Alrex Shortage: What Providers and Prescribers Need to Know in 2026

Alrex Shortage: What Providers and Prescribers Need to Know in 2026

As an ophthalmologist, optometrist, or primary care provider prescribing Alrex (Loteprednol Etabonate 0.2%) for seasonal allergic conjunctivitis, you may be hearing from patients that they can't find their medication at the pharmacy. This briefing provides an up-to-date picture of Alrex availability, the factors driving access challenges, and practical strategies to help ensure your patients get the treatment they need.

Current Supply Status

As of March 2026, Alrex is not listed on the FDA Drug Shortage database or the ASHP Drug Shortages list. There is no formal, manufacturer-reported supply disruption for either brand-name Alrex or generic Loteprednol Etabonate 0.2%.

However, providers should be aware that practical access challenges exist. Brand-name Alrex has become increasingly difficult for patients to locate at retail pharmacies. This is driven primarily by the widespread adoption of generic Loteprednol Etabonate 0.2%, which has led many pharmacy chains to discontinue stocking the brand-name product.

Timeline and Market Dynamics

Understanding the market evolution helps frame current availability:

• 1998: Alrex (Loteprednol Etabonate 0.2%) approved by the FDA for seasonal allergic conjunctivitis
• Post-patent expiration: FDA approved generic Loteprednol Etabonate 0.2% ophthalmic suspension
• 2024-2026: Progressive shift in pharmacy inventory from brand-name Alrex to generic Loteprednol, driven by cost differential and payer pressure
• Current state: Brand-name Alrex remains available from Bausch + Lomb but is stocked at fewer retail pharmacy locations; generic is widely available through major distributors

Prescribing Implications

The availability landscape has several implications for prescribers:

Generic Substitution

Unless there is a clinical reason to specify brand-name Alrex, prescribing generic Loteprednol Etabonate Ophthalmic Suspension 0.2% will improve your patients' ability to fill their prescriptions. Generic Loteprednol 0.2% meets the same FDA standards for bioequivalence and is typically available at most retail pharmacies.

If you write for "Alrex" without DAW (dispense as written), most pharmacies will automatically substitute the generic. However, explicitly prescribing the generic can reduce confusion and delays.

Step Therapy Considerations

Many commercial payers and pharmacy benefit managers now require step therapy before covering ophthalmic corticosteroids for allergic conjunctivitis. Common first-step requirements include:

• Over-the-counter antihistamine drops (Olopatadine/Pataday, Ketotifen/Zaditor)
• Prescription antihistamine/mast cell stabilizer combinations

Documenting prior OTC antihistamine trial and failure in the patient's chart can expedite prior authorization when a corticosteroid like Alrex is clinically indicated.

Prior Authorization

Brand-name Alrex increasingly requires prior authorization. Generic Loteprednol Etabonate 0.2% is more commonly on preferred formulary tiers. When submitting prior authorization requests, emphasize:

• Severity and duration of symptoms
• Failure of first-line therapies (OTC antihistamines)
• Clinical rationale for corticosteroid intervention
• Alrex/Loteprednol's favorable IOP safety profile compared to Prednisolone

Availability Picture

To help contextualize the current situation for your practice:

• Generic Loteprednol Etabonate 0.2%: Widely available at CVS, Walgreens, Walmart, Costco, and most independent pharmacies
• Brand-name Alrex: Stocked at fewer locations; patients may need to check multiple pharmacies or use availability tools
• Distribution channels: Both brand and generic are available through major wholesalers (McKesson, Cardinal Health, AmerisourceBergen)

Cost and Access

Understanding the cost landscape helps when counseling patients:

• Brand-name Alrex: Retail price approximately $200-$262 per 5 mL bottle
• Generic Loteprednol 0.2%: $80-$132 per 5 mL bottle with discount cards (GoodRx, SingleCare)
• Bausch + Lomb Access Program: Previously offered copay assistance for commercially insured patients; current inclusion of Alrex should be verified at bauschaccessprogram.com
• Patient Assistance Program: Bausch + Lomb offers a PAP for uninsured patients at patientassistance.bausch.com

For patients struggling with cost, our detailed resource on saving money on Alrex covers all available discount and assistance programs.

Tools and Resources for Providers

Several tools can help your practice and patients navigate availability challenges:

Medfinder for Providers

Medfinder allows providers and patients to check real-time pharmacy availability for Alrex and generic Loteprednol. Consider recommending this tool to patients at the point of prescribing, particularly during peak allergy season when local shortages are more common.

Prescribing Best Practices

1. Prescribe generically unless there is a specific clinical reason for brand-name Alrex
2. Document step therapy compliance in the chart to streamline prior authorizations
3. Recommend Medfinder to patients who report difficulty finding the medication
4. Maintain relationships with local independent pharmacies that can order specialty ophthalmic products quickly
5. Consider samples for bridging therapy while patients locate the medication

Alternative Prescribing Options

When Alrex or generic Loteprednol 0.2% is unavailable, consider these alternatives based on clinical severity:

• Mild symptoms: OTC Olopatadine (Pataday) or Ketotifen (Zaditor)
• Moderate symptoms: Prescription Olopatadine 0.7% (Pazeo) or other prescription antihistamine/mast cell stabilizer combinations
• Severe symptoms requiring steroid: Lotemax (Loteprednol Etabonate 0.5%) or Prednisolone Acetate 1% (Pred Forte) with appropriate IOP monitoring

For a comprehensive comparison, see our clinical guide to alternatives to Alrex.

Looking Ahead

The ophthalmic allergy treatment landscape continues to evolve. Key trends to watch:

• Generic competition will continue to drive down costs for Loteprednol Etabonate 0.2%, improving patient access
• Payer requirements for step therapy are likely to continue or expand, making documentation of OTC antihistamine trials increasingly important
• Digital pharmacy tools like Medfinder are becoming essential for practices dealing with specialty medication access issues

Final Thoughts

While there is no formal Alrex shortage, practical access challenges are real and ongoing. The most impactful steps providers can take are prescribing generically, documenting step therapy compliance, and directing patients to tools like Medfinder for real-time availability information.

For patients who need additional support finding their medication, our provider-facing guide on helping patients find Alrex in stock offers a step-by-step workflow for your practice.

Related provider resources:

• How to Help Your Patients Find Alrex in Stock
• How to Help Patients Save Money on Alrex
• How Does Alrex Work? Mechanism of Action Explained