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

Prescribing Trulance (plecanatide) in 2026 means navigating a landscape defined less by supply chain shortfalls and more by insurance barriers, narrow formulary placement, and payer step therapy requirements. This clinical overview summarizes what gastroenterologists, primary care physicians, and NPs/PAs need to know to keep their IBS-C and CIC patients on Trulance — or to help them transition to an appropriate alternative when Trulance is inaccessible.

Is There an Active Trulance Shortage?

As of 2026, there is no FDA-declared shortage of Trulance. Salix Pharmaceuticals (which acquired Trulance along with other assets from the bankrupt Synergy Pharmaceuticals in 2019) continues to manufacture and distribute plecanatide without any reported supply disruptions. Pharmacies actively stocking the drug can order it from their distributors, and wholesaler availability is normal.

Patient-reported difficulty accessing Trulance in 2026 is driven primarily by insurance coverage barriers — not supply chain failure. Understanding these barriers is essential for efficient patient advocacy.

Insurance Coverage Landscape for Trulance in 2026

Trulance is covered by Medicare Part D and most commercial insurance plans, but coverage terms vary significantly by payer:

• Prior authorization: Required by most major payers. Criteria typically include a diagnosis of CIC or IBS-C, documentation of symptoms lasting ≥3 months, and failure of lifestyle modifications or OTC laxatives.
• Step therapy: Some payers (notably Federal Employee Program Blue Cross Blue Shield) require patients to try Linzess (linaclotide) — the preferred GC-C agonist on many formularies — before Trulance will be authorized. Document and submit evidence of prior Linzess trials to expedite approval.
• Quantity limits: Many plans limit coverage to a 30-day supply per fill. A 90-day supply may require a mail-order pharmacy and separate authorization.
• Medicare Part D: Covered under most Part D plans, typically Tier 3–4. Patients with Medicare cannot use the manufacturer's commercial savings card. Encourage them to use Medicare's Extra Help program or compare Part D plans annually.

Prior Authorization Best Practices for Trulance

To maximize first-pass approval of Trulance prior authorizations, ensure clinical documentation includes:

1. Confirmed diagnosis of CIC or IBS-C with symptom duration ≥3 months
2. Documentation of trial and failure/intolerance of osmotic or stimulant laxatives
3. Trial and failure/intolerance of Linzess if required by the payer's step therapy policy
4. Absence of gastrointestinal obstruction
5. Patient's age ≥18 (required; Trulance is not approved for pediatric patients)

If a prior authorization is denied, request a peer-to-peer review with the payer's medical director. Peer-to-peer reviews frequently result in approval reversals for specialty GI medications when clinical necessity is clearly documented.

Patient Assistance and Savings Programs

Salix Pharmaceuticals offers two key programs to help patients afford Trulance:

• Trulance Savings Card: For commercially insured patients. Reduces out-of-pocket cost to as little as $25 per prescription for up to 12 fills per year. Not available for Medicare, Medicaid, or other government insurance beneficiaries.
• Patient Assistance Program (PAP): For uninsured or underinsured patients meeting income eligibility criteria. Provides Trulance at no cost or reduced cost. Contact Salix at 1-800-321-4576 for eligibility details and application support.

Your practice's front desk or prior authorization team can assist patients in enrolling in these programs at the point of prescribing.

Clinical Alternatives When Trulance Is Inaccessible

When Trulance cannot be accessed due to coverage denial or availability issues, consider these ACG-recommended alternatives:

• Linzess (linaclotide): GC-C agonist with comparable efficacy for CIC and IBS-C. ACG strong recommendation. Diarrhea rate slightly higher; must be taken fasting. Generic linaclotide may be available in some markets by 2025-2026.
• Lubiprostone (Amitiza): Chloride channel activator; generic available. Approved for CIC in adults and IBS-C in adult women. Twice-daily dosing; nausea is the most common complaint.
• Prucalopride (Motegrity): 5-HT4 agonist; approved for CIC in adults. Targets motility rather than secretion. Caution with patients with a history of depression, suicidal ideation, or psychiatric medications.
• Tenapanor (Ibsrela): NHE3 inhibitor; approved for IBS-C in adults only. Different mechanism from GC-C agonists; may be an option for patients who fail other secretagogues.

How medfinder Supports Your Patients

When your patients call your office unable to fill their Trulance prescription, medfinder for providers offers a practical tool: it calls pharmacies in the patient's area to identify which ones have the medication in stock, then texts the patient the results. Directing struggling patients to medfinder reduces call volume to your office and empowers patients to solve the logistical side of their medication access independently.

Key Takeaways for Prescribers

• No FDA shortage of Trulance exists as of 2026
• Insurance barriers (prior auth, step therapy) are the primary access problem
• Document step therapy failure (Linzess) to strengthen PA submissions
• Salix's copay card brings patient cost to $25/fill for commercially insured patients

See also our provider guide on helping patients find Trulance in stock for additional tools and referral strategies.