As of November 2025, over 270 medications are still in short supply across the United States - a number that may seem lower than the peak of 323 in early 2024, but still represents a persistent and dangerous gap in care. These aren’t minor inconveniences. For cancer patients, dialysis recipients, and critically ill children, a missing drug can mean delayed treatment, risky substitutions, or even life-threatening outcomes. The problem isn’t getting better - it’s just changing shape.
What’s Actually Running Out?
The most critical shortages are in sterile injectable medications, especially those used in hospitals. These aren’t pills you can pick up at the corner pharmacy. They’re life-sustaining drugs delivered directly into the bloodstream. Right now, the biggest gaps are in:- 5% Dextrose Injection (small volume bags) - used to deliver fluids and medications, especially in pediatric and ICU settings. This shortage began in February 2022 and is expected to last until August 2025.
- 50% Dextrose Injection - critical for treating severe low blood sugar. It’s been unavailable since December 2021, with no resolution until September 2025.
- Cisplatin - a cornerstone chemotherapy drug for testicular, ovarian, and lung cancers. A 2022 FDA shutdown of an Indian manufacturing plant that supplied half the U.S. market still echoes today. Hospitals are rationing doses, prioritizing patients with the highest chance of survival.
- Vancomycin and Meropenem - essential antibiotics for resistant infections. These shortages have forced clinicians to use older, less effective, or more toxic alternatives.
- Normal Saline (0.9% Sodium Chloride) - the most common IV fluid in hospitals. While large bags are more available now, small-volume bags for pediatric and emergency use remain tight.
Outside of injectables, demand-driven shortages are rising fast. ADHD medications like methylphenidate and amphetamine salts are in short supply due to a 35% annual spike in prescriptions since 2020. GLP-1 weight-loss drugs like semaglutide and tirzepatide are also hitting limits - not because of manufacturing failure, but because demand has outpaced production capacity.
Why Is This Happening?
It’s not one problem. It’s a chain of failures.First, most of the raw ingredients - called active pharmaceutical ingredients (APIs) - come from just two countries: India (45%) and China (25%). When a factory in Hyderabad fails an FDA inspection, or a port in Shanghai gets shut down by weather or policy, the ripple effect hits U.S. hospitals within weeks.
Second, generic drugs - which make up 90% of prescriptions - are made on razor-thin margins. Manufacturers earn only 5-8% profit on these drugs, compared to 30-40% on brand-name drugs. Why invest in modern equipment or backup lines when you’re barely breaking even? Many plants operate with outdated tech and no redundancy. One breakdown = nationwide shortage.
Third, the FDA can’t force companies to produce more. They can inspect, warn, and even shut down facilities, but they can’t order a manufacturer to ramp up output. In 2025, the FDA says it prevented about 200 potential shortages by stepping in early - but that’s reactive, not preventative. There’s no legal tool to require a company to keep making a drug just because it’s essential.
And then there’s demand. When a new drug becomes popular - like GLP-1s for weight loss - manufacturers can’t instantly build new factories. It takes 18-24 months to scale production. By the time they catch up, the demand curve has shifted again.
Who’s Most Affected?
It’s not just hospitals. Patients are paying the price.According to a 2024 survey by the American Medical Association, 78% of doctors reported treatment delays because of drug shortages. Nearly half had to switch patients to less effective or more dangerous alternatives. One oncologist in Ohio told a Reddit thread how they had to deny cisplatin to a patient with ovarian cancer because it was reserved only for those with testicular cancer - the group where the drug has the highest survival benefit.
For cancer patients, delays aren’t just inconvenient. A 14.7-day average interruption in treatment, as reported by Patients for Affordable Drugs, can mean the difference between remission and progression. One mother in Arizona shared how her 8-year-old son’s chemotherapy was delayed for three weeks because the hospital ran out of vincristine. His tumor grew during the wait.
Pharmacists are drowning. Nearly 70% of hospital pharmacists report spending over 10 hours a week just tracking down alternatives, checking inventory, and documenting substitutions. And 67% say those substitutions have led to medication errors - like giving the wrong dose because the look-alike vial was misread.
What’s Being Done?
There are patches - but no fix yet.The FDA launched a new public reporting portal in January 2025. Healthcare providers can now submit unlisted shortages directly. In its first three months, it received 1,247 reports - 87% of which triggered FDA action. That’s progress. But it’s still a fire department running to every blaze instead of preventing the sparks.
Some states are acting. New York is developing an online map showing which pharmacies still have specific shortage drugs. Hawaii approved a program allowing Medicaid to cover foreign-approved versions of drugs when U.S. supplies run out. That’s bold - and controversial. But in a crisis, sometimes you take what you can get.
Pharmacists are using every trick in the book: diluting IV fluids to stretch supplies, switching from IV to oral forms when possible, and using alternative drugs with similar effects. The American Society of Health-System Pharmacists has published detailed guidelines for conserving fluids and optimizing doses. But these are temporary fixes. They don’t solve the broken system.
What’s Next?
The Congressional Budget Office warns that without major policy changes, drug shortages will stay above 250 through 2027. If new tariffs on Chinese and Indian pharmaceuticals go through - as some lawmakers are pushing - the number could spike to 350 or higher.Experts agree on three needed actions:
- Financial incentives for domestic manufacturing of APIs. Right now, it’s cheaper to import. The government needs to subsidize U.S. production to make it viable.
- Mandatory strategic stockpiles for critical drugs. Hospitals shouldn’t be left guessing. A federal reserve of essential injectables - like a national oil reserve - could prevent panic during supply dips.
- A national early warning system that connects manufacturers, distributors, and hospitals in real time. If a plant in India reports a quality issue, the FDA and hospitals should know within hours - not months.
For now, patients and providers are stuck in a holding pattern. You can’t predict when a drug will vanish. You can only prepare for it. That means asking your doctor: “What if this medication runs out? What’s the backup?” It means pharmacists checking inventory daily. It means hospitals building relationships with alternate suppliers - even if it costs more.
This isn’t just a healthcare issue. It’s a public safety issue. When a child can’t get their saline drip, or a cancer patient misses their chemo cycle, the system has already failed. The solutions exist. What’s missing is the will to make them real.
What are the most common drugs in short supply right now?
As of late 2025, the most common shortages include 5% and 50% Dextrose injections, cisplatin (a chemotherapy drug), vancomycin and meropenem (antibiotics), and normal saline in small-volume bags. ADHD medications and GLP-1 weight-loss drugs are also experiencing high-demand shortages.
Why are generic drugs more likely to be in shortage than brand-name drugs?
Generic drugs have very low profit margins - often just 5% to 8% - compared to 30% to 40% for brand-name drugs. Manufacturers have little financial incentive to invest in reliable production, backup lines, or quality upgrades. Many rely on single overseas factories with no redundancy, making them vulnerable to disruptions.
Can pharmacists substitute a different drug if mine is unavailable?
In 47 states, pharmacists can substitute a therapeutically equivalent drug during a shortage. But only 19 states allow them to do so without calling the prescriber first. This creates delays and confusion. Always ask your pharmacist what alternatives are available - and whether they’re safe for your condition.
How do drug shortages affect cancer treatment?
Cancer patients often face treatment delays of nearly 15 days on average during shortages. Drugs like cisplatin, vincristine, and doxorubicin are critical for survival. When they’re unavailable, doctors may delay therapy, use less effective alternatives, or reduce doses - all of which can lower the chance of remission.
Is there a way to know if my medication is in shortage?
Yes. The American Society of Health-System Pharmacists (ASHP) maintains a public Drug Shortages Database. Your pharmacist can also check real-time inventory alerts. If you’re on a critical medication, ask your provider to sign you up for shortage notifications through your hospital’s pharmacy service.
Will new tariffs make drug shortages worse?
Yes. Proposed tariffs of 50% to 200% on pharmaceutical ingredients from China and India could raise costs and reduce supply. Since 70% of APIs come from these countries, even small tariffs could trigger new shortages or make existing ones last longer. Experts warn this could push the total number of shortages above 350 by 2026.
What You Can Do
If you’re on a medication that’s frequently in short supply - like insulin, chemotherapy drugs, or antibiotics - talk to your doctor now. Ask:- Is there an alternative drug with the same effect?
- Can I switch to an oral version instead of an injection?
- Is there a different manufacturer that makes the same drug?
- Can we keep a small backup supply on hand?
Don’t wait until your prescription runs out. Shortages don’t announce themselves. They just appear - and when they do, you need options already in place.
