How to Help Your Patients Find Besifloxacin in Stock

You've determined that Besifloxacin (Besivance) is the right clinical choice for your patient's bacterial conjunctivitis — but now comes the practical challenge: making sure they can actually fill the prescription. As a brand-only ophthalmic antibiotic with no generic equivalent, Besivance presents unique access hurdles that can delay treatment and generate frustrating callbacks to your office.

This guide provides actionable steps your clinical team can take to improve your patients' success rate in filling Besifloxacin prescriptions.

Understanding the Current Availability Challenge

Before diving into solutions, it helps to understand why your patients are having trouble:

• Brand-only status: Besivance has no generic (patents extend through November 2030), so the entire U.S. supply comes from a single manufacturer, Bausch + Lomb
• Retail price of $230-$350: Many pharmacies, especially chains, don't routinely stock it because of low turnover and high inventory cost
• Insurance restrictions: Prior authorization is required for approximately 30% of commercial and 80% of Medicaid plans, plus step therapy may be required
• Not on FDA shortage list: The issue is pharmacy stocking, not manufacturing — so there's no formal shortage guidance from the FDA

For a deeper dive into these factors, see our Besifloxacin shortage briefing for providers.

What Providers Can Do: 5 Steps

Step 1: Check Availability Before Sending the Script

The single most impactful thing your practice can do is verify pharmacy stock before sending the prescription. Medfinder for Providers lets your team check real-time inventory across pharmacies in your patient's area. This simple step can:

• Prevent the prescription from sitting unfilled at a pharmacy that doesn't stock Besivance
• Reduce patient frustration and callbacks to your office
• Speed time-to-treatment for bacterial conjunctivitis

Make this a standard workflow step whenever prescribing Besifloxacin or any other brand-only medication.

Step 2: Proactively Manage Prior Authorization

If your patient's insurance requires prior authorization for Besivance, starting the PA process at the time of prescribing — rather than waiting for the pharmacy to flag a rejection — can save days of delay.

Document the clinical rationale clearly:

• Why Besifloxacin was selected over generic alternatives (e.g., suspected resistance, treatment failure, clinical judgment for specific pathogens)
• Any previous antibiotics tried and their outcomes
• Culture and sensitivity results, if available

Many EHR systems have PA workflow integrations. If yours does, use them. If not, consider designating a staff member to handle ophthalmic PA requests promptly.

Step 3: Inform Patients About Cost and Savings

Sticker shock at the pharmacy counter is a common reason Besifloxacin prescriptions go unfilled. Proactively educating patients about cost and savings options can prevent abandonment:

• Bausch + Lomb Access Program: Commercially insured patients may pay as little as $25 copay (up to 5 refills). Enrollment is available at besivance.com
• GoodRx / SingleCare coupons: Can bring the cash price down to approximately $204-$227
• Bausch + Lomb Patient Assistance Program: For uninsured patients who meet income eligibility criteria; provides medication at no cost

Consider printing savings program information or having it available in your patient handout materials. For more details, direct patients to our Besifloxacin savings guide.

Step 4: Have a Ready Alternative Plan

Not every Besifloxacin prescription will get filled. Having a pre-planned alternative protocol avoids delays when patients call back:

• First-line alternative: Generic moxifloxacin 0.5% ophthalmic solution — the most clinically comparable option ($15-$40)
• Second-line: Generic ofloxacin 0.3% ophthalmic solution ($10-$25) or ciprofloxacin 0.3% ophthalmic drops/ointment ($10-$30)
• For fluoroquinolone-allergic patients: Erythromycin 0.5% ophthalmic ointment ($10-$20) or trimethoprim/polymyxin B ophthalmic solution ($10-$25)

Some providers include both a Besifloxacin prescription and a conditional alternative in the patient's chart, with instructions to switch if Besivance can't be filled within 24 hours.

Step 5: Leverage Specialty and Independent Pharmacies

When chain pharmacies don't stock Besivance, specialty and independent pharmacies may be more reliable sources:

• Eye care specialty pharmacies: Pharmacies associated with ophthalmology practices are more likely to stock ophthalmic antibiotics including Besivance
• Independent pharmacies: Often more willing to special-order brand-name medications and may have relationships with multiple wholesalers
• Compounding pharmacies: In rare cases where no commercial product is available, compounding pharmacies may be able to prepare a Besifloxacin formulation (though this is typically a last resort)

If your practice has a preferred pharmacy for specialty ophthalmic medications, communicate this to patients at the time of prescribing.

Workflow Tips for Your Practice

Integrating these steps into your daily workflow doesn't have to be complicated:

• Create a Besifloxacin prescribing checklist that includes: checking Medfinder, verifying insurance coverage, providing savings program info, and documenting an alternative plan
• Train front desk staff to handle Besivance access calls — many questions can be answered by directing patients to Medfinder or the Bausch + Lomb savings programs
• Keep a running list of pharmacies in your area that reliably stock or order Besivance — this saves time for your team and patients
• Use e-prescribing to target specific pharmacies that you know have Besivance in stock, rather than sending to the patient's default pharmacy

Alternatives Quick Reference

For a comprehensive clinical comparison, see our Besifloxacin alternatives guide. Quick reference:

• Moxifloxacin (generic Vigamox): 4th-gen fluoroquinolone, 1 drop TID x 7 days, $15-$40
• Ofloxacin (generic Ocuflox): 2nd-gen fluoroquinolone, 1-2 drops q2-4h x 2 days then QID x 5 days, $10-$25
• Ciprofloxacin (generic Ciloxan): 2nd-gen fluoroquinolone, drops or ointment, $10-$30
• Erythromycin ointment: Macrolide, apply TID-QID, $10-$20
• Trimethoprim/Polymyxin B (generic Polytrim): Combination, 1 drop q3h x 7-10 days, $10-$25

Final Thoughts

Helping patients access Besifloxacin requires a proactive, system-level approach. By checking inventory before prescribing, managing prior authorizations efficiently, educating patients about cost, maintaining an alternative protocol, and building relationships with stocking pharmacies, you can significantly reduce access friction and improve patient outcomes.

Visit Medfinder for Providers to integrate real-time pharmacy inventory into your prescribing workflow.