Injectable Medication Shortages: Why Hospital Pharmacies Are on the Front Line

When a patient in intensive care needs a life-saving injection, and the vial is empty, it’s not a glitch-it’s a system failure. As of July 2025, injectable medication shortages are affecting over 220 drugs in the U.S., and hospital pharmacies are feeling the worst of it. While community pharmacies might run low on a few pills now and then, hospitals are dealing with critical drugs that can’t be swapped out like over-the-counter painkillers. These aren’t just inconveniences. They’re delays in surgery, postponed chemotherapy, and nurses scrambling to find alternatives that may not work as well.

Why Injectables Are the Weakest Link

Not all drugs are made the same. Oral pills can be made in bulk, stored for years, and shipped easily. Injectable medications? They’re a different beast. They have to be sterile. No dust. No bacteria. No contamination. That means manufacturing happens in clean rooms under strict controls, often by hand, with every step monitored. It’s slow. It’s expensive. And it’s fragile.

About 60% of all drug shortages involve injectables. Why? Because the profit margins are razor-thin. Most of these drugs are generics-like normal saline, epinephrine, or cisplatin-that cost pennies per dose. Manufacturers don’t make much money off them, so they don’t invest in backup equipment or extra staff. One machine breaks down? One factory shuts down? The whole supply collapses.

And it’s not just one factory. Eighty percent of the raw ingredients for these injectables come from just two countries: China and India. A tornado hits a plant in North Carolina, or the FDA finds a quality issue at a facility in Mumbai, and suddenly, the entire country runs out of a drug used in 80% of emergency rooms.

Hospital Pharmacies Are Ground Zero

Retail pharmacies might see 15-20% of their inventory affected by shortages. Hospital pharmacies? They’re dealing with 35-40%. And 60-65% of those are injectables. That’s not a minor hiccup. That’s a crisis in the core of patient care.

Anesthetics? 87% are in shortage. Chemotherapy drugs? 76%. Cardiovascular injectables? 68%. These aren’t optional meds. They’re the difference between life and death in the OR, the ICU, or the cancer ward. A nurse at Massachusetts General Hospital reported postponing 37 surgeries in just one quarter because they couldn’t get the right anesthetic. That’s not a backlog-it’s a human cost.

And there’s no easy fix. You can’t just swap in a different drug. Injectables have exact dosing, bioavailability, and delivery requirements. A substitute might work in theory, but in practice? It could cause a drop in blood pressure, a bad reaction, or even death. Hospitals have to get approval from pharmacy and therapeutics committees just to switch to a different brand or formulation. That takes time. Time patients don’t have.

Who’s Affected the Most?

It’s not just the hospitals. It’s the people inside them. The Department of Health and Human Services estimates each drug shortage impacts about 500,000 people. Over 30% of them are between 65 and 85. Elderly patients. Cancer patients. Those on dialysis. People with heart failure. They’re the ones getting IV fluids, antibiotics, and chemo-exactly the drugs that are vanishing.

One hospital pharmacist in Ohio told a colleague, “We had to use oral rehydration for post-op patients because we ran out of normal saline for three weeks straight.” That’s not standard care. That’s improvisation under pressure. And it’s happening everywhere.

Why the System Keeps Failing

The FDA knows about this. The government knows about this. But the tools they have are weak. The Drug Supply Chain Security Act requires tracking, but doesn’t stop shortages. The Consolidated Appropriations Act of 2023 asked manufacturers to notify the FDA earlier-but only 7% of shortages got resolved faster because of it.

Manufacturers operate on 3-5% profit margins. If a machine breaks, they can’t afford to fix it fast. If demand spikes, they can’t ramp up production. There’s no incentive to build redundancy. No penalty for letting a shortage linger.

Even the FDA’s own data shows only 14% of shortage notifications lead to timely fixes. That means 86% of the time, hospitals are left in the dark, waiting for a drug that might never come back.

And now, climate change is making it worse. Tornadoes, floods, and heatwaves are hitting manufacturing hubs harder and more often. In 2023, a single storm knocked out 15 critical drugs from one Pfizer plant. That’s not an outlier. It’s the new normal.

What Hospitals Are Doing to Survive

No one’s waiting for Washington to fix this. Hospitals are building their own lifelines.

Most now have shortage management committees. But only 32% of them feel properly funded. Pharmacists are spending over 11 hours a week just finding alternatives, calling distributors, and coordinating with doctors. That’s 11 hours they’re not spending counseling patients, checking doses, or preventing errors.

Some hospitals are consolidating stock-keeping all the scarce drugs in one central location so they can ration them better. Others are rewriting standing orders to include approved alternatives. A few have built relationships with smaller, niche suppliers who can fill gaps when the big players can’t.

One hospital in Minnesota started using oral fluids for non-critical patients when saline ran out. It worked. But it wasn’t ideal. It meant more monitoring, more paperwork, and more stress for nurses.

The learning curve is steep. New pharmacy directors take an average of six months to get good at managing shortages. And even then, they’re just managing-not solving.

The Bigger Picture: No Quick Fixes

The Biden administration pledged $1.2 billion to boost domestic drug manufacturing. That sounds good. But experts say it’ll take 3 to 5 years to see any real impact. By then, another 200 drugs could be in shortage.

Only 12% of sterile injectable manufacturers have switched to newer, more resilient methods like continuous manufacturing. That’s because it costs millions to retrofit a plant. And with margins this thin, no one wants to take the risk.

The American Medical Association called the FDA’s new shortage prevention plan “insufficient.” The American College of Physicians says the system is broken. And hospital pharmacists? They’re just trying to keep patients alive day by day.

What’s Next?

If nothing changes, hospital pharmacies will keep being the first to feel the squeeze. By 2026, 68% of hospital pharmacy directors expect shortages to stay the same-or get worse. The same drugs will keep disappearing. The same surgeries will keep getting canceled. The same nurses will keep making impossible choices.

There’s no magic solution. But there are steps that could help: higher margins for essential generics, mandatory backup production lines, faster FDA approvals for alternative suppliers, and penalties for manufacturers who let shortages drag on for years.

Until then, hospital pharmacies are doing the impossible-stretching every vial, every drop, every hour-to keep people alive. And they’re running out of everything but willpower.