Shortage Mitigation Strategies: How Health Systems Are Fighting Drug Shortages

Drug shortages aren’t just inconvenient-they’re dangerous

When a hospital runs out of a critical antibiotic like vancomycin or a life-saving chemotherapy drug like cisplatin, doctors don’t have time to wait for a solution. Patients delay treatment. Some skip doses. Others end up in emergency rooms because there’s no alternative. In 2024, the U.S. Food and Drug Administration tracked over 300 active drug shortages, with 40% of them involving injectable medications used in ICUs and cancer centers. These aren’t rare glitches-they’re systemic failures in a supply chain that’s been stretched thin by globalization, manufacturing bottlenecks, and rising demand.

Why do drug shortages keep happening?

The root causes are simple but hard to fix. Most generic injectable drugs are made in just a few factories, often overseas. If one plant shuts down for an FDA inspection-or if a key raw material gets delayed-the whole country feels it. In 2023, a single manufacturer in India halted production of phenylephrine, a blood pressure drug used in over 90% of U.S. hospitals. Within weeks, emergency rooms were rationing doses. Meanwhile, profit margins on generic drugs are razor-thin. Companies don’t invest in backup lines or extra inventory because there’s no financial upside. And when demand spikes-like during flu season or a pandemic-the system cracks.

Health systems are building buffer stocks

One of the most direct fixes? Keeping extra supplies on hand. Hospitals that used to order drugs just-in-time are now holding 30 to 60 days of safety stock for high-risk medications. Memorial Sloan Kettering Cancer Center started stockpiling 45 days’ worth of key chemotherapies in 2023. They now have a digital dashboard that tracks inventory levels across all 12 of their clinics. When stock dips below 20%, the system auto-orders replacement. It cost them $2.1 million upfront to build the system, but they cut emergency purchases by 68% in 2024. That’s $4.7 million saved in last-minute, premium-priced orders.

They’re diversifying suppliers-fast

Going all-in on one manufacturer is a gamble. Leading health systems are now requiring at least two FDA-approved suppliers for every critical drug. Kaiser Permanente’s pharmacy team now vets at least three vendors for each high-demand medication. In 2024, they switched from a single-source supplier of epinephrine to two new manufacturers-one in the U.S., one in Europe. When the original supplier had a quality issue, the transition took less than 72 hours. No patient care was disrupted. That kind of agility used to take six months. Now, it’s standard practice.

Pharmacists are taking charge of substitutions

When a drug is out of stock, pharmacists don’t just sit and wait. They’re actively finding safe, FDA-approved alternatives. At Cleveland Clinic, pharmacists now have pre-approved substitution lists for over 80 high-risk drugs. For example, if dobutamine isn’t available, they can switch to dopamine or norepinephrine based on patient weight, kidney function, and heart rate-all standardized in a digital protocol. In 2024, their pharmacy team managed 1,200 substitution events without a single adverse event. That’s not luck. It’s training. Pharmacists now get quarterly updates on substitution guidelines and real-time alerts when a drug is flagged for shortage.

Technology is predicting shortages before they happen

Some health systems are using AI to see around corners. Intermountain Healthcare built a predictive model that pulls data from FDA shortage reports, global raw material shipments, weather patterns affecting overseas factories, and even social media chatter about drug rumors. The system gives a 30-day warning before a shortage hits. In 2024, it flagged a potential shortage of propofol two weeks before the FDA announcement. The hospital ordered extra stock, redistributed inventory across its 22 facilities, and trained staff on usage limits. They never ran out. The model has since been expanded to track 140 critical drugs. Its accuracy rate? 89%.

Collaboration is replacing competition

Hospitals used to hoard information. Now, they’re sharing. In 12 states, health systems have formed regional drug shortage coalitions. In the Midwest, 47 hospitals share real-time inventory data through a secure portal. If one hospital runs low on midazolam, another can transfer a shipment within hours. No paperwork. No billing. Just a text alert and a courier. The coalition, launched in 2023, reduced regional drug shortages by 41% in 18 months. The American Hospital Association is now pushing for a national version. The goal? Make scarcity a shared problem, not a hospital-by-hospital crisis.

Regulators are changing the rules

The FDA is no longer just reacting. In 2024, they started requiring manufacturers to report potential supply issues six months in advance-not three. They also fast-tracked approvals for new generic drug makers. In 2023, only 12 new generic injectable manufacturers got FDA approval. In 2024, that number jumped to 31. One of them, a small U.S.-based plant in Ohio, now supplies 15% of the nation’s amiodarone, a heart rhythm drug that was nearly impossible to get in 2022. The FDA also started publishing a public dashboard showing which drugs are at risk, how long shortages are expected to last, and where alternatives are available.

Patients are being informed-before it’s too late

Health systems are no longer hiding shortages from patients. At Mayo Clinic, if a patient’s medication is on the shortage list, their doctor explains the situation during the appointment. They show them the alternative options, why it’s safe, and how it’s being monitored. Patients get a printed card with contact info for the pharmacy team if they have questions. This transparency reduces panic. It also builds trust. In a 2024 survey, 78% of patients said they felt more confident in their care when they understood why a drug changed.

What’s still broken?

Not everything is fixed. Rural clinics still struggle. Many don’t have the budget for safety stock or AI tools. And some drugs-like those made from rare biological materials-still have no alternatives. The biggest gap? Workforce. Pharmacists and nurses are stretched thin. A 2025 survey found that 61% of hospital pharmacists are spending more than 20 hours a week managing shortages instead of counseling patients. Without more staff, even the best systems can’t scale.

The future: Prevention over panic

The most successful health systems aren’t just reacting-they’re preventing. They’re investing in domestic manufacturing, supporting small drug makers, and tying supplier contracts to inventory transparency. Some are even funding research into new drug formulations that use more stable ingredients. The goal? Make shortages the exception, not the norm. It’s not about having more drugs. It’s about having smarter systems. And that’s the real fix.