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

Proctofoam HC (Hydrocortisone Acetate 1% / Pramoxine Hydrochloride 1% rectal foam) remains one of the more difficult prescriptions for patients to fill in 2026. As a prescriber, you're likely hearing about this from frustrated patients who can't locate the medication at their pharmacy. This guide gives you a practical, step-by-step workflow to help your patients access treatment more efficiently.

For background on the shortage itself, see our provider briefing: Proctofoam Shortage: What Providers and Prescribers Need to Know in 2026.

Current Availability Overview

As of early 2026, the Proctofoam HC supply landscape looks like this:

• Brand-name Proctofoam HC: Largely discontinued by original manufacturer (Schwarz Pharma/UCB). Rarely available at pharmacies.
• Generic Hydrocortisone-Pramoxine rectal foam: Produced by a small number of manufacturers. Intermittently available with significant regional variation.
• Alternative formulations: Cream and lotion versions of Hydrocortisone-Pramoxine (e.g., Pramosone) are more consistently available.

The core issue is that aerosol foam is difficult and expensive to manufacture, which severely limits the number of companies willing to produce it.

Why Patients Can't Find Proctofoam

Understanding the barriers helps you communicate more effectively with patients and develop workaround strategies:

1. Pharmacies don't routinely stock it: Due to low turnover, many pharmacies — especially chains — don't keep Proctofoam or its generic on their shelves
2. Wholesaler inventory is inconsistent: Even when a pharmacy tries to order it, their distributor may not have it available
3. Patients don't know to look beyond their usual pharmacy: Most patients call one or two pharmacies and give up
4. Insurance hurdles: Prior authorization requirements and formulary exclusions add additional delays

5 Steps to Help Your Patients Find Proctofoam

Step 1: Check Availability Before Prescribing

Before writing a Proctofoam prescription, use Medfinder for Providers to check real-time stock at pharmacies near your patient. This takes 30 seconds and can prevent the cycle of rejected prescriptions and frustrated patient callbacks.

If a pharmacy near the patient has stock, send the prescription directly there. If not, consider one of the alternatives below before the patient leaves your office.

Step 2: Prescribe Generically and Allow Substitution

Write the prescription as "Hydrocortisone Acetate 1% / Pramoxine HCl 1% rectal foam" rather than brand-name Proctofoam HC. This gives the pharmacy maximum flexibility to fill from any available manufacturer. Ensure "dispense as written" is not checked unless there's a specific clinical reason.

Step 3: Include an Alternative on the Prescription or in the Chart

Proactively provide a backup plan. Consider documenting in the patient's chart or writing a secondary prescription for:

• Pramosone Cream (Hydrocortisone 1% / Pramoxine 1%): Same active ingredients, widely available in generic form. Most direct alternative.
• Hydrocortisone Rectal Cream 2.5% (generic Anusol-HC): Stronger anti-inflammatory, no anesthetic. Good option when inflammation predominates.
• Compounded Hydrocortisone-Pramoxine preparation: For patients who need both ingredients and can access a compounding pharmacy.

This way, if the pharmacy can't fill the foam, the patient has an immediate fallback without needing to contact your office again.

Step 4: Direct Patients to the Right Pharmacies

Share these tips with patients:

• Independent pharmacies often have better success sourcing specialty products through diverse wholesaler relationships
• Compounding pharmacies can prepare custom formulations
• Mail-order pharmacies sometimes maintain inventory when local pharmacies don't
• Medfinder: Direct patients to medfinder.com to search for availability themselves

Step 5: Address Insurance and Cost Barriers

If insurance denies coverage or requires prior authorization:

• Submit the prior authorization with clinical justification (e.g., patient has tried OTC Hydrocortisone without adequate relief)
• Recommend discount cards (GoodRx, SingleCare) for patients paying cash — generic foam may cost $50-$150 with these programs
• For uninsured or underinsured patients, refer to patient assistance resources at NeedyMeds.org or RxAssist.org
• Consider whether a more affordable alternative (generic Pramosone cream at $30-$80) would be clinically appropriate

Alternatives at a Glance

Quick reference for substitution decisions:

• Pramosone Cream/Lotion: Same active ingredients, different vehicle. Most similar. Generic: $30-$80.
• Anusol-HC / generic HC rectal cream 2.5%: Stronger steroid, no anesthetic. Generic: $15-$50.
• Epifoam: Same ingredients, foam vehicle, but labeled for skin (off-label for rectal). $100-$300+.
• Preparation H Hydrocortisone (OTC): HC 1% only, no Pramoxine. $8-$15. Suitable for mild symptoms.
• Compounded preparation: Custom formulation, pricing varies ($40-$100 typical).

For the patient perspective on alternatives: Alternatives to Proctofoam.

Workflow Tips for Your Practice

• Build a favorites list: Identify 2-3 pharmacies in your area that have successfully stocked Proctofoam and preferentially route prescriptions there
• Create a standing protocol: Develop an office protocol for Proctofoam prescribing that includes: check Medfinder → prescribe generically → include backup alternative → provide patient handout on finding the medication
• Educate your staff: Make sure your MAs and nurses know about the shortage so they can field patient calls efficiently and set appropriate expectations
• Use e-prescribing notes: Include a note to the pharmacist: "If Hydrocortisone-Pramoxine foam unavailable, please dispense generic Pramosone cream and notify prescriber"

Final Thoughts

The Proctofoam HC shortage requires prescribers to be proactive rather than reactive. By checking availability before prescribing, offering alternatives upfront, and directing patients to the right resources, you can significantly reduce the frustration and treatment gaps your patients experience.

Medfinder for Providers is designed to make this process easier. Use it to check stock in real time, and share medfinder.com with your patients so they can search for themselves.

For guidance on helping patients with cost barriers, see: How to Help Patients Save Money on Proctofoam: A Provider's Guide.