Provider Briefing: Phexx Availability in 2026

As demand for hormone-free contraceptive options continues to grow, Phexx (lactic acid, citric acid, and potassium bitartrate vaginal gel) has become an important part of the contraceptive toolkit for many OB/GYNs, family medicine physicians, and reproductive health providers. However, patients frequently report difficulty filling Phexx prescriptions at retail pharmacies.

This briefing covers the current availability picture, prescribing implications, cost and access considerations, and practical tools to help your patients get the medication they need.

Timeline: Phexx Approval and Market History

Understanding Phexx's relatively short market history helps contextualize current availability challenges:

• 2020: FDA approval of Phexx (originally marketed as Phexxi) — the first hormone-free, on-demand prescription vaginal contraceptive gel
• 2020-2023: Initial commercial launch and market building by Evofem Biosciences. Slow adoption due to provider and patient awareness challenges
• 2024-2025: Rebranding from Phexxi to Phexx. Growing prescriber base and increased patient demand for non-hormonal options
• 2026: Not on FDA shortage list. Availability challenges persist primarily at the pharmacy stocking level

Prescribing Implications

Phexx occupies a unique clinical niche that is important to understand when counseling patients:

Clinical Profile

• Indication: Prevention of pregnancy in females of reproductive potential as an on-demand contraceptive
• Mechanism: Maintains vaginal pH at 3.5-4.5 in the presence of semen, reducing sperm motility
• Efficacy: Pearl Index of 14 (typical use) and 7 (perfect use) in clinical trials. Approximately 86% effective with typical use, 93% with correct use
• Dosing: One 5g pre-filled applicator vaginally, immediately before or up to 60 minutes before each act of intercourse
• Safety: No boxed warning. Most common adverse reactions include vulvovaginal burning (18%), pruritus (14.5%), and mycotic infection (9.1%)

Key Prescribing Considerations

• Avoid in patients with: History of recurrent UTIs or urinary tract abnormalities (risk of cystitis/pyelonephritis — 0.36% in trials)
• Avoid concomitant use with: Vaginal rings
• Compatible with: Hormonal contraceptives, latex/polyurethane/polyisoprene condoms, vaginal diaphragms, and vaginal infection treatments (miconazole, metronidazole, tioconazole)
• Not effective post-coitally: Must be applied before intercourse
• Male partner effects: 9.8% of male partners reported local discomfort (burning, itching, pain) in clinical trials — the majority were mild

Patient Selection

Phexx is particularly well-suited for patients who:

• Cannot or prefer not to use hormonal contraception (e.g., clotting disorders, hormone-sensitive cancers, personal preference)
• Want on-demand rather than continuous contraception
• Are transitioning between methods or need a bridge contraceptive
• Desire more personal control over their contraceptive timing

Current Availability Picture

As of early 2026, Phexx is not on the FDA drug shortage list. The supply chain from Evofem Biosciences appears stable. However, retail pharmacy availability is inconsistent for several reasons:

• Low stocking priority: Chain pharmacies manage inventory algorithmically based on prescription volume. Low-volume items like Phexx may not be stocked at many locations.
• Ordering lag: Pharmacies that don't routinely stock Phexx can typically order it within 1-3 business days, but this creates an inconvenient gap for patients.
• Awareness gaps: Some pharmacy staff remain unfamiliar with the product, leading to confusion or misinformation at the point of dispensing.

Cost and Access Landscape

Understanding the cost picture helps when counseling patients about access:

• Retail (cash) price: ~$795 per box of 12 applicators
• Coupon pricing: ~$374 via SingleCare
• ACA coverage: Most commercial insurance plans cover Phexx at $0 copay under the ACA contraceptive mandate
• Medicaid: Coverage varies by state
• No generic available: Phexx is a branded product with no generic equivalent as of 2026

For patients with cost barriers, refer them to our patient-facing guide on saving money on Phexx.

Tools and Resources for Providers

Several tools can help streamline Phexx access for your patients:

Medfinder for Providers

Medfinder offers provider-facing tools that help you and your staff locate pharmacies with Phexx in stock. This can be integrated into your prescribing workflow to direct prescriptions to pharmacies that carry the medication.

Telehealth Pathway

Evofem offers a telehealth consultation and home delivery service through phexx.com. While you may prefer to prescribe directly, this can be a useful backup option for patients who cannot find Phexx locally.

NDC Reference

When directing patients to call pharmacies, provide the NDC number 69751-101-12 (box of 12 applicators) to help pharmacy staff locate the product in their ordering system.

Alternatives to Consider

When Phexx is not accessible or clinically appropriate, consider these non-hormonal alternatives:

• Copper IUD (Paragard): >99% effective, long-acting (up to 10 years), hormone-free. Requires office insertion.
• Condoms: 87% effective (typical use for male condoms). Also provide STI protection — a key advantage over Phexx.
• Diaphragm with spermicide (Caya): ~83% effective (typical use). Reusable barrier method.
• OTC spermicides (nonoxynol-9): ~79% effective alone. May cause vaginal irritation with frequent use.

For a patient-facing comparison, direct patients to our alternatives to Phexx guide.

Looking Ahead

The hormone-free contraceptive space is attracting growing interest from both patients and researchers. Phexx represents an important first-in-class option, and as provider adoption increases and pharmacy stocking improves, access challenges are likely to diminish. In the meantime, proactive prescribing strategies — including directing prescriptions to pharmacies with confirmed stock and educating patients about telehealth delivery — can help bridge the gap.

Final Thoughts

Phexx is not in shortage, but access requires more provider engagement than a typical contraceptive prescription. By understanding the availability landscape, leveraging tools like Medfinder for Providers, and proactively counseling patients on where and how to fill their prescriptions, you can help ensure your patients get the hormone-free contraception they've chosen.

For additional provider resources, visit medfinder.com/providers or see our companion guide on how to help your patients find Phexx in stock.