Provider Briefing: Orilissa Availability in 2026

Orilissa (Elagolix) remains an important tool in the management of moderate to severe endometriosis-associated pain. As the first orally active GnRH antagonist approved for endometriosis, it filled a significant gap when it launched in 2018. However, provider awareness of current access challenges is essential for ensuring continuity of care.

This briefing covers the current availability landscape, prescribing implications, cost and insurance considerations, and practical tools for helping your patients access Orilissa in 2026.

Current Availability Status

As of early 2026, Orilissa is not listed on the FDA or ASHP drug shortage databases. Supply from AbbVie appears stable. However, many prescribers and patients report difficulty locating the medication at retail pharmacies.

The root causes are structural rather than supply-driven:

• Single-source manufacturing: AbbVie is the sole manufacturer. No generic Elagolix is available.
• Low pharmacy stocking rates: Retail chains often do not stock Orilissa due to low prescription volume and high per-unit cost ($1,200–$1,700 for a 28-day supply at 150 mg).
• Specialty pharmacy channeling: Many payers require Orilissa to be dispensed through designated specialty pharmacies.

Timeline and Background

Key milestones for Orilissa:

• July 2018: FDA approval for moderate to severe pain associated with endometriosis in premenopausal women.
• 2020: Oriahnn (Elagolix/Estradiol/Norethindrone acetate) approved for uterine fibroid-related heavy menstrual bleeding — a combination product using the same active ingredient.
• 2026: No generic available. Patent protections remain in place. Single-source brand-name product.

Prescribing Implications

When prescribing Orilissa, consider the following access-related factors:

Dosing and Duration Limits

• 150 mg once daily: Up to 24 months. Partial estrogen suppression. Lower risk of BMD loss.
• 200 mg twice daily: Up to 6 months. More substantial estrogen suppression. Higher risk of BMD loss and side effects.

The duration limits are clinically significant — bone mineral density loss is progressive and may not fully reverse after discontinuation. Lumbar spine BMD decreases of 0.3–1.3% (150 mg) and 2.5–3.1% (200 mg) were observed at 6 months in clinical trials.

Contraindications

• Pregnancy (risk of early pregnancy loss)
• Known osteoporosis
• Severe hepatic impairment (7-fold increase in drug exposure)
• Concomitant strong OATP1B1 inhibitors (cyclosporine, gemfibrozil)

Key Drug Interactions

• Strong CYP3A4 inhibitors (ketoconazole): ~2-fold increase in Elagolix exposure
• Rifampin: Paradoxically increases Elagolix levels (200 mg BID not recommended with rifampin)
• Combined hormonal contraceptives: Estrogen component may reduce Orilissa efficacy; recommend non-hormonal or progestin-only contraception
• Digoxin: Elagolix may increase digoxin levels

For a complete drug interaction profile, see our article on Orilissa drug interactions.

The Availability Picture for Providers

In practice, the most common access barriers your patients will encounter are:

1. Pharmacy not stocking it: Especially at high-volume retail chains that optimize inventory for frequently dispensed medications.
2. Insurance prior authorization: Most commercial plans require PA. Step therapy (typically NSAIDs, then hormonal contraceptives) is common.
3. Specialty pharmacy requirements: Payers may mandate dispensing through specific specialty pharmacies, which may not be geographically convenient.
4. Cost without insurance: $1,200–$1,700/month for 150 mg, $2,400–$3,400/month for 200 mg BID — a significant barrier for uninsured or underinsured patients.

Cost and Access Programs

AbbVie offers two programs to help with Orilissa access:

• Orilissa Savings Card: For commercially insured patients — eligible patients may pay as little as $5/month. Not valid for government insurance (Medicare, Medicaid, Tricare).
• myAbbVie Assist: Patient assistance program for uninsured or underinsured patients meeting income eligibility. May cover full cost of the medication. Apply at abbvie.com/myAbbVieAssist or call 1-800-222-6885.

Proactively informing patients about these programs at the time of prescribing can significantly reduce abandonment rates.

Tools and Resources for Your Practice

Consider integrating the following into your endometriosis management workflow:

• Medfinder for Providers: Real-time pharmacy inventory search. Help patients locate Orilissa near them before they leave the office.
• Specialty pharmacy relationships: Establish standing relationships with 1–2 specialty pharmacies that reliably stock Orilissa. Provide patients with direct contact information.
• Prior authorization support: Many specialty pharmacies handle PA on behalf of the prescriber. If your office handles PA internally, consider using electronic PA tools to reduce turnaround time.
• Patient education materials: Direct patients to resources like how to find Orilissa in stock and how to save money on Orilissa.

Alternative Therapies to Consider

If Orilissa is inaccessible or clinically inappropriate, the following alternatives may be considered:

• Lupron Depot (Leuprolide acetate): GnRH agonist. Injectable (monthly or every 3–6 months). Well-established for endometriosis. Consider with Norethindrone add-back therapy.
• Myfembree (Relugolix/Estradiol/Norethindrone acetate): Oral GnRH antagonist combination. Once-daily dosing with built-in add-back therapy. May have better BMD profile.
• Norethindrone acetate: Oral progestin, off-label for endometriosis. Very affordable (under $30/month). Good first-line option for mild-moderate symptoms.
• Depo-Provera (Medroxyprogesterone acetate): Injectable progestin every 3 months. Affordable, effective for pain management, also provides contraception.

For more detail, see our provider guide: How to help your patients find Orilissa in stock.

Looking Ahead

Key developments to watch:

• Generic Elagolix: No near-term generic launch is anticipated. AbbVie's patent protections remain in place. When generic availability materializes, it would likely improve both access and cost.
• Expanding GnRH antagonist landscape: Newer oral GnRH antagonists (including Relugolix-based combinations) are expanding the toolbox for endometriosis management.
• Prior authorization reform: Ongoing legislative and payer initiatives may streamline PA processes for specialty medications.

Final Thoughts

Orilissa is not in a supply shortage, but it is functionally difficult to access for many patients. Providers who anticipate these barriers — and proactively address them at the point of prescribing — can significantly improve the patient experience and treatment adherence.

Use Medfinder for Providers to check real-time availability, connect patients with savings programs before they leave the office, and maintain relationships with specialty pharmacies that reliably stock Orilissa.