Your Patient Has a Prescription. Now They Need Help Filling It.

You've diagnosed opioid-induced constipation, determined that Symproic (Naldemedine) 0.2 mg is the right treatment, and written the prescription. But your patient calls back two days later: "My pharmacy says they don't have it."

This scenario is increasingly common with Symproic in 2026. While there is no FDA-reported shortage, the reality is that many retail pharmacies don't stock this brand-only, niche medication. As a provider, you can play a pivotal role in helping patients navigate these access barriers.

Current Availability: What's Going On?

Symproic continues to be manufactured and distributed in the United States. The drug is commercially available through BioDelivery Sciences International (a Collegium Pharmaceutical subsidiary), which holds the U.S. license from Shionogi.

However, pharmacy-level stocking is inconsistent. Key factors include:

• Brand-only status: No FDA-approved generic of Naldemedine exists, which means a single supply chain and higher wholesale cost for pharmacies
• Low prescription volume: OIC in chronic non-cancer pain is a relatively small market compared to conditions like diabetes or hypertension
• High retail price: At $484–$746/month, pharmacies face significant inventory cost for a drug that may sit on the shelf
• Insurance friction: Prior authorization and step therapy requirements reduce the number of prescriptions that actually get dispensed

Why Patients Can't Find It: The Real-World Picture

When patients report difficulty finding Symproic, the root cause typically falls into one of these categories:

1. The chain pharmacy doesn't stock it. CVS, Walgreens, and similar chains make stocking decisions based on local demand data. If fewer than a handful of patients at a location fill Symproic, it may not be in the system at all.
2. The wholesaler order hasn't arrived. Even when a pharmacy agrees to order Symproic, it may take 1–3 business days to arrive from the wholesaler.
3. The patient's insurance denied coverage. Without insurance, the patient faces the full cash price and may abandon the prescription entirely.
4. The patient gave up. After one or two rejections at the pharmacy counter, many patients simply stop trying — and their OIC goes untreated.

What Providers Can Do: 5 Actionable Steps

Step 1: Direct Patients to Medfinder

The single most effective thing you can do is point patients to Medfinder. This free tool lets patients search for pharmacies near them that currently have Symproic in stock. It eliminates the need to call pharmacy after pharmacy and significantly reduces the chance of prescription abandonment.

Consider adding Medfinder to your patient handouts or after-visit summary for patients prescribed Symproic or other hard-to-find medications.

Step 2: Identify a Reliable Local Pharmacy

Build a relationship with one or two independent or specialty pharmacies in your area that reliably stock or can order Symproic. Independent pharmacies often:

• Work with multiple wholesalers
• Are more willing to special-order niche medications
• Offer more personalized patient communication when medications arrive

Having a go-to pharmacy for Symproic prescriptions saves time for both you and your patients.

Step 3: Prepare Prior Authorization Documentation in Advance

Most insurers require prior authorization for Symproic. Streamline this process by preparing documentation proactively:

• Diagnosis: OIC (ICD-10: K59.09 or appropriate code)
• Current opioid regimen: Drug name, dose, duration
• Laxative trial documentation: Which OTC laxatives were tried, duration, and why they were inadequate
• Clinical rationale: Why Symproic is medically necessary for this patient

Having this documentation ready before the PA request is submitted can cut approval times significantly.

Step 4: Discuss Cost and Savings Programs

Many patients don't know about available savings programs. During the prescribing conversation, mention:

• Symproic Savings Card: Commercially insured patients may pay as little as $0 (available at symproic.com)
• Discount cards: GoodRx, SingleCare, and similar services can reduce cash prices to approximately $484/month
• Patient assistance programs: Uninsured patients can check NeedyMeds.org or RxAssist.org

For a comprehensive patient-facing resource, direct patients to our Symproic savings guide.

Step 5: Have an Alternative Ready

If Symproic access proves consistently problematic for a patient, be prepared to pivot. Appropriate alternatives include:

• Movantik (Naloxegol) 25 mg once daily: Same drug class (PAMORA), similar efficacy, different formulary positioning
• Relistor (Methylnaltrexone): PAMORA available as injection (12 mg SC) or oral tablet (450 mg); the injection offers rapid onset
• Amitiza (Lubiprostone) 24 mcg twice daily: Chloride channel activator; different mechanism, may be preferred by some plans

Formulary placement varies by payer. Checking the patient's specific plan formulary before prescribing can prevent multiple pharmacy rejections.

Alternative Therapies: A Quick Comparison

Here's a summary to help guide your prescribing decisions when Symproic isn't accessible:

• Movantik: Oral, once daily, empty stomach required, ~$400–$600/month cash price, PAMORA
• Relistor (oral): Oral, once daily, 450 mg tablet, PAMORA
• Relistor (injection): SC injection, as needed or scheduled, 12 mg, fast onset, PAMORA
• Amitiza: Oral, twice daily with food, chloride channel activator, different side effect profile (nausea more common)

For a patient-facing comparison, see our alternatives to Symproic guide.

Workflow Tips for Your Practice

Here are some practical ways to integrate Symproic access management into your clinical workflow:

• Add a "preferred OIC pharmacy" note in your EHR for patients who successfully fill Symproic at a specific location — this saves time on future prescriptions
• Use e-prescribing with pharmacy selection: When you know which pharmacy has Symproic, send the prescription directly there rather than to the patient's default pharmacy
• Schedule a follow-up check: For new Symproic prescriptions, have your team follow up within a week to confirm the patient was able to fill it. This catches access issues early before the patient gives up.
• Provide a printed resource: Give patients a handout with Medfinder, the manufacturer savings program, and your recommended specialty pharmacy. Patients are more likely to follow through when they leave the office with a clear next step.
• Document PA preemptively: If you know the patient's insurance requires prior authorization, submit it at the time of prescribing rather than waiting for a pharmacy rejection

Final Thoughts

Symproic access in 2026 requires more than just writing a prescription. The combination of brand-only availability, high cost, and inconsistent pharmacy stocking means that providers who proactively address these barriers will see better outcomes for their OIC patients.

The most impactful steps are simple: direct patients to Medfinder, build a relationship with a reliable pharmacy, streamline prior authorizations, and always have an alternative ready.

For the latest on Symproic supply and access, see our provider shortage briefing.