Drug Shortages: What Happens When Your Medication Disappears

U.S. drug shortages are rising again, with 227 active shortages reported at the end of June 2026. Most stem from manufacturing quality problems, thin margins on older generics, and supply chains that depend on very few suppliers. When a drug is on the FDA’s shortage list, licensed compounding pharmacies have more room to help, but that pathway narrows once the shortage ends. Talk to your prescriber and pharmacist before changing how you take anything.

At the end of June 2026, the United States had 227 active drug shortages, according to American Society of Health-System Pharmacists (ASHP) data reported by AJMC. That count has been rising again through mid-2026, and nearly half of this year’s new shortages involve a drug made by only one manufacturer. The list includes chemotherapy agents, imaging contrast dyes, and ADHD medications.

Behind every one of those numbers is a person at a pharmacy counter being told to check back next week. That message can be frightening for people managing a chronic condition, a child’s treatment, or recovery after surgery. It also raises fair questions: why does this keep happening, and what can a patient do?

How Big the Drug Shortage Problem Is in 2026

ASHP counted 216 active drug shortages at the end of 2025, 223 in the first quarter of 2026, and 227 by the end of the second quarter. That is well below the all-time high of 323 set in early 2024, but after a long decline, the total is climbing again.

There is a hopeful detail in the data. ASHP recorded just 89 new shortages in 2025, the lowest yearly total since 2006, according to Becker’s Hospital Review. The catch is that older shortages linger: about three-quarters of active shortages began in 2022 or later.

Controlled substances, including medications for ADHD, pain, and surgery, made up about 15% of active shortages in early 2026, Becker’s reported. CT and MRI contrast agents accounted for 10% of new shortages this year, and the chemotherapy drug ifosfamide has been scarce because of quality problems at a key supplier, MedicalDaily noted.

ASHP has also cautioned that a lower count does not mean fewer patients are affected. For patients, a shortage feels less like a statistic and more like uncertainty: a refill that doesn’t arrive or a treatment that gets rescheduled.

Why Drug Shortages Happen

Most drug shortages trace back to three structural problems: quality failures at manufacturing plants, prices on older generics so low that companies have little reason to invest in backup capacity, and supply chains concentrated in a few plants and countries. Sudden jumps in demand add pressure on top of all three.

Quality Problems and Plant Shutdowns

The FDA’s drug shortage FAQ names manufacturing and quality issues as the leading cause, followed by production delays, raw material problems, increased demand, and discontinuations. When a plant pauses production to resolve a quality problem, supply can drop quickly. Manufacturers do not always explain, though: 59% of shortages reported to ASHP in 2025 had an unknown or undisclosed cause.

The Economics of Cheap Generics

The FDA’s report on root causes identified three drivers. Companies have little incentive to make less profitable drugs, the market does not reward mature quality systems, and logistical and regulatory hurdles slow recovery after a disruption.

A U.S. Department of Health and Human Services white paper found that generic sterile injectables made up about 63% of shortages between 2013 and 2017. It describes generic prices falling so low that manufacturers have little reason to build redundancy. Put simply, some of the cheapest drugs are also the most fragile.

Single Suppliers and Global Dependence

Drugs made by only one manufacturer accounted for 48% of new shortages in 2026. The HHS paper also notes that roughly 90-95% of generic sterile injectables used in critical acute care rely on key starting materials from China and India.

Demand surges strain supply too, as the GLP-1 medications semaglutide and tirzepatide showed. Meanwhile, the FDA cannot require a company to make a drug or increase production, and it does not regulate prices.

The FDA Drug Shortage List and Why It Matters

The FDA keeps a public shortage database, updated daily, that shows each shortage’s reason and estimated duration when available. The agency can also work with manufacturers on quality problems, expedite reviews, extend expiration dates when data support it, and temporarily allow imports of versions approved abroad.

ASHP runs its own list with broader criteria, so a drug can appear there without appearing on the FDA’s. That matters legally: federal compounding rules depend on the FDA list when deciding whether a drug counts as commercially available, while California’s rules accept either list.

How Compounding Pharmacies Can Help During Drug Shortages

When a drug is listed as “currently in shortage” on the FDA’s list, federal law no longer treats it as commercially available. That means a state-licensed 503A compounding pharmacy may prepare it for individual patients with valid prescriptions, as long as every other 503A requirement is still met.

Normally, a 503A pharmacy cannot routinely compound drugs that are essentially copies of a commercially available product. Compounding exists to meet a specific patient’s need, such as a different strength or a liquid for someone who cannot swallow tablets. Our overview of what compounding is covers the basics.

The FDA’s guidance on compounding when drugs are on the shortage list makes clear that a shortage lifts the copy restriction and nothing else. A patient-specific prescription is still required, and under federal law, bulk ingredients must come from FDA-registered sources with a valid certificate of analysis. 503B outsourcing facilities may also use bulk substances to make shortage drugs.

There are real limits. Compounded drugs are not FDA-approved, even during a shortage, so the FDA does not review them for safety, effectiveness, or quality. Complex sterile injectables, chemotherapy agents, and contrast dyes are usually impractical for a community compounding pharmacy, and ingredient shortages can hit compounders too.

California adds its own layer. Under the state’s updated compounding regulations, operative since October 2025, the copy restriction does not apply when a drug appears on the ASHP or FDA shortage list within specified timeframes. Otherwise, a pharmacist must verify and document a clinically significant difference, which is part of how compounded medications differ from generics.

What the GLP-1 Shortage Taught Us About Where Compounding’s Role Ends

Semaglutide and tirzepatide show the full cycle. Both were on the FDA’s shortage list, compounders helped fill the gap, and once the FDA declared the shortages resolved, the broad pathway to compound copies closed after short wind-down periods.

The tirzepatide shortage was declared resolved on December 19, 2024. According to the FDA’s policy update, 503A pharmacies had until February 18, 2025, and 503B facilities until March 19, 2025, to wind down. Semaglutide followed on February 21, 2025, with wind-downs ending April 22 and May 22, 2025.

Since then, a compounded version generally requires a documented, patient-specific significant difference. It is not banned outright, but it looks very different than it did during the shortage.

The FDA has kept watching. On March 3, 2026, it sent warning letters to 30 telehealth companies over marketing that implied compounded GLP-1 products were the same as approved drugs. The lesson is about timing: shortage-based compounding is temporary by design, so plan with your prescriber for what happens when supply returns.

“Compounding can bridge a shortage, but the law is built so that bridge ends when supply returns.”

What to Do If Your Medication Is in Short Supply

The most important step is also the simplest: do not stop, split, skip, or stretch doses on your own. Some medications cause serious problems when stopped suddenly, and only your prescriber can weigh those risks. Call their office as soon as you hear about a supply problem, ideally before you run out.

Your pharmacist is the next call. The FDA notes that many supply problems are local, so ask whether another pharmacy has your medication and whether a different strength, form, or manufacturer is available.

If those options do not work, your prescriber may consider a therapeutic alternative, meaning a different medication for the same condition. You can also ask whether a compounded preparation is an appropriate and lawful option for you.

Be wary of websites selling hard-to-find drugs without a prescription. You can also report a shortage to the FDA at drugshortages@fda.hhs.gov.

How King’s Pharmacy Approaches Shortages With Patients and Prescribers

King’s Pharmacy and Compounding Center in Irvine operates under Section 503A, preparing medications for individual patients with a valid prescription. When a needed medication becomes hard to get, our pharmacists work directly with the prescriber to understand the patient’s needs and whether a compounded option is appropriate and allowed.

Sometimes compounding helps by offering a different form or strength rather than a copy of the missing product. Our alternative dosage forms include customized capsules, troches, transdermal creams and gels, oral suspensions, and suppositories. Whether any of these fits depends on the drug, the prescription, and the prescriber’s documented reasons.

We cannot promise that any particular shortage drug can be compounded. King’s is NABP accredited, partners with Eagle Analytics for independent testing, and is licensed in 13 states. On our prescribers page, prescribers can reach our pharmacists or call 949.387.0780 to confirm the best way to send a prescription (fax 949.387.0784).

Facing a Shortage? Start With a Conversation

Those 227 active drug shortages are more than a statistic, because each one represents patients waiting on a refill, a treatment, or a procedure. In the right cases, a licensed compounding pharmacy can serve as a lawful, short-term bridge, but the first move is always a conversation with your prescriber and pharmacist.

Have questions about whether a compounded medication is right for you? Talk to your prescribing physician, then connect with the pharmacists at King’s Pharmacy and Compounding Center in Irvine, CA, to get started. Request a Refill or Contact King’s Pharmacy at 949.387.0780.

This article is for educational purposes only and is not a substitute for professional medical advice. Compounded medications require a valid prescription.

Frequently Asked Questions

How many drug shortages are there in the U.S. right now?

ASHP data reported by AJMC showed 227 active drug shortages at the end of June 2026, up from 216 at the end of 2025. That is below the 2024 record of 323, but the total has been rising again through mid-2026.

Why do drug shortages keep happening?

Most shortages come from manufacturing quality problems, very low prices on older generics that discourage backup production, and supply chains that depend on a few suppliers. Demand spikes can also outpace supply, and the FDA cannot require a company to make a drug.

Can a compounding pharmacy make my medication if it is on the shortage list?

Possibly. When a drug is listed as currently in shortage by the FDA, a state-licensed 503A pharmacy may compound it for an individual patient with a valid prescription if all other requirements are met. Many shortage drugs are impractical to compound, and compounded drugs are not FDA-approved.

Can I still get compounded semaglutide or tirzepatide now that the shortages are over?

Both shortages were declared resolved, and the compounding wind-down periods ended in 2025. Compounding is not banned outright, but it now generally requires a documented, patient-specific significant difference, so talk with your prescriber.

What should I do if my pharmacy can’t fill my prescription because of a shortage?

Do not stop, skip, or stretch doses on your own, and call your prescriber before you run out. Ask your pharmacist whether another pharmacy, strength, form, or manufacturer is available, and let your prescriber decide on any alternative.