Brenzavvy (Bexagliflozin) Shortage: What Providers and Prescribers Need to Know in 2026

Bexagliflozin (Brenzavvy) is an FDA-approved SGLT2 inhibitor that offers patients with type 2 diabetes an affordable alternative to higher-cost agents in its class. However, its unconventional distribution model creates unique challenges for prescribers and their patients. This guide covers the clinical and practical considerations providers need to navigate in 2026.

Is There an Actual Shortage of Bexagliflozin?

No FDA-declared shortage exists for bexagliflozin as of early 2026. TheracosBio, the manufacturer, has confirmed nationwide availability through its partner pharmacy network at $50/month or less. The access difficulties your patients may be experiencing are a consequence of the non-traditional distribution strategy — not a manufacturing or supply chain disruption.

Understanding this distinction is critical for patient counseling: the drug is available, but patients need to know where to look.

Clinical Profile: What Providers Should Know About Bexagliflozin

Bexagliflozin received FDA approval on January 23, 2023, for adults with type 2 diabetes as an adjunct to diet and exercise. It is a selective SGLT2 inhibitor that reduces renal glucose reabsorption, thereby increasing urinary glucose excretion and lowering blood glucose.

Key clinical data:

HbA1c reduction: 0.7–1.0% over 24 weeks across monotherapy and combination trials

Non-inferior to glimepiride (60-week trial) and sitagliptin (24-week trial)

First SGLT2 inhibitor shown effective in patients with type 2 diabetes and stage 3 CKD (eGFR 30–59)

Modest reductions in systolic blood pressure (~2–3 mmHg) and body weight (~2–3 kg over 48 weeks)

CV safety data: lower rate of HF hospitalization (5% vs. 9% placebo) and all-cause mortality (3.45% vs. 4.59%) in a CV outcomes trial

Limitations vs. Jardiance/Farxiga:

Bexagliflozin is approved only for glycemic control in type 2 diabetes. It does not carry FDA-approved indications for heart failure, cardiovascular risk reduction (beyond T2DM), or CKD without diabetes — indications where empagliflozin and dapagliflozin have established outcomes data. For patients with active HF, established ASCVD, or CKD requiring these specific outcomes benefits, Jardiance or Farxiga remain preferred agents.

Prescribing Considerations

Dose: 20 mg orally once daily in the morning, with or without food. Do not crush or chew.

Renal function: Assess eGFR before initiating. Not recommended if eGFR < 30 mL/min/1.73 m²; contraindicated on dialysis. Glucose-lowering efficacy declines as eGFR falls.

Volume status: Correct volume depletion before initiating. Monitor in elderly patients and those on loop diuretics.

Pre-surgery: Consider temporarily discontinuing at least 3 days before scheduled surgery to reduce DKA risk.

Key drug interactions: Bexagliflozin is a major substrate of UGT1A9. Concomitant UGT1A9 inducers (e.g., carbamazepine) may reduce efficacy. Insulin and sulfonylureas increase hypoglycemia risk — consider dose reductions.

Distribution Model and Formulary Status

Understanding the distribution model is essential for successful prescribing:

Not at chain pharmacies: CVS, Walgreens, and Rite Aid generally do not stock it. Sending the prescription to a standard pharmacy will likely result in a patient unable to fill it.

E-prescribe directly: Providers can send e-prescriptions directly to Cost Plus Drugs or DiRx — no prior authorization required for cash pay. These pharmacies ship to patients.

Insurance formulary: Most Medicare Part D plans and commercial plans do not list Brenzavvy. When covered, prior authorization and/or step therapy is typically required. Some PBMs (e.g., Scripius) have moved to prefer Brenzavvy for glycemic control indications.

Cash pay recommendation: At $47–$50/month, cash price may be lower than the insurance copay for covered SGLT2 alternatives. Counsel patients that bypassing insurance may be their best financial option.

Ideal Patient Profile for Bexagliflozin

Adults with type 2 diabetes whose primary need is glycemic control (not HF or CKD-specific outcomes)

Patients without insurance coverage or with high-deductible plans who struggle with Jardiance/Farxiga costs

eGFR ≥ 30 mL/min/1.73 m² (not on dialysis)

Patients with type 2 diabetes and stage 3 CKD who benefit from renal protection data

Patients comfortable with online pharmacy ordering and home delivery

How to Help Patients Get Bexagliflozin Filled

E-prescribe to Cost Plus Drugs or DiRx at the time of prescribing — include the patient's email for order tracking

Counsel patients on expected delivery time (3–5 business days) and encourage ordering before running out

If patient prefers a local pharmacy, refer them to medfinder.com/providers for real-time pharmacy inventory search

For patients in the southeastern US, check if a local Publix pharmacy stocks it

medfinder's provider portal at medfinder.com/providers allows prescribers to search real-time pharmacy inventory for Brenzavvy and other medications, making it easier to direct patients to a pharmacy that can fill their prescription.