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

For ophthalmologists, optometrists, and allergists prescribing Verkazia (cyclosporine ophthalmic emulsion 0.1%) for patients with vernal keratoconjunctivitis (VKC), the supply disruptions of late 2025 and early 2026 have created significant management challenges. This guide provides a clinical overview of the shortage's cause, current supply status, patient management strategies, and available bridging therapies.

Clinical Background: Why Verkazia Is Irreplaceable for Many VKC Patients

Vernal keratoconjunctivitis is a chronic, bilateral, sight-threatening form of allergic eye disease. The inflammatory cascade in VKC involves both IgE-mediated and non-IgE-mediated pathways, including T-cell activation, eosinophilic infiltration, and fibroproliferative changes. Approximately 50% of VKC patients do not show allergic sensitization, making antihistamines inadequate as monotherapy for most moderate-to-severe cases.

Prior to Verkazia's FDA approval in June 2021, steroid-sparing therapy for VKC relied on compounded cyclosporine, off-label tacrolimus, or sustained corticosteroid use — all of which carry limitations. Verkazia is the first and only FDA-approved nonsteroidal therapy specifically indicated for VKC, offering a standardized, tested formulation with a 12-month safety profile established in clinical trials.

What Caused the Verkazia Supply Disruption?

The supply disruption was primarily the result of a commercial transition. Harrow Eye, LLC acquired the U.S. commercial rights to Verkazia from Santen Inc. During this transition in late 2025, Harrow acknowledged inventory shortages that carried into Q1 2026. The disruption was logistical rather than a manufacturing or safety issue — new distribution agreements, wholesaler relationships, and pharmacy contracting all required time to establish.

In June 2026, Harrow relaunched Verkazia as one of three commercial priority products, with CEO Mark L. Baum publicly stating the company is "entering a period of accelerating commercial execution" and projecting sequential revenue growth through 2026.

Current Availability Status (June 2026)

As of June 2026, Verkazia is commercially available in the U.S. under Harrow's distribution. However, pharmacy-level stock is not yet uniform nationwide. Key points for providers:

Large retail chains (CVS, Walgreens, Walmart) may stock it at select locations — verify before routing prescriptions

Specialty pharmacies (Walgreens Specialty, CVS Specialty, Optum Specialty) are generally the most reliable sourcing channel

Independent pharmacies may need to place special orders through wholesalers (AmerisourceBergen, McKesson, Cardinal Health)

Harrow maintains a provider support line to assist with sourcing: 1-833-4HARROW (1-833-442-7769)

Clinical Management Strategies During a Supply Disruption

When Verkazia is unavailable, the following clinical approaches are commonly used:

Short-Term Bridging: Topical Corticosteroids

For patients experiencing moderate-to-severe VKC flares during a Verkazia gap, a short course of topical corticosteroids — loteprednol etabonate (Lotemax), prednisolone acetate, or fluorometholone — can rapidly suppress inflammation. Monitor intraocular pressure and lens status in patients requiring repeated courses. This is not a long-term management strategy.

Steroid-Sparing Bridging: Mast Cell Stabilizers

Lodoxamide (Alomide) and cromolyn sodium (Opticrom) are FDA-approved for VKC and may help maintain some control in mild-to-moderate cases. These are insufficient for severe disease but may reduce flare frequency and steroid dependence during supply disruptions.

Off-Label Calcineurin Inhibitors: Compounded Cyclosporine and Tacrolimus

For patients with moderate-to-severe VKC requiring a calcineurin inhibitor, compounded cyclosporine (0.05%, 0.1%, or 2% concentrations) or tacrolimus (0.005%–0.03%) represent off-label alternatives that work via a similar mechanism. Published literature supports their use in VKC. Quality and consistency depend on the compounding pharmacy, and insurance typically does not cover compounded medications. Inform patients of the off-label status.

Refractory Cases: Emerging Biologics

For patients with severe, treatment-refractory VKC, case series and small trials support the use of systemic biologics including omalizumab (Xolair) and dupilumab (Dupixent) in off-label settings. These should be reserved for patients who have failed multiple topical therapies and ideally managed in collaboration with an allergist-immunologist.

Supporting Your Patients: Access Resources

Directing patients to pharmacy-finding services can reduce the administrative burden on your practice. medfinder for providers allows your patients to submit their medication and location, and medfinder calls pharmacies on their behalf to find which ones can fill the prescription. This is especially valuable for rare-disease medications like Verkazia where stock is inconsistent.

Additionally, the Harrow Savings Program provides:

Commercially insured patients: as little as $0 copay if covered by insurance

Uninsured/underinsured patients: as little as $79 per fill

Medicare Part D patients: as little as $79 per fill

Key Takeaways for Prescribers

Verkazia is back on the market as of June 2026 under Harrow's commercial relaunch — route prescriptions to specialty pharmacies for most reliable access

Short-term corticosteroids are appropriate for bridging acute flares during gaps in supply

Compounded calcineurin inhibitors (cyclosporine, tacrolimus) are viable off-label alternatives for moderate-to-severe disease

Enroll patients in the Harrow Savings Program to reduce financial barriers

Direct patients to medfinder to reduce pharmacy-hunting burden