Navigating Drug Shortages: Understanding the Supply Chain

February 3, 2026

Drug shortages are no longer an exception

Drug shortages have become a persistent challenge across the U.S. health care system. What was once considered a temporary supply disruption has evolved into a systemic issue affecting hospitals, pharmacies, providers, and patients alike. From injectable oncology agents to commonly used antibiotics, shortages now touch nearly every therapeutic category.

According to the American Society of Health-System Pharmacists (ASHP), the U.S. experienced 309 active drug shortages at the end of Q2 2023, followed by a record high of 323 active shortages in Q1 2024.¹ While ASHP reports that the number of active shortages declined to 216 in Q4 2025, the second lowest level since early 2018, ongoing disruptions continue to affect widely used medications and essential therapies. ²

For pharmacy benefit managers and health plans, these fluctuations create downstream impacts that extend beyond supply chain logistics. Drug shortages can compromise patient care, increase operational burden, and drive unexpected cost increases. Addressing them requires coordination, transparency, and proactive strategy.

Understanding the scope of the problem

Drug shortages are rarely driven by a single factor. According to the U.S. Food and Drug Administration, manufacturing quality issues are the most common cause of drug shortages, with additional contributors including production delays, raw material and active pharmaceutical ingredient availability, and manufacturer decisions to discontinue products or reduce output.³

Many shortages disproportionately affect sterile injectable drugs, where production is concentrated among a small number of manufacturers. When a single facility experiences quality or compliance issues, alternatives may be limited or nonexistent.³

Economic pressures also play a role. The highly competitive, low-margin nature of the generic drug market can make producing older medications financially unsustainable, leading manufacturers to reconsider production of lower-margin, often older medicines and increasing vulnerability in the supply chain.⁴

Clinical impact on patients and providers

Drug shortages can force providers to delay treatment, substitute less-effective therapies, or adjust dosing strategies. In some cases, alternative therapies may introduce new safety risks or require additional monitoring.

The potential for medication errors increases during drug shortages, particularly when clinicians must rapidly shift to unfamiliar agents or different dosage forms, concentrations, or administration protocols.⁵ These risks are amplified in high-acuity settings, such as oncology, critical care, and pediatrics.

For patients managing chronic or acute conditions, therapy disruptions can undermine treatment stability and confidence in care. Providers, meanwhile, face increased administrative workload as they identify alternatives, communicate changes, and navigate coverage constraints.

Operational challenges for PBMs and health plans

For pharmacy benefit managers (PBMs), drug shortages disrupt formulary management, utilization controls, and network coordination. Standard protocols may no longer apply when preferred products are unavailable. Plans may need to issue temporary overrides, adjust prior authorization criteria, or broaden coverage for non-preferred alternatives.

These changes introduce operational complexity and can strain call centers and clinical teams. Members seeking clarification on therapy changes often require additional support, increasing call volume and case management needs.

Health plans also face financial implications. Substitute therapies may be more expensive, less predictable in supply, or associated with higher administration costs. Without proactive management, shortages can erode cost-containment strategies and impact budget forecasting.

The role of proactive pharmacy management

Effective drug shortage management depends on early identification and rapid response. PBMs play a central role by monitoring supply trends, collaborating with manufacturers and wholesalers, and communicating changes to providers and members.

Key strategies include:

• Continuous monitoring of U.S. Food and Drug Administration (FDA) and ASHP shortage data
• Clinical evaluation of therapeutic alternatives
• Advanced communication with provider networks
• Temporary formulary and utilization policy adjustments
• Member education to reduce confusion and nonadherence

These efforts help minimize disruption while maintaining safety and continuity of care.

Coordinating care during shortages

Drug shortages often require closer coordination between PBMs, providers, and pharmacies. Clear communication is essential to ensuring that substitutions are clinically appropriate and aligned with benefit design.

In some cases, shortages highlight the value of integrated clinical support, including pharmacist consultation and nurse case management. These teams can help guide therapy transitions, monitor outcomes, and identify patients at higher risk of adverse effects

Research supported by the Agency for Healthcare Research and Quality shows that medication reconciliation and other coordinated medication management strategies can significantly reduce medication discrepancies and improve clinical outcomes, particularly during care transitions or periods of therapeutic disruption.⁶

Policy and regulatory considerations

Federal agencies have taken steps to improve transparency and resilience in the drug supply chain. The U.S. Food and Drug Administration now requires manufacturers to notify the agency well in advance of any permanent discontinuance or interruption that could lead to a meaningful disruption, and it works with firms to address potential quality issues before they result in shortages.³

However, policy solutions alone cannot eliminate shortages. Long-term resilience will require broader collaboration across manufacturers, regulators, payers, and providers to address economic and structural drivers.

Why drug shortages matter for plans and advisors

For health plans and consultants, drug shortages are not just an operational nuisance. They represent a risk to quality, member experience, and financial performance.

Plans that work with PBMs capable of proactive shortage management are better positioned to:

• Maintain continuity of care.
• Reduce member dissatisfaction and confusion.
• Limit unplanned cost increases.
• Support providers during treatment transitions.

As shortages continue to affect a wide range of therapies, preparedness and responsiveness are becoming key differentiators in PBM performance.

Looking ahead

Drug shortages are unlikely to disappear in the near term. Instead, they will require ongoing vigilance and adaptive strategies. PBMs that invest in data monitoring, clinical expertise, and coordinated communication can help buffer plans and members from the most severe impacts.

By treating drug shortage management as a core component of pharmacy operations rather than a reactive task, organizations can strengthen resilience and protect patient care.

Partner with PerformRx to navigate drug shortages

Drug shortages demand more than reactive fixes. They require informed oversight, clinical coordination, and clear communication. PerformRx works with plans and providers to manage disruptions, support safe therapy transitions, and maintain continuity of care for members.

If you are seeking a PBM partner that brings transparency, responsiveness, and clinical insight to pharmacy operations, contact us at info@performrx.com to learn how PerformRx can help your organization navigate today’s challenges while preparing for tomorrow’s risks.

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References

1. Paul Abramowitz, “ASHP Calls for Policy Solutions as Drug Shortages Reach All-Time High,”  American Society of Health-System Pharmacists, April 11, 2024. 
2. “Drug Shortage Statistics: National Drug Shortages: January 2001 to December 2025,” American Society of Health-System Pharmacists.
3. “Frequently Asked Questions About Drug Shortages,” U.S. Food and Drug Administration.
4. “Drug Shortages: Causes & Solutions,” Association for Accessible Medicines.
5. Hughes KM Hughes, et al., “Impact of a Drug Shortage on Medication Errors and Clinical Outcomes in the Pediatric Intensive Care Unit,” Journal of Pediatric Pharmacology and Therapeutics, November 2015.
6. “Medication Reconciliation Interventions Reduce Medication Discrepancies,” AHRQ News Now, No. 862, May 2, 2023.