Drug Shortage

A drug shortage is a period when the supply of a medication cannot meet demand, so pharmacies and hospitals cannot fill orders. The FDA keeps an official list, and the American Society of Health-System Pharmacists keeps a broader one. Most shortages involve cheap, old generics, especially injectables used in hospitals: saline, lidocaine, chemotherapy drugs like cisplatin, and ADHD stimulants. In early 2024 the ASHP count reached 323 active shortages, the highest since it began tracking in 2001.

Shortages happen for a plain reason. A generic that sells for a dollar a vial leaves so little margin that only one or two factories still make it, and when one has a quality problem or a hurricane, there is no backup. For a patient, a shortage means a call from the pharmacy saying the drug is not available, a switch to a substitute that may work differently, or a scramble across pharmacies. For an employer, the cost shows up sideways: the substitute is often a brand drug at ten times the price, or a compounded version outside the plan's contract. During the 2023 stimulant shortage, families on my clients' plans drove to three or four pharmacies a month to find a child's prescription.

The takeaway: if your pharmacy says a drug is short, ask the prescriber for the FDA-listed alternative in the same class before accepting whatever is on the shelf, and ask the pharmacy to check the wholesaler's next delivery date. A 90-day fill when the drug is available is the simplest protection.