Cancer Drug Shortages Persist Into Fourth Year, NCCN Data Show

Generic drug shortages have become an entrenched part of the cancer care landscape, even as tariffs loom, according to new survey data released today by the National Comprehensive Cancer Network (NCCN).¹

New data show that every responding cancer center reported a current shortage of at least 1 anticancer agent, and more than 20% were managing shortages of 5 or more different medications.

NCCN began tracking shortages of cancer drugs in June of 2023, after an FDA inspection forced the shutdown of a manufacturing plant in India; this set off major shortages of carboplatin and cisplatin, both mainstays of chemotherapy regimens.²

These new findings were drawn from 2 companion surveys of NCCN Member Institutions conducted in late August 2026. One was through 31 institutions of the NCCN Best Practices Committee, and the other was through the NCCN Pharmacy Directors Forum, involving 23 institutions.¹ Together, the results paint a picture of a health system that has grown accustomed to managing scarcity while making little headway in resolving the causes of generic drug shortages.

“It is disheartening that we remain in the same situation, including recurring or continued shortages of some drugs, despite years of raising the alarm and providing insight about this disruptive and dangerous issue for cancer care in America,” Crystal S. Denlinger, MD, Chief Executive Officer, NCCN, said in a statement accompanying the survey results.¹ “The good news is the cancer centers in our network have developed internal strategies, task forces, and communications plans for keeping patient care and clinical trials on track. The bad news is that this takes time and attention that could be better spent on improving patient experiences and outcomes and adds additional stress to an already burdened system.”

What Drugs Are in Short Supply?

Ifosfamide topped the list, with 94% of centers reporting a current shortage. The drug is used to treat bladder, ovarian, testicular, and uterine cancers, soft tissue sarcoma, osteosarcoma, and several adult and pediatric leukemias and lymphomas. Carboplatin shortages have returned, affecting 71% of centers, while cisplatin shortages affect 16%. The BCG immunotherapy that is a mainstay of bladder cancer treatment was in shortage at more than half of responding centers. Other drugs cited included dacarbazine, docetaxel, streptozocin, 5-fluorouracil, dexrazoxane, etoposide, leucovorin, and a long list of additional agents such as cyclophosphamide, chlorambucil, and several injectable biosimilars.

What Are Cancer Centers Doing to Respond?

The survey suggests that clinical operations have not broken down, but only because of cancer centers have shown a remarkable ability to adapt. The survey found:

• 61% of centers said they could still treat all patients on the intended dose and schedule, but only by actively enacting mitigation strategies;
• 32% said they hadn't needed to alter care,
• 7% said they could not maintain intended dosing for all patients.

Among centers deploying mitigation strategies, the most common tactic, deployed by 79% of centers, was waste management, such as pooling or maximizing use of partial vials. Another 43% limited use of current stock, while 32% adjusted doses or treatment intervals within acceptable clinical ranges.

Despite drug shortages, the burden of prior authorization has continued. In many cases, this adds to administrative headaches for cancer centers and practices, with 66% of centers reporting that when a treatment plan is modified or interrupted because of a shortage, prior authorization must be repeated both before and during ongoing treatment; 90% said repeat prior authorization was needed in some form. Although 69% of centers said this had not caused treatment delays, 17% said it had.

At 71% of centers, a dedicated multidisciplinary committee, often anchored by pharmacy and physician staff, is tasked with tracking inventory, developing substitution protocols, and setting allocation criteria when supply must be rationed. Of note, 32% of those committees are tasked with directly notifying patients about interim protocol changes that might affect their care.

Beyond individual institutions, 77% of centers said they were aware of shortage issues affecting community oncology practices in their region, and 39% said shortages had affected clinical trials at their center.

A Lack of Progress, and New Threats on the Horizon

NCCN’s survey shows that despite significant attention to this issue from advocacy groups and hearings in Congress,² little has changed. Asked whether national or state policy changes since 2023 have made drug shortages better, worse, or the same, 96% of pharmacy directors said, “about the same,” and 4% said “better.”

So far, respondents are not reporting that things are worse. However, the survey comes as the Trump administration has released a new tariff timeline that could deepen the shortage problem rather than ease it.

The administration announced in July that imported generic drugs, which have no tariffs at present, will face a 100% tariff beginning in 2028, rising to 200% in 2029, after a 2-year exemption period. The stated goal is to pressure manufacturers into bringing production back to the United States. However, generics operate on notoriously thin profit margins, and roughly 80% of active pharmaceutical ingredients used in the US are sourced from China and India.⁴

Industry groups have warned that tariffs layered onto a market already constrained by Medicaid inflation rebates and 340B pricing limits could push manufacturers to exit low-margin products entirely rather than absorb added costs, risking exactly the kind of sterile injectable and generic chemotherapy shortages NCCN's survey documents.

“Patients pay the tariff,” Sandoz CEO Richard Saynor told CNBC in an interview earlier this week.⁵

Asked in the NCCN survey what policy solutions they'd like to see, 91% of pharmacy directors favored economic incentives for high-quality generic manufacturing—the opposite, essentially, of a tariff regime. Other preferred solutions included better systems for rating generic suppliers (57%), exempting generics from tariffs altogether (48%), and restrictions on group purchasing organizations that push generic pricing below sustainable floors (30%).¹

“Nearly every pharmacy director who responded to our survey would like to see economic incentives put in place to encourage high-quality manufacturing for generic cancer medications,” Alyssa Schatz, DrPh, MSW, NCCN’s Vice President of Policy & Advocacy, said in the group’s statement. “That is something that advocates have been requesting for years. As one respondent noted: ‘many oncology generics are clinically indispensable but economically unattractive. Without correcting that economic imbalance, shortages are likely to recur.’ The survey results also illuminated a desire for better information around generics suppliers and requests for earlier notifications by manufacturers to FDA.”¹

References

1. New NCCN survey highlights persistent cancer medication shortages across United States. News release. PR Newswire. September 10, 2026. Accessed September 10, 2026. https://www.prnewswire.com/news-releases/new-nccn-survey-highlights-persistent-cancer-medication-shortages-across-united-states-302875325.html
2. Page P. At hearing on recurring cancer drug shortages, rural areas come into focus. Am J Manag Care. 2024;30(Spec 5):SP415.
3. Steinzor P. Trump announces timeline for 100% generic tariffs beginning in 2028, 200% in 2029. AJMC. July 22, 2026. Accessed September 10, 2026. https://www.ajmc.com/view/trump-announces-timeline-for-100-generic-drug-tariffs-beginning-in-2028-200-in-2029
4. Steinzor P. How Trump’s trade policy could raise costs, deepen drug shortages. AJMC. November 14, 2025. Accessed September 10, 2026. https://www.ajmc.com/view/how-trump-s-trade-policy-could-raise-costs-deepen-drug-shortages
5. Ohlen E. ‘Patients pay the tariff’: Swiss pharma CEO warns of Trump’s generic drug tariff threat. CNBC. September 8, 2026. Accessed September 10, 2026. https//www.cnbc.com/2026/09/08/pharma-tariffs-trump-generic-drugs-sandoz-cmd-stock.html