There is a national shortage of generic tacrolimus which may result in difficulty obtaining the medication. Currently, only generic tacrolimus is affected, brand products and long-acting formulations are not currently affected.
To minimize the impact on our patients, we ask that all post-transplant patients refill their tacrolimus at least seven days prior to running out of medication. This will help you avoid delays in therapy or missed doses. As you know, missed doses will increase the risk of rejection.
If you are unable to fill your medication at your local pharmacy, you may consider contacting one of the specialty pharmacies that Emory works with. These pharmacies currently have adequate stock of tacrolimus and are able to ship medication to you in most cases.
If you are still unable to fill your tacrolimus due to the shortage, please call us at 404-778-0638 (Monday–Friday, 8 a.m.– 5 p.m. EST) and we will help you find a way to obtain your anti-rejection medication.
Frequently Asked Questions
Q: What is tacrolimus?
A: Tacrolimus (also known as Prograf) is a medication taken to prevent rejection of the transplanted organ. It is known as an anti-rejection medication or an immunosuppressant.
Q: What happens if I miss a dose or more of tacrolimus?
A: Missing one or more doses of tacrolimus can increase your risk of rejection. Rejection can lead to the need for more immunosuppressant medications, clinic visits, or hospitalization. In severe forms, rejection can result in loss of the transplanted organ.
Q: Why is there a shortage of tacrolimus?
A: We do not know all of the reasons why tacrolimus is in shortage. One reason is a raw ingredient shortage leading to manufacturer delays in producing tacrolimus. Generic tacrolimus is being allotted to pharmacies based on past usage.
Q: What does it mean if a medication is on allocation?
A: When a medication is allotted, a certain amount of medication is given to pharmacies to help ensure that the drug is distributed in a fair and equal manner. Allocation helps to manage a scarce resource.
Q: Are all formulations of tacrolimus affected by the shortage?
A: Currently, generic tacrolimus is the product most affected by the shortage. In the current state, brand Prograf is available. Other formulations, such as long-acting formulations of tacrolimus (for example, Astagraf and Envarsus) are not currently affected.
Q: How will I know if this affects me?
A: It is not certain what, if any, effect this will have on patients. The Emory Transplant Center is working to be proactive to avoid any disruptions in medication therapy. We are in daily communication with our specialty pharmacies that service many of our patients to ensure they have an adequate stock of tacrolimus. We are asking that patients be proactive with refilling medications so that any issues with drug availability can be identified and dealt with in a timely manner.
Q: How will I obtain tacrolimus?
A: The Emory Transplant Center is suggesting that you refill your medications 7 days in advance of running out of medication. This will allow you time to be notified by your pharmacy if they are unable to fill the prescription. If the pharmacy is unable to fill your tacrolimus, we recommend that you reach out to a specialty pharmacy, such as Encompass Pharmacy, Community Pharmacy, or Diplomat Pharmacy to see if they are able to fill your prescription. If they are, you may ask them to transfer your prescription of tacrolimus to the specialty pharmacy. If you are still unable to fill your prescription of tacrolimus, please reach out to the Emory Transplant Center as soon as possible to notify us.
Q: What is a specialty pharmacy?
A: A specialty pharmacy deals with specific patient populations. Specialty pharmacies are equipped to deal with special populations and high cost or hard to find medications. Examples of specialty pharmacies include Encompass Pharmacy, Community Pharmacy, and Diplomat Pharmacy. If you would like to have your tacrolimus filled at a specialty pharmacy, you may reach out to one of the above specialty pharmacies at the numbers listed above.
Q: What if I don’t want to use a specialty pharmacy or they cannot fill for me?
A: You can try to find tacrolimus at a local pharmacy immediately. In some cases, one pharmacy may have more tacrolimus in stock than another pharmacy. You will need to notify The Emory Transplant Center immediately if you are unable to fill your tacrolimus.
Q: What is The Emory Transplant Center doing to help with the shortage?
A: The Emory Transplant Center is working closely with physicians, pharmacies, the Centers for Medicare and Medicaid, industry professionals, and others to help minimize the effect of the tacrolimus shortage on our patients.
Q: Can I have my medications filled at The Pharmacy at Emory?
A: The Pharmacy at Emory is unable to process prescriptions for patients with Medicare Part B insurance. The Pharmacy at Emory has a limited supply of generic tacrolimus at this time. The Emory Transplant Center recommends reaching out to a specialty pharmacy first.
Q: Is brand Prograf an option?
A: Yes, brand Prograf (tacrolimus) is currently an option for patients. When changing to a brand product, the patient’s insurance may require prior authorization. Patients using brand medication are also more likely to have to pay a higher copay for the medication compared to the generic tacrolimus.
Q: Are there other anti-rejection or immunosuppressant medications I can use?
A: Yes, there are other immunosuppressants (medications to prevent rejection) available for transplant patients. You will need to discuss any medication changes with your treatment team who will determine if you are a candidate for a different agent.