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

The 2026 estradiol patch shortage has created a steady stream of patient calls, messages, and appointment requests — all from women who can't fill their Dotti prescriptions. As a provider, you're in a unique position to help. This guide outlines a practical, step-by-step approach to supporting your patients through the shortage.

For the clinical background on the shortage itself, see our provider briefing on the Dotti shortage.

Current Availability

As of early 2026, Dotti (estradiol transdermal system, Amneal Pharmaceuticals) is experiencing intermittent availability nationwide. The shortage affects most estradiol patch products to varying degrees:

• Dotti: Intermittent, with certain strengths (0.05 mg/day, 0.075 mg/day) particularly scarce
• Generic estradiol patches: Also constrained, availability varies by region and wholesaler
• Climara: Somewhat better availability in some areas
• EstroGel / Divigel: Less affected; generally the most available transdermal option
• Oral estradiol: Widely available

Why Patients Can't Find It

Understanding the root causes helps you communicate effectively with frustrated patients:

1. Demand surge: The FDA's November 2025 removal of the black box warning from bioidentical transdermal estradiol drove a rapid increase in new prescriptions.
2. Limited manufacturing capacity: Only a handful of facilities produce estradiol patches, and scaling takes 6–18 months.
3. Uneven distribution: Large chain pharmacies often receive priority allocations but serve more patients, leading to faster depletion. Independent pharmacies may have stock that chains don't.
4. Patient hoarding: Some patients, hearing about the shortage, have tried to fill prescriptions early or stockpile, further straining supply.

What Providers Can Do: 5 Steps

Step 1: Prescribe With Substitution Flexibility

When writing or renewing prescriptions for estradiol transdermal patches, consider language that gives pharmacists flexibility:

• "Estradiol transdermal 0.05 mg/day, twice weekly — Dotti, generic, or therapeutic equivalent"
• Avoid "DAW" (Dispense As Written) unless there's a specific clinical reason for brand-only
• Consider writing backup prescriptions for alternative formulations (e.g., EstroGel) to prevent callbacks

Step 2: Use Medfinder to Locate Stock

Medfinder for Providers lets you search real-time pharmacy inventory for Dotti and other estradiol products. You can:

• Check availability by zip code before sending a prescription
• Direct patients to specific pharmacies that have stock
• Reduce failed fills and patient frustration

Integrating a quick Medfinder check into your prescribing workflow can significantly reduce the number of "my pharmacy can't fill it" callbacks.

Step 3: Recommend Independent Pharmacies

Independent pharmacies often have access to different wholesaler networks and may carry stock when chains are depleted. Advise patients to:

• Search for independent pharmacies in their area
• Call ahead to confirm availability before transferring their prescription
• Consider compounding pharmacies as a backup (some can prepare custom estradiol formulations)

Step 4: Prepare to Switch Formulations

When patches are simply unavailable, be ready to transition patients to equivalent alternatives:

• Climara (once-weekly patch): Direct dose equivalence with Dotti. Well-tolerated, fewer patch changes.
• EstroGel: One pump (1.25 g) daily delivers estradiol levels comparable to a 0.05 mg/day patch. No adhesive-related skin issues.
• Divigel: Single-dose packets (0.25–1.0 mg) applied daily to the thigh.
• Oral estradiol: 1 mg oral ≈ 0.05 mg/day transdermal (approximate). Consider thrombotic risk profile before switching to oral. Not ideal for patients with elevated VTE risk, obesity, or hepatic concerns.

Remember to reassess progestogen dosing when changing estradiol formulations or routes of administration.

Step 5: Communicate Proactively With Patients

Patients are anxious about the shortage. Proactive communication reduces appointment burden and builds trust:

• Send a patient portal message acknowledging the shortage and outlining your plan
• Provide a handout or link to patient-friendly resources: Dotti Shortage Update for Patients
• Set expectations: "Supply may be inconsistent for the next several months. We have backup options ready."
• Encourage patients to refill 7–10 days before they run out

Alternatives at a Glance

A quick reference for discussing options with patients:

• Climara: Once-weekly estradiol patch. $27–$84 with coupon.
• Generic estradiol patch: Twice-weekly. $25–$50 with coupon.
• EstroGel: Daily topical gel. $130–$170 retail; less with coupon.
• Divigel: Daily topical gel packets. Similar pricing to EstroGel.
• Oral estradiol: Daily tablets. $4–$15/month generic.

For detailed comparisons, see Alternatives to Dotti.

Workflow Tips

• Batch your shortage communications. Send one patient portal message to all affected patients rather than handling inquiries individually.
• Flag affected patients in your EHR. Create a tag or registry for patients on estradiol patches so you can proactively manage refills and substitutions.
• Designate a staff point person. A medical assistant or nurse who handles shortage-related calls can triage efficiently and reduce provider burden.
• Keep a pharmacy contact list. Maintain a short list of independent pharmacies in your area that have been reliable sources during the shortage.
• Use Medfinder for Providers as part of your standard prescribing workflow during the shortage period.

Final Thoughts

The Dotti shortage is a logistics problem, not a clinical one. The medication exists; it's just not reaching pharmacies fast enough. By prescribing flexibly, using availability tools like Medfinder, and communicating proactively with patients, you can ensure that hormone therapy continuity isn't disrupted — even when a specific product is hard to find.

For the full clinical picture, revisit our provider briefing on the Dotti shortage. To help patients save on costs, share How to Save Money on Dotti and our provider's guide to helping patients save.