Jelmyto Patient assistance program
Complete a free online enrollment application to find out if you’re eligible to pay only $49 per month for your Jelmyto medication with our help.Get Started Now
Secure: Your personal and medical information is safe with us
Convenient: Your medication is delivered straight to your door
Ongoing refills: Your medication is refilled automatically
NiceRx works with your healthcare provider to help you access affordable medications directly from U.S. pharmaceutical companies.
An introduction to NiceRx(01:52)
Next steps after qualifying(00:38)
Uploading documents and billing(00:50)
SSN & billing information(00:33)
Medication delivery time(00:41)
How it works
Get started by filling out the online enrollment application to find out if you are eligible.
NiceRx verifies your eligibility for medication assistance and notifies you if you are qualified. The pharmaceutical company provides your medication for free and you only pay our service fee.
You may be required to submit further information and documents required by the pharmaceutical company which can be securely uploaded online.
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.
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 Jelmyto cost savings if eligible
The Jelmyto patient assistance program can provide your medication for free. We simply charge $49 per month for each medication to cover the cost of our services. With NiceRx, you will only pay $49 to obtain your Jelmyto, regardless of the retail price.
Am I eligible for the Jelmyto patient assistance program?
To find out if you are eligible for Jelmyto assistance you can apply online using our enrollment application. Each pharmaceutical company sets its eligibility criteria, and we will review your application individually to determine if you may be eligible. The three main factors to consider 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 Jelmyto patient assistance program?
Our application process aims to make it as easy as possible to apply for the Jelmyto patient assistance program. The first step is to complete our online enrollment application. We will ask you for details about your healthcare provider, your insurance plan, and your household income as this information is required by the pharmaceutical companies. We may be able to help you apply for other patient assistance programs too, so be sure to tell us about any medications you are taking as well as Jelmyto.
NiceRx will review your application and determine whether you may be eligible for Jelmyto assistance. If so, we will handle the full enrollment process for you and prepare all required documents for your healthcare provider to sign. Once you are successfully enrolled in the Jelmyto patient assistance program, we will help you manage your prescription refills by requesting refills on your behalf throughout your enrollment period. At the end of your enrollment period, we will contact you for updated information and seek to re-enroll you so you can continue to access affordable Jelmyto.
Is NiceRx a Jelmyto coupons provider?
NiceRx is a service provider that helps eligible individuals access the Jelmyto patient assistance program. We do not offer trial offers or free Jelmyto samples. When obtaining your medication through NiceRx, you will only pay $49 a month per medication. This will likely save you more money than if you were to use Jelmyto coupons, discount cards, or Jelmyto copay cards.
Can NiceRx help me get Jelmyto if I have insurance?
NiceRx may be able to help you if your insurance company will not pay for your Jelmyto medication. We may also be able to help if you have a high copay or coinsurance responsibility. Whether you have insurance or not, apply online using our enrollment application to find out more.
How much does Jelmyto cost without insurance?
Jelmyto prices without insurance will vary depending on how much you buy. Prices will also vary by retailer. As a guide, Jelmyto ureteral kit 40 mg typically costs $22,700 for 1 kit.
How much does Jelmyto cost with insurance?
The copay for Jelmyto will vary by the terms of your healthcare plan. To find out what you might need to pay for Jelmyto with insurance, your insurance provider or pharmacist will be able to help you calculate the copay costs with your current insurance.
What is Jelmyto?
Jelmyto is an FDA (U.S. Food and Drug Administration) approved medication manufactured by UroGen Pharma, Inc. It was granted approval on the basis of data from the Phase III Olympus trial. Jelmyto is an alkylating drug indicated for the treatment of low-grade upper tract urothelial cancer, LG-UTUC, (bladder cancer) in adult patients.
What doses of Jelmyto are available?
Jelmyto is available in pyelocalyceal solution form, in the following doses: Two 40 mg (each) single-dose vials of mitomycin for pyelocalyceal solution, one vial of 20 mL sterile hydrogel for reconstitution.
Your healthcare provider will carry out blood tests prior to each treatment to check your blood cell counts during treatment. Jelmyto is for pyelocalyceal use only and not for intravenous use, topical use, or oral administration.
Administer 1.3 g of sodium bicarbonate orally the evening prior to, the morning of, and 30 minutes prior to instillation procedure (total of 3.9 g). Instill 4 mg per mL of Jelmyto via the ureteral catheter or nephrostomy tube to the renal pelvis and calyces, with total instillation volume based on volumetric measurements using pyelography. Do not exceed 15 mL (60 mg of mitomycin). Instill Jelmyto once weekly for six weeks. For patients with a complete response 3 months after initiation, further Jelmyto instillations may be given once a month for a maximum of 11 additional instillations.
Please read the prescribing information and instructions for administration, and always speak with a healthcare professional about any changes to your dose so they can monitor and evaluate your condition.
Jelmyto active ingredients
Jelmyto contains mitomycin as the active ingredient.
Jelmyto side effects
The most common side effects of Jelmyto in clinical trials include:
- Ureteric obstruction
- Flank pain (side pain)
- Urinary tract infection
- Hematuria (blood in your urine)
- Renal dysfunction (kidney problems – impairment of kidney function)
- Nausea, vomiting
- Abdominal pain
In rare instances, Jelmyto can cause more serious side effects. These can include:
- Ureteric obstruction – transient or long-term ureteral stents or alternative procedures may be required
- Bone marrow suppression – thrombocytopenia and neutropenia may occur
- Embryo-fetal toxicity
Your doctor will assess the benefits of using Jelmyto against your risk of side effects. Patients are encouraged to report negative side effects or adverse reactions of Jelmyto to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.
Jelmyto drug interactions
Jelmyto can interact with other medications. These include:
- Vaccines – BCG, measles, mumps, rubella, smallpox, yellow fever
- DMARDs – leflunomide, teriflunomide
- Immunosuppressants – fingolimod, ozanimod, siponimod
- Antipsychotics – clozapine
This list is not exhaustive and other prescription drugs may interact with Jelmyto.
You should not use Jelmyto if you:
- Are allergic to the active ingredient mitomycin
- Are allergic to any of the other ingredients in Jelmyto
- Have perforation of the bladder or upper urinary tract
- Are pregnant or are planning to become pregnant – use effective contraception during treatment and for 6 months after the last dose
- Are breastfeeding or are planning to breastfeed
Talk to your doctor before using Jelmyto if you:
- Are taking any of the medications that could interact with Jelmyto
Jelmyto is the trademark brand name for mitomycin manufactured by UroGen Pharma, Inc. A generic version of mitomycin is not available. Generic drugs are generally cheaper than brand-name drugs, but you can still find Jelmyto savings through NiceRx.
*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 the different programs and filling out all the required paperwork for each program. Subject to medication availability.
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.
The content on this website is intended for information purposes only. It does not constitute medical advice. The information on this website should not be relied upon and is not a substitute for professional medical advice. You should always speak to your doctor regarding the risks and benefits of any treatment.