Your Patient Needs Ibsrela — Now What?

You've determined that Ibsrela (tenapanor) is the right treatment for your patient's IBS-C. The clinical rationale is sound, but the prescription journey is about to get complicated. Your patient may call back within days saying they can't find Ibsrela at their pharmacy — or that their insurance denied coverage.

This guide provides a practical, step-by-step framework for helping your IBS-C patients access Ibsrela efficiently, reducing prescription abandonment and patient frustration.

Current Availability: What You Need to Know

As of early 2026, Ibsrela's supply situation can be summarized as:

• No formal shortage: Ibsrela is not on the FDA Drug Shortage Database
• Single source: Manufactured exclusively by Ardelyx, Inc.
• Limited retail stocking: Many chain pharmacies don't carry Ibsrela routinely due to low volume and high cost ($2,000-$2,500 per 30-day supply)
• No generic available: Earliest generic entry estimated August 2033

For the complete supply landscape, see our provider shortage briefing.

Why Patients Can't Find Ibsrela

Understanding the barriers helps you address them proactively:

Pharmacy Stocking Gaps

Chain pharmacies use demand-driven inventory systems. If a location dispenses fewer than a handful of Ibsrela prescriptions per month, the medication drops off their automatic ordering list. This means your patient's prescription sits unfilled until the pharmacy places a manual order — which some pharmacies are reluctant to do for a $2,000+ medication.

Insurance Friction

Most commercial plans require prior authorization for Ibsrela, and many impose step therapy (typically requiring trial of linaclotide or plecanatide first). If the prior auth isn't completed before the patient arrives at the pharmacy, the claim rejects and the prescription goes unfilled.

Cost Shock

Patients who arrive at the pharmacy without insurance coverage or copay assistance face a cash price of $2,000 to $2,500. Many abandon the prescription at that point, unaware that savings programs exist.

What Providers Can Do: 5 Steps

Step 1: Submit Prior Authorization at the Time of Prescribing

Don't wait for the pharmacy to trigger a prior auth rejection. Submit the prior authorization proactively when you write the Ibsrela prescription. Include:

• IBS-C diagnosis with Rome IV criteria documentation
• Prior IBS-C medications tried (names, doses, duration, outcome)
• Clinical rationale for NHE3 inhibitor therapy
• Relevant lab work or diagnostic studies

This reduces the delay between prescription and fill by days or even weeks.

Step 2: Enroll the Patient in the Ardelyx Copay Program

For commercially insured patients, the Ardelyx Commercial Copay Program reduces out-of-pocket costs to as little as $0 per fill (Ardelyx covers up to $1,786 per 30-day supply). Key details:

• No physical copay card needed — the discount is applied automatically at most pharmacies
• Not available for Medicare, Medicaid, or other government-funded insurance patients
• Enrollment can be done at the point of prescribing through the Ardelyx HCP portal

Informing patients about the copay program before they go to the pharmacy prevents cost-related prescription abandonment.

Step 3: Direct Patients to a Pharmacy That Has Ibsrela in Stock

Instead of sending patients to their usual pharmacy and hoping for the best, use Medfinder to check real-time availability. You or your staff can:

1. Search for Ibsrela availability by the patient's zip code
2. Identify pharmacies that currently have it in stock
3. Send the prescription directly to a stocked pharmacy

This simple step can eliminate the most common patient complaint: "My pharmacy doesn't have it."

Step 4: Consider Specialty or Mail-Order Pharmacy Referral

For patients who have recurring difficulty finding Ibsrela locally, consider routing the prescription to:

• Specialty pharmacies that focus on GI medications and have established Ibsrela inventory
• Ardelyx Transition Pharmacy Services for initial fills while insurance and local pharmacy access is being established
• Mail-order pharmacy through the patient's insurance plan for ongoing fills

Step 5: Document Everything for Appeals

If the initial prior authorization is denied, a well-documented appeal has a strong chance of success. Keep records of:

• All prior IBS-C treatments with specific dates, doses, and clinical outcomes
• Patient-reported symptom scores and quality-of-life impact
• Peer-reviewed literature supporting NHE3 inhibitor use after GC-C agonist failure
• Any adverse events from prior therapies

Alternatives to Consider While Waiting

If there's a delay in accessing Ibsrela (prior auth pending, pharmacy ordering, etc.), consider bridging with:

• Linzess (linaclotide): Generic available, widely stocked, GC-C agonist
• Trulance (plecanatide): GC-C agonist, once daily, favorable GI tolerability
• Amitiza (lubiprostone): Generic available, chloride channel activator (higher nausea rates)
• Motegrity (prucalopride): 5-HT4 agonist, off-label for IBS-C when slow transit is predominant

See our patient-facing guide on alternatives to Ibsrela for a comparison you can share with patients.

Workflow Tips for Your Practice

Integrate these steps into your practice workflow to minimize disruption:

• Create an Ibsrela prescribing checklist that includes prior auth submission, copay enrollment, and pharmacy availability check
• Designate a staff member to handle specialty medication access — this reduces the burden on providers and improves turnaround
• Bookmark medfinder.com/providers for quick pharmacy availability checks during or after patient visits
• Keep a short list of local pharmacies known to stock or readily order Ibsrela
• Set up a 2-week follow-up for new Ibsrela starts to confirm the patient filled the prescription and tolerated the first doses

Final Thoughts

Prescribing Ibsrela requires more logistical effort than writing a script for a generic medication, but with proactive steps, your patients can access it reliably. Submit prior authorizations early, enroll patients in the copay program before they leave your office, and use tools like Medfinder to route prescriptions to pharmacies that have the medication in stock.

For clinical details, see our Ibsrela shortage briefing for providers. For patient cost assistance information, see our guide on helping patients save money on Ibsrela.