Drug shortages have plagued health systems nationwide for decades. When hospitals run short on critical medications — from common cancer treatments to basic IV fluids — pharmacists are forced to substitute therapies, ration supplies or delay care. Even as the headlines fade in and out, pharmacy leaders say the problem never really does.
Systems are experimenting with ways to keep their shelves stocked. Some are expanding relationships with wholesalers or building internal dashboards to flag potential disruptions. Others are developing contingency plans to rotate limited drugs across hospitals. At Louisville, Ky.-based Baptist Health, one strategy has proved especially effective: dedicating staff entirely to the cause.
“We’ve found that having a dedicated pharmacist and technician to manage drug shortages has been immensely beneficial,” said Nilesh Desai, chief pharmacy officer at Baptist Health System. “These individuals are instrumental in communicating, navigating and implementing strategies to manage shortages on a day-to-day basis, ensuring that we can continue to provide optimal patient care despite the challenges.”
That constant vigilance has become essential in an era when shortages can emerge with little warning and ripple through the supply chain in days. Yet Mr. Desai said the national discussions about shortages — from those of policymakers to the public — still fail to capture the scale of the crisis.
“There needs to be a greater emphasis on the criticality of the issue from both an operational and a patient care perspective,” he said. “The conversation must reflect a long-term strategy and the impact it has on healthcare delivery.”
For many pharmacy leaders, the frustration is that the same vulnerabilities persist year after year: fragile supply chains, razor-thin profit margins for generic drugs and a lack of manufacturing transparency. Majid Tanas, PharmD, vice president of pharmacy at Aurora, Colo.-based UCHealth, said those weaknesses have largely gone unaddressed in favor of Band-Aid solutions and lax oversight.
“We lack early warning systems to identify disruptions before they affect patients, and manufacturers or distributors are not required to provide transparency around production capacity or supply risks,” Dr. Tanas said. “There are no meaningful penalties for failing to deliver essential medications, and most supply chains still rely on just-in-time models, leaving little room for error or disruption.”
In his view, the system rewards efficiency over resilience. Building stronger safeguards would require a national early warning system, enforced transparency rules and accountability measures — not only penalties for missed deliveries but also incentives for manufacturers that invest in reliability. He also supports diversifying suppliers and bolstering domestic manufacturing, particularly for generic injectables that hospitals rely on daily.
“Without these steps,” he said, “we will continue reacting to crises instead of preventing them, putting patient care at risk.”
That reactive posture is a theme bemoaned by many in hospital pharmacy. The problem, some argue, is not simply logistical but structural — embedded in the economics of how drugs are priced, purchased and produced. Erin Fox, PharmD, associate chief pharmacy officer for shared services at Salt Lake City-based University of Utah Health, has studied shortages for years and said the market’s financial incentives make reliability nearly impossible.
“The margins are very slim on these products, which doesn’t allow for redundancy or other methods to improve reliability,” Dr. Fox said. “There are no factors to differentiate products besides price because FDA ratings say they’re all equivalent. Meanwhile, health systems work hard to purchase products at the very lowest prices and we have a race to the bottom and continued shortages.”
That race to the bottom, she said, discourages investment in quality manufacturing or backup capacity. When one facility goes offline — whether from contamination, natural disaster or financial collapse — there are few alternatives.
Even as the federal government explores solutions, including potential stockpiles and transparency requirements, leaders say the needle won’t budge unless the conversation moves beyond crisis management to prevention. Shortages are not a series of isolated supply disruptions but a predictable outcome of an economic system that prizes cost-cutting above resilience.
For now, hospitals like Baptist Health System, UCHealth and University of Utah Health continue to build their local stopgaps of dedicated staff, internal tracking systems and constant coordination with clinicians. But, as Mr. Desai noted, these measures only go so far.
“We can manage the symptoms,” he said. “But until there’s a stronger national commitment to fixing the root causes, we’ll keep fighting the same battle year after year.”
