At the current time, patient affordability programs for the selected insurance option are not available for this product. Please check back, as programs change.

You may be eligible for one or more of the following   programs:

This program is affiliated with Janssen and is updated on a regular basis. Be sure to visit the program site for additional information. Last updated 7-21-14

ELMIRON® EarlyAssist™ Savings Card

This program is an instant savings card that reduces your out-of-pocket expenses by up to $35 per month for up to 4 months.

You may be eligible if:

  • You have been prescribed ELMIRON® for an FDA-approved use


  • Your prescription is not covered and/or reimbursed by a federal healthcare program, including Medicare, Medicaid, or any similar federal or state program, including a state pharmaceutical assistance program

    View application requirements

    Application Requirements for ELMIRON® EarlyAssist™ Savings Card

    To apply, you'll need to have:

    • Your prescription

    • A printed version of the EarlyAssist™ Savings Card coupon

    Any eligible reduction of your out-of-pocket expenses should take place immediately upon checkout.

The following programs are not affiliated with Janssen. Be sure to contact the programs directly to get details on eligibility and application requirements, and to see if they have funding available to help you.

Johnson & Johnson Patient Assistance Foundation

Johnson & Johnson Patient Assistance Foundation, Inc. (JJPAF) is committed to providing access to medicines for uninsured patients who lack the financial resources to pay for them. If you need ELMIRON® (pentosan polysulfate sodium) Capsules, and are uninsured and unable to pay for your medicine, please contact a JJPAF program specialist at 1-800-652-6227 9 AM to 6 PM ET or visit the foundation website at to see if you might qualify for assistance.

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.

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 coinsurance. Find out if your state has a program that can help you.

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.

View eligibility requirements

Eligibility Requirements for Medicare Part D Extra Help - LIS

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