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

As a prescriber, you've chosen Duavee (conjugated estrogens 0.45 mg/bazedoxifene 20 mg) for a reason: it's the only FDA-approved estrogen/SERM combination that treats menopausal vasomotor symptoms and prevents osteoporosis without requiring a progestin. But your patients may be coming back to you frustrated because they can't find it at their pharmacy.

This guide offers practical steps you can take — right from your office — to improve your patients' chances of filling their Duavee prescriptions.

For a broader overview of the supply situation, see our provider briefing on the Duavee shortage in 2026.

Current Availability: What You Need to Know

Duavee's availability in 2026 remains limited at many retail pharmacies. Key factors:

• No generic exists — Pfizer is the sole manufacturer
• Low pharmacy stocking — chain pharmacies often don't carry it due to low local demand
• Intermittent supply — manufacturing constraints have caused periodic disruptions
• High cost — $300–$500/month cash price discourages stocking and prescribing

This doesn't mean Duavee is unavailable — it means patients (and providers) need to know where to look.

Why Patients Can't Find Duavee

Understanding the root causes helps you guide patients effectively:

• Chain pharmacy inventory systems are demand-driven. If a location hasn't filled a Duavee prescription recently, it won't stock it.
• Prior authorization requirements can delay filling by days, during which the pharmacy may return the stock to the wholesaler.
• Patients may not know they can request transfers, use mail-order, or check independent pharmacies.
• Cost shock at the pharmacy counter can cause patients to walk away without filling.

5 Steps You Can Take to Help

Step 1: Direct Patients to Medfinder

The simplest action is to share Medfinder for Providers with your patients. Medfinder checks real-time pharmacy inventory for Duavee across pharmacies near the patient's location. You can:

• Bookmark the link in your office workflow
• Print a QR code or handout for patients
• Have front desk staff share it when scheduling follow-ups

Step 2: Send Prescriptions to Pharmacies That Stock It

Rather than sending every Duavee prescription to the patient's default pharmacy, check availability first. Use Medfinder or call ahead to identify a pharmacy that currently has Duavee in stock. Then e-prescribe directly to that location.

Consider building a short list of "Duavee-friendly" pharmacies — independent pharmacies, specialty pharmacies, or mail-order services that reliably carry it.

Step 3: Submit Prior Authorization Proactively

Many insurance plans require PA for Duavee. Don't wait for the pharmacy to reject the claim — submit the PA at the time of prescribing. Key documentation to include:

• Diagnosis (vasomotor symptoms, osteoporosis prevention)
• History of progestin intolerance or treatment failure (if applicable)
• Clinical rationale for SERM-based endometrial protection
• Duration of therapy

Proactive PA submission can prevent 3–7 day delays that often lead to patients going without medication.

Step 4: Recommend Mail-Order Pharmacy

Mail-order pharmacies generally have better access to brand-name medications. Recommend that patients check with their insurance for mail-order benefits. Common options include:

• Express Scripts
• CVS Caremark mail order
• OptumRx home delivery
• Amazon Pharmacy

A 90-day mail-order supply reduces the frequency of refill challenges and may cost less per month than retail fills.

Step 5: Connect Patients with Savings Programs

Cost is a major barrier. Ensure patients know about available financial assistance:

• Pfizer co-pay savings card: Reduces copay to as low as $30–$50/month for commercially insured patients
• Pfizer RxPathways: Free medication for eligible uninsured/underinsured patients (PfizerRxPathways.com or 1-844-989-7284)
• Discount cards: GoodRx, SingleCare, and similar services may offer some savings on the cash price

For more details, see our guide: How to help patients save money on Duavee.

Alternative Therapies When Duavee Isn't Available

Have a documented backup plan in each patient's chart. Appropriate alternatives include:

• Prempro (CE/MPA): Generic available, $15–$50/month. Most similar in estrogen component (conjugated estrogens). Progestin may cause side effects in sensitive patients.
• Bijuva (estradiol/progesterone): Bioidentical option, brand-only, $200–$400/month. Good option for patients who prefer bioidentical hormones.
• Activella (estradiol/NETA): Generic available, $20–$60/month. Well-tolerated by most patients.
• Premarin + Prometrium: Separate pills allow independent dose titration. Both available as generics.

For a patient-facing comparison, share: Alternatives to Duavee.

Workflow Tips for Your Practice

Integrating Duavee access support into your workflow doesn't have to be time-consuming. Here are some practical tips:

• Create a Duavee checklist for your MA or nurse to follow when the medication is prescribed: check availability → submit PA → share Medfinder link → share savings program info.
• Set up a preferred pharmacy list in your EHR for Duavee that includes specialty and mail-order pharmacies known to carry it.
• Document the backup plan in the patient's chart at the time of initial prescribing, so transitions are seamless if Duavee becomes unavailable.
• Use Medfinder for Providers (medfinder.com/providers) as a quick reference tool during patient visits.

Final Thoughts

Duavee is a clinically distinct medication that serves a real need for postmenopausal women who cannot tolerate progestin. The availability challenges are real, but with a few proactive steps, you can significantly improve your patients' experience.

Direct patients to Medfinder, submit PAs early, recommend mail-order when possible, and always have a backup plan documented. These small workflow changes can make a big difference for the women who rely on this medication.

For the patient perspective, share our guide: How to find Duavee in stock near you.