Injectable Medication Shortages: Why Hospital Pharmacies Are on the Front Line

When a patient needs an IV antibiotic, a life-saving chemotherapy drug, or even just normal saline to stay hydrated, they expect it to be there. But for hospital pharmacies across the U.S., that expectation is becoming harder to meet. As of July 2025, there were still 226 active drug shortages in the country-down slightly from earlier in the year, but far from resolved. And the hardest hit? Hospital pharmacies. They’re not just feeling the pinch. They’re drowning in it.

Why Injectables Are the Weakest Link

Not all medications are created equal when it comes to supply chain fragility. Injectable drugs-especially sterile ones-are uniquely vulnerable. They require aseptic manufacturing environments, where even the tiniest contamination can shut down an entire production line. These drugs can’t be packaged in pill bottles or blister packs. They need clean rooms, trained technicians, and complex quality checks. That makes them expensive and slow to produce.

And here’s the kicker: they make up about 60% of all current drug shortages. That’s not a coincidence. The average shortage for a sterile injectable lasts 4.6 years. Compare that to the 3+ years for other drugs. Why? Because manufacturers don’t make much money on them. Most generic sterile injectables operate on profit margins of just 3% to 5%. When a factory in India gets shut down by an FDA inspection, or a tornado hits a plant in North Carolina, there’s little financial incentive to rebuild fast-or even at all.

Eighty percent of the active pharmaceutical ingredients (APIs) used in these injectables come from just two countries: China and India. That means a single weather event, political shift, or regulatory crackdown overseas can ripple across every hospital in America. In February 2024, a quality issue at a major Indian facility halted production of cisplatin, a key chemotherapy drug. Within weeks, oncology units were scrambling. Patients had to delay treatment. Some were switched to less effective alternatives.

Hospital Pharmacies vs. Retail Pharmacies: A Stark Difference

Think about your local pharmacy. If they run out of a common antibiotic, they can call a distributor, wait a day or two, or maybe suggest an oral version. It’s inconvenient, but rarely life-threatening.

Hospital pharmacies don’t have that luxury. About 35% to 40% of their essential inventory is affected by shortages-nearly double the rate of retail pharmacies. And nearly two-thirds of those are sterile injectables. These aren’t drugs you can swap out easily. A patient in the ICU needs a specific dose of norepinephrine for blood pressure. There’s no oral substitute. No over-the-counter alternative. If it’s gone, the patient’s condition can deteriorate fast.

Academic medical centers report being hit 2.3 times harder than community hospitals. Why? They treat the sickest patients-those needing complex infusions, anesthesia, and critical care drugs. Anesthetics? 87% are in shortage. Chemotherapeutics? 76%. Cardiovascular injectables? 68%. These aren’t niche drugs. They’re the backbone of modern hospital care.

One nurse manager at Massachusetts General Hospital documented 37 surgical procedures postponed in just three months because of anesthetic shortages. That’s not a backlog. That’s a crisis.

The Human Cost: Delays, Dilemmas, and Distress

Behind every shortage statistic is a real person. An elderly patient with sepsis waiting for antibiotics. A child needing IV fluids because they can’t keep anything down. A cancer patient whose treatment is delayed because the only available drug has different side effects.

Seventy-eight percent of hospital pharmacists say shortages have directly caused treatment delays for critically ill patients in the past year. Nearly 70% report being forced to use less effective or more toxic alternatives. That’s not just a clinical compromise-it’s an ethical burden.

A hospital pharmacist on Reddit shared how, after three straight weeks without normal saline, they started using oral rehydration for post-op patients. "Never thought I’d see the day," they wrote. That’s not innovation. That’s desperation.

And it’s getting worse. Hospital staff now spend an average of 11.7 hours per week just trying to find substitutes, track inventory, and coordinate with other facilities. That’s more than a full workday each week spent on crisis management instead of patient care.

Why the System Keeps Failing

You’d think with all the attention, something would change. But the fixes keep falling short.

The FDA can’t force manufacturers to make more drugs. They can only request notifications-and even then, only 14% of reported shortages are resolved quickly. The Consolidated Appropriations Act of 2023 required earlier warnings, but the Government Accountability Office found it cut shortage duration by just 7%.

The Biden administration pledged $1.2 billion in 2024 to rebuild domestic manufacturing. That sounds promising. But experts say it’ll take 3 to 5 years to see results. Meanwhile, the problem grows.

The market is also dangerously concentrated. Just three companies control 65% of the supply for basic injectables like sodium chloride and potassium chloride. That means if one fails, the whole system stumbles. And with only 12% of manufacturers using modern continuous manufacturing technology-something that could make production faster and more reliable-there’s little innovation to offset the risk.

What Hospitals Are Doing to Survive

No one is waiting for Washington to fix this. Hospitals are building their own solutions.

Most now have formal shortage management committees. But only 32% feel they’re properly staffed or funded. Many pharmacists are creating tiered allocation systems-prioritizing the sickest patients first. Others are working with pharmacy and therapeutics committees to approve therapeutic substitutions, even if they’re not ideal.

Some are consolidating stock in central locations to stretch supplies. Others are building direct relationships with alternative suppliers, even if they’re smaller or less familiar. One hospital in Ohio started sourcing potassium chloride from a Canadian manufacturer after their U.S. supplier failed. It took six months of paperwork, but it worked.

These strategies reduce clinical disruption by 15% to 20%. That’s meaningful. But they’re not fixes. They’re bandages on a wound that keeps bleeding.

And here’s the problem: only 45% of hospitals have well-documented, regularly updated shortage protocols. The rest are winging it. That increases the risk of medication errors. One wrong dose of a substituted drug can kill.

The Road Ahead: No Easy Answers

The data is clear. Injectable drug shortages aren’t going away. They’re becoming the new normal. Hospital pharmacies are on the front line-not because they’re better equipped, but because they’re the last place patients can turn.

Without major policy changes-like incentives for manufacturers to invest in resilient production, or penalties for chronic underproduction-this crisis will keep deepening. Climate events, geopolitical instability, and economic pressure on generic drug makers aren’t going to disappear.

For now, hospital pharmacists are doing what they always do: adapting, improvising, and pushing through. But they can’t do it alone. Patients deserve more than creative workarounds. They deserve reliable access to the medicines they need to live.

The question isn’t whether we can afford to fix this. It’s whether we can afford not to.