ELMIRON® (pentosan polysulfate sodium) Capsules
(pentosan polysulfate sodium) Capsules
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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 programs are affiliated with Janssen.

Be sure to visit the program site for program requirements and additional information.

ELMIRON® EarlyAssist™

Eligible patients using commercial or private insurance can save on out-of-pocket costs for ELMIRON®. Eligible patients pay an initial $5 per fill at participating retail pharmacies and receive up to $50 off their out-of-pocket prescription costs, with a maximum program benefit of $200 or 4 total fills per lifetime, 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. See full eligibility requirements.

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

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.

No health insurance?

Check the Health Insurance Marketplace at www.HealthCare.gov to see if you can enroll in a plan.

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 800-652-6227 (Monday–Friday, 9:00 AM to 6:00 PM ET) or visit the foundation website at JJPAF.org.

July 23, 2020
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IMPORTANT SAFETY INFORMATION

WHAT IS ELMIRON® (pentosan polysulfate sodium)?

ELMIRON® is used to treat the pain or discomfort of 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.

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.

Pigment changes in the retina of the eye (also referred to as pigmentary maculopathy in medical journal articles) have been reported with long-term use of ELMIRON®. While the cause of the pigmentary changes is unclear, continued long-term dosing with ELMIRON® may be a risk factor. The consequences of these pigmentary changes in the retina are not fully understood.

Visual symptoms that have been reported include: difficulty reading, slow adjustment to low or reduced light environments, and blurred vision. If you already have retinal pigment changes from other causes, it may be difficult to distinguish future retinal pigment changes if they occur.

Call your doctor (including your eye doctor) if you notice any changes in your 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 since these changes may be irreversible and may progress even after stopping treatment.

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.

Call your doctor if any of 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.

Keep out of reach of children.

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.

cp-11575v3

IMPORTANT SAFETY INFORMATION

WHAT IS ELMIRON® (pentosan polysulfate sodium)?

ELMIRON® is used to treat the pain or discomfort of 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.

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.

Pigment changes in the retina of the eye (also referred to as pigmentary maculopathy in medical journal articles) have been reported with long-term use of ELMIRON®. While the cause of the pigmentary changes is unclear, continued long-term dosing with ELMIRON® may be a risk factor. The consequences of these pigmentary changes in the retina are not fully understood.

Visual symptoms that have been reported include: difficulty reading, slow adjustment to low or reduced light environments, and blurred vision. If you already have retinal pigment changes from other causes, it may be difficult to distinguish future retinal pigment changes if they occur.

Call your doctor (including your eye doctor) if you notice any changes in your 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 since these changes may be irreversible and may progress even after stopping treatment.

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.

Call your doctor if any of 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.

Keep out of reach of children.

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.

cp-11575v3