Drug shortages remain a thorn in the side of hospital pharmacy leaders nationwide, but one health system has found the right combination of tools to manage them.
The American Society of Health-System Pharmacists reported 216 active drug shortages in early 2026, up slightly from the previous quarter. While new shortages fell to 89 in 2025 — a 20-year low — three-fourths of active shortages originated in 2022 or later, underscoring persistent supply issues affecting hospital operations.
David Young, vice president of pharmacy operations at Brockton, Mass.-based Signature Healthcare, told Becker’s that systemwide improvements have helped stabilize how hospitals respond to disruptions.
“The biggest thing is the GPOs [group purchasing organizations] we are partnering with; they have better reach and research departments than a regular pharmacy,” he said.
At Signature Healthcare, that difference has allowed for a more proactive approach to supply management, with pharmacy teams using historical shortage patterns to guide purchasing decisions and maintain roughly one month’s supply of critical medications.
However, Mr. Young said, drugs such as lorazepam, midazolam and methadone remain among the most disruptive.
“When you have a shortage, you have to change practices on the fly,” he said.
In practice, that can mean overhauling prescribing protocols, modifying EMR workflows and coordinating closely with physicians. Some hospitals have also turned to informal collaboration across systems to shore up supply: Mr. Young said Signature partners with other hospitals to borrow and swap medications when needed, creating a backstop when primary supply channels fall short.
While these workarounds preserve day-to-day functioning, deeper supply chain vulnerabilities still stand to be corrected. Heavy reliance on overseas manufacturing for generic drugs and active pharmaceutical ingredients leaves hospitals vulnerable to disruption.
“All you need is a hurricane to hit, and then you’re running around trying to get that,” he said.
The U.S.-Iran war has disrupted key shipping routes and driven up energy costs, raising the risk of shortages across multiple drug classes. The impact is magnified by global supply patterns: India supplies roughly 47% of generic drugs used in the U.S. and depends heavily on those routes.
Even small production hubs carry outsized risk. Jordan, for instance, produces about 50% of the world’s amoxicillin oral suspension and half of the active pharmaceutical ingredient for etomidate, while Israel and Jordan together account for 73% of the global flumazenil active pharmaceutical ingredient supply. About 99% of pharmaceutical manufacturing also depends on petrochemical-derived inputs, further tying drug availability to energy market stability.
Those risks hit hardest at smaller and community-based hospitals, which often lack the purchasing volume to secure priority access from distributors.
“When it becomes a shortage and we need that drug now, it becomes 10 times more difficult because there’s no allocation,” Mr. Young said.
Without that access, smaller systems must rely on close monitoring of usage patterns and more deliberate decisions about which medications to keep on hand.
Gaps in long-term planning also compound the challenge — when new therapies reach the market unexpectedly, they can upend hospital budgets overnight.
“When a drug comes on in the middle of your fiscal year, you can’t plan for that,” Mr. Young said. More forward-looking visibility from the FDA on upcoming drug approvals could help hospitals better plan for both clinical adoption and financial impact, he added.
As shortages persist, pharmacy leaders need a sharper focus on the medications most likely to disrupt care and finances. “Have a pulse on your top 10 to 20 critical drugs,” Mr. Young said.
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