Your Patient Needs Natacyn — Now What?

You've diagnosed fungal keratitis and prescribed Natacyn (Natamycin 5% ophthalmic suspension). But as any ophthalmologist knows, prescribing Natacyn is only half the battle — your patient still needs to find it.

Because Natacyn is the sole FDA-approved topical ophthalmic antifungal in the U.S. and most retail pharmacies don't stock it, patients frequently return to your office reporting they can't fill their prescription. This delay in treatment can have serious consequences for vision outcomes.

This guide provides a practical, step-by-step approach to help your patients access Natacyn as quickly as possible.

Current Availability Landscape

As of early 2026, Natacyn supply from Alcon Laboratories is not in official shortage per the FDA. However, the practical availability picture remains challenging:

• Limited retail stocking: Chain pharmacies rarely carry Natacyn as standard inventory
• Single manufacturer: Alcon is the sole producer, with no generic alternative
• High unit cost: At $400-$700 per 15 mL bottle, pharmacies avoid stocking without confirmed orders
• Wholesaler dependency: Special orders typically require 1-3 business days

For a full breakdown of supply factors, see our clinical briefing: Natacyn Shortage: What Providers Need to Know in 2026.

Why Patients Can't Find Natacyn

Understanding the patient's experience helps inform your workflow:

1. Their regular pharmacy doesn't have it — and may not even know what it is
2. They call multiple pharmacies and get the same answer: "We don't carry that"
3. Cost shock — Even if they find it, the $400-$700 price tag may cause them to hesitate
4. Time pressure — They know their infection needs treatment, which adds anxiety to an already frustrating process

The result: patients return to your office with an unfilled prescription and a worsening infection.

What Providers Can Do: 5 Steps

Step 1: Verify Availability Before the Patient Leaves

The single most impactful thing you can do is confirm pharmacy availability while the patient is still in your office. Options include:

• Use Medfinder for Providers to search pharmacy inventory in your area
• Call your preferred specialty pharmacy to confirm stock
• Have your staff maintain a short list of pharmacies that reliably carry Natacyn

This proactive step prevents the most common scenario: a patient leaving with a prescription they can't fill.

Step 2: Consider In-Office Dispensing

Many ophthalmology practices stock Natacyn and dispense it directly. If your state permits physician dispensing, this eliminates the pharmacy availability problem entirely.

Benefits of in-office dispensing:

• Patient starts treatment immediately
• No pharmacy delays or stock issues
• Potentially billable under medical benefit
• Better adherence — patient has medication in hand

Check your state's pharmacy board regulations for physician dispensing requirements.

Step 3: Build Relationships with Specialty Pharmacies

Identify 2-3 pharmacies in your area that reliably stock or can rapidly order Natacyn:

• Hospital outpatient pharmacies affiliated with your institution
• Independent pharmacies near your practice that serve ophthalmology patients
• Compounding pharmacies with sterile ophthalmic capabilities (for alternatives)

Communicate these pharmacy options to patients at the point of prescribing. A printed handout with pharmacy names and phone numbers reduces patient burden significantly.

Step 4: Initiate Prior Authorization Early

For insured patients, Natacyn often requires prior authorization. Initiate this process at the time of prescribing rather than waiting for a pharmacy rejection:

• Document the clinical indication (fungal keratitis with culture results if available)
• Note that Natacyn is the sole FDA-approved ophthalmic antifungal
• Emphasize urgency — fungal keratitis is sight-threatening

Many insurers will expedite authorization for sight-threatening conditions when the request includes appropriate clinical documentation.

Step 5: Have a Contingency Plan

If Natacyn cannot be obtained within a clinically acceptable timeframe, be prepared to pivot:

• Prescribe compounded Voriconazole 1% drops as the primary alternative
• Consider compounded Amphotericin B 0.15%-0.5% for Candida infections
• Use oral antifungals (Voriconazole, Fluconazole) as systemic adjunct therapy when indicated

Having standing relationships with compounding pharmacies ensures you can pivot quickly without additional delays.

Alternatives to Natacyn

When Natacyn is not available or clinically suboptimal, consider these compounded alternatives:

• Voriconazole 1% eye drops — Broad-spectrum triazole; superior corneal penetration; first-line alternative for filamentous fungi
• Amphotericin B 0.15%-0.5% eye drops — Polyene antifungal; preferred for Candida; more irritating than Natacyn
• Fluconazole 0.2% eye drops — Best for yeast keratitis; limited filamentous coverage

All require sterile compounding. For a detailed comparison, direct patients to: Alternatives to Natacyn.

Workflow Tips for Your Practice

Integrate these steps into your clinical workflow to minimize disruption:

• Create a "hard-to-find medications" protocol that your staff follows when prescribing Natacyn or similar specialty drugs
• Maintain a pharmacy contact list updated quarterly with Natacyn availability status
• Designate a staff member to handle specialty medication access and prior authorizations
• Use Medfinder as a real-time availability check tool — medfinder.com/providers is designed for clinical workflows
• Provide patient handouts with pharmacy options, cost expectations, and savings resources

Final Thoughts

Natacyn access challenges are a known issue in ophthalmology practice. By building proactive systems — verifying availability at the point of care, maintaining specialty pharmacy relationships, and having compounded alternatives ready — you can ensure your patients receive timely antifungal treatment regardless of supply fluctuations.

Key takeaways for providers:

• Don't assume the patient can fill Natacyn at their regular pharmacy
• Verify availability before discharge using Medfinder
• Stock Natacyn in-office if your state allows physician dispensing
• Build compounding pharmacy relationships for backup alternatives
• Address cost proactively with PA and patient assistance referrals

For the latest supply updates, see our 2026 provider briefing on Natacyn availability.