Your Patients Need Leucovorin — Here's How to Help Them Find It

When a patient on a FOLFOX or FOLFIRI regimen can't fill their Leucovorin prescription, it's not just an inconvenience — it's a potential treatment disruption. As a provider, you're often the most trusted resource your patients have when navigating drug shortages. This guide offers a practical framework for helping patients locate Leucovorin and maintain continuity of care.

Current Availability: Where Things Stand

As of early 2026, Leucovorin Calcium remains in an active shortage across multiple formulations:

• Injectable 500 mg vials: On long-term back order from Sagent with no estimated release date. Other manufacturers have intermittent supply.
• Oral tablets (5 mg, 10 mg, 15 mg, 25 mg): Intermittent availability. The FDA has authorized importation of Calcium Folinate 5 mg tablets from Canada (Pfizer/Farmasierra).
• Smaller injectable vials (50-350 mg): Availability varies. Contact wholesalers directly for current stock.

For the full shortage timeline and context, see our Leucovorin shortage briefing for providers.

Why Patients Can't Find Leucovorin

Understanding the patient experience helps you intervene more effectively:

• Retail pharmacies deplete first: Large chain pharmacies (CVS, Walgreens, Rite Aid) often run out before independent or specialty pharmacies because they serve the broadest population.
• Patients don't know where to look: Most patients call their usual pharmacy, hear "out of stock," and don't know what to do next.
• Limited awareness of alternatives: Many patients don't know about Levoleucovorin or that it can be substituted at half the dose.
• Cost confusion: Even when Leucovorin is available, cash prices ranging from $24 to $150+ for tablets (and much more for injectables) can create access barriers.

What Providers Can Do: 5 Practical Steps

Step 1: Proactively Discuss the Shortage With Patients

Don't wait until the patient calls in distress. At the time of prescribing, let patients know that Leucovorin may be difficult to find and provide them with a plan. This simple communication can reduce anxiety and prevent treatment delays.

Consider providing patients with a printed or digital list of resources, including Medfinder for pharmacy availability searches.

Step 2: Write for Levoleucovorin as an Alternative

If Leucovorin cannot be located, prescribe Levoleucovorin (Fusilev, Khapzory, or generic) at half the dose. Levoleucovorin contains only the active L-isomer and is FDA-approved for the same indications. Having both prescriptions ready — Leucovorin as primary and Levoleucovorin as backup — gives patients and pharmacies flexibility.

Key dosing note: Leucovorin 200 mg/m² = Levoleucovorin 100 mg/m². See our post on alternatives to Leucovorin for a full comparison.

Step 3: Direct Patients to Real-Time Availability Tools

Medfinder for Providers allows you and your staff to search for pharmacies with Leucovorin in stock by location. This saves time compared to calling pharmacies individually and gives patients a concrete next step.

You can also direct patients to our guide on how to find Leucovorin in stock near them.

Step 4: Leverage Your Institutional Supply Chain

If your practice is affiliated with a hospital or health system, your pharmacy department may have access to institutional distributors and group purchasing organizations (GPOs) that retail pharmacies don't use. Options include:

• Sourcing Leucovorin through your hospital's outpatient pharmacy
• Administering Leucovorin at your infusion center using institutional stock
• Coordinating with your pharmacy buyer to increase par levels when supply becomes available

Step 5: Connect Patients With Financial Assistance

For patients facing cost barriers in addition to supply issues:

• Discount cards: GoodRx and SingleCare can reduce oral tablet costs to approximately $24-$25 for 12 tablets of 5 mg.
• Prescription Hope: Offers Wellcovorin (brand) for $70/month for qualifying patients.
• NeedyMeds and RxAssist: Directories of patient assistance programs.
• Pfizer RxPathways: May assist with brand Wellcovorin for uninsured or underinsured patients.

Share our patient guide on saving money on Leucovorin with patients who need help navigating costs.

Therapeutic Alternatives at a Glance

• Levoleucovorin (Fusilev, Khapzory, generic): Direct substitute at half the dose. FDA-approved for methotrexate rescue and colorectal cancer with 5-FU. Most clinically equivalent option.
• Glucarpidase (Voraxaze): For methotrexate toxicity with delayed clearance — not a direct Leucovorin substitute but an adjunctive rescue agent. Do not administer within 2 hours of Leucovorin.
• Folic Acid: Only appropriate for megaloblastic anemia indication. Not a substitute in oncology or methotrexate rescue.

Workflow Tips for Your Practice

1. Build shortage awareness into your EMR: Add alerts or notes to Leucovorin-containing order sets flagging the shortage and prompting Levoleucovorin as an alternative.
2. Batch prescriptions when possible: If supply becomes available, consider prescribing larger quantities (within clinical appropriateness) to buffer against future disruptions.
3. Designate a shortage coordinator: In larger practices, assign a staff member to monitor ASHP shortage updates and communicate changes to the clinical team.
4. Document the shortage in patient charts: This supports payer appeals for Levoleucovorin coverage and creates an institutional record of supply disruptions.

Final Thoughts

The Leucovorin shortage requires providers to be proactive communicators, creative problem-solvers, and patient advocates. By preparing alternative prescriptions, leveraging tools like Medfinder, and connecting patients with financial resources, you can minimize treatment disruptions and maintain the quality of care your patients deserve.

For the patient-facing version of this information, see our Leucovorin shortage update for patients. For cost-saving strategies you can share with patients, see our provider's guide to helping patients save on Leucovorin.