Pharmacists know the consequences of drug shortages: conversations with patients whose treatment plans must change, calls to prescribers to identify alternative therapies, and hours spent navigating product availability across an increasingly complex pharmaceutical supply chain.
Although the total number of active drug shortages declined in 2025 for the second consecutive year, shortages that remain last longer and reveal vulnerabilities deep within the medicines supply chain. According to the latest United States Pharmacopeia (USP) Annual Drug Shortages Report, the average duration of an active drug shortage now exceeds 5 years. Nearly two-thirds of shortages have persisted for more than 3 years.
These findings reinforce an important reality: addressing drug shortages requires strengthening the resilience of the entire medicine supply chain, not just responding to individual disruptions.
Prolonged Drug Shortages Affect Patient Care
USP’s analysis found that shortages continue to affect a broad range of therapeutic areas, including pediatric medicines, anesthesia agents, and products for gastroenterology, endocrinology, and oncology.
When a crucial medicine becomes unavailable, pharmacists and health care teams must identify therapeutic alternatives, adjust treatment protocols, or implement conservation strategies. While these efforts help maintain a standard of care, prolonged shortages raise risks for medication errors, treatment delays, and/or inconsistent regimens.
Pediatric patients tend to be particularly vulnerable. USP’s report highlights shortages of intravenous fluids and additives commonly used in pediatric care. Because these products also serve as diluents for other medications, shortages can create ripple effects across multiple therapeutic categories.
Look Beyond Finished Products to Identify Hidden Supply Risks
For the first time, USP’s annual report examined upstream supply chain data on key starting materials (KSMs), the chemical building blocks used to manufacture active pharmaceutical ingredients (APIs) and finished medicines. The findings reveal that geographic concentration may begin much earlier in the supply chain than many realize.
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- 44% rely on at least one KSM that is manufactured exclusively in a single country.
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- 6 shortage drugs depend entirely on KSMs sourced from one country.
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- 59% of drugs in shortage rely on either China or India as the primary supplier of KSMs.
This data displays a clear potential for single points of failure that can increase vulnerabilities for medicines. Geopolitical events, natural disasters, or other manufacturing interruptions can ripple throughout the pharmaceutical supply chain and ultimately affect patients thousands of miles away.
Strengthen Supply Chain Resilience Before Emergencies Occur
Recent public health emergencies have shown the importance of having multiple tools available to maintain patient access when supply disruptions occur. Pharmaceutical compounding, stockpiling, importation, and consulting with other manufacturers have helped address urgent patient needs when conventional supply channels are strained.
However, these shorter-term mitigation methods cannot solve the underlying challenges that lead to shortages.
USP’s findings continue to show a combination of interconnected potential drivers behind shortages, including low prices, manufacturing complexity, geographic concentration, and quality-related challenges. Addressing these structural issues will require improved supply chain visibility, policies that support sustainable production of critical medicines, and greater collaboration among manufacturers, distributors, pharmacies, health care providers, regulators, policymakers, and supply chain partners.
Boards of pharmacy can also play a unique role. By advancing supply chain integrity, supporting secure product tracing, facilitating information sharing, and engaging in collaborative solutions, regulators help strengthen the systems that protect patients and pharmacies alike.
While the number of active drug shortages has declined, the underlying vulnerabilities that contribute to shortages remain. The challenge is not simply to manage the next shortage but to build a medicine supply chain that is more resilient, transparent, and capable of delivering reliable access to quality medicines for every patient who depends on them.
