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

Besifloxacin Availability: A Provider Briefing for 2026

As a prescriber, you may have received calls from patients unable to fill their Besifloxacin (Besivance) prescriptions, or your pharmacy liaison may have flagged stocking issues. While Besifloxacin is not currently on the FDA's formal drug shortage list, the practical reality is that many patients face significant barriers to accessing this medication.

This briefing covers the current availability landscape, prescribing implications, cost considerations, and tools to help your patients — and your practice — navigate the situation.

Timeline and Background

Besifloxacin was FDA-approved in May 2009 as a fourth-generation fluoroquinolone ophthalmic suspension indicated for the treatment of bacterial conjunctivitis. Manufactured exclusively by Bausch + Lomb, it's available as Besivance — a 0.6% ophthalmic suspension in a 5 mL dropper bottle.

Key characteristics that distinguish Besifloxacin from other ophthalmic fluoroquinolones:

• Designed exclusively for topical ophthalmic use — never marketed as a systemic antibiotic, reducing pre-existing bacterial exposure and theoretical resistance selection pressure
• Dual-target mechanism: Inhibits both DNA gyrase and topoisomerase IV with balanced potency against both targets
• Broad-spectrum activity against common conjunctivitis pathogens including S. aureus, S. epidermidis, S. pneumoniae, H. influenzae, and M. lacunata
• No generic available: Patent protection extends through November 2030

Prescribing Implications

When Besifloxacin Is the Preferred Choice

There are clinical scenarios where Besifloxacin may be the preferred agent:

• Suspected resistant organisms: Besifloxacin's unique resistance profile — owing to its topical-only development history — makes it a reasonable choice when resistance to older fluoroquinolones is a concern
• Treatment failure: Patients who haven't responded to first-line agents like generic moxifloxacin or ofloxacin may benefit from Besifloxacin's different resistance profile
• Recurrent bacterial conjunctivitis: In cases of recurrent infection, selecting an agent with a lower resistance pressure may be clinically appropriate

When Alternatives Are Acceptable

For routine bacterial conjunctivitis in an otherwise healthy patient, generic alternatives are clinically appropriate first-line choices:

• Moxifloxacin 0.5% ophthalmic solution (generic Vigamox): Fourth-generation fluoroquinolone with broad-spectrum activity; the most comparable alternative
• Ofloxacin 0.3% ophthalmic solution (generic Ocuflox): Second-generation; cost-effective for susceptible organisms
• Ciprofloxacin 0.3% ophthalmic drops/ointment (generic Ciloxan): Second-generation; ointment formulation available
• Erythromycin 0.5% ophthalmic ointment: Macrolide; alternative class for fluoroquinolone-allergic patients
• Trimethoprim/Polymyxin B ophthalmic solution (generic Polytrim): Commonly used in pediatrics

For a patient-facing overview of these options, direct patients to our Besifloxacin alternatives guide.

The Availability Picture

Besifloxacin's availability challenges stem from several converging factors:

• Single-source manufacturing: Bausch + Lomb is the sole manufacturer. Any production or distribution disruption affects the entire national supply
• Low pharmacy stocking rates: With a retail cash price of $230-$350 per bottle and limited demand relative to generic alternatives, many pharmacies don't routinely carry Besivance
• Insurer restrictions: Prior authorization is required for approximately 30% of ACA enrollees and 80% of Medicaid enrollees. Step therapy protocols at many plans require trial of generic fluoroquinolones first
• No FDA-listed shortage: The absence of a formal shortage listing means distributors don't receive priority allocation guidance, and the issue remains a stocking/access problem rather than a manufacturing one

Cost and Access Landscape

Understanding the cost environment helps in counseling patients and anticipating access barriers:

• Cash price: $230-$350 per 5 mL bottle
• Discount card pricing: $204-$227 with GoodRx or SingleCare coupons
• Bausch + Lomb Access Program: Commercially insured patients may pay as little as $25 copay (up to 5 refills)
• Bausch + Lomb Patient Assistance Program: Provides medication to qualifying uninsured patients at no cost (income-based eligibility)

By contrast, generic moxifloxacin costs $15-$40, and generic ofloxacin costs $10-$25 — making them significantly more accessible for patients with cost concerns.

Tools and Resources for Your Practice

Medfinder for Providers

Medfinder offers a provider-focused platform that helps clinical teams locate pharmacy inventory in real time. Instead of having your staff call multiple pharmacies to confirm stock, Medfinder can show which locations near your patient have Besivance available. This can be especially useful for:

• Sending prescriptions to pharmacies that actually have the medication
• Reducing patient callbacks about unfilled prescriptions
• Streamlining workflows for patients with access challenges

Prior Authorization Tips

When submitting prior authorization requests for Besifloxacin, document:

• Clinical rationale for Besifloxacin over generic alternatives (e.g., treatment failure, suspected resistance, allergy to other agents)
• Previous antibiotics tried and outcomes
• Culture and sensitivity results, if available

Patient Education Resources

Direct patients to these resources to help them navigate access and cost:

• How to find Besifloxacin in stock
• How to save money on Besifloxacin
• Besifloxacin shortage update for patients

Looking Ahead

No generic Besifloxacin is expected before late 2030 or 2031, given the current patent expiration timeline. Until then, the availability and cost dynamics are unlikely to change significantly. Providers should:

• Consider prescribing generic alternatives as first-line for routine bacterial conjunctivitis
• Reserve Besifloxacin for cases where its unique resistance profile provides a clinical advantage
• Have a workflow for handling patient callbacks about unfilled Besivance prescriptions
• Familiarize front desk and nursing staff with Medfinder and the Bausch + Lomb savings programs

Final Thoughts

Besifloxacin remains a valuable agent in the ophthalmic antibiotic armamentarium, particularly for its low resistance selection pressure and exclusive topical development. However, its brand-only status, high cost, and practical availability challenges require providers to approach prescribing with awareness of the access landscape.

For a complementary guide on operationalizing these recommendations in your practice, see our article on how to help your patients find Besifloxacin.