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

Combigan (brimonidine tartrate 0.2%/timolol maleate 0.5% ophthalmic solution) remains a workhorse second-line agent for patients requiring adjunctive IOP reduction in open-angle glaucoma and ocular hypertension. While there is no declared national shortage as of 2026, intermittent access disruptions — particularly for brand-name Combigan — are prompting calls to ophthalmology and optometry offices across the country. This briefing outlines the current landscape and gives you practical tools to minimize treatment gaps for your patients.

Current Availability Status

As of 2026:

• Combigan is NOT on the FDA or ASHP shortage lists.
• Generic brimonidine tartrate/timolol maleate (0.2%/0.5%) has been FDA-approved and commercially available since April 2022.
• Brand-name Combigan may not be routinely stocked at many retail pharmacies, which now default to the generic. Patients with DAW (Dispense As Written) prescriptions may be turned away even when the generic is on the shelf.
• Localized access gaps exist due to supply chain variability, formulary routing, and low per-location inventory volumes for ophthalmic solutions.

Generic Substitution: What Prescribers Should Know

Generic brimonidine tartrate/timolol maleate is FDA-rated as therapeutically equivalent to brand Combigan. For the vast majority of patients, switching to the generic presents no clinical concern. Key considerations:

• Preservative composition: Different generic manufacturers may use slightly different inactive ingredients or preservatives (commonly BAK). In patients with significant dry eye, ocular surface disease, or known preservative sensitivity, monitor closely for tolerance changes after substitution.
• Bottle design variation: Different dropper mechanisms can affect drop size and delivery. For patients with dexterity challenges, a brief technique re-check may be warranted.
• IOP verification: Consider a follow-up IOP check within 4–6 weeks for patients switched from brand to generic, especially those with narrowly controlled pressures near the optic nerve damage threshold.

Prescribing Practices That Minimize Patient Access Disruptions

Consider these practical changes to reduce callbacks and emergency rx rewrites:

1. Write for generic by default: Unless there is a clinical reason for brand-only dispensing, prescribe "brimonidine tartrate/timolol maleate ophthalmic solution 0.2%/0.5%" to maximize pharmacy options.
2. Authorize DAW substitution proactively: For existing patients on brand Combigan, consider adding a note in the chart and a new prescription line authorizing generic substitution to prevent access issues.
3. Maintain a bridge supply of samples: AbbVie representatives can provide Combigan samples. Having a few on hand allows you to bridge patients experiencing urgent access gaps while they locate their prescription.
4. Proactively address prior authorization: Combigan may require prior authorization on some commercial and Medicare Part D plans. Submitting PA documentation at the time of prescribing — rather than waiting for a denial — prevents delays at the pharmacy counter.

Clinical Alternatives When Combigan Is Truly Unavailable

For patients who cannot access Combigan or the generic within 24–48 hours, consider these evidence-based alternatives:

• Cosopt (dorzolamide 2%/timolol 0.5%): Fixed-dose combination, twice daily. Generic widely available at low cost. Same timolol contraindications apply (asthma, COPD, significant bradycardia, AV block).
• Simbrinza (brinzolamide 1%/brimonidine 0.2%): Beta-blocker-free. Appropriate for patients with pulmonary disease or cardiac contraindications to timolol. Dosed TID.
• Separate brimonidine + timolol: Prescribe components individually (Alphagan P 0.1% and timolol 0.5%). Provides equivalent active ingredient exposure but requires two separate instillations (wait ≥5 minutes).
• Prostaglandin analog addition or substitution: If the patient was also using a prostaglandin, temporarily intensifying that therapy while locating Combigan may maintain IOP control. Use clinical judgment based on the patient's baseline IOP and optic nerve status.

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Helping Patients Find Combigan Quickly

For practices that routinely manage patients on specialty ophthalmic medications, medfinder for providers offers a tool your staff can use to help locate in-stock Combigan at pharmacies near your patients. Rather than having patients call around on their own — often giving up and going without their medication — medfinder contacts pharmacies and delivers results directly to the patient via text.

Patient Savings Resources to Share

Cost is another reason patients fail to pick up Combigan. Make sure your team is communicating these options:

• AbbVie AYS Co-pay Card: Commercially insured patients may pay as little as $30/month. Maximum annual benefit: $2,160. Call 833-342-5297 or text SAVINGS to 72428. Not valid for Medicare/Medicaid patients.
• myAbbVie Assist: Patient assistance program for uninsured or underinsured patients. Visit abbvieaccess.com/patient-assistance.
• GoodRx/SingleCare: Generic brimonidine/timolol is available as low as $24–$34 with discount cards at many pharmacies.