Elmiron and IC - Side Effects, Cost & Effectiveness Question Title * 1. Have you been diagnosed with interstitial cystitis? Yes No Question Title * 2. Have you been prescribed oral Elmiron for your IC? Yes No Question Title * 3. 3. Approximately how long did you take it? Less than a month Three Months Six Months One Year Two Years Three or More Years Question Title * 4. What dosage? 100mg 200mg - 2 capsules per day 300mg - 3 capsules per day 400mg - 4 capsules per day 500mg - 5 capsules per day 600mg - 6 capsules per day More than 600mg per day Question Title * 5. How much do you think it helped you? I didn't notice any improvement in my IC symptoms Small improvement - My IC improved slightly but IC still kept me from doing many things. Moderate improvement - My IC symptoms improved modestly and, with elmiron, I was able to function better in my daily life Good improvement - Elmiron helped to reduce my symptoms dramatically. I'm grateful for its help. Excellent improvement - My IC symptoms resolved almost completely. Elmiron has kept my IC symptoms completely controlled Question Title * 6. Did you experience any side effects with Elmiron (Check all that apply) I experienced no side effects Minor diarrhea / loose bowels Moderate to severe diarrhea Mild Stomach upset/nausea Moderate to severe stomach upset/nausea Liver Dysfunction / Elevated Liver Enzyme Increase Mild Hair Loss Moderate to Severe Hair Loss Headache Dizziness Skin rash / mild rash Depressed mood Other (please specify) Question Title * 7. Did side effects eventually prevent you from using Elmiron? Yes No Question Title * 8. When did the side effects begin? Within the first week of treatment A month into treatment Three months into treatment Six months into treatment One year into treatment Question Title * 9. Is (or was) Elmiron covered by your health insurance plan? No. I don't have health insurance. I pay out of pocket. Yes and No. It's partially covered but I have to pay full price for atleast six months. (i.e. the Medicare donut hole) Yes. It is fully covered and I pay a small copay to refill. Don't know Question Title * 10. In 2014, if covered by health insurance (for one or more months), what is (or was) your average copayment for your monthly Elmiron prescription? If you have a donut hole, please give us the low copayment here. It's not covered by health insurance Under $10 $10 to $19 $20 to $29 $30 to $39 $40 to $49 $50 to $59 $60 to $69 $70 to $79 $80 to $99 I didn't take it in 2014 Other (please specify) Question Title * 11. In 2014, if (or when) NOT covered by insurance, how much do you pay out of pocket each month for your Elmiron? Under $24 $25 to $49 $50 to $99 $100 to $249 $250 to $499 $500 to $749 $740 to $999 $1000 to $1500 More than $1500 I didn't take it in 2014 Question Title * 12. Has Elmiron become difficult for you to afford? No. I can afford it comfortably. Yes. It's a bit of a strain but I can pay for it. Yes. It's become challenging to pay for Elmiron. It's affecting my monthly expenses and I've had to go without other essentials. Yes. I can barely afford it. I've had to cut back substantially on my other daily expenses to pay for Elmiron. Question Title * 13. Has your health insurance company cancelled their coverage of Elmiron? Yes, they cancelled in 2014 Yes, they cancelled in 2013 Yes, they cancelled in 2012 Yes, they cancelled in 2011 Yes, they cancelled in 2010 Don't remember when No, they still cover Elmiron Question Title * 14. Have you talked with your physician about reducing the costs of Elmiron? No Yes. They suggested reducing the dosage to help my prescription last longer. Yes. They had no suggestions. Yes. My physician suggested that I try other medications or supplements instead. Question Title * 15. Have you stopped taking Elmiron because you can no longer afford it? Yes No Question Title * 16. How much would you be willing to pay for a generic pentosan? Under $25 Under $50 Under $75 Under $100 Under $200 Question Title * 17. What Country/Region Do You Live In? USA Canada Mexico United Kingdom European Union Australia/New Zealand Asia Africa Done