Medicare's premiums and may pay Medicare deductibles and co-insurance. Find out if your state has a program that can help you.

Visit this program site

Medicare Part D Extra Help — Low-Income Subsidy

Medicare patients who have limited income and resources may qualify for "extra help" to pay for prescription drugs. The Low-Income Subsidy (LIS) program from Medicare provides financial assistance for patients who may otherwise be unable to afford the costs associated with their Medicare Part D plan.

Those who are eligible for LIS may:

  • Receive assistance paying their monthly premium
  • Have a reduced or no deductible
  • Have reduced or no prescription co-insurance and co-payments
  • Have no gap in coverage

Visit this program site

Medicaid

Medicaid and the Children's Health Insurance Program (CHIP) provide free or low-cost health coverage to millions of Americans, including some low-income people, families and children, pregnant women, the elderly, and people with disabilities.

Some states have expanded their Medicaid programs to cover all people below certain income levels.

Visit this program site

Additional Affordability Support from Janssen

Patient assistance is available if you have commercial, employer-sponsored, or government coverage that does not fully meet your needs. You may be eligible to receive your Janssen medication free of charge for up to one year. You must meet the eligibility and income requirements for the Janssen Patient Assistance Program. See terms and conditions at PatientAssistanceInfo.com or call 833-742-0791.

State-Sponsored Programs

Some states sponsor prescription financial assistance programs, each with its own eligibility requirements. Find out if your state has a program that can help you.

Visit this program site

Medicaid

Medicaid and the Children's Health Insurance Program (CHIP) provide free or low-cost health coverage to millions of Americans, including some low-income people, families and children, pregnant women, the elderly, and people with disabilities.

Some states have expanded their Medicaid programs to cover all people below certain income levels.

Visit this program site

Independent co-pay assistance foundations

Independent co-pay assistance foundations have their own rules for eligibility, which are subject to change. We cannot guarantee a foundation will help you. We can only refer you to foundations that support your disease state. This information is provided as a resource for you. We do not endorse any particular foundation. The foundations on this list are not the only ones that might be able to help you.

Johnson & Johnson Patient Assistance Foundation, Inc. (JJPAF)

The Johnson & Johnson Patient Assistance Foundation, Inc. (JJPAF) is an independent, nonprofit organization. JJPAF gives eligible patients free prescription medicines donated by Johnson & Johnson companies. You may be eligible if you don't have insurance.

Want to see if you qualify? Get an application at JJPAF.org.

Questions? Call 800-652-6227 (Monday through Friday, 8:00 AM to 8:00 PM ET).

ELMIRON® Savings Program

Eligible patients using commercial or private insurance can save on out-of-pocket costs for ELMIRON®. Eligible patients pay an initial $25 per fill at participating retail pharmacies and receive up to $300 off their out-of-pocket prescription costs, with a maximum program benefit of $3,600 or 12 fills per calendar year, whichever comes first. Not valid for patients using Medicare, Medicaid, or other government-funded programs to pay for their medications. Terms expire at the end of each calendar year and may change. There is no income requirement.

We provide cost support directly to patients through the Janssen CarePath Savings Program. This benefit is intended to help eligible patients afford their out-of-pocket obligations as set by their health plans. The cost support is meant solely for patients—not health plans and/or their partners.

See program requirements and visit the program site

State-Sponsored Programs

Some states sponsor prescription financial assistance programs, each with its own eligibility requirements. Find out if your state has a program that can help you.

Visit this program site

Medicare Savings Program

Many states have programs for people with limited income and resources that pay some or all of Medicare's premiums and may pay Medicare deductibles and co-insurance. Find out if your state has a program that can help you.

Visit this program site

Medicare Part D Extra Help — Low-Income Subsidy

Medicare patients who have limited income and resources may qualify for "extra help" to pay for prescription drugs. The Low-Income Subsidy (LIS) program from Medicare provides financial assistance for patients who may otherwise be unable to afford the costs associated with their Medicare Part D plan.

Those who are eligible for LIS may:

  • Receive assistance paying their monthly premium
  • Have a reduced or no deductible
  • Have reduced or no prescription co-insurance and co-payments
  • Have no gap in coverage

Visit this program site

Medicaid

Medicaid and the Children's Health Insurance Program (CHIP) provide free or low-cost health coverage to millions of Americans, including some low-income people, families and children, pregnant women, the elderly, and people with disabilities.

Some states have expanded their Medicaid programs to cover all people below certain income levels.

Visit this program site

Independent co-pay assistance foundations

Independent co-pay assistance foundations have their own rules for eligibility, which are subject to change. We cannot guarantee a foundation will help you. We can only refer you to foundations that support your disease state. This information is provided as a resource for you. We do not endorse any particular foundation. The foundations on this list are not the only ones that might be able to help you.

Additional Affordability Support from Janssen

Patient assistance is available if you have commercial, employer-sponsored, or government coverage that does not fully meet your needs. You may be eligible to receive your Janssen medication free of charge for up to one year. You must meet the eligibility and income requirements for the Janssen Patient Assistance Program. See terms and conditions at PatientAssistanceInfo.com or call 833-742-0791.

Johnson & Johnson Patient Assistance Foundation, Inc. (JJPAF)

The Johnson & Johnson Patient Assistance Foundation, Inc. (JJPAF) is an independent, nonprofit organization. JJPAF gives eligible patients free prescription medicines donated by Johnson & Johnson companies. You may be eligible if you don't have insurance.

Want to see if you qualify? Get an application at JJPAF.org.

Questions? Call 800-652-6227 (Monday through Friday, 8:00 AM to 8:00 PM ET).

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IMPORTANT SAFETY INFORMATION
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WHAT IS ELMIRON® (pentosan polysulfate sodium)?

ELMIRON® is a prescription medicine used to treat bladder pain or discomfort associated with interstitial cystitis. It is not known if ELMIRON® is safe and effective in children under 16 years of age.

IMPORTANT SAFETY INFORMATION

What is the most important information I should know about ELMIRON® (pentosan polysulfate sodium) Capsules?

Serious side effects have been reported with the use of ELMIRON®, including:

  • Changes in the retina of the eye (pigmentary maculopathy). Taking ELMIRON® may be associated with pigment changes in the retina of the eye that may continue even after stopping treatment with ELMIRON®. Tell your healthcare provider including your eye doctor right away if you have any vision changes including any of these symptoms:
    • difficulty reading
    • your vision takes longer to adjust to low or reduced light
    • blurred vision

Throughout your treatment, regular eye examinations that include retinal examinations are suggested for early detection of retinal/macular changes. Your doctor will discuss with you when to get your first eye examination and follow up exams, and whether the treatment should be continued.

  • Increased bleeding. ELMIRON® may increase bleeding. Tell your healthcare provider right away if you have any of these symptoms:
    • bruising easily
    • nosebleeds
    • bleeding gums
    • blood in your stool

Your risk of bleeding may be increased if you take ELMIRON® along with other medicines such as:

  • warfarin sodium
  • high doses of aspirin
  • heparin
  • anti-inflammatory medicines such as ibuprofen

Tell your healthcare provider if you are taking any of these medicines.

Tell your healthcare provider if you are going to have surgery. Your healthcare provider may stop ELMIRON® before you have surgery.

Talk to your healthcare provider about when to stop taking ELMIRON® and when to start taking it again.

What should I tell my healthcare provider before taking ELMIRON®?

Tell your healthcare provider if you:

  • have a personal or family history of eye problems of the retina
  • have a history of aneurysms
  • have problems with easy bleeding (thrombocytopenia)
  • have hemophilia
  • have gastrointestinal problems such as ulcerations, polyps, or diverticula
  • have any liver problems
  • are pregnant or plan to become pregnant. ELMIRON® should be used during pregnancy only if clearly needed. Tell your healthcare provider if you become pregnant while taking ELMIRON®. You and your healthcare provider should decide if you should continue to take ELMIRON®
  • are breastfeeding or plan to breastfeed. It is not known if ELMIRON® passes into your breastmilk. You and your healthcare provider should decide if you will take ELMIRON® or breastfeed
  • Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements

What are the possible side effects of ELMIRON®?

ELMIRON® may cause serious side effects including:

  • changes in the retina of the eye
  • increased bleeding

See “What is the most important information I should know about ELMIRON® (pentosan polysulfate sodium) Capsules?”

The most common side effects of ELMIRON® are:

  • hair loss
  • diarrhea
  • nausea
  • stomach pain
  • upset stomach
  • headache
  • rash
  • abnormal liver function tests
  • dizziness

These are not all the possible side effects of ELMIRON®.

Call your doctor for medical advice about side effects. You are also encouraged to report side effects to the FDA: visit http://www.fda.gov/medwatch or call 1-800-FDA-1088. You may also report side effects to Janssen Pharmaceuticals, Inc., at 1-800-JANSSEN (1-800-526-7736).

How should I store ELMIRON®?

  • Store ELMIRON® at room temperature between 68°F to 77°F (20°C to 25°C).
  • Keep ELMIRON® and all other medicines out of the reach of children.

How should I take ELMIRON®?

  • Take ELMIRON® exactly as your healthcare provider tells you to take it.
  • Take 1 capsule of ELMIRON® by mouth 3 times a day with water at least 1 hour before meals or 2 hours after meals. Each capsule contains 100 mg of ELMIRON®.
  • If you take too much ELMIRON®, call your healthcare provider right away or go to the nearest emergency room.

Please click here to see full Prescribing Information and read the Medication Guide.

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