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

When patients can't fill their Conjugated Estrogens (Premarin) prescription, they often turn to their provider for help. And while prescribers can't control manufacturing or supply chains, there are concrete steps you can take to help patients maintain treatment continuity during the ongoing shortage.

This guide covers the current availability picture, why patients are having trouble, and a practical workflow for your practice.

Current Availability

As of early 2026, the availability of Conjugated Estrogens varies by formulation:

• Premarin Oral Tablets: Generally in stock at most pharmacies. Sporadic regional shortages may occur at high-volume locations.
• Premarin Vaginal Cream: Remains on the ASHP drug shortage list due to Pfizer manufacturing delays. This is the formulation patients have the most difficulty finding.
• Premarin Injection: Supply was restored in late 2025 and is expected to remain stable.

Pfizer is the sole manufacturer of brand-name Premarin, and no FDA-approved generic exists in the US.

Why Patients Can't Find It

Understanding the root causes helps you counsel patients effectively:

1. Single-source manufacturing: Pfizer is the only maker of Premarin. Any production issue creates immediate shortages with no backup supply.
2. Complex biological sourcing: Natural Premarin is derived from pregnant mare urine, making production scaling slower and less predictable than synthetic drugs.
3. No generic competition: Without an AB-rated generic, pharmacies can't substitute — they need the exact product or a new prescription for an alternative.
4. Increased HRT demand: Growing awareness of menopause treatment options has driven prescription volume upward, outpacing supply capacity.

What Providers Can Do: 5 Steps

Step 1: Direct Patients to Real-Time Availability Tools

Recommend Medfinder to patients as a first step. Medfinder provides real-time pharmacy stock data, allowing patients to find which pharmacies near them currently have Conjugated Estrogens in stock — without calling dozens of pharmacies.

Consider adding Medfinder to your patient handouts or after-visit summaries for medications known to be in shortage.

Step 2: Write Backup Prescriptions for Alternatives

When the supply situation is uncertain, consider sending two prescriptions: one for Conjugated Estrogens and one for a therapeutic alternative. This gives the patient (and pharmacist) flexibility to fill whichever is available. Clearly communicate to the patient that only one should be filled.

Evidence-based alternatives include:

• Estradiol oral (Estrace, generics): 0.5–2 mg daily. The most widely available estrogen. Generic estradiol tablets are inexpensive and rarely in shortage.
• Estradiol transdermal (Climara, Vivelle-Dot, generics): 0.025–0.1 mg/day patches. May be preferred for patients with thrombotic risk factors.
• Estradiol vaginal cream (Estrace cream): Alternative for patients who can't find Premarin Vaginal Cream.
• Esterified Estrogens (Menest): 0.3–2.5 mg tablets. Closest oral alternative to Premarin.
• Synthetic Conjugated Estrogens (Cenestin, Enjuvia): Plant-derived alternatives with a similar estrogen profile.

Approximate dose conversions: Conjugated Estrogens 0.625 mg ≈ Estradiol 1 mg oral ≈ Estradiol 0.05 mg/day patch.

Step 3: Ensure Progestin Coverage When Switching

When transitioning patients to an alternative estrogen, confirm that concurrent progestin therapy remains in place for women with an intact uterus. The type of estrogen may change, but endometrial protection remains essential. Options include:

• Medroxyprogesterone acetate (Provera)
• Micronized progesterone (Prometrium)
• Norethindrone acetate

The exception is Duavee (bazedoxifene/conjugated estrogens), which provides endometrial protection without a separate progestin.

Step 4: Connect Patients with Financial Resources

Cost barriers compound access problems during shortages. Help patients access savings programs:

• Pfizer Co-Pay Card (PfizerForAll): Eligible commercially insured patients pay as little as $25/fill
• Pfizer RxPathways: Free or reduced-cost Premarin for qualifying uninsured/low-income patients
• Discount coupons: GoodRx, SingleCare — can reduce Premarin tablet costs from ~$280 to ~$99

For a comprehensive guide, see how to help patients save money on Conjugated Estrogens.

Step 5: Set Patient Expectations

Proactive communication reduces patient frustration. Let patients know:

• The shortage may persist — plan for potential switches
• Refill early (7-10 days before running out)
• Try independent pharmacies if chain pharmacies are out of stock
• Call the pharmacy Monday or Tuesday mornings for best stock availability
• Never stop HRT abruptly — always coordinate with your provider

Workflow Tips for Your Practice

• Flag shortage medications in your EHR: Add alerts for medications on the ASHP shortage list so staff can proactively discuss alternatives at the point of prescribing.
• Standardize patient handouts: Create a handout for patients on Conjugated Estrogens that includes the Medfinder link, savings program details, and alternative medication names.
• Use e-prescribing flexibility: Send prescriptions to pharmacies patients identify as having stock (via Medfinder) rather than defaulting to their usual pharmacy.
• Coordinate with your pharmacist: Build a relationship with a local pharmacist who can alert your office when Conjugated Estrogens come back in stock.

Final Thoughts

Drug shortages are disruptive, but providers are uniquely positioned to smooth the path for patients. By directing patients to real-time tools like Medfinder, preparing backup prescriptions, and connecting patients with savings programs, you can keep treatment on track even when supply is uncertain.

For more clinical detail on the shortage, see our provider briefing on the Conjugated Estrogens shortage. For patient-facing resources you can share, see our patient guide to finding Conjugated Estrogens in stock.