Your Patients Are Struggling to Find Prempro — Here's How You Can Help

If your patients on Prempro 0.625/2.5 28 Day have been calling your office about unfilled prescriptions, you're hearing a story that's playing out across practices nationwide. Combination HRT products containing Conjugated Estrogens have faced intermittent supply disruptions, and the 0.625/2.5 mg strength has been particularly affected.

As a provider, you're in a unique position to help. This guide offers practical steps your practice can take to minimize treatment disruptions, keep patients on appropriate therapy, and streamline the process for your staff.

For the clinical and supply background, see our companion article: Prempro Shortage — What Providers Need to Know in 2026.

Current Availability of Prempro 0.625/2.5 28 Day

As of early 2026, Prempro and its generic equivalent (Conjugated Estrogens/Medroxyprogesterone Acetate 0.625/2.5 mg) are being manufactured and distributed, but pharmacy-level stockouts remain common. Key points:

• Large chain pharmacies (CVS, Walgreens, Rite Aid) experience more frequent stockouts due to centralized allocation systems
• Independent pharmacies often have better sourcing flexibility through multiple wholesalers
• Mail-order pharmacies generally maintain larger inventories
• The generic version is slightly more available than the brand but still subject to supply variability
• Regional differences are significant — some areas are well-supplied while others face persistent gaps

Why Your Patients Can't Find It

Understanding the root causes helps you communicate effectively with patients and plan accordingly:

• Manufacturing complexity: Conjugated Estrogens require specialized production from natural sources, creating a more fragile supply chain than fully synthetic drugs.
• Demand surge: HRT prescribing has increased significantly as more women seek treatment and clinical guidance has evolved to support broader use in appropriate candidates.
• Manufacturer consolidation: Fewer companies produce combination Conjugated Estrogen products, amplifying the impact of any single production disruption.
• Wholesale allocation: During supply tightness, wholesalers limit per-pharmacy orders, creating artificial scarcity at the retail level even when aggregate supply is adequate.

What Your Practice Can Do: 5 Steps

Step 1: Check Real-Time Inventory Before Sending Prescriptions

The most impactful change you can make is checking pharmacy inventory before routing a prescription. Medfinder for Providers lets your staff search for Prempro 0.625/2.5 28 Day by zip code and see which pharmacies currently have it in stock.

This takes about 30 seconds and can prevent the cascade of patient calls, pharmacy transfers, and rework that follows a failed fill. Consider making this a standard step in your prescription workflow for medications with known supply issues.

Step 2: Include Generic Substitution Permissions on Every Prescription

Ensure that all Prempro prescriptions allow generic substitution (Conjugated Estrogens/Medroxyprogesterone Acetate). The generic is therapeutically equivalent and often more available. If you've been writing for brand-only or if your EHR defaults to "dispense as written," update your settings.

Some patients may have preferences about brand vs. generic. Address these proactively by explaining that the generic contains the same active ingredients in the same doses and is FDA-approved as equivalent.

Step 3: Proactively Discuss Backup Medications

Don't wait for a supply crisis to discuss alternatives. During routine visits with patients on Prempro, take 60 seconds to say: "In case we ever have trouble getting Prempro, here's what we'd switch to and why."

This reduces patient anxiety and enables faster transitions when needed. Document the backup plan in the patient's chart so any provider in your practice can act on it.

Step 4: Build Relationships with Independent Pharmacies

Independent pharmacies can be valuable partners during supply disruptions. They often:

• Work with multiple wholesalers and can source from secondary distributors
• Are willing to special-order medications for specific patients
• Provide more personalized communication with your office
• May have compounding capabilities for custom HRT formulations

Identify 2–3 independent pharmacies near your practice and establish a working relationship. Your staff can call them first when chain pharmacies report stockouts.

Step 5: Connect Patients with Cost Assistance

Supply problems and cost problems often compound each other. When a patient's usual pharmacy is out of stock and the only available option is a pharmacy where their insurance copay is higher (or that's out of network), cost becomes a barrier to access.

Equip your staff with information on:

• Pfizer RxPathways: Manufacturer patient assistance for qualifying uninsured or underinsured patients
• Discount cards: GoodRx, SingleCare, and similar services can reduce generic Prempro to $30–$70 per month
• NeedyMeds and RxAssist: Databases of patient assistance programs

You can also direct patients to our guide: How to Save Money on Prempro.

Therapeutic Alternatives to Consider

When Prempro is consistently unavailable and a switch is warranted, these are the most clinically appropriate alternatives:

• Activella (Estradiol/Norethindrone Acetate): Continuous combined HRT with bioidentical estradiol. Generic available with generally good supply. Well-established efficacy for vasomotor symptoms and osteoporosis prevention.
• Bijuva (Estradiol/Progesterone): Fully bioidentical combination HRT. Brand-only; higher cost but may be preferred by patients seeking bioidentical options.
• Angeliq (Drospirenone/Estradiol): Continuous combined HRT with mild anti-mineralocorticoid effect. Monitor potassium in patients on ACE inhibitors, ARBs, or potassium-sparing diuretics.
• Component therapy: Prescribing Premarin (Conjugated Estrogens) and Provera (Medroxyprogesterone Acetate) separately. Same pharmacology as Prempro with more dosing flexibility but increased pill burden.

For a patient-friendly comparison to share, see: Alternatives to Prempro.

Workflow Tips for Your Practice

Integrating supply-awareness into your daily workflow doesn't have to be burdensome. Here are some practical suggestions:

• Flag affected medications in your EHR: Add a note or alert to Prempro in your prescribing system reminding providers and staff to check availability before sending.
• Create a supply status board: A simple shared document listing medications with known supply issues, updated weekly, helps the whole team stay informed.
• Designate a point person: Assign one staff member to monitor supply-sensitive prescriptions, handle pharmacy callbacks, and coordinate transfers when needed.
• Batch check availability: When several patients are due for Prempro refills in the same week, check availability once and route all prescriptions to stocked pharmacies at the same time.
• Bookmark Medfinder for Providers: Make it a browser bookmark on all clinical workstations for quick access.

Final Thoughts

Supply disruptions for Prempro 0.625/2.5 28 Day are an inconvenience for patients and a workflow challenge for practices. But with the right tools and processes, you can minimize treatment gaps and reduce the burden on your staff.

The key steps: check inventory before prescribing, allow generic substitution, discuss backup plans proactively, leverage independent pharmacies, and connect patients with cost resources. These small changes can make a meaningful difference in your patients' experience during a frustrating supply period.

Medfinder for Providers is designed to help practices like yours navigate exactly these situations. Try it for your next Prempro prescription.