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

Prescribers who manage patients with moderate to severe dry eye disease (DED) are likely familiar with the frustration that Lacrisert's supply history has caused. From the COVID-19-related manufacturing shutdowns in 2020 to the multi-year backorder that followed Bausch + Lomb's manufacturing recertification, Lacrisert has been one of the most supply-challenged ophthalmic medications in recent years. This guide consolidates current shortage status, alternative management strategies, and practical clinical approaches for 2026.

Current Supply Status: 2026

As of 2026, Lacrisert (hydroxypropyl cellulose ophthalmic insert, 5 mg, 60-count, NDC 24208-800-60) is not listed on the FDA Drug Shortages database. Bausch + Lomb completed FDA recertification of its new manufacturing process and restored supply in late 2023. However, "resolved" at the national level does not translate to consistent pharmacy-level availability. Many pharmacies — particularly independent and smaller retail locations — do not routinely stock Lacrisert due to low turnover. Providers should be aware that patients may still face significant difficulty filling prescriptions even when the drug is technically available.

Why Lacrisert Is Structurally Vulnerable to Shortages

Understanding the root causes helps predict future risk. Lacrisert's structural vulnerabilities include:

Single-source manufacturing. The specialized sterile ophthalmic insert format limits the number of facilities capable of manufacturing the product.

No approved generic equivalent. Without an AB-rated generic, there is no pharmaceutical fallback when the brand is unavailable. The niche market has not attracted generic manufacturers.

Low prescription volume. A PMC analysis found only 990 Medicare claims for Lacrisert in 2017. The small market means manufacturers maintain minimal safety stock and pharmacies carry it only on demand.

Manufacturing complexity. Sterile ophthalmic inserts require specialized equipment and cGMP compliance. A transition between manufacturers requires a new FDA review, creating long gaps in supply.

Clinical Alternatives When Lacrisert Is Unavailable

When patients cannot access Lacrisert, the management approach depends on the underlying DED phenotype and severity:

For Aqueous-Deficient Dry Eye

Cyclosporine ophthalmic emulsion 0.05% (Restasis, generic): First-line prescription option; reduces T-cell-mediated inflammation and increases goblet cell density. Generic availability reduces cost barriers. Onset 3–6 months.

Lifitegrast 5% (Xiidra): LFA-1/ICAM-1 antagonist; faster onset (2–4 weeks for symptom improvement). Useful when quicker relief is needed. Brand only.

Cyclosporine 0.09% (Cequa): Higher-concentration cyclosporine with NCELL nanomicellar technology for improved corneal penetration. Consider for patients with inadequate response to 0.05%.

For Evaporative or Mixed Dry Eye

Perfluorohexyloctane (Miebo): Four times daily; targets the lipid layer and reduces evaporation. Useful when MGD is the primary driver.

Frequent preservative-free artificial tears: PF carboxymethylcellulose (Refresh Optive PF) or PF sodium hyaluronate drops used hourly provide mechanical lubrication when Lacrisert is unavailable.

Autologous serum tears: Reserved for severe cases unresponsive to standard therapies; contains growth factors and immunoglobulins that support corneal healing.

Key Patient Populations Where Lacrisert Is Most Valuable

Certain patients particularly benefit from Lacrisert's sustained-release format, and shortage effects hit them hardest:

Patients with Sjögren's syndrome and near-complete aqueous tear deficiency

Patients with exposure keratitis or lagophthalmos who need prolonged corneal protection

Post-LASIK or post-cataract patients with reduced corneal sensitivity

Patients with recurrent corneal erosions benefiting from overnight mucosal coverage

Patients who cannot tolerate frequent drop instillation due to compliance, dexterity, or occupation constraints

Practical Steps for Providers in 2026

Pre-authorize an alternative. Proactively issue a concurrent prescription for cyclosporine or lifitegrast so patients have an immediate fallback if they cannot fill Lacrisert.

Recommend medfinder to patients. medfinder.com/providers is a provider-facing resource you can recommend to patients. It calls pharmacies on their behalf to find which ones have Lacrisert in stock.

Identify your preferred pharmacy. Maintain a working relationship with a pharmacy or two that reliably carries Lacrisert, and direct new patients there.

Educate patients on early refill. Patients should refill with 2–3 weeks of supply remaining, not when they are on their last few inserts.

Learn more about how medfinder supports providers at medfinder.com/providers.