How to Help Your Patients Find Fluorouracil In Stock: A Provider's Guide

When fluorouracil is in shortage, your patients feel it. Patients on active chemotherapy regimens like FOLFOX or FOLFIRI, or dermatology patients using topical fluorouracil for actinic keratosis, are calling your office asking where to get their medication filled. Your care team is fielding these calls, and your staff is spending time they don't have on the phone with pharmacies.

This guide gives you concrete tools, workflows, and scripts to help patients navigate the fluorouracil shortage efficiently — while reducing the administrative burden on your practice.

Why Your Practice Needs a Fluorouracil Shortage Protocol

The fluorouracil injection shortage has been active since January 2023. As of early 2026, multiple manufacturers remain affected. This is not a short-term disruption you can wait out — it requires a systematic approach to ensure no patient misses a treatment cycle due to supply issues.

Practices without a shortage protocol end up in reactive mode: staff scrambling to locate product the day before an infusion, patients calling the office in a panic, and oncology nurses spending clinical time on supply logistics instead of patient care.

Step 1: Identify Which Patients Are at Risk

Run a report of all active patients receiving fluorouracil-containing regimens. This includes:

All patients on FOLFOX, FOLFIRI, FLOT, FOLFIRINOX, mFOLFIRINOX, or CMF regimens.

Patients scheduled for fluorouracil-based chemoradiation.

Dermatology patients prescribed topical fluorouracil 0.5%, 4%, or 5% (e.g., Efudex, Carac, Tolak).

Prioritize patients in active curative-intent or neoadjuvant/adjuvant settings — a delayed cycle for these patients carries greater clinical risk than for patients in palliative or maintenance settings.

Step 2: Establish Pharmacy and Distributor Relationships

Your infusion pharmacy or retail pharmacy partner may not be receiving fluorouracil from their primary distributor. Instruct your pharmacy team to:

Contact Fresenius Kabi and Sagent directly — both have available product as of early 2026. Direct manufacturer accounts can bypass distributor bottlenecks.

Consider short-dated inventory from Accord (10 mL/20 mL vials expiring June 2026) for patients with near-term treatment cycles where the medication will be used before expiration.

Identify 503B outsourcing facilities that can produce compounded sterile fluorouracil injection during documented shortage conditions.

Step 3: Use Patient-Facing Tools to Reduce Staff Burden

One of the most practical resources you can give patients is a tool that does pharmacy calling for them. medfinder for providers helps practices direct patients to a service that calls local pharmacies on their behalf to find which ones have their medication in stock. Instead of patients tying up your phone lines, they can initiate a search themselves and receive results by text.

For practices, this means fewer inbound calls from patients asking "which pharmacy has my 5-FU?" and more time for clinical work.

Step 4: Pre-Authorize Alternative Regimens Proactively

For patients where capecitabine substitution is clinically appropriate, consider obtaining insurance pre-authorization in advance — not as a crisis response. Capecitabine (Xeloda and generic) is generally well-covered, but prior authorization requirements vary by payer. Having this approval in place means that if fluorouracil becomes unavailable for a specific cycle, the alternative is ready.

Step 5: Give Patients Clear Written Guidance

A simple one-page handout or after-visit summary note can reduce patient anxiety and after-hours calls. Include:

The drug name, strength, and form exactly as needed for pharmacy searches.

Instructions to start searching 5-7 days before their scheduled treatment.

A direct phone number for your infusion pharmacy.

A link to medfinder.com for expanded pharmacy searching.

Clear instructions to contact the office if they cannot locate the medication — not to delay treatment or self-manage.

Special Considerations for Dermatology Practices

Dermatologists prescribing topical fluorouracil should be aware that while the FDA shortage list covers the injection, topical supply is also intermittently tight. For actinic keratosis patients who cannot obtain topical fluorouracil:

Tirbanibulin (Klisyri) is FDA-approved for AK on the face/scalp and requires only a 5-day treatment course.

Imiquimod 3.75% (Zyclara) is approved for AK field treatment.

Compounding pharmacies can prepare fluorouracil cream from bulk API — write a compounding prescription specifying concentration and base.

For a broader clinical overview of the shortage, see our fluorouracil shortage clinical briefing for providers.