When your regular medication runs out and no pharmacy has it in stock, it’s not just inconvenient-it’s dangerous. In 2025, over 250 different active drug ingredients were in short supply across the U.S. and Australia, with many shortages lasting over two years. Insulin, antibiotics like amoxicillin, cancer drugs, and even basic pain relievers like acetaminophen injections have all hit critical lows. You’re not imagining things. This isn’t a one-off glitch. It’s a growing crisis, and knowing what to do when your prescription disappears can make all the difference.
Why Are Medications Running Out?
Drug shortages aren’t random. They’re the result of a fragile supply chain. Most generic drugs-about 85%-are made by just five manufacturers. If one factory has a quality issue, a power outage, or a delay in sourcing raw materials, it can ripple across the entire country. The FDA started inspecting high-risk facilities monthly in early 2025, and while that’s helped cut new shortages by 15%, the backlog of long-term shortages hasn’t cleared. Many drugs, especially sterile injectables and chemotherapy agents, are made in overseas plants with little redundancy. When shipping delays hit or political tensions affect supply routes, patients pay the price.
What Counts as a Safe Alternative?
Not all substitutes are created equal. The key is
therapeutic equivalence. This means the alternative drug has the same active ingredient, strength, dosage form, and works the same way in your body. For example, Semglee and Lantus are both insulin glargine. Semglee is an FDA-approved interchangeable biosimilar, meaning pharmacists can swap it for Lantus without a new prescription. That’s a safe, direct swap.
But some alternatives aren’t direct swaps. If amoxicillin is gone, your doctor might switch you to azithromycin. It treats similar infections, but it’s a different class of antibiotic. It doesn’t work the same way, and it can cause different side effects like stomach upset or heart rhythm changes. Your doctor needs to weigh the risks. For chronic conditions like autoimmune diseases, switching drugs can mean adjusting doses or waiting weeks to see results. One study showed patients on sarilumab reduced their total yearly dose by over 65% during a shortage-not because it worked better, but because they got less of it.
How to Find Alternatives Fast
Don’t wait until your last pill is gone. Start early. Here’s what works:
- Check the FDA Drug Shortage Database. It’s free, updated daily, and lists current shortages with approved alternatives. Look for the "Alternatives" column. If it says "Therapeutically Equivalent," that’s your safest bet.
- Call your pharmacy first. Don’t assume they’re out of stock. Ask if they can get it from a wholesaler or if another location has it. Many chain pharmacies now have internal inventory tracking systems.
- Contact your doctor. Don’t try to self-switch. Your doctor knows your history. They can check formulary guides, request prior authorizations for alternatives, or even contact the manufacturer for estimated restock dates.
- Ask your pharmacist. Most major pharmacies now offer free shortage consultations. They can tell you which alternatives are covered by your insurance and if any require prior approval.
- Check mail-order pharmacies. They often have larger inventories. If your regular pharmacy is out, try your insurer’s mail-order service. Some patients found insulin during the 2025 shortage only through these channels.
What If Your Insurance Won’t Cover the Alternative?
This is where things get messy. In March 2025, Blue Cross NC changed its formulary during the Semglee shortage: they removed prior authorization for Lantus on some plans and lifted non-formulary restrictions on others. But not every insurer did the same. If your plan denies coverage for the alternative, here’s what to do:
- Ask your doctor to submit a letter of medical necessity. Explain why the original drug was prescribed and why the alternative is necessary.
- Call your insurer’s member services. Ask for a coverage exception. Sometimes, just asking triggers a review.
- Check if the manufacturer offers patient assistance programs. Many big drugmakers have free or low-cost programs for people who can’t afford their meds during shortages.
What You Should Never Do
During a shortage, desperation leads to bad choices. Don’t:
- Stop taking your medication. A 2025 survey found 32% of patients stopped their drugs during shortages. For insulin, blood pressure meds, or seizure medications, that can mean hospitalization-or worse.
- Buy from unverified online pharmacies. Fake drugs are a real risk. Look for VIPPS certification (Verified Internet Pharmacy Practice Sites) if you’re buying online.
- Split pills or change doses without approval. Some people cut insulin pens in half to stretch them. That’s dangerous. Dosing isn’t linear. A half-dose might not control your blood sugar-and could cause dangerous lows later.
- Use human or veterinary drugs as substitutes. Just because something looks similar doesn’t mean it’s safe. Veterinary insulin, for example, isn’t tested for human use.
What’s Being Done to Fix This?
Some states are taking action. Hawaii’s Medicaid program now allows drugs approved in other countries-like Canada or the EU-if they’re on the FDA’s approved list. New Jersey is pushing a law that lets pharmacists give emergency insulin supplies without a prescription. California, New York, and Massachusetts are stockpiling critical drugs, including abortion medications, to guard against future disruptions.
The FDA is also ramping up inspections and asking manufacturers to give 6-month advance notice of potential shortages. That’s a step forward, but it doesn’t help people right now. Meanwhile, pilot programs at 47 major hospitals are using AI tools to predict shortages and suggest alternatives in real time during prescribing. Early results show doctors find safe substitutes 28% faster.
What You Can Do Today
You can’t control the supply chain. But you can control your response. Start now:
- Keep a printed list of all your medications, including generic names and dosages.
- Set a reminder to check the FDA Drug Shortage Database every 3 months-even if you’re not having issues.
- Ask your doctor if any of your meds are on the shortage list. If they are, ask about alternatives before you need them.
- Sign up for pharmacy alerts. Many chains will text you if your med is back in stock.
- Connect with patient groups on Reddit or Facebook. Real people share where they found insulin, antibiotics, or cancer drugs when pharmacies were empty.
Drug shortages aren’t going away. But they don’t have to derail your health. With the right steps, you can stay safe, stay on treatment, and avoid the panic that comes with running out.
What should I do if my insulin is out of stock?
First, check the FDA Drug Shortage Database to confirm the shortage and see if an interchangeable biosimilar like Semglee or Lantus is available. Call your pharmacy and ask if they can source it from a wholesaler. If not, contact your doctor-they may be able to switch you to another long-acting insulin like Toujeo or Tresiba, though that usually requires a new prescription. Don’t delay. Insulin shortages can be life-threatening. Many patients found supplies through mail-order pharmacies during the 2025 shortage.
Can my pharmacist substitute my medication without a new prescription?
Only if the alternative is FDA-designated as "interchangeable." For example, Semglee can be swapped for Lantus without a new script because they’re biosimilars with identical effects. But for most other drugs-like switching from one antibiotic to another-a new prescription is required. Pharmacists can’t legally substitute unless the drug is on the FDA’s interchangeable list. Always confirm with your pharmacist or doctor before switching.
Are generic drugs more likely to be in shortage?
Yes. About 90% of U.S. prescriptions are for generics, but they’re made by far fewer manufacturers-just five companies produce 85% of them. If one plant shuts down due to quality issues, the entire supply chain is affected. Brand-name drugs often have more backup suppliers and higher profit margins, so they’re less likely to disappear. That’s why shortages hit antibiotics, insulin, and chemotherapy drugs hardest-they’re mostly generic and low-cost.
What if I can’t afford the alternative medication?
Many drug manufacturers offer patient assistance programs for people struggling with costs during shortages. Ask your doctor or pharmacist for the name of the manufacturer and visit their website. Some programs provide free medication for up to a year. Nonprofits like NeedyMeds and the Patient Access Network Foundation also help with co-pays and access. Don’t assume you can’t afford it-many programs have simple applications and quick approvals.
How long do drug shortages usually last?
About 75% of drug shortages last over a year, and nearly 60% last two years or longer. The average duration has increased since 2018. Shortages of sterile injectables, like chemotherapy drugs or antibiotics, tend to last the longest because they’re harder to produce quickly. Some, like acetaminophen injection, resolved in a few months after manufacturing fixes. Others, like certain cancer drugs, have been in shortage since 2022. Always check the FDA database for the latest status and estimated resolution dates.
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