ELMIRON® SAVINGS PROGRAM

PATIENTS WITH COMMERCIAL INSURANCE:

Eligible patients using commercial or private insurance can save on out-of-pocket costs for ELMIRON® (pentosan polysulfate sodium).

Eligible patients pay an initial $5 per fill at participating retail pharmacies and receive up to $150 off their out-of-pocket prescription costs, with a maximum annual program benefit of $1,800. 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 program requirements below.

PATIENTS WITHOUT COMMERCIAL INSURANCE:

Find out more about assistance programs that could provide discounted or free prescriptions for patients without prescription drug coverage at JanssenCarePath.com.

References: 1. U.S. Department of Health and Human Services. Interstitial cystitis/painful bladder syndrome. Accessed June 6, 2022. https://www.niddk.nih.gov/health-information/urologic-diseases/interstitial-cystitis-painful-bladder-syndrome 2. Butrick CW. Patients with chronic pelvic pain: endometriosis or interstitial cystitis/painful bladder syndrome? J Soc Laparoendosco Surg. 2007;11(2):182-189. 3. Metts JF. Interstitial cystitis: urgency and frequency syndrome. Am Fam Physician. 2001;64(7):1199-1207. 4. Dell JR, Mokrzycki ML, Jayne CJ. Differentiating interstitial cystitis from similar conditions commonly seen in gynecologic practice. Eur J Obstet Gynecol Reprod Biol. 2009;144(2):105-109. 5. Myers DL, Aguilar VC. Gynecologic manifestations of interstitial cystitis. Clin Obstet Gynecol. 2002;45(1):233-241. 6. Dason S, Dason JT, Kapoor A. Guidelines for the diagnosis and management of recurrent urinary tract infection in women. Can Urol Assoc J. 20011(5):316-22. 7. Hummelshoj L, De Graaff A, Dunselman G, et al. Let's talk about sex and endometriosis. J Fam Plann Reprod Health Care. 2014;40(1):8-10. 8. Fariello JY, Moldwin RM. Similarities between interstitial cystitis/bladder pain syndrome and vulvodynia: implications for patient management. Transl Androl Urol. 2015;4(6):643-652. 9. ELMIRON® [Prescribing Information]. Titusville, NJ: Janssen Pharmaceuticals, Inc. 10. Hanno PM, Erickson D, Moldwin R, et al. Diagnosis and treatment of interstitial cystitis/bladder pain syndrome: AUA guideline amendment. J Urol. 2015;193(5):1545-1553.