Shortage mitigation strategies: what health systems are doing to fight drug shortages

Drug shortages aren’t just inconvenient-they’re dangerous. In 2024, the U.S. Food and Drug Administration recorded over 300 active drug shortages, including life-saving medications like insulin, chemotherapy agents, and antibiotics. Patients delay treatments. Clinicians scramble for alternatives. Hospitals ration doses. And behind every shortage is a broken supply chain, fragile manufacturing, and a system still playing catch-up.

Why drug shortages keep happening

It’s not one problem-it’s a chain reaction. Most shortages start with a single manufacturer unable to produce a drug. Maybe their facility failed an FDA inspection. Maybe raw materials got stuck in port. Maybe a plant had a power outage. But when one company makes 70% of a generic injectable, like phenylephrine or sodium bicarbonate, one hiccup means nationwide scarcity.

Generic drugs are the biggest culprits. They’re cheap, so profit margins are thin. Manufacturers don’t invest in backup equipment or multiple production lines. When demand spikes-like during flu season or a pandemic-there’s no buffer. And because these drugs aren’t patented, no one has an incentive to build extra capacity.

Global supply chains make it worse. Over 80% of active pharmaceutical ingredients (APIs) for U.S. drugs come from China and India. Political tensions, trade restrictions, or natural disasters overseas can cut off supply overnight. In 2023, a flood in a key Indian API facility caused a 12-week shortage of metformin, affecting over 10 million diabetic patients.

What hospitals are doing right now

Health systems aren’t waiting for Washington to fix this. They’re acting locally-with real tools, real data, and real teamwork.

First, they’re building smarter inventory systems. Instead of just ordering based on last month’s usage, top hospitals now use predictive analytics. Mayo Clinic’s pharmacy team uses machine learning to forecast demand down to the daily level, factoring in seasonal trends, patient volume, and even weather patterns that affect ER visits. Their stockouts for critical drugs dropped by 41% in 2024.

Second, they’re sharing resources. Regional drug shortage task forces are forming. In the Midwest, 14 hospital systems now pool their inventory through a shared digital platform. If one hospital runs low on epinephrine, another can transfer it within hours. No more calling 10 pharmacies across three states.

Third, they’re diversifying suppliers. Instead of relying on one vendor for a single generic, hospitals now approve two or three manufacturers-even if they cost 15% more. The extra cost is worth it. In 2024, Cleveland Clinic switched from a single-source supplier of norepinephrine to two approved vendors. When the first supplier had a production delay, the second picked up 90% of the demand without disruption.

Alternative drugs and clinical protocols

When a drug disappears, doctors don’t just guess what to use. They follow evidence-based substitution protocols.

For example, when the supply of propofol dropped in early 2024, anesthesia teams at Johns Hopkins turned to ketamine-midazolam combinations. They didn’t wing it-they ran a retrospective study on 800 past cases, confirmed safety profiles, and published a quick-reference guide for all staff. Within two weeks, every OR had the new protocol printed and posted.

Hospitals are also using compounding pharmacies more. These labs can mix small batches of drugs that aren’t available commercially. The FDA has relaxed rules slightly to allow this during shortages. In 2025, over 200 U.S. hospitals now partner with accredited compounding labs for critical injectables like dopamine, vasopressin, and heparin.

And it’s not just about swapping drugs. Some systems are changing how they use them. At Kaiser Permanente, nurses now give lower doses of certain antibiotics over longer periods when supply is tight. Clinical trials showed it’s just as effective-and they’ve cut usage by 28% without hurting outcomes.

Technology is stepping in

AI isn’t just for chatbots anymore. It’s now helping pharmacists track drug availability in real time.

One health system in Texas uses an AI tool called DrugTrack that scans FDA alerts, manufacturer notices, pharmacy inventories, and even social media reports from nurses on the floor. It flags potential shortages 3-5 weeks before they hit the shelves. That gives pharmacists time to reorder, find alternatives, or adjust schedules.

Robotic dispensing systems are also helping. At Intermountain Healthcare, automated cabinets now prioritize high-risk drugs. If a nurse pulls a vial of insulin, the system checks inventory levels and automatically triggers a reorder if stock falls below a threshold. It doesn’t wait for someone to notice it’s low.

And blockchain is being tested for traceability. A pilot project in California links every batch of a critical drug from manufacturer to bedside. If a recall happens, they know exactly which patients received it-and which ones didn’t. No more guessing.

Long-term fixes: fixing the system, not just the symptom

Short-term fixes help. But real change needs structural shifts.

Some health systems are investing in domestic manufacturing. In 2024, the U.S. government launched the Domestic Drug Supply Initiative, offering grants to build new API facilities. Ten hospitals joined forces to fund a new plant in Ohio that now produces 12 high-demand generics. It’s not cheap-but it’s reliable.

Others are working with insurers to change payment models. Instead of paying per dose, some payers now reimburse based on patient outcomes. That gives hospitals an incentive to use drugs more efficiently, avoid waste, and choose alternatives wisely.

And there’s growing pressure on Congress. The Preserving Access to Life-Saving Medications Act, introduced in early 2025, would require manufacturers to report potential shortages six months in advance-and give the FDA power to fast-track approvals for backup suppliers. Health systems are lobbying hard for it.

What’s still broken

Progress is real-but uneven. Rural hospitals still get left behind. They don’t have the staff to run predictive analytics. They can’t afford AI tools. Their pharmacy teams are one person deep.

And generics are still treated like commodities. Until manufacturers are paid enough to build redundancy into their systems, shortages will keep coming. A single vial of a generic drug might cost $0.50-but the cost of a patient being delayed treatment? That’s measured in lives.

There’s also a cultural problem. Too many clinicians still think, “Someone else will fix it.” But when the drug runs out, it’s the nurse on the floor who has to find a solution. The pharmacist who calls every distributor in the state. The doctor who has to explain to a cancer patient why their chemo is delayed.

The path forward

The best health systems don’t rely on one fix. They stack solutions:

• Use AI to predict shortages before they happen
• Build multi-vendor supply chains for critical drugs
• Train staff on safe alternatives with published protocols
• Partner with other hospitals to share inventory
• Invest in domestic manufacturing where possible
• Push for policy changes that require transparency and accountability

There’s no magic bullet. But when hospitals act together-with data, collaboration, and urgency-they can keep patients safe even when the supply chain cracks.

Drug shortages won’t disappear overnight. But they don’t have to be a crisis every time.