Amifampridine Shortage Update: What Patients Need to Know in 2026

If you've been searching online about an amifampridine shortage, you may have found conflicting information. Here is the clear answer for 2026: amifampridine (Firdapse) is not currently on the FDA's official drug shortage database. However, that doesn't mean it's easy to access. The barriers LEMS patients face are real and significant — they're just different from a traditional drug shortage.

What the FDA Shortage Database Says

The FDA maintains a database of current and resolved drug shortages. A drug shortage is declared when a medically necessary drug's supply falls short of demand nationwide. As of 2026, amifampridine (Firdapse) does not appear on this list. The manufacturer — Catalyst Pharmaceuticals — has maintained production, and there are no reports of Firdapse being unavailable through specialty pharmacy channels.

Why It Still Feels Like a Shortage

LEMS patients often describe their experience of trying to access amifampridine as similar to dealing with a shortage — and that's understandable. The barriers they face are significant:

Retail pharmacies don't stock it: It's not available at CVS, Walgreens, or similar chains.

Prior authorization delays: All major insurers require PA, adding days or weeks before the drug can be dispensed.

Specialty pharmacy routing: Finding the right specialty pharmacy that accepts your insurance can be confusing.

Insurance denials: Some patients face repeated denials requiring expensive appeals processes.

The loss of Ruzurgi: The 2022 court ruling removed the only competing brand, leaving Firdapse as the sole option with no generic available.

The History of Amifampridine Access in the US

Amifampridine has a unique history in the United States that helps explain why access is so fraught. For decades before FDA approval, Jacobus Pharmaceutical provided the free-base form of the drug for free under an FDA compassionate use program. When Catalyst Pharmaceuticals launched Firdapse (the phosphate salt form) in November 2018 at approximately $375,000 per year, it triggered immediate controversy.

Senator Bernie Sanders publicly questioned why a drug that had been given away freely was now priced at $375,000 per year. In response, the FDA approved Jacobus's Ruzurgi brand in May 2019 for pediatric LEMS patients. However, in 2022, a federal court ruled that Ruzurgi's approval violated Catalyst's orphan drug exclusivity, and Ruzurgi was effectively removed from the market. This left Firdapse as the only option.

The May 2024 Dose Increase and What It Means

In May 2024, the FDA approved a supplemental New Drug Application for Firdapse that increased the maximum approved daily dose from 80 mg to 100 mg for adults and pediatric patients weighing more than 45 kg. This update was clinically significant for patients who were hitting the dose ceiling and not achieving adequate symptom control. If your prior authorization was written based on the old 80 mg limit, work with your neurologist to update it to reflect the new 100 mg maximum.

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What Patients Can Do Right Now

If you are having trouble accessing amifampridine, here are the most actionable steps:

Contact Catalyst Pathways (1-833-422-8259) for help with specialty pharmacy routing and financial assistance enrollment.

Ask your neurologist to request an expedited prior authorization review if your symptoms are significantly impacting your daily function.

If your PA was denied, appeal it. Neurologists can request a peer-to-peer review with the insurer's medical director, which is often effective.

Ask about the Firdapse Bridge Program, which can provide free medication during coverage gaps.

Contact NORD (National Organization for Rare Diseases) at 800-999-6673 for additional financial assistance resources.

Managing Symptoms While Awaiting Access

While working through access barriers, talk to your neurologist about symptom management. Pyridostigmine (Mestinon) is a commonly available alternative that can provide some relief. For patients with severe or rapidly worsening symptoms, IVIG or plasmapheresis may be considered as bridge therapies.

See also: Alternatives to Amifampridine If You Can't Fill Your Prescription and How to Find Amifampridine in Stock Near You.