Your Patients Can't Find Rectiv — Here's How You Can Help

As a prescriber, you've likely heard from patients who can't fill their Rectiv (Nitroglycerin 0.4% rectal ointment) prescription. The ongoing supply disruption for this single-source, brand-only medication creates a unique burden — not just on patients, but on clinical workflows. When a patient can't obtain a prescribed medication, the resulting phone calls, follow-up visits, and treatment delays consume time and resources.

This guide provides actionable strategies your practice can implement to help patients navigate Rectiv access challenges more efficiently.

Understanding the Access Landscape

Before addressing solutions, it's important to understand the scope of the problem. Rectiv faces a combination of access barriers that most commonly prescribed medications do not:

• No FDA-approved generic: No ANDA has been approved for Nitroglycerin 0.4% rectal ointment
• Single manufacturer: Allergan (AbbVie) is the sole producer
• Low pharmacy stocking rates: Most retail chain pharmacies do not maintain Rectiv inventory
• High cash price: $500-$900+ per tube without insurance
• Prior authorization requirements: Many payers require PA, adding further delays

For a detailed clinical overview of the shortage, see: Rectiv shortage: What providers and prescribers need to know in 2026

Strategy 1: Build a Preferred Pharmacy Network

One of the most effective steps you can take is identifying pharmacies in your area that are most likely to carry or order Rectiv. This eliminates the trial-and-error process for patients.

Where to Look

• Specialty pharmacies: These are the most reliable sources for niche medications like Rectiv. Identify 2-3 specialty pharmacies in your service area and establish a relationship.
• Independent pharmacies: Often more flexible than chain pharmacies in ordering low-volume medications. Some will special-order Rectiv with advance notice.
• Compounding pharmacies: Essential partners for when Rectiv is unavailable. They can prepare Nitroglycerin ointment (0.2%-0.4%) or Diltiazem 2% topical.

How to Implement

1. Call or visit local pharmacies to determine who stocks or can order Rectiv
2. Maintain a reference list accessible to all prescribers and clinical staff in your practice
3. Update the list quarterly or whenever supply changes
4. Include compounding pharmacies as a standing backup option

Strategy 2: Use Real-Time Availability Tools

MedFinder for Providers offers real-time pharmacy stock data that can be used at the point of prescribing. Rather than sending a prescription into the void and hoping the pharmacy has it, you can verify availability first.

Workflow integration options:

• Check MedFinder before sending the electronic prescription
• Have a medical assistant or pharmacy liaison check availability as part of the visit workflow
• Share the MedFinder link with patients so they can check availability on their own

Recommend the patient-facing version to your patients as well: How to find Rectiv in stock near you

Strategy 3: Prescribe to Compounding Pharmacies Directly

When brand-name Rectiv is unavailable, compounded Nitroglycerin ointment is the most direct alternative. Streamlining this process can significantly reduce patient wait times and office callbacks.

Best Practices for Compounding Prescriptions

• Specify concentration and quantity clearly: e.g., "Nitroglycerin 0.4% ointment, 30g, apply 1 inch intra-anally every 12 hours x 3 weeks"
• Send directly to the compounding pharmacy: Avoid sending to a retail pharmacy that will then need to redirect
• Confirm the compounding pharmacy's turnaround time: Most can prepare the ointment within 1-3 business days
• Counsel patients about differences: Compounded products are not FDA-approved. Discuss this with patients to set appropriate expectations.

Strategy 4: Proactive Patient Education at Point of Prescribing

The most effective intervention is proactive communication. When prescribing Rectiv (or any medication with known supply issues), set expectations at the time of the visit.

Key talking points for patients:

• "Rectiv can be difficult to find at regular pharmacies due to supply limitations."
• "If your pharmacy doesn't have it, here are some alternatives we can try." (Provide specific pharmacy names or a handout.)
• "You can check MedFinder to see which pharmacies near you have it in stock."
• "If we can't get Rectiv, I can prescribe a compounded version or an alternative medication like Diltiazem."

Consider creating a patient handout specific to Rectiv access that includes:

• Names and phone numbers of local pharmacies that may stock Rectiv
• Compounding pharmacy contact information
• Link to MedFinder
• Brief explanation of compounded alternatives
• Patient-facing articles: Alternatives to Rectiv and How to save money on Rectiv

Strategy 5: Streamline Prior Authorization

For patients whose insurance requires prior authorization for Rectiv:

• Have PA paperwork templates pre-filled with standard clinical language for chronic anal fissure
• Document ICD-10 K60.1 (chronic anal fissure) and failure of conservative measures in the chart
• Include a note about the medication's FDA-approved status to support medical necessity
• Assign a dedicated staff member to handle Rectiv PAs to reduce turnaround time

Strategy 6: Consider Diltiazem 2% Topical as First-Line

Given the persistent Rectiv supply issues and the significant headache rate associated with Nitroglycerin (up to 64% of patients), some providers have shifted to prescribing compounded Diltiazem 2% topical ointment as their initial therapy for chronic anal fissures.

Clinical rationale:

• Comparable healing rates to Nitroglycerin in published literature
• Significantly lower headache incidence
• Readily available through compounding pharmacies
• Lower cost ($30-$80 vs. $500-$900+)
• Eliminates supply-related treatment delays entirely

This approach avoids the access problem altogether while providing effective treatment. For patients who specifically require Nitroglycerin (e.g., those who have responded well to it previously), compounded Nitroglycerin remains the appropriate backup.

Strategy 7: Address Cost Barriers

Even when Rectiv is available, the $500-$900+ cash price can be prohibitive. Help patients access financial support:

• AbbVie patient assistance programs: May provide Rectiv at reduced cost or free for eligible patients
• Manufacturer copay cards: Check current availability through Allergan/AbbVie
• NeedyMeds and RxAssist: Third-party databases for financial assistance programs
• Compounded alternatives: Often the most practical cost solution at $30-$100

For a comprehensive cost guide to share with patients: How to save money on Rectiv in 2026

For provider-specific cost strategies: How to help patients save money on Rectiv: A provider's guide

Summary: A Systematic Approach

The Rectiv supply problem isn't going away soon. The most effective response is a systematic approach that anticipates access issues rather than reacting to them:

1. Maintain an updated list of pharmacies that stock Rectiv or can order it
2. Integrate MedFinder into your prescribing workflow
3. Establish relationships with compounding pharmacies for backup prescriptions
4. Educate patients proactively at the point of prescribing
5. Streamline prior authorization processes
6. Consider Diltiazem 2% topical as a first-line alternative when clinically appropriate
7. Connect patients with financial assistance resources

By building these systems into your practice, you can reduce the administrative burden of the shortage while ensuring patients receive timely, effective treatment for chronic anal fissures.