How to Help Your Patients Find Dhivy in Stock: A Provider's Guide

Dhivy — the functionally scored carbidopa/levodopa tablet from Avion Pharmaceuticals — is a valuable tool for precisely titrating carbidopa/levodopa in Parkinson's disease patients. Its unique four-segment design allows dosing in 6.25 mg carbidopa/25 mg levodopa increments, enabling the kind of granular dose adjustment that can make a meaningful clinical difference for "brittle" patients, early-stage patients, and those with dysphagia.

However, because Dhivy is a specialty brand-name product with a narrower distribution network than generic carbidopa/levodopa, patients may encounter variable availability across pharmacies. This guide gives you a practical, repeatable workflow to help your patients maintain consistent access to Dhivy.

Step 1: Proactively Educate Patients at the Point of Prescribing

The most effective way to prevent access problems is to set expectations at the time of prescribing. When you prescribe Dhivy, counsel patients on:

• Why Dhivy may not be immediately available at every pharmacy and may require a special order
• The importance of starting their refill search 10–14 days before they run out
• The danger of abrupt discontinuation — NMS-like reactions, worsening motor symptoms, fall risk
• How to reach your office if they anticipate a supply problem

Step 2: Direct Patients to a Reliable Pharmacy Source at Prescribing

Rather than having the patient figure out where to fill Dhivy on their own, consider routing the prescription to a pharmacy you know stocks it. Options to identify:

• Specialty pharmacies: Pharmacies affiliated with your health system or neurology practice often stock specialty brand-name medications like Dhivy more consistently.
• Mail-order pharmacy: Through the patient's insurance plan, mail-order pharmacy can supply 90-day fills and avoids the recurrent availability search.
• Avion referral network: Contact Avion Pharmaceuticals at 1-888-612-8466 — they can provide information on which pharmacies in your area routinely stock Dhivy.

Step 3: Recommend medfinder for Real-Time Pharmacy Stock Search

For patients who call your office unable to locate Dhivy, medfinder provides a practical first-line tool. medfinder.com/providers allows you to direct patients to a service that contacts pharmacies on their behalf to check current stock — saving both the patient and your staff time.

This can be embedded into your patient visit workflow: when prescribing Dhivy, hand the patient a written resource or add it to your after-visit summary noting medfinder as a pharmacy-finding tool for their next refill.

Step 4: Establish a Practice Protocol for Supply Gap Calls

When a Dhivy patient calls your office reporting unavailability, your team should have a clear triage protocol. Consider this escalating response:

1. Assess urgency: How many doses does the patient have remaining? This determines how quickly action is needed.
2. Direct to medfinder first: If the patient has >5 days of medication remaining, direct them to medfinder to search for pharmacies with stock while awaiting further escalation.
3. Consider early refill authorization: If the patient is within 5–7 days of running out, authorize an early refill and consider transferring the prescription to a pharmacy known to stock Dhivy.
4. Bridge prescription if critically low: If the patient is within 1–2 days of running out and Dhivy cannot be located, prescribe generic carbidopa/levodopa 25/100 mg IR as a temporary bridge. Counsel on the difference in splitting reliability.

Step 5: Address Insurance and Prior Authorization Proactively

Insurance coverage for Dhivy varies by plan. Some Medicare Part D and commercial plans cover it; others may require step therapy or prior authorization. To minimize delays:

• Check formulary coverage before prescribing when possible
• Document the clinical rationale for Dhivy's precise-dose feature in the chart to support any PA appeal
• If coverage is denied, contact Avion Pharmaceuticals about their patient support program at dhivy.com/savings-and-support

Step 6: Manage the New B6 Monitoring Requirement

The 2026 FDA labeling update for all carbidopa/levodopa products (including Dhivy) adds a requirement to evaluate vitamin B6 levels prior to initiating treatment. For existing patients, incorporate B6 monitoring into annual labs, particularly for those on higher doses or with unexplained neurological symptoms. B6 deficiency can cause confusion, depression, and — in severe cases — seizures refractory to standard antiepileptics.

Quick Reference Checklist: Dhivy Prescribing Workflow

• Evaluate baseline vitamin B6 levels before initiating or at next visit for established patients
• Verify insurance coverage / check formulary status at point of prescribing
• Route initial prescription to a specialty or mail-order pharmacy when possible
• Counsel patient on early refill timeline (start searching 10–14 days before running out)
• Provide patient with medfinder as a pharmacy-search resource
• Document clinical rationale for Dhivy in chart to support PA appeals if needed
• Have a defined triage protocol for supply-gap calls to your office

For a full clinical briefing on the 2026 supply landscape, see our companion article: Dhivy shortage: what providers and prescribers need to know in 2026.