Drug shortages in the United States have eased from their peak, but they have not gone away. The American Society of Health-System Pharmacists (ASHP) counted 227 active shortages in the second quarter of 2026, the third consecutive quarterly increase and still well below the all-time high of 323 recorded in the first quarter of 2024. For distributors and wholesalers, the headline number matters less than what sits behind it: shortages that last longer, concentrate in hard-to-make products, and trace back to a small number of suppliers.
This article summarises the latest data from ASHP and the United States Pharmacopeia (USP), explains why shortages persist, and sets out a practical playbook distributors can use to protect supply continuity. The figures are US-based; the supply-chain logic applies more widely.
Where drug shortages stand in 2026
ASHP and the University of Utah Drug Information Service have tracked national shortages since 2001. Their mid-2026 report highlights several points that matter to anyone managing inventory:
- Active shortages stand at 227, up for the third quarter in a row but far below the 323 peak of Q1 2024.
- Just under half (48%) of all new shortages in 2026 are sole-source products, meaning a single manufacturer supplies them.
- Sixteen percent of active shortages are controlled substances, which affects patients with chronic pain or ADHD and complicates stocking for dispensers.
- Ten percent of new 2026 shortages are contrast agents used in CT and MRI procedures, and chemotherapy shortages remain a concern, with ifosfamide a severe new case.
- ASHP also cautions that a lower shortage count does not necessarily mean fewer patients are affected, because a single shortage can affect very large numbers of people.
USP’s 2026 Annual Drug Shortages Report, published on 9 June 2026, adds the duration picture:
- The average shortage now lasts more than five years, up from 4.3 years in 2024 and roughly two years in 2019.
- Of 75 shortages active at the end of 2025, only four were first reported in 2025. Almost all were carried over from earlier years.
- Product discontinuations reached their highest level since 2019, rising 60 percent from 2024 to 2025.
- Sterile injectables make up 71 percent of shortages, the largest share of any dosage form.
The practical message for distributors is that many of today’s shortages are not short-term disruptions. They are structural, and planning should assume that some products will stay constrained for years.
Why shortages persist
USP identifies four consistent drivers: low prices, manufacturing complexity, geographic concentration and quality concerns. External shocks such as natural disasters, geopolitical tension or policy changes can make each of them worse.
Thin margins. USP’s report links very low prices to a higher likelihood of discontinuation. In the words of USP’s Matthew Christian, generic manufacturers “operate on thin, sometimes unsustainable margins.” When a producer exits a low-priced product, the remaining suppliers may not be able to absorb demand.
Hidden upstream concentration. For the first time, USP’s report included data on key starting materials (KSMs), the chemical building blocks of active ingredients. It found that 44 percent of drugs in shortage have at least one KSM made solely in a single country, typically China or India. A distributor can hold a diversified list of finished-product suppliers and still be exposed if those suppliers depend on the same upstream source.
Complex, sole-source products. A federal analysis of 2018 to 2023 shortages (ASPE, 2025) found that injectables made up half of all shortage products and that injectable shortages lasted a median of 4.6 years, compared with 1.6 years for oral products. The same data brief notes the FDA’s finding that about 40 percent of generic drug markets have a single manufacturer.
Quality failures. ASHP attributes the ifosfamide shortage to manufacturing quality problems at a key supplier, a reminder that one site-level problem can remove a product from the market.
The distributor’s playbook
1. Map your exposure SKU by SKU
Start with the products you actually stock. Flag those that are sole-source or have only two suppliers, those that are sterile injectables, those on the FDA or ASHP shortage lists, and those with a history of repeated shortages. Where you can, extend the map upstream by asking suppliers about API and key-starting-material sources. USP’s Medicine Supply Map is one commercial tool built for this purpose; USP states that it forecasts shortages four to twelve months ahead, although that is the vendor’s own claim and should be evaluated before purchase.
2. Qualify secondary sources before you need them
Qualifying a new supplier takes time, and shortages compress that time. Run licensing checks, quality review and commercial terms while supply is stable, so a backup is ready to activate. Where possible, choose backup sources that differ from your primary supplier in manufacturing site and upstream material source, not just in company name.
3. Watch early signals, not just official lists
The FDA’s Drug Shortages Database and ASHP’s current shortages list are essential references, and ASHP updates its bulletins frequently. Both tend to confirm problems that your own data may already show. Build internal triggers: short-shipped orders, rising backorder rates, allocation notices from manufacturers and unexplained lead-time changes. FDA states that the sooner it is notified of an interruption, the more time it has to prevent or reduce a shortage, so supplier communication matters as well.
4. Hold buffers with discipline and avoid protective purchasing
Buffer inventory has support from the pharmacy community: ASHP has recommended that providers and distributors maintain a buffer supply of critical medicines. But reactive over-ordering can backfire. USP’s Medicine Supply Map analysis of 117 products newly listed as short by ASHP in 2023 found that 47 percent saw higher unit sales in the month after the announcement. USP calls this protective purchasing and warns that it can deepen shortages and leave smaller or rural buyers without supply.
The sensible approach is to set buffers by clinical criticality, supplier risk and replenishment lead time, and to decide those levels in advance rather than after headlines appear. No single number of days suits every product, so treat any universal rule of thumb with caution.
5. Allocate transparently
USP notes that allocation limits can temper protective purchasing. If you must ration, publish simple, consistent rules, communicate them early and give customers realistic delivery expectations. Predictable allocation protects relationships better than surprise cuts.
6. Support customers with alternatives, within professional boundaries
Pharmacy partners are best placed to decide on therapeutic substitution. Distributors can help by sharing availability data quickly and pointing customers to resources such as ASHP’s shortage bulletins, which include information on alternatives. Clinical substitution decisions remain with prescribers and pharmacists.
7. Track discontinuations and price pressure
Because USP ties discontinuations to low prices, a sharp fall in a product’s market price or a manufacturer’s exit notice is an early warning. Review your portfolio for products where a supplier’s departure would leave you without a source.
What to watch next
ASHP will publish new quarterly figures, and the 227 count will move. Two things are worth monitoring: whether sole-source products keep making up close to half of new shortages, and whether discontinuations continue to rise. ASHP has also said the effect of the conflict in Iran on the US drug supply remains unclear.
Key takeaways
- ASHP counts 227 active US drug shortages (Q2 2026), up for three consecutive quarters but below the 2024 peak of 323.
- USP reports that the average shortage now lasts more than five years.
- Nearly half of new 2026 shortages involve a sole-source product, and 44 percent of shortage drugs have a key starting material made in only one country.
- A resilient distributor maps exposure by product, qualifies backup sources in advance, monitors early signals, sets buffers by criticality and avoids panic buying.
Frequently asked questions
How many drugs are currently in shortage in the US?
ASHP reported 227 active drug shortages as of the second quarter of 2026. Other databases count differently. The FDA’s database is organised at product-presentation level, so its totals are not directly comparable.
How long do drug shortages last?
USP reports that the average shortage now lasts more than five years, compared with roughly two years in 2019.
What is protective purchasing?
It is the surge in ordering that often follows a shortage announcement. USP found it in 47 percent of products it analysed from 2023 and cautions that it can worsen shortages.
This article is for general industry information and is not medical advice. Shortage figures change; check ASHP and the FDA for current data before relying on any number.
Sources
- ASHP, Drug Shortages Statistics (Jan 2001 – June 2026): https://www.ashp.org/drug-shortages/shortage-resources/drug-shortages-statistics
- ASHP, National Drug Shortages report (PDF): https://www.ashp.org/-/media/assets/drug-shortages/docs/Drug-Shortages-Report.pdf
- USP, Annual Drug Shortages Report press release, 9 June 2026: https://www.usp.org/news/usp-2026-annual-drug-shortages-report-rising-discontinuations-supply-chain-risk
- USP, Protective purchasing: a hidden amplifier of drug shortages (10 June 2026): https://www.usp.org/blog/protective-purchasing-hidden-amplifier-drug-shortages
- USP, Medicine Supply Map: https://www.usp.org/supply-chain/medicine-supply-map
- HHS ASPE, Analysis of Drug Shortages 2018-2023 (data brief, 8 Jan 2025): https://www.ncbi.nlm.nih.gov/books/NBK611681/
- FDA, Drug Shortages Database information: https://dps.fda.gov/drugshortages and https://fda.gov/drugs/drug-safety-and-availability/drug-shortages
- FDA, Strategic Plan for Preventing and Mitigating Drug Shortages: https://www.fda.gov/downloads/Drugs/DrugSafety/DrugShortages/UCM372566.pdf
- ASHP, Policy Solutions to Address the Drug Shortage Crisis (buffer inventory recommendation): https://www.ashp.org/-/media/assets/advocacy-issues/docs/2023/ASHP-Drug-Shortage-Recommendations.pdf
- AJMC, Active US Drug Shortages Rise for Third Straight Quarter (corroboration of ASHP Q2 2026 figure): https://www.ajmc.com/view/active-us-drug-shortages-rise-for-third-straight-quarter