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Elmiron Patient assistance program

Is your Elmiron medication too expensive? Start receiving your medication for only $49 per month.*

Complete a free online enrollment application to find out if you’re eligible to pay only $49 per month for your Elmiron medication.

Get started today
  • Secure: Your personal and medical information is safe with us
  • Convenient: We manage the whole process and we’re here to assist you
  • Ongoing refills: We request your medication refills on your behalf
  • Secure: Your personal and medical information is safe with us
  • Convenient: We manage the whole process and we’re here to assist you
  • Ongoing refills: We request your medication refills on your behalf

NiceRx works with your healthcare provider to help you access affordable medications directly from U.S. pharmaceutical companies.

An introduction to NiceRx

Play video (01:52)
  • An introduction to NiceRx
  • Next steps after qualifying
  • Uploading documents and billing
  • SSN & billing information
  • Medication delivery time

How it works

  • Apply Online

    Get started by filling out the online enrollment application to find out if you are eligible.

  • Qualification

    NiceRx verifies your eligibility for medication assistance and notifies you if you are qualified.

  • Upload Documents

    You may be required to submit further information and documents required by the pharmaceutical company which can be securely uploaded online.

  • Application Created

    Your application is created and sent to your doctor for signature. At this stage, you will be billed $49 and will not be billed again until you receive your first medication delivery.

  • Receive Medication

    Your application is sent to the pharmaceutical company. You will be billed again once you receive your medication. We handle the entire ordering process including requesting ongoing refills.

Your monthly Elmiron cost savings if eligible

With our assistance, you could access the Elmiron patient assistance program and obtain your medication for free. We only charge a flat monthly fee of $49 per medication for our services. You could save:

Strength Avg. monthly price at
a US pharmacy
NiceRx monthly
Monthly savings
with NiceRx
30 capsules 100mg$272.66$49.00$223.66
60 capsules 100mg$536.78$49.00$487.78

Am I eligible for Elmiron patient assistance?

We review each Elmiron enrollment application individually to determine if you are eligible. Each assistance program has its own eligibility criteria and the factors considered by most programs are:

  • I am a permanent, legal resident of the United States or Puerto Rico
  • I am uninsured or my insurance doesn’t cover my medication
  • I meet certain income eligibility requirements

How do I apply for the Elmiron patient assistance program?

Our process makes it as easy as possible to apply for the Elmiron patient assistance program. Begin by completing the enrollment application form on our website. Tell us about any medications that you are taking, including Elmiron. You must also provide details about your healthcare provider, your insurance plan, and your household income. This is required by the pharmaceutical manufacturers who will supply the medication, so it is important to make sure this information is accurate and up to date.  

We will review the information that you have provided to determine whether you are eligible for patient assistance. If we can pre-qualify you for assistance, NiceRx will handle the full enrollment process on your behalf. If you are approved by the pharmaceutical company, you will typically start receiving your medication in 6 – 8 weeks.

Is NiceRx an Elmiron coupons provider?

NiceRx is not an Elmiron coupon, Elmiron discount card, or Elmiron copay card provider. We do not offer Elmiron manufacturer coupons, Elmiron discounts, rebates, Elmiron savings cards, trial offers, or free Elmiron samples. We are a service provider that helps eligible individuals access the Elmiron patient assistance program.  

Can NiceRx help me get Elmiron if I have insurance?

NiceRx may be able to help you get Elmiron if: 

  • You have a high copay or coinsurance responsibility for Elmiron
  • Your insurance company will not pay for your Elmiron prescription 
  • Your healthcare plan does not cover Elmiron medication 
  • You do not have insurance 

Please apply online to find out if we can help you.

How much is Elmiron with insurance?

The cost of Elmiron with insurance will depend on the terms of your healthcare plan. Your healthcare provider or pharmacist will be able to calculate your copay with your current insurance. Contact them to find out more.  

How much does Elmiron cost without insurance?

Elmiron prices without insurance will vary, but as a guide the cost of Elmiron Is often between $950 and $1000.

What is Elmiron?

Elmiron is a medication prescribed for a bladder condition called interstitial cystitis. It helps manage the discomfort and pain caused by the condition, and the persistent need to urinate.

Normally, when your bladder fills with urine, you get a feeling of pressure and a need to empty it. With interstitial cystitis, you can get this feeling before your bladder is full. This happens even if you only have a little urine in it. Interstitial cystitis can cause bladder pressure, a persistent need to urinate, and mild discomfort. Occasionally it can also cause severe pain. While it is a chronic condition that affects both men and women, women are five times more likely to develop it. There isn’t a known cure that can get rid of interstitial cystitis, but the right medication can help you manage the symptoms.

Elmiron active ingredient

The active ingredient in Elmiron is called pentosan polysulfate sodium. After you take Elmiron, the active ingredient passes into your urine. Once inside your bladder, it forms a protective layer on the inner bladder wall. This shields it from substances that can irritate it and cause pain and discomfort.

Elmiron side effects & drug interactions

Like all medications, Elmiron can have side effects. The most common Elmiron side effects (which affect around 1 in 10 people) are relatively mild. These include headaches, back pain, dizziness, nausea, indigestion, and diarrhea. You will find a full list of Elmiron side effects in the leaflet which comes with the medication. 

In rare instances, Elmiron can have side effects which affect your vision. Talk to your physician straight away if you have any changes to your vision. This includes difficulty reading or slower adjustment to low light levels. If you have any concerns about Elmiron’s side effects, talk to your physician or a pharmacist. Tell them about all the medication you’re taking. This includes any supplements and especially any medicines which reduce or prevent blood clotting. 

Elmiron warnings & precautions

Do not take Elmiron if you:

  • Are allergic to the active ingredient pentosan polysulfate sodium
  • Are allergic to any of the other ingredients found in Elmiron (listed in the leaflet which comes with the medication)
  • Are bleeding (including menstruation)
  • Are under 18 years of age

Elmiron is also not recommended during pregnancy and when breastfeeding.

Talk to your doctor before taking Elmiron if you:

  • Are about to have surgery
  • Have a blood clotting disorder or increased risk of bleeding
  • Have reduced liver or kidney function
  • Have ever had a reduced number of blood platelets caused by the medicine heparin

Related medication

*Qualifying persons may obtain medications directly from patient assistance programs without any out-of-pocket cost (or for less than $49 per medication). However, our monthly flat rate of just $49 per medication spares you the hassle of tracking down the different programs and filling out all the required paperwork for each program.

Enrollees enjoy a full-service solution, as NiceRx assists them and their physicians with the entire process. We prepare all required documents for the physician to sign, help enrollees manage all prescription refills, monitor eligibility criteria, and maintain enrollment.

**If you do not receive medications because you were determined to be ineligible for the prescription assistance by the applicable pharmaceutical companies and you have a letter of denial, we will refund any fees you paid toward medications for which you did not qualify to receive prescription assistance (“Refund”).

To receive a refund, you must send the letter of denial to us by fax to 888-517-7444, or by e-mail to [email protected] within 30 days of your receipt of such letter. The Refund is your sole and exclusive remedy for any fees you may wish to dispute.