Provider Briefing: Duavee Availability in 2026

If you prescribe Duavee (conjugated estrogens 0.45 mg/bazedoxifene 20 mg) for your menopausal patients, you've likely heard from them that filling the prescription is a challenge. Duavee's availability has been inconsistent since its 2013 FDA approval, and the situation in 2026 continues to affect patient adherence and clinical decision-making.

This article provides an overview of the current supply situation, prescribing implications, cost and access considerations, and tools you can use to help your patients get the medication they need.

Timeline: Duavee Supply Issues

Duavee has faced intermittent supply constraints throughout its commercial life:

• 2013: FDA approval of Duavee (CE 0.45 mg/BZA 20 mg) — the first and only estrogen/SERM combination for menopausal vasomotor symptoms and osteoporosis prevention in women with an intact uterus.
• 2014–2019: Gradual adoption, but limited formulary placement and high costs restricted prescribing volume. Some pharmacies stopped stocking it due to low turnover.
• 2020–2023: Intermittent manufacturing disruptions. Patients increasingly reported difficulty filling prescriptions, particularly at chain pharmacies.
• 2024–2026: No generic approval. Pfizer remains the sole manufacturer. Supply remains limited at many retail pharmacies, though specialty and mail-order pharmacies have been more reliable.

Duavee has not always appeared on the FDA Drug Shortage Database during these periods, but real-world access has been a persistent challenge.

Prescribing Implications

The ongoing availability issues have several clinical implications:

Adherence Concerns

Patients who cannot fill their Duavee prescriptions face gaps in therapy. For those using it for vasomotor symptom management, interruptions can mean a return of bothersome hot flashes. For those relying on it for osteoporosis prevention, gaps may compromise bone health over time.

Therapeutic Uniqueness

Duavee's estrogen/SERM mechanism is distinct from traditional estrogen/progestin HRT. Bazedoxifene provides endometrial protection without the progestin-associated side effects (breast tenderness, bloating, mood changes) that some patients find intolerable. For patients who have tried and failed progestin-containing therapies, Duavee may be the preferred — or only acceptable — option.

When to Consider Alternatives

If a patient cannot reliably access Duavee, it may be clinically appropriate to discuss alternatives proactively rather than waiting for adherence gaps. This is especially important for patients using Duavee for osteoporosis prevention, where consistent therapy is critical.

Current Availability Picture

In 2026, Duavee availability varies significantly by pharmacy type and region:

• Major chain pharmacies (CVS, Walgreens, Rite Aid): Inconsistent stocking. Many locations do not carry Duavee routinely due to low local demand.
• Independent pharmacies: More likely to special-order, but may take 1–2 business days.
• Specialty pharmacies: Often the most reliable source, particularly those focused on women's health or hormone therapy.
• Mail-order pharmacies: Generally have better access to brand-name products and can provide 90-day supplies.

Providers can direct patients to Medfinder for Providers to check real-time pharmacy stock for Duavee and other hard-to-find medications.

Cost and Access Considerations

Duavee's cost creates an additional barrier to access:

• Cash price: $300–$500 per 30-day supply
• Insurance: Often placed on Tier 3 (non-preferred brand) or higher. Many plans require prior authorization or step therapy with lower-cost HRT options.
• Pfizer co-pay card: Can reduce commercially insured patients' copay to $30–$50/month
• Pfizer RxPathways: Patient assistance program for uninsured/underinsured patients (PfizerRxPathways.com or 1-844-989-7284)

When writing a prescription for Duavee, consider including a prior authorization letter proactively if the patient's plan requires one. Documenting that the patient has tried or is intolerant of progestin-containing alternatives can strengthen the case.

Tools and Resources

Several resources can help you and your patients navigate Duavee access:

• Medfinder for Providers: Real-time pharmacy stock checker. Share with patients or use in your office workflow.
• Pfizer Medical Information: For questions about supply timelines or product availability, contact Pfizer Medical Information at 1-800-438-1985.
• Specialty pharmacy referrals: Consider establishing a relationship with a specialty pharmacy that reliably stocks Duavee and can serve as a default fill location for your patients.
• Prior authorization support: Many EHR systems have integrated PA tools. Proactively submit PAs when prescribing Duavee to avoid delays.

Alternative Therapies to Consider

When Duavee is unavailable or cost-prohibitive, the following alternatives may be appropriate:

• Prempro (CE/MPA): Generic available. Well-studied. May cause progestin-related side effects. $15–$50/month.
• Bijuva (estradiol/progesterone): Bioidentical combination. Brand-only. $200–$400/month.
• Activella (estradiol/NETA): Generic available. $20–$60/month.
• Premarin + separate progestin: Allows independent dose titration. Generics available for both components.

For patients who specifically benefit from Duavee's SERM-based endometrial protection, there is no direct therapeutic equivalent. Document this in the chart when advocating for coverage.

For a patient-facing comparison, see: Alternatives to Duavee.

Looking Ahead

As of early 2026, no generic Duavee has been approved, and no competing estrogen/SERM combination products are in late-stage development. The availability situation is unlikely to change dramatically in the near term.

Providers can mitigate the impact by:

• Discussing availability proactively at the time of prescribing
• Having a documented backup plan (alternative medication) in the patient's chart
• Directing patients to reliable pharmacy sources and savings programs
• Using Medfinder for Providers as part of your prescribing workflow

Final Thoughts

Duavee remains a clinically valuable option for postmenopausal women who need HRT without progestin. But its limited supply, lack of generic competition, and high cost create ongoing challenges for patients and prescribers alike.

By staying informed about the availability landscape and equipping your patients with the right tools and resources, you can help minimize treatment gaps and ensure continuity of care.

For additional resources, see our provider's guide to helping patients find Duavee and our guide on helping patients save money on Duavee.