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

Provider Briefing: Neffy Availability in 2026

Neffy (Epinephrine nasal spray) has quickly become one of the most requested epinephrine products since its FDA approval in August 2024. As the first needle-free option for anaphylaxis treatment, it addresses a well-documented barrier to epinephrine use: needle phobia and hesitancy.

However, prescribers across specialties are hearing a consistent complaint from patients: "I can't find it at my pharmacy." This briefing covers the current state of Neffy's availability, what's driving the access challenges, and what providers can do to help their patients.

Timeline: Neffy's Regulatory and Commercial Milestones

• August 2024: FDA approval of Neffy 2 mg/0.1 mL nasal spray for adults and children ≥30 kg (66 lbs). Fast Track designation.
• Late 2024: Commercial launch; initial pharmacy distribution begins.
• Early 2025: FDA approval of Neffy 1 mg/0.1 mL for pediatric patients 15 to <30 kg (33-65 lbs), aged 4+.
• May 2025: Neffy 1 mg becomes commercially available in the U.S.
• 2025-2026: Expanding pharmacy distribution and insurance formulary placement. ARS Pharmaceuticals (Nasdaq: SPRY) continues scaling commercial operations.

Prescribing Implications

Dosing

Neffy dosing is weight-based:

• Patients ≥30 kg (66 lbs): Neffy 2 mg/0.1 mL — one spray into one nostril
• Patients 15 to <30 kg (33-65 lbs): Neffy 1 mg/0.1 mL — one spray into one nostril

If symptoms persist or recur, a second dose may be administered into the same nostril starting 5 minutes after the first dose using a new device. More than two sequential doses should be administered under direct medical supervision.

Key Clinical Considerations

• No absolute contraindications in a life-threatening allergic emergency — same as all epinephrine products.
• Nasal conditions: Patients with significant structural or anatomical nasal conditions should be evaluated. The intranasal route may be affected by nasal congestion, polyps, or recent nasal surgery.
• Drug interactions: Use caution with beta-blockers (may diminish effectiveness and cause severe hypertension), MAO inhibitors, tricyclic antidepressants, cardiac glycosides, and diuretics (hypokalemia risk). Epinephrine intranasal may alter nasal mucosa for up to 2 weeks, potentially increasing systemic absorption of other nasal products.
• No boxed warning, consistent with other epinephrine products.

For detailed interaction information, see our post on Neffy drug interactions.

Current Availability Picture

Neffy is not in an FDA-listed drug shortage. The manufacturer reports adequate supply. The access challenge is at the pharmacy distribution level:

• Chain pharmacies: Coverage is inconsistent. Many CVS, Walgreens, and Rite Aid locations don't yet stock Neffy by default. Centralized ordering systems may not trigger automatic stocking until local prescription volume hits certain thresholds.
• Independent pharmacies: Generally more responsive to special orders. Can typically obtain Neffy within 1-3 business days through their wholesaler.
• Specialty/allergy-focused pharmacies: Most likely to stock Neffy routinely.
• Mail-order pharmacies: Increasingly available through insurance mail-order programs.

Cost and Access Considerations

Understanding the financial landscape helps set patient expectations:

• Cash price: $685-$800 per 2-pack (each pack contains 2 single-dose devices)
• Commercial insurance: Coverage varies. Some plans cover Neffy on formulary; others require prior authorization or step therapy (trial of auto-injector first).
• Co-Pay Savings Program: Eligible commercially insured patients can pay as little as $0 for up to 4 devices.
• Patient Assistance Program: Uninsured patients without commercial or government drug coverage may qualify to receive Neffy at no cost.
• Uninsured savings: Patients may pay as little as $25 per prescription through manufacturer programs.

Direct patients to neffy.com/savings-and-support or call 1-877-MY-NEFFY (877-696-3339).

Tools and Resources for Your Practice

Medfinder for Providers

Medfinder offers real-time pharmacy inventory data that you and your staff can use to identify which pharmacies near your patients have Neffy in stock. This allows you to route prescriptions to pharmacies that actually carry the medication, reducing patient frustration and improving fill rates.

Prior Authorization Support

When insurance requires prior authorization for Neffy, document:

• History of needle phobia or documented failure to self-administer auto-injector
• Pediatric patient where needle-free administration improves compliance
• Caregiver concerns about ability to administer injection in emergency
• Patient preference based on demonstrated correct technique with nasal spray vs. auto-injector

Patient Education

Share these resources with patients:

• What is Neffy? — comprehensive patient overview
• How to find Neffy in stock — practical pharmacy-finding guide
• How to save money on Neffy — savings programs and coupon information

Looking Ahead

Several trends suggest Neffy access will improve through 2026 and beyond:

• Expanding formulary placement as payers accumulate real-world utilization data and respond to patient demand
• Growing prescriber adoption across allergists, pediatricians, and primary care
• International approvals (including China) signal manufacturing investment and supply chain maturity
• Increasing pharmacy stocking as prescription volume reaches tipping points at more locations

In the interim, the most effective strategy is to verify pharmacy stock before sending prescriptions and to proactively connect patients with savings programs.

Final Thoughts

Neffy fills a genuine unmet need in anaphylaxis management — particularly for needle-phobic patients, young children, and caregivers who struggle with auto-injectors under stress. The availability challenges are distribution-related, not supply-related, and are expected to resolve as the product matures in the market.

Providers can make a significant difference by using tools like Medfinder to route prescriptions effectively and by connecting patients with manufacturer savings programs. For a practical workflow guide, see our post on how to help your patients find Neffy in stock.