Upneeq Availability in 2026: A Provider Briefing

Upneeq (Oxymetazoline Hydrochloride ophthalmic solution, 0.1%) continues to be the sole FDA-approved topical pharmacologic treatment for acquired blepharoptosis in adults. Since its approval in July 2020, Upneeq has established a meaningful role in the management of ptosis for patients who are not candidates for — or prefer to avoid — surgical intervention.

However, providers across ophthalmology, optometry, oculoplastic surgery, and primary care continue to encounter a recurring issue: patients are unable to fill their Upneeq prescriptions at retail pharmacies. This article provides an updated assessment of Upneeq's availability landscape in 2026, along with practical guidance for prescribers navigating these challenges.

Current Status: No Formal Shortage

As of February 2026, Upneeq is not listed on the FDA Drug Shortage Database. RVL Pharmaceuticals (Bridgewater, NJ) continues to manufacture and distribute the product. The supply-side fundamentals are intact — this is not a manufacturing or raw material shortage.

The challenge lies in the distribution model. Upneeq is distributed primarily through:

• Specialty pharmacies
• Physician dispensing (in-office)
• Aesthetic clinics and medical spas
• Select telehealth platforms with direct-to-patient shipping

Major retail pharmacy chains (CVS, Walgreens, Walmart, Rite Aid) generally do not stock Upneeq as a formulary item. Some locations can special-order it, but availability is inconsistent.

Timeline and Context

A brief history of Upneeq's market presence:

• July 2020: FDA approval for acquired blepharoptosis in adults, based on Phase 3 clinical trial data showing statistically significant improvement in upper eyelid elevation.
• 2020–2022: Initial market launch with distribution focused on eye care specialists and aesthetic providers.
• 2023–2024: Growing awareness through social media, direct-to-consumer marketing, and expanded telehealth channels. Patient demand increased while the distribution footprint remained relatively narrow.
• 2025–2026: No generic entrants. No FDA-reported shortages. Availability challenges persist due to the specialty distribution model. Increased provider inquiries about sourcing.

Prescribing Implications

When writing a prescription for Upneeq, prescribers should be aware of several practical considerations:

Pharmacy Selection

Sending a prescription to a patient's default retail pharmacy will frequently result in a "not in stock" callback. To improve fill rates:

• Maintain a list of specialty pharmacies in your area that reliably stock Upneeq
• Consider in-office dispensing if your practice model supports it
• Direct patients to telehealth platforms that include Upneeq fulfillment
• Use tools like Medfinder for Providers to identify stocking pharmacies near your patients

Prior Authorization

For patients with commercial insurance, prior authorization is frequently required. Key documentation points:

• Diagnosis of acquired blepharoptosis (ICD-10: H02.40x series)
• Visual field testing demonstrating superior field obstruction
• Clinical photographs showing lid margin position relative to the pupil
• Documentation that the condition is acquired (not congenital)
• Note that many plans still classify Upneeq as cosmetic and deny coverage

Cost Counseling

Be prepared to discuss cost with patients. Key pricing data for 2026:

• Average cash price: $225–$350 per 30-count box (one month supply)
• SingleCare price: Approximately $205
• Manufacturer savings card: Eligible commercially insured patients may pay as little as $0
• Medicare/Medicaid: Coverage is limited; manufacturer copay cards cannot be used with federal programs

Direct patients to resources for financial assistance. Our patient-facing guide on saving money on Upneeq can be shared with patients.

Availability Picture: Where Patients Can Find Upneeq

Based on current distribution patterns, the most reliable channels for patients to access Upneeq include:

1. Physician-dispensed: Practices that stock and dispense Upneeq directly offer the most streamlined patient experience.
2. Specialty pharmacies: Pharmacies specializing in ophthalmology or dermatology products are the most consistent retail source.
3. Independent pharmacies: Some independent pharmacies with flexible wholesaler relationships can source Upneeq.
4. Telehealth platforms: Several platforms offer consultation plus direct-to-patient Upneeq delivery.
5. Medfinder: Medfinder for Providers allows clinicians and staff to check real-time pharmacy availability and direct patients accordingly.

Cost and Access Considerations

The intersection of cost and access creates a compounding challenge for Upneeq patients:

• Patients who lack insurance coverage face a $225–$350/month out-of-pocket cost
• Pharmacies that don't see consistent demand may de-stock the product
• The lack of a generic alternative means no lower-cost substitution option exists
• Patient assistance from RVL Pharmaceuticals is available but not widely publicized

Providers can help by proactively sharing cost-saving resources, including the RVL Pharmaceuticals savings program (available at upneeq.com) and third-party discount cards.

Tools and Resources for Providers

Several resources can streamline the Upneeq prescribing and fulfillment workflow:

• Medfinder for Providers: Search for pharmacies stocking Upneeq near your patients. Share availability information directly with patients.
• RVL Pharmaceuticals provider portal: Access prescribing information, savings card enrollment, and patient education materials at upneeq.com.
• Specialty pharmacy networks: Establish relationships with 1–2 specialty pharmacies in your area that reliably carry Upneeq.

For guidance on helping patients navigate the fulfillment process, see our companion article: How to help your patients find Upneeq in stock.

Looking Ahead

Several factors may influence Upneeq access in the coming years:

• Generic competition: No generic Oxymetazoline ophthalmic product is currently on the horizon, which means the brand-name product will continue to dominate.
• Expanded distribution: RVL Pharmaceuticals may broaden its distribution network as demand grows, potentially making Upneeq available at more retail locations.
• New indications or formulations: Any label expansions or new delivery formats could increase demand and potentially improve supply chain investment.
• Insurance formulary changes: As ptosis treatment becomes more established, more plans may add Upneeq to their formularies, improving access for insured patients.

Final Thoughts

Upneeq remains an effective, well-tolerated, and unique treatment option for acquired blepharoptosis. The primary barrier to patient access in 2026 is not supply — it's distribution. By understanding the current availability landscape and proactively guiding patients to appropriate fulfillment channels, providers can significantly improve the prescribing-to-fill experience.

Use Medfinder for Providers to check availability, maintain specialty pharmacy contacts, and consider in-office dispensing when feasible. For clinical details on the medication itself, refer to our articles on Upneeq uses and dosage, Upneeq side effects, and Upneeq drug interactions.