Amnesteem Shortage: A Provider Briefing for 2026

Isotretinoin remains the gold standard for severe recalcitrant nodular acne, yet prescribers and clinical teams continue to face persistent availability challenges heading into 2026. Whether you're a dermatologist managing a full Isotretinoin caseload or a primary care provider co-managing acne patients, understanding the current supply landscape is essential for patient outcomes and workflow efficiency.

This briefing covers the current state of Amnesteem and Isotretinoin availability, the factors driving supply disruptions, prescribing considerations, cost and access issues, and tools to help your patients and practice navigate the situation.

Supply Timeline: How We Got Here

Isotretinoin supply issues aren't new, but they've intensified over the past several years due to a convergence of factors:

• 2020-2021: COVID-related manufacturing and supply chain disruptions affected multiple pharmaceutical categories, including retinoids
• December 2021: The iPLEDGE REMS program transitioned to a new technology platform. The rollout was plagued by technical failures — login issues, verification errors, and system outages — causing widespread dispensing delays nationwide. Many patients went weeks without medication.
• 2022-2023: Supply gradually stabilized, but some pharmacies permanently reduced their Isotretinoin inventory after the iPLEDGE disruptions, citing operational complexity and low margins
• 2024-2026: Intermittent regional shortages persist. Demand continues to climb, with over 1 million prescriptions annually. Manufacturing consolidation means a production disruption at any single facility can create ripple effects across the entire supply chain.

Prescribing Implications

The supply landscape has several practical implications for prescribers:

Write for Generic Isotretinoin When Possible

Prescribing generic Isotretinoin rather than a specific brand (Amnesteem, Claravis, Myorisan, Zenatane) gives pharmacies maximum flexibility to dispense whatever brand they have in stock. Unless there's a clinical reason to specify a brand — such as Absorica's food-independent absorption — a generic prescription reduces fill delays.

Educate Patients on iPLEDGE Timelines

Compliance with iPLEDGE timelines remains one of the most common barriers to successful dispensing. Patients who miss their monthly verification or exceed the pickup window lose access and require a new prescription cycle. Consider incorporating iPLEDGE reminders into your patient communication workflow:

• Women of childbearing potential: 7-day pickup window after pregnancy test
• All other patients: 30-day pickup window after provider visit
• Monthly online or phone verification required for all patients

Prepare for Brand Substitution Conversations

Patients who have been stable on a particular brand may be concerned about switching. While all FDA-approved Isotretinoin products are therapeutically equivalent (with the exception of Absorica's formulation differences), addressing patient concerns proactively can improve adherence and reduce calls to your office.

Current Availability Picture

As of early 2026, Isotretinoin availability varies significantly by:

• Brand: Claravis and Zenatane tend to have the broadest distribution. Amnesteem (Viatris) and Myorisan (Almirall/Aqua) may be less consistently available depending on region.
• Pharmacy type: Independent and specialty pharmacies often have better stock than major chains. Some dermatology practices have established preferred pharmacy relationships for Isotretinoin patients.
• Geography: Urban areas with multiple pharmacy options generally have better availability than rural areas.

There is no current formal FDA shortage listing for Isotretinoin as a class, though individual products may appear on the ASHP shortage list intermittently.

Cost and Access Considerations

Cost is a significant barrier for many Isotretinoin patients, particularly the uninsured:

• Brand-name Amnesteem: $250-$1,506/month retail (30 capsules)
• Generic Isotretinoin with coupon: $86-$400/month
• Absorica (brand): $400-$1,000+/month, though Sun Pharma offers a savings card
• Insurance coverage: Most plans cover generic Isotretinoin at Tier 2-3 with prior authorization and step therapy (prior trial of oral antibiotics + topicals)

For uninsured patients, the Viatris Patient Assistance Program may provide Amnesteem at no cost for qualifying patients. Additionally, discount card services (SingleCare, GoodRx) can reduce generic costs to under $100/month at select pharmacies.

Providers can refer patients to our savings guide: How to Help Patients Save Money on Amnesteem.

Tools and Resources for Your Practice

Medfinder for Providers

Medfinder for Providers offers real-time pharmacy stock data for Isotretinoin and other medications experiencing availability issues. You can use it to:

• Identify pharmacies near your patients that currently have Isotretinoin in stock
• Compare availability across brands and dosage forms
• Reduce time your staff spends calling pharmacies on behalf of patients

iPLEDGE Resources

• iPLEDGE website: ipledgeprogram.com — For patient enrollment, provider certification, and monthly verification
• iPLEDGE help line: For resolving system issues and patient access problems

Prior Authorization Support

Many insurance plans require PA for Isotretinoin. Having a streamlined PA workflow — including documentation of prior antibiotic trial failure and clinical photographs — can reduce approval delays. Consider using electronic PA platforms that integrate with your EHR.

Alternative Prescribing Considerations

When Isotretinoin is completely unavailable or clinically inappropriate, consider:

• Oral antibiotics (Doxycycline, Minocycline) — For moderate inflammatory acne; not appropriate for long-term use
• Hormonal therapy (Spironolactone, combined oral contraceptives) — For female patients with hormonal acne patterns
• High-potency topical retinoids (Tazarotene, Adapalene 0.3%) — As adjunctive or bridging therapy

However, for severe nodular acne, these alternatives are generally not equivalent to Isotretinoin in efficacy. Switching patients off Isotretinoin should be a last resort, with clear documentation of the clinical rationale.

Looking Ahead

Several developments may affect Isotretinoin availability and access going forward:

• iPLEDGE modernization: Ongoing discussions about streamlining the REMS program, including potential changes to verification processes and pickup windows
• Manufacturing expansion: Additional generic manufacturers may enter the market, though the iPLEDGE REMS requirements raise the barrier to entry
• Telehealth prescribing: Currently, most Isotretinoin prescribing requires in-person visits for iPLEDGE compliance, but there is growing discussion about allowing greater telehealth flexibility

Final Thoughts

The Isotretinoin supply challenge in 2026 requires a proactive, multi-pronged approach from prescribers. Writing for generic Isotretinoin, educating patients on iPLEDGE compliance, leveraging tools like Medfinder for Providers, and maintaining awareness of cost-saving resources can all help ensure your patients maintain access to this essential acne treatment.

For patient-facing resources you can share, see our posts on finding Amnesteem in stock, Amnesteem alternatives, and the patient shortage update.

For a complete guide to helping your patients locate their medication, read: How to Help Your Patients Find Amnesteem in Stock.