ROCKVILLE, Md. – The United States Pharmacopeia (USP) has published the latest edition of its Annual Drug Shortages Report, which shows that prolonged drug shortages continue to impact patient care and health system operations in the United States.
For the first time, this report reflects an end-to-end view of the supply chain through the inclusion of upstream data on Key Starting Materials (KSMs). Newly added to the USP Medicine Supply Map, KSM data show that geographic concentration often begins far earlier in the supply chain than previously understood. Nearly half (44 percent) of drugs in shortage have at least one KSM solely manufactured in a single country, typically China or India.
The average duration of a drug shortage has grown to over 5 years, up from 4.3 years in 2024 and roughly 2 years in 2019. Nearly all active drug shortages at the end of 2025 were carried over from 2024, with only 4 of the 75 active shortages first reported in 2025. At the same time, product discontinuations have reached their highest level since 2019, with an acute 60 percent increase from 2024 to 2025. The price of discontinued medicines fell, suggesting that very low prices are closely associated with a higher likelihood of discontinuation.
“Manufacturers of generic drugs and their ingredients operate on thin, sometimes unsustainable margins,” said Matthew Christian, Director of Supply Chain Insights at USP. “This report shows a relationship between prices received by manufacturers and continued production. Product discontinuations add to supply fragility and risk of future shortages if supply cannot meet demand.”
Low prices, manufacturing complexity, geographic concentration, and quality concerns remain the primary drivers of drug shortages. These risk factors can be worsened by external shocks like natural disasters, geopolitical tension, or policy changes.
Shortages can arise from a single risk factor or a combination of the risk factors, with their severity varying based on the number and intensity of the factors involved. Sterile injectable drugs, for example, are particularly complex to manufacture and make up 71 percent of all shortages, the largest of any dosage form.
“These findings underscore a fundamental reality: today’s market does not reward resilience,” said Anthony Lakavage, Executive Vice President for Global External Affairs at USP. “Policymakers and stakeholders must act to realign incentives—establishing clear benchmarks for supply reliability, creating sustainable payment mechanisms that value quality and continuity, and advancing reforms that strengthen the foundation of our medicines supply chain.”
Learn more about the USP Medicine Supply Map: https://www.usp.org/medicinesupplymap
