USP's Matt Christian: Why Drug Shortages Are Becoming Longer—and Harder to Solve

Although the total number of US drug shortages declined in 2025, many shortages have become increasingly prolonged, highlighting persistent vulnerabilities throughout the pharmaceutical supply chain. In an interview with Pharmacy Times, Matt Christian, director of Supply Chain Insights at USP, discussed the factors driving long-term shortages, the growing role of geographic concentration, and what pharmacists should understand about supply chain resilience.

Pharmacy Times: Drug shortages are down, but the average shortage now lasts more than 5 years. Should pharmacists view this as progress, or does it suggest that the underlying problem is actually getting worse?

Matt Christian: I believe it's both. Drug shortages decreasing in number is definitely a positive sign of progress, but what remains are these chronic, long-lasting drug shortages. With the average drug shortage duration now lasting more than 5 years, it indicates that this problem is systemic.

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

Facilities that have quality problems also tend to have supply chain reliability problems. Drugs that are more complex to manufacture tend to have greater resiliency issues. Geographic concentration also creates vulnerabilities because when production is concentrated in only a few locations, events such as trade disputes, natural disasters, or quality issues can have widespread downstream effects.

Pharmacy Times: Nearly half of drugs in shortage rely on at least 1 key starting material source from a single country. What are the biggest risks of these dependencies, and which drug categories should pharmacists be most concerned about moving forward?

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

That tells us shortages are not concentrated within a single specialty. Instead, they're indicative of a systemic supply chain issue rather than a problem confined to one area of the pharmaceutical market.

Pharmacy Times: The report found a 60% increase in drug product discontinuations. Are economic pressures making some medications simply unprofitable to manufacture, and how does that contribute to shortages?

Christian: Absolutely. Many of the resiliency factors correlated with drug shortages are also correlated with product discontinuations.

In fact, 65% of drug product discontinuations in 2025 involved products priced below $1 per unit. At that pricing level, manufacturers simply don't have enough margin to invest in quality improvements or supply chain resilience systems.

Pharmacy Times: Geopolitical tensions continue to affect global supply chains. Are current conflicts and trade disruptions involving major manufacturing and sourcing regions creating new risks for drug shortages in the United States?

Christian: Being specific about the particular geopolitical conflict matters, but visibility is absolutely critical.

We're proud to have tools like the USP Medicine Supply Map that help identify, characterize, and quantify supply chain risk. Our new key starting materials module demonstrates a significant lack of geographic diversity within upstream manufacturing, and those dependencies can ultimately create downstream drug shortage risks for US patients.

Pharmacy Times: Which drug shortages concern you most from a patient care perspective? Are there any emerging areas healthcare professionals should be watching closely?

Christian: Based on the sheer diversity of therapeutic classes affected, the impact is broad.

In general, older generic sterile injectable products remain the medications most susceptible to disruption because manufacturers often lack sufficient financial incentives to invest in supply chain resiliency programs.

Pharmacy Times: Pharmacists are often on the front lines of managing drug shortages. What strategies can help them prepare proactively, and how can resources such as the USP Resiliency Center support those efforts?

Christian: We understand that pharmacists are on the front lines. Beyond the impact on patients, pharmacists are also responsible for developing alternative treatment protocols and coordinating with suppliers to manage shortages.

Specific shortage management strategies are outside the scope of the Medicine Supply Map, but programs such as the USP Resiliency Center work with a broad range of stakeholders across the pharmaceutical industry to strengthen the supply of medicines for US patients.

Pharmacy Times: Is there anything else from the report that you believe pharmacists should know?

Christian: One of the most important findings from the report is that 44% of drugs in shortage at the end of 2025 have at least 1 key starting material manufactured exclusively in a single country.

That's a substantial geographic dependence. Most of those key starting materials originate from China or India, making US patients highly dependent on manufacturing within those regions.