For Clinicians | Why Drug Shortages Happen and How Long They Actually Last

For Clinicians | Why Drug Shortages Happen and How Long They Actually Last

By Dr. Jamie Wilkey, PharmD — Director of Clinical Strategy, Jase
Medically reviewed and edited by Kristen Carpenter, PA-C

Hi, I’m Jamie. I’m also a pharmacist. I’ve spent more than ten years behind the pharmacy counter, and I’ve helped thousands of patients and prescribers work around a drug shortage. Unfortunately, I know a lot about drug shortages and what a pain they can be. 

Drug shortages peaked in 2024, when 323 of them were active at once. We’re lower now, but 227 drugs are still in shortage as of mid-2026.¹ So I thought it would be fun to do this one question-and-answer style: what a shortage actually is, why they happen, what your pharmacist can and can’t do, and what you should know as a prescriber to help your patient through one.

These are the questions I get the most, and my answers.

“Why do drug shortages keep happening?”

Most of the time nobody tells us. When the University of Utah Drug Information Service asked manufacturers why a drug went short in 2025, 59% either didn’t know or wouldn’t say.¹ Independent analysis fills in some of that gap and points to manufacturing quality problems as the largest single driver.² A problem turns up at a plant, the manufacturer slows or halts production to fix it, and supply that was already thin disappears. Just under half of this year’s new shortages came from sole-source products, where one manufacturer is the whole supply.¹Most of the drugs that go short are generic sterile injectables, hard to make and sold for almost nothing because hospitals buy on price.³

Which explains why a shortage doesn’t ease just because the whole country needs the drug. In most markets, high demand pulls in new suppliers. Here in the pharmacy manufacturing world it barely does. A company that wanted to start making a short drug needs its own FDA approval for that product at that specific plant, plus tech transfer and validation batches on a sterile line. That’s a multi-year project ending in a product that sells for pennies, and the shortage may be over before they arrive. So nobody comes and medication stays short sometimes for whole years.

The drug comes back when that manufacturer fixes what the FDA found, revalidates the line, and passes reinspection. That clock runs on remediation, not on how badly your patient needs it.

“How long do drug shortages last?”

Way too long. HHS looked at every shortage between 2018 and 2023 and found a median duration of 2.55 years.⁴ Not weeks or months that you’d mentally expect. Years.

The split by dosage form is important here for you healthcare providers. Oral drugs ran a median of 1.59 years, injectables 4.60.⁴ Three years into a shortage, 8.1% of oral products were still short. For injectables it was 64.6%.⁴ So if what your patient needs is a tablet, waiting it out is at least a real strategy. If it’s an injectable, the odds are close to two in three that it’s still short three years from now.

“So what does this mean for your patients?”

Here’s the weird part: a drug in shortage is usually not 100% unavailable. Shortage means supply isn’t meeting demand, and day to day that looks like dribs and drabs are coming into the pharmacy. Some weeks the wholesaler releases a little, some weeks nothing. One strength ships while another doesn’t. Most of the time the drug goes on allocation, so a pharmacy can order only a fraction of what it normally buys, based on its own purchase history.

Which is why two pharmacies in the same town tell your patient different things in the same week, and both are being truthful for their situation. One got a partial shipment Tuesday. The other is capped well below what it needs and spent its allocation on patients already established on the drug.

So when a pharmacy says they can’t get it, that’s true, and it’s also not the whole story. It’s this pharmacy, this week, this strength.

“But the FDA site says there’s no shortage…”

Great question. And it is confusing here! Two national lists intentionally count different things. FDA calls it a shortage when nationwide supply isn’t meeting current or projected demand. ASHP lists any shortage a practitioner reports and it confirms, down to the specific manufacturer, strength, and vial size.7 So a drug can be truly unavailable from the manufacturer your patient’s pharmacy buys from and never show up on FDA’s list, because nationally the supply is holding.

Same reason this year’s headline numbers look like they contradict each other. Only 89 new shortages started in 2025, the fewest since 2006.⁵ Active shortages climbed anyway, three quarters in a row.⁶ Fewer beginnings, yes, but the existing backlog isn’t clearing.

So when your patient says the FDA site shows their drug isn’t short, they aren’t wrong. They’re reading the answer to a different question.

“What can the pharmacy actually do?”

Most of this is our job as pharmacists and pharmacy technicians, and it starts before we call you. We’re checking what the wholesaler will release, calling nearby locations, pulling the manufacturer’s estimated resupply date, and working out which substitution is actually available today. By the time your phone rings, we’ve usually ruled out the easy options and we’re calling because the remaining one needs your signature.

Here’s what we’re working through behind the scenes:

• Another manufacturer. For a generic we can usually source a different labeler without calling you at all, unless you wrote it brand-specific or dispense as written.
• Another strength at the same total dose. Two 10 mg tablets instead of one 20 mg. Depending on your state, we can often do this without a new prescription.
• Another formulation. A capsule substituted for a tablet, etc. Requires a new Rx from you.
• A transfer (as long as it hasn’t been filled yet). Since 2023, even controlled substances can move. An electronic prescription for a Schedule II through V drug can transfer between retail pharmacies one time, at the patient’s request, pharmacist to pharmacist, where state law allows.⁸

One caution on the resupply date we quote you. It comes from the manufacturer and it moves. Treat it as an estimate with the best information we get…. not a promised delivery date.

“How do I work with the pharmacy most efficiently on this?”

Your pharmacist will probably reach out with a substitution already in mind, or handle it without you when we’re able to. That’s going to be more effective than sending over a best guess that may well be out of stock too.

Controlled substances are where the order of operations flips. A Schedule II prescription can’t be refilled, so every fill is a new prescription, and you can’t scatter one across three pharmacies to see who has stock. ADHD stimulants are the poster-child drug classes most of us have lived through recently.⁵ So have your patient call around first and confirm the exact drug, strength, and quantity is physically on the shelf of a pharmacy, then send the prescription to that pharmacy. Some won’t confirm controlled stock over the phone, so your patient may have to walk in and ask. Either way it beats your staff calling every pharmacy in the county. And if a prescription is already sitting at the first pharmacy, ask them to delete it so you don’t leave a duplicate out there.

The bottom line

Shortage guidance exists, but look who it’s written for. ASHP’s is built for a P&T committee, FDA’s for manufacturers. Neither one tells you what to do about one patient, one prescription, and one pharmacy that got a partial shipment Tuesday with a waitlist a mile long.

Shortages have stopped being interruptions. They’re part of the job now. The prescribers who handle them well decided how they would handle them before the call came in. That outpatient gap is where we work. Appropriate medical preparation is our name for it: a licensed provider reviews the request and writes the prescription ahead of the moment a patient needs it, for a short list of common conditions. It complements primary care, it doesn’t replace it.

If your patients are asking questions you don’t have time for, send them to us at Jase.com. We’d rather help you plan for the next shortage than help your patient recover from the last one.

Sources

1. National Drug Shortages, January 2001 to June 2026. American Society of Health-System Pharmacists, data from the University of Utah Drug Information Service. 227 active shortages as of Q2 2026, up for a third consecutive quarter, against an all-time high of 323 in the first quarter of 2024; 89 new shortages in 2025; 16% of active shortages are controlled substances; 48% of new 2026 shortages are sole-source; manufacturers reported no reason or an unknown reason for 59% of 2025 shortages. https://www.ashp.org/drug-shortages/shortage-resources/drug-shortages-statistics 
2. Wosińska ME. Drug shortages: a guide to policy solutions. Brookings Institution, March 13, 2024. Manufacturing quality disruptions the leading cause of shortages, 46% in 2022; generic sterile injectables 63% of current shortages. https://www.brookings.edu/articles/drug-shortages-a-guide-to-policy-solutions/ 
3. McGeeney JD, McAden E, Sertkaya A. Analysis of Drug Shortages, 2018-2023, Introduction. Data brief prepared for HHS ASPE Office of Science and Data Policy, January 8, 2025. Purchasers have limited ability to assess manufacturers’ quality systems or backup capacity and often choose drugs solely on price, rewarding companies that reach lower costs by sacrificing investment in resilient manufacturing; facilities typically run above 80% capacity, so firms cannot easily increase production during a shortage. https://aspe.hhs.gov/reports/drug-shortages-2018-2023 
4. McGeeney JD, McAden E, Sertkaya A. Analysis of Drug Shortages, 2018-2023, Results. Median shortage duration 2.55 years overall, 1.59 years oral, 4.60 years injectable. Three years after onset, 64.6% of injectable shortages remained unresolved, against 8.1% of orals and 26.1% of topicals. https://aspe.hhs.gov/reports/drug-shortages-2018-2023 
5. Silverman E. The number of new drug shortages in the U.S. hits lowest level in 20 years, but myriad problems remain. STAT News, January 22, 2026, reporting ASHP’s year-end 2025 data. 89 new shortages in 2025, the fewest since 2006; ADHD medications and controlled substances remain difficult to source. https://www.statnews.com/pharmalot/2026/01/22/medicines-pharma-biotech-shortages-hospitals-injectables/ 
6. Active US drug shortages rise for third straight quarter. AJMC. 227 active shortages as of the second quarter of 2026. https://www.ajmc.com/view/active-us-drug-shortages-rise-for-third-straight-quarter
7. FDA vs. ASHP Drug Shortages List. American Society of Health-System Pharmacists. ASHP confirms practitioner-reported shortages at the manufacturer, strength, and fill-volume level; FDA assesses shortages against nationwide supply and demand. https://www.ashp.org/-/media/assets/drug-shortages/docs/drug-shortages-fda-vs-ashp-shortage-list.pdf 
8. Transfer of Electronic Prescriptions for Schedules II-V Controlled Substances Between Pharmacies for Initial Filling. Drug Enforcement Administration final rule, 88 Fed. Reg. 48365 (July 27, 2023), effective August 28, 2023; Docket No. DEA-637, RIN 1117-AB64. One-time transfer for initial filling at the patient’s request, communicated directly between two licensed pharmacists, prescription unaltered and in electronic form, permissible only where state law allows. https://www.federalregister.gov/documents/2023/07/27/2023-15847/transfer-of-electronic-prescriptions-for-schedules-ii-v-controlled-substances-between-pharmacies-for