Why Drug Shortages Are Lasting Longer Than Ever: Expert Insights on Supply Chain Risks

Pharmacy Times speaks with Matt Christian, the Director of Supply Chain Insights at US Pharmacopeia (USP), about the factors driving persistent drug shortages, emerging supply chain vulnerabilities, and what pharmacists should know moving forward.

Drug shortages may be declining in number, but persistent vulnerabilities continue to threaten the US medicine supply chain, according to Matt Christian, Director of Supply Chain Insights at USP. Speaking with Pharmacy Times, Christian explained that while the reduction in active shortages is encouraging, the average shortage duration now exceeds five years, signaling deeper systemic issues rather than a fully recovering supply chain.

Christian identified four primary drivers of supply chain fragility: low drug prices, quality concerns, manufacturing complexity, and geographic concentration. He noted that medications with lower prices often generate insufficient margins for manufacturers to invest in quality improvements and resiliency measures. This economic challenge was reflected in USP’s findings that 65% of drug product discontinuations in 2025 involved products priced below $1 per unit.

The impact of shortages extends across numerous therapeutic areas. Christian highlighted pediatrics, gastroenterology, anesthesiology, endocrinology, and oncology among the most affected categories, emphasizing that the breadth of affected specialties points to a widespread supply chain issue rather than isolated market failures. Older generic sterile injectable medications remain particularly vulnerable due to limited manufacturer incentives to strengthen production infrastructure and supply chain resilience.

One of the report’s most notable findings involved upstream manufacturing dependencies. Christian explained that 44% of drugs in shortage at the end of 2025 relied on at least one key starting material produced exclusively in a single country. Many of these materials originate from China or India, creating significant geographic concentration risks. Such dependencies can leave the US drug supply vulnerable to disruptions caused by trade disputes, natural disasters, quality failures, or other geopolitical events.

For pharmacists, these shortages create operational challenges that extend beyond patient care, often requiring alternative treatment protocols and extensive efforts to secure medication supplies. Christian emphasized the importance of supply chain visibility tools, such as USP’s Medicine Supply Map and the USP Resiliency Center, which help stakeholders identify vulnerabilities and strengthen medicine supply resilience for US patients.