Hyperrho Shortage: A Provider Briefing for 2026

The intermittent shortage of Rho(D) immune globulin products — including Hyperrho (HyperRHO S/D) — has created real clinical challenges for obstetricians, maternal-fetal medicine specialists, and emergency physicians across the country. Patients are arriving at appointments anxious about whether they'll be able to receive this critical immunoprophylaxis on schedule.

This article provides an up-to-date summary of the Hyperrho shortage situation, its implications for prescribing, and practical tools to help you and your patients navigate availability and cost challenges in 2026.

Shortage Timeline

Rho(D) immune globulin supply issues first became widely apparent in 2023, when the FDA added several products to its drug shortage list. The root causes — limited Rh-negative donor plasma, lengthy manufacturing timelines, and concentrated production among a small number of manufacturers — have been slow to resolve.

Key milestones:

• 2023: Initial reports of spot shortages at retail pharmacies and some hospital systems. FDA adds Rho(D) immune globulin to the drug shortage database.
• 2024: Shortage intensifies. ACOG issues guidance on prioritizing Rho(D) immune globulin use. Some institutions implement conservation protocols, including limiting use to the most critical indications.
• Late 2024–2025: Manufacturers increase plasma collection and production capacity. Supply begins to stabilize, though intermittent gaps persist.
• 2026: Supply is improved but not fully normalized. Regional variability remains significant. Hyperrho (Grifols) availability continues to lag behind RhoGAM (Kedrion) in many markets.

Prescribing Implications

The shortage has prompted several important considerations for prescribers:

Brand Flexibility

When writing prescriptions for Rho(D) immune globulin, consider specifying "Rho(D) Immune Globulin" rather than a specific brand name. This allows pharmacies to fill with whichever product is in stock — whether that's Hyperrho, RhoGAM, WinRho SDF, or Rhophylac. All are therapeutically equivalent for Rh immunoprophylaxis.

Route of Administration

Hyperrho is an IM-only product. If you need IV capability — for example, in the management of a large fetomaternal hemorrhage or in an ITP context — WinRho SDF or Rhophylac offer both IV and IM options. Be aware that WinRho SDF carries a boxed warning for intravascular hemolysis when administered IV, particularly in the ITP setting.

Dosing Considerations

Standard dosing for Rh immunoprophylaxis remains:

• Antepartum: 300 mcg (1500 IU) IM at 28 weeks gestation
• Postpartum: 300 mcg IM within 72 hours of delivery of an Rh-positive infant
• First-trimester events (miscarriage, ectopic, CVS): 50 mcg (Mini-Dose) or 300 mcg (Full Dose) depending on gestational age
• Fetomaternal hemorrhage >30 mL whole blood: Additional doses calculated via Kleihauer-Betke test or flow cytometry

Dosing is consistent across all available Rho(D) immune globulin brands for these indications.

Conservation Strategies

During acute shortage periods, some institutions have implemented evidence-based conservation strategies, including:

• Confirming Rh status before administration (avoiding unnecessary doses in Rh-positive patients misidentified as Rh-negative)
• Using Kleihauer-Betke testing to guide dosing after potential large fetomaternal hemorrhage rather than empirically overdosing
• Ensuring documentation of Rh status early in prenatal care to prevent duplicate testing and unnecessary prophylaxis

Current Availability Picture

As of early 2026, availability by product:

• Hyperrho (Grifols): Intermittently available. More commonly found at hospital pharmacies and specialty distributors than retail pharmacies.
• RhoGAM (Kedrion Biopharma): Most widely available product. Kedrion has expanded production and RhoGAM remains the most commonly stocked option.
• WinRho SDF (Saol Therapeutics): Available but distribution is more limited. Often found in hospital and specialty pharmacy settings.
• Rhophylac (CSL Behring): Moderate availability. CSL Behring's global manufacturing scale provides some supply resilience.

Availability can change weekly. We recommend using real-time tracking tools rather than relying on assumptions about stock levels.

Cost and Access Considerations

Rho(D) immune globulin is typically billed under the medical benefit when administered in a clinical setting (office, hospital, infusion center), not under the pharmacy benefit. This has important implications:

• In-office administration: Billed as a medical procedure. Most commercial insurance plans cover Rho(D) immune globulin without prior authorization for standard obstetric indications. Medicare Part B also covers when medically necessary.
• Retail pharmacy fill: Less common but possible. May be subject to pharmacy benefit rules, formulary restrictions, or higher copays.
• Uninsured patients: Cash prices range from $150–$350 per full dose. Grifols offers a patient assistance program, and organizations like NeedyMeds and RxAssist can help connect patients with financial support.

For patients struggling with cost, refer them to our patient-facing guide on saving money on Hyperrho.

Tools and Resources for Providers

Several resources can help you manage the shortage in your practice:

• Medfinder for Providers: medfinder.com/providers offers real-time medication availability tracking that you can use to help patients locate Rho(D) immune globulin in their area.
• FDA Drug Shortage Database: Check FDA.gov for the latest official shortage status and estimated resolution dates.
• ACOG Practice Advisories: The American College of Obstetricians and Gynecologists has issued guidance on managing Rho(D) immune globulin shortages, including conservation strategies.
• Manufacturer direct contacts: Grifols, Kedrion, Saol, and CSL Behring all have medical affairs and customer service lines that can provide real-time supply information.

Looking Ahead

The medium-term outlook for Rho(D) immune globulin supply is cautiously optimistic. Key developments include:

• Increased plasma collection: Major plasma companies are investing in new collection centers and donor recruitment programs targeting Rh-negative donors.
• Manufacturing expansion: Several manufacturers have announced capacity expansions that should come online over the next 1-2 years.
• Recombinant anti-D research: Monoclonal and recombinant anti-D antibodies are in various stages of clinical development. If approved, these products could dramatically reduce dependence on human plasma and potentially eliminate shortages. However, no recombinant product has yet reached the U.S. market.

In the meantime, flexibility in prescribing, proactive stock management, and patient education remain the most effective strategies for navigating the shortage.

Final Thoughts

The Hyperrho shortage is a supply-side challenge with no quick fix, but it is manageable with the right approach. By prescribing generically when possible, maintaining relationships with multiple suppliers, and leveraging tools like Medfinder for Providers, you can help ensure your Rh-negative patients receive the immunoprophylaxis they need.

For a complementary perspective, see our patient-facing articles on the Hyperrho shortage and alternatives to Hyperrho. For a practical guide to helping patients find stock, read our provider's guide to helping patients find Hyperrho.