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

If you prescribe Prometrium or generic Progesterone capsules, you've likely heard from frustrated patients who can't get their prescription filled. The ongoing Progesterone capsule shortage has affected pharmacies nationwide since late 2023, and heading into 2026, availability remains inconsistent.

As a prescriber, you're in a unique position to make a real difference. This guide outlines five practical steps you can take, along with alternative prescribing strategies and workflow tips to minimize disruptions to your patients' care.

Current Availability Snapshot

The Progesterone capsule shortage affects both brand-name Prometrium (Virtus Pharmaceuticals) and generic formulations (primarily Amneal Pharmaceuticals). Key points:

• Both 100 mg and 200 mg capsules have been affected
• Supply is intermittent — pharmacies may have stock one week and not the next
• Independent pharmacies often have better sourcing options than large chains
• Regional variation is significant; availability in one market doesn't indicate national supply recovery

The ASHP drug shortage database remains the most reliable source for up-to-date manufacturer information. For a full timeline of the shortage, see our companion article: Prometrium shortage: What providers need to know in 2026.

Why Patients Can't Find It

Understanding the root causes helps frame your conversations with patients:

• Supply-side constraints: A limited number of manufacturers produce Progesterone capsules. Production delays or raw material shortages at even one facility can significantly reduce nationwide supply.
• Demand growth: Bioidentical hormone therapy has grown in popularity. Off-label use for fertility support, PMS/PMDD, and irregular bleeding has broadened the patient population.
• Distribution inequity: Large chain pharmacies and smaller independents are supplied through different channels. Patients who only check one chain may not realize other pharmacies have stock.
• Patient timing: Patients who wait until they're out of medication face the most pressure and have the fewest options.

5 Steps Providers Can Take

Step 1: Recommend Medfinder to Patients

Direct patients to Medfinder, a free tool that lets them search for pharmacies near them with Prometrium or generic Progesterone in stock. This empowers patients to find their own medication without requiring your office staff to make calls on their behalf.

Consider including a Medfinder recommendation in your standard patient discharge instructions or after-visit summaries for Progesterone prescriptions.

Step 2: Prescribe Generically and Flexibly

Prescribing "Progesterone capsules" rather than brand-name "Prometrium" gives pharmacists maximum flexibility to dispense whatever manufacturer's product is available. Additionally:

• Avoid DAW (Dispense As Written) codes unless medically necessary
• Specify that substitution is permitted
• Consider writing for both 100 mg and 200 mg to give pharmacists flexibility (e.g., two 100 mg capsules if 200 mg is unavailable)

Step 3: Write for 90-Day Supplies

When patients do find Progesterone in stock, a 90-day prescription reduces the number of times they need to navigate the shortage. Confirm that the patient's insurance supports 90-day fills at retail. Many plans allow this with a slightly higher copay.

Step 4: Have Alternative Prescriptions Ready

Prepare backup prescriptions or documented contingency plans in the patient's chart. This saves time when a patient calls unable to fill their primary prescription. Appropriate alternatives by indication:

• Endometrial protection (HRT): Medroxyprogesterone Acetate (Provera) 5-10 mg daily for 12-14 days/cycle
• Amenorrhea: Medroxyprogesterone 10 mg daily for 10 days, or Norethindrone Acetate 5 mg for 10 days
• Luteal phase support: Endometrin 100 mg vaginal insert 2-3x daily, or Progesterone in oil IM, or compounded vaginal suppositories

For detailed comparisons, see: Alternatives to Prometrium.

Step 5: Partner with Compounding Pharmacies

Establish a relationship with one or two accredited compounding pharmacies in your area. When commercial Progesterone products are unavailable, compounding pharmacies can prepare micronized Progesterone in capsules, suppositories, creams, or troches. Having this relationship in place before a patient needs it streamlines the process.

Look for pharmacies accredited by PCAB (Pharmacy Compounding Accreditation Board) or ACHC (Accreditation Commission for Health Care).

Alternative Medications at a Glance

Here's a quick reference for common Prometrium alternatives:

• Medroxyprogesterone (Provera): Synthetic progestin. Well-established for endometrial protection and amenorrhea. Widely available. Cost: under $15/month with discount card.
• Norethindrone Acetate (Aygestin): Synthetic progestin. FDA-approved for endometriosis, amenorrhea, abnormal uterine bleeding. Generally available.
• Endometrin: Vaginal Progesterone insert. FDA-approved for luteal phase support in ART. Specialty pharmacy distribution. More expensive.
• Compounded Progesterone: Custom formulations from compounding pharmacies. Not FDA-approved. Typically $30-$90/month.

Workflow Tips for Your Practice

• Proactive patient communication: When prescribing Progesterone, proactively inform patients about the potential for supply issues and what steps to take if their pharmacy is out.
• Chart documentation: Document the patient's alternative medication plan in the chart so any covering provider can act quickly.
• Staff training: Brief your medical assistants and front desk staff on the shortage so they can triage patient calls efficiently and direct patients to Medfinder.
• E-prescribe to multiple pharmacies: In some EHR systems, you can send prescriptions to a primary and backup pharmacy. Consider this for patients in areas with known supply issues.
• Batch refill outreach: For patients on chronic Progesterone therapy, consider reaching out proactively before their supply runs out to check on availability and adjust plans if needed.

Final Thoughts

The Progesterone capsule shortage places an extra burden on both patients and providers, but a few proactive steps can make a significant difference. Recommending Medfinder, prescribing with flexibility, maintaining alternative plans, and building compounding pharmacy relationships will help ensure your patients stay on therapy.

For patient-facing resources you can share directly, see: How to find Prometrium in stock near you and How to save money on Prometrium.