What the Latest Count Shows
Pharmacists now count 223 drugs in active shortage in the United States, a figure that has been rising for two consecutive quarters.
The count comes from the American Society of Health-System Pharmacists and the University of Utah Drug Information Service, which have tracked shortages since 2001. ASHP describes the number as "trending up for the second quarter in a row," while noting it remains well below the all-time high of 323 recorded in the first quarter of 2024.
Two details in that data matter more than the headline number. Fifteen percent of active shortages involve controlled substances, which ASHP says can leave patients with chronic pain or ADHD struggling to fill monthly prescriptions and health systems struggling to stock enough for surgeries and procedures. And roughly three-quarters of active shortages, 77 percent, began in 2022 or later, meaning long-standing shortages are gradually resolving while newer ones accumulate.
ASHP also makes a point that undercuts easy comparisons: a falling count does not necessarily mean fewer patients affected, because a single shortage of a widely used drug can touch enormous numbers of people.
Why Two Official Numbers Disagree
Anyone who has tried to reconcile shortage coverage has run into a puzzle. Pharmacists report hundreds of shortages while the FDA's database lists far fewer, and both are telling the truth.
The two organizations measure different things. The FDA tracks shortages for a defined list of medically necessary drugs and marks a shortage when national supply cannot meet national demand. ASHP counts every product that is short from a working pharmacist's perspective, which includes drugs the FDA does not track and regional or local supply gaps that never become national shortages.
The scale of the gap is easier to see historically. When ASHP counted a record 323 active shortages in early 2024, the FDA counted 113 ongoing shortages at the end of that same year.
The FDA number answers how many national shortages are officially open. The ASHP number answers whether a pharmacist can get a drug today. For a patient standing at a counter being told a medication is unavailable, the second question is the relevant one, which is why the higher figure usually matches lived experience better.
The visibility problem is real. A regional gap that never enters the federal database is invisible in official reporting, even though the patient affected by it experiences a shortage in every practical sense.
How Expiration Date Extensions Hold the System Together
One of the least visible tools in the federal response is also one of the most consequential, and it explains why hospital pharmacies track multiple expiration dates for the same product.
When supply of a drug tightens, the FDA can review stability data from a manufacturer and grant an extended use date, allowing specific lots to be used beyond the expiration printed on the label. The extension applies to identified lots rather than to the drug generally, and it is temporary. Once new production arrives, facilities are expected to move back to normally dated stock.
The extensions vary in size. The agency has allowed certain intravenous solutions to be used up to 24 months after manufacture, while other products, including dantrolene, an emergency drug used for a rare and dangerous reaction to general anesthesia, have received extensions in the range of six to nine months.
This creates an administrative burden that rarely gets described. Pharmacies may hold the same drug in two boxes with different usable dates, requiring inventory systems and staff training to distinguish them. When an extension lapses on a particular lot, that lot comes out of use, which is a routine inventory event rather than a shortage in itself.
The tool works, but it is a bridge rather than a fix, and its heavy use is itself a signal about how tight supply has been.
Which Patients Feel This First
Shortages do not distribute evenly, and the pattern has been consistent for years.
Generic sterile injectables account for a disproportionate share. These are low-margin products, often made by few manufacturers on aging lines, and a single quality problem at one plant can remove much of the national supply. That category includes chemotherapy drugs, anesthetics, and the emergency medications stocked in hospital crash carts.
Controlled substances form the other cluster patients notice most, because federal production quotas and monthly prescribing rules interact badly with tight supply. A patient who must obtain a new prescription each month has no buffer when a pharmacy runs out.
There is a countervailing fact worth reporting. According to the FDA's report to Congress for calendar year 2024, the agency's drug and biologics centers "worked with manufacturers to successfully prevent 283 drug shortages," while 15 new shortages were identified that year, compared with a peak of 251 new shortages in 2011. Early-warning requirements Congress imposed in 2012 obliging manufacturers to notify the agency about manufacturing interruptions are the mechanism behind much of that improvement.
The picture that emerges is a system that has become good at stopping new shortages and remains poor at ending existing ones. Senate investigators have reported that the average shortage lasts about a year and a half, with at least 15 critical drugs short for more than a decade.
What to Do When Your Prescription Is Short
For a patient, the useful response is practical rather than political.
Ask the pharmacist directly whether the shortage is at that pharmacy or broader, since a regional gap may be solved by another location. Ask whether a different strength, a different formulation, or an equivalent generic is available, since substituting two 10 milligram tablets for one 20 milligram tablet often works and requires only a prescriber's confirmation.
Refill early rather than on the last day. Building in a week of margin turns a supply problem into an inconvenience instead of an interruption. For a controlled substance, ask the prescriber's office about the timing rules that apply, because those prescriptions cannot always be filled ahead.
If a substitution is needed, ask what to expect. A different formulation may work slightly differently, and knowing that in advance prevents unnecessary alarm.
Nobody should stop a medication, stretch doses to make a supply last, or split tablets without first asking the prescriber or pharmacist. Rationing a prescription independently is more dangerous than the shortage in most cases. Patients can also ask whether a manufacturer patient assistance program or a compounded alternative prepared by a licensed pharmacy is appropriate, which is a clinician's judgment rather than a consumer choice.
The confirmed fact is 223 active shortages by the pharmacist count, rising for a second quarter. Those most affected are patients on generic injectables and controlled substances. The reasonable action is to refill early and ask about alternatives. The central uncertainty is how much regional shortage remains invisible in federal data. The next expected development is ASHP's next quarterly update.
Frequently Asked Questions
How many drugs are in shortage right now? Pharmacists count 223 active shortages, up for a second consecutive quarter and below the record of 323 set in early 2024.
Why does the FDA report a smaller number? The FDA tracks national shortages for a defined list of medically necessary drugs. Pharmacists count every product that is hard to obtain, including regional gaps.
Which drugs are most affected? Generic sterile injectables, including chemotherapy and emergency drugs, and controlled substances such as ADHD and pain medications.
What is an extended use date? FDA permission to use specific lots of a drug beyond the printed expiration, based on stability data, as a temporary shortage measure.
Is the situation getting better or worse? Both. Fewer new shortages start than a decade ago, but existing ones last longer, averaging about a year and a half.
What should I do if my pharmacy is out of my medication? Ask whether it is a local or national shortage, whether another strength or formulation works, and check other pharmacies. Do not ration doses yourself.
Can I get a compounded version instead? Sometimes, but that is a decision for your prescriber and pharmacist based on the specific drug, not a consumer substitution.
