Provider Briefing: The Ciclesonide Supply Situation in 2026

If you prescribe Ciclesonide — whether as Alvesco for persistent asthma or Omnaris for allergic rhinitis — you have likely heard from patients struggling to fill their prescriptions. While Ciclesonide is not currently listed on the FDA drug shortage list, it remains a single-source brand product with no generic competition, which makes supply disruptions more impactful when they occur.

This article provides a clinical overview of the current Ciclesonide availability landscape, what it means for your prescribing decisions, and practical tools you can share with patients.

Timeline: How We Got Here

Ciclesonide was originally developed by Altana Pharma (later Nycomed) and brought to the U.S. market by Sunovion Pharmaceuticals. The product line was later acquired by Covis Pharma. As a single-manufacturer product with no FDA-approved generic, Ciclesonide has always been vulnerable to supply chain disruptions.

Several factors have contributed to intermittent availability issues:

• Single-source manufacturing: With only Covis Pharma producing Ciclesonide, any production delay affects the entire U.S. supply.
• No generic competition: Unlike Fluticasone or Budesonide, there is no generic Ciclesonide available, limiting pharmacies' ability to substitute.
• Insurance formulary shifts: Some insurance plans have moved Ciclesonide to higher tiers or removed it from formularies entirely, favoring OTC alternatives like Flonase or Rhinocort for nasal indications.
• Distributor variability: Availability can differ significantly between wholesalers and geographic regions.

Prescribing Implications

The limited availability of Ciclesonide creates several considerations for prescribers:

When to Continue Prescribing Ciclesonide

Ciclesonide has a unique pharmacological profile as a prodrug that is activated locally in the airways. Its active metabolite, des-ciclesonide, has high glucocorticoid receptor affinity (approximately 120 times greater than the parent compound). This local activation may offer advantages for patients who experience systemic side effects with other inhaled corticosteroids or who have had oral candidiasis with other agents.

Continue prescribing Ciclesonide when:

• The patient has documented intolerance to alternatives (Fluticasone, Budesonide, Mometasone, Beclomethasone)
• The patient is well-controlled on Ciclesonide and switching poses a risk of destabilization
• The prodrug mechanism offers a meaningful clinical advantage for the individual patient

When to Consider Alternatives

For new prescriptions or patients who have not yet started Ciclesonide, consider alternatives with better availability:

• Fluticasone Propionate (Flovent inhaler, Flonase nasal spray) — widely available, Flonase is OTC
• Budesonide (Pulmicort inhaler/nebulizer, Rhinocort nasal spray) — generic available, Rhinocort is OTC
• Mometasone Furoate (Asmanex inhaler, Nasonex nasal spray) — Nasonex now available OTC
• Beclomethasone Dipropionate (QVAR inhaler, Beconase AQ nasal spray) — widely available as generic

For a detailed comparison of alternatives, see our guide: Alternatives to Ciclesonide If You Can't Fill Your Prescription.

Current Availability Landscape

Ciclesonide availability varies significantly by formulation:

• Alvesco (inhaler): Generally available at major chain pharmacies, though stock levels fluctuate. Independent pharmacies may have less consistent supply.
• Omnaris (nasal spray): More widely stocked, though some pharmacies may not carry it due to the availability of OTC nasal corticosteroid alternatives.
• Zetonna (nasal aerosol): Limited availability or discontinued at many pharmacies.

Encourage patients to use real-time stock-checking tools rather than calling pharmacies individually. MedFinder's provider tools can help your practice direct patients to pharmacies with confirmed stock.

Cost and Access Considerations

Cost remains a significant barrier for many patients:

• Cash price: Alvesco ranges from $150 to $420 depending on pharmacy and dose strength. Omnaris ranges from $290 to $400.
• Insurance coverage: Alvesco is covered by approximately 77% of insurance plans with typical copays of $15 to $75. Omnaris coverage varies widely.
• Prior authorization: Many plans require prior authorization or step therapy, especially for nasal formulations where OTC alternatives exist.
• Manufacturer savings: The Alvesco Savings Card from Covis Pharma may reduce costs to as low as $0 for eligible commercially insured patients. Details at alvesco.us/savings-card.
• Patient assistance: The Covis Patient Assistance Program serves uninsured or underinsured patients who meet income criteria.

For more on helping patients manage costs, see: How to Help Patients Save Money on Ciclesonide: A Provider's Guide.

Tools for Your Practice

Several resources can streamline your workflow when managing Ciclesonide prescriptions:

1. MedFinder for Providers: medfinder.com/providers — real-time pharmacy stock data you can share with patients or use during the visit.
2. Prior authorization templates: Document the clinical rationale for Ciclesonide when alternatives have failed. Note specific adverse events with other agents.
3. E-prescribing pharmacy selection: Before sending a prescription, verify stock at the patient's preferred pharmacy or suggest an alternative location with confirmed availability.
4. Patient handouts: Direct patients to How to Find Ciclesonide in Stock Near You and How to Save Money on Ciclesonide for self-service resources.

Final Thoughts

Ciclesonide remains a valuable option in the inhaled corticosteroid class, particularly for patients who benefit from its prodrug mechanism and lower risk of local side effects. However, its single-source status and lack of generic competition make supply unpredictable.

As a prescriber, the most impactful steps you can take are: (1) proactively discuss availability with patients before writing the prescription, (2) verify pharmacy stock using tools like MedFinder, and (3) have a documented alternative plan ready if Ciclesonide becomes unavailable.

For the latest on the Ciclesonide supply situation, see our Ciclesonide Shortage Update for 2026.