Budesonide Shortage: A Provider Briefing for 2026

The ongoing supply disruptions affecting Budesonide formulations continue to create challenges for providers managing patients with inflammatory bowel disease, asthma, allergic rhinitis, and other inflammatory conditions. This article provides an evidence-based overview of the current situation, prescribing considerations, and practical resources to support your patients.

Shortage Timeline

Budesonide supply issues have evolved over several years:

• 2023: Initial reports of generic oral Budesonide capsule shortages as key manufacturers experienced production disruptions. The FDA added Budesonide to its drug shortage list.
• 2024: Shortages persisted and expanded to include Pulmicort Respules (nebulization suspension), particularly during fall/winter respiratory illness seasons. Multiple generic manufacturers reported intermittent supply limitations.
• 2025: Some improvement in oral capsule availability as additional generic production came online, but supply remained inconsistent. Pulmicort Respules continued to experience seasonal fluctuations.
• 2026 (current): Supply is stabilizing for some formulations but has not fully normalized. Oral delayed-release capsules (3 mg) and nebulization suspensions remain the most affected. Brand products (Uceris, Tarpeyo) have separate supply chains and are generally available, though at significantly higher cost.

Prescribing Implications

The shortage has direct implications for treatment decisions across several specialties:

Gastroenterology

Oral Budesonide (Entocort EC, Ortikos generics) is a first-line treatment for mild-to-moderate ileal and ileocolonic Crohn's disease, and is increasingly used for microscopic colitis and eosinophilic esophagitis. When unavailable:

• Prednisone remains the primary alternative for active Crohn's flares, though the higher systemic side effect profile should be weighed — particularly for patients requiring longer courses or those with comorbidities (diabetes, osteoporosis, psychiatric conditions).
• Mesalamine (5-ASA) formulations may suffice for mild ulcerative colitis maintenance, though evidence for Crohn's disease is limited.
• Uceris (extended-release Budesonide, 9 mg) is FDA-approved for UC induction and may be available when generic oral capsules are not, though cost ($1,200-$1,800/month without insurance) is a barrier for many patients.
• For eosinophilic esophagitis, compounding pharmacies can prepare oral viscous Budesonide slurry — an alternative supply pathway worth exploring.

Pulmonology and Allergy

Inhaled Budesonide (Pulmicort) is a guideline-recommended inhaled corticosteroid (ICS) for persistent asthma, and the preferred ICS during pregnancy. When unavailable:

• Fluticasone propionate (Flovent HFA, ArmonAir) is the most common ICS alternative with equivalent efficacy.
• Beclomethasone (QVAR) provides another ICS option.
• Mometasone (Asmanex) is an additional alternative, particularly for patients who need a dry powder inhaler.
• For pediatric patients using Respules, switching delivery devices may be necessary — consider whether the patient can use a metered-dose inhaler with spacer instead of a nebulizer.

Nephrology

Tarpeyo (delayed-release Budesonide, 4 mg) for IgA nephropathy uses a distinct formulation and supply chain. It has generally remained available through specialty pharmacies, but the high cost ($3,000+/month) necessitates ensuring patients have adequate coverage and financial support.

Current Availability Picture

Availability varies significantly by formulation, geography, and pharmacy type:

• Most affected: Generic oral delayed-release capsules (3 mg); Pulmicort Respules
• Moderately affected: Pulmicort Flexhaler
• Generally available: Uceris (brand), Tarpeyo (specialty), Rhinocort (OTC nasal spray)

Independent pharmacies frequently report better access than large chain pharmacies, likely due to different wholesaler relationships. Specialty pharmacies typically maintain separate inventory for brand products.

Cost and Access Considerations

The financial impact of the shortage compounds the access problem:

• Patients unable to find affordable generic capsules ($50-$150/month) may face brand-name prices of $1,200+ for Uceris.
• Discount card programs (GoodRx, SingleCare) can reduce generic prices by 20-50% when stock is available.
• Manufacturer assistance programs exist for brand products: Salix/Bausch offers copay support for Uceris, and Calliditas provides the TARGET Support program for Tarpeyo.
• Patient assistance programs through NeedyMeds, RxAssist, and AstraZeneca's AZ&Me program can help uninsured or underinsured patients.

Tools and Resources for Your Practice

Several tools can help you support patients navigating the shortage:

• Medfinder for Providers — real-time pharmacy stock lookup that you and your staff can use to direct patients to pharmacies with Budesonide in stock.
• FDA Drug Shortage Database — official shortage status updates from the FDA.
• ASHP Drug Shortage Resource Center — clinical guidance for managing drug shortages.
• Manufacturer medical affairs lines — AstraZeneca, Bausch Health, and Calliditas all have medical information departments that can provide supply updates and patient support resources.

Consider incorporating a brief availability check into your prescribing workflow. When writing a Budesonide prescription, a 30-second search on Medfinder can save your patient multiple pharmacy visits and reduce callback volume to your office.

Looking Ahead

Several developments may improve the Budesonide supply situation in 2026 and beyond:

• FDA efforts to accelerate generic approvals for drugs in shortage
• Additional generic manufacturers entering the market
• Improved manufacturer communication about expected resolution dates
• Growing compounding pharmacy capacity for specialized formulations

However, structural factors — including generic manufacturer consolidation and the inherent complexity of delayed-release formulations — suggest that supply volatility may continue for the near term.

Final Thoughts

The Budesonide shortage requires a multifaceted approach: proactive prescribing decisions, awareness of alternatives, and leveraging tools like Medfinder to help patients find available stock. For a practical guide on directing patients, see our companion article on how to help your patients find Budesonide in stock.

For patient-facing resources you can share, our patient shortage update and savings guide are written at an accessible reading level and can be shared directly with patients.