Zilxi Shortage: A Provider Briefing for 2026

Zilxi (Minocycline topical foam, 1.5%) has established itself as a valuable treatment option for inflammatory rosacea since its FDA approval in 2020. As the only topical minocycline product approved for this indication, it fills an important niche in the dermatologic armamentarium. However, providers across the country continue to hear from patients who struggle to fill their Zilxi prescriptions.

This briefing covers the current shortage status, prescribing implications, the availability and cost landscape, and actionable tools to help your patients access this medication in 2026.

Timeline and Current Status

Zilxi received FDA approval in October 2020 based on two pivotal clinical trials involving 1,522 adult patients with inflammatory rosacea. It is manufactured by Journey Medical Corporation (a subsidiary of Journey Medical, formerly developed by Foamix Pharmaceuticals).

Key timeline points:

• October 2020: FDA approval for inflammatory lesions of rosacea in adults
• 2021-2022: Gradual market availability; limited pharmacy stocking due to specialty status
• 2023-2025: Increasing prescriber awareness, but persistent access challenges
• Early 2026: No official shortage per FDA/ASHP databases, but functional availability gaps continue

It is important to note that Zilxi has never been listed on the FDA or ASHP drug shortage databases. The access difficulties patients experience are driven by market dynamics rather than manufacturing supply issues.

Prescribing Implications

When prescribing Zilxi, providers should be aware of several practical considerations:

Prior Authorization Requirements

The majority of commercial and managed care plans require prior authorization for Zilxi. Most payers mandate step therapy, typically requiring documented failure of two preferred agents (commonly topical Metronidazole, Azelaic Acid, and/or Ivermectin) within the preceding 180 days.

Clinical tip: Document treatment failures thoroughly in your notes. Specific language about inadequate response, intolerance, or adverse effects strengthens prior authorization submissions.

Contraindications and Precautions

As a tetracycline-class product, standard precautions apply:

• Contraindicated in patients with known hypersensitivity to tetracyclines
• Not recommended during pregnancy (Category D equivalent for oral tetracyclines; topical formulation has limited systemic absorption but caution is warranted)
• Avoid concomitant use with isotretinoin due to increased risk of intracranial hypertension
• Monitor for signs of C. difficile-associated diarrhea, hepatotoxicity, and autoimmune syndromes
• Advise patients about photosensitivity and flammability of the foam propellant

The most commonly reported adverse reaction in clinical trials was diarrhea (≥1%). For complete safety information, refer to the Zilxi side effects guide and drug interactions overview.

The Availability Picture

The functional availability challenge stems from several converging factors:

Single-Source Manufacturing

With no generic version available and only one manufacturer, the supply chain is inherently more fragile than multi-source generic products. Any manufacturing or distribution disruption could create real shortages.

Limited Pharmacy Stocking

Many retail pharmacies — particularly large chains — do not maintain standing inventory of Zilxi. The relatively low prescription volume compared to first-line agents means pharmacies often need to special-order the product, adding 1-3 business days to fill times.

Payer Restrictions

Step therapy requirements reduce the overall volume of Zilxi prescriptions filled, which in turn reduces pharmacy incentive to stock the product. This creates a self-reinforcing cycle of limited access.

Cost and Access Considerations

Understanding the financial landscape helps providers counsel patients effectively:

• Cash price: Approximately $400-$600 per 60g canister
• Zilxi Savings Card: Eligible commercially insured patients may pay as little as $25/prescription (not valid for government insurance)
• Insurance coverage: Varies widely; specialty tier placement is common, with copays ranging from $25-$100+ after prior authorization approval
• Patient assistance: Journey Medical Corporation offers support programs. Contact: 1-844-375-3673

For patients facing financial barriers, see our guide on helping patients save money on Zilxi.

Tools and Resources for Providers

Several tools can help streamline the process of getting Zilxi to patients who need it:

Medfinder for Providers

Medfinder allows providers and their staff to check real-time pharmacy availability for Zilxi. This can save significant time compared to calling pharmacies individually and can be incorporated into your clinical workflow.

Journey Medical Provider Resources

The manufacturer's HCP portal at zilxihcp.com offers:

• Copay savings card enrollment for patients
• Prior authorization support and sample request tools
• Clinical data and prescribing information

Alternative Treatment Protocols

When Zilxi is unavailable or not covered, evidence-based alternatives include:

• Topical Metronidazole 0.75%-1% — First-line, widely available as generic
• Topical Ivermectin 1% (Soolantra) — Particularly effective for papulopustular rosacea with Demodex component
• Topical Azelaic Acid 15% (Finacea) — Good for both inflammatory lesions and erythema
• Oral Doxycycline 40mg MR (Oracea) — Sub-antimicrobial dose with anti-inflammatory benefit

For a patient-facing comparison, see alternatives to Zilxi.

Looking Ahead

Several developments may impact Zilxi availability in the coming years:

• Generic entry: No generic is currently on the horizon, but future patent expiration could open the market to competition
• Formulary evolution: As more clinical data accumulates, some payers may revise step therapy requirements
• Rosacea pipeline: New treatment modalities in development could expand options for patients who struggle to access Zilxi

Final Thoughts

Zilxi remains a clinically valuable option for inflammatory rosacea, but the practical reality of access, cost, and availability requires proactive management. By leveraging tools like Medfinder, supporting patients through the prior authorization process, and maintaining familiarity with alternative treatment protocols, providers can ensure their rosacea patients receive effective care regardless of Zilxi's availability status.

For a step-by-step guide on incorporating pharmacy availability tools into your practice, see our companion article: How to help your patients find Zilxi in stock.