Drug Shortages Are Declining, But Persistent Supply Chain Vulnerabilities Continue to Threaten Access

Although the number of active drug shortages in the US declined in 2025, emerging data from United States Pharmacopeia (USP) indicate the supply chain challenges underlying many shortages remain largely unresolved. The average drug shortage duration now exceeds 5 years, according to USP's Annual Drug Shortages Report, suggesting that many shortages have evolved from temporary disruptions into chronic supply challenges.¹^,²

USP's findings signify that persistent drug shortages are driven by broader structural weaknesses within the pharmaceutical supply chain that continue to affect patients, pharmacists, health systems, and manufacturers alike.¹

Drug Shortages Remain a Systemic Problem

The decline in the total number of shortages may appear encouraging on the surface, but the remaining shortages are proving increasingly difficult to resolve. Pharmacy Times spoke with Matt Christian, director of Supply Chain Insights at USP, to discuss the problem with drug shortages.

"Drug shortages decreasing in number is definitely a positive sign of progress," explained Christian, "But what's left are some of these chronic, long-lasting drug shortages, with the average drug shortage duration now lasting more than 5 years. That indicates this problem is systemic with ongoing shortage issues."

According to USP's analysis, several underlying vulnerabilities continue to drive supply instability across the pharmaceutical market.¹

"Our analysis suggests 4 drivers of vulnerabilities within the supply chain, including low prices that discourage investments in resilience, quality concerns, manufacturing complexity, and geographic concentration," Christian said.

These factors frequently interact with one another, creating conditions that make products more susceptible to disruption when unexpected events occur.

Four Key Drivers of Supply Chain Risk

Low-cost generic medicines remain among the products most vulnerable to shortages. When manufacturers operate with narrow margins, investments in quality improvements, facility upgrades, redundancy, and contingency planning may become financially difficult.¹ Christian noted that quality issues and supply reliability are often closely connected.

"Facilities that have quality problems also tend to have supply chain reliability problems," he said.

Complex production processes can create additional points of vulnerability within the pharmaceutical supply chain. Products that require specialized production processes, sterile manufacturing environments, or complex supply networks may be more difficult to produce consistently and may experience greater disruptions when problems emerge.¹

Another major concern remains geographic concentration. When production of active pharmaceutical ingredients (APIs), key starting materials (KSMs), or finished drug products is concentrated within a limited number of countries or facilities, disruptions can rapidly affect global supply.¹

"When all of your production is geographically concentrated into only a few places, that opens up a series of vulnerabilities, whether it's trade wars, natural disasters, or even a negative quality event," Christian explained.

Drug Shortages Span Multiple Therapeutic Areas

The report found that shortages are not confined to a single clinical specialty. Instead, they affect a broad range of therapeutic categories, highlighting the widespread nature of supply chain vulnerabilities.¹

"The picture is surprisingly diverse," Christian stated. "Pediatrics, gastroenterology, anesthesiology, endocrinology, and oncology were all among the top therapeutic categories at the end of 2025."

The diversity of affected therapeutic areas indicates shortages are not driven by isolated market failures.

"That shows that shortages are not concentrated in a single specialty, which is indicative of a systematic supply chain issue rather than a problem that's narrowly confined to one corner of the market," Christian added.

This broad impact means shortages can emerge across multiple practice settings for pharmacists, from hospital pharmacies and oncology centers to outpatient clinics and community pharmacies.

Low Prices May Also Contribute to Product Discontinuations

USP's findings suggest that many of the same factors associated with shortages may also contribute to manufacturers permanently exiting the market.¹

"We found that many of the resiliency factors that are correlated with drug shortages are also correlated with discontinuations," Christian said.

Notably, according to USP, 65% of drug product discontinuations in 2025 involved products priced below $1 per unit.¹

"In fact, 65% of the drug product discontinuations in 2025 had a price point below $1 per unit," he said. "At that pricing level, it simply doesn't leave enough margin to invest in quality or supply chain resilience systems."

These data signify that economic pressures may be contributing not only to supply disruptions but also to shrinking market participation among manufacturers.¹

Geographic Dependence Continues to Raise Concerns

One of the report's most critical findings involved the sourcing of key starting materials used in pharmaceutical manufacturing.¹ According to USP, 44% of drugs in shortage at the end of 2025 had at least one key starting material manufactured exclusively in a single country.¹

Christian noted that many of these materials originate from China or India, creating substantial geographic concentration within the pharmaceutical supply chain.

"That's a heavy, heavy geographic dependence," Christian said. "Most of those key starting materials are either coming from China or India, making US patients very dependent on manufacturing within those regions."

To help stakeholders better understand these vulnerabilities, USP has expanded resources such as its Medicine Supply Map, which provides visibility into supply chain dependencies and manufacturing concentration risks.³

"Visibility is absolutely critical here," Christian said. "We're proud to have tools like the Medicine Supply Map that help identify, characterize, and quantify risk.

Implications for Pharmacists

Older generic sterile injectable medications remain among the products most susceptible to disruption, according to USP.¹ These shortages can force pharmacists into a position to identify therapeutic alternatives, modify treatment protocols, coordinate inventory management efforts, and communicate with prescribers regarding supply limitations.

"We understand that pharmacists are on the front lines," Christian said. "In addition to the patient impacts of these drug shortages, they are impacted by having to come up with alternative protocols or call around to manage some of these supply shortages."

With the progression of evolution in drug shortages from short-term disruptions into long-term supply challenges, this report displays the importance of greater transparency, diversification, and investment in pharmaceutical manufacturing resilience.¹^,³ While overall shortage numbers may be moving in the right direction, the persistence of lengthy shortages suggests that addressing the underlying vulnerabilities of the drug supply chain will remain a priority for years to come.

References

1. United States Pharmacopeia. Drug Shortages. USP. Accessed June 16, 2026. https://www.usp.org/supply-chain/drug-shortages

2. United States Pharmacopeia. Long-Lasting Drug Shortages Drive Average Duration Higher, Disrupting Patient Care. USP. Published 2026. Accessed June 16, 2026. https://www.usp.org/news/long-lasting-drug-shortages-drive-average-duration-higher-disrupting-patient-care

3. United States Pharmacopeia. Medicine Supply Map. USP. Accessed June 16, 2026.https://www.usp.org/supply-chain/medicine-supply-map