Provider Briefing: Ketamine Supply in 2026

The Ketamine supply situation in 2026 continues to present challenges for prescribers across anesthesiology, psychiatry, pain medicine, and emergency medicine. Injectable Ketamine remains on the ASHP drug shortage list, and several manufacturers are operating with constrained capacity.

This briefing covers the current supply picture, key regulatory developments, prescribing considerations, and resources to help you manage your patients' access to Ketamine during this period.

Shortage Timeline

Ketamine injection supply disruptions have been ongoing since the early 2020s, driven by a confluence of factors:

• 2020–2022: COVID-19 pandemic increased ICU demand for sedation agents, including Ketamine. Simultaneously, off-label psychiatric use accelerated rapidly as Ketamine clinics expanded nationwide.
• 2023–2024: Compounding pharmacy demand surged as telehealth platforms began prescribing at-home oral and sublingual Ketamine formulations. Supply chain constraints became more pronounced.
• 2025: Eugia discontinued its 100 mg/mL 10 mL vials and reported ongoing shortages due to increased demand. Mylan Institutional divested its Ketamine product to AuroMedics, adding supply chain uncertainty during the transition.
• 2026: Hikma maintains available supply. Eugia and Fresenius Kabi continue to experience intermittent constraints. The shortage is most acute for the 100 mg/mL concentration.

Prescribing Implications

Anesthesiology and Emergency Medicine

For procedural sedation and anesthesia, the shortage may require flexibility in concentration selection. If the 100 mg/mL vials are unavailable, the 50 mg/mL or 10 mg/mL solutions remain options with appropriate dose volume adjustments. Consult your pharmacy to determine which concentrations are currently available in your formulary.

Consider protocol-level adjustments for departments that use Ketamine as a first-line procedural sedation agent. Having standing alternatives (Propofol, Midazolam + Fentanyl, Etomidate) documented in your procedural sedation protocols will reduce delays when Ketamine is unavailable.

Psychiatry and Pain Medicine

For providers operating Ketamine infusion clinics or prescribing compounded formulations for treatment-resistant depression, CRPS, or other off-label indications:

• Injectable supply: Establish relationships with multiple wholesalers and contact manufacturers (Hikma, Eugia, Fresenius Kabi) directly when supply is constrained.
• Compounded formulations: The FDA has increased scrutiny of compounded Ketamine products, particularly oral and at-home formulations. Ensure your compounding pharmacy partners operate under Section 503A or 503B of the Federal Food, Drug, and Cosmetic Act and maintain current FDA compliance.
• Spravato (Esketamine) referral: For appropriate patients, Spravato offers an FDA-approved, insurance-covered alternative. If your practice is not REMS-certified for Spravato administration, consider developing a referral pathway to a certified clinic.

Telehealth Prescribing

The DEA and HHS have extended telemedicine flexibilities for prescribing controlled substances through December 31, 2026. Providers who established patient relationships via telemedicine during or after the COVID-19 public health emergency can continue to prescribe Schedule III–V controlled substances, including Ketamine, without an initial in-person examination.

However, prescribers should be aware of increasing FDA enforcement actions related to at-home compounded Ketamine. Ensure that your prescribing practices align with current DEA and state medical board requirements, and that patients receiving at-home Ketamine have appropriate monitoring protocols in place.

Availability Picture

The following summarizes current manufacturer status (as of early 2026):

• Hikma: Ketamine injection available
• Eugia: Shortage reported (increased demand); 100 mg/mL 10 mL vials discontinued
• Fresenius Kabi: Intermittent shortage
• AuroMedics: Variable availability (acquired Mylan product line)
• Par Pharmaceutical (Ketalar brand): Limited availability

Compounded Ketamine (oral, sublingual, nasal) is generally available through 503A and 503B compounding pharmacies, though availability varies by region.

Cost and Access Considerations

Cost remains a significant barrier for many Ketamine patients, particularly those using it off-label for psychiatric indications:

• IV infusion (off-label depression): $400–$800 per session; typically 6 initial sessions recommended. Not covered by most insurance plans.
• Spravato (Esketamine): $800–$1,200 per session retail; covered by BCBS, Aetna, Cigna, UnitedHealthcare, and Anthem with prior authorization. Janssen savings program available.
• Compounded oral/sublingual: $1–$5 per dose; telehealth programs $150–$400/month.
• Injectable vial (pharmacy purchase): $12–$50 per vial with discount cards.

When counseling patients on cost, it's worth noting that Spravato may be the most cost-effective option for insured patients with treatment-resistant depression who meet prior authorization criteria (typically failure of 2+ antidepressants).

Tools and Resources

The following resources can help both you and your patients navigate the shortage:

• Medfinder for Providers: Help patients locate pharmacies with Ketamine in stock. Integrates real-time availability data.
• ASHP Drug Shortage Resource Center: Updated shortage details, alternative therapy recommendations, and manufacturer contact information.
• FDA Drug Shortage Database: Official FDA information on shortage status and estimated resolution dates.
• NeedyMeds (needymeds.org): Patient assistance resources for Ketamine and Spravato.

Looking Ahead

Several developments may affect Ketamine supply and access in the coming months:

• DEA telemedicine rulemaking: Permanent rules for controlled substance prescribing via telemedicine are still being finalized. The current extensions run through December 2026, but the outcome of permanent rulemaking will significantly affect telehealth Ketamine access.
• FDA compounding enforcement: Continued enforcement actions against compounding pharmacies producing Ketamine without proper oversight may reduce supply of compounded formulations but improve safety.
• New market entrants: Additional generic manufacturers may enter the injectable Ketamine market if shortages persist, though the Schedule III classification and manufacturing requirements create barriers to entry.

Final Thoughts

The Ketamine shortage requires proactive planning from prescribers. Key steps include diversifying your pharmacy supply chain, establishing alternative medication protocols, ensuring regulatory compliance for telehealth prescribing, and directing patients to availability tools like Medfinder for Providers.

For patient-facing resources you can share with your patients, see our articles on how to find Ketamine in stock and Ketamine alternatives.