By the end of 2025, over 270 medications are still in short supply across the United States - a number that may seem lower than last year’s peak, but still represents a dangerous level of instability in the healthcare system. Patients are getting delayed treatments. Hospitals are rationing life-saving drugs. Pharmacists are spending hours each week just trying to find alternatives. This isn’t a temporary glitch. It’s a systemic crisis rooted in global supply chains, low profits, and regulatory gaps that haven’t been fixed.
What’s Actually Running Out?
The most critical shortages aren’t obscure niche drugs. They’re the ones you’d expect to be easy to find: saline bags, dextrose solutions, chemotherapy agents, and antibiotics. Here’s what’s still hard to get as of December 2025:- 5% Dextrose Injection (small volume bags) - Shortage started in February 2022. Expected to last until August 2025. Used for IV hydration, blood sugar control, and as a carrier for other drugs.
- 50% Dextrose Injection - Shortage since December 2021. Resolution expected September 2025. Critical for treating severe hypoglycemia in diabetic emergencies.
- Cisplatin - A frontline chemotherapy drug for testicular, ovarian, and lung cancers. Production halted in 2022 after an Indian manufacturer failed FDA inspections. Hospitals now ration it, prioritizing patients with the best chance of survival.
- Vancomycin - A last-resort antibiotic for MRSA and other resistant infections. Shortages have returned in 2025 after a brief recovery in late 2024.
- Levothyroxine - The most common thyroid medication. Demand has surged 35% since 2020, and manufacturers can’t keep up. Patients report switching brands or going weeks without refills.
- GLP-1 agonists (e.g., semaglutide, liraglutide) - Used for weight loss and type 2 diabetes. Demand exploded after these drugs went mainstream. Production hasn’t scaled fast enough, leading to multi-month waits.
These aren’t random outliers. They’re symptoms of a deeper problem. About 60% of the active ingredients in U.S. drugs come from just two countries: India and China. When a single plant in India fails an FDA inspection - like the one that made half the country’s cisplatin - the ripple effect hits every hospital in America.
Why Are Generic Drugs the Biggest Problem?
You might assume brand-name drugs are harder to get. But it’s the opposite. Generic drugs make up 90% of all prescriptions filled in the U.S., yet they account for nearly 85% of current shortages. Why?It’s simple: profit margins. Generic drug makers operate on 5-8% margins. Brand-name drugs? 30-40%. That means when a generic manufacturer faces a spike in raw material costs, a regulatory delay, or a production hiccup, they don’t have the financial cushion to absorb it. They just stop making it.
Compare that to a brand-name drug like Ozempic. Even with massive demand, the manufacturer has the resources to build extra production lines, stockpile ingredients, and even pay premium prices to keep supply flowing. Generic makers don’t have that luxury. They compete on price - and that’s exactly why they’re the first to drop out when things get tough.
Who’s Getting Hurt the Most?
It’s not just hospitals. It’s patients. A 2024 survey by the American Medical Association found that 78% of doctors had to delay treatment because a drug wasn’t available. Nearly half had to switch patients to less effective alternatives.In cancer care, the impact is brutal. Patients for Affordable Drugs reported that 31% of cancer patients experienced treatment interruptions in 2024. The average delay? Nearly 15 days. For someone with aggressive cancer, that’s not just inconvenient - it’s life-threatening.
Diabetics are struggling too. With levothyroxine and insulin supplies stretched thin, some patients are cutting doses or skipping refills. One Ohio pharmacist told Reddit users they had to ration cisplatin so only patients with testicular cancer - where it’s most effective - got it. Others had to wait or try less proven drugs.
And it’s not just about getting the drug. It’s about safety. When pharmacists substitute one drug for another - even if they’re technically “therapeutically equivalent” - errors spike. ASHP found that 67% of hospital pharmacists have seen medication errors directly tied to substitutions during shortages. A wrong dose, a wrong route, a wrong interaction - all possible when you’re scrambling to fill a gap.
Why Can’t the FDA Fix This?
The FDA says it prevents about 200 potential shortages every year by stepping in early - warning manufacturers, helping them fix issues, or fast-tracking inspections. But here’s the catch: they can’t force anyone to make more of a drug.FDA Commissioner Robert Califf told Congress in February 2025 that the agency lacks the legal power to require production increases. They can’t tell a company, “You must make 20% more of this saline solution.” They can only ask. And if a company decides it’s not profitable enough, they walk away.
Even the new FDA public portal - launched in January 2025 to let providers report shortages not yet listed - has only processed 1,247 reports in its first three months. That’s helpful, but it’s reactive, not preventative. It’s like having a smoke alarm that only goes off after the fire’s already burning.
What’s Being Done to Fix It?
Some states are trying. New York is working on a public online database that shows which drugs are in short supply and which pharmacies still have stock. Hawaii passed a rule in 2025 allowing Medicaid to use foreign-approved versions of drugs during shortages - something the FDA normally blocks.Hospitals are doing what they can. Some are keeping 30-day stockpiles of critical drugs. But only 28% can afford it. The rest are flying blind, relying on last-minute calls to distributors.
At the federal level, two bills are being pushed: the Drug Shortage Prevention Act and the End Drug Shortages Act. Both aim to make manufacturers report production problems earlier - before they become full-blown shortages. But neither has passed. And even if they do, they won’t fix the core issue: low profits for generics.
What You Can Do
If you’re a patient:- Ask your doctor or pharmacist: “Is this drug currently in short supply?”
- If your medication is unavailable, ask: “Is there a therapeutically equivalent alternative?” Don’t accept “We don’t have it” as the final answer.
- Keep a list of your meds, dosages, and why you take them. It helps if you need to switch.
- Don’t skip doses or split pills without talking to your provider. It’s dangerous.
If you’re a caregiver or family member:
- Check the ASHP Drug Shortages Database regularly. It’s free and updated weekly.
- Call ahead to your pharmacy before picking up prescriptions - especially for IV fluids, insulin, or chemo drugs.
- Advocate. Tell your state representative you’re worried about drug access. This isn’t just a medical issue - it’s a policy failure.
The Bigger Picture
The U.S. imports 80% of its active pharmaceutical ingredients. Most of that comes from India and China. That’s not just a supply chain issue - it’s a national security risk. A geopolitical event, a natural disaster, or a factory shutdown halfway across the world can leave American hospitals empty.The solution isn’t just better reporting or more inspections. It’s rebuilding domestic manufacturing capacity. It’s paying generic drug makers enough to stay in business. It’s creating mandatory stockpiles for life-saving drugs - not just for hospitals, but for communities.
Right now, we’re treating drug shortages like a temporary inconvenience. But they’re not. They’re a slow-moving public health emergency - and the people paying the price aren’t CEOs or politicians. They’re the elderly, the chronically ill, the cancer patients, the diabetics - the ones who need these drugs just to live.
What are the most common drugs in short supply in 2025?
As of late 2025, the most commonly scarce drugs include 5% and 50% Dextrose injections, cisplatin (a chemotherapy drug), vancomycin (an antibiotic), levothyroxine (for thyroid conditions), and GLP-1 agonists like semaglutide used for weight loss and diabetes. These shortages are driven by manufacturing issues, supply chain delays, and surging demand.
Why are generic drugs more likely to be in shortage than brand-name drugs?
Generic drugs have much lower profit margins - typically 5-8% - compared to 30-40% for brand-name drugs. When manufacturing costs rise or demand spikes, generic manufacturers often stop producing drugs that aren’t profitable enough. Brand-name companies can absorb losses, invest in extra capacity, or raise prices. Generics can’t.
Can pharmacists substitute drugs during a shortage?
Yes, in 47 states, pharmacists can substitute a therapeutically equivalent drug during a shortage. But only 19 states allow them to do so without a doctor’s approval. Even when substitutions are allowed, they carry risks - wrong dosage, interactions, or reduced effectiveness - which is why medication errors rise during shortages.
Is the FDA doing enough to prevent drug shortages?
The FDA prevents about 200 potential shortages each year through early warnings and inspections, but they can’t force manufacturers to produce more. They lack legal authority to require production increases or mandate transparency from suppliers. Their tools are reactive, not preventative, which limits their ability to stop shortages before they happen.
How do drug shortages affect cancer patients?
Cancer patients are among the hardest hit. In 2024, 31% experienced treatment delays due to drug shortages, with average delays of nearly 15 days. Drugs like cisplatin and doxorubicin are critical for survival in certain cancers. When they’re unavailable, hospitals must ration them - often prioritizing patients with the best prognosis - leaving others without timely care.
Are there any new solutions being tested to fix drug shortages?
Yes. Hawaii now allows Medicaid to use foreign-approved versions of drugs during shortages. New York is developing a public database to show which pharmacies have scarce drugs in stock. The U.S. Pharmacopeia recommends financial incentives for domestic manufacturing, mandatory stockpiles, and a national early warning system. But none of these are nationwide yet - and progress is slow.
What Comes Next?
Without major policy changes - like funding domestic API production, creating financial incentives for generic manufacturers, or requiring minimum stockpiles - the number of shortages will stay above 250 through at least 2027, according to the Congressional Budget Office. If new tariffs on Chinese and Indian pharmaceuticals are imposed, that number could jump past 350.This isn’t about politics. It’s about survival. People need their medications. And right now, the system is failing them - not because of a lack of science or skill, but because of a lack of will.