When your prescription runs out and no pharmacy has it in stock, it’s not just inconvenient-it’s scary. You might be on insulin, blood pressure meds, or a drug for a chronic condition. Skipping doses isn’t an option. But what do you do when the drug you rely on disappears from shelves across the city? You’re not alone. In 2025, over 258 active drug ingredients were in shortage across the U.S. and Canada, with many lasting more than two years. Some of the most critical shortages involve insulin, chemotherapy agents, antibiotics like amoxicillin, and even basic injectables like acetaminophen. The system is strained. But there are real, practical steps you can take right now to keep your treatment on track.
Check the FDA Drug Shortage Database First
Before you panic or call ten pharmacies, go to the FDA Drug Shortage Database. It’s free, updated daily, and lists every active shortage with approved alternatives. For example, when Semglee (a biosimilar insulin) ran out in March 2025, the database clearly showed that Lantus was a direct substitute-no new prescription needed. That’s critical. Many patients don’t know that some drugs are interchangeable by law, especially biosimilars. The database also tells you if a shortage is temporary or long-term. If a drug was pulled in October 2025 and listed as resolved in March 2025, you know it’s back in stock. Don’t waste time chasing something that’s already available again.Call Your Pharmacist, Not Just the Pharmacy
Pharmacists are your best ally in a shortage. Eighty-nine percent of major pharmacy chains now have dedicated shortage navigators on staff. These aren’t just cashiers-they’re trained to know which locations have stock, which alternatives are covered by your insurance, and which substitutions are safe. When a patient in Toronto couldn’t find Semglee, their pharmacist checked three regional warehouses and found Lantus at a nearby Shoppers Drug Mart. The pharmacist also confirmed that Blue Cross Blue Shield had waived prior authorizations for Lantus during the shortage. That saved the patient a doctor’s visit. Don’t just ask, “Do you have this?” Ask, “What can I use instead? And will my insurance cover it?”Ask Your Doctor About Therapeutic Alternatives
Not every drug has a direct substitute. Sometimes you need a different class of medication. During the amoxicillin shortage in early 2025, doctors in Ontario switched patients to azithromycin for bacterial infections. But that’s not always safe-azithromycin can cause heart rhythm issues in some people. Your doctor needs to weigh risks. For diabetes, if insulin is unavailable, some providers may switch patients to oral GLP-1 agonists like semaglutide, if appropriate. For high blood pressure, if a specific ACE inhibitor is gone, an ARB might work. But these aren’t swaps you make on your own. Always talk to your provider. A 2025 survey found that 68% of patients who switched medications with their doctor’s guidance had no negative outcomes. Those who switched without consulting a provider were three times more likely to experience side effects or worsening symptoms.Use Mail-Order and Specialty Pharmacies
Big box pharmacies often run out because they only keep a few days’ supply on hand. Mail-order pharmacies and specialty distributors carry larger inventories. If you’re on a long-term medication like insulin, rheumatoid arthritis drugs, or cancer treatments, consider switching to a mail-order service. Many insurers cover them at the same cost as retail. During the GLP-1 shortage from 2022 to mid-2025, patients who used mail-order services like CVS Caremark or Walgreens Specialty Pharmacy kept their treatment going without interruption. These services also get early alerts from manufacturers about supply changes. If your local pharmacy says they’re out, ask your doctor to send your prescription to a mail-order pharmacy instead.
Know When a Foreign Drug Is an Option
In 2025, Hawaii’s Medicaid program began allowing certain foreign-approved versions of drugs during shortages. These aren’t counterfeit-they’re the same medication made by the same company, just approved in Canada, the EU, or Australia. For example, some Canadian versions of insulin glargine or metformin are identical to U.S. versions but cheaper and more available. While U.S. federal law usually blocks importing foreign drugs, some states have emergency waivers. In Ontario, pharmacists can legally dispense certain foreign-approved drugs under specific conditions if no domestic version is available. Ask your pharmacist: “Is there an equivalent version made in Canada or Europe?” It’s not always possible, but it’s worth asking-especially for life-saving drugs.Don’t Skip Doses or Split Pills Without Guidance
Some patients try to stretch their supply by splitting pills or reducing doses. That’s dangerous. A patient on a low-dose blood thinner who cut their dose in half during a shortage ended up with a blood clot. Another patient on thyroid medication skipped doses for a week and developed severe fatigue and heart palpitations. Medications aren’t like coffee-you can’t just drink half and call it a day. Dosage is carefully calculated based on weight, kidney function, and disease severity. If you’re running low, call your doctor. They might prescribe a lower-strength version, extend your refill, or give you a short-term sample. Never guess.Track Manufacturer Updates
Pharmaceutical companies often release public updates when they expect to fix a shortage. Pfizer, for example, posted weekly production updates during the amoxicillin shortage in 2025, letting patients know when new batches would ship. Eli Lilly and Sanofi also publish shortage timelines for insulin products on their websites. If you’re on a brand-name drug, go to the manufacturer’s site and look for a “Patient Support” or “Drug Availability” section. Sign up for email alerts if they offer them. Knowing the timeline helps you plan-whether it’s switching temporarily or preparing for a delay.What About Oncology and Pediatric Drugs?
Cancer treatments are among the hardest-hit. Between 2023 and 2025, 15 oncology drugs were in shortage, and 7 of them were used for children. There’s often no good alternative. In these cases, hospitals use emergency protocols. Some patients get access to clinical trials or compassionate use programs. Others receive drugs from hospital stockpiles. If you or a loved one is affected, ask your oncologist about the hospital’s shortage plan. Many cancer centers now have dedicated pharmacists who monitor inventory daily and coordinate with other hospitals to share supplies. Don’t assume there’s no option-there’s usually a system in place, but you need to ask.
State-Level Help Exists
Some states have created emergency tools. New York is working on a public online map showing which pharmacies have specific shortage drugs in stock. California, Massachusetts, and Washington have stockpiled abortion medications and insulin in case of federal restrictions. In New Jersey, pharmacists can now give emergency insulin supplies without a prescription during shortages. In Canada, provincial health plans have similar flexibilities. Check your provincial or state pharmacy board website. You might be eligible for emergency access you didn’t know about.What to Do Right Now
If you’re facing a shortage today, here’s your action plan:- Go to the FDA Drug Shortage Database and search your medication.
- Call your pharmacist and ask for alternatives and insurance coverage.
- Contact your doctor to discuss therapeutic substitutes.
- Ask if your insurer covers mail-order or specialty pharmacy options.
- Visit the drug manufacturer’s website for updates.
- If it’s a life-critical drug (insulin, chemo, seizure meds), don’t wait-call your provider immediately.
What Doesn’t Work
Avoid these common mistakes:- Buying from online pharmacies that aren’t verified (look for VIPPS certification).
- Using someone else’s leftover prescription.
- Waiting until your last pill is gone before acting.
- Assuming a cheaper generic is always safe-some aren’t interchangeable.
Final Thought
Drug shortages aren’t going away anytime soon. With just five companies making 85% of generic drugs, one factory shutdown can ripple across the country. But you’re not powerless. The tools are there-FDA database, pharmacist support, mail-order services, manufacturer updates. The key is acting early and using the right resources. Don’t wait for a crisis. If you’re on a chronic medication, check its status every few months. Keep a printed copy of your medication list and alternatives in your wallet. Knowledge and preparation are your best defenses.What should I do if my insulin is in short supply?
If your insulin is unavailable, check the FDA Drug Shortage Database first. For biosimilar insulins like Semglee, Lantus is often a direct substitute with no new prescription needed. Contact your pharmacist to confirm availability and insurance coverage. If Lantus isn’t available, ask your doctor about alternatives like Toujeo or Tresiba-though these may require a new prescription. Don’t skip doses or reduce your amount without medical advice.
Can I use a Canadian version of my medication?
In some cases, yes. Canadian versions of certain drugs like insulin, metformin, and levothyroxine are identical to U.S. versions and are approved in other countries. While U.S. law restricts importing drugs, some Canadian pharmacies ship legally to U.S. patients, and Canadian provinces allow pharmacists to dispense foreign-approved drugs during shortages. Always confirm with your pharmacist that the version is the same active ingredient and dosage.
Are generic drugs always interchangeable?
No. While most generics are approved as bioequivalent, some drugs-especially those with narrow therapeutic windows like warfarin, levothyroxine, or seizure meds-require exact dosing. Switching between different generic brands can cause side effects. Always check with your pharmacist or doctor before switching, even if it’s labeled as “generic.”
How long do drug shortages usually last?
Half of all drug shortages last over a year, and nearly 60% last two years or longer. The average duration has increased since 2018. Some shortages, like for acetaminophen injection, resolve in weeks. Others, like certain chemotherapy agents, have been ongoing for over three years. Always check the FDA database for the latest timeline.
Can pharmacists prescribe alternatives during a shortage?
In most states and provinces, pharmacists cannot prescribe new medications. But in places like New Jersey and some Canadian provinces, pharmacists can dispense emergency supplies of insulin or other critical drugs without a prescription during a shortage. They can also substitute interchangeable drugs (like Lantus for Semglee) without contacting the doctor. Always ask your pharmacist what options they have under local laws.
What if I can’t afford the alternative drug?
Many drug manufacturers offer patient assistance programs for high-cost alternatives. For example, Eli Lilly and Sanofi have free insulin programs for eligible patients. Your pharmacist can help you apply. Some states also have emergency drug assistance funds. Nonprofits like NeedyMeds and RxAssist list free or low-cost options for hundreds of medications.
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