Provider Briefing: Ibrexafungerp Availability in 2026

If you prescribe Ibrexafungerp (brand name: Brexafemme) for vulvovaginal candidiasis, you've likely heard from patients who can't find it at their pharmacy. This article provides a concise, evidence-based overview of the current availability situation, prescribing implications, and tools you can use to help patients access this medication.

Background and Timeline

Ibrexafungerp is a first-in-class triterpenoid antifungal that inhibits glucan synthase — the same target as echinocandins, but available in an oral formulation. Key milestones:

• June 2021: FDA approval for treatment of vulvovaginal candidiasis (VVC) in adult and post-menarchal pediatric females
• November 2022: Supplemental approval for reduction in the incidence of recurrent VVC (RVVC), with updated boxed warning regarding embryo-fetal toxicity
• 2024-2026: Ongoing clinical trials for IV formulation targeting invasive candidiasis and aspergillosis

Brexafemme remains the only FDA-approved oral non-azole antifungal for VVC, making it a critical option for patients with azole-resistant Candida strains or contraindications to azole therapy.

Current Shortage Status

As of early 2026, Ibrexafungerp is not listed on the FDA Drug Shortage database. There is no formal supply interruption from the manufacturer (Scynexis, Inc.).

However, practical availability remains limited at the retail pharmacy level due to:

• Single-source manufacturing (no generic exists)
• Low prescription volume relative to Fluconazole
• High wholesale acquisition cost
• Limited pharmacy stocking incentives

This creates a de facto access gap: the drug is manufactured and distributed, but many community pharmacies don't carry it.

Prescribing Implications

When considering Ibrexafungerp for your patients, several factors are worth noting:

Dosing

• VVC treatment: 300 mg (two 150 mg tablets) twice daily for one day (total 600 mg)
• RVVC prevention: 300 mg twice daily for one day, monthly for six months
• With strong CYP3A4 inhibitors: Reduce to 150 mg twice daily for one day
• May be taken with or without food

Boxed Warning: Embryo-Fetal Toxicity

Brexafemme carries a boxed warning for embryo-fetal toxicity based on animal reproductive studies (fetal malformations at ≥5x human exposure). It is contraindicated in pregnancy. For the RVVC regimen, reassess pregnancy status before each monthly dose. Advise effective contraception during treatment and for 4 days after the last dose.

Drug Interactions

Ibrexafungerp is metabolized via CYP3A4. Key interactions include:

• Strong CYP3A4 inhibitors (ketoconazole, itraconazole, clarithromycin, ritonavir): Dose reduction required
• Strong/moderate CYP3A4 inducers (rifampin, carbamazepine, phenytoin, efavirenz, St. John's Wort): Avoid concomitant use

For a comprehensive overview of interactions, see Ibrexafungerp drug interactions.

Common Adverse Reactions

The most common adverse reactions in VVC trials (≥2% incidence) were diarrhea (16.7%), nausea (11.9%), abdominal pain (11.4%), dizziness (3.3%), and vomiting (2.0%). For RVVC trials, headache, abdominal pain, diarrhea, nausea, UTI, and fatigue were reported at ≥2%.

The Availability Picture

Despite being on the market since 2021, Brexafemme distribution remains concentrated in specialty pharmacy channels. Factors affecting availability:

• Retail pharmacy stocking: Most chain pharmacies do not routinely stock Brexafemme due to low volume. Independent and specialty pharmacies are more likely to carry it or order it
• Distribution channels: Available through standard wholesale distributors, but pharmacy purchasing decisions are volume-driven
• Patient experience: Many patients report being told the drug is "unavailable" or "not in our system," which can lead to abandonment of the prescription

Cost and Access Considerations

Cost is a significant barrier to access:

• Cash price: Approximately $700-$900 per treatment course (four 150 mg tablets)
• Insurance coverage: Varies by plan. Many require prior authorization and/or step therapy (typically failed Fluconazole first)
• Manufacturer savings program: The Brexafemme Savings Card may reduce commercially insured patients' out-of-pocket costs to as little as $0
• Patient assistance: Scynexis offers a Patient Assistance Program for uninsured/underinsured patients meeting income criteria (1-888-982-7299)

Consider proactively initiating prior authorization when prescribing Brexafemme, particularly for RVVC where the six-month regimen requires ongoing coverage approval.

Tools and Resources for Providers

Several tools can help streamline patient access to Ibrexafungerp:

• Medfinder for Providers: Search for pharmacies with Brexafemme in stock and direct patients to verified availability
• Specialty pharmacy referral: Identify specialty pharmacies in your area that routinely fill Brexafemme prescriptions
• Prior authorization support: Scynexis offers resources to assist with the PA process — contact their support line for materials

For step-by-step guidance on helping patients find the medication, see how to help your patients find Ibrexafungerp in stock.

Therapeutic Alternatives

When Brexafemme is unavailable or cost-prohibitive, consider:

• Fluconazole: First-line for uncomplicated VVC; 150 mg single oral dose; generic, widely available ($4-$15)
• Topical azoles (Miconazole, Clotrimazole): OTC options for patients who prefer or require non-oral therapy
• Terconazole: Prescription topical for azole-responsive but OTC-resistant cases

Note that for confirmed azole-resistant Candida infections, therapeutic alternatives are limited, which underscores the clinical importance of maintaining access to Ibrexafungerp.

Looking Ahead

Several developments may impact Ibrexafungerp access in the coming years:

• Ongoing clinical trials for an IV formulation targeting invasive candidiasis (including C. auris) and aspergillosis
• Potential expanded indications could increase prescription volume and pharmacy stocking
• No generic competition is expected in the near term

Final Thoughts

Ibrexafungerp fills a unique niche as the only oral non-azole antifungal for VVC and RVVC. While it is not in formal shortage, limited retail pharmacy stocking and high cost create meaningful access barriers for patients. Providers can help by using tools like Medfinder for Providers, proactively managing prior authorization, and directing patients to specialty pharmacies and savings programs.