Your Patients Can't Find CombiPatch — Here's How You Can Help

You've prescribed CombiPatch for your patient's menopausal symptoms, but she calls your office two days later saying no pharmacy in town has it. This scenario has become increasingly common since 2022, and in 2026, the supply of Estradiol/Norethindrone Acetate transdermal patches remains inconsistent.

As a prescriber, you're in a unique position to help. This guide provides a practical, step-by-step approach to helping your patients find CombiPatch — or an appropriate alternative — without adding unnecessary burden to your clinical workflow.

Current Availability

CombiPatch and its generic equivalents (Estradiol/Norethindrone Acetate transdermal system) are still being manufactured, but supply doesn't meet demand at many retail pharmacies. The situation varies by region and changes frequently:

• Some pharmacies have consistent stock; many don't
• Independent pharmacies often fare better than large chains
• Mail-order and specialty pharmacies may have larger reserves
• Both brand and generic versions experience intermittent stockouts

The transdermal patch market is constrained by manufacturing complexity and a small number of producers. Unlike oral generics with many competitors, the patch market has limited redundancy, making it vulnerable to disruption.

Why Your Patients Can't Find It

Understanding the root causes helps you communicate effectively with patients and plan accordingly:

• Manufacturing bottlenecks: Transdermal patches require specialized drug-in-adhesive technology and quality controls that limit how quickly production can scale.
• Demand surge: HRT prescribing has increased substantially due to growing awareness of menopause treatment. More patients are seeking therapy, and more are choosing transdermal over oral routes.
• Wholesaler allocation: During shortages, wholesalers may limit how much each pharmacy can order, creating artificial scarcity at the retail level even when product exists in the supply chain.
• Limited generic competition: Few manufacturers produce combination estrogen/progestin patches, so a single production issue has outsized effects.

What Providers Can Do: 5 Practical Steps

Step 1: Direct Patients to Real-Time Availability Tools

The most immediate thing you can do is point patients to Medfinder. This tool lets patients (or your staff) search for CombiPatch availability by zip code and see which pharmacies currently have stock.

Consider adding Medfinder to your after-visit summary or patient handouts for any patient on a shortage-affected medication. This single step can save your patients hours of phone calls and your staff dozens of callback requests.

Step 2: Write Prescriptions That Allow Substitution

Unless there's a clinical reason to insist on brand-name CombiPatch, write prescriptions that allow generic substitution. The generic Estradiol/Norethindrone Acetate transdermal system is therapeutically equivalent and may be available when the brand isn't.

Additionally, avoid "DAW" (Dispense as Written) codes unless medically necessary, as these can prevent pharmacists from filling with available generic stock.

Step 3: Provide a Backup Prescription

One of the most effective strategies is to give patients a contingency prescription for an alternative HRT product. This way, if CombiPatch is unavailable, they can fill the backup without needing to contact your office and wait for a callback.

Good backup options include:

• Activella (oral Estradiol/Norethindrone Acetate) — same active ingredients, different delivery route
• Climara Pro (Estradiol/Levonorgestrel patch) — still transdermal, different progestin, once-weekly
• Separate estradiol patch + oral Norethindrone Acetate — component approach that offers more sourcing flexibility

Clearly label the backup prescription and instruct the patient on when to use it (e.g., "Fill this only if CombiPatch is not available").

Step 4: Recommend Independent and Specialty Pharmacies

Large chain pharmacies often face the worst shortages because they serve the highest volume and are subject to wholesaler allocation caps. Recommend that patients also check:

• Independent community pharmacies: Often work with multiple wholesalers and are more resourceful in sourcing
• Specialty pharmacies: May maintain dedicated HRT inventory
• Mail-order pharmacies: Can access larger distribution pools, though delivery takes several days

If your practice has relationships with specific pharmacies that reliably stock HRT products, share those with patients.

Step 5: Set Expectations and Communicate Proactively

Patients who understand the shortage situation are less likely to panic when a pharmacy says "we don't have it." During the initial prescribing conversation, consider mentioning:

• That CombiPatch may be difficult to find at some pharmacies
• That they should start looking for refills 2 weeks before running out
• That a backup alternative is available if needed
• That Medfinder can help them check availability

Setting expectations upfront reduces anxiety, phone calls to your office, and the risk of therapy gaps.

Alternative Medications to Consider

When switching a patient away from CombiPatch, consider the following options based on clinical needs:

For Patients Who Need Transdermal Delivery

• Climara Pro: Once-weekly Estradiol/Levonorgestrel patch. Different progestin but similar efficacy for vasomotor symptoms and endometrial protection.
• Estradiol patch + oral progestin: Prescribe an estradiol-only patch (Vivelle-Dot, Climara, Minivelle) plus oral Norethindrone Acetate 5 mg or Medroxyprogesterone Acetate. This component approach lets you source each piece independently.

For Patients Who Can Use Oral Therapy

• Activella: Same Estradiol/Norethindrone Acetate combination as CombiPatch, in oral form. Generic available. Generally more consistent supply.
• Prempro: Conjugated estrogens/Medroxyprogesterone Acetate. Extensive clinical data. Generic available.
• Bijuva: Estradiol/Progesterone (bio-identical). Brand-only, higher cost, but preferred by patients seeking bio-identical hormones.

Important Clinical Considerations When Switching

• Oral estrogen undergoes first-pass hepatic metabolism, increasing hepatic protein synthesis including coagulation factors. For patients at elevated thromboembolic risk, prioritize transdermal alternatives.
• Dose conversion: 0.05 mg/day transdermal Estradiol ≈ 1 mg/day oral Estradiol.
• Monitor for breakthrough bleeding in the first 3-6 months after any change.
• Reassess after 3 months to evaluate symptom control and tolerability.

Workflow Tips for Your Practice

Managing shortage-related issues can create administrative burden. Here are some efficiency strategies:

• Create a shortage protocol: Develop a standard operating procedure for your front desk and nursing staff to follow when patients call about CombiPatch availability. Include a decision tree: check Medfinder → offer backup prescription → schedule follow-up if needed.
• Batch prescription adjustments: If you have many patients on CombiPatch, consider proactively reaching out to offer backup prescriptions rather than waiting for individual calls.
• Use e-prescribing flexibility: When possible, send prescriptions to pharmacies that you know have stock, rather than always defaulting to the patient's usual pharmacy.
• Document the shortage: Note in the patient's chart that the switch was due to a supply shortage, not a clinical decision. This is important for continuity of care and for insurance appeals if needed.

Final Thoughts

The CombiPatch shortage requires prescribers to be more hands-on with supply-side logistics than usual, but the strategies outlined above can minimize therapy disruptions for your patients while keeping your workflow manageable.

Direct patients and staff to Medfinder for Providers as a first-line tool for availability checks, and build contingency prescribing into your standard practice for any patient on a shortage-affected medication.

For the clinical details on alternative prescribing strategies, see our companion article: CombiPatch shortage: what providers and prescribers need to know in 2026.