ELMIRON® SAVINGS PROGRAM

PAY AS
LITTLE
AS
$
25
PER
FILL

Eligible commercial patients can save on out‍-‍of‍-‍pocket costs for ELMIRON® (‍pentosan polysulfate sodium‍)‍. 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 annual program benefit of $3,600. 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.

Consider ELMIRON® for relief of bladder pain or discomfort associated with interstitial cystitis (IC)

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.