Active US Drug Shortages Rise for Third Straight Quarter

Active drug shortages in the US climbed to 227 as of the second quarter of 2026, marking the third consecutive quarterly increase.¹ The good news? This figure remains well below the all-time high of 323 recorded in the first quarter of 2024¹ and the 277 shortages recorded as of September 2024.² Among the new shortages driving concern is ifosfamide, a chemotherapy agent used in curative regimens for testicular cancer and sarcoma, which entered severe shortage after manufacturing quality problems surfaced at a key supplier.

The uptick, reported by the American Society of Health-System Pharmacists (ASHP) and the University of Utah Drug Information Service, underscores a persistent theme in US pharmaceutical supply: even as the raw shortage count has retreated from its 2024 peak, the underlying fragility of the generic manufacturing base means any single plant disruption can quickly cascade into a life-threatening gap in care.

Why Does the Ifosfamide Shortage Threaten Curative Regimens?

Ifosfamide is not an isolated case. Ifosfamide is not an isolated case. It's also a component of the RICE regimen (rituximab, ifosfamide, carboplatin, and etoposide), a common salvage therapy for relapsed diffuse large B-cell lymphoma, meaning its unavailability reaches beyond the 2 cancers named in the new ASHP data, much as a carboplatin shortage did for RICE in 2023.³ Health care practitioners have described these recurring generic sterile injectable (GSI) shortages as primarily rooted in the business and quality-control decisions that manufacturers make when profit margins on decades-old generics shrink toward zero.⁴

That pricing dynamic has been raised repeatedly in congressional testimony. Oncologists and drug-supply-chain specialists have told lawmakers that market forces have pushed GSI prices so low that manufacturers cannot justify the capital investment needed to sustain the quality-control systems that prevent contamination and plant shutdowns.⁴ A similar wave of sterile injectable shortages in 2010 and 2011 also was traced to a shrinking pool of manufacturers willing to produce low-margin generic injectables, leaving the market without redundancy when any single plant faltered.⁵

Which Drug Classes and Populations Are Bearing the Load?

Central nervous system medications remain the largest category of active shortages, followed by antimicrobials, then chemotherapy and hormone agents, which tied for third, according to the new data.¹ Sixteen percent of all active shortages involve controlled substances, a category that has direct implications for patients managing chronic pain or attention-deficit/hyperactivity disorder, who may struggle to fill monthly prescriptions, and for health systems trying to secure adequate supply for scheduled surgeries and procedures.

Just under half (48%) of all new 2026 shortages involve sole-source products, meaning a single manufacturer’s disruption can eliminate the entire domestic supply of a given drug with no immediate alternative. Further, contrast agents used in CT and MRI scans made up 10% of all new shortages identified in 2026, a category with direct bearing on diagnostic capacity for potentially life-saving procedures.

The sole-source statistic reflects a structural problem that industry groups have also flagged in recent years. A 2023 white paper attributed the broader generic shortage crisis to the same forces cited in congressional testimony: thin margins, increasing concentration among drug purchasers, and a shrinking number of registered manufacturing sites for any given product.⁶

Manufacturers reported the cause of 59% of 2025 shortages as “unknown” or declined to provide a reason at all, according to the University of Utah’s investigation, with supply-and-demand mismatches (16%), manufacturing issues (15%), business decisions (6%), regulatory hindrances (2%), and shipping delays and raw material issues (1% each) accounting for the remainder.¹ That opacity has been a recurring frustration for health system pharmacists and policy makers alike, who have called for stronger FDA authority to compel earlier notification when a manufacturer plans to discontinue or interrupt production.⁵

What Are the Broader Implications for Health Systems?

The ASHP/University of Utah report’s authors caution that a declining shortage count does not necessarily mean fewer patients are affected, since a single shortage still touches large patient populations.¹ This burden extends to the health systems’ operations as well; for example, reconfiguring pharmacy automation and electronic health records to manage each new shortage adds to workloads at a time when many pharmacy departments are themselves understaffed.

An analysis from The American Journal of Managed Care^® (AJMC^®) found that the time hospitals spend managing drug shortages more than doubled between 2019 and 2024, transforming what was once a routine purchasing task into a costly, staff-intensive undertaking that touches both margins and patient access.⁷ The report also notes that the impact of the conflict in Iran on the US drug supply remains unclear, an open variable that adds further uncertainty to an already strained system.¹

Overall, for health system leaders and payers, the data suggest that near-term relief will depend less on any single new shortage resolving and more on structural fixes that address why sole-source and thin-margin generics keep failing in the first place.

References

1. Fox ER, Ganio M. National drug shortages: January 2001–June 2026. American Society of Health-System Pharmacists and University of Utah Drug Information Service. 2026. Accessed July 20, 2026. https://www.ashp.org/-/media/assets/drug-shortages/docs/Drug-Shortages-Report.pdf
2. McCormick B. 5 essential drugs currently facing shortages. AJMC. Accessed July 20, 2026. https://www.ajmc.com/view/5-essential-drugs-currently-facing-shortages
3. Flinn R. Health care practitioners push for legislative solution to prevent chemotherapy shortage “Groundhog Day.” AJMC. April 15, 2024. Accessed July 20, 2026. https://www.ajmc.com/view/health-care-practitioners-push-for-legislative-solution-to-prevent-chemotherapy-shortage-groundhog-day-
4. Page P. At hearing on recurring cancer drug shortages, rural areas come into focus. AJMC. May 20, 2024. Accessed July 20, 2026. https://www.ajmc.com/view/at-hearing-on-recurring-cancer-drug-shortages-rural-areas-come-into-focus
5. Corso MT. Crisis averted? manufacturers scurry to meet demand for drugs. OncLive^®. March 12, 2011. Accessed July 20, 2026. https://www.onclive.com/view/crisis-averted-manufacturers-scurry-to-meet-demand-for-drugs
6. Drug shortages: causes & solutions. Association for Accessible Medicines. June 22, 2023. Accessed July 20, 2026. https://accessiblemeds.org/wp-content/uploads/2024/11/AAM_White_Paper_on_Drug_Shortages-06-22-2023.pdf
7. Jeremias S. Report reveals mounting burdens of drug shortages on US health system. AJMC. June 27, 2025. Accessed July 20, 2026. https://www.ajmc.com/view/report-reveals-mounting-burdens-of-drug-shortages-on-us-health-system