A provider-focused update on the Anagrelide shortage in 2026. Shortage timeline, prescribing implications, alternatives, and tools to help your patients.
Anagrelide hydrochloride (Agrylin) remains a cornerstone of second-line cytoreductive therapy for essential thrombocythemia (ET). However, ongoing supply constraints continue to create access challenges for patients. This update provides hematologists, oncologists, and primary care providers with the current state of Anagrelide availability, prescribing considerations, and actionable resources.
Anagrelide supply disruptions have been a recurring issue since the mid-2010s:
The original brand, Agrylin, was manufactured by Shire US Manufacturing (now part of Takeda). Generic versions are available from Teva and select other manufacturers.
The availability picture has several practical implications for prescribers:
Patients filling at large retail chains may encounter stock-outs more frequently than those using specialty or independent pharmacies. Consider directing patients to:
Given intermittent availability, proactive strategies include:
If availability forces a temporary switch, close monitoring is essential. Anagrelide discontinuation can lead to rapid platelet count rebound. Transitioning to an alternative agent should include:
As of early 2026, the availability landscape is as follows:
Providers can direct patients to Medfinder for Providers to help locate in-stock pharmacies in real time.
While generic Anagrelide is generally covered by commercial insurance and Medicare Part D, access barriers include:
For patients facing cost barriers, Prescription Hope offers Anagrelide through patient assistance programs at $70/month. NeedyMeds and RxAssist maintain databases of additional assistance programs. Discount cards from GoodRx and SingleCare can reduce generic costs to $48-$91 for 60 capsules. See our provider's guide to helping patients save on Anagrelide for a comprehensive breakdown.
When Anagrelide is unavailable or contraindicated, the following alternatives should be considered based on patient risk stratification:
Remains the preferred first-line cytoreductive agent for high-risk ET. The PT-1 trial demonstrated superiority of Hydroxyurea plus low-dose aspirin over Anagrelide plus aspirin in preventing thrombotic events. Widely available and affordable (generic cost often under $20/month).
Increasingly favored for younger patients and those with a JAK2 V617F mutation. Offers potential disease-modifying activity. Administered as weekly subcutaneous injection. Consider for patients where disease modification is a priority.
JAK1/JAK2 inhibitor approved for myelofibrosis and polycythemia vera; used off-label in ET. May be appropriate for patients refractory to or intolerant of Hydroxyurea and Anagrelide. Insurance coverage for off-label ET use can be challenging.
Reserved for older patients refractory to or intolerant of first and second-line agents. Leukemogenic risk limits use to short-term or later-line therapy.
For patient-facing information on alternatives, see: Alternatives to Anagrelide.
The fundamental challenge with Anagrelide availability is structural: limited manufacturer diversity for a niche medication. Until additional generic suppliers enter the market, intermittent supply disruptions are likely to continue.
Proactive prescribing practices — directing patients to specialty pharmacies, prescribing 90-day supplies, and maintaining familiarity with alternative agents — can mitigate the impact on patient care. Encourage patients to use Medfinder to check availability before filling.
Anagrelide remains a valuable second-line option for essential thrombocythemia, and its availability, while imperfect, is not at crisis levels. However, the limited supplier landscape demands vigilance from prescribers. Building systems to monitor supply, educate patients about proactive refilling, and maintain fluency with alternative agents will ensure continuity of care for this vulnerable patient population.
For the patient-facing perspective on this issue, share our patient shortage update with your patients.
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