Your Patients Are Struggling to Find Azasan — Here's How You Can Help

When patients can't fill their Azasan (Azathioprine) prescription, they often turn to their prescriber for help. And for good reason — missing doses of an immunosuppressant can have serious consequences, from transplant rejection to autoimmune flares. As a provider, you're in a unique position to help patients navigate supply challenges and maintain continuity of care.

This guide provides a practical, step-by-step approach to helping your patients find Azasan or generic Azathioprine in stock, along with workflow tips to streamline the process in your practice.

Current Availability Overview

Understanding the current supply landscape is the first step:

• Brand-name Azasan (75 mg, 100 mg tablets) — manufactured solely by Salix Pharmaceuticals (Bausch Health). Supply is limited due to single-source manufacturing. Available at some pharmacies but not consistently stocked at all locations.
• Generic Azathioprine (25 mg, 50 mg tablets) — produced by multiple generic manufacturers including Mylan and Teva. Generally available and significantly less expensive.
• Azathioprine sodium injection (100 mg vials) — in ASHP shortage since September 2024. Hikma maintains limited supply.

For the latest details, see our provider shortage briefing.

Why Patients Can't Find Azasan

The most common reasons patients report difficulty filling their prescriptions include:

1. Pharmacy doesn't stock it: Many chain pharmacies only carry medications they fill regularly. If they don't have a steady stream of Azathioprine patients, they may not keep it on the shelf.
2. Brand-name specified: If the prescription specifies "Azasan" and the pharmacy only carries generic, they may not be able to fill it without a new prescription or DAW (Dispense As Written) code change.
3. Distributor backorders: Even pharmacies that want to order Azathioprine may face temporary backorders from their wholesaler.
4. Patient awareness: Many patients don't know that generic Azathioprine is the same drug, and may not think to ask about it when the brand is unavailable.
5. Timing: Patients who wait until they're out of medication have no buffer to absorb supply delays.

What Providers Can Do: 5 Actionable Steps

Step 1: Prescribe Generic When Clinically Appropriate

Unless there's a specific clinical reason to require brand-name Azasan, prescribing generic Azathioprine improves the likelihood of the prescription being filled. Generic Azathioprine is available from multiple manufacturers, is therapeutically equivalent per the FDA, and costs a fraction of the brand — as low as $6 to $15 for a 30-day supply with a discount coupon versus $340+ for Azasan.

If dose-specific strengths are needed (75 mg or 100 mg), note that generic 50 mg tablets are scored and can be split, or that multiple 25 mg tablets can be combined. Discuss with your patient and pharmacist to find a practical solution.

Step 2: Use Medfinder for Providers to Check Availability

Medfinder for Providers allows you to search for real-time pharmacy stock by medication name and location. You can:

• Identify pharmacies near your patient that currently have Azathioprine in stock
• Send the prescription directly to a pharmacy with confirmed availability
• Share the link with patients so they can check on their own

This eliminates the trial-and-error of calling pharmacies and reduces the time from prescription to fill.

Step 3: Connect With Specialty and Independent Pharmacies

Build relationships with local independent pharmacies and specialty pharmacies that focus on transplant or autoimmune medications. These pharmacies typically:

• Work with multiple wholesale distributors (not just one)
• Have experience stocking and sourcing immunosuppressants
• Offer more personalized service for patients on chronic medications
• May be willing to proactively order based on anticipated prescriptions from your practice

Consider maintaining a short list of 2–3 reliable pharmacies that your team can recommend to patients.

Step 4: Facilitate Communication Between Patient and Pharmacy

When a patient reports difficulty finding Azasan:

• Have your staff call the pharmacy to confirm whether the issue is stocking, backorder, or formulary-related
• If needed, send a new prescription specifying "Azathioprine (generic okay)" to eliminate DAW barriers
• Consider calling the pharmacy yourself for transplant patients or other high-priority situations where medication gaps pose significant risk

Step 5: Have a Contingency Plan Ready

For patients at highest risk from treatment interruption (e.g., recent transplant recipients), have a documented contingency plan:

• Alternative pharmacy contacts (specialty, mail-order, hospital outpatient)
• Alternative medication orders that can be activated quickly (e.g., Mycophenolate, Tacrolimus) — see our alternatives guide for patient-facing information
• Bridge supply: If your practice has clinic samples or access to an outpatient pharmacy, consider providing a short-term supply while the patient locates a regular pharmacy source

Alternative Medications by Indication

When Azathioprine is unavailable and the clinical situation requires an immediate switch:

• Transplant rejection prevention: Mycophenolate Mofetil (CellCept) is the most common alternative. Tacrolimus (Prograf) and Cyclosporine (Neoral) are also options, though they are typically used in combination rather than as direct replacements.
• Rheumatoid arthritis: Methotrexate is the first-line DMARD and is widely available. Leflunomide is another option for patients who can't tolerate Methotrexate.
• IBD (off-label): Mercaptopurine (6-MP), Methotrexate, or biologic agents may be appropriate depending on disease severity.
• Other autoimmune conditions: Mycophenolate and Methotrexate are the most commonly used alternatives across lupus, myasthenia gravis, and autoimmune hepatitis.

Workflow Tips for Your Practice

• Flag Azathioprine patients: Add a flag or note in your EHR for patients on Azathioprine so your team can proactively address refill issues before they become urgent.
• Standardize pharmacy recommendations: Create a quick-reference list of pharmacies that reliably stock Azathioprine for your clinical support staff to share with patients.
• Educate patients proactively: At each visit, remind patients to refill 7–10 days early and to use Medfinder if they encounter availability issues.
• Monitor for non-adherence: During routine labs, be alert for unexpected changes that could indicate the patient missed doses due to supply issues but didn't report it.
• Share savings resources: For patients facing cost barriers, share our provider guide to helping patients save money on Azasan.

Final Thoughts

Drug shortages are frustrating for everyone — patients, pharmacists, and prescribers alike. But providers who take a proactive, systematic approach can make a meaningful difference in their patients' experience. By prescribing generics when appropriate, leveraging tools like Medfinder for Providers, building pharmacy relationships, and having contingency plans in place, you can help ensure your patients on Azathioprine maintain uninterrupted therapy.

For the latest supply information, see our Azasan shortage briefing for providers. For patient-facing resources to share, see how to find Azasan in stock and the patient shortage update.