Helping Your Patients Find Welchol: A Clinical Workflow

When patients report difficulty filling their Welchol (Colesevelam) prescriptions, a systematic approach can save time for both your practice and your patients. This guide outlines a practical workflow for providers to help patients navigate Colesevelam supply disruptions.

Step 1: Verify the Shortage in Your Area

Not all pharmacy stock-outs represent a regional shortage. Before changing a patient's therapy, verify whether Colesevelam is available nearby:

• Use MedFinder for Providers: Visit medfinder.com/providers to search real-time pharmacy inventory data. Enter "Colesevelam" or "Welchol" and the patient's zip code to see which pharmacies currently have stock.
• Check the FDA Drug Shortage Database: Confirm whether Colesevelam is listed as an active shortage.
• Contact your pharmacy partners: Your clinic's affiliated pharmacies may have wholesale-level visibility into upcoming supply.

If the medication is available at a nearby pharmacy, the simplest solution is to transfer or send a new prescription there.

Step 2: Optimize the Current Prescription

Small changes to the prescription can significantly improve fill rates:

Allow Generic Substitution

Ensure the prescription does not specify "brand necessary" or "DAW" (dispense as written) for Welchol. Generic Colesevelam is therapeutically equivalent and may be available when brand Welchol is not.

Consider Alternative Formulations

Colesevelam is available in three dosage forms:

• Tablets (625 mg): Most commonly prescribed; 6 tablets daily
• Powder for oral suspension (3.75 g packets): 1 packet daily mixed with liquid
• Chewable bars: 1 bar daily (note: contains 80 calories per bar)

If tablets are out of stock, the oral suspension or chewable bars may be available. Discuss formulation preferences with your patient.

Prescribe 90-Day Supplies

When the medication is available, prescribe 90-day supplies to build a buffer against future disruptions. This is especially effective with mail-order pharmacies.

Step 3: Explore Pharmacy Options

Mail-Order Pharmacies

Mail-order pharmacies typically maintain larger inventories and may have access to supply that retail pharmacies don't. Encourage patients to check with their insurance plan's preferred mail-order pharmacy.

Specialty Pharmacies

For patients who need the oral suspension formulation or have complex insurance situations, specialty pharmacies may be better equipped to source and dispense Colesevelam.

Independent Pharmacies

Independent pharmacies may use different wholesalers than large chains, giving them access to different supply channels. Patients should consider calling local independents.

Step 4: When Switching Therapy Is Necessary

If Colesevelam is truly unavailable and the patient needs continued treatment, consider the clinical context:

Patients on Colesevelam for Hyperlipidemia

Same-class options:

• Cholestyramine (Questran): 4-24 g/day in divided doses. More GI side effects; more drug interactions (timing-dependent). Available as powder.
• Colestipol (Colestid): Tablets (2-16 g/day) or granules. Similar profile to Cholestyramine. Tablet form may improve adherence.

Different-class options:

• Ezetimibe (Zetia): 10 mg once daily. Cholesterol absorption inhibitor. Well-tolerated, affordable generic. Good option for statin-intolerant patients.
• Bempedoic acid (Nexletol): 180 mg once daily for statin-intolerant patients.

Patients on Colesevelam for Type 2 Diabetes

Other bile acid sequestrants lack FDA approval for glycemic control. Consider:

• Optimizing doses of existing oral antidiabetic agents (Metformin, SGLT2 inhibitors, DPP-4 inhibitors)
• Adding or adjusting GLP-1 receptor agonists
• Closer glycemic monitoring during the transition

For a detailed comparison of alternatives, see Welchol Shortage: What Providers Need to Know.

Step 5: Address Drug Interactions During Transitions

When switching from Colesevelam to Cholestyramine or Colestipol, pay close attention to drug interactions. These older bile acid sequestrants have a broader interaction profile:

• Levothyroxine: Must be taken 4+ hours apart from bile acid sequestrants. Monitor TSH.
• Warfarin: Monitor INR closely; Cholestyramine can significantly reduce warfarin absorption.
• Oral contraceptives: Ensure timing separation to maintain efficacy.
• Cardiac medications (Digoxin, Thiazides): Review timing and monitor levels.

See the full interaction reference: Welchol Drug Interactions: What to Avoid.

Step 6: Help Patients With Cost Concerns

Patients switched to alternative medications or different pharmacies may face unexpected costs. Resources include:

• Manufacturer savings programs: Daiichi Sankyo offers a patient assistance program for Welchol
• Discount cards: GoodRx, SingleCare, and other coupon card programs for generic Colesevelam
• Patient assistance programs: NeedyMeds and RxAssist maintain databases of assistance options

For a comprehensive cost-saving guide, direct patients to How to Save Money on Welchol in 2026 or review the provider version: How to Help Patients Save Money on Welchol.

Step 7: Document and Follow Up

For every patient affected by the shortage:

• Document the shortage and any therapy changes in the chart
• Schedule follow-up labs (lipid panel, A1C as applicable) 4-8 weeks after any medication change
• Set a reminder to attempt re-prescribing Colesevelam once supply stabilizes
• Provide patients with MedFinder as a self-service tool for checking pharmacy inventory

Quick Reference: Provider Checklist

• ☐ Check medfinder.com/providers for nearby stock
• ☐ Allow generic substitution on prescription
• ☐ Consider alternative formulation (suspension, chewable bar)
• ☐ Try mail-order or specialty pharmacy
• ☐ If switching: choose alternative based on indication
• ☐ Review drug interactions for new therapy
• ☐ Address cost concerns with savings resources
• ☐ Document changes and schedule follow-up