Provider Briefing: Natamycin Availability in 2026

For ophthalmologists and other eye care providers, Natamycin (Natacyn, Alcon Laboratories) remains a cornerstone of fungal keratitis management. As the only FDA-approved topical ophthalmic antifungal in the United States, its availability directly impacts patient outcomes. This briefing provides an up-to-date overview of Natamycin's supply status, prescribing considerations, alternative options, and tools to help your patients access this medication.

Current Supply Status

As of February 2026, Natamycin ophthalmic suspension 5% is not listed on the FDA Drug Shortage database. Alcon Laboratories continues to manufacture and distribute Natacyn. However, the practical availability at the pharmacy level remains inconsistent for several well-documented reasons:

• Single-source product: No generic Natamycin is FDA-approved in the U.S., making Natacyn the sole commercial option
• Limited retail distribution: Most retail chain pharmacies do not stock Natacyn due to low demand and high unit cost ($250-$600 per 15 mL bottle)
• Specialty channel dependency: Distribution is concentrated in specialty and hospital pharmacies

Providers should be aware that "not in shortage" per the FDA does not equate to "readily available" at the patient's local pharmacy.

Shortage Timeline and History

Natamycin has experienced intermittent supply disruptions over the past decade, though most have not met the threshold for formal FDA shortage designation. Key factors contributing to historical availability issues include:

• Raw material constraints: Natamycin is produced by fermentation of Streptomyces natalensis, a process with inherent variability
• Single-manufacturer risk: Any quality hold, facility maintenance, or production issue at Alcon's manufacturing site can disrupt the entire U.S. supply
• Demand spikes: Regional outbreaks of fungal keratitis (e.g., contact lens-associated Fusarium outbreaks) can rapidly exceed available inventory
• Distributor inventory practices: Low-volume specialty products often have minimal safety stock in the distribution pipeline

There have been no publicly reported major shortages in 2025-2026, but the structural vulnerability remains.

Prescribing Implications

When prescribing Natamycin, providers should consider the following practical factors:

Timely Initiation of Therapy

Fungal keratitis outcomes are closely tied to early initiation of appropriate antifungal therapy. Delays in obtaining Natamycin — whether due to pharmacy stocking issues, insurance prior authorization, or supply disruptions — can have meaningful clinical consequences. Consider the following strategies:

• Maintain a small emergency supply of Natacyn in your clinic if your practice regularly treats fungal keratitis
• Establish a standing relationship with a specialty pharmacy that reliably stocks Natamycin
• Have compounded antifungal alternatives available as a bridge therapy option

Insurance and Prior Authorization

Natacyn is a brand-name product with no generic equivalent. Many insurance plans require prior authorization for coverage, and some may classify it as a specialty tier medication with elevated copays. Providers should:

• Anticipate prior authorization requirements and submit documentation promptly
• Include fungal culture or smear results to support medical necessity
• Be prepared to file appeals if initial coverage is denied
• Direct patients to resources for financial assistance when needed

Standard Dosing Protocol

The standard dosing for fungal keratitis is well-established:

• Initial: One drop every 1-2 hours
• Maintenance (after 3-4 days): One drop 6-8 times daily
• Duration: 14-21 days, with gradual taper at 4-7 day intervals
• Blepharitis/conjunctivitis: 4-6 times daily may be sufficient

Availability Picture: Where Patients Can Find Natamycin

Directing patients to the right pharmacy is often the most impactful intervention a provider can make. The most reliable sources for Natamycin include:

1. Hospital outpatient pharmacies at academic medical centers with ophthalmology departments
2. Specialty ophthalmic pharmacies with established Alcon distribution channels
3. Mail-order specialty pharmacies that can ship within 1-2 business days
4. Medfinder for Providers — a tool that helps locate pharmacies with current Natamycin stock by location

Encourage your staff to use Medfinder as a first step when patients report difficulty finding the medication.

Cost and Access Challenges

The cost of Natamycin presents a significant access barrier for many patients:

• Cash price: $250-$600 per 15 mL bottle
• Insured patients: Copays of $50-$200 depending on formulary tier
• Uninsured patients: Full cash price with limited discount options

Available financial assistance options include:

• Prescription discount cards (SingleCare, GoodRx, BuzzRx) — savings may be modest for this product
• Alcon Patient Assistance — contact 1-800-757-9195 for qualification criteria
• NeedyMeds and RxAssist — databases of patient assistance programs

For patient-facing cost guidance, refer patients to our post on saving money on Natamycin. For provider-specific cost tools, see our guide on helping patients save money on Natamycin.

Tools and Resources for Providers

The following resources can streamline Natamycin prescribing and improve patient access:

• Medfinder for Providers — search pharmacy stock by medication and location
• FDA Drug Shortage Database — monitor official shortage designations at accessdata.fda.gov
• ASHP Drug Shortage Resource Center — additional shortage monitoring and clinical guidance
• Compounding pharmacy partnerships — establish relationships with compounding pharmacies that can prepare Voriconazole 1% or Amphotericin B 0.15% ophthalmic solutions on short notice

Alternative Antifungal Options

When Natamycin is unavailable or clinically inappropriate, the following compounded alternatives are most commonly employed:

• Voriconazole 1% ophthalmic solution — broad-spectrum triazole with superior corneal penetration; may be preferred for Aspergillus keratitis; generally $50-$150 compounded
• Amphotericin B 0.15-0.5% ophthalmic solution — polyene antifungal similar to Natamycin; useful for Candida and Aspergillus; $40-$120 compounded
• Fluconazole 0.2% ophthalmic solution — triazole with good Candida activity; less effective against filamentous fungi; $30-$80 compounded
• Oral Voriconazole or Itraconazole — for adjunctive systemic therapy in severe or deep infections

For a patient-facing overview of alternatives, see alternatives to Natamycin.

Looking Ahead

Several factors may influence Natamycin availability in the coming years:

• Generic entry: No generic applications for Natamycin ophthalmic suspension are currently known to be pending, but the lack of patent protection could theoretically allow generic entry
• Novel formulations: Research into nanoparticle and in-situ gel formulations of Natamycin continues in academic settings, though commercial timelines remain uncertain
• Compounding standardization: FDA guidance on ophthalmic compounding may evolve, potentially affecting the availability of compounded alternatives

Final Thoughts

Natamycin remains an essential tool in the management of fungal ocular infections, and its single-source status creates an inherently fragile supply situation. Providers who proactively establish specialty pharmacy relationships, maintain awareness of alternative options, and leverage tools like Medfinder will be best positioned to ensure their patients receive timely, effective treatment.

For a complementary guide on patient access workflows, see our post on how to help your patients find Natamycin in stock.