A Cup of Coffee or Life-Saving Drugs: Shifting Decision-Making Practices in Health Care

"How many of you [went to] Starbucks this morning, [or] yesterday, and paid, I don't know, $7 to $8 for coffee?" asked Michael Ganio, PharmD, MS, BCPS, BCSCP, FASHP, to a full breakfast conference room at the ASHP Midyear 2025 Clinical Meeting and Exposition.

As more than half the room raised their hands, Ganio continued, "Now, think of a life-saving drug that we would use in an [intensive care unit] or maybe [a] parenteral nutrition component. Does it make sense that your cup of coffee costs more than that life-saving drug?"

Thus opened a discussion of the root causes of drug shortages, especially sterile injectable drug shortages, across the country. Most of the sterile injectable drugs currently in shortage cost less than $5 per unit. While the number of active shortages has decreased to the lowest levels in the past 7 years, "that doesn't mean that some of these shortages aren't very impactful," Ganio said, and "a disproportionate number of these shortages ... are sterile injectables."

Root Causes of Sterile Injectable Drug Shortages

According to a 2019 FDA report cited by Ganio in his presentation, the core issues behind drug shortages are economic²:

1. Manufacturers lack any incentive to produce less profitable drugs.
2. The pharmaceutical industry has no metric for supplier quality, so providers' only motivation is to buy drugs at the lowest cost.
3. Regulatory and logistical hurdles slow market recovery after any disruption

April Giles, EMBA, executive director of the End Drug Shortages Alliance, said drug manufacturers often have to operate at a deficit for several years when they begin production on a new generic sterile injectable drug. For this reason, they require a predictable and reliable supply chain. However, she said, "The supply chain is incredibly interdependent...We know that a disruption at one point in the supply chain...reverberates across the entire system."

Eric M. Tichy, PharmD, MBA, BCPS, described the behavior of health care systems during disruption as "the sort of classic prisoner's dilemma." He hearkened to the COVID-19 pandemic when items such as toilet paper and hand sanitizer were hoarded, creating shortages in the market. "When you do that, you create a problem for everyone else, and you create a problem where there are winners and losers. And really, we need to have coordination that would help us better allocate [drugs in shortage] where [they're] needed most."

As the division chair of supply chain management at the Mayo Clinic, Tichy has seen these forces at work in the market.

"When I first got involved," he said, "I always thought that health systems were kind of a victim...[that] it's really the suppliers, the manufacturers, the distributors that are failing us. As I learned more about what really causes shortages, I realized that actually, a big part of it is how we behave as health systems."

How Does This Impact Pharmacists?

Drug shortages have a potentially dramatic impact on pharmacy practice by increasing labor and operational costs. Pharmacies and pharmacists may also face ethical challenges regarding rationing or allocating drugs in shortage to their patients, putting them in the position of deciding who deserves to get their medication.

Tichy outlined some best-practice policies, which largely consisted of collaboration and cooperation across organizations, including suppliers and pharmacies. "It's important to require transparency and then reward supplier efforts around quality and reliability," he said. Then, even if pharmacists have to defend paying higher prices to leadership, they can "explain to them that we might be paying a little bit more for this product, but...we're ensuring that we're going to be able to operate in times of stress."

Jesse Schafer, executive director of the Healthcare Industry Resiliency Collaborative (HIRC), said his organization's key goals are to standardize industry measurements and practices that can help hospitals and health systems weather drug shortages without sacrificing patient care. "We have a resiliency...assessment with over 300 diagnostics," Schafer said, adding that it was built by more than 300 health system leaders and 65 organizations across the country.

Under the assessment, health systems submit to an external third-party review of key operational capabilities, quality, risk management, people processes, and more. Organizations that successfully pass the assessment get a resiliency badge from HIRC which they can display publicly so patients and practitioners can see "that investment and resiliency are measured and visible," Schafer said.

By providing a shared metric, purchasers can differentiate between and reward suppliers who invest proactively in quality and risk mitigation, thus incentivizing the entire ecosystem of drug manufacturing and provision to patients.

REFERENCES

1. Ganio, M, et al. Behind the Shortages: Addressing Economic Factors Contributing to Sterile Injectable Drug Shortages. American Society of Health-systems Pharmacists Midyear 2025 Clinical Meeting and Exposition. December 7-11, 2025. Las Vegas, Nevada.

2. Report | drug shortages: root causes and potential solutions. FDA. Updated March 11, 2020. Accessed December 9, 2025. https://www.fda.gov/drugs/drug-shortages/report-drug-shortages-root-causes-and-potential-solutions