A practical guide for providers: help your patients locate Hydroxocobalamin in stock during the 2026 shortage with these 5 actionable steps and workflow tips.
If your clinical workflow now includes fielding calls from patients who can't fill their Hydroxocobalamin prescriptions, you're not alone. The ongoing national shortage — driven by active ingredient supply disruptions and limited manufacturers — has left patients across the country struggling to access this essential B12 injection.
As a provider, you're uniquely positioned to help. This guide covers the current availability landscape, explains why patients are hitting roadblocks, and gives you five concrete steps to help your patients get the B12 therapy they need — plus alternatives to consider and workflow tips to manage the situation efficiently.
Here's the supply picture as of early 2026:
Understanding the barriers helps you support patients more effectively:
The generic Hydroxocobalamin IM market in the U.S. is dominated by a single supplier (Actavis/Hikma). When that manufacturer paused production due to API shortages in December 2025, there was no ready alternative in the commercial pipeline.
Retail pharmacies, especially chains, depleted their existing inventory quickly once the shortage was announced. Many pharmacies have been unable to reorder from their wholesalers since late 2025.
Many patients don't know that compounding pharmacies exist or that they could be a solution. They may also not realize that their doctor can prescribe an alternative B12 formulation. Without guidance, patients may simply go without treatment — which can have serious consequences.
Compounded medications may not be covered by insurance, creating a cost barrier for some patients. Additionally, patients switching to a different formulation may face insurance hurdles if the new medication requires a different prior authorization.
Don't wait for patients to call. If you have patients on Hydroxocobalamin maintenance therapy, reach out proactively to let them know about the shortage and their options. This can be done through patient portal messages, phone calls, or at the next scheduled visit.
A brief, reassuring message can prevent anxiety and ensure patients don't simply skip their injections. Let them know that alternatives exist and that you'll help them stay on track.
Medfinder for Providers allows you and your staff to quickly search for pharmacies with Hydroxocobalamin in stock by medication and location. When a patient calls about a failed fill, you can check availability in real-time and direct them to a pharmacy that has it.
Consider making Medfinder a standard part of your workflow during shortages. Your medical assistants or nursing staff can check availability before the patient leaves the office and provide them with specific pharmacy options.
If you haven't already, identify one or two compounding pharmacies that can prepare Hydroxocobalamin injections. National compounding pharmacies like Empower Pharmacy and Bayview Pharmacy can ship to patients across the country.
Benefits of having a compounding pharmacy option:
Write prescriptions that are compounding-friendly by specifying the drug, concentration, volume, route, and frequency (e.g., "Hydroxocobalamin 10 mg/mL, 10 mL vial, inject 1 mL IM weekly").
When Hydroxocobalamin is unavailable, discuss these alternatives with patients:
For details on each alternative, see our alternatives guide.
After switching a patient to an alternative, schedule follow-up labs (serum B12, methylmalonic acid, homocysteine) at 4-8 weeks to confirm the new regimen is maintaining adequate levels. Patients with neurological symptoms should be monitored more closely.
Document the reason for the switch (drug shortage) in the medical record. This is important for insurance purposes if questions arise about the medication change.
Here's a quick comparison for clinical decision-making:
Develop a brief clinical protocol for your practice that outlines:
Share this with your entire care team so everyone is on the same page.
If you have many patients on Hydroxocobalamin, send a batch patient portal message rather than waiting for individual calls. Include the shortage information, available alternatives, and next steps. This saves your staff significant phone time.
If your practice maintains its own B12 injection supply (common in primary care and gastroenterology), check whether your in-office stock includes Hydroxocobalamin or Cyanocobalamin. Administering in-office ensures the patient gets their injection and avoids the pharmacy fill problem entirely.
Note the drug shortage in the patient's chart when making any medication changes. This protects you clinically and helps with insurance documentation if the patient encounters coverage issues with the alternative.
Drug shortages are an ongoing challenge in clinical practice, and the Hydroxocobalamin shortage of 2025-2026 is a clear example of how a limited manufacturing base can disrupt care for thousands of patients. As providers, your proactive communication, familiarity with alternatives, and use of tools like Medfinder for Providers can make the difference between a patient who gets their B12 therapy on time and one who goes without.
For a patient-facing resource you can share, direct them to our guide on finding Hydroxocobalamin in stock. And for cost-saving resources, see our provider's guide to helping patients save money on Hydroxocobalamin.
You focus on staying healthy. We'll handle the rest.
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