Your Patients Can't Find Lyllana. Here's How You Can Help.

The Estradiol transdermal patch shortage has turned a routine prescription into a source of significant patient distress. Women who depend on Lyllana for managing menopause symptoms — hot flashes, night sweats, sleep disruption, mood changes — are calling multiple pharmacies, paying out of pocket for brand-name alternatives, or going without treatment altogether.

As a provider, you're in a unique position to help. This guide offers practical steps you can take to improve access for your patients during the ongoing shortage.

Current Availability

As of early 2026, Lyllana (Amneal Pharmaceuticals) is widely backordered at major chain pharmacies including CVS, Walgreens, and Optum mail-order. The shortage extends beyond Lyllana to include Vivelle-Dot, generic Estradiol patches, and other transdermal Estradiol products.

For a detailed analysis of what's driving the shortage, see our provider shortage briefing.

Why Patients Can't Find It

Understanding the barriers your patients face helps you intervene more effectively:

• Chain pharmacy dependency: Many patients fill prescriptions at large chains tied to their insurance network. These pharmacies source from centralized distribution centers that may be depleted.
• Insurance restrictions: Some plans require specific pharmacies or brands, limiting patients' ability to switch to available alternatives without administrative hurdles.
• Information gaps: Patients often don't know they can check other pharmacies or request brand substitution. They wait for their pharmacy to restock rather than searching proactively.
• Cost barriers: When a patient's preferred generic is unavailable and a brand-name alternative is the only option, out-of-pocket costs of $150–$250/month can be prohibitive.

What Providers Can Do: 5 Steps

Step 1: Write Flexible Prescriptions

Instead of prescribing Lyllana by brand name, consider writing for "Estradiol transdermal system" with a note allowing substitution with any therapeutically equivalent product. This gives pharmacists the latitude to dispense whatever Estradiol patch is currently in stock — whether that's Lyllana, Dotti, Vivelle-Dot, Climara, or a generic.

If your patient needs a specific twice-weekly or once-weekly formulation, note that preference while still allowing brand flexibility.

Step 2: Direct Patients to Medfinder

Medfinder for Providers offers real-time pharmacy inventory search that shows which pharmacies have Estradiol patches in stock. You can:

• Search on behalf of your patient during the visit
• Send the patient home with the Medfinder URL and instructions
• Integrate the recommendation into your discharge or after-visit summary

This is significantly more helpful than telling a patient "call around" — it gives them a concrete tool and saves hours of phone calls.

Step 3: Recommend Independent Pharmacies

Independent pharmacies frequently have different wholesaler relationships than large chains. During the current shortage, many patients are finding Estradiol patches at independent pharmacies when chains are completely out of stock. If you know of independent pharmacies in your area, share those recommendations directly with patients.

Step 4: Prepare Alternative Treatment Plans

Have a ready-made backup plan for when Estradiol patches are unavailable:

• EstroGel (Estradiol gel): Applied daily to the arm. Similar transdermal delivery without adhesive. May have better availability.
• Divigel (Estradiol gel packets): Applied daily. Available in multiple strengths.
• Evamist (Estradiol spray): Transdermal spray applied to the forearm.
• Oral Estradiol: Widely available and inexpensive ($5–$15/month generic). Appropriate for patients without elevated VTE risk.

Discuss alternatives proactively — before the patient runs out — so the transition is planned rather than panicked. See our patient-facing alternatives guide for a resource you can share.

Step 5: Support Prior Authorization and Cost Mitigation

When a patient's insurer requires a specific product that's unavailable:

• Submit a prior authorization citing the supply shortage as the reason for the alternative
• Provide a letter of medical necessity documenting that the preferred product is backordered
• Direct patients to discount card programs (SingleCare, GoodRx) — generic Estradiol patches can cost $29–$55/month with these cards
• Refer eligible patients to Amneal's Patient Assistance Program (1-877-835-5472) or NeedyMeds.org

For a detailed cost breakdown and savings resources, see our provider cost guide.

Alternatives at a Glance

Quick reference for prescribing alternatives during the shortage:

• Climara — Once-weekly Estradiol patch, 0.025–0.1 mg/day. May have better regional availability.
• Dotti — Twice-weekly Estradiol patch. Closest equivalent to Lyllana.
• Vivelle-Dot — Twice-weekly Estradiol patch. Also affected by shortage but sometimes available.
• EstroGel — Daily Estradiol gel. No adhesive. Generally better supply.
• Oral Estradiol — Daily tablet. Widely available. Consider VTE risk profile.

Workflow Tips

• Flag HRT patients in your EHR. Add a note to charts of patients on Estradiol patches so you can proactively reach out if supply information changes.
• Write 90-day prescriptions when stock is found to maximize the buffer between refills.
• Designate a staff member to monitor Medfinder and local pharmacy availability weekly — this prevents scrambles when patients call.
• Include shortage info in patient communications. Add a note to your patient portal or website about the Estradiol shortage and what patients should do.

Final Thoughts

The Lyllana shortage is a supply chain problem, not a clinical one. The science supporting Estradiol-based HRT has never been stronger. By writing flexible prescriptions, directing patients to real-time inventory tools like Medfinder, preparing alternative treatment plans, and supporting patients through insurance and cost barriers, you can meaningfully reduce the impact of this shortage on your patients' health and quality of life.