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

Perforomist (formoterol fumarate 20 mcg/2 mL inhalation solution) is an important nebulized LABA for COPD maintenance therapy. While Perforomist is not on the FDA's official Drug Shortage List in 2026, your COPD patients may still be calling your office unable to fill their prescriptions. This clinical guide provides a concise overview of the availability landscape and your options for managing affected patients.

Current Availability Status (2026)

Formoterol fumarate inhalation solution is not on the FDA Drug Shortage List as of 2026. Generic formoterol fumarate inhalation solution is available from multiple manufacturers, and an authorized generic of Perforomist is also available from Viatris. The primary challenge is localized stocking — retail pharmacies often do not keep this product on hand due to:

• Refrigeration requirements (2°C–8°C, or room temperature for up to 3 months)
• Low per-location demand relative to carrying cost
• High brand list price (~$865–$1,484/month), driving PBM formulary steering toward alternatives
• Variable generic manufacturer supply and NDC switching at the pharmacy level

Which Patients Are Most Affected?

Patients who rely on Perforomist are typically those for whom inhaler-based therapy is suboptimal or contraindicated. This includes:

• Elderly patients with poor inhaler technique or hand dexterity issues
• Patients with severe COPD and reduced inspiratory flow inadequate for DPI use
• Patients already using a nebulizer for other medications (e.g., ipratropium, albuterol)
• Patients who have failed or cannot tolerate inhaler-based LABAs

Therapeutic Alternatives to Consider

If a patient cannot access Perforomist, consider these clinically appropriate alternatives in order of similarity:

1. Arformoterol (Brovana) 15 mcg/2 mL: Closest nebulized LABA alternative. Arformoterol is the (R,R)-enantiomer of formoterol. Same delivery modality and dosing frequency. Generic arformoterol is available. No comparative data show superiority over formoterol.
2. Revefenacin (Yupelri) 175 mcg/3 mL: Once-daily nebulized LAMA. If the patient is not already on a LAMA, this provides a mechanistically different but clinically effective option with once-daily convenience.
3. Inhaler LABA (if technique is adequate): Olodaterol (Striverdi Respimat) once daily or salmeterol (Serevent Diskus) twice daily. Reassess inhaler technique before transitioning.
4. LAMA inhaler: Tiotropium (Spiriva), umeclidinium (Incruse Ellipta), or aclidinium (Tudorza). LAMAs are generally preferred over LABAs for exacerbation prevention per GOLD guidelines.

Prescribing Considerations When Switching

When transitioning a patient from Perforomist to an alternative:

• Do not use two LABA agents concurrently. If switching, discontinue Perforomist before starting another LABA.
• Assess inhaler technique for any device switch, particularly for DPIs in patients with severe COPD (FEV1 < 40% predicted).
• If switching to arformoterol, note that the dose is 15 mcg twice daily (not 20 mcg).
• Check formulary coverage for any alternative before prescribing — prior authorization requirements vary by payer.

37,599+ patients found their medications in stock

37K+

Find Perforomist In Stock Today →

How to Help Your Patient Find Perforomist

Before switching therapy, it's worth helping patients locate Perforomist. Practical steps include:

• Calling your preferred specialty or mail-order pharmacy to confirm stock before sending the prescription
• Directing patients to medfinder.com/providers — a service that calls area pharmacies to locate in-stock medications
• Confirming whether generic formoterol fumarate is accessible at the patient's preferred pharmacy

Documentation and Safety Considerations

When a patient cannot access their COPD maintenance medication, document this in the chart and establish a safety plan. Patients on Perforomist should always have a short-acting rescue inhaler (albuterol) available for acute symptoms. Emphasize that Perforomist is not a rescue medication and should not be used for acute bronchospasm.

For a guide to helping patients find and afford Perforomist, visit

medfinder for providers.