A Practical Guide for Pharmacy Drug Shortages

On any given day in the United States, a community pharmacist is likely managing at least 1 drug shortage, and often several. A wholesaler allocates less than what was ordered. A manufacturer issues a backorder notice. A patient arrives expecting a refill that can't be filled. For independent pharmacies, these moments are not rare disruptions—they are routine.

Drug shortages have become one of the most persistent operational and clinical challenges in community pharmacy practice. According to the American Society of Health-System Pharmacists (ASHP), the US currently has approximately 200 active drug shortages as of 2026, with controlled substances—including pain and attention-deficit/hyperactivity disorder medications—representing 15% of shortages and among the most disruptive for independent pharmacy patients.^1,2 A recent survey found that 97% of independent pharmacy owners and managers reported actively dealing with a drug shortage.³

Independent pharmacies face these challenges with fewer resources than their chain and health system counterparts. Limited storage space constrains the ability to carry buffer stock. Lower purchasing volumes reduce negotiating leverage with wholesalers. Lean staffing leaves little time for proactive shortage monitoring.

Although no pharmacy can prevent shortages at the manufacturer or national supply level, the good news is that meaningful resilience does not require a large budget or an enterprise procurement team. It requires the right systems, the right supplier relationships, and a shift from reactive to proactive thinking.

A drug shortage is defined as a supply issue that affects how the pharmacy prepares or dispenses a drug or influences patient care when prescribers must use an alternative agent.⁴ Drug shortages vary widely in scope and severity, arising from a range of underlying causes, including the following⁵:

• Unique market for drug products. Many essential medications, particularly older generics and sterile injectables, are manufactured by only 1 or 2 suppliers globally. Thin profit margins on generic drugs also discourage new manufacturers from entering the market, leaving supply permanently concentrated with no backup when disruptions occur.
• Manufacturing and quality problems. FDA inspections identifying contamination, sterility failures, or Good Manufacturing Practice violations can force immediate production halts. These shutdowns are often unplanned and can last months while remediation occurs, with little advance notice to downstream pharmacies.
• Production delays and lack of capacity. Even without quality issues, manufacturers may lack the capacity to scale production quickly in response to demand spikes. Catching up after a shortage begins can take far longer than the shortage itself.
• Manufacturer business decisions. Pharmaceutical companies routinely discontinue unprofitable products, redirecting manufacturing capacity toward higher-margin products, or exit certain markets entirely.
• Shortages of active pharmaceutical ingredients or raw materials. Most active pharmaceutical ingredients used in US medications are manufactured overseas, with significant concentration in India and China. Disruptions at the raw-material level, whether from regulatory action, natural disaster, or geopolitical tension, ripple through the entire supply chain long before they become visible at the pharmacy counter.
• Restricted distribution and allocation of drug products. During shortages, wholesalers and manufacturers often implement allocation limits regardless of patient need. Independent pharmacies have lower purchasing volumes and are frequently at a disadvantage compared with larger chain buyers.
• Inventory practices. Panic buying by pharmacies and health systems can accelerate and deepen shortages that might otherwise be manageable, inadvertently triggering the very supply gap they were trying to avoid.

Inventory Management

Managing inventory in a small pharmacy is a constant balancing act. Tie up too much capital in stock and cash flow suffers; carry too little and patients go without. Staying informed is the most cost-effective tool for managing shortages. For independent pharmacies, effective pharmacy inventory management is crucial for maintaining profitability, ensuring compliance, and meeting customer demands.⁶

Start by identifying which medications carry the highest shortage risk. Generic sterile injectables, controlled substances, narrow therapeutic index drugs, and single-source products are historically most vulnerable. A simple spreadsheet categorizing your top 50 to 100 dispensed medications by shortage risk tier lets you allocate your limited buffer inventory budget where it matters most.⁷

Establish a monitoring routine that integrates into your pharmacy’s workflow, including daily review of wholesaler order confirmations to identify shorted items, which are often the earliest indicator of an emerging shortage. Run dispensing reports monthly and consistently monitor the FDA Drug Shortage Database and ASHP shortage websites that list timely information on emerging shortages, expected durations, and available alternatives.⁶ In addition, quarterly staff reviews can reveal ground-level insights about what has been sitting on shelves, what they're seeing increased need for, and emerging demand trends.⁶ Customers with special or rare medication needs are often willing to notify their pharmacy in advance of when they'll need to restock, a simple but effective way to anticipate demand during shortage periods.⁷

For medications currently listed on shortage databases or historically prone to supply gaps, temporarily increasing par levels can provide a small cushion. Even an extra 2-week supply of a high-risk medication can make the difference between serving a patient and turning them away. Rather than stockpiling reactively when a shortage is announced, which worsens supply conditions for everyone, use a flexible stocking model with smaller, more frequent orders for most products.^7,8

Finally, align with prescribers before shortages occur. Pharmacies that proactively identify therapeutic alternatives and communicate substitution preferences to local providers are better positioned to respond quickly.⁸

Supplier Strategies

For independent pharmacies, supplier strategy is often the most constrained aspect of shortage management. Independent pharmacies typically purchase the majority of their inventory from one primary wholesaler, most commonly McKesson, Cencora, or Cardinal Health. Although these relationships are essential, overreliance on a single supplier is a significant vulnerability during shortages.^6,7,9,10

Establishing accounts with at least 1 secondary wholesaler is one important step an independent pharmacy can take. Secondary and specialty wholesalers often carry products that primary wholesalers are allocating or have run out of. Having a preestablished account, with credit terms already in place, means you can act immediately when your primary source falls short. In addition, neighboring pharmacies can also be part of the sourcing network and can help bridge temporary gaps.

Group purchasing organizations (GPOs) are among the most accessible ways for independent pharmacies to strengthen both purchasing power and resilience against shortages.⁹ By aggregating volume across hundreds or thousands of member pharmacies, GPOs negotiate contracts that include shortage allocation provisions, minimum supply commitments, and early notification requirements from manufacturers. Beyond pricing, GPO membership typically provides access to shortage intelligence feeds, peer communication networks, and collective advocacy with wholesalers and manufacturers. Knowing 2 weeks in advance that a drug is entering shortage because another member of your network just heard from their wholesaler representative is exactly the kind of early warning that separates prepared pharmacies from reactive ones.

The most accessible entry points for independent pharmacies are networks tied directly to primary wholesalers, such as Good Neighbor Pharmacy through Cencora and Health Mart through McKesson. These networks layer GPO benefits onto an existing wholesaler relationship at little or no additional cost. Independent-focused organizations such as the National Community Pharmacists Association offer additional options with broader advocacy and educational resources.

Technology Solutions

One of the key challenges independent pharmacies face is limited visibility into supply chain dynamics. Larger organizations rely on dedicated procurement teams and enterprise analytics platforms, whereas independents must make the same decisions with considerably less information. Closing that gap does not require significant technology investment. Much of what is needed is already available within the systems pharmacies use or pay for.

Most independent pharmacy management systems include inventory capabilities that go well beyond basic ordering, such as automated reorder points, dispensing velocity tracking, near-expiry alerts, and usage reporting.⁶ These features are widely available but frequently underutilized. Configuring your existing system to generate low-stock alerts before a stockout occurs, flag accelerating demand on specific products, and produce regular shortage-risk reports is one of the highest-return steps a pharmacy can take at zero additional cost.

Primary wholesaler portals have expanded significantly beyond order placement. Most now include low-supply flags on product pages, equivalent product suggestions during shortage periods, and purchasing trend analytics.¹¹ However, many independent pharmacies use these platforms solely for ordering and are leaving meaningful shortage intelligence on the table. Spending time with your wholesaler account representative to review analytics and shortage management capabilities can be highly valuable.

Pharmacy-specific procurement platforms designed for community settings can consolidate real-time pricing, inventory analytics, shortage signals, and alternative product identification within a single interface. Complementing these, shortage-tracking tools can provide forecasting insights and visibility into emerging supply disruptions. Free resources, including the FDA Drug Shortage Database and ASHP shortage alerts, remain foundational and should be consistently monitored regardless of other tools in use.

The Drug Supply Chain Security Act now mandates electronic track-and-trace for all dispensers.¹² Beyond compliance, these serialization systems provide real-time visibility into where a product is in the distribution chain and whether it has moved through authorized channels, which is an important safeguard when sourcing from secondary suppliers during shortage periods. At the national level, the National Association of Boards of Pharmacy is developing Pulse, a secure digital platform designed to proactively identify and address potential disruptions to medication availability.⁵

Drug and supply shortages are unlikely to be resolved in the near term. The US generic drug supply chain's reliance on foreign manufacturing and downward pressure on generic drug prices suggest that disruptions will remain a recurring and potentially worsening challenge.⁹ For independent pharmacies, the goal is not to eliminate shortages but to build systems that can absorb and adapt to them.

An effective response to drug shortages does not depend on a large budget, but it does require consistency and discipline. Regular inventory reviews, strong relationships with multiple suppliers, effective use of existing technology, and well-trained staff are all essential to ensuring a timely and consistent response. Studies of community pharmacy shortage management consistently identify early communication, supplier diversification, and active consumption monitoring as central to better outcomes.^6,8 Independent pharmacies that approach drug shortages as a strategic challenge rather than a temporary inconvenience will be better positioned to maintain patient care, protect margins, and serve their communities through whatever disruptions come next.

REFERENCES

1. Drug shortages list. American Society of Health-Systems Pharmacists. Accessed April 11, 2026. https://www.ashp.org/drug-shortages/current-shortages/drug-shortages-list?page=CurrentShortages

2. Jeffries E. New drug shortages hit 20-year low: ASHP report. Becker's Hospital Review. January 23, 2026. Accessed April 12, 2026. https://www.beckershospitalreview.com/pharmacy/new-drug-shortages-hit-20-year-low-ashp-report

3. NCPA releases latest survey on drug supply chain and staffing. News release. National Community Pharmacists Association. February 14, 2024. Accessed April 3, 2026. https://ncpa.org/newsroom/news-releases/2024/02/14/ncpa-releases-latest-survey-drug-supply-chain-and-staffing

4. Liu I, Colmenares E, Tak C, et al. Development and validation of a predictive model to predict and manage drug shortages. Am J Health Syst Pharm. 2021;78(14):1309-1316. doi:10.1093/ajhp/zxab152

5. Solving the puzzle of chronic medication shortages. National Association of Boards of Pharmacy. October 15, 2025. Accessed April 8, 2026. https://nabp.pharmacy/news/blog/solving-the-puzzle-of-chronic-medication-shortages/

6. Mitigating the impact of drug shortages – essential steps for pharmacy technicians. National Pharmacy Technician Association. July 10, 2023. Accessed April 8, 2026. https://cpht.org/mitigating-the-impact-of-drug-shortages-essential-steps-for-pharmacy-technicians/

7. Best Practices for Independent Pharmacy Inventory Management. TRC Healthcare. April 6, 2023. Accessed April 10, 2026. https://trchealthcare.com/best-practices-for-independent-pharmacy-inventory-management/

8. Fox ER, McLaughlin MM. ASHP guidelines on managing drug product shortages. Am J Health Syst Pharm. 2018;75(21):1742-1750. doi:10.2146/ajhp180441

9. Nightengale BR, Huseby T. Emerging trends in pharmacy operations: perspectives on the 2024 AMCP Foundation Survey. J Manag Care Spec Pharm. 2025;31(Suppl 2a):S25-S28. doi:10.18553/jmcp.2025.31.2-a.s25

10. SureCost. Navigating drug shortages and price fluctuations. White paper. SureCost; 2025. Accessed May 5, 2026. https://www.surecost.com/navigating-drug-shortages-and-pharmacy-inventory-solutions#download

11. Gallagher J. Pharmacy undergoes a tech takeover. Drug Store News. February 2, 2026. Accessed April 12, 2026. https://drugstorenews.com/pharmacy-undergoes-tech-takeover

12. Drug Supply Chain Security Act (DSCSA). FDA. Updated October 16, 2025. Accessed April 15, 2026. https://www.fda.gov/drugs/drug-supply-chain-integrity/drug-supply-chain-security-act-dscsa