Kerendia Shortage: What Providers and Prescribers Need to Know in 2026

As prescribing of Kerendia (Finerenone) continues to expand — particularly following its additional indication for heart failure with preserved ejection fraction — providers are increasingly fielding patient questions about availability and cost. This article provides a concise clinical and logistical briefing for nephrologists, cardiologists, endocrinologists, and primary care physicians managing patients on Kerendia.

Provider Briefing: Current Supply Status

As of February 2026, Kerendia is not listed on the FDA Drug Shortage database. Bayer Healthcare, the sole manufacturer, reports normal production and distribution. There is no formal shortage of Finerenone in the United States.

However, providers should be aware that patient-reported difficulty filling Kerendia prescriptions is common. This is driven by pharmacy stocking patterns, not supply chain disruption. Because Kerendia is a high-cost, single-source brand-name product, many retail pharmacies — particularly chain locations with lower specialty medication volume — do not maintain it in regular inventory.

Timeline: Kerendia's Expanding Role

Understanding Kerendia's regulatory history provides important context:

• July 2021: FDA approval for reducing kidney and cardiovascular risk in adults with CKD associated with type 2 diabetes, based on FIDELIO-DKD and FIGARO-DKD trials.
• Post-2021: Integration into ADA and KDIGO clinical guidelines as recommended therapy for CKD-T2DM patients with albuminuria already on maximally tolerated ACEi/ARB.
• 2024-2025: Expanded FDA approval to include reduction of cardiovascular death, heart failure hospitalization, and urgent HF visits in adults with HFpEF/HFmrEF (LVEF ≥40%).
• 2026: Increasing prescribing volume across nephrology, cardiology, and endocrinology, with growing adoption in primary care.

Prescribing Implications

Kerendia's unique profile as a non-steroidal mineralocorticoid receptor antagonist offers distinct advantages over steroidal MRAs (Spironolactone, Eplerenone):

• Greater selectivity: Minimal cross-reactivity with androgen, glucocorticoid, and progesterone receptors, reducing risk of gynecomastia and sexual side effects.
• Proven kidney outcomes: The only MRA with dedicated phase III trial data demonstrating kidney-specific endpoints in CKD-T2DM.
• Complementary to SGLT2 inhibitors: Evidence supports combining Kerendia with SGLT2 inhibitors (Dapagliflozin, Empagliflozin) for additive kidney and cardiac protection.

Key prescribing considerations:

• Potassium monitoring: Serum potassium must be ≤4.8 mEq/L before initiation. Monitor potassium at 4 weeks after starting, after dose adjustments, and periodically thereafter.
• Starting dose: 10 mg daily if eGFR 25 to <60; 20 mg daily if eGFR ≥60. Target dose is 20 mg daily.
• CYP3A4 interactions: Contraindicated with strong CYP3A4 inhibitors (Itraconazole, Ketoconazole, Ritonavir, Clarithromycin, etc.). Dose adjustment needed with moderate CYP3A4 inhibitors. Avoid strong CYP3A4 inducers. Patients must avoid grapefruit.
• No boxed warning: Kerendia does not carry a boxed warning.

For a detailed interaction reference, see Kerendia Drug Interactions: What to Avoid.

The Availability Picture

While supply is stable at the manufacturer level, several factors contribute to patient difficulty:

1. Pharmacy stocking: Many retail pharmacies stock medications based on local prescription volume. Kerendia, as a relatively newer specialty drug, may not meet the threshold for routine stocking at all locations.
2. Prior authorization: The majority of commercial and Medicare Part D plans require prior authorization. Step therapy requirements (e.g., documented ACEi/ARB use) may further delay access.
3. Cost barrier: Without insurance, Kerendia costs $670 to $950 per month. Even with insurance, Tier 3 or Tier 4 placement can result in significant out-of-pocket costs for patients.
4. Single-source supply: No generic Finerenone exists. Patent expiry is anticipated around 2029.

Cost and Access Considerations

Proactively addressing cost can improve adherence and reduce prescription abandonment:

• Bayer Kerendia Savings Card: Eligible commercially insured patients may pay as low as $0 copay per month. Not available for government insurance beneficiaries.
• Bayer Patient Assistance Program: Provides Kerendia at no cost to qualifying uninsured or underinsured patients meeting income criteria.
• Medicare Extra Help: Patients enrolled in Medicare's Extra Help program may pay $10 or less per month.
• Coupon cards: Third-party discount programs (SingleCare, etc.) may reduce cash price to approximately $670 for 30 tablets.

For comprehensive savings information to share with patients, see How to Save Money on Kerendia.

Tools and Resources for Your Practice

Several resources can help your practice navigate Kerendia access:

• Medfinder for Providers: medfinder.com/providers allows you to search real-time pharmacy availability and help patients locate Kerendia in stock near them.
• Specialty pharmacy referrals: Specialty pharmacies are significantly more likely to stock Kerendia. Consider establishing a referral relationship with one or two specialty pharmacies in your area.
• Prior authorization support: Ensure your practice has a streamlined PA workflow. Having diagnosis codes (E11.22 for CKD-T2DM), lab values (eGFR, UACR, potassium), and documentation of ACEi/ARB use readily available speeds the process.
• Bayer's HCP portal: Bayer offers provider-facing resources including prescribing information, samples, and patient support enrollment.

For a step-by-step guide on supporting patient access, read How to Help Your Patients Find Kerendia in Stock.

Looking Ahead

Several developments may impact Kerendia access in the coming years:

• Generic entry (~2029): Patent expiration could introduce generic Finerenone, dramatically reducing cost and increasing pharmacy stocking.
• Guideline evolution: As MRA therapy becomes more firmly embedded in CKD and HF guidelines, pharmacy stocking is likely to increase organically.
• Combination therapies: The trend toward multi-pillar CKD treatment (ACEi/ARB + SGLT2i + MRA) may normalize Kerendia prescribing and improve supply chain responsiveness.

Final Thoughts

Kerendia represents a significant advance in CKD and heart failure management, but patient access remains a practical challenge in 2026. As prescribers, we can mitigate these barriers by proactively addressing insurance hurdles, connecting patients with savings programs, and directing them to tools like Medfinder to locate available stock.

The clinical evidence for Finerenone continues to strengthen. Ensuring our patients can actually access the medication is the next critical step in translating that evidence into better outcomes.