Tenofovir Disoproxil Shortage: A Provider Briefing for 2026

Tenofovir Disoproxil Fumarate (TDF) remains a cornerstone of HIV treatment, pre-exposure prophylaxis, and chronic hepatitis B management. As prescribers, you may be hearing from patients who are struggling to fill their prescriptions — or encountering pharmacy-level stockouts firsthand.

This briefing covers the current supply landscape, clinical implications, alternative options, and tools to help your patients maintain uninterrupted therapy.

Timeline: How Did We Get Here?

Tenofovir Disoproxil Fumarate has been available since 2001, when Gilead Sciences launched Viread. Key milestones in the supply story:

• 2017–2018: Generic TDF entered the U.S. market after patent expiration, with manufacturers including Teva, Mylan (Viatris), Aurobindo, and Cipla
• 2019–2021: Rapid expansion of PrEP prescribing following updated CDC guidelines and the federal Ready, Set, PrEP program launch
• 2023–2024: Intermittent supply disruptions reported as PrEP uptake outpaced some manufacturers' production capacity; no FDA-listed critical shortage
• 2025–2026: Supply has largely stabilized, but pharmacy-level stockouts persist in high-demand areas and at pharmacies with low antiretroviral dispensing volume

Prescribing Implications

The availability challenges with Tenofovir Disoproxil have several practical implications for prescribers:

Treatment Continuity Is Critical

For patients on TDF-based HIV regimens, any interruption in therapy risks viral rebound and potential resistance development. For hepatitis B patients, abrupt discontinuation carries the risk of severe hepatic flares — a boxed warning on the label.

PrEP Adherence Gaps

Patients using TDF/emtricitabine for PrEP who experience even short gaps in medication access lose protection during that period. In a clinical context where we're encouraging daily adherence, supply-side barriers undermine our messaging and patient trust.

Patient Anxiety

Many patients on antiretrovirals already face significant psychosocial stress. Being told their medication is unavailable compounds this burden. Proactive communication and contingency planning can mitigate anxiety and prevent patients from disengaging from care.

Current Availability Picture

As of early 2026:

• National supply: Adequate — TDF is not on the FDA Drug Shortage list
• Pharmacy-level availability: Variable — stockouts reported primarily at chain pharmacies in urban areas with high PrEP volume and at rural pharmacies with low antiretroviral turnover
• Generic manufacturers: Multiple active suppliers (Teva, Viatris, Aurobindo, Cipla, and others)
• Brand Viread: Still available but rarely dispensed due to cost differential

Cost and Access Considerations

Understanding the financial landscape helps when counseling patients:

• Generic TDF 300 mg: $30–$80/month with discount cards (GoodRx, SingleCare)
• Brand Viread: $300–$400+/month cash price
• Insurance: Widely covered on most commercial and Medicaid formularies; typically Tier 1 or Tier 2
• PrEP-specific coverage: ACA-compliant plans must cover PrEP with $0 cost-sharing (medication + labs)
• Patient assistance: Gilead Advancing Access provides free medication to uninsured/underinsured patients; Ready, Set, PrEP covers TDF-based PrEP for uninsured individuals

Tools and Resources for Your Practice

Several resources can help you and your staff manage TDF access for patients:

Medfinder for Providers

Medfinder offers real-time pharmacy stock checking that your staff can use to locate Tenofovir Disoproxil for patients before they leave your office. Integrating a quick availability check into your workflow can prevent patients from facing an empty shelf at the pharmacy.

Specialty Pharmacy Networks

Establishing relationships with specialty pharmacies that focus on HIV and infectious disease medications ensures a more reliable supply chain for your patients. Many Ryan White-funded clinics have on-site or affiliated specialty pharmacies.

Gilead Advancing Access

For patients facing financial barriers, Gilead's program offers copay assistance for commercially insured patients and free medication for eligible uninsured patients. Enrollment can be initiated by the prescriber's office. Visit gileadadvancingaccess.com.

Electronic Prescribing Flexibility

When sending prescriptions electronically, consider noting "generic Tenofovir Disoproxil Fumarate — any manufacturer" to give pharmacies maximum flexibility in sourcing available stock.

Alternative Agents to Consider

When TDF is unavailable or clinically suboptimal, consider these alternatives:

• Tenofovir Alafenamide (TAF): Preferred in patients with renal impairment (eGFR 30–60 mL/min), osteoporosis risk, or prior TDF-related toxicity. Available as Vemlidy (HBV), Descovy (HIV/PrEP), and in fixed-dose combinations (Biktarvy, Genvoya, Odefsey). Note: Descovy is not approved for PrEP via receptive vaginal sex.
• Entecavir: For hepatitis B patients (not co-infected with HIV). Generic, affordable, well-tolerated.
• Cabotegravir (Apretude): Long-acting injectable PrEP given every 2 months. Eliminates daily adherence burden.
• Lenacapavir (Sunlenca): Twice-yearly injectable for HIV prevention — the longest-acting PrEP option available.

Looking Ahead

The HIV prevention and treatment pipeline continues to evolve. Long-acting injectables and broadly neutralizing antibodies are expected to reduce reliance on daily oral TDF over the coming years. However, for the foreseeable future, generic Tenofovir Disoproxil remains a workhorse medication — affordable, effective, and widely prescribed.

Ensuring your patients can access it consistently requires a combination of proactive prescribing, pharmacy partnerships, and awareness of available support programs.

Final Thoughts

While Tenofovir Disoproxil is not in a formal nationwide shortage, pharmacy-level access challenges are real and clinically significant. As prescribers, we can mitigate the impact by building flexible prescribing practices, leveraging tools like Medfinder, and maintaining open communication with patients about contingency plans.

For patient-facing guidance you can share, see: Tenofovir Disoproxil Shortage Update: What Patients Need to Know in 2026.