Why Is Methotrexate So Hard to Find? [Explained for 2026]

If you've been trying to fill a methotrexate prescription and come up empty at the pharmacy, you're not alone. Methotrexate — a cornerstone treatment for rheumatoid arthritis, psoriasis, and several cancers — has been on the FDA's official drug shortage list since March 2023. Here's what's driving the shortage and what you can do about it.

What Is Methotrexate Used For?

Methotrexate is one of medicine's most versatile drugs. At low weekly doses, it acts as a disease-modifying antirheumatic drug (DMARD) for autoimmune conditions like rheumatoid arthritis, psoriatic arthritis, and psoriasis. At higher doses, it serves as a chemotherapy agent for leukemia, lymphoma, breast cancer, osteosarcoma, and other cancers. It is also used off-label for lupus, Crohn's disease, and vasculitis.

Because methotrexate serves such a wide range of patients — from children with leukemia to adults managing arthritis — a shortage of any formulation can have far-reaching consequences.

Why Did the Methotrexate Shortage Start?

The current methotrexate injection shortage can be traced primarily to manufacturing disruptions beginning in early 2023. An FDA inspection of a key manufacturing facility uncovered quality control problems that did not meet the agency's standards, leading to halted production. Combined with a surge in demand driven by increased prescribing of DMARDs and cancer treatments post-pandemic, supply chains were unable to keep up.

Multiple major manufacturers — including Accord Healthcare, Pfizer, and Teva — reported either back orders or limited availability. Accord attributed its supply gap directly to an active ingredient shortage. The FDA worked to mitigate the crisis by identifying alternative manufacturers and, in some cases, importing product from overseas sources.

Which Methotrexate Formulations Are Affected?

It's important to understand that the shortage has primarily affected injectable methotrexate — not the oral tablet. Here's a breakdown:

Methotrexate injection (25 mg/mL vials): Most affected. Preservative-free vials used for intrathecal administration and high-dose oncology regimens have been particularly scarce. Some manufacturers remain available (Fresenius Kabi, Hikma).

Methotrexate oral tablets (2.5 mg): Generally available at most pharmacies. Patients on oral methotrexate for arthritis or psoriasis are less likely to be affected.

Subcutaneous auto-injectors (RediTrex): Availability varies. Some patients prescribed these for RA may need to switch to oral tablets or standard injections.

How Has the Shortage Impacted Patients?

For cancer patients, especially children with acute lymphoblastic leukemia (ALL), methotrexate is not easily substituted. Treatment delays can have serious clinical consequences. Oncologists and hospital pharmacies have been forced to ration preservative-free vials, prioritizing intrathecal (spinal) administrations for pediatric leukemia patients.

For autoimmune patients, the guidance has been to switch to oral methotrexate wherever possible and to consider alternative DMARDs like leflunomide or hydroxychloroquine. However, not all patients respond equally to alternatives.

Is the Methotrexate Shortage Getting Better?

The situation has improved somewhat since the worst of 2023, but methotrexate injection remains on the FDA shortage list as of 2026. Some manufacturers have resumed production — Accord restarted output in late 2023 — but availability still varies significantly by region, pharmacy, and specific formulation. Patients should not assume their pharmacy has it in stock without checking first.

Why Is Methotrexate Still Prone to Shortages?

Methotrexate is a decades-old, inexpensive generic drug. Like many generic injectables, it has thin profit margins, which means fewer manufacturers invest in robust production capacity. When one facility goes offline, the entire supply chain feels the impact. The active pharmaceutical ingredient (API) for methotrexate is also primarily sourced from a small number of global suppliers, making it vulnerable to raw material shortages.

This structural problem — sometimes called the "generic drug market failure" — affects many essential, low-cost medications and is unlikely to fully resolve without policy changes.

What Should You Do If You Can't Find Methotrexate?

Here are practical steps to take right now:

Call multiple pharmacies. Availability varies significantly by location. Independent pharmacies and hospital outpatient pharmacies may have stock that chain pharmacies don't.

Ask your provider about the oral form. If you're on injectable methotrexate for a non-cancer indication, ask your doctor if oral tablets are an appropriate substitute.

Use a pharmacy finder service. Services like medfinder will call local pharmacies on your behalf to find which ones have your medication in stock — saving you hours of calling around.

Ask about alternatives. Leflunomide, hydroxychloroquine, and biologic DMARDs may be options depending on your condition and history.

For more detailed guidance, read our posts on how to find methotrexate in stock near you and alternatives to methotrexate.

How medfinder Can Help

Tracking down a medication in shortage doesn't have to mean spending your afternoon on hold. medfinder calls pharmacies near you, checks which ones have your specific medication and dosage in stock, and texts you the results — typically within 24 hours. No more guessing, no more runaround.