ELMIRON® (pentosan polysulfate sodium) Capsules
(pentosan polysulfate sodium) Capsules
AXERT® (almotriptan malate) Tablets
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DARZALEX® (daratumumab)
DOXIL® (doxorubicin HCl liposome injection)
DURAGESIC® (fentanyl transdermal system) CII
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ELMIRON® (pentosan polysulfate sodium) Capsules
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Need help paying for your ELMIRON® (pentosan polysulfate sodium) Capsules prescription?

We want to guide you to programs that may help. Here you'll find the financial assistance programs available for ELMIRON®. We have also listed most of the eligibility requirements for each, so you can narrow your focus to those that best suit your circumstances. Call the programs or visit their websites to learn more.

To view programs that are best suited for you, select your coverage status for ELMIRON® or view all assistance programs

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

To view programs that are best suited for you, select your insurance status for ELMIRON® or view all assistance programs

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

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

The following program(s) is (are) affiliated with Janssen.

They are updated on a regular basis. Be sure to visit the program site for additional information.

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 per calendar year. You are required to pay an initial $5 out-of-pocket cost to receive UP TO $35 off your co-payment or cash payment each time you fill your monthly prescription for ELMIRON®, for UP TO 4 total uses. Please check the ELMIRON® EarlyAssist™ Savings Card expiration date prior to use. The card is limited to one (1) per patient and is not transferable.

You may be eligible if:

  • You have been prescribed ELMIRON® for an FDA-approved use
    AND
  • Your prescription is not covered and/or reimbursed by a federal healthcare program, including Medicare, Medicaid, TRICARE, or any other federal or state healthcare plan.
  • You use the card only in the United States.
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

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.

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 co-insurance.

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.

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

Independent co-pay assistance foundations

Independent co-pay assistance foundations have their own rules for eligibility. We cannot guarantee a foundation will help you. We only can refer you to a foundation that supports 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.

Other Resources

The Johnson & Johnson Patient Assistance Foundation, Inc. (JJPAF) is an independent, nonprofit organization that is committed to helping eligible patients without insurance coverage receive prescription products donated by Johnson & Johnson operating companies. To see if you might qualify for assistance, please contact a JJPAF program specialist at 1-800-652-6227 (Monday – Friday, 9:00 AM to 6:00 PM ET) or visit the foundation website at www.JJPAF.org.

July 12, 2018
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IMPORTANT SAFETY INFORMATION

INDICATION

What is ELMIRON® (pentosan polysulfate sodium)?

ELMIRON® is a prescription medication used to treat the bladder pain or discomfort associated with interstitial cystitis (IC). It is not known exactly how ELMIRON® works, but it is not a pain medication like aspirin or acetaminophen and therefore must be taken continuously for relief as prescribed by your doctor.

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

You must take ELMIRON® as prescribed by your doctor in the dosage prescribed but no more frequently than prescribed. ELMIRON® is a weak anticoagulant (blood thinner) which may increase bleeding. Call your doctor if you will be undergoing surgery or will begin taking anticoagulant therapy such as warfarin sodium, heparin, high doses of aspirin, or anti-inflammatory drugs such as ibuprofen.

Who should not take ELMIRON®?

What does your doctor need to know?

What should I avoid while taking ELMIRON®?

Anticoagulant therapy such as warfarin sodium, heparin, high doses of aspirin, or anti-inflammatory drugs such as ibuprofen until you speak with your doctor.

What are the most common side effects of ELMIRON®?

The most common side effects are hair loss, diarrhea, nausea, blood in the stool, headache, rash, upset stomach, abnormal liver function tests, dizziness, and bruising. Weight gain and swelling caused by fluid buildup in the body have also been reported in patients taking ELMIRON®. Call your doctor if these side effects persist or are bothersome or if there is blood in your stool or if you have any other side effect that bothers you or that does not go away.

You are also encouraged to report side effects to the FDA: visit 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).

Please see full Prescribing Information and read the Patient Leaflet.

080475-170915

IMPORTANT SAFETY INFORMATION

INDICATION

What is ELMIRON® (pentosan polysulfate sodium)?

ELMIRON® is a prescription medication used to treat the bladder pain or discomfort associated with interstitial cystitis (IC). It is not known exactly how ELMIRON® works, but it is not a pain medication like aspirin or acetaminophen and therefore must be taken continuously for relief as prescribed by your doctor.

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

You must take ELMIRON® as prescribed by your doctor in the dosage prescribed but no more frequently than prescribed. ELMIRON® is a weak anticoagulant (blood thinner) which may increase bleeding. Call your doctor if you will be undergoing surgery or will begin taking anticoagulant therapy such as warfarin sodium, heparin, high doses of aspirin, or anti-inflammatory drugs such as ibuprofen.

Who should not take ELMIRON®?

What does your doctor need to know?

What should I avoid while taking ELMIRON®?

Anticoagulant therapy such as warfarin sodium, heparin, high doses of aspirin, or anti-inflammatory drugs such as ibuprofen until you speak with your doctor.

What are the most common side effects of ELMIRON®?

The most common side effects are hair loss, diarrhea, nausea, blood in the stool, headache, rash, upset stomach, abnormal liver function tests, dizziness, and bruising. Weight gain and swelling caused by fluid buildup in the body have also been reported in patients taking ELMIRON®. Call your doctor if these side effects persist or are bothersome or if there is blood in your stool or if you have any other side effect that bothers you or that does not go away.

You are also encouraged to report side effects to the FDA: visit 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).

Please see full Prescribing Information and read the Patient Leaflet.

080475-170915