By Beverly Cosgrove, version 2, 5-13-2021

Injectable Estradiol Valerate in the US has had only one generic source for years: Perrigo. But serious shortages of EV, especially in affordable generic form, has plagued transgender patients, forcing them to buy expensive brand-name equivalents costing up to 8 times more, or in some cases encouraging black market amateur-cooked injectables of dubious quality and safety. In addition, the present Coronavirus pandemic has itself caused drug shortages.

Finally, there is good news – a new generic source, American Regent. The company has decided to provide a reliable EV source and is offering both concentrations: 20mg/ml and 40mg/ml, and at reasonable prices too.

But the US pharmaceutical system is not a freely trading one. Pharmacies and pharmaceutical manufacturers tend to be tied to exclusive distributor agreements. For instance, if you go to CVS Pharmacy and ask for the generic EV, the pharmacy technician will typically consult the in-stock information at McKessen, a major distributor which may NOT handle American Regent products — because of exclusivity. When CVS only buys from McKessen, and McKessen only buys from Perrigo, then when Perrigo runs out of stock, CVS customers cannot access their medicine. [example only] This is a terrible way to do business, when patients’ access to their medicines is blocked by these agreements. It’s not free and equal competition either — exclusivity agreements are restraints to trade, which is the evil side of “Free Trade” and capitalism. Customers must seek out a way to find their medicine themselves, and the pharmacies are NO HELP typically — because it is not in their interest to tell their customer to go to a different pharmacy.

At present, American Regent lists these distribution centers as the ones able to order their products. However it is individual pharmacies that you, the patient, must visit for your prescription, and the connection between that pharmacy and a distributor that actually stocks the new generic is unknown. Any information I give you here is subject to change, but there is one way to order your prescription that forces the pharmacy to search for the Am. Regent product: the NDC number. These are the official FDA numbers for the exact drug and package combination. The NDC for the 20 mg/ml vial is 0517-0420-01. The NDC for the 40 mg/ml concentration is 0517-0440-01. You can read these numbers over the phone to the pharmacy technician and insist that they check them exactly as written. This will maximize the chances that your pharmacy can obtain it. For reference, the numbers for the Perrigo EV are 0574-0872-05 (20 mg/ml) and 0574-0872-05 (40 mg/ml), respectively. NDC numbers are listed on the official FDA website.

At present, I obtain my personal prescription for the Am. Reg. 20 mg/ml EV from CostCo Pharmacy, which uses the distributor Ameri-Source Bergen. Other pharmacies using the same distributor should also be able to obtain it. If your pharmacy says they cannot get it or are “out of stock”, do not take them at their word. My experience with pharmacy technicians shows that some are looking at a list of distributors, but if the first one they look at does not stock a drug, they may tell the patient that it is unavailable instead of going to the trouble to check the distributors further down on their list. This is pure laziness, in my opinion, and you the patient should get pushy and insist they look again. This is not the only reason your prescription might be hard to get filled, though. Good luck!

[Note: please don’t leave comments asking “Where can I buy this?” You buy this from your local pharmacy just like other medicines. See the comments regarding how to talk to your pharmacy, above. If you are outside the United States it is much more difficult: but you may be able to travel to the US, get the prescription, have it filled, then travel back home.]