Your Patient Needs Besifloxacin — Now What?

You've examined the patient, diagnosed bacterial conjunctivitis, and determined that Besifloxacin (Besivance) is the right treatment. But prescribing is only half the battle. In 2026, patients regularly report difficulty filling Besifloxacin prescriptions due to limited pharmacy stocking, high costs, and insurance barriers.

As a provider, you can significantly improve your patient's experience — and treatment outcomes — by taking a few proactive steps before they leave your office. This guide covers the current availability landscape, why patients struggle, and a practical five-step approach to ensuring your patients can access this medication.

Current Availability of Besifloxacin

Besifloxacin (Besivance) is a brand-name-only, fourth-generation fluoroquinolone ophthalmic suspension (0.6%) manufactured exclusively by Bausch + Lomb. Key facts about its current availability:

• No generic version exists — the FDA has not approved any generic Besifloxacin
• Single manufacturer: Bausch + Lomb is the sole source
• Not on shortage lists: Not currently listed on FDA or ASHP drug shortage databases
• Intermittent stocking: Many retail pharmacies do not routinely stock it due to low volume and high unit cost ($130 to $300 per bottle)
• Special-order availability: Most pharmacies can order it with delivery in one to three business days

For a broader picture of the supply situation, see our provider briefing on Besifloxacin availability.

Why Your Patients Can't Find Besifloxacin

Understanding the barriers your patients face helps you address them proactively:

Pharmacy Stocking Decisions

Retail pharmacies make stocking decisions based on demand volume and shelf cost. With a unit price of $130 to $300 and relatively low prescription volume (compared to generic alternatives), many pharmacies — particularly chains — don't maintain routine stock. Patients arrive expecting to fill a prescription immediately and encounter unexpected delays.

Insurance Friction

Most commercial payers and Medicare Part D plans subject Besivance to step therapy requirements, requiring documentation that a generic fluoroquinolone was tried first. Prior authorization processing adds 24 to 72 hours to an already delayed fill. Some patients abandon the prescription entirely when faced with these hurdles.

Cost Shock

Patients without adequate coverage face cash prices of $130 to $300. Without advance warning about the cost — or information about savings programs — many patients experience sticker shock at the pharmacy counter and leave without their medication.

Geographic Variability

Availability varies significantly by region. Urban areas with ophthalmology practices nearby tend to have better pharmacy stocking. Rural patients and those in underserved areas may face the greatest access challenges.

What Providers Can Do: 5 Practical Steps

Step 1: Verify Availability Before the Patient Leaves

Use Medfinder for Providers to check which pharmacies near your patient currently have Besifloxacin in stock. You can then send the prescription directly to a pharmacy with confirmed availability, eliminating the most common failure point.

This takes less than a minute and dramatically reduces callback volume from patients who can't fill their prescription.

Step 2: Provide Cost Information Upfront

Set expectations before the patient reaches the pharmacy. Key points to communicate:

• "This medication typically costs $130 to $300 without insurance"
• "There's a manufacturer savings program that may reduce your cost to $25 to $69"
• Share the Bausch + Lomb Access Program information — patients can enroll at bauschaccessprogram.com or call 877-494-4372

Consider having printed or digital handouts with savings program details readily available in your exam rooms.

Step 3: Document Clinical Rationale for Prior Authorization

If your patient's insurance requires prior authorization, having documentation ready accelerates the process. Key elements to include:

• Specific clinical indication (bacterial conjunctivitis with identified or suspected organism)
• Prior treatment history — especially if a generic fluoroquinolone was tried and failed
• Rationale for Besifloxacin specifically (e.g., DuraSite formulation benefits, resistance concerns, prior adverse reaction to alternatives)

Step 4: Have a Backup Plan Ready

For patients who need immediate treatment and can't wait for Besifloxacin procurement:

• Dispense a Besivance sample to start treatment immediately (register for samples at besivancepro.com or call 855-770-0191)
• Prescribe a generic alternative as a bridge: generic Moxifloxacin ($15 to $50) or generic Ofloxacin ($10 to $30)
• Send two prescriptions: one for Besifloxacin (to be filled when available) and one for a generic alternative (to start now)

Step 5: Educate Your Staff

Front desk and clinical staff who handle prescription-related calls should know:

• Besifloxacin is brand-name only and may not be stocked everywhere
• How to direct patients to Medfinder if they call about availability
• The manufacturer savings program phone number: 877-494-4372
• Which generic alternatives you typically prescribe as substitutes

Alternative Medications to Consider

When Besifloxacin is unavailable or cost-prohibitive, these alternatives are clinically appropriate for most bacterial conjunctivitis cases:

• Moxifloxacin 0.5% ophthalmic (generic Vigamox): Fourth-generation fluoroquinolone with dual-enzyme targeting. One drop TID × 7 days. Generic cost: $15 to $50. Closest pharmacologic match to Besifloxacin.
• Ofloxacin 0.3% ophthalmic (generic Ocuflux): Second-generation fluoroquinolone. Drops q2–4h × 2 days, then QID × 5 days. Generic cost: $10 to $30.
• Ciprofloxacin 0.3% ophthalmic (generic Ciloxan): Second-generation fluoroquinolone available as drops and ointment. Drops q2h × 2 days, then q4h × 5 days. Generic cost: $10 to $25.

For a detailed comparison, see our Besifloxacin alternatives guide.

Workflow Tips for Your Practice

Integrating these steps into your clinical workflow doesn't have to be time-consuming:

• Add a "Besifloxacin access" template to your EHR's patient education library with savings program links and Medfinder instructions
• Bookmark Medfinder for Providers on workstations in exam rooms for quick availability checks
• Keep a small stock of Besivance samples for urgent cases — request through the Bausch Sample Vault program
• Create a prior authorization template with pre-filled clinical rationale for Besivance to speed up payer submissions
• Train one staff member as your point person for Besifloxacin access issues to streamline patient callbacks

Final Thoughts

Besifloxacin is an effective and well-differentiated medication, but its brand-name exclusivity creates predictable access challenges. By building a few simple steps into your prescribing workflow — verifying availability, setting cost expectations, and having alternatives ready — you can significantly improve your patients' experience and ensure timely treatment.

Start by registering your practice on Medfinder for Providers and bookmarking the Bausch + Lomb savings program. These two resources alone can eliminate most of the friction your patients currently face. For additional information on how to help patients reduce costs, see our provider guide to saving on Besifloxacin.