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

Myasthenia gravis (MG) patients who cannot access their Pyridostigmine may present with worsening symptoms — or, in severe cases, may be at risk of myasthenic crisis. As a provider, understanding the current supply landscape and having a clear action plan can make a significant difference in your patients' safety and quality of life during the ongoing shortage.

This guide covers the practical steps you and your care team can take to help patients locate their medication, navigate formulation differences, and access the brand-name product when generics are unavailable.

Understand the Supply Landscape Before Counseling Patients

The supply problem is formulation-specific. Here is a quick reference:

Generic Pyridostigmine ER 180 mg: Primary problem area. Back-ordered from Alvogen and Rising Pharmaceuticals since mid-2024.

Brand-name Mestinon Timespan 180 mg: More available but expensive ($800+ list price without insurance). Insurance prior auth may be needed.

Generic Pyridostigmine IR 60 mg: Generally available. Most affordable option, especially with discount cards.

Oral solution (60 mg/5 mL): Available but may need to be special-ordered.

Step 1: Counsel Patients to Search Multiple Pharmacies

Many patients with MG have limited stamina for prolonged phone calls. Equip your care team (medical assistants, nurses, social workers) to help with pharmacy outreach:

Recommend patients start with independent pharmacies before chain pharmacies — independent pharmacies often use different wholesale distributors and may have different inventory.

Suggest Costco and Walmart pharmacies, which tend to carry strong generic inventory and frequently have lower prices.

For patients who cannot make calls themselves, medfinder.com can contact pharmacies in their area to locate their medication.

Step 2: Write a Script That's Easy to Fill

Where clinically appropriate, consider writing the prescription to allow both the ER and IR formulations, or writing two separate prescriptions:

Primary prescription: Pyridostigmine ER 180 mg (preferred formulation)

Backup prescription: Pyridostigmine IR 60 mg with written instructions — e.g., 'Take 1 tablet (60 mg) every 4–6 hours while awake if ER formulation unavailable; equivalent to 1 tablet ER twice daily'

Give patients written instructions for the IR formulation so they don't have to wait for a call-back appointment if they encounter a shortage mid-month.

Step 3: Proactively Address Insurance Barriers

When the generic ER formulation is unavailable, patients may need brand-name Mestinon Timespan — but their insurer may require a prior authorization or step therapy. To expedite access:

Submit a PA request with documentation of: (a) medical necessity for the ER formulation, (b) documented unavailability of the generic, and (c) the clinical risk of switching to IR (if applicable)

For uninsured or underinsured patients, refer them to Bausch Health's Patient Assistance Program at bauschhealthpap.com, which can provide brand-name Mestinon at no cost for eligible patients

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Step 4: Educate Patients on Warning Signs During Any Transition

Patients switching formulations need to know which symptoms require immediate attention. Provide written guidance covering:

Myasthenic crisis warning signs: Rapidly worsening muscle weakness, difficulty swallowing or speaking, shortness of breath — call 911 or go to the ER

Cholinergic overdose warning signs: Excessive secretions, pinpoint pupils, bradycardia, profuse sweating, worsening weakness — stop the dose and call your provider immediately

GI side effects: Nausea, cramping, and diarrhea are common with IR tablets. These may improve over time but should be reported if severe

Step 5: Consider Pharmacy Tools That Save Patients Time

For practices with a high volume of MG patients, medfinder for providers can help streamline the medication access process. medfinder contacts pharmacies near the patient to identify which ones have their specific Pyridostigmine formulation in stock, reducing calls and reducing the risk that a patient runs out of medication without realizing it.

Skip the calls, skip the stress.

Find Pyridostigmine In Stock Today →

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Documentation and Follow-Up

Document in the chart that the generic ER formulation is unavailable, the reason for any formulation switch, and the plan for monitoring. Schedule a follow-up within 1–2 weeks of any change to assess symptom control. For a broader clinical summary of the shortage, see our clinical overview of the Pyridostigmine shortage for providers.