2026 Health Care Outlook: Ron Piervincenzi, U.S. Pharmacopeia

By Ron Piervincenzi, CEO of U.S. Pharmacopeia

As we look ahead to 2026, the pharmaceutical and retail pharmacy industries face the exposed fragility of global medicine supply chains. Drug shortages persist, and their duration continues to lengthen, signaling that the underlying economic and structural challenges remain unresolved. Retail pharmacists continue to navigate patient frustration when essential medicines are unavailable. At the same time, they must often answer difficult questions about sources of essential medicines and lack of alternatives.

Why Shortages Persist

Insights from USP’s Medicine Supply Map show that preventable shortages can stem from four systemic vulnerabilities:

• Unsustainably low prices, particularly for generics, discourage investment in redundancy and resilience.

• Complex production processes raise the number of points where quality failures can occur.

• Geographic concentration of manufacturing, particularly for active pharmaceutical ingredients (APIs) and key starting materials (KSMs), makes disruptions more harmful to the downstream supply of quality medicines.

• Quality issues disrupt supply chains and delay facility approvals that can help supply chains rebound.

These vulnerabilities are interconnected. Take geographic concentration: It’s about economics, not natural resources. Most KSMs, the building blocks of APIs, are synthetic chemicals and can be made almost anywhere. Yet decades of downward economic pressure have pushed early manufacturing steps to countries with lower labor and production costs along with less stringent environmental regulations, notably China and India. Over time, this outsourcing created a self-reinforcing cycle in which regional specialization makes it harder for others to catch up and compete. For certain KSMs, specialized technology requirements, such as those for beta-lactam antibiotics further entrench production in specific geographies.

Can We Diversify? Yes, But it Requires Commitment

From a chemistry perspective, there’s no reason that KSMs or APIs must only be sourced from certain geographies. With the right investment and technology, we can rebuild manufacturing capacity in the United States and elsewhere. But solving this problem will take smart policy and economics, not just good science.

Diversification requires:

• End-to-end medicine supply chain mapping to pinpoint ­vulnerabilities.

• Investment in advanced manufacturing technologies to enable more production, better quality and greater ­sustainability.

• Purchasing incentives that value resilience, reliability and quality.

Today, purchasing decisions often prioritize the lowest price above all else. Until resilience becomes a factor in procurement, generic medicine manufacturers who operate with very slim margins will have little incentive or ability to invest in redundancy or domestic capacity. 

Policy Momentum: Domestic Manufacturing and Beyond

Regulatory and policy clarity can also serve as tailwinds for geographic diversification of manufacturing. Efforts that began in 2025 already show progress on that front.

The Food and Drug Administration’s newly launched PreCheck program gives manufacturers practical support through early, consistent feedback on facility design and quality review. This approach helps manufacturers identify and resolve potential challenges well before production begins, with the goal of reducing costly late-stage modifications and inspection delays. By improving regulatory predictability, FDA PreCheck promotes investment in domestic manufacturing. The program reflects a broader trend, also seen in new biosimilars regulatory guidance, in which the FDA embraces smart reforms aimed at getting patients the quality medicines they need.

PreCheck is one example of a push to strengthen supply chain resilience. Recent bipartisan legislative action, including reports from the Senate Aging and Finance Committees and House proposals on generic drug sustainability, also reflect growing consensus that the U.S. must reduce geographic concentration of production and incentivize redundancy. These efforts, combined with Food and Drug Administration initiatives, signal that resilience is becoming a national priority.

The Outlook for 2026

I am optimistic. The conversations happening now are smart, strategic and focused on long-term solutions. Pharmacists and their professional organizations play an essential role in educating policy makers and other decision makers on how drug shortages harm patients, providers and communities.

If we act decisively — investing in technology, diversifying production and rethinking procurement — we can build a more resilient system that ensures patients have access to quality medicines when and where they need them.

The challenge is significant, but so is the opportunity. Let’s make 2026 the year we turn awareness into action.

Ron Piervincenzi is CEO of U.S. Pharmacopeia.