Exparel Shortage Update: What Patients Need to Know in 2026

If you've searched online for "Exparel shortage" and landed here, you're probably preparing for a surgery and want to know: Is Exparel hard to get right now? The short answer is that Exparel is not currently listed on the FDA's active drug shortage database as of 2026. But that doesn't mean access is guaranteed — and it doesn't mean the challenges patients face are imaginary.

This guide explains the difference between a true drug shortage and a formulary access issue, what the current landscape looks like for Exparel in 2026, and what patients can do if they're having trouble getting this medication for their surgery.

Is There a National Exparel Shortage in 2026?

As of early 2026, Exparel (bupivacaine liposome injectable suspension), manufactured by Pacira BioSciences, does not appear on the FDA's current drug shortage database. The product is commercially available through hospital distributors and is manufactured at Pacira's dedicated facilities.

However, "no national shortage" does not mean "readily available everywhere." Exparel's access barriers are structural — rooted in cost, formulary policies, and insurance coverage — rather than a manufacturing or supply chain problem.

The Real Access Problem: Formulary Restrictions

The most common barrier to Exparel access is hospital formulary restriction. Exparel costs approximately $378–$444 or more per 20 mL vial at wholesale — compared to just $2–$8 for a vial of standard bupivacaine. This pricing difference has led many hospital pharmacy and therapeutics (P&T) committees to restrict Exparel to specific procedures or to remove it from formulary entirely.

Studies have shown mixed results on whether Exparel's clinical benefits — extended pain relief for up to 72 hours, reduced opioid use — justify its higher cost compared to less expensive alternatives. This ongoing evidence debate means that access to Exparel can vary significantly from one hospital to the next, even within the same city or health system.

Historical Context: Has Exparel Ever Been in Shortage?

Exparel has not had a significant documented national shortage in the FDA database since its commercial launch in April 2012. This is consistent with its status as a single-manufacturer brand-name injectable — Pacira BioSciences controls supply and has maintained commercial availability. Some brief, localized supply disruptions have occasionally been reported at the distributor level, but these have not risen to the level of an FDA-declared shortage.

Compare this to other injectable drugs — like bupivacaine HCl, epinephrine, or lidocaine — that have experienced true manufacturing shortages in recent years. Exparel, as a single-source product from a focused pharmaceutical company, has generally maintained consistent supply.

Why Some Patients Feel Like There's a Shortage

Patients who "can't get" Exparel are typically experiencing one of these situations — none of which are traditional drug shortages, but all of which are real barriers:

• Their hospital doesn't have it on formulary. Smaller hospitals and community surgical centers may not stock Exparel due to cost.
• Their surgeon doesn't use it routinely. Even if available, not every surgeon or anesthesiologist chooses to incorporate Exparel.
• Insurance denied coverage. Some plans don't cover Exparel or require prior authorization that wasn't obtained.
• The procedure isn't an approved indication. Exparel is FDA-approved for specific uses; off-label use may face more coverage hurdles.

The NOPAIN Act and Medicare Coverage in 2026

A significant development for Exparel access is the Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act, which took effect January 1, 2025. This legislation authorized Medicare to make a separate payment for non-opioid pain management drugs like Exparel when used in the outpatient surgical setting — meaning hospitals and ASCs could receive additional reimbursement for using Exparel rather than having it bundled into procedure payments at no extra value.

This policy change has the potential to improve access significantly for Medicare patients and may encourage more facilities to add Exparel to their formularies. If you're a Medicare beneficiary scheduled for outpatient surgery in 2026, ask your facility if they're taking advantage of the NOPAIN Act reimbursement for Exparel.

What Should You Do If You Can't Access Exparel?

If Exparel isn't available for your surgery, talk to your surgical team about what alternatives they'll use for pain management. Effective options include ropivacaine or standard bupivacaine nerve blocks, continuous catheter techniques, and well-designed multimodal analgesia protocols using acetaminophen, NSAIDs, and other non-opioid agents.

For a detailed overview of those alternatives, see: Alternatives to Exparel If You Can't Get It for Your Surgery.

Navigating All Your Post-Surgery Medications

While Exparel is administered in the hospital, your post-discharge pain management typically involves oral prescriptions. medfinder is a paid service that calls pharmacies near you to find which ones have your prescriptions in stock, then texts you the results — so you can get home from surgery and get your medications without making a dozen frustrating phone calls.