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

Provider Briefing: Collagenase Santyl in 2026

Collagenase Santyl Ointment remains a cornerstone of enzymatic wound debridement in the United States. As the only FDA-approved collagenase-based topical debriding agent, it plays a critical role in the management of chronic dermal ulcers, pressure injuries, diabetic foot ulcers, venous stasis ulcers, and severe burns.

However, availability challenges that began in 2023 left many providers scrambling for alternatives and patients without access to a medication they depended on. This briefing covers where things stand in 2026, what the shortage timeline looked like, and how prescribers can ensure their patients get the care they need.

Shortage Timeline

Understanding the timeline helps frame current availability:

• August 2023: ASHP first reports a collagenase ointment shortage. Smith+Nephew, the sole manufacturer of Santyl, experiences supply chain disruptions affecting both 30g and 90g tube sizes.
• 2023-2024: Patients and wound care clinics report widespread difficulty filling Collagenase prescriptions. Alternative debridement methods see increased utilization.
• October 2024: ASHP updates the shortage status — Smith+Nephew confirms both 30g and 90g tubes are available. The shortage is officially resolved.
• 2025-2026: Manufacturing has stabilized, but residual pharmacy stocking gaps and awareness of the shortage persist. Some patients continue to report difficulty finding Santyl at retail pharmacies.

Prescribing Implications

The shortage experience raised several important considerations for prescribers:

Single-Source Vulnerability

Collagenase Santyl has no generic equivalent and is manufactured exclusively by Smith+Nephew. This single-source dependency means that any future disruption — whether manufacturing, regulatory, or supply-chain related — could recreate the shortage scenario. Providers should maintain awareness of alternative debridement approaches.

REMS and Formulary Considerations

While Santyl itself is not subject to a REMS program (unlike the injectable Xiaflex formulation for Dupuytren's contracture and Peyronie's disease), some payers have implemented quantity limits and may require prior authorization. Cigna, for example, has drug quantity management policies for Santyl. Providers should be prepared to submit clinical justification when needed.

Patient Education

Patients who experienced the shortage may have lingering concerns about availability. Proactive communication about current stock levels and alternative options can reduce anxiety and improve adherence to wound care plans.

Current Availability Picture

As of early 2026, the supply situation is largely normalized:

• Manufacturing: Smith+Nephew has confirmed ongoing production of both 30g and 90g tube sizes
• Distribution: Product is flowing through standard wholesale channels
• Retail availability: Variable — many chain pharmacies do not routinely stock Santyl due to its specialty nature and lower dispensing volume. Independent pharmacies and wound care specialty pharmacies tend to have better availability.
• Institutional settings: Hospitals, wound care centers, and skilled nursing facilities generally have stable access through their wholesale purchasing agreements

For providers who want to check real-time pharmacy availability on behalf of patients, Medfinder for Providers offers tools to locate pharmacies with Collagenase in stock.

Cost and Access Considerations

Collagenase Santyl represents a significant cost consideration in wound care planning:

Pricing

• Cash price: $333–$437 for a 30g tube (varies by pharmacy)
• With insurance: Smith+Nephew reports that more than half of patients pay $10 or less with insurance coverage
• GoodRx: Approximately $347 for a 30g tube with a free coupon

Coverage

• Commercial insurance: Generally covered under prescription drug benefit
• Medicare Part D: Covered; copay varies by plan
• Medicaid: Covered in most states
• Skilled nursing/wound care settings: May be covered under the facility's medical supply benefit rather than the patient's prescription benefit

Patient Financial Assistance

• Smith+Nephew Copay Assistance Card: Patients pay the first $50; Smith+Nephew covers up to $250 per fill. Available for up to 6 fills per year ($1,000 annual maximum). Open to both insured and uninsured patients.
• Smith+Nephew Patient Assistance Program (PAP): For uninsured or underinsured patients who meet income criteria. Applications require both prescriber and patient signatures and can be faxed to 833-965-1621.

For a patient-facing overview of savings options that you can share, see how to save money on Collagenase.

Tools and Resources for Providers

Managing Collagenase prescriptions effectively requires awareness of available tools:

Medfinder for Providers

Medfinder helps providers and care coordinators locate pharmacies with Collagenase in stock in real time. This is particularly useful for patients who report difficulty filling their prescriptions at local retail pharmacies.

Pharmacy Coordination

Consider establishing relationships with pharmacies that reliably stock Santyl. Independent pharmacies and wound care specialty pharmacies are often better sources than chain pharmacies. Some providers maintain a short list of "Santyl-friendly" pharmacies to streamline the fill process for patients.

Smith+Nephew Resources

Smith+Nephew provides reimbursement support and clinical resources at santyl.com/hcp, including prior authorization templates, coverage guidance, and copay card enrollment for patients.

Alternative Debridement Approaches

When Collagenase is unavailable or cost-prohibitive, evidence-based alternatives include:

• Medihoney (Active Leptospermum Honey): FDA-cleared for wound management; promotes autolytic debridement with antibacterial properties
• Hydrogel dressings: Maintain moist wound environment; soften eschar for autolytic debridement
• Sharp debridement: In-office removal by a trained provider; fastest method for thick eschar
• Wet-to-dry dressings: Mechanical debridement; less selective than enzymatic methods

For a patient-facing guide you can share, see alternatives to Collagenase.

Looking Ahead

Several factors will shape the Collagenase landscape in the coming years:

• No generic competition expected: As a biologically derived enzyme with complex manufacturing, generic development faces significant barriers. No generics have been announced.
• Aging population: Increasing prevalence of chronic wounds, particularly diabetic foot ulcers and pressure injuries, will sustain and likely increase demand for Santyl.
• Wound care innovation: Ongoing research in advanced wound care (bioengineered skin substitutes, growth factors, negative pressure wound therapy) may provide additional debridement options in the future.
• Single-source risk: The 2023-2024 shortage demonstrated the vulnerability of single-source medications. Some healthcare systems have incorporated contingency planning for specialty products like Santyl.

Final Thoughts

Collagenase Santyl remains an essential tool in wound care, and its availability has largely stabilized in 2026. However, the single-manufacturer, no-generic reality means that proactive prescribing — including pharmacy coordination, patient education about savings programs, and awareness of alternatives — is more important than ever.

For provider tools and real-time pharmacy stock checking, visit Medfinder for Providers. For guidance on helping patients access affordable wound care, see our provider's guide to helping patients find Collagenase.