Your Patient Needs Natamycin — Now What?

You've diagnosed fungal keratitis, prescribed Natamycin (Natacyn 5% ophthalmic suspension), and now your patient calls back: their pharmacy doesn't have it. This scenario is all too familiar for ophthalmologists and eye care providers across the country.

Natamycin is the only FDA-approved topical antifungal eye drop in the United States, yet it's one of the hardest ophthalmic medications for patients to obtain. As a provider, you're uniquely positioned to help bridge this gap. This guide outlines practical, actionable steps your practice can take to ensure patients get timely access to Natamycin.

Current Availability: What You Need to Know

As of 2026, Natamycin is not on the FDA Drug Shortage list, meaning Alcon Laboratories is actively manufacturing and distributing Natacyn. However, practical availability remains limited at the pharmacy level:

• Most retail chains (CVS, Walgreens, Rite Aid) do not routinely stock Natacyn
• Specialty and hospital pharmacies are the most reliable sources
• Cash price remains high at $250-$600 per 15 mL bottle, discouraging retail stocking
• No generic is currently available

For the latest supply information, see our provider shortage briefing.

Why Patients Can't Find Natamycin

Understanding the barriers your patients face helps you design better access workflows:

Low Retail Stocking

Fungal eye infections represent a tiny fraction of ophthalmic prescriptions. Pharmacies stock based on demand, and Natamycin simply doesn't generate enough volume at any single location to justify shelf space.

Specialty Distribution

Natacyn is primarily distributed through specialty channels. Many standard pharmacy wholesalers carry limited quantities or require special ordering, adding one to two business days to fulfillment.

Insurance Barriers

Prior authorization requirements, specialty tier placement, and high copays create additional delays. Patients may arrive at the pharmacy only to learn their insurance requires paperwork that hasn't been completed.

Patient Confusion

Many patients don't understand why a "simple eye drop" is so hard to find. They may try one pharmacy, get discouraged, and delay treatment — which can have serious consequences for fungal keratitis outcomes.

What Providers Can Do: 5 Actionable Steps

Step 1: Establish a Preferred Specialty Pharmacy

The single most effective step is identifying one or two specialty pharmacies that reliably stock Natamycin and establishing them as your practice's preferred dispensing partners. Options include:

• Hospital outpatient pharmacies at your affiliated institution
• Regional ophthalmic specialty pharmacies
• National specialty mail-order pharmacies

Once you have a preferred pharmacy, send Natamycin prescriptions there by default rather than leaving it to the patient's usual retail pharmacy.

Step 2: Use Medfinder to Locate Stock

Medfinder for Providers allows your team to quickly search for pharmacies with Natamycin in stock by location. This can be done at the point of prescribing, before the patient even leaves your office. Integrating a Medfinder check into your workflow takes seconds and can save patients hours of frustration.

Step 3: Proactively Manage Prior Authorization

Don't wait for the pharmacy to trigger the prior authorization process. Instead:

• Submit prior authorization at the time of prescribing if the patient's insurance is known to require it
• Include fungal culture/smear results and clinical documentation of fungal keratitis
• Have a template letter or form ready for Natamycin PA requests to minimize staff time
• Follow up within 24 hours if authorization hasn't been confirmed

Step 4: Keep Emergency Stock When Possible

If your practice treats fungal keratitis with any regularity, consider maintaining a small clinic inventory of Natacyn. Even one or two bottles can serve as bridge therapy while the patient's prescription is being processed through a pharmacy. Check with your state pharmacy board regarding regulations for office dispensing.

Step 5: Have a Compounded Alternative Ready

Establish a relationship with a compounding pharmacy that can prepare antifungal ophthalmic solutions on short notice. The most commonly compounded alternatives include:

• Voriconazole 1% ophthalmic solution — broad-spectrum, good corneal penetration ($50-$150)
• Amphotericin B 0.15-0.5% ophthalmic solution — polyene antifungal, similar mechanism to Natamycin ($40-$120)

Having a compounding pharmacy on standby means you can initiate alternative therapy within hours if Natamycin cannot be obtained in time.

Alternative Antifungal Options

When Natamycin is unavailable or a patient cannot afford it, the following alternatives should be considered based on the specific clinical scenario:

• Fusarium keratitis: Natamycin is preferred, but Voriconazole 1% is the most common substitute
• Aspergillus keratitis: Voriconazole 1% may be equally or more effective than Natamycin
• Candida keratitis: Amphotericin B or Fluconazole 0.2% are reasonable options
• Severe or deep infections: Consider adding oral Voriconazole or Itraconazole as adjunctive systemic therapy

Direct patients to our resource on alternatives to Natamycin for additional patient-facing information.

Workflow Tips for Your Practice

Here are additional practical tips to streamline Natamycin access for your patients:

Create a Natamycin Protocol

Develop a written protocol for your clinical staff that outlines the steps to follow whenever Natamycin is prescribed:

1. Check stock at preferred specialty pharmacy via Medfinder or direct call
2. Send prescription to confirmed pharmacy
3. Initiate prior authorization if required
4. Confirm patient has the medication within 24 hours
5. If unavailable, prescribe compounded alternative and re-attempt Natamycin order

Educate Patients at the Point of Prescribing

Set expectations upfront. Tell patients:

• Natamycin is a specialty medication that most pharmacies don't carry
• You're sending the prescription to a pharmacy known to stock it
• If they have trouble, they should call your office immediately — not wait
• They can also search Medfinder independently

Track Outcomes

Keep a simple log of Natamycin prescriptions, fill times, and any access issues. This data can help you refine your workflow, identify the most reliable pharmacies, and build a case for stocking the medication in-house.

Final Thoughts

Natamycin access is a known challenge in ophthalmology, but it's a solvable one. Providers who build proactive workflows — establishing specialty pharmacy partnerships, leveraging tools like Medfinder, managing prior authorization aggressively, and maintaining compounding pharmacy relationships — can dramatically reduce the time it takes for their patients to start treatment.

Fungal keratitis outcomes depend on timely therapy. By taking these steps, you're not just solving a logistics problem — you're protecting your patients' vision.

For the latest supply updates, see our Natamycin shortage briefing for providers.