Provider Briefing: Divigel Availability in 2026

Patients presenting with difficulty filling Divigel (Estradiol gel 0.1%) prescriptions has become increasingly common in clinical practice. While Divigel is not formally listed on the FDA drug shortage database, real-world availability remains inconsistent across pharmacy networks. This guide provides prescribers with an up-to-date summary of the supply landscape, prescribing considerations, and tools to help patients access their medication.

Timeline: How We Got Here

The current availability challenges with Divigel exist within a broader context of hormone replacement therapy (HRT) supply strain:

• 2022–2023: Rising awareness of menopause treatment options drives significant increases in HRT prescribing volume nationwide.
• 2023–2024: Estradiol transdermal patches (Climara, generic patches) enter intermittent shortage due to manufacturing capacity constraints, pushing patients toward gel and oral formulations.
• 2024–2025: Continued patch supply disruptions create sustained elevated demand for Divigel and EstroGel. Some pharmacies report difficulty sourcing both brand and generic Estradiol gel.
• November 2025: FDA initiates comprehensive review of menopausal hormone therapy product labeling.
• February 2025: FDA removes boxed warnings from Divigel and five other MHT products (Prometrium, Cenestin, Enjuvia, Estring, Bijuva), reflecting updated evidence review. Risks remain described in Warnings and Precautions.
• 2026: Divigel manufacturer Vertical Pharmaceuticals reports adequate supply. However, pharmacy-level stocking gaps persist due to distribution patterns and demand variability.

Prescribing Implications

Boxed Warning Removal

The February 2025 FDA labeling update is clinically significant. The removal of the boxed warning from Divigel reflects the agency's determination — based on a comprehensive literature review — that the class-wide warning derived primarily from the Women's Health Initiative (WHI) trial of oral conjugated equine estrogens was not appropriately applied to all MHT product types.

For prescribers, this means:

• The risk-benefit conversation with patients remains important, but the regulatory framing has shifted.
• Risks of cardiovascular events, breast cancer, and dementia are now addressed in the Warnings and Precautions section rather than as a boxed warning.
• This change may reduce patient anxiety about starting or continuing transdermal estradiol therapy.

Dosing Flexibility

Divigel offers a wider dose range than most transdermal estradiol options: 0.25 mg, 0.5 mg, 0.75 mg, 1.0 mg, and 1.25 mg per day (corresponding to gel packet sizes of 0.25 g to 1.25 g). This allows for more granular dose titration compared to patches or EstroGel.

When switching patients from Divigel to alternatives, approximate equivalences include:

• Divigel 0.5 mg/day ≈ Climara 0.05 mg/day patch
• Divigel 1.0 mg/day ≈ EstroGel 0.75 mg/day (one pump)
• Divigel 0.25 mg/day ≈ Vivelle-Dot 0.025 mg/day patch

Serum estradiol levels should be monitored when switching formulations, as bioavailability varies across delivery systems.

Current Availability Picture

As of early 2026:

• Brand Divigel: Manufacturer reports adequate supply. Pharmacy-level availability varies. Chain pharmacies may not routinely stock it; independent pharmacies and specialty pharmacies tend to have better sourcing flexibility.
• Generic Estradiol gel 0.1%: More widely available and significantly less expensive. With discount programs, patients can access generic gel for approximately $32 to $50 per 30 packets.
• Estradiol patches: Supply remains inconsistent for some brands and generics, though improving compared to 2024.
• EstroGel: Generally available, though also subject to periodic stocking variability.

Cost and Access Considerations

Cost remains a significant barrier for patients on brand Divigel:

• Brand Divigel retail: $650 to $900+ per month
• Manufacturer savings: Up to $25 off copay via the Divigel Savings Program (divigel.com)
• Generic Estradiol gel: $32 to $50/month with GoodRx or SingleCare coupons
• Insurance: Most commercial and Medicare Part D plans cover generic Estradiol gel. Brand Divigel may require prior authorization or step therapy.

For patients with financial hardship, resources include NeedyMeds.org, RxAssist.org, and RxHope.com. For a comprehensive cost-reduction guide to share with patients, see: How to Save Money on Divigel. For provider-specific savings strategies, see: How to Help Patients Save Money on Divigel.

Tools and Resources for Providers

Medfinder for Providers

Medfinder is a free tool that allows providers and patients to check real-time Divigel availability at pharmacies. Instead of sending patients away with a prescription and hoping for the best, you can direct them to Medfinder to locate pharmacies with stock before they leave your office.

Prescribing Strategies

• Write for generic when possible: Prescribing "Estradiol gel 0.1%" rather than "Divigel" gives pharmacies more flexibility and reduces patient cost.
• Include alternatives on the prescription: When supply is uncertain, consider noting acceptable alternatives (e.g., "If Estradiol gel unavailable, may substitute Estradiol patch 0.05 mg/day") with a follow-up plan.
• Recommend refilling early: Advise patients to refill 5 to 7 days before running out to account for potential sourcing delays.

Drug Interaction Awareness

When prescribing Divigel or Estradiol gel, be mindful of CYP3A4 interactions. Inducers like St. John's Wort, Carbamazepine, and Rifampin can decrease estradiol levels, while inhibitors like Ketoconazole, Clarithromycin, and Ritonavir can increase levels. Grapefruit juice is also a CYP3A4 inhibitor. See our detailed drug interactions guide.

Looking Ahead

The HRT market is evolving. The FDA's labeling updates, growing demand, and improving generic availability suggest that access to Estradiol gel products will continue to stabilize through 2026. However, pharmacy-level stocking variability is likely to persist, making tools like Medfinder an important part of the patient access workflow.

Staying informed about supply status and proactively guiding patients on where to fill their prescriptions can significantly reduce treatment interruptions and improve adherence.

Final Thoughts

Divigel remains an effective and well-tolerated option for transdermal estradiol delivery with flexible dosing. While not formally in shortage, real-world access challenges require prescribers to be strategic about prescribing generics, recommending availability tools, and having backup alternatives ready.

For patient-facing resources, consider sharing these guides: How to Find Divigel in Stock and Alternatives to Divigel.