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

Azasite Supply in 2026: A Provider Briefing

As the erythromycin ophthalmic ointment shortage continues into 2026, many providers have turned to Azasite (Azithromycin ophthalmic solution 1%) as an alternative for bacterial conjunctivitis and other superficial ocular infections. However, Azasite's unique distribution model and brand-only status present challenges that prescribers should understand to help patients access this medication effectively.

This briefing covers the current availability picture, prescribing implications, cost and access considerations, and tools available to support your patients and practice.

Timeline: How We Got Here

Azasite has a complex history that informs its current supply situation:

• 2007: FDA approval for bacterial conjunctivitis. Originally developed by InSite Vision using DuraSite sustained-release technology.
• 2011: Marketing transitioned to Akorn, Inc.
• 2023: Akorn filed for bankruptcy. Product rights and distribution were acquired by Sun Pharma.
• 2024–2026: The ongoing erythromycin ophthalmic ointment shortage led the FDA, CDC, and American Academy of Ophthalmology to recommend Azasite as an alternative for superficial ocular infections, dramatically increasing demand.
• December 2025: FDA reports Azasite as "currently available" — no formal shortage, but practical access remains limited due to specialty distribution.

Prescribing Implications

Approved Indication

Azasite is FDA-approved for the treatment of bacterial conjunctivitis caused by susceptible isolates of: CDC coryneform group G, Haemophilus influenzae, Staphylococcus aureus, Streptococcus mitis group, and Streptococcus pneumoniae.

Off-Label Considerations

Clinicians frequently prescribe Azasite off-label for:

• Blepharitis
• Meibomian gland dysfunction (MGD)
• Ocular rosacea
• As an alternative to erythromycin ointment for superficial ocular infections (per FDA/CDC guidance during the shortage)

Dosing

Standard dosing: 1 drop in the affected eye(s) twice daily for days 1–2, then once daily for days 3–7. Total treatment: 9 drops over 7 days. Approved for patients aged ≥1 year.

Key Contraindications

Hypersensitivity to azithromycin or any product component. Not for injection. Patients should remove contact lenses during treatment (preservative can permanently stain soft lenses). For detailed interaction information, see: Azasite drug interactions.

Current Availability Picture

The most important thing prescribers should know is that Azasite is not available through standard retail pharmacy channels. It is distributed exclusively through the EyeRx Direct specialty pharmacy program at azasite.com.

This means:

• Prescriptions sent to CVS, Walgreens, Walmart, or other chain pharmacies cannot be filled in most cases
• Prescribers should route prescriptions to EyeRx Direct or instruct patients to use the azasite.com portal
• Some independent pharmacies with specialty distribution relationships may be able to order it

For real-time availability checking, providers can direct patients to Medfinder for Providers.

Cost and Access Considerations

Azasite is significantly more expensive than most alternative ophthalmic antibiotics:

• Retail cash price: $259–$300 for 2.5 mL
• GoodRx coupon price: approximately $205
• EyeRx Direct program: approximately $60 — the most cost-effective channel

For comparison:

• Generic Moxifloxacin: $15–$30
• Generic Tobramycin: $10–$20
• Generic Polytrim: $10–$15

No generic Azasite exists. Insurance coverage varies — many plans require prior authorization or step therapy (trial of a cheaper antibiotic first). Medicare Part D plans may cover with varying copays.

For patient savings guidance, refer to: How to help patients save money on Azasite.

Tools and Resources for Your Practice

Medfinder for Providers

Medfinder offers real-time pharmacy availability data that helps providers direct patients to pharmacies with medications in stock. This is particularly valuable for specialty-distribution products like Azasite where standard channels don't apply.

EyeRx Direct

The primary distribution channel for Azasite. Accessible at azasite.com. Providers can send prescriptions directly to this program. Price: approximately $60 per bottle.

Patient Assistance

NeedyMeds (needymeds.org) and RxAssist (rxassist.org) list patient assistance options for qualifying low-income patients. Sun Pharma may offer additional programs — contact their customer service for current information.

Looking Ahead

Several factors will shape Azasite availability going forward:

• Erythromycin shortage resolution: If erythromycin ointment supply normalizes, demand pressure on Azasite should decrease
• Generic entry: No generic is currently approved, and no confirmed timeline exists. Generic competition would dramatically improve access and affordability
• Manufacturer stability: Sun Pharma's stewardship of the product following Akorn's bankruptcy will be important to monitor

In the meantime, maintaining awareness of effective alternatives and the specialty distribution pathway is essential for ensuring patient access to timely treatment.

Final Thoughts

Azasite remains a valuable tool in the ophthalmic antibiotic armamentarium, particularly during the erythromycin shortage. However, its specialty-only distribution and brand-only pricing require providers to be proactive in guiding patients to the right channels. Route prescriptions through EyeRx Direct, consider alternatives when appropriate, and use tools like Medfinder for Providers to help patients locate their medications.

For a comprehensive prescribing overview, see: What is Azasite? Uses, dosage, and what you need to know. For side effect guidance to share with patients, see: Azasite side effects.