How to Help Your Patients Find Hydrocortisone in Stock: A Provider's Guide

When a patient calls your office unable to fill their hydrocortisone prescription, time matters. For patients with adrenal insufficiency, days without medication can be dangerous. As the shortage of hydrocortisone oral tablets enters its sixth year in 2026, prescribers need a practical toolkit for helping patients access their medication — or a safe alternative — as quickly as possible.

This guide provides actionable steps you can take right now to help patients navigate the shortage.

Step 1: Direct Patients to medfinder for Real-Time Availability Checking

The most efficient first step is directing patients to medfinder for Providers. medfinder contacts pharmacies on behalf of your patient to check which ones have hydrocortisone in stock near them. Results are texted to the patient. This eliminates hours of phone calls from both your staff and your patients.

What medfinder checks:

Multiple pharmacies near the patient simultaneously

Specific dose and formulation (e.g., 20 mg tablets vs. 5 mg tablets)

Both chain and independent pharmacies

Step 2: Prescribe Brand-Name Cortef When Generics Are Unavailable

Pfizer's brand-name Cortef tablets have generally maintained better availability than generics throughout the shortage. If your patient cannot find generic hydrocortisone, consider:

Writing a new prescription specifically for "Cortef" with "Dispense as Written" (DAW)

Including a brief clinical note citing the FDA shortage of generic hydrocortisone

Submitting a prior authorization to the patient's insurer citing medical necessity and the active shortage

Referring patients to the HealthWell Foundation, which offers financial assistance for patients who need brand-name products

Step 3: Consider Referring to a Compounding Pharmacy — Especially for Pediatric Patients

For pediatric patients with CAH who require precise low doses (e.g., 0.5 mg, 1 mg, 2.5 mg), compounding pharmacies are often the most clinically appropriate solution during a shortage. Licensed compounding pharmacies can prepare:

Custom-dosed hydrocortisone capsules or tablets in any strength

Oral suspensions for infants and very young children

Modified-release formulations that more closely mimic the circadian cortisol rhythm

Note: Compounded products are not FDA-approved and are not typically covered by insurance. However, the clinical benefit often outweighs the cost burden, particularly for pediatric patients. Instruct patients to use a licensed 503A or 503B compounding pharmacy.

Step 4: Optimize Prescription Writing to Maximize Fill Success

Write for all available strengths: Consider prescribing 10 mg tablets with instructions to take ½ tablet for patients who normally take 5 mg. During the shortage, a specific strength may be available while another is not.

Allow 90-day fills: When stock is available, authorize 90-day supply fills to reduce refill frequency and give patients a buffer.

Specify manufacturer if relevant: If a patient has had problems with a specific manufacturer's generic (dissolution, excipient allergies), specifying "Greenstone" or "Vensun" may improve outcomes.

Step 5: Ensure Patients Have Emergency Access Protocols

All patients with adrenal insufficiency should have — and be trained to use — an emergency hydrocortisone injection kit (typically Solu-Cortef 100 mg for injection). During the 2023 Solu-Cortef injectable shortage, many patients lacked emergency access. Review emergency preparedness at each visit:

Confirm the patient has an in-date emergency injection kit

Ensure the patient AND a family member know how to administer the injection

Confirm the patient wears a medical alert ID and carries an emergency card

Review sick day dosing rules (doubling or tripling dose during illness, fever, injury, or before procedures)

Step 6: When Therapeutic Substitution Is Necessary

If brand-name Cortef and compounded hydrocortisone are both inaccessible, the preferred substitution for most adults with adrenal insufficiency is prednisone 5 mg once daily (equivalent to approximately 20 mg hydrocortisone). Key clinical notes:

Continue fludrocortisone (Florinef) — do not discontinue when switching to prednisone

Educate patient on sick day rule adjustments (equivalent stress dose guidance in prednisone units)

Plan to transition back to hydrocortisone when supply is restored — no taper required for equivalent dose transitions between steroids

For detailed dose conversion guidance, see our Hydrocortisone shortage provider briefing.