Provider Briefing: The CombiPatch Supply Disruption

If your patients have been reporting difficulty filling CombiPatch prescriptions, the problem is real and ongoing. The supply of Estradiol/Norethindrone Acetate transdermal patches — both brand-name CombiPatch and its generic equivalents — has been inconsistent since 2022, and the situation in 2026 remains unresolved.

This briefing covers the timeline, clinical implications, alternative prescribing strategies, and practical tools you can use to help your patients maintain continuity of care.

Shortage Timeline

The CombiPatch supply disruption didn't happen overnight. Here's how it developed:

• 2022-2023: Initial reports of spotty availability for combination estrogen/progestin transdermal patches. The FDA Drug Shortage Database began listing related products. Manufacturing issues at key production facilities contributed to supply gaps.
• 2023-2024: The shortage widened as HRT prescribing volumes increased significantly. Media coverage of menopause health, patient advocacy efforts, and growing clinical awareness led to a surge in new HRT prescriptions — particularly for transdermal products, which many providers prefer due to the potentially lower thromboembolic risk compared to oral formulations.
• 2024-2025: Intermittent improvements occurred as manufacturers worked to increase output, but supply never fully stabilized. Regional availability varied widely, with some markets adequately supplied and others chronically short.
• 2026 (current): Supply remains inconsistent. Pharmacies report unpredictable restocking timelines, and patients frequently face stockouts that can lead to gaps in therapy.

Prescribing Implications

The shortage creates several clinical challenges that prescribers should be aware of:

Therapy Gaps and Symptom Recurrence

When patients can't fill their CombiPatch prescription, they may go days or weeks without hormone therapy. Abrupt discontinuation of combined HRT can lead to rapid return of vasomotor symptoms (hot flashes, night sweats), sleep disruption, and mood disturbances. For patients using CombiPatch for osteoporosis prevention, even short therapy gaps may impact bone density maintenance over time.

Endometrial Safety Considerations

If patients independently switch to an estrogen-only product during a CombiPatch shortage without progestin coverage, the risk of endometrial hyperplasia increases. Ensure patients understand they should not take estrogen alone if they have an intact uterus — even temporarily — without concurrent progestin therapy.

Patient Adherence and Trust

Repeated difficulty filling prescriptions erodes patient confidence in their treatment plan and in the healthcare system. Proactive communication about the shortage and contingency planning can help maintain the therapeutic relationship.

Current Availability Picture

As of early 2026, CombiPatch and generic Estradiol/Norethindrone Acetate patches are being manufactured but not consistently available at all retail pharmacies. Key points:

• Large chain pharmacies (CVS, Walgreens) frequently report stockouts due to high demand and allocation-based ordering systems.
• Independent pharmacies may have more success sourcing from secondary wholesalers.
• Mail-order and specialty pharmacies sometimes maintain larger inventories.
• Availability can change week to week — a pharmacy that's out today may have stock next Tuesday.

You can direct patients to Medfinder for Providers to check real-time availability across pharmacies by zip code, helping them locate stock without calling multiple pharmacies individually.

Cost and Access Considerations

The shortage has also affected pricing and insurance dynamics:

• Cash prices: Brand CombiPatch runs $250-$450/month; generics range from $150-$350/month without insurance.
• Insurance coverage: Most plans cover CombiPatch or its generic, but some require prior authorization or step therapy (trying oral HRT first). During shortages, patients may need to fill at out-of-network pharmacies, potentially at higher cost.
• Discount programs: GoodRx, SingleCare, and RxSaver can reduce generic patch prices to $120-$200/month at participating pharmacies.
• Patient assistance: NeedyMeds and RxAssist maintain databases of assistance programs for HRT products. Uninsured patients may qualify for manufacturer or foundation programs.

Tools and Resources for Your Practice

Here are practical resources to integrate into your workflow:

• Medfinder for Providers: Real-time medication availability search. Recommend to patients or check during the visit to identify pharmacies with current stock.
• FDA Drug Shortage Database: Official shortage listings and estimated resolution dates (when available) at accessdata.fda.gov.
• Pre-written contingency prescriptions: Consider providing patients with a backup prescription for an alternative (e.g., Activella or Climara Pro) that they can fill if CombiPatch is unavailable. This avoids delays from needing a new appointment or phone call.

Alternative Prescribing Strategies

When CombiPatch isn't available, consider these therapeutic alternatives:

Transdermal Alternatives

• Climara Pro (Estradiol 0.045 mg/Levonorgestrel 0.015 mg per day): Once-weekly combination patch. Different progestin (Levonorgestrel vs. Norethindrone Acetate) but similar clinical profile. Also subject to transdermal patch supply constraints.
• Separate estradiol patch + oral progestin: Prescribe an estradiol-only patch (e.g., Vivelle-Dot, Climara) plus oral Norethindrone Acetate or Medroxyprogesterone Acetate. This gives you more flexibility — if the estradiol patch is available, you can add any oral progestin.

Oral Alternatives

• Activella (Estradiol 1 mg/Norethindrone Acetate 0.5 mg): Same active ingredients as CombiPatch in oral form. Generic available. Generally more consistent supply than patches.
• Prempro (Conjugated Estrogens/Medroxyprogesterone Acetate): Well-established oral combination HRT. Extensive clinical data. Generic available.
• Bijuva (Estradiol 1 mg/Progesterone 100 mg): Bio-identical combination. Brand-only, so cost may be higher. Bedtime dosing recommended due to Progesterone sedation effects.

Clinical Notes on Switching

• When switching from transdermal to oral HRT, counsel patients about the difference in delivery route. Oral estrogen undergoes first-pass hepatic metabolism, which increases hepatic protein synthesis (including clotting factors and SHBG). For patients who were specifically on transdermal HRT due to thromboembolic risk factors, switching to oral may not be appropriate.
• Dose equivalency between transdermal and oral estradiol is not 1:1. CombiPatch delivers 0.05 mg/day of Estradiol transdermally; the oral equivalent is approximately 1 mg/day of Estradiol due to first-pass metabolism.
• Monitor for breakthrough bleeding after any switch, especially in the first 3-6 months.

Looking Ahead

Several developments could improve the supply picture:

• New generic entrants: The FDA has signaled interest in facilitating additional generic competition for transdermal drug products, though the timeline for new approvals remains uncertain.
• Manufacturing expansion: Existing manufacturers have indicated plans to increase production capacity, but scaling up patch manufacturing is a multi-year process.
• Telehealth integration: Telehealth platforms are making it easier for patients to access prescribers who can adjust therapy quickly during shortages, reducing the delay between recognizing a supply problem and getting an alternative prescription.

Final Thoughts

The CombiPatch shortage is unlikely to resolve completely in the near term, making it essential for prescribers to have contingency plans in place. Proactive patient communication, backup prescriptions, and familiarity with alternative regimens can help minimize therapy disruptions.

Direct your patients to Medfinder for real-time availability checks, and consider the tools and strategies outlined above to streamline your workflow during this challenging supply period.

For the patient-facing perspective on this shortage, see our patient shortage update and provider guide to helping patients find CombiPatch.