Your Patients Need Bicillin L-A — Here's How to Help Them Get It

As a healthcare provider, you already know the Bicillin L-A (Penicillin G Benzathine) shortage is a serious clinical challenge. But for your patients, it's often a confusing and frightening experience. They've been diagnosed with syphilis or another infection, they need treatment, and the medication simply isn't available at their pharmacy.

This guide provides practical, actionable steps you can take to help your patients access Bicillin L-A or an appropriate alternative during the ongoing shortage. For a broader clinical overview, see our companion briefing: Bicillin L-A Shortage: What Providers and Prescribers Need to Know in 2026.

Current Availability

As of Q1 2026, Bicillin L-A supply remains very limited nationwide. Key facts:

• Pfizer is the sole domestic manufacturer
• A voluntary recall in July 2025 (due to particulates in prefilled syringes) significantly worsened the shortage
• The shortage is projected to continue through Q3 2026
• Two FDA-authorized imported equivalents are available: Extencilline (since January 2024) and Lentocilin (since March 2026)

Why Your Patients Can't Find It

Patients face several barriers beyond simple supply constraints:

• Chain pharmacy limitations: Large retail pharmacies often have rigid inventory systems and may not stock or special-order shortage medications
• Lack of awareness: Many patients don't know about imported alternatives or public health department resources
• Cost: Without insurance, a single 2.4 million unit syringe costs $813-$1,037 — a significant barrier for uninsured patients
• Stigma: Patients being treated for syphilis may be reluctant to make multiple phone calls or visit unfamiliar clinics
• Administration requirement: Unlike oral medications, Bicillin L-A requires clinical administration, adding logistical complexity

5 Steps Providers Can Take to Help

Step 1: Check Stock Before the Patient Leaves

Don't send patients out with a prescription and hope for the best. Before they leave your office:

• Use Medfinder for Providers to search for pharmacies and clinics with current Bicillin L-A stock in the patient's area
• Call the pharmacy to confirm availability before sending the prescription
• If your practice or clinic stocks Bicillin L-A, consider administering it on-site

Step 2: Connect With Your Local Health Department

Public health STI programs are often the most reliable source of BPG during shortages:

• Many health departments receive priority allocations of Bicillin L-A and imported equivalents
• STI clinics typically provide syphilis treatment at no cost to patients regardless of insurance status
• Your health department may be able to transfer stock to your clinic for high-priority patients
• Build a relationship with your local STD program director — they can be an invaluable resource

Step 3: Familiarize Yourself With Imported Alternatives

Two FDA-authorized imported alternatives are currently available:

• Extencilline: Benzathine benzylpenicillin injection (powder for reconstitution). Same active ingredient as Bicillin L-A, same dosing. Available since January 2024.
• Lentocilin: Benzathine benzylpenicillin tetrahydrate. Authorized March 2026. Distribution ramping up through healthcare systems.

Key preparation differences: Unlike Bicillin L-A's prefilled syringes, Extencilline requires reconstitution. Review the product-specific administration guidelines from the CDC and your state health department. Ensure your nursing staff is trained on the preparation process.

Step 4: Have a Clear Alternative Protocol

When no benzathine penicillin product is available, have a documented protocol ready:

• Non-pregnant syphilis patients: Doxycycline 100 mg PO BID × 14 days (primary/secondary) or 28 days (late latent/tertiary)
• Penicillin-allergic patients: Doxycycline as above, or Ceftriaxone 1-2 g IM/IV daily × 10-14 days
• Pregnant patients: Benzathine penicillin is the ONLY option. Exhaust all avenues (health department, imported alternatives) before considering penicillin desensitization
• Strep pharyngitis: Use oral Amoxicillin or Penicillin V during the shortage

For complete alternative guidance, see: Alternatives to Bicillin L-A.

Step 5: Help Patients Navigate Cost Barriers

For uninsured or underinsured patients, cost can be a significant barrier even when stock is available:

• Pfizer RxPathways: May provide Bicillin L-A at reduced or no cost for eligible patients. Call 1-844-989-PATH (7284) or visit pfizerrxpathways.com
• Public health clinics: Typically provide syphilis treatment free of charge
• NeedyMeds and RxAssist: List additional patient assistance resources
• For savings options, share with patients: How to Save Money on Bicillin L-A

Alternatives to Consider

When counseling patients on alternative treatments, consider the following evidence-based options:

• Doxycycline: Well-established oral alternative for syphilis. Inexpensive ($4-$20 for a course), widely available. Not safe in pregnancy.
• Ceftriaxone: Injectable alternative requiring 10-14 daily doses. Available and not in shortage. Small cross-reactivity risk with penicillin allergy.

Document the clinical rationale for any alternative therapy in the patient's medical record, including the unavailability of BPG.

Workflow Tips for Your Practice

• Designate a point person in your practice to monitor BPG supply and coordinate with distributors
• Maintain a waitlist for patients needing BPG so you can schedule them quickly when stock arrives
• Consider stocking BPG in-office to administer during appointments rather than relying on pharmacy availability
• Print patient handouts about the shortage, alternatives, and resources like Medfinder to reduce patient anxiety
• Set up alerts with your drug distributor for BPG availability notifications
• Coordinate with nearby practices — if a colleague's clinic has stock, consider referral for injection

Final Thoughts

The Bicillin L-A shortage requires providers to be proactive, creative, and patient-centered. Your patients are counting on you not just for diagnosis and prescribing, but for help navigating a system that's making it unusually difficult to get a basic antibiotic.

By using tools like Medfinder for Providers, coordinating with public health departments, staying current on imported alternatives, and having clear protocols for when BPG isn't available, you can ensure your patients get the treatment they need — even during this challenging shortage.

For the patient perspective, share our article: How to Find Bicillin L-A in Stock Near You. For the clinical overview, see: Bicillin L-A Shortage: What Providers and Prescribers Need to Know.