Your Patient Needs Brexafemme — Here's How to Help Them Find It

When you prescribe Brexafemme (Ibrexafungerp) and your patient calls back saying no pharmacy has it, you're both dealing with the consequences of a shortage that's been ongoing since 2023. As a provider, there are concrete steps you can take to help — and to ensure your patient gets effective treatment even if Brexafemme isn't available.

This guide offers a practical, workflow-friendly approach to navigating the Brexafemme shortage for your patients.

Current Availability of Brexafemme

As of early 2026, Brexafemme is listed as temporarily unavailable by the ASHP drug shortage database. The drug has been off the market since a voluntary recall in 2023, followed by a 19-month FDA clinical hold (lifted May 2025). Scynexis is in the process of transferring the NDA to GSK, which is expected to initiate FDA discussions about resuming production in 2026.

For the full timeline, see our provider shortage briefing.

Why Patients Can't Find Brexafemme

Patients encounter multiple barriers when trying to fill a Brexafemme prescription:

• Supply is depleted: The recall removed all commercial stock, and no new batches have been produced
• No generic exists: There is no generic Ibrexafungerp, so there's no alternative manufacturer
• Chain pharmacies share supply networks: If one chain location is out, nearby locations from the same chain likely are too
• Limited awareness: Pharmacy staff may not be aware of the shortage details and may give patients incomplete information

What Providers Can Do: 5 Practical Steps

Step 1: Verify the Shortage Status Before Prescribing

Before writing a prescription for Brexafemme, check current availability. This saves your patient the frustration of visiting multiple pharmacies only to leave empty-handed.

• Check the ASHP drug shortage database for the latest status
• Use Medfinder for Providers to search pharmacy availability by location
• Contact your pharmacy partners directly to ask about stock

Step 2: Communicate Transparently with Your Patient

If you determine Brexafemme is unavailable, let your patient know proactively. Explain:

• Why the drug is unavailable (recall + FDA hold + corporate transition)
• That it's not discontinued — it's expected to return, but the timeline is uncertain
• What alternative treatments are available now

This transparency builds trust and prevents patients from spending hours calling pharmacies.

Step 3: Prescribe an Alternative With a Clear Rationale

Have a ready alternative based on the patient's clinical profile:

• For uncomplicated VVC: Fluconazole 150 mg oral x1 (generic, $4-$15)
• For RVVC maintenance: Fluconazole 150 mg weekly x6 months, or Oteseconazole (Vivjoa) if azole-sensitive
• For azole-resistant VVC: Compounded boric acid suppositories (600 mg intravaginal daily x14-21 days), topical Nystatin, or compounded Amphotericin B
• For pregnant patients: Topical Miconazole or Clotrimazole (OTC options)

For a complete comparison, see our alternatives guide (patient-facing) or the provider shortage briefing.

Step 4: Help Patients Navigate Cost

If an alternative is significantly more expensive (e.g., Oteseconazole at ~$900), provide cost context and resources:

• Direct patients to discount card programs (SingleCare, GoodRx) for generic Fluconazole
• Check if the alternative has a manufacturer copay assistance program
• For uninsured patients, consider NeedyMeds.org or RxAssist.org
• If Brexafemme becomes available again, remind patients about the manufacturer copay assistance program (as little as $30 for eligible commercially insured patients)

See our patient resource on saving money on Brexafemme.

Step 5: Set Up a Follow-Up Plan

For patients who specifically need Brexafemme (e.g., documented azole resistance), establish a follow-up plan:

• Prescribe an interim treatment to manage symptoms
• Schedule a follow-up appointment to reassess
• Note in the chart to check Brexafemme availability at future visits
• Direct the patient to Medfinder for ongoing availability monitoring

Alternatives at a Glance

• Fluconazole (generic): First-line for most VVC. Oral, single dose. $4-$15.
• Miconazole (Monistat): OTC topical. 1-7 day courses. $10-$20. Safe in pregnancy.
• Clotrimazole: OTC topical. 3-7 day courses. $7-$15. Safe in pregnancy.
• Oteseconazole (Vivjoa): Oral, RVVC prevention. ~$900+. Contraindicated in pregnancy.
• Boric acid (compounded): Intravaginal, 14-21 days. For resistant cases. Not FDA-approved for VVC.

Workflow Tips for Managing the Shortage

• Add a clinical note template: Create a standard note for Brexafemme unavailability discussions — include the alternative prescribed, rationale, and plan for when Brexafemme returns
• Bookmark Medfinder for Providers: Quick access for real-time medication availability searches during appointments
• Brief your staff: Ensure front desk and nursing staff are aware of the shortage so they can proactively address patient calls about Brexafemme refills
• Keep a running list: Track patients who specifically need Brexafemme so you can notify them when availability changes
• Monitor updates: Check ASHP and FDA shortage databases periodically for status changes

Patient Education Resources

Share these resources directly with patients who have questions about the Brexafemme shortage:

• Brexafemme shortage update for patients
• Why Brexafemme is hard to find
• Alternatives to Brexafemme
• How to save money on Brexafemme

Final Thoughts

The Brexafemme shortage is a frustrating reality for both providers and patients. By staying informed about the status, having clear alternative protocols ready, and using tools like Medfinder for Providers, you can minimize disruption to patient care. The drug is expected to return as GSK works through the regulatory process, but in the meantime, proactive communication and a solid backup plan make all the difference.