Report Reveals Mounting Burdens of Drug Shortages on US Health System

A recent 2024 survey by Vizient illuminated the persistent and escalating challenges posed by drug shortages across US health care facilities, with a particularly pronounced impact on pediatric settings.¹ The report underscored that these disruptions necessitated increased staffing burdens and placed significant demands on already strained resources.

The landscape of drug shortages in the US has worsened significantly, reaching a record 323 active shortages in the first quarter of 2024, with hospitals nationwide dedicating an estimated 20 million hours annually and incurring nearly $900 million in labor costs—more than double the impact reported in 2019. | Image credit: OntheRun Photo - stock.adobe.com

Notably, hospitals nationwide collectively dedicated an estimated 20 million hours annually to managing these shortages, incurring a staggering cost of nearly $900 million in labor—more than double the impact reported in 2019. A critical finding emphasized significant communication gaps, underscoring an urgent need for earlier, more transparent notifications and accurate product release dates to facilitate better planning and resource allocation within the health care ecosystem.

“Drug shortages in the US are no longer an unfamiliar phenomenon and continue to rise, reaching an all-time high in recent years…. Managing shortages has become an ongoing and labor-intensive process that further stretches already limited resources and tight margins,” the authors wrote.

The landscape of drug shortages in the US has seen a concerning rise, reaching an unprecedented high in the first quarter of 2024 with 323 active shortages. Historically, managing these shortages has been intensely labor-intensive, stretching limited resources and tightening financial margins.

A 2019 survey by Vizient had already highlighted the substantial burden, reporting $359 million in financial implications and 8.6 million hours of pharmacy labor annually consumed by shortage management.²

A critical trend observed in the post-pandemic era is the increasing duration of these shortages. A recent Pharmacy Times^® report indicated that many shortages originating in 2022 or earlier continued well into 2024.³ For instance, injectable products, which are often critical for hospital care and cancer treatment, experienced a median shortage duration of 4.6 years, significantly longer than oral medications (1.6 years). The types of drugs most affected generally mirrored pre-pandemic trends, frequently including sterile injectable drugs, chemotherapies, antimicrobials, central nervous system medications, fluids, and electrolytes.

The new Vizient survey aimed to assess how this complex environment had evolved, gathering insights from 132 respondents regarding the profound impact of drug shortages on facilities and patient care.¹

The survey drew responses from a diverse range of health care facilities, with individual facilities accounting for 73% of responses and health systems contributing 27%. Most respondents held leadership positions within pharmacy and procurement departments, providing a knowledgeable perspective on the issue. On average, hospitals actively monitored 43 drug shortages, with pediatric facilities reporting monitoring at least 25% more shortages than their general counterparts, indicating a heightened vulnerability in specialized care settings.

Financial and Staffing Impact

The financial strain on health care institutions remained evident, with 74% of respondents reporting that drug shortages caused them to exceed their pharmacy budgets, a figure consistent with the 75% reported in 2019. Pediatric facilities experienced this issue more frequently, with 79% citing budget overruns compared with 72% of general facilities. Lorazepam injectables emerged as the most frequently cited drug with the highest impact for both general and pediatric facilities, alongside a recurring emphasis on oncology agents. Despite these challenges, Vizient’s National Emergency Stockpile (NES) program reportedly provided clients with access to more than 4 million additional supply units of manufacturer inventory, including more than 750,000 units of high-impact products.

The human cost of managing these shortages had escalated dramatically. The average time pharmacy staff spent managing shortages more than doubled, increasing from 10.5 hours per week in 2019 to 24.2 hours per week per general facility in 2024. This cumulative effort translated into a total labor cost of $900 million and 20 million hours spent across all hospitals, reaffirming the significant increase in workload since 2019. The report cautioned that this trend would likely persist unless drug shortages experienced a substantial decrease.

Staffing Considerations and Secondary Distributor Utilization

In response to the increased burden, 98% of pediatric facilities reported making staffing changes, a significantly higher percentage than the 83% of general facilities. Many facilities, between 48% and 60%, opted to redistribute workload among existing staff without adding new personnel. Additionally, 23% to 36% offered overtime, whereas a smaller proportion (2% to 11%) hired additional staff. Pediatric facilities particularly demonstrated a higher frequency of hiring additional pharmacy buyers to manage shortages, underscoring their unique staffing needs.

A concerning finding related to procurement practices was that almost half (46%) of the 56 facilities providing specific information resorted to purchasing at least 1 molecule from a secondary distributor. This included critical medications such as cisplatin, carboplatin, and fluorouracil. When acquiring medications from secondary distributors, facilities reported an average price increase of approximately 214% compared with standard purchasing practices before a shortage. Vizient’s NES programs were positioned as a safer and more reliable alternative, offering additional months of onshore inventory warehoused directly by manufacturers, thereby aiming to preserve product integrity and reduce reliance on secondary markets.

Patient Care Impact and Disruptions

The direct impact on patient care was also a significant concern. The survey revealed that 43% of respondents identified medication errors related to drug shortages, a rise from 38% in the 2019 survey. Alarmingly, 37% of respondents selected “unknown” or “do not track” when queried about medication errors, highlighting a critical area for improvement in tracking these incidents to better understand the downstream effects on patients.

Patient care disruptions were most prevalent in outpatient infusion services, where 41% of patient cases were omitted, missed, or delayed due to shortages. Planned medical procedures were affected in 32% of cases, hospital admissions in 22%, and emergency procedures in 15%. To mitigate these disruptions, facilities implemented various strategies, including maintaining alternative options, collaborating with other entities, using alternative treatments, and postponing non-urgent cases.

Gaps, Strategies, and Advancements

Health care facilities utilized a range of resources for drug shortage identification, including the American Society of Health-System Pharmacists, the FDA, wholesalers, group purchasing organizations, manufacturer communications, 503B offerings, and internal systems. The majority of respondents particularly valued Vizient’s assurance programs as crucial aids in addressing shortages. Mitigation strategies encompassed identifying alternative medications, conserving existing inventory, implementing operational changes, establishing clinical restrictions, and fostering robust collaboration among clinical teams.

Despite these efforts, significant gaps in assistance for drug shortages persisted. Communication issues, particularly the demand for earlier, more transparent notifications and accurate product release dates, were identified as the most pressing need. Respondents also called for improved allocation management by wholesalers, increased medication production, and better oversight of the entire supply chain and secondary distributors. Potential solutions suggested included dedicated shortage management software, the application of artificial intelligence, increased resources, and enhanced communication and transparency.

Responding to these ongoing challenges, Vizient made efforts to enhance drug shortage management and mitigation. These included leveraging data-driven insights, fostering collaborations, and developing new frameworks. Key advancements involved promoting drug shortage stewardship, which supported the formation of dedicated committees and encouraged responsible mitigation strategies while discouraging inappropriate purchasing. Additionally, the Essential Medications List was revamped in 2024 to include demand planning and market resiliency, and a national workgroup was convened to establish standardized metrics for tracking supply chain issues.

References

1. Beyond the shortage: the hidden cost of drug supply chain disruptions. Vizient. June 2025. Accessed June 26, 2025. https://vizientinc-delivery.sitecorecontenthub.cloud/api/public/content/0fed86e17e654732ba642464400e713f?v=323b8a49 

2. Kistner D, Kuper K, Kucera D, et al. Drug shortages and labor costs. Vizient. June 2019. Accessed June 26, 2025. https://vizientinc-delivery.sitecorecontenthub.cloud/api/public/content/6991b801835943d786a3edb9e7b4855b

3. Knudsen KJ. Medication meltdown: unpacking drug shortages. Pharmacy Times^®. May 15, 2025. Accessed June 27, 2025. https://www.pharmacytimes.com/view/medication-meltdown-unpacking-drug-shortages