Your Patients Need Carac — Here's How to Help Them Get It

As a prescriber, you've likely had patients return to your office or call your staff to report that their pharmacy can't fill a Carac (Fluorouracil 0.5% cream) prescription. This isn't an isolated incident — Carac has faced persistent supply challenges, and the problem continues into 2026.

The good news: with a few workflow adjustments and the right tools, your practice can help patients navigate these barriers more efficiently. This guide provides a practical, step-by-step approach to helping your patients access Carac or find appropriate alternatives.

Current Availability: What You Need to Know

Carac 0.5% cream is manufactured exclusively by Bausch Health, with no generic equivalent at this concentration. Key availability facts for 2026:

• Supply remains intermittent and regionally variable
• Large chain pharmacies frequently report Carac as unavailable
• Independent and specialty pharmacies may have better sourcing options
• Generic Fluorouracil 5% remains widely available and is not affected by the Carac shortage
• Cash price for Carac ranges from $800 to $1,500+ per 30g tube

For a detailed overview of what's driving the shortage, see our provider briefing on the Carac shortage.

Why Your Patients Can't Find Carac

Understanding the barriers helps you address them proactively:

• Single-source manufacturing: Only one company makes Carac, creating supply vulnerability
• Low stocking priority: Many pharmacies don't routinely stock a high-cost, low-volume brand-name cream
• Insurance hurdles: Prior authorization and step therapy requirements slow access and reduce filled prescriptions
• Patient confusion: Patients may not know to try specialty pharmacies, independent pharmacies, or availability search tools

What Providers Can Do: 5 Practical Steps

Step 1: Check Real-Time Availability Before the Patient Leaves

The most impactful thing your practice can do is check Carac availability before the patient walks out the door. Medfinder for providers lets your staff search for pharmacies that currently have Carac in stock, organized by proximity to the patient's location.

By sending the prescription to a pharmacy you've confirmed has inventory, you dramatically reduce the chance of a failed fill and an unhappy patient callback.

Step 2: Build Relationships with Specialty Pharmacies

Identify 2-3 specialty or independent pharmacies in your area that have a track record of stocking or sourcing Carac. Building a relationship with these pharmacies creates a reliable channel for your patients:

• Ask the pharmacy about their Fluorouracil product availability
• Confirm they can accept prescriptions from your practice
• Keep their contact information readily accessible to your front desk and clinical staff
• Consider pharmacies that offer mail-order or delivery services to expand patient access

Step 3: Submit Prior Authorizations Proactively

Don't wait for the pharmacy to trigger the PA request. If you know a patient's plan requires prior authorization for Carac, initiate it at the time of prescribing. Key documentation to include:

• Diagnosis and extent of actinic keratoses (with body location)
• Prior treatment history, including any trial of generic Fluorouracil 5%
• Specific reasons for intolerance to higher-concentration Fluorouracil (e.g., excessive pain, erosion, treatment discontinuation)
• Clinical rationale for the 0.5% formulation

Proactive PA submission saves days of back-and-forth and gets the patient started on treatment sooner.

Step 4: Have a Written Backup Plan

When prescribing Carac, consider providing the patient with a documented backup plan in case Carac can't be filled. This might include:

• A secondary prescription for generic Fluorouracil 5% cream with modified instructions
• A note to call your office for an alternative if Carac is unavailable within 5-7 days
• A printed list of specialty pharmacies to try
• A link to Medfinder.com for the patient to check availability independently

This approach reduces patient anxiety and prevents treatment delays.

Step 5: Educate Your Staff

Ensure your front desk, nursing staff, and medical assistants understand the Carac supply situation. They're often the first point of contact when a patient calls about a failed fill. Staff should be prepared to:

• Check Medfinder for alternative pharmacies
• Facilitate prescription transfers
• Escalate to the prescribing provider for alternative medication decisions
• Direct patients to cost-saving resources if price is a barrier

Alternative Treatments to Consider

When Carac is unavailable, these evidence-based alternatives can maintain treatment continuity:

• Generic Fluorouracil 5% cream: Most direct substitute. More intense local reactions but highly effective. Cost: $30-$150.
• Imiquimod (Aldara 5%, Zyclara 3.75%): Immune-mediated mechanism. Good for patients intolerant to Fluorouracil. Cost: $50-$300 generic.
• Diclofenac 3% gel (Solaraze): Gentlest topical option. Requires 60-90 days. Cost: $40-$200 generic.
• Tirbanibulin (Klisyri): 5-day treatment course. Newer agent with growing insurance coverage. Cost: $700-$1,000+ brand.
• Cryotherapy: In-office procedural option for isolated or limited AKs.
• Photodynamic therapy: Field treatment for widespread AKs.

For a patient-facing comparison, share our post on alternatives to Carac.

Workflow Tips for Your Practice

Small workflow changes can make a big difference in managing Carac access issues:

• Add a Carac availability check to your prescribing workflow: Before sending the prescription, a staff member checks Medfinder and confirms stock at the target pharmacy.
• Create a Carac patient handout: Include what to expect, links to Medfinder, specialty pharmacy contacts, and instructions for what to do if the medication is unavailable.
• Track prescription fulfillment: Follow up with patients within a week to confirm they were able to fill the prescription. A quick call or patient portal message can catch problems early.
• Stay updated on supply changes: Check our Carac shortage update periodically for the latest information.

Final Thoughts

The Carac shortage is an ongoing challenge, but it's one your practice can manage with preparation. By integrating real-time availability tools like Medfinder for providers, maintaining relationships with specialty pharmacies, submitting proactive prior authorizations, and having backup plans ready, you can ensure your patients get the actinic keratosis treatment they need — even when Carac is hard to find.

For the complete provider perspective on the Carac shortage, see our provider briefing. To help patients with cost concerns, share our guide on saving money on Carac.