How Drug Shortages Are Putting Patient Care at Risk

When a patient needs a life-saving drug and it’s simply not available, the consequences aren’t theoretical-they’re immediate. A child with leukemia waits weeks for asparaginase. A cardiac patient gets a less reliable anticoagulant because heparin is gone. An elderly person with severe pain skips doses because their opioid prescription can’t be filled. These aren’t rare exceptions. They’re everyday realities in U.S. hospitals right now.

What’s Really Going On With Drug Shortages?

Drug shortages aren’t new, but they’ve reached a breaking point. As of June 2025, there were still 253 active drug shortages in the U.S., according to the American Society of Health-System Pharmacists (ASHP). That’s down from a peak of 323 in early 2024, but still far higher than the 187 shortages recorded in 2021. Most of these shortages started after 2022, meaning this isn’t a lingering problem-it’s accelerating.

The majority of these shortages involve generic drugs, which make up 83% of the list. Why? Because manufacturers have little financial incentive to produce low-margin medications. A single vial of a generic antibiotic might cost $2. A company that spends millions to upgrade a factory for quality compliance won’t make back that investment on a drug that sells for pennies. So they shut down production, and the supply vanishes.

The root causes are structural: 47% of shortages come from fractured global supply chains, 32% from manufacturing quality failures, and 21% from raw material shortages. A single factory in India or China that fails an FDA inspection can wipe out the entire U.S. supply of a critical drug. And there’s no backup.

How Shortages Directly Hurt Patients

It’s not just about inconvenience. When a drug disappears, patients suffer.

In oncology, delays of 7 to 14 days during asparaginase shortages have been linked to lower survival rates in children with acute lymphoblastic leukemia. For patients with rare cancers, there are often no alternatives. Nelarabine, used for T-cell leukemia, has been in shortage for over four years. Doctors are forced to use older, more toxic drugs-or worse, delay treatment entirely.

In emergency and surgical care, heparin shortages have forced cardiac centers to switch to alternative anticoagulants. This isn’t a simple swap. These alternatives require different dosing, more monitoring, and longer procedures-increasing surgery time by 22%. That means more time under anesthesia, higher risk of complications, and longer hospital stays.

Even common medications are affected. Lorazepam injections, used for seizures and severe anxiety, are often unavailable. Patients with epilepsy risk breakthrough seizures. Those in emergency rooms face longer waits while staff scramble to find a substitute.

A 2024 JAMA Network Open study found that nearly one in three patients either skipped doses, took less than prescribed, or didn’t fill prescriptions at all because of shortages or cost. That’s not adherence-it’s survival strategy.

The Hidden Burden on Healthcare Workers

Behind every shortage is a team of pharmacists, nurses, and doctors working overtime to keep patients safe.

Hospitals now monitor an average of 43 drug shortages at once. For pediatric units, that number jumps to 54. Each shortage demands 15 to 20 hours of staff time per week-just to find alternatives, update protocols, train staff, and communicate changes. Pediatric facilities need 25% more time because children’s doses are more complex and fewer alternatives exist.

One hospital pharmacist described it like playing 10 simultaneous games of chess while the board keeps changing. One day, it’s IV saline bags. The next, it’s insulin. Then antibiotics. Then sedatives. Each switch carries risk. Medication errors linked to shortages jumped 43% between 2019 and 2024. That’s not a typo. It’s a crisis.

Nurses are forced to use unfamiliar drugs they haven’t been trained on. Pharmacists spend hours calling distributors, checking inventory across states, and begging for small quantities. In some cases, they’ve had to split single vials among multiple patients to stretch supply.

Costs That Go Beyond the Price Tag

Drug shortages cost the U.S. healthcare system nearly $900 million a year in extra labor alone. That doesn’t include the cost of more expensive alternative drugs, cancelled surgeries, longer hospital stays, or emergency room visits caused by untreated conditions.

Patients pay too. Out-of-pocket costs rise by an average of 18.7% during shortages because alternatives are often newer, branded, or off-label drugs with no generic competition. One study found that 31% of pharmacy directors reported adverse events directly tied to shortages-including overdoses from incorrect substitutions, allergic reactions, and treatment failures.

And it’s not just hospitals. Outpatient infusion centers-where patients receive chemotherapy, immunotherapy, or IV antibiotics-have seen 41% of treatments delayed, omitted, or rescheduled. For cancer patients, that’s not just a scheduling issue. It’s a threat to survival.

What’s Being Done-And Why It’s Not Enough

There are efforts to fix this. The FDA’s Drug Shortage Electronic Registration and Notification Act, which took effect in January 2023, requires manufacturers to report potential shortages six months in advance. That’s a step forward. But many shortages still come out of nowhere.

Some hospitals have formed shortage management committees. Others use real-time monitoring tools from group purchasing organizations like Vizient. These tools have saved hospitals $300 million in avoided inventory costs since 2023. But they don’t solve the root problem: no one is forcing drugmakers to keep producing low-profit medications.

Congress held hearings in late 2023 and early 2024. The Biden administration included drug supply chains in its 2022 Executive Order on America’s Supply Chains. But there’s been no major policy shift-no subsidies, no guaranteed minimum production quotas, no penalties for companies that abandon critical drugs.

The result? A system that’s constantly firefighting, never preventing.

What This Means for You

If you or a loved one relies on a chronic medication-whether it’s for diabetes, heart disease, epilepsy, or cancer-you need to be prepared.

Talk to your pharmacist. Ask if your medication is on the shortage list. Ask what alternatives exist and whether they’re safe for you. Ask if your doctor can prescribe a different formulation or brand.

Don’t assume your prescription will be filled. Keep a 7- to 10-day backup supply if possible. If you’re on a long-term treatment, consider switching to a different pharmacy or provider who may have better access.

And speak up. If you’ve had to skip doses, delay treatment, or pay more because of a shortage, tell your doctor. Share your story. The only way this system changes is when patients demand it.

Where Do We Go From Here?

This isn’t just a pharmacy problem. It’s a public health emergency. We can’t keep patching a broken system with workarounds.

We need policies that reward manufacturers for producing essential generic drugs-not just the profitable ones. We need stockpiles of critical medications, like we have for vaccines and pandemic supplies. We need transparency so hospitals know weeks ahead when a drug is at risk.

Until then, the burden falls on patients and frontline workers. And every day, someone is forced to choose between a treatment that might not work and no treatment at all.

The drugs are supposed to save lives. Right now, the system is making them harder to get.