Provider Briefing: Endometrin Supply in 2026

For reproductive endocrinologists, OB/GYNs, and fertility clinic staff, the Endometrin (Progesterone vaginal insert, 100 mg) shortage has been a significant operational challenge since late 2023. This post provides a comprehensive update on the current supply situation, prescribing considerations, and tools to support your patients through ongoing availability fluctuations.

Shortage Timeline

Understanding how we got here helps contextualize current supply dynamics:

• Late 2023: Ferring Pharmaceuticals initiated a voluntary recall of Endometrin after Burkholderia bacteria were identified in four unreleased batches during routine quality control testing. No affected product reached the supply chain. Production at the contract manufacturing facility was suspended pending investigation.
• Q1-Q2 2024: The investigation proved more complex than initially anticipated. Ferring worked with the contract manufacturer to determine root cause and implement corrective actions. The FDA's ASHP drug shortage database listed Progesterone vaginal inserts as in active shortage. Supply was severely constrained nationwide.
• Q3-Q4 2024: Production gradually resumed. Supply began flowing back to specialty distributors and pharmacies, though regional disparities in availability persisted.
• September 2025: Xiromed LLC received FDA approval and launched the first generic Progesterone vaginal insert (100 mg) under Competitive Generic Therapy (CGT) designation. This added a second manufacturer to the market.
• Q1 2026: Supply has stabilized considerably. Both brand-name Endometrin and the Xiromed generic are available through specialty pharmacy channels. Sporadic availability gaps at retail pharmacies may still occur.

Prescribing Implications

The shortage and subsequent market changes have several implications for prescribers:

Generic Substitution

With the Xiromed generic now available, pharmacies may dispense the generic Progesterone vaginal insert unless the prescription specifies "Dispense as Written" (DAW). The generic is rated as therapeutically equivalent (AB-rated) by the FDA. For most patients, this substitution should be seamless.

If you have clinical reasons to prefer brand-name Endometrin, document your rationale and use DAW designation. Otherwise, allowing generic substitution improves the likelihood of prompt fill and may reduce patient cost.

Protocol Flexibility

Clinics that previously used exclusively Endometrin for luteal phase support may benefit from building protocol flexibility that accommodates multiple Progesterone formulations. Having pre-established alternative protocols means faster pivots when a specific product is unavailable.

Evidence supports comparable efficacy across vaginal Progesterone formulations (inserts, gel) and intramuscular Progesterone for luteal phase support in fresh and frozen embryo transfer cycles, though some studies suggest nuanced differences in specific populations.

Patient Communication

Patients undergoing ART are already under significant emotional and financial stress. Proactive communication about potential medication availability issues — and reassurance that effective alternatives exist — can reduce anxiety and improve adherence. Consider including a medication availability discussion as part of your cycle orientation process.

Current Availability Picture

As of early 2026, the availability landscape includes:

• Brand-name Endometrin (Ferring): Available through specialty fertility pharmacies and select retail pharmacies. Supply is consistent at major specialty distributors.
• Generic Progesterone vaginal insert (Xiromed): Distribution is expanding. Available at many specialty pharmacies and increasingly at retail chains. Coverage by insurance plans and PBMs is growing.
• Crinone (Progesterone vaginal gel, 8%): Remains available as an alternative, though pricing can be higher.
• Prometrium/generic Progesterone capsules: Widely available and affordable. Off-label vaginal use is well-established in clinical practice.
• Progesterone in oil (PIO): No shortage issues. Available from multiple manufacturers.

Cost and Access Considerations

Cost remains a significant factor for fertility patients, many of whom have limited or no insurance coverage for ART:

• Brand-name Endometrin: $327-$393 per 21 inserts at retail cash price
• With coupon cards (GoodRx, SingleCare): As low as $91-$113 per 21 inserts
• Ferring h.e.a.r.t.+ Savings Card: Up to $30 savings every 2 weeks for eligible insured and cash-paying patients
• Ferring patient assistance programs: Available for qualifying patients through ferringusa.com
• Generic Progesterone capsules (Prometrium equivalent): Under $35 for 90-day supply with coupon — significantly more affordable for cash-pay patients

When discussing alternatives with patients, cost transparency helps them make informed decisions, especially when multiple clinically appropriate options exist.

Tools and Resources for Providers

Several resources can help your practice manage Endometrin availability challenges:

• Medfinder for Providers: Real-time medication availability search that can help your team locate Endometrin and alternatives at pharmacies in your patients' areas. Useful for nurse coordinators and pharmacy liaisons.
• ASHP Drug Shortage Database: Official tracking of drug shortage status, including estimated resolution timelines and therapeutic alternatives.
• Ferring Medical Information: For product-specific questions, Ferring's medical affairs team can provide clinical and supply updates.
• Specialty pharmacy partnerships: Establishing relationships with multiple specialty fertility pharmacies (Freedom Fertility, Encompass, Village Fertility, Alto Pharmacy) ensures your patients have access to broader inventory.

Looking Ahead

The entry of a generic Progesterone vaginal insert is the most significant positive development for Endometrin availability since the shortage began. As Xiromed's distribution footprint expands and potentially additional generic manufacturers enter the market, supply resilience should improve.

However, providers should remain vigilant about:

• Supply chain vulnerabilities: The fertility medication market remains dependent on a small number of manufacturers for several key products.
• Insurance coverage evolution: PBM formulary decisions regarding brand vs. generic coverage may affect patient access and cost.
• State fertility mandates: Expanding insurance coverage mandates for ART in various states will increase demand for luteal phase support medications.

Final Thoughts

The Endometrin shortage tested the resilience of fertility practices and their patients. While the acute phase is behind us, the lessons about supply chain diversification, protocol flexibility, and proactive patient communication remain relevant.

Tools like Medfinder for Providers can streamline the process of locating medications for your patients. For patient-facing resources on finding and affording Endometrin, consider sharing our guides on finding Endometrin in stock and saving money on Endometrin.

Staying informed and maintaining flexible protocols will help ensure your patients receive uninterrupted luteal phase support — regardless of which specific product is on the shelf.