Provider Briefing: Addyi Availability in 2026

If your patients are reporting difficulty filling their Addyi (Flibanserin) prescriptions, they're encountering a real and well-documented access challenge. While Addyi is not in a formal FDA-reported shortage, its unique distribution model means that most retail pharmacies do not stock it — creating a de facto availability gap that affects patient adherence and outcomes.

This briefing covers the current Addyi availability landscape, prescribing considerations, cost and access pathways, and tools that can streamline your clinical workflow.

Timeline: Addyi's Distribution History

Understanding how we got here helps contextualize the current situation:

• August 2015: FDA approves Flibanserin (Addyi) for HSDD in premenopausal women, with a Risk Evaluation and Mitigation Strategy (REMS) requiring certified prescribers and pharmacies
• October 2015: Commercial launch through limited pharmacy network; underwhelming initial uptake
• 2016–2018: Sprout Pharmaceuticals acquired by Valeant (later Bausch Health); commercial strategy shifts
• April 2019: FDA removes REMS requirements after postmarketing safety data review; modifies alcohol boxed warning to allow moderate consumption with a 2-hour waiting period
• 2019–2024: PhilRx mail-order pharmacy becomes primary distribution channel; retail pharmacy stocking remains minimal
• 2025: FDA expands indication to women under 65 years of age (previously limited to premenopausal women)
• 2026: No generic available; earliest generic entry estimated May 2028

Prescribing Implications

REMS No Longer Required

A common misconception among providers is that Addyi still requires REMS certification. The REMS was removed in 2019. Any licensed prescriber can write a prescription for Addyi without special certification or training requirements.

Updated Indication

As of 2025, Addyi is indicated for the treatment of acquired, generalized HSDD in women under 65 years of age — expanding beyond the original premenopausal-only indication. The HSDD diagnosis should not be attributable to co-existing medical or psychiatric conditions, relationship issues, or medication effects.

Boxed Warning: Current Language

The boxed warning addresses two primary risks:

1. Alcohol interaction: Patients should wait at least 2 hours after consuming 1–2 standard alcoholic drinks before taking Addyi at bedtime. If 3 or more drinks are consumed, the dose should be skipped entirely.
2. CYP3A4 inhibitors: Addyi is contraindicated with moderate or strong CYP3A4 inhibitors (e.g., Ketoconazole, Fluconazole, Clarithromycin, HIV protease inhibitors, Diltiazem, Verapamil). If initiating Addyi following CYP3A4 inhibitor use, start Addyi 2 weeks after the last inhibitor dose.

Additionally, Addyi is contraindicated in patients with hepatic impairment of any degree.

Key Drug Interactions to Screen

Beyond the boxed warning interactions, providers should screen for:

• Multiple weak CYP3A4 inhibitors (including herbal supplements like Ginkgo and Resveratrol, and OTC medications like Cimetidine)
• CYP2C19 inhibitors (Benzodiazepines, PPIs, SSRIs)
• CNS depressants that may compound sedation and hypotension risk
• P-glycoprotein substrates with narrow therapeutic indices (e.g., Digoxin)

For a comprehensive interaction reference, see our post on Addyi drug interactions.

Current Availability Picture

Addyi's availability challenges are distribution-related, not manufacturing-related. Key points:

• Sprout Pharmaceuticals continues to manufacture Addyi
• PhilRx mail-order pharmacy is the primary dispensing channel and always has stock
• Most retail chain pharmacies (CVS, Walgreens, Walmart, Rite Aid) do not routinely stock Addyi
• Some independent pharmacies may stock or special-order it
• No generic Flibanserin is available; estimated generic entry is May 2028

Cost and Access Pathways

Cost is a significant barrier to patient access. Here's the current landscape:

Pricing

• Retail cash price: $800–$1,173/month (30 tablets, 100 mg)
• PhilRx cash price: $149/month
• PhilRx with insurance + coupon: As low as $20/month

Insurance Coverage

• Not covered by most Medicare plans
• Variable commercial coverage; often requires prior authorization
• PhilRx provides prior authorization support for insured patients

Patient Assistance

• Addyi Coupon Program: Available at addyicoupon.com — reduces cost through PhilRx
• NeedyMeds and RxAssist: Additional patient assistance resources for qualifying patients

For a patient-facing guide on savings, see how to save money on Addyi.

Tools and Resources for Providers

Medfinder for Providers

Medfinder offers a provider-facing platform that helps you and your staff check real-time Addyi availability at pharmacies near your patients. This can be incorporated into your prescribing workflow to reduce callbacks and prescription abandonment.

PhilRx Prescribing Workflow

Sprout Pharmaceuticals has streamlined the prescribing process through PhilRx:

1. Write the prescription for Addyi 100 mg, #30, 1 refill
2. Send electronically to PhilRx (or fax)
3. PhilRx contacts the patient, applies the coupon, and handles PA if needed
4. Medication is shipped directly to the patient with free delivery

This workflow minimizes the risk of prescription abandonment that occurs when patients can't find the medication at their local pharmacy. Details at addyihcp.com.

Telehealth Integration

For providers offering telehealth visits, Addyi's mail-order model integrates well — there's no need for the patient to visit a specific pharmacy. The entire process from consultation to delivery can happen remotely.

Alternative Therapies to Consider

When Addyi isn't appropriate or accessible, consider:

• Vyleesi (Bremelanotide): FDA-approved for HSDD in premenopausal women; 1.75 mg subcutaneous injection as needed (max 8 doses/month); different mechanism (melanocortin receptor agonist); no alcohol interaction; caution in cardiovascular disease
• Off-label testosterone: Low-dose compounded testosterone cream/gel; requires monitoring of blood levels; supported by some evidence, particularly in postmenopausal women
• CBT/sex therapy: Evidence-based non-pharmacologic approach; can be combined with medication

Our patient-facing guide on alternatives to Addyi can be shared with patients exploring their options.

Looking Ahead

Several developments may improve the Addyi access landscape in coming years:

• Generic entry (est. May 2028): Should significantly expand distribution and reduce cost
• Expanded indication: The 2025 label update to include women under 65 (not just premenopausal) may increase prescribing volume and downstream availability
• HSDD pipeline: Research into new HSDD treatments continues, though no near-term approvals are anticipated

Final Thoughts

Addyi remains an effective, FDA-approved option for HSDD — but its distribution model requires prescribers to be proactive about guiding patients to accessible channels. Routing prescriptions through PhilRx and equipping patients with tools like Medfinder can significantly reduce access barriers.

For a step-by-step workflow guide, see our companion post: How to help your patients find Addyi in stock.