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

You've prescribed Divigel (Estradiol gel 0.1%) because it's the right fit for your patient — flexible dosing, transdermal delivery, and well-tolerated. But then the call comes: "My pharmacy doesn't have it." Or worse, the patient simply doesn't fill the prescription and misses weeks of therapy.

This scenario has become increasingly common as the hormone replacement therapy (HRT) market faces sustained demand pressure. While Divigel is not formally in shortage, pharmacy-level availability remains inconsistent. As a prescriber, there are concrete steps you can take to close this gap and keep your patients on track.

Current Availability Landscape

As of 2026, Divigel's manufacturer, Vertical Pharmaceuticals, reports that supply remains adequate at the distribution level. The disconnect between supply and patient access typically occurs at the pharmacy level:

• Chain pharmacies may not routinely stock Divigel, treating it as a special-order item.
• Generic Estradiol gel 0.1% is more widely available but still not universally stocked.
• Estradiol patch shortages (ongoing since 2023) have redirected patients to gel formulations, increasing demand.
• Independent pharmacies often have better sourcing flexibility through alternative distributors.

For a full supply timeline, see our provider shortage briefing.

Why Patients Can't Find Divigel

Understanding the patient experience helps frame the problem. Common reasons patients report difficulty:

1. Their usual pharmacy doesn't carry it. Many chain locations only stock high-volume generics and don't keep Divigel on the shelf.
2. They don't know about the generic. Patients often search specifically for "Divigel" without realizing generic Estradiol gel is the same drug at a fraction of the cost.
3. They wait until they're out. Without a refill buffer, any sourcing delay means missed doses.
4. They don't know where else to look. Patients typically try their one pharmacy and then call your office for help.

What Providers Can Do: 5 Actionable Steps

Step 1: Prescribe Generic When Clinically Appropriate

Writing for "Estradiol gel 0.1%" rather than "Divigel" gives pharmacies more flexibility to dispense what they have in stock. Generic Estradiol gel is bioequivalent and available from multiple manufacturers. The cost difference is significant:

• Brand Divigel: $650 to $900+/month cash price
• Generic Estradiol gel: $32 to $50/month with coupons

Unless there's a specific clinical reason to require the brand, generic prescribing improves both access and affordability.

Step 2: Direct Patients to Medfinder

Medfinder allows patients (and your staff) to check real-time pharmacy availability for Divigel and generic Estradiol gel. Integrating a quick Medfinder recommendation into your prescribing workflow can prevent the "I couldn't find it" callback.

Consider adding a note to your after-visit summary: "If your pharmacy doesn't have this medication in stock, visit Medfinder.com to find a nearby pharmacy that does."

Step 3: Suggest Independent and Specialty Pharmacies

If your area has independent pharmacies, recommend them as a first option. They're often better positioned to order specialty products and may have relationships with multiple wholesalers. Compounding pharmacies can also prepare Estradiol gel formulations, though these are not FDA-approved and may not be covered by insurance.

Step 4: Recommend Early Refills

Advise patients to start the refill process 5 to 7 days before their current supply runs out. This builds in time for the pharmacy to source the product if it's not immediately on the shelf. Most insurance plans allow refills at the 75% to 80% mark of the prescription period.

Step 5: Have a Backup Plan Ready

When prescribing Divigel or Estradiol gel, consider documenting an alternative therapy in case of access failure. Options include:

• Estradiol patches (Climara, Vivelle-Dot, Dotti, Lyllana) — applied once or twice weekly
• EstroGel — pump-dispensed estradiol gel applied to the arm
• Oral Estradiol (Estrace) — widely available and inexpensive, though with different pharmacokinetic profile
• Bijuva — combined Estradiol/Progesterone capsule for patients with a uterus

Approximate dose equivalencies for switching:

• Divigel 0.25 mg/day ≈ Estradiol patch 0.025 mg/day
• Divigel 0.5 mg/day ≈ Estradiol patch 0.05 mg/day
• Divigel 1.0 mg/day ≈ EstroGel 0.75 mg/day (one pump)

For a patient-facing alternatives guide to share, see: Alternatives to Divigel.

Alternatives at a Glance

Here's a quick-reference comparison for your prescribing toolkit:

• Generic Estradiol gel 0.1%: Same drug as Divigel. Foil packets. $32–$50/month with coupon. Most direct substitute.
• EstroGel: Estradiol gel via pump. 0.75 mg/day fixed dose. Applied to arm. ~$170+/month with coupon.
• Estradiol patches: 1–2x weekly application. Multiple dose options. Generic widely available. Subject to own supply variability.
• Oral Estradiol: Daily tablet. Under $20/month generic. First-pass hepatic metabolism — consider for patients without elevated clotting or liver risk.
• Bijuva: Combined E2/P4 capsule. Convenient for patients requiring progestogen. Brand only.

Workflow Tips for Your Practice

• Add Medfinder to your patient handouts. A simple line directing patients to medfinder.com can reduce follow-up calls about access issues.
• Flag patients on Divigel in your EHR. A simple note like "check availability at refill" can prompt proactive outreach.
• Educate MA/nursing staff. Ensure your team knows that Divigel = Estradiol gel 0.1% (generic) and can guide patients accordingly.
• Track local pharmacy patterns. Over time, you'll learn which pharmacies in your area reliably stock Estradiol gel products.

Final Thoughts

Divigel is a well-suited transdermal estradiol option for many menopausal patients, but access barriers mean prescribers need to be proactive. By prescribing generically, directing patients to Medfinder, and having backup alternatives ready, you can significantly reduce treatment interruptions.

For additional resources: Divigel Shortage: Provider Briefing | How to Help Patients Save Money on Divigel