Product Details
Elmiron
Pentosan Polysulfate Sodium100 mg
Capsule
DIN/PIN/NPN
02029448
Manufacturer
Janssen Inc.
Formulary Listing Date
2026-01-30
Unit Price
4.6905
Amount MOH Pays
4.6905
Coverage Status
Exceptional Access Program Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
C05BA04
Interchangeable Products
NOLU Clinical Criteria
NORequirements
EAP Criteria
| Therapeutic Class | Reimbursement Criteria |
|---|---|
| Unclassified EAP Drugs | These drugs are not currently listed in the Exceptional Access Program Reimbursement Criteria for Frequently Requested Drugs – January 1, 2025 Edition Physicians may wish to contact the EAP directly by phone at 416-327-8109 or 1-866-811-9893 or by email at EAPFeedback.MOH@ontario.ca to see if an unlisted drug product and/or indication may be considered for EAP funding. |