While the total number of US drug shortages has decreased since 2023, their average duration is now more than five years, and discontinuations are at their highest level since 2019, US Pharmacopeia (USP) says in its just-released 2025 drug shortages report.

USP analyzed drug products listed in the Food and Drug Administration’s (FDA’s) drug shortages database and mapped medications to production facilities and countries, noting prices, volumes, and upstream supply-chain indicators up to December 31.

“Low prices, manufacturing complexity, geographic concentration, and quality concernsremain the consistent and interconnected drivers of drug shortages as identified by USP,” the authors wrote. “Evaluating the drivers is essential to identifying systemic vulnerabilities in the supply chain and how these factors contribute to drug shortages.”

Pediatric medications most affected

Drug shortages declined by 23% in 2025, from 98 in 2024 to 75. Of the 75 drugs, 71% were sterile injectable drugs, 16% were oral solid drugs, and 13% were in other forms. Nearly all shortages at the end of 2025 began in 2024. 

Four new-onset drug shortages were reported in 2025, down from 11 in 2024. These medications included two injectables and two topical formulations. While 28% of the 2025 shortages resolved by the end of the year, shortages that persist continue to grow in duration.

Increased durations of drug shortages are a critical public health risk that can lead to compromised patient care, treatment delays, and unfavorable outcomes,

Consistent with previous years, pediatric medications were the most affected category (16 shortages). Six of the affected drugs were intravenous fluids and diluting agents for other drugs, which worsens other shortage and often leads to rationing, clinical instability with substitutions, and negative long-term clinical practices.

The other most-affected categories were gastroenterology (11), anesthesia (10), endocrinology/metabolism (10), and oncology (six).

The average duration of drug shortages rose to 5.3 years in 2025, up from 4.3 years in 2024 and about two in 2019. More than half (64%) medicines currently in shortage have been so for more than three years, with 39% in short supply for more than five years (Figure 4). 

“Increased durations of drug shortages are a critical public health risk that can lead to compromised patient care, treatment delays, and unfavorable outcomes,” the report said. “Without intervention, prolonged shortages will continue to directly burden patients and healthcare providers.”

Link to very low prices

While discontinuations can occur for reasons such as formulation changes or portfolio consolidation, manufacturers most often discontinue drugs in response to poor market conditions, especially low-profit margins. 

Discontinuations climbed from 106 in 2024 to 170 in 2025, a 60% rise, reversing the decrease seen from 2023 to 2024. This is the greatest number of discontinued drugs since December 2019 (155 discontinuations). Of the 170 discontinued drugs, 55% were oral solid products, 29% were injectables, and 16% were other types.

As in previous years, drugs in shortage are priced much lower than those in adequate supply. 

On average, in 2025, the price of a generic injectable not in shortage ($169) was 8.5 times higher than a generic injectable that was in shortage ($20). For generic oral solid drugs, the average price was $8 for those not in shortage, compared with $3 for those that were scarce.  

Of the 12 oral solid drug products in shortage in 2025, 83% were priced below $6 per unit, with 42% under $2/unit and 25% below $1/unit. Seventy-three percent of the 51 injectable drugs in shortage were priced below $15/unit, with 47% under $5/unit.

Likewise, the 2025 analysis revealed that 65% of discontinued oral solids were priced below $1/unit. In addition, the median price of these drugs plunged 78%, from $1.80 in 2024 to $0.40 in 2025—shifting the proportion of discontinuations priced below $1 from 46% to 65%. 

For injectable drug discontinuations, 35% were priced below $15/unit, a 19% increase in the fraction of these drugs priced below $15/unit relative to the previous year. “These findings suggest that very low prices may be closely associated with a higher likelihood of discontinuation,” the authors wrote.

Geographic concentration, reliance on a single country for ingredients

In 2025, the United States produced 21% of all oral solid drug volume and 58% of these drugs in shortage. In contrast, India manufactured 63% and 23%, respectively. For injectables, the United States made 47% of all volume and 57% of the volume in shortage, while the European Union produced 20% and 5%, respectively. And India manufactured 16% and 26%, respectively. 

Reliance on manufacturing from materials to final products concentrated in domestic or foreign facilities creates single points of failure that are highly vulnerable to disruptions.

“These figures help show that geographic concentration anywhere—including within the United States—may increase the risk of drug shortages,” the report said. “Therefore, promoting geographic diversification of the manufacturing base for U.S. drug products can help reduce supply chain vulnerabilities.”

Reliance on foreign manufacturers, especially for key starting materials (KSMs) and active pharmaceutical ingredients (APIs), can increase US drug supply exposure to disruption. Of the 75 drug shortages, 44% require at least one KSM made only in a single country, and six rely solely on KSMs from one country. 

“Reliance on manufacturing from materials to final products concentrated in domestic or foreign facilities creates single points of failure that are highly vulnerable to disruptions,” the authors wrote. “Events ranging from quality incidents to natural disasters or trade barriers can quickly interrupt production, leading to significant consequences and limiting patients’ access to care.”

By the end of 2025, 34 of 75 drugs (45%) in shortage are on USP’s Vulnerable Medicines List. Of them, 79% are injectables, six are oral solids, and one is mucosal. “At the same time, 70% of drugs on the 2025 Vulnerable Medicines List are not currently in shortage, indicating that proactive supply chain surveillance aids in identifying those drugs that are most vulnerable,” the report said.