Provider Briefing: Creon Supply Constraints Continue Into 2026

Creon (Pancrelipase delayed-release capsules) remains the most widely prescribed pancreatic enzyme replacement therapy (PERT) in the United States. However, intermittent supply disruptions that began in late 2022 have continued to affect patient access into 2026. As a prescriber, understanding the current landscape — and knowing what tools are available — is essential to ensuring continuity of care for your EPI patients.

This briefing covers the supply timeline, clinical implications, alternative prescribing options, and practice-level resources to help you and your patients navigate Creon availability challenges.

Timeline of Creon Supply Issues

Pancreatic enzyme replacement products have faced a uniquely complex regulatory and supply history:

• 2006–2010: The FDA issued a mandate requiring all pancreatic enzyme products (previously marketed without NDAs) to obtain formal New Drug Application approval. Several products were removed from the market, consolidating the PERT landscape to five approved brands.
• 2020–2021: COVID-19-related disruptions to the global porcine supply chain and pharmaceutical logistics created initial pressure on enzyme product availability.
• 2022–2023: Reports of Creon stock-outs became increasingly common at retail pharmacies, particularly for 12,000 and 24,000 lipase unit capsules — the most commonly prescribed adult strengths.
• 2024: Supply improved in some regions but remained inconsistent. AbbVie reported efforts to increase manufacturing capacity.
• 2025–2026: Creon is not currently on the FDA's official shortage list, but regional and strength-specific availability gaps persist. Patients in rural areas and those relying on single-chain pharmacies are disproportionately affected.

Prescribing Implications

The intermittent nature of Creon's availability creates several clinical considerations:

Dose-Specific Shortages

Not all strengths are equally affected. The 12,000 and 24,000 unit capsules have been the most difficult to source. The 3,000, 6,000, and 36,000 unit capsules have generally had better availability. When prescribing, consider whether an equivalent dose can be achieved using an available strength (e.g., two 12,000 unit capsules instead of one 24,000, or three 12,000 unit capsules instead of one 36,000).

Therapeutic Switching

If Creon is unavailable, switching to an alternative PERT product is clinically appropriate. The FDA-approved alternatives include:

• Zenpep — delayed-release capsules, 3,000–40,000 lipase units. Most comparable to Creon.
• Pancreaze — delayed-release capsules, 4,200–21,000 lipase units. Note the different strength increments.
• Pertzye — delayed-release capsules with bicarbonate, 8,000 and 16,000 lipase units.
• Viokace — non-enteric-coated tablets, 10,440 and 20,880 lipase units. Requires concomitant PPI use. Not FDA-approved for cystic fibrosis.

When switching products, recalculate the dose based on lipase units per meal rather than assuming capsule-for-capsule equivalence. Monitor patients after switching for signs of inadequate enzyme replacement (steatorrhea, weight loss, abdominal symptoms) and adjust dosing as needed.

Patient Communication

Many patients are anxious about medication access. Proactively discussing the availability situation and having a documented backup plan (including preferred alternative PERT product and dose) can reduce patient anxiety and prevent gaps in therapy. Consider adding a note to the chart with the patient's preferred alternative and backup pharmacy.

Current Availability Picture

As of early 2026, Creon availability varies by:

• Geography: Urban areas with multiple pharmacy options generally have better access than rural communities.
• Pharmacy type: Specialty pharmacies and independent pharmacies may have more consistent access than major retail chains.
• Strength: Higher-volume strengths (12,000 and 24,000 units) are more prone to stock-outs than less commonly prescribed strengths.

AbbVie has not issued formal allocation notices but has acknowledged supply variability and reports ongoing investment in manufacturing capacity.

Cost and Access Considerations

Creon's cost remains a significant barrier for many patients:

• Cash price: $700–$1,500/month depending on strength and dose
• Typical insured copay: $30–$100/month (often Tier 3 or specialty tier)
• Medicare Part D: Covered on most formularies; prior authorization may be required

AbbVie offers two programs that prescribers should be aware of:

• Creon Savings Card: For commercially insured patients. Eligible patients may pay $0 per fill. Not valid for government insurance.
• AbbVie Patient Assistance Foundation: Provides Creon at no cost to qualifying uninsured/underinsured patients (income threshold typically ≤600% FPL). Apply at abbviepaf.org or call 1-800-222-6885.

For a patient-facing resource on cost reduction, you can direct patients to our guide: How to Save Money on Creon. For provider-specific savings strategies, see our provider's cost guide.

Tools and Resources for Providers

Medfinder for Providers

Medfinder offers a real-time pharmacy stock search tool that can help your practice identify pharmacies with Creon in stock. This can be especially useful when patients call reporting stock-outs, or when your team is sending a new prescription and wants to direct it to a pharmacy that has availability.

Practice Workflow Integration

Consider these workflow improvements:

• Keep a list of 2–3 local pharmacies known to carry Creon consistently (update monthly)
• Document each patient's preferred alternative PERT product and dose in their chart
• Train front-desk and nursing staff to use Medfinder for real-time stock checks
• Include a backup prescription in the patient's chart that can be activated quickly if Creon is unavailable

For a detailed workflow guide, see How to Help Your Patients Find Creon in Stock.

Looking Ahead

The fundamental supply constraints affecting Creon — porcine sourcing, biological manufacturing complexity, and limited competition — are unlikely to change dramatically in the near term. No FDA-approved generic Pancrelipase products are on the horizon, and the five-brand PERT market structure has remained stable since the FDA's 2010 NDA mandate.

That said, AbbVie has indicated ongoing investment in production capacity, and some of the acute supply pressures from 2022–2024 have eased. The most likely trajectory for 2026 is continued improvement with occasional regional and strength-specific gaps.

Providers who proactively plan for availability disruptions — documenting alternatives, using real-time stock tools, and educating patients — will be best positioned to maintain uninterrupted enzyme replacement therapy for their EPI patient panels.

Final Thoughts

Creon supply issues in 2026 are manageable but require proactive planning. Stay informed about availability trends, equip your practice with tools like Medfinder, and ensure every EPI patient has a documented backup plan. Your patients depend on these enzymes for basic nutrition — helping them maintain access is a critical part of their care.