You’ve probably noticed it firsthand by now — the pharmacy is out of your medication, the chain across town is also out, the manufacturer says supply is “expected to recover next quarter.” It’s not just one drug, and it’s not just bad luck. The number of active drug shortages in the US has hit some of its highest levels in over a decade, and the pattern is structural, not anecdotal. Here’s what’s actually happening and how to navigate it.

Why shortages happen

• Manufacturing problems. A single FDA inspection finding can shut down a factory that supplies a meaningful portion of the entire US market for a particular drug. Sterile injectables (chemotherapy drugs, IV antibiotics, common ICU medications) are particularly vulnerable because relatively few facilities make them and the manufacturing standards are unforgiving.
• Demand surges. GLP-1 medications (Ozempic, Wegovy, Mounjaro, Zepbound) are the most visible recent example: demand more than doubled since 2020, manufacturing couldn’t keep up, and supply was constrained for years. Adderall has been similarly stretched by increased ADHD prescribing.
• Concentrated supply chains. Many generic medications are made by only a handful of manufacturers, often in a small number of overseas facilities. When one goes offline, there’s no slack in the system.
• Active ingredient shortages. The active pharmaceutical ingredient (API) is often produced in a different facility than the finished tablet — sometimes a different country. Disruption at the API level cascades.
• Economics. Generic injectables are often unprofitable, which has driven manufacturers out of certain markets entirely. Less competition means more fragility.
• Controlled substance quotas. For Schedule II medications like Adderall, the DEA sets annual production quotas. If demand exceeds the quota, even a willing manufacturer can’t legally produce more.
• Natural disasters and geopolitics. Hurricane Maria in 2017 disrupted IV saline supply for years (a huge fraction of US production was in Puerto Rico). Trade disputes and pandemic-era shipping problems have had similar effects.

What’s currently been hit (recent context)

• GLP-1 medications — tirzepatide came off the official shortage list in late 2024 and semaglutide in early 2025, though intermittent local shortages have continued. Compounded versions that proliferated during the shortage are now mostly being phased out.
• ADHD stimulants — Adderall and other amphetamine-based products have been on and off the shortage list since 2022. Generic Vyvanse availability has been particularly variable.
• Chemotherapy drugs — carboplatin, cisplatin, methotrexate, and others have had serious shortages, in some cases forcing oncologists to ration treatments or switch protocols.
• Common antibiotics — amoxicillin liquid for kids, certain forms of penicillin, occasional shortages of clindamycin and IV antibiotics.
• IV fluids — saline and other basic IV solutions have been periodically scarce, with significant impact on hospital operations.
• Insulin — not typically national shortages but distribution issues at the pharmacy level happen frequently.
• Common older generics — lots of medications that no one makes the news for: certain blood pressure medications, certain seizure medications, certain hormone therapies.

The FDA maintains a current drug shortage list at accessdata.fda.gov/scripts/drugshortages/. Worth checking if you’re dealing with a recurring fill problem.

What to do if your medication is short

• Call ahead before showing up. Pharmacies often know about shortages before pickup time. A 60-second phone call saves an hour of frustration.
• Ask about other manufacturers’ generics. Many shortages are manufacturer-specific. Generic lisinopril from one company might be unavailable while generic lisinopril from another is in stock. The pharmacy may need to call other suppliers; ask if they can.
• Try other pharmacy chains. Stock varies pharmacy by pharmacy. CVS might be out, Walgreens might have it, the independent pharmacy down the block might have a different generic. Some chains will check their stores in your area for you.
• Ask about different doses that add up to your dose. If your 20 mg is unavailable, two 10 mg tablets might be in stock. The prescriber can call in a new prescription with the alternative dosing. Not safe for every medication — ask the pharmacist.
• Ask about a related medication in the same class. If one ADHD stimulant is out, another might be available. If atorvastatin is out, rosuvastatin might be in stock. The pharmacist can suggest reasonable substitutes for the prescriber to consider.
• Mail-order vs retail. Sometimes one has stock and the other doesn’t. If you usually use mail-order, your retail pharmacy might be a backup option, and vice versa.
• Don’t skip doses or stretch supply. Cutting tablets in half or extending dosing intervals to make medication last longer can be dangerous for many medications (anti-seizure, blood pressure, antidepressants, blood thinners). Talk to your prescriber or pharmacist about a plan if you’re running low.
• Get refills earlier. If your insurance allows it, refilling a few days early when there’s supply means you have a buffer if next month’s supply is short.

A word on compounded versions

Compounding pharmacies can sometimes make a version of a drug when the brand-name supply is short. This was the case for GLP-1s during the 2022 to 2024 shortage. Compounded versions are typically much cheaper than brand-name medications and have provided real access for patients who couldn’t otherwise afford treatment.

But there are real considerations. Compounded medications are not FDA-approved. The FDA has received hundreds of reports of adverse events from compounded GLP-1s, including dosing errors when patients self-administered. Some online pharmacies operating in the compounding space have been outright illegitimate — selling counterfeit medications, operating without proper licensing, or sourcing ingredients from unregulated overseas suppliers.

When the FDA declares a shortage resolved, compounding pharmacies generally lose the legal authority to produce copies. The GLP-1 situation is the most prominent recent example: with the shortage officially over, most compounded versions are no longer legally available.

If you’re considering a compounded medication, vet the source carefully. Use a state-licensed pharmacy with a verifiable physical address. Ask whether they’re a 503A or 503B facility. Be skeptical of any source that doesn’t require a prescription, ships from overseas, or has prices dramatically below other options.

When to call the prescriber

• If you’re running out and can’t find your medication anywhere within a reasonable radius
• If the only available option is a different dose or different form than what you were prescribed
• If a pharmacist suggests a substitution and you want clinical input on whether it’s appropriate for you
• If you’re considering an out-of-pocket alternative (compounded, international pharmacy, etc.) and want guidance
• If you’re missing doses and unsure whether that’s safe

Most prescribers are familiar with the current shortage situation and can navigate alternatives quickly. The pharmacy is often the more efficient first call — they know the local supply situation in real time. The prescriber’s role is approving any change.

Living with the broader picture

Drug shortages aren’t going away in the short term. The structural causes — thin manufacturing margins, concentrated supply chains, demand spikes — take years to address. The practical things that help: build relationships with your pharmacy team, don’t wait until the last minute to refill, know what your alternatives are, and use the FDA shortage list as your reference for whether something’s a national problem or just a local stockout.

For the broader practical side of managing your medications — storage, organization, what to ask the pharmacist — the article on medication safety across all ages covers the ground-level habits. And if a shortage is making you reconsider your insurance options or how you’re paying, the post on why drug prices vary so wildly between pharmacies is a useful read.

References

• https://www.fda.gov/drugs/drug-safety-and-availability/drug-shortages
• https://www.pharmacytimes.com/view/fda-moves-to-permanently-close-the-door-on-compounded-glp-1s
• https://www.biopharmadive.com/news/drug-shortages-pharma-regulations-hhs-fda/715228/