Tacrolimus in 2026: What's the Availability Situation?

If you're a transplant patient who relies on Tacrolimus, you've probably experienced the anxiety of going to your pharmacy and wondering if your medication will be there. Over the past few years, drug shortages across the board have made headlines — and immunosuppressants like Tacrolimus haven't been immune to supply disruptions.

In this update, we'll break down the current state of Tacrolimus availability in 2026, explain why finding it can still be challenging, cover what it costs, and give you practical steps to make sure you stay supplied.

Is Tacrolimus Still in Shortage?

As of early 2026, Tacrolimus is not listed in a formal nationwide shortage on the FDA or ASHP (American Society of Health-System Pharmacists) drug shortage databases. That's the good news.

However, "not in shortage" doesn't always mean "easy to find." Many transplant patients continue to report difficulties at the pharmacy level, particularly with:

• Specific generic manufacturers being temporarily unavailable
• Certain strengths (like 0.5 mg or 5 mg capsules) being harder to get than others
• The IV formulation of Tacrolimus, which has historically been more prone to shortage than oral forms
• Extended-release formulations (Envarsus XR, Astagraf XL) having limited distribution compared to generic immediate-release capsules

The situation is best described as intermittent and localized — meaning some pharmacies in some areas may have trouble stocking it, while others have no issues at all.

Why Is Tacrolimus Hard to Find?

Even without a formal shortage, several factors can make Tacrolimus difficult to locate:

Manufacturing Complexity

Tacrolimus is a complex drug derived from a soil bacterium (Streptomyces tsukubaensis). Manufacturing it requires specialized processes, and any disruption at a production facility can affect supply downstream.

Multiple Non-Interchangeable Formulations

Tacrolimus comes in immediate-release capsules (Prograf), extended-release capsules (Astagraf XL), and extended-release tablets (Envarsus XR). These are not interchangeable — they release the drug differently in your body. Pharmacies must stock the exact formulation your doctor prescribed, which fragments demand and can lead to stockouts of specific versions.

Consolidation of Generic Manufacturers

A handful of generic manufacturers produce the majority of generic Tacrolimus. When one manufacturer has a production issue, the remaining suppliers may not be able to make up the difference quickly enough.

Just-in-Time Pharmacy Inventory

Most retail pharmacies use "just-in-time" inventory systems, meaning they only keep small quantities of specialty medications on hand. This is efficient when supply is steady, but it leaves very little buffer when supply hiccups occur.

For a deeper dive into these issues, read our article on why Tacrolimus is so hard to find.

How Much Does Tacrolimus Cost in 2026?

Cost is a major concern for transplant patients, especially those who need to take Tacrolimus for the rest of their lives. Here's what you can expect:

• Brand-name Prograf: Approximately $570 to $720 for 60 capsules (1 mg) without insurance
• Generic Tacrolimus IR capsules: About $65 to $300 without insurance at retail price, but as low as $30 to $65 with discount coupons from services like GoodRx or SingleCare
• Envarsus XR: Brand-name only, significantly more expensive — often $1,000+ per month without insurance
• Astagraf XL: Also brand-name pricing, with copay cards available that can reduce out-of-pocket costs to as low as $0 for commercially insured patients (up to $3,000/year)

Most insurance plans and Medicare Part D cover generic Tacrolimus. Brand-name versions may require prior authorization or step therapy. For detailed savings strategies, see our guide on how to save money on Tacrolimus.

Are There New Options in 2026?

The transplant medication landscape continues to evolve. While Tacrolimus remains the cornerstone of post-transplant immunosuppression, there are a few developments worth knowing about:

• Additional generic manufacturers: More companies have entered the generic Tacrolimus market over the past few years, which should help stabilize supply over time
• Emerging therapies: Newer immunosuppressant strategies — including combination regimens with mTOR inhibitors like Everolimus (Zortress) that allow lower Tacrolimus doses — continue to gain traction in transplant centers
• Belatacept (Nulojix): This IV-administered alternative continues to be used for select kidney transplant patients who want to avoid calcineurin inhibitor toxicity

For more about these options, read our article on alternatives to Tacrolimus.

How to Find Tacrolimus in Stock

If you're having trouble finding Tacrolimus at your pharmacy, here's what to do:

1. Search on Medfinder: Medfinder shows you which pharmacies near you currently have Tacrolimus in stock. It's the fastest way to find availability without calling around.
2. Try specialty pharmacies: Pharmacies that specialize in transplant medications are much more likely to have consistent Tacrolimus stock.
3. Contact your transplant center: Your transplant coordinator can often help locate the medication or provide a temporary bridge supply.
4. Refill early: Always request refills 7 to 10 days before you run out to give yourself a buffer.

For the full guide, see how to find Tacrolimus in stock near you.

Final Thoughts

While Tacrolimus isn't in a formal nationwide shortage in 2026, finding it can still be a challenge depending on your location, pharmacy, and specific formulation. The best defense is a good offense: use tools like Medfinder, build a relationship with a reliable pharmacy, and never wait until the last minute to refill.

Your transplanted organ depends on this medication. Stay proactive, stay informed, and always keep your transplant team in the loop if you're having trouble getting your Tacrolimus.

Related reading:

• What Is Tacrolimus? Uses, Dosage, and What You Need to Know
• Tacrolimus Side Effects: What to Expect
• How to Find a Doctor Who Can Prescribe Tacrolimus