Provider Briefing: Besifloxacin Availability in 2026

If you prescribe Besifloxacin (Besivance) for bacterial conjunctivitis, you've likely heard from patients who can't find it at their pharmacy. While Besifloxacin is not currently listed on the FDA or ASHP drug shortage databases, real-world access remains a persistent challenge — driven by its brand-name exclusivity, single-manufacturer supply chain, and formulary restrictions.

This briefing covers what prescribers need to know about Besifloxacin availability in 2026, including supply chain dynamics, prescribing considerations, cost and access barriers, and practical tools to help your patients fill their prescriptions.

Timeline: How We Got Here

Besifloxacin was FDA-approved on May 28, 2009, as the first fluoroquinolone developed exclusively for ophthalmic use. Manufactured by Bausch + Lomb, it's available only as the brand-name product Besivance (besifloxacin ophthalmic suspension 0.6%).

Key timeline points:

• 2009: FDA approval for bacterial conjunctivitis
• 2013: Key formulation patents granted (U.S. Patent 8,415,342)
• 2009–2026: No generic version approved; Bausch + Lomb remains the sole manufacturer
• 2024–2026: Ongoing patient reports of difficulty locating Besivance at pharmacies, despite no formal shortage listing

The absence of generic competition is the central issue. Unlike Moxifloxacin, Ofloxacin, and Ciprofloxacin — all available as generics — Besifloxacin has no alternative manufacturer, making supply inherently fragile.

Prescribing Implications

For ophthalmologists, optometrists, and primary care providers who treat bacterial conjunctivitis, the practical implications of Besifloxacin's limited availability include:

Step Therapy and Prior Authorization

Most commercial payers and Medicare Part D plans require step therapy before covering Besivance, typically mandating a trial of generic Moxifloxacin or another fluoroquinolone first. Prior authorization requests for Besivance may take 24 to 72 hours to process, which can delay treatment initiation for an acute infection.

Patient Non-Fill Rates

Given the high out-of-pocket cost ($130 to $300 without insurance), patients who encounter sticker shock at the pharmacy counter may abandon the prescription entirely. Proactively discussing cost and providing savings program information at the point of prescribing can improve fill rates.

Clinical Differentiation

Besifloxacin's clinical differentiation from other ophthalmic fluoroquinolones includes:

• Dual-enzyme targeting (DNA gyrase + topoisomerase IV) — shared with Moxifloxacin and Gatifloxacin
• DuraSite delivery system — polycarbophil-based mucoadhesive formulation that extends ocular surface contact time
• No systemic formulation — developed exclusively for ophthalmic use, theoretically reducing selection pressure for systemic resistance
• Three-times-daily dosing for seven days

When the clinical situation doesn't specifically warrant Besifloxacin's unique properties, prescribing a generic fourth-generation alternative like Moxifloxacin may improve patient access and adherence.

Current Availability Picture

Besifloxacin availability in 2026 is best characterized as "spotty but not formally short":

• Not listed on the FDA Drug Shortage Database or ASHP shortage list
• Available through standard wholesale channels but not routinely stocked at many retail pharmacies
• Independent pharmacies and ophthalmology-adjacent pharmacies are more likely to maintain stock
• Special orders through chain pharmacies typically fulfill in one to three business days

Cost and Access in 2026

Cost remains a significant access barrier:

• Average wholesale price (AWP): Approximately $300 for a 5 mL bottle
• Typical cash price: $130 to $300 depending on pharmacy
• Discount card pricing: $130 to $205 (SingleCare, GoodRx)
• Bausch + Lomb Access Program: $25 copay for commercially insured patients; $69 maximum for cash-paying patients (up to 6 fills per 12-month period)
• Patient Assistance Program: Free medication for qualifying uninsured patients through Bausch + Lomb (call 855-770-0191)

Directing patients to the manufacturer's savings program at the point of prescribing can significantly reduce abandonment rates.

Tools and Resources for Your Practice

Several tools can help streamline Besifloxacin access for your patients:

Medfinder for Providers

Medfinder for Providers allows your practice to check real-time pharmacy stock for Besifloxacin and other medications. You can direct patients to pharmacies that have the medication in stock before they leave your office, reducing failed fills and callback volume.

Manufacturer Resources

• Besivance Pro: besivancepro.com — clinical resources, savings program enrollment, and sample requests
• Bausch + Lomb Access Program: bauschaccessprogram.com — patient savings card enrollment
• Sample Vault: Registered providers can request Besivance samples through the Bausch Sample Vault program (call 855-770-0191)

Alternative Prescribing Quick Reference

When Besifloxacin is unavailable or cost-prohibitive, consider these evidence-based alternatives:

• Moxifloxacin 0.5% (generic Vigamox): 4th-generation FQ; 1 drop TID × 7 days; $15–$50 generic
• Ofloxacin 0.3% (generic Ocuflox): 2nd-generation FQ; 1–2 drops q2–4h × 2 days, then QID × 5 days; $10–$30
• Ciprofloxacin 0.3% (generic Ciloxan): 2nd-generation FQ; drops or ointment; $10–$25
• Gatifloxacin 0.5% (Zymaxid): 4th-generation FQ; 1 drop q2h × 1 day, then BID–QID × 6 days; $150–$250 (brand)

A more detailed comparison is available in our Besifloxacin alternatives guide.

Looking Ahead

No generic Besifloxacin is expected in the near term. The situation is unlikely to change significantly until generic entry occurs or Bausch + Lomb expands manufacturing capacity. In the meantime, providers can optimize patient outcomes by:

1. Considering whether Besifloxacin's specific clinical advantages are necessary for each patient
2. Proactively providing cost and access information at the point of prescribing
3. Using tools like Medfinder for Providers to verify availability before the patient leaves the office
4. Keeping Besivance samples on hand for urgent cases
5. Documenting clinical rationale when prior authorization is needed

Final Thoughts

Besifloxacin remains a valuable fourth-generation fluoroquinolone with unique formulation advantages, but its brand-name exclusivity creates real access challenges for patients. By staying informed about current availability, proactively addressing cost barriers, and leveraging tools like Medfinder for Providers, prescribers can help ensure their patients get the treatment they need — whether that's Besifloxacin or an effective alternative.

For additional provider resources, see our companion guide on how to help your patients find Besifloxacin in stock.