Provider Briefing: Intrarosa Availability in 2026

If your patients have been reporting difficulty filling Intrarosa (Prasterone) prescriptions, they're not imagining the problem. While Intrarosa is not listed on the FDA's drug shortage database, pharmacy-level availability remains inconsistent, creating real barriers for patients who depend on this medication for moderate to severe dyspareunia associated with menopausal vulvar and vaginal atrophy.

This article provides a clinical and practical overview for prescribers navigating Intrarosa access challenges in 2026.

Timeline and Background

Intrarosa received FDA approval in November 2016 as the first and only vaginal DHEA (Prasterone) product indicated for moderate to severe dyspareunia, a symptom of vulvar and vaginal atrophy due to menopause. It was originally marketed by AMAG Pharmaceuticals under an exclusive license from Endoceutics, Inc., the Canadian company that developed the product.

Following corporate transitions, the U.S. commercial rights now sit with Cosette Pharmaceuticals, Inc. (through its subsidiary Myriel Pharmaceuticals, LLC). The product continues to be manufactured and distributed, but the commercial trajectory has been marked by limited market penetration relative to established vaginal estrogen therapies.

Key milestones:

• November 2016: FDA approval of Intrarosa (Prasterone 6.5 mg vaginal insert)
• 2017: U.S. commercial launch by AMAG Pharmaceuticals
• 2020-2022: Corporate transitions; rights eventually acquired by Cosette Pharmaceuticals
• 2026: No generic version available; no FDA-listed shortage; pharmacy stocking remains limited

Prescribing Implications

Intrarosa occupies a unique therapeutic niche. As the only FDA-approved intravaginal DHEA product, it offers a differentiated mechanism of action: Prasterone is an inactive endogenous steroid that is converted locally in vaginal tissues into both androgens and estrogens. This intracrinology-based approach may be particularly relevant for patients who:

• Have concerns about exogenous estrogen exposure (though estrogen is a metabolite of Prasterone)
• Have not responded adequately to vaginal estrogen therapies
• Prefer a vaginal insert over a cream formulation
• Wish to avoid systemic therapy (e.g., Ospemifene)

Contraindications include undiagnosed abnormal genital bleeding. The prescribing information also includes a precaution regarding use in women with a known or suspected history of breast cancer, given that estrogen is a metabolite of Prasterone. While Intrarosa does not carry a boxed warning, clinicians should weigh the estrogen-metabolite profile against individual patient risk factors.

Side effects are generally mild. In clinical trials, vaginal discharge was the most common treatment-emergent adverse reaction (~6% vs. ~4% placebo). Abnormal Pap smear findings (ASCUS, LSIL) occurred in approximately 2% of patients in the 52-week open-label study.

Current Availability Picture

The core availability challenge with Intrarosa is not a supply shortage — it's a stocking gap. As a brand-name specialty product with:

• No generic equivalent
• A relatively small prescribing base (primarily OB/GYN and menopause specialists)
• A retail price of $288 to $402 per 28-day supply

...many retail pharmacies, particularly large chains, do not maintain standing inventory. Patients are frequently told the medication is "not in stock" or "unavailable," which they understandably interpret as a shortage.

In practice, most pharmacies can order Intrarosa through standard wholesale channels within one to two business days. The challenge is communicating this to patients and setting appropriate expectations for fill timelines.

Cost and Access Considerations

Cost remains a significant barrier to Intrarosa access:

• Cash price: $288-$402 for a 28-day supply
• Manufacturer savings program: Eligible commercially insured patients may pay as little as $35/month through the Intrarosa Savings Program (intrarosasavingscard.com). This program is not available to patients on Medicare, Medicaid, TRICARE, or other government insurance.
• Insurance coverage: Variable. Some commercial and Medicare plans cover Intrarosa, often with prior authorization. Step therapy requirements may mandate trial of vaginal estrogen before approving Intrarosa.

When writing prescriptions, consider proactively providing patients with savings card information and initiating prior authorization early to minimize delays.

Tools and Resources for Providers

Several tools can help you and your patients navigate Intrarosa access:

• Medfinder for Providers: Helps locate pharmacies with Intrarosa in stock in your patients' area. Consider integrating this into your prescription workflow.
• Intrarosa Savings Program: Direct patients to intrarosasavingscard.com for copay assistance (commercially insured patients only).
• NeedyMeds and RxAssist: For uninsured or underinsured patients who may qualify for patient assistance programs.
• Prior authorization support: Cosette Pharmaceuticals may offer assistance with payer communications through their HCP portal at hcpintrarosa.com.

For a patient-facing version of this guide, you can direct patients to: Intrarosa shortage update: What patients need to know in 2026.

Alternative Therapies to Consider

When Intrarosa is unavailable or cost-prohibitive, the following alternatives may be appropriate depending on patient history and preferences:

• Estradiol vaginal inserts (Vagifem / Yuvafem): Generic available; most directly comparable in dosage form; $50-$120/month
• Estradiol vaginal cream (Estrace): Generic available; well-established safety profile; $20-$80/month
• Conjugated estrogens vaginal cream (Premarin Vaginal Cream): Brand-name only; widely stocked; $200-$280/month
• Ospemifene (Osphena): Oral SERM; only non-vaginal option; carries boxed warning (endometrial cancer, VTE); $200-$300/month

A detailed comparison for patients is available at: Alternatives to Intrarosa.

Looking Ahead

No generic version of Intrarosa has been announced, and the patent landscape does not suggest imminent generic entry. Providers should anticipate continued availability challenges for the foreseeable future and plan accordingly:

• Set patient expectations about potential pharmacy ordering delays at the time of prescribing
• Recommend patients use Medfinder or call ahead to confirm pharmacy stock
• Proactively initiate prior authorization when required
• Have a backup plan (alternative therapy) ready in case of extended delays

Final Thoughts

Intrarosa remains an important therapeutic option for postmenopausal dyspareunia, offering a unique DHEA-based mechanism that differentiates it from vaginal estrogen products. The availability challenges are real but manageable with proactive prescribing practices and the right tools.

For provider-specific resources, visit Medfinder for Providers. For guidance on helping patients manage costs, see our provider guide on helping patients save money on Intrarosa.