Besivance Availability: What Providers and Prescribers Need to Know in 2026

Besivance (besifloxacin 0.6% ophthalmic suspension) remains a clinically valuable first-line option for bacterial conjunctivitis, but prescribers and their staff continue to face significant operational challenges in getting it into patients' hands. This guide summarizes the current availability landscape, payer dynamics, and practical strategies for providers managing these barriers in 2026.

Current Availability Status

As of 2026, Besivance is not listed on the FDA Drug Shortage Database. Bausch + Lomb has not issued any public manufacturing alerts for besifloxacin. The supply exists at the national level — the challenge is at the pharmacy level. Because Besivance remains brand-only (no generic, patents estimated through November 2030), pharmacies stock it conservatively based on demand patterns rather than maintaining large safety stocks.

The result: patients frequently call back after receiving a Besivance prescription to report their pharmacy doesn't have it. This is particularly common with smaller independent pharmacies or chains without specialized ophthalmic supply relationships.

Clinical Considerations: Why Besivance May Be Preferred

Besifloxacin's clinical profile distinguishes it from earlier-generation fluoroquinolone eye drops:

Novel compound with no systemic counterpart. Besifloxacin was developed exclusively for ophthalmic use, which limits its exposure to systemic-use resistance selection pressure — a theoretical resistance advantage.

Balanced dual-target inhibition. Unlike older fluoroquinolones, besifloxacin has relatively balanced activity against both DNA gyrase and topoisomerase IV, which may reduce the risk of resistance development.

DuraSite formulation. The mucoadhesive polymer delivery system extends drug residence time on the ocular surface to up to 12 hours, supporting three-times-daily dosing with sustained exposure.

Broad spectrum. Active against Gram-positive organisms including MRSA strains, as well as key Gram-negative pathogens (H. influenzae, M. catarrhalis, P. aeruginosa).

Pediatric approval. Approved for patients 1 year and older, with safety and efficacy established in clinical studies involving over 1,000 patients ages 1 to 98.

Payer Environment and Prior Authorization Challenges

Prior authorization (PA) is a significant barrier for Besivance, particularly in government-funded insurance programs:

Commercial insurance: PA rarely required; most patients can fill immediately

ACA marketplace plans: PA required for approximately 3 in 10 enrollees

Medicaid: PA required for approximately 8 in 10 enrollees; step therapy common

Medicare: Coverage available for approximately 50% of beneficiaries; PA requirements vary by Part D plan

Step therapy protocols typically require documentation that a first-line agent (commonly generic ciprofloxacin or tobramycin) was tried and failed or is clinically inappropriate before Besivance will be covered.

Strategies to Improve Patient Access

The following strategies can reduce prescription abandonment and treatment delays for your Besivance patients:

Direct patients to medfinder. Recommend medfinder.com/providers to your patients — medfinder calls pharmacies near them to check current Besivance stock so patients don't waste time calling pharmacies themselves.

Direct prescriptions to known-stocking pharmacies. Identify which local pharmacies reliably stock Besivance and route prescriptions there as a default. Walgreens is a participating pharmacy in the Bausch + Lomb Access Program and often maintains better stock.

Discuss the Bausch + Lomb Access Program. Commercially insured patients can pay as little as $25 per prescription with this copay card. Point patients to blsavings.com or 1-866-693-4880 to activate.

Register for the Bausch Sample Vault. Providers who register can receive free samples, allowing immediate dispensing while the patient pursues their prescription.

Pre-fill PA documentation. For known PA-requiring plans, prepare a letter of medical necessity in advance documenting the clinical rationale for Besivance over generic alternatives.

When to Prescribe a Besivance Alternative

For most uncomplicated community-acquired bacterial conjunctivitis, generic fourth-generation fluoroquinolone alternatives are clinically reasonable. Consider a direct switch to generic moxifloxacin 0.5% or gatifloxacin 0.5% when:

The patient's insurer requires prior authorization and the infection requires prompt treatment

No local pharmacy can confirm same-day availability

The patient has Medicaid and step therapy criteria cannot be rapidly bypassed

Cost is a primary concern and no savings program applies

Summary for Providers

Besivance remains clinically valuable but requires proactive strategies to ensure reliable patient access in 2026. By building a consistent dispensing workflow — including pointing patients to medfinder, leveraging the Bausch + Lomb Access Program, and maintaining office samples — you can minimize prescription abandonment and treatment delays.