What is a Z-Pack?

couple looking at computer asking questions

What is a Z-Pack?

You’ve heard of a Z-Pack.

Maybe your doctor prescribed one when a respiratory infection dragged on too long. Maybe you’ve watched a family member take it when a sinus infection turned serious. Maybe you can picture the blister pack — six pills, five days, done.

Azithromycin is one of the most recognized antibiotics in the country, and for good reason. With approximately 10.3 million prescriptions written annually in the United States, it ranks among the most commonly prescribed medications in modern medicine. That familiarity is actually part of why it earned its place in the JaseCase.

Here’s the part that’s worth understanding: what happens when you need it and can’t get it?

THE GAP BETWEEN NEEDING AN ANTIBIOTIC AND GETTING ONE

Most of the time, accessing medical care is inconvenient but manageable. You wait for an appointment. You stop by an urgent care. You pick something up at the pharmacy on the way home.

But life doesn’t always cooperate with business hours.

Consider a few situations that are more common than people realize. A child develops an ear infection on the third day of a beach vacation. A sinus infection that seemed mild at the start of a cross-country work trip turns serious by day two. A family member with a penicillin allergy — affecting roughly 10% of the population — spikes a 102-degree fever on a Sunday night when the nearest urgent care has already closed.

In each of these situations, the question isn’t whether an antibiotic is appropriate. The question is whether you have one.

WHAT AZITHROMYCIN ACTUALLY TREATS

Azithromycin covers a broad range of common bacterial infections — respiratory infections like community-acquired pneumonia, bronchitis, and sinusitis, as well as skin and soft tissue infections, traveler’s diarrhea, and more. It’s taken orally, which means no injections or infusion centers. It works quickly, typically within the first 24 to 48 hours. And its dosing schedule — usually a short course of three to five days — is forgiving enough to manage during a chaotic travel week or a demanding few days at home.

For patients who can’t take penicillin, azithromycin has long served as one of the most clinically reliable alternatives. Our clinical team made this choice deliberately — not because it was the path of least resistance, but because the evidence supports it and the real-world use cases are undeniable.

WHY IT’S IN THE JASECASE

At Jase, every medication in the JaseCase earns its place through the same process: clinical evaluation by a team of medical doctors, physician assistants, and pharmacists, weighed against evidence-based guidelines and practical patient scenarios.

Azithromycin cleared that bar on multiple fronts. It offers broad enough coverage to be genuinely useful across a range of situations. It has a well-established safety profile that most clinicians and patients already understand. And it represents the kind of medication that, when access to care is delayed, actually changes outcomes.

The framework we’re building around this is what we call Appropriate Medical Preparation. It’s not about stockpiling medications or avoiding the healthcare system. It’s about creating a legitimate, clinically-supported bridge for the moments when your primary care provider isn’t available — the closed pharmacy, the remote trail, the storm that keeps you home for four days, the country where no one speaks your language.

WHAT THIS ISN’T

We want to be straightforward about something, because it matters.

Having azithromycin available through Jase doesn’t mean using it casually. Every prescription that comes through our platform is issued by a licensed U.S. clinician who has reviewed your health history. Every medication comes with clear clinical guidance on when and how it’s appropriate to use.

This is the same antibiotic your doctor would likely prescribe in these situations. The difference is that you’ve done the responsible work ahead of time — establishing care with a clinician before the emergency, understanding how your health history intersects with these medications, and knowing exactly what you have and when it’s the right call.

That preparation doesn’t replace your primary care relationship. It protects it. Because when the moment comes and you’re far from home or the system simply isn’t available right now, you’re not making decisions under pressure from a place of uncertainty. You already have a plan.

A TRUSTED ANTIBIOTIC, ON YOUR SHELF, BEFORE THE MOMENT YOU NEED IT

The goal of the JaseCase has always been clear: get the right medications to the right people before they’re in crisis, with clinical oversight built in from the start.

Azithromycin is one of the most familiar, most trusted antibiotics in modern medicine. It treats infections that can escalate when left untreated and that respond well when addressed early. In the situations where access to care is delayed — a trip, a natural disaster, a Sunday night — having it available with proper guidance could be the difference between a manageable situation and a serious one.

If you’re curious about what else is in the JaseCase and why each medication was chosen, our patient education library is built exactly for that.

Explore the JaseCase →

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For Clinicians | What Summer Heat Actually Does to Your Patients’ Medications

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For Clinicians | What Summer Heat Actually Does to Your Patients’ Medications

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

Most patients don’t call about how to store their medications. They Google it. They land on WebMD or a Reddit thread, depending on what SEO surfaces that morning, and they read whatever shows up first. The one exception is cold-chain medications. Insulin and GLP-1 questions do come into the office or the pharmacy, usually right before a vacation or right after a fridge incident, because the bottle says “refrigerate” in big letters and the patient knows it costs a lot. Everything else, the prescription bottle just says “store at room temperature” and the patient extrapolates from there.

But medications are some of the most valuable, fragile things in the average household that don’t play well with a boiling hot summer. A 90-day supply of a maintenance drug, an EpiPen, a JaseCase on the shelf, a vial of insulin in the door of the fridge: these are the household items that matter most on the day something goes wrong, and they’re surprisingly easy to degrade. Summer is hard on all of them. Heat, humidity, light, and the slow accumulation of a parked-car afternoon all chip at potency in ways the label doesn’t quite explain. A brush-up on the basics is overdue: so we have something clean to say when a patient does ask, and because every prescribing clinician should be able to answer this kind of question without scrambling.

So we wrote the answer. Below is everything that actually matters about summer medication storage: what heat does, where patients should keep their medications at home, the room-temperature windows for refrigerated medications that most labels underestimate, how to travel with all of it, and the cold-chain devices worth knowing by name. Read it yourself, or send the link to patients with a lot of questions.

What does heat actually do to medications?

Heat speeds up the chemical breakdown of the active ingredient. The molecule degrades faster than it would at room temperature, the medication loses potency, and the same pill or vial does less of what it’s supposed to do. For tablets and capsules, prolonged heat can also soften capsule shells and damage the stabilizers that keep the active ingredient intact between manufacture and ingestion. For biologics and protein medications like insulin and monoclonal antibodies, proteins unfold under heat and the medication loses activity in a way that’s harder to reverse than potency loss in a tablet.

The risk is almost always reduced potency, not toxicity. The medication does less, not something different. That distinction carries the rest of this article.

USP storage definitions are simpler than the label suggests:

  • Room temperature: 68 to 77°F
  • Brief excursions to 86°F: explicitly tolerated
  • Sustained above 86°F: stability concerns start
  • Sustained above 104°F: real degradation territory for most medications

The frame that carries every storage conversation is brief excursion vs. sustained exposure. Most of us learned this in some form in school, but the prescription label doesn’t carry the math; it just says “store at room temperature” and stops there.

The most useful number anyone can carry: a 2018 ASU and UC San Diego study found that on a 100°F day in direct sun, a car interior reaches an average of 116°F within an hour.¹ Dashboards hit 157°F. Even on a 72°F day, a closed car parked in the sun can reach 117°F within 60 minutes. About 80% of the temperature rise happens in the first 30 minutes.² The car isn’t a controlled-room-temperature environment. It’s an oven with windows.

For most medications, what actually matters is the answer to two questions: how hot did it get, and for how long. A single afternoon on a hot passenger seat is closer to “excursion” than “sustained exposure” for most solid oral dosage forms in their original packaging. A summer in the glove compartment is the opposite. The line to teach patients, and the one to keep in our own heads, is the difference between an excursion and a season.

Where should medications actually live at home?

The two most popular places to store medications are also two of the worst: the bathroom medicine cabinet and the kitchen counter or cabinet. Each fails for a different reason.

Bathrooms run hot and humid. Measured temperatures range from 57 to 89°F and relative humidity from 33 to 100%, with shower steam pushing the high end well past pharmaceutical tolerances.³ Pills absorb water and capsule shells soften. Dissolution profiles shift and pharmacokinetics get less predictable. The “don’t store meds in the bathroom” advice is one of the few storage rules that’s actually right, even if most patients haven’t heard it explained.

Kitchens fail differently. Measured temperatures range from 61 to 97°F. Cooking heat and sink humidity spike unpredictably; an open oven or a warm dishwasher can push the room well above room-temperature thresholds in minutes.³ A 2023 case report documented enzalutamide degrading in a patient’s kitchen at sustained temperatures of 32 to 34°C, a real outcome from a perfectly normal storage location.⁴ Kitchens look benign on a 70°F morning. The medications inside don’t stay benign through a few weeks of summer.

Glove compartments and garages are the worst of the lot in summer. Glove compartment heat accumulates and is documented as unsuitable for any drug storage. Garages in heat-wave conditions routinely exceed 104°F for days at a time, which is the threshold where stability concerns become guarantees.

The FDA’s recommended locations are mundane on purpose: a bedroom dresser drawer, a closet shelf, a storage box, or a kitchen cabinet that’s away from the stove and the sink.⁵ The dresser drawer is the consistent winner: cool, dark, dry, and out of reach of shower steam. A JaseCase belongs there too. The kit is room-temperature stable as designed; it just needs a sensible address.

Mail-order pharmacy and the summer porch

Mail-order pharmacy is now standard for millions of patients, and that matters in summer. A package leaving an Express Scripts or OptumRx fulfillment center in July spends hours in a non-climate-controlled truck, then more hours sitting on a porch in the sun before anyone brings it inside.

Internal package temperatures in summer delivery trucks and on porches have been measured at over 100°F in 2024 investigations.⁶ For solid oral medications in original packaging, a single hot transit is closer to “excursion” than “sustained exposure” and usually doesn’t matter. For biologics and refrigerated medications, every hour above label tolerance matters.

We ship by mail too. If a Jase package lands on a 95°F porch, the right move is to bring it inside as soon as it arrives, not when the lawn gets watered or the dog gets walked. Pharmacy counters see the back end of the same problem: patients picking up a prescription, walking to a hot car, running errands for two more hours before they get home. The trip from that pharmacy counter to the drawer at home matters too.

What does light do to medications?

UV light degrades the active ingredient in many medications the same way heat does, just through a different mechanism. The amber tint on prescription bottles is the simplest defense pharma has built into the supply chain: it blocks the wavelengths most likely to break down photosensitive drugs. The bottles are orange for a reason. It isn’t aesthetic or because pharmacists love the color orange.

Ciprofloxacin and metronidazole both carry explicit “protect from light” guidance. Doxycycline does too, and adds patient phototoxicity on top: the exaggerated sunburn from minimal sun exposure that we warn patients about at prescription or pickup.⁷ The same UV that’s bad for the patient is also bad for the drug.

The practical implication: keep antibiotics in their original packaging until use. Pill organizers are fine for daily-use chronic medications taken every morning, but they’re a poor home for an antibiotic that might sit there for months. Original amber bottle or original blister pack. 

Does refrigerating medications make them last longer?

The patient logic is easy to reconstruct: cold keeps food fresh longer, so cold should keep pills fresh longer. Old antibiotics, expensive maintenance meds, anything the patient wants to “stay good” ends up in the refrigerator door next to the ketchup. Ask anyone who has done a brown-bag medication review.

The chemistry instinct isn’t wrong. Cold does slow degradation. The problem is everything else about a refrigerator. It’s a high-humidity box, and every trip out of it sets a cold bottle in a warm room, where condensation forms on and inside the container. For tablets and capsules, moisture is a worse enemy than mild warmth: hygroscopic tablets absorb water, capsule shells soften, and dissolution shifts, the same failure mode as the bathroom shelf. Aspirin is the classic example. Hydrolysis breaks it into salicylic acid and acetic acid, which is why an old bottle smells faintly of vinegar.

Two more points worth having ready at the counter:

  1. Refrigeration doesn’t extend the expiration date. Stability testing assumes room temperature, and the date on the bottle is the date no matter where it sits. The cold may slow the chemistry a little, but the patient can’t bank that time, and the moisture exposure can outrun whatever it adds.
  2. Some medications actively don’t tolerate cold. Clarithromycin suspension is the standard counterexample: refrigerate it and it thickens and turns intensely bitter, which is why the label says not to. Amoxicillin suspension, meanwhile, goes in the fridge for taste. The label decides, not the drug category.

Refrigerate what the label tells you to refrigerate, nothing else.
Everything else does better in the drawer.

How long do refrigerated medications last at room temperature?

Insulin and GLP-1s are the top medications that patients ask about the most, with the refrigerated biologics (Humira, Dupixent, Enbrel) close behind. Anything that lives in the fridge gets the patient’s full attention, because the bottle says so and the price tag enforces the lesson. The question we get most often is the one with the cleanest answer: how long can this sit at room temperature?

Room-temperature windows at or below 86°F (30°C):

  • NovoLog (insulin aspart): 28 days
  • Levemir (insulin detemir): 42 days
  • Toujeo (insulin glargine U-300): 56 days
  • Humira (adalimumab): 14 days
  • Dupixent (dupilumab): 14 days
  • Enbrel (etanercept): 30 days, in original carton
  • Insulin in a pump at body temperature: 7 days

These windows are conservative. The 2025 Cureus review of 150 FDA-approved refrigerated medications found that around 60% are stable at room temperature for between a week and a month, often longer than the label permits.⁸ The labeled window is what we use for patient guidance because it’s what the manufacturer will stand behind. Real-world stability is usually more generous. We stay on the label, but we don’t pretend it’s the only data.

The fridge isn’t a free pass either. A 230-patient sensor study found that about a quarter of household refrigerators expose insulin to sub-freezing temperatures, usually on the back wall or on the shelf next to the freezer.⁹ Average exposure is roughly three hours per month, which adds up over a year. The safe spot is the middle of the fridge, on a center shelf, away from the freezer wall. Where you store it matters as much as whether you store it.

Does a hot car ruin an EpiPen?

Almost certainly not, if it was an afternoon. A 2016 systematic review in Annals of Allergy, Asthma & Immunology analyzed brief heat and cold excursions and found that single short exposures to temperatures outside the labeled range do not produce meaningful epinephrine degradation, and do not warrant replacing the auto-injector.¹⁰ Brief freezing did not show significant degradation either, though the label still says don’t freeze for a separate reason: a frozen glass syringe can crack.

Sustained heat is the real problem. Bench studies show meaningful degradation after 240 hours at 70°C, the kind of exposure that comes from leaving an auto-injector in a glove compartment for a whole season, not an afternoon at a soccer game.¹⁰

A brief excursion doesn’t degrade the drug. Sustained exposure does. An EpiPen that spent four hours in a car on a 100°F day and then went back into the dresser drawer is almost certainly still fine. One that lived in the glove compartment from June through August is not.

Navigating TSA with insulin and other refrigerated medications

At security, the most common mistake travelers make is surrendering a gel ice pack because it’s slushy. The TSA medical-screening rules are explicit: gel ice packs in any state, even partially melted or fully thawed, are allowed if they’re medically necessary and declared.¹¹ Insulin coolers do not have to be frozen solid at screening. Liquid medications, including insulin and GLP-1 injectables, are also exempt from the 3.4-ounce limit on carry-on liquids. Pharmacists and prescribers field most of the travel questions; the instruction that matters most is the one most travelers don’t know to give: declare, don’t surrender.

A few consumer products exist for keeping refrigerated medications cool on a trip including evaporative cooling wallets, battery-powered cooling caps, and small temperature sensors that drop into any case or fridge and report to a phone app. Useful as a verification layer when a patient wants to know whether their cooler held, or whether the hotel fridge dropped below freezing overnight.

The bottom line

Summer is hard on medications because most patients don’t think about storage as part of the prescription. The basics carry most of the weight: keep medications in their original packaging, in a cool dry drawer away from the bathroom and the kitchen and the car, and bring mail-order packages inside as soon as they arrive. Cold-chain medications get their own playbook: room-temp windows on the label, a cooling wallet or cap on the road, and gel packs declared at TSA.

This is what we mean by appropriate medical preparation: the everyday work that makes a household ready before the day something goes wrong. It’s a complement to primary care, not a substitute. Send this to your patients ahead of the busy, hot summer travel days.

Sources

  1. Vanos JK et al. Evaluating the impact of solar radiation on pediatric heat balance within enclosed, hot vehicles. Temperature, 2018. https://news.asu.edu/20180516-discoveries-asu-study-hot-cars-can-hit-deadly-temperatures-within-one-hour
  2. McLaren C, Null J, Quinn J. Heat stress from enclosed vehicles: moderate ambient temperatures cause significant temperature rise in enclosed vehicles. Pediatrics, 2005;116(1):e109-12. https://www.kidsandcars.org/document_center/download/hot-cars/2005-07-01-heat-stress-enclosed-veh-study.pdf
  3. Household storage temperature and humidity ranges for kitchens and bathrooms. PMC8326694. https://pmc.ncbi.nlm.nih.gov/articles/PMC8326694/
  4. Enzalutamide degradation in a household kitchen at sustained temperatures of 32-34°C: case report, 2023. PMC10192985. https://pmc.ncbi.nlm.nih.gov/articles/PMC10192985/
  5. US Food and Drug Administration. Don’t Be Tempted to Use Expired Medicines. https://www.fda.gov/drugs/safe-disposal-medicines/dont-be-tempted-use-expired-medicines
  6. Mail-order pharmacy heat investigations: Advisory Board, 2024 (https://www.advisory.com/daily-briefing/2024/08/19/mail-order-drugs); North Carolina Health News, 2024 (https://www.northcarolinahealthnews.org/2024/08/22/extreme-heat-mail-order-medicine-temperature-tracking/)
  7. Drug storage and stability: photosensitive medications and packaging considerations. em-consulte. https://www.em-consulte.com/article/513841/drug-storage-and-stability
  8. Room-temperature stability of FDA-approved refrigerated medications: a review of 150 products. Cureus, 2025. PMC12465357. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12465357/
  9. In-use stability of insulin and household refrigerator temperature monitoring in 230 patients. PMC7783014. https://pmc.ncbi.nlm.nih.gov/articles/PMC7783014/
  10. Kassel L et al. Stability of epinephrine in auto-injectors after exposure to temperature excursions: systematic review. Annals of Allergy, Asthma & Immunology, 2016. https://www.annallergy.org/article/S1081-1206(16)30130-2/fulltext
  11. US Transportation Security Administration. Medical screening guidelines for travelers with medications and medical devices. https://www.tsa.gov/travel/security-screening/whatcanibring/medical

 

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Why You Can’t Count on the Pharmacy in a Crisis

couple looking at computer asking questions

Why You Can’t Count on the Pharmacy in a Crisis

By Aaron Asay, PA-C, DMSc — Executive Director, JaseResponse

Most of the time, the pharmacy works exactly the way we expect it to.

Your child develops strep throat, the pediatrician sends in amoxicillin, and you pick it up on your way home. You’ve taken the same blood pressure medication for years, and each month your refill is waiting for you. A specialist adjusts a medication, and within a day or two it’s available through your local pharmacy.

Until suddenly, it isn’t.

Maybe it’s October and your child needs amoxicillin suspension, but the pharmacist tells you they don’t have any in stock. Maybe the medication you’ve taken successfully for years is suddenly backordered, and the substitute offered feels unfamiliar. Maybe a family member receives a call from their infusion center explaining that their treatment has been placed “on allocation” and that no one can confidently say when a stable supply will return.

These moments feel frustrating because we’ve grown accustomed to assuming medications will always be available when we need them. But increasingly, these aren’t unusual weeks in healthcare. They are becoming part of the environment patients, pharmacists, and prescribers are practicing inside.

I’ve spent years responding to disasters, humanitarian crises, and disruptions where access to healthcare suddenly changed overnight. During these deployments, I’ve witnessed families struggling to obtain medications they depend on simply because roads were impassable, pharmacies were closed, or healthcare systems were overwhelmed.

What’s been striking over the past several years is recognizing that families no longer need a hurricane, wildfire, or flood to experience similar disruptions. Sometimes, all it takes is a manufacturing issue halfway around the world, a shortage of active pharmaceutical ingredients, transportation bottlenecks, or increased demand for a commonly prescribed medication.

The Healthcare System Itself Has Begun Acknowledging This Reality

In a recent survey published in JAMA Network Open, nearly 90% of primary care physicians reported experiencing drug shortages within the previous six months. Almost half reported watching a patient’s disease progress while trying to navigate workarounds, and more than one in ten reported a major adverse event related to medication shortages.

This doesn’t mean families should panic or begin stockpiling medications.

It does mean we may need to rethink what preparedness looks like.

At Jase, our family team of medical doctors, physician assistants, and pharmacists has spent years working in the space between traditional primary care and the moments when traditional access breaks down. We often describe this as appropriate medical preparation.

For many families, appropriate medical preparation has two practical layers:

The first layer is continuity. It’s maintaining a documented supply of the medications your family already depends on whenever possible. It means keeping a written medication list that includes drug names, dosages, prescribing providers, and pharmacies. It means having enough margin that an unexpected backorder, shipping delay, or shortage doesn’t immediately become a crisis.

Second Layer

The second layer involves contingency planning. Certain conditions repeatedly emerge during disruptions, whether they’re caused by disasters, shortages, or healthcare access challenges. Having contingency antibiotics and emergency medications available, accompanied by clinician-reviewed guidance about when to use them and when to seek additional care, can help families navigate those situations more confidently.

Importantly, none of this replaces a relationship with a primary care physician.

Primary Care Foundation

Primary care remains the foundation of good healthcare. Chronic conditions, ongoing management decisions, preventive care, and new diagnoses belong in the exam room. Appropriate medical preparation simply acknowledges that healthcare increasingly operates within a system that isn’t always predictable. It offers patients and clinicians a thoughtfully built second layer so that the phone call from the pharmacy doesn’t become the only plan a family has.

Resilience

After years of disaster response, one lesson has become increasingly clear to me: resilience isn’t built in the middle of a crisis. It’s built beforehand, through small decisions that create stability when systems become strained.

For some families, that may simply mean asking their provider about extending a maintenance medication supply. For others, it may mean building a more comprehensive preparedness plan. The goal isn’t fear. The goal isn’t stockpiling. The goal is having enough margin that when the routine channel temporarily stops working, your family still has options.

Because whether the disruption comes from a hurricane, a wildfire, a global manufacturing issue, or a medication shortage no one saw coming, preparation creates capacity.

Capacity to stay calm. Capacity to adapt. Capacity to have compassion for others in crisis. 

And ultimately, capacity to care for the people around us while the system catches up.At Jase, that’s what we believe appropriate medical preparation looks like

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For Clinicians | Drug Shortages 2026

couple looking at computer asking questions

For Clinicians | Drug Shortages 2026

Prescribing Inside a Supply Chain the System Has Admitted Isn’t Built for Disruption

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

A Dad comes to the counter an hour before the pharmacy closes for the night and asks why his daughter’s strep Rx isn’t ready yet. 

“Sorry, sir, that antibiotic for your child isn’t something we have in stock right now so I can’t fill the prescription for you tonight since I don’t have anything on hand I can easily switch it to.”

      “Ah. That’s so frustrating!!!! You’ll get it in tomorrow, right?!”

That’s the question I’ve answered more times than I can count, standing behind a pharmacy counter on a holiday weekend, looking at a parent trying to fill a script for liquid amoxicillin or azithromycin for a kid who is miserable. The shelves behind me look full. They are. They just don’t have what this family needs. The wholesaler order will show up on Monday or Tuesday…. but I won’t know what’s actually in it until I open the tote and see what ABC or Cardinal sent me. Until then, all I can tell her is, “I don’t have it now, and I hope to get it on Monday.” She can’t bank on that either. She knows it.

The next options aren’t great. The pharmacy across town might have it, but her insurance isn’t accepted there, or it’s already closed for the weekend, or it has shorter holiday hours and will be closed before she can get there, or it means setting up a new profile and re-entering all her billing info just for this one prescription. That’s a big old pain. And the kid feels worse by the hour. 

This isn’t a one-off year. It feels monthly. And when there’s no substitute formulation on the shelf, the call goes back to the prescriber for a new drug at a different dose. On a Saturday night, both of us trying to track each other down in time to actually get the kid treated.

Today we’re talking about drug shortages in 2026: what ASPE/HHS now says on the record about a supply chain that isn’t built for disruption, and what a stable practice posture looks like when you’re prescribing inside it.

How bad are drug shortages in 2026, really?

Worse than we realize, and lasting longer than the system has trained us to expect.

Three-quarters of the drug shortages currently active in the US began in 2022 or later¹. The median active shortage now runs 2.55 years across all drugs, and 4.60 years for sterile injectables². This isn’t a temporary interruption you and your patient ride out. It’s a sustained structural condition we’re prescribing inside.

The supply side explains the durability. As of August 2024, only 24% of the API manufacturing facilities producing drugs for the US market sat inside the United States, down from 28% in August 2019³. Most of what we hand a patient is made upstream of a global chain we don’t control, and the chain isn’t getting more local.

In its September 2025 report on supply chain resilience, ASPE/HHS reviewed the methods that exist for measuring whether the medical supply chain is actually prepared, and concluded that “few have been widely adopted or proven scalable across product types or supply chain segments”⁴. HHS doesn’t yet have widely-adopted tools for measuring its own resilience. We’re prescribing inside it anyway.

What’s actively short in summer 2026

In Q1 2026, ASHP counted 223 active national drug shortages, the second consecutive quarter the count has risen⁵. The mix isn’t the headlines you might remember.

ADHD stimulants: amphetamine mixed salts (IR and XR), lisdexamfetamine, and methylphenidate ER are in their fourth year of active shortage. Specific strengths of amphetamine XR had release dates as recently as mid-May and early-June 2026.

Sterile injectable chemotherapy: vinblastine, methotrexate, and cisplatin are all currently short. Vinblastine is the most-shorted oncology drug, reported in shortage at 57% of surveyed centers⁶.

Injectable opioids: morphine sulfate (on the FDA shortage list since 2017) and fentanyl citrate (since 2012) remain chronically short. Acute pain, surgical anesthesia, palliative care.

Estradiol and progesterone: added to the shortage list in January and February 2026. Demand is up; manufacturing capacity hasn’t caught up.

88% of PCPs hit a shortage in the past six months

Pharmacy school, medical school, PA school: all of us trained inside a system where medication stock was reasonably predictable. That system isn’t real life these days. What replaced it is a fragmented, partly-imported, partly-allocated, partly-rationed pipeline that none of us were taught to prescribe inside. The training assumed reliability. The job no longer offers it.

And the data has caught up to what we already knew. In a JAMA Network Open survey published January 7, 2026, 88% of primary care physicians (795 of 902 surveyed) reported experiencing a drug shortage in the prior six months. Eighty-seven percent of those PCPs reported quality-of-care changes tied directly to the shortage. Forty-nine percent watched a patient’s disease progress while they were trying to find a workaround. Thirteen percent had a patient hit a major adverse event7. That isn’t a hypothetical risk profile. That’s the clinical environment we’re working in right now.

The 2022-2023 amoxicillin shortage is the clean case. After the FDA shortage declaration, the odds of a pediatric acute otitis media patient being prescribed amoxicillin dropped by 91%. Amoxicillin-clavulanate and cefdinir prescriptions rose 7-fold and 9-fold8. The shortage didn’t just delay care; it shifted the entire prescribing pattern for the most common pediatric bacterial infection toward broader-spectrum, second-line antibiotics. The stewardship cost of that shift is real, and nobody planned for it.

This is what practicing inside a structurally unreliable supply chain looks like, right now.

What stable practice posture looks like in 2026

Stable practice posture inside this environment has three concrete components. Together they hold when the routine channel doesn’t.

  1. Chronic supply, patient-held: the patient holds an extended physical supply of their actual maintenance medications, with a written list they and any covering provider can read. Ninety days, where insurance allows. Longer where it doesn’t, by self-pay or workaround. The point is the patient has the medication in hand before the routine channel breaks, not after.
  1. Contingency layer: for shortage-prone categories like antibiotics and emergency medications, the patient holds a prescribed supply with clear guidance on when to use it. The clinical work happens on the front end. The patient isn’t winging it on their own at 11pm.
  1. Documentation and decision criteria: what the patient has, what triggers its use, when to defer back to primary care. The framework is written down. Any provider can read it in thirty seconds.

This is what Jase has been building carefully for more than 5 years: appropriate medical preparation. It complements primary care; it does not replace it. The second layer is there for the gap, not the relationship.

Charting the grey area in public

Appropriate medical preparation is a new clinical category, and we’re building it carefully. Documented criteria, not vibes. If a patient is asking you what to have at home just in case and the conversation is going to take longer than you have, you can refer them to us at Jase.com. We’ll do the clinical work in front, document it, and route them back to you for everything else.

Going forward, we’ll share how we make those calls: what we prescribe and why, where the evidence is solid, and where it’s still being written. Public knowledge gets better when clinicians chart the grey area in public, not when we leave the internet to do it.

The team is family medicine physicians, physician assistants, and pharmacists with field experience in disaster medicine and humanitarian response. The clinical work happens on the front end, so the patient isn’t winging it on their own at 11pm.

Sources

  1. ASHP National Drug Shortages Report, Q4 2025. Released January 2026. https://www.ashp.org/drug-shortages/shortage-resources/drug-shortages-statistics
  2. ASPE/HHS Office of Science and Data Policy. Analysis of Drug Shortages, 2018-2023 (Data Brief). January 10, 2025. https://aspe.hhs.gov/reports/drug-shortages-data-brief
  3. ASPE/HHS Office of Science and Data Policy. Analysis of Drug Shortages, 2018-2023 (Data Brief). January 10, 2025. The 28% (August 2019) baseline references Janet Woodcock, FDA testimony, “Safeguarding Pharmaceutical Supply Chains in a Global Economy,” October 30, 2019. https://aspe.hhs.gov/reports/drug-shortages-data-brief
  4. ASPE/HHS (Mathematica). Defining and Measuring the Resilience, Criticality, and Vulnerability of Medical Product Supply Chains. September 2025. https://aspe.hhs.gov/reports/measuring-supply-chain-resilience
  5. ASHP Drug Shortage Statistics. Current National Shortages list, Q1 2026. Cross-referenced with the FDA Drug Shortages Database. https://www.ashp.org/drug-shortages/current-shortages and https://www.fda.gov/drugs/drug-safety-and-availability/drug-shortages
  6. JCO Oncology Practice. National survey on the impact of cancer drug shortages on US oncology practices, 2025. doi:10.1200/OP-25-00381. https://ascopubs.org/doi/10.1200/OP-25-00381
  7. Jarrett JB, Dillane KE, Hollett G, et al. Treatment Modifications After Drug Shortages Among Primary Care Physicians. JAMA Network Open. January 7, 2026. doi:10.1001/jamanetworkopen.2025.52802. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2843516
  8. Brewster RC, Khazanchi R, Butler A, O’Meara D, Bagchi D, Michelson KA. The 2022 to 2023 Amoxicillin Shortage and Acute Otitis Media Treatment. Pediatrics. September 2023;152(3):e2023062482. doi:10.1542/peds.2023-062482. https://pmc.ncbi.nlm.nih.gov/articles/PMC10895544/

 

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For Clinicians | Appropriate Medical Preparation

couple looking at computer asking questions

For Clinicians | Appropriate Medical Preparation 

The Clinical Category We’ve Been Practicing Without a Name

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

Patients have been asking us a version of the same question for years. “What’s reasonable to have on hand,…… just in case?” Most of us don’t have a clean answer.

  • The toddler spiking a fever past 11pm after the only instacare in town just closed. 
  • The UTI that announces itself Friday at 6pm with a weekend ahead.
  • Pink eye Sunday morning with school Monday. 
  • Strep in a rural county where the nearest ER is three hours away and urgent care closed at 6. 
  • The pharmacy that’s open but out of stock on the antibiotic the prescriber just called in
  • The cruise-ship UTI on night three. 
  • A traveler’s fever in a hotel in a country where nobody at the front desk speaks English. 
  • A national pharmacy chain offline for two days after a ransomware attack. 
  • A maintenance refill backordered the week of a long-planned trip. 

Different sizes of disruption, same shape underneath: a moment when primary care isn’t reachable, and the patient doesn’t have what they need on the shelf.

Our patients have been living in this middle for years without a word for it. We are giving it one: appropriate medical preparation. A clinically grounded buffer to primary care, not around it.  Common, predictable medical disruption that ends with an avoidable ER bill, a missed dose, a ruined vacation, or just a really bad week.

Between full healthcare and full prepper

Right now, patients are choosing between two answers. Full healthcare, available when you’re close to the doctor and the pharmacy and the schedule is cooperating. Or full prepper, where the assumption is help isn’t coming. Neither was built for the life they actually live. The institutional advice in between (FEMA’s 72-hour kit, the written medication list every family is told to clear) is what everyone’s told to have, but in practice almost no family does.¹

Patients are hungry for something better. Access. Travel. Geography. Timing that doesn’t fit a normal clinic schedule. The things that go wrong on a Friday night don’t wait for Monday morning. When healthcare doesn’t fill the gap, patients fill it themselves, often from dubious sources online, because they need a real answer and someone has to give them one.

The disruption doesn’t even need to be exotic to be miserable. My brother-in-law spent an hour and a half in a seemingly neverending line at 9pm on a Friday at the only 24-hour pharmacy in his county (and at 750K+ people, it’s not a small, rural podunk county). Just Friday at 9pm, not even a holiday weekend. The whole evening was gone for something he should’ve been able to have on his own shelf ahead of time.

Survival medicine has its place for the long-term disruptions where help really isn’t coming. But for the disruptions that fill most families’ calendars, the question isn’t whether help is coming. It’s whether the family already has what they need on the shelf, before the wait causes major inconvenience and perhaps deterioration in their condition. That’s what we’re building into: a clinical bridge that meets patients where they are, instead of asking them to work around healthcare hours that aren’t always in their best interest.

What’s actively short in summer 2026

In Q1 2026, ASHP counted 223 active national drug shortages, the second consecutive quarter the count has risen⁵. The mix isn’t the headlines you might remember.

ADHD stimulants: amphetamine mixed salts (IR and XR), lisdexamfetamine, and methylphenidate ER are in their fourth year of active shortage. Specific strengths of amphetamine XR had release dates as recently as mid-May and early-June 2026.

Sterile injectable chemotherapy: vinblastine, methotrexate, and cisplatin are all currently short. Vinblastine is the most-shorted oncology drug, reported in shortage at 57% of surveyed centers⁶.

Injectable opioids: morphine sulfate (on the FDA shortage list since 2017) and fentanyl citrate (since 2012) remain chronically short. Acute pain, surgical anesthesia, palliative care.

Estradiol and progesterone: added to the shortage list in January and February 2026. Demand is up; manufacturing capacity hasn’t caught up.

The guidelines that haven’t been written

Naming the category is half the work. The other half is writing the clinical guidelines that define it: what patients can safely have on hand before a clinical event arrives, and how to use it well when it does. Clinicians love guidelines and frameworks, and the ones for this category have not been written yet. We are building them.

Appropriate medical preparation is, in no way, a replacement for primary care. Chronic conditions and the long-term continuity that primary care exists to provide belong in the exam room. We are here for the moments primary care isn’t, not for the moments primary care is. The line is sharp and we hold it.

What it actually is: a clinically grounded model of preparation, built by a team of board-certified physicians, physician assistants, and pharmacists. Protocols are reviewed. Decisions are cross-checked. Medications are matched to common and predictable conditions where the clinical decision is well-understood. When something changes after the patient has the medication on the shelf, the team is reachable by call or email, no runaround. The work is structured around preparation, before symptoms arrive.

And it is not fear-based stockpiling dressed up in clinical language. The doomsday posture sold as health care is a different category. Ours stays in the lane of common, predictable conditions where the clinical evidence is settled.

The work the literature already supports

Any clinician in practice more than a few months has seen this conversation in a dozen different costumes. The patient calling Friday at 4:55pm…….the colleague who watched a UTI hijack a family’s vacation……the pharmacist taking the 9pm phone call asking about an antibiotic shortage with no known arrival date for the backordered amoxicillin² and the parents are really upset because the other pharmacy that can get it in is closed for the weekend……the provider who got the late-night text from a friend traveling abroad asking how he can get an antibiotic for strep overseas. We have been navigating this informally for years, one patient at a time, with no shared language and no defined framework.

The reason is partly that we were trained for a different system. Pharmacy school, medical school, PA school all assumed a closed loop: one patient, one prescriber, one chart, one local pharmacy that knew about all three. That loop is gone. Patients now have access to direct-to-consumer telehealth, mail-order chains, foreign pharmacies, cross-border purchasing, online communities, and TikTok dosing advice³. The job is harder than the one we trained for: guiding patients toward appropriate access in a landscape where access is everywhere and quality is uneven.

The frame for this kind of work already exists in the literature. The Patient Activation Measure⁴ has documented for two decades that clinical outcomes improve when patients are activated and prepared to participate in their own care. Appropriate medical preparation is clinician-supported patient activation, not patient autonomy alone. The category needs both halves; neither one works on its own.

Charting the gray area in public

Public knowledge gets better when clinicians chart the gray area in public, instead of leaving the internet to do it. Patients today can get almost anything they want from an online pharmacy. Without a clinical voice in that conversation, they will keep filling the gap themselves, more often and with less guidance. We’re choosing to do that work in the open.

What we are doing right now is defining what is safe to have on hand and what is not, and edging out the boundaries of the category as we go. We are confident doing this work. We are also finding it is more complex than it sounds. A UTI workup is straightforward. Building a complete framework for the range of conditions a reasonable family could face is a different scale of clinical work. Not impossible. Just hard to do well in the cracks of an office visit. If you are doing this work for your own patients, we champion that. If you would rather refer or follow along, both options are here. You can refer at Jase.com, or follow our work as we share how we are thinking about it.

What we are sharing going forward: how we make clinical decisions, where we draw the lines, what the evidence supports, what we’re still working through. The category is new. The protocols are being written at the highest clinical standard we know. We want medical professionals at the table while we build, not after.

Building this in the open

This article is one of many we are writing. The category needs a clinical framework, written and revised in public, and we are starting that work here. Each week we will be sharing a piece of it: a condition we are working through, a protocol, a decision we made and why, a question we are still chewing on, and current news stories and how they relate to appropriate medical preparation.

If this is interesting to you….follow along! We are publishing a few times a week, having a lot of fun building this in the open, and we would love to have you join us. 

Sources

  1. FEMA. 2023 National Household Survey on Disaster Preparedness: Key Findings. Federal Emergency Management Agency, Individual and Community Preparedness Division, 2023. https://community.fema.gov/PreparednessConnect/s/article/Results-from-the-2023-National-Household-Survey-on-Disaster-Preparedness
  2. Brewster RCL, Khazanchi R, Butler A, O’Meara D, Bagchi D, Michelson KA. The 2022-2023 Amoxicillin Shortage and Acute Otitis Media Treatment. Pediatrics. 2023;152(3):e2023062482. https://pmc.ncbi.nlm.nih.gov/articles/PMC10895544/
  3. Trilliant Health. Telehealth Demand: An Update Four Years After the Onset of the COVID-19 Pandemic. Trilliant Health Market Research, 2024. https://www.trillianthealth.com/market-research/studies/telehealth-demand-an-update-four-years-after-the-onset-of-the-covid-19-pandemic
  4. Hibbard JH, Stockard J, Mahoney ER, Tusler M. Development of the Patient Activation Measure (PAM): Conceptualizing and Measuring Activation in Patients and Consumers. Health Services Research. 2004;39(4 Pt 1):1005-1026. https://onlinelibrary.wiley.com/doi/10.1111/j.1475-6773.2004.00269.x

 

Lifesaving Solutions

Everyone should be empowered to care for themselves and their loved ones during the unexpected. Check out our recent lifesaving products today.

Learn More

Recent Posts

Keeping you informed and safe.

Why You Can’t Count on the Pharmacy in a Crisis

Why You Can’t Count on the Pharmacy in a Crisis

Why You Can't Count on the Pharmacy in a Crisis By Aaron Asay, PA-C, DMSc — Executive Director, JaseResponse Most of the time, the pharmacy works exactly the way we expect it to. Your child develops strep throat, the pediatrician sends in amoxicillin, and you pick it...

read more
For Clinicians | Drug Shortages 2026

For Clinicians | Drug Shortages 2026

For Clinicians | Drug Shortages 2026 Prescribing Inside a Supply Chain the System Has Admitted Isn't Built for Disruption By Dr. Jamie Wilkey, PharmD — Director of Clinical Strategy, JaseMedically reviewed by Kristen Carpenter, PA-C — Clinical Advisory Board Member A...

read more
For Clinicians | Appropriate Medical Preparation

For Clinicians | Appropriate Medical Preparation

For Clinicians | Appropriate Medical Preparation  The Clinical Category We've Been Practicing Without a Name By Dr. Jamie Wilkey, PharmD — Director of Clinical Strategy, JaseMedically reviewed by Kristen Carpenter, PA-C — Clinical Advisory Board Member Patients have...

read more
View Other Blog Posts

Join Our Newsletter

Our mission is to help you be more medically prepared. Join our newsletter and follow us on social media for health and safety tips each week!