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

The ASHP-documented shortage of collagenase ointment (Santyl) that began in August 2023 has formally resolved, with Smith & Nephew reporting both 30-gram and 90-gram tubes available as of October 2024. However, as a prescriber or wound care provider, you likely know that "resolved" at the national level doesn't guarantee your patients can walk into any pharmacy and fill their prescription. This guide covers what you need to know to manage Santyl prescribing and patient access in 2026.

Shortage Status and Current Supply Landscape

The ASHP Drug Shortage Bulletin for collagenase ointment was created August 23, 2023, and updated October 2, 2024 to reflect restored availability. Smith & Nephew confirmed supply of both NDC 50484-0010-30 (30g) and NDC 50484-0010-90 (90g) tubes.

In practice, your patients may still encounter difficulty at the retail pharmacy level for several structural reasons:

Santyl is not routinely stocked at most retail chains. It remains a specialty wound care product with lower turnover at standard retail pharmacies. Chain pharmacies like CVS, Walgreens, and Rite Aid may not carry it, or may order on demand with a multi-day wait.

Specialty and wound care pharmacies have the most reliable stock. If your facility or practice has an affiliated pharmacy, that's often the most reliable channel. Otherwise, directing patients to specialty pharmacies or your insurance plan's specialty network is the best approach.

Prior authorization remains a common barrier. Most commercial plans, Medicare Part D, and Medicaid require prior authorization for Santyl. PA is typically approved for 3-month periods for documented chronic dermal ulcers or burns. Step therapy may be required by some payers.

Clinical Alternatives When Santyl Is Unavailable

Santyl is the only FDA-approved enzymatic debriding agent in the U.S. When it is genuinely unavailable or unaffordable, consider the following evidence-based alternatives:

Medihoney (Active Leptospermum Honey): Promotes autolytic and osmotic debridement with antimicrobial properties. FDA-cleared for wound management. Research comparing Medihoney to Santyl shows Santyl achieves faster full debridement, but Medihoney can be effective for pressure ulcers and partial-thickness wounds — especially those with concurrent infection risk. Generally available OTC and significantly less expensive.

Autolytic debridement with hydrogel dressings (Intrasite Gel, SoloSite, SAF-Gel): Appropriate for wounds with light to moderate necrotic tissue when time is not critical. Significantly cheaper than Santyl, widely available, and manageable by patients at home. Less effective for thick eschar.

Sharp/surgical debridement: No medication cost; billed as a procedure. Provides the fastest results and may be covered differently by insurance. Consider for urgent wounds or those with heavy necrotic burden where enzymatic debridement would be too slow.

A practical note from the literature: a 2021 systematic review and meta-analysis found that enzymatic debridement with collagenase showed faster wound size reduction compared to autolytic methods. When you substitute, set patient expectations appropriately — autolytic methods will work more slowly.

Prior Authorization: What to Document

To support a Santyl prior authorization, ensure your documentation includes:

Diagnosis with ICD-10 code (e.g., L89.xx for pressure ulcer, E11.621 for diabetic foot ulcer with necrosis)

Description of necrotic tissue requiring debridement

Wound size and depth measurements

Documentation that the wound is chronic (not acute or superficial)

Prior treatments tried and failed (for payers requiring step therapy)

Specialist consultation documentation if required by the plan (some payers require prescription by or in consultation with a wound care specialist, burn specialist, podiatrist, or surgeon)

Helping Your Patients Navigate Santyl Access

If your patients are having trouble finding Santyl at their pharmacy, you can direct them to specialty pharmacy resources or to medfinder for Providers — a service that calls pharmacies on patients' behalf to find which ones have Santyl in stock. This can dramatically reduce the time between prescribing and the patient starting treatment.

The Smith & Nephew Santyl Copay Assistance Program reduces patient out-of-pocket costs to as little as $20–$50 per fill for commercially insured patients (not valid for Medicare/Medicaid). For uninsured or underinsured patients, the Patient Assistance Program can provide Santyl at no cost. Providing patients with this information at the point of prescribing can prevent unfilled prescriptions.

Key Clinical Reminders for Santyl Use

Optimal pH range for collagenase activity is 6–8; acidic wound environments or acid-containing products will reduce efficacy

Avoid concurrent use of heavy metal antiseptics (silver sulfadiazine, mercury-containing products) and povidone-iodine — these inactivate the enzyme

Dakin's solution and normal saline are compatible cleansing agents

Monitor debilitated patients for systemic bacterial infections, as debriding enzymes may theoretically increase bacteremia risk

Discontinue when debridement of necrotic tissue is complete and granulation tissue is well established

For a detailed provider guide to helping patients locate Santyl in stock, see: How to Help Your Patients Find Santyl In Stock: A Provider's Guide.