Medication Alternatives: What to Do During a Shortage

When your prescription 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., with many shortages lasting more than two years. This isn’t a rare glitch. It’s the new normal. And if you’re taking insulin, chemotherapy drugs, antibiotics, or even something as basic as acetaminophen injection, you’ve probably felt the panic of calling five pharmacies in one day just to find one vial.

Why Do Drug Shortages Happen?

It’s not one thing. It’s a chain of failures. Most generic drugs-about 85%-are made by just five manufacturers. If one factory has a quality issue, a power outage, or a supply glitch, it can knock out half the country’s supply of a critical drug. In October 2025, a single plant producing acetaminophen injection shut down for weeks, leaving hospitals scrambling. The FDA stepped in with monthly inspections instead of quarterly, and that helped cut new manufacturing shortages by 15%-but it didn’t fix the root problem.

Then there’s profit. Generic drug makers often skip making low-margin drugs because they’re not worth the cost. If a drug sells for $2 a pill and costs $1.80 to produce, why would a company invest in it? That’s why antibiotics, chemotherapy agents, and even some thyroid meds keep disappearing. And when a drug is discontinued, it’s rarely brought back. Once a manufacturer leaves a market, they rarely return.

What Can You Do When Your Drug Is Gone?

The first thing to do is don’t stop taking it. Skipping doses or cutting them in half can make your condition worse-especially with blood pressure meds, insulin, or seizure drugs. Instead, follow these steps:

1. Check the FDA Drug Shortage Database-it’s the most reliable source for current shortages and approved alternatives. Type in your drug name, and it will list whether there’s a therapeutic substitute and if it’s approved for interchangeability.
2. Call your pharmacist. Not just one-call three. Pharmacies get stock at different times. Mail-order pharmacies often have better inventory than local ones. In March 2025, during the Semglee insulin shortage, patients who used mail-order services found supply 40% faster than those relying only on neighborhood pharmacies.
3. Ask your doctor about alternatives. Not every substitute is perfect, but many are safe. For example, if Semglee (a biosimilar to Lantus) is unavailable, Lantus can often be substituted without a new prescription because they’re considered interchangeable. But Toujeo or Tresiba? Those require a new prescription. Your doctor needs to know the difference.
4. Check your insurance formulary. Some insurers changed their rules during the 2025 insulin shortage. Blue Cross NC removed prior authorizations for Lantus on certain plans. That means you might get it covered even if it wasn’t on your list before. Call your insurer or log in to your portal-don’t assume your coverage hasn’t changed.

Therapeutic Substitutions: Safe or Risky?

Not all alternatives are created equal. Some are exact matches. Others are close-but not the same.

For antibiotics like amoxicillin, azithromycin was used as a substitute during the 2025 shortage. But it’s not just a swap. Azithromycin works differently. It’s taken for fewer days, has different side effects, and can contribute to antibiotic resistance if used incorrectly. In hospitals, doctors had to adjust protocols to avoid overprescribing it.

With insulin, the situation is clearer. Semglee and Lantus are biosimilars-meaning they’re nearly identical in structure and effect. Swapping them is safe and common. But if your doctor prescribed a specific brand for a reason (like a pump compatibility issue), switching without consultation can cause blood sugar swings.

Oncology drugs are the toughest. Of the 15 cancer medications in shortage between 2023 and 2025, 12 had no direct substitute. Doctors had to stretch doses, delay treatments, or use older, less effective drugs. One study found that in German hospitals, the clot-busting drug alteplase-used for strokes-was repurposed for pulmonary embolism during shortages. It worked, but less reliably. The risk? You might survive, but with more complications.

What States Are Doing to Help

Some states are taking action. New Jersey proposed letting pharmacists hand out emergency insulin supplies without a prescription during shortages. Hawaii went further: in 2025, their Medicaid program started allowing drugs approved in other countries-like Canada or the EU-if they’re FDA-recognized for safety. That’s huge. It means if a drug is running out in the U.S., you might get the same medicine from a trusted international source.

California, New York, and Massachusetts started stockpiling critical drugs, especially those used in abortions or emergency care, in case federal restrictions cut off supply. These aren’t just political moves-they’re public health safeguards.

New York also proposed a public online database that shows exactly which pharmacies have what in stock. Right now, you have to call every place. With this tool, you’d see real-time inventory like you’re checking movie times. It’s not live yet, but if it passes, it could cut the time to find a drug from days to minutes.

What Patients Are Saying

Reddit threads from March 2025 tell the real story. One user, ‘DiabeticDad87’, spent three days calling seven pharmacies before finding Semglee for his child. Another said her doctor switched her from a brand-name GLP-1 weight-loss drug to a generic alternative-and her insurance covered it. She lost weight, felt better, and didn’t miss a dose.

But 32% of patients in a February 2025 survey admitted they stopped taking their meds during a shortage. That’s dangerous. One woman with high blood pressure stopped her pill for a week. She ended up in the ER with a stroke.

Those who reached out to manufacturers often got answers. Pfizer shared exact timelines for amoxicillin restocks. Eli Lilly told patients when their insulin production would resume. That kind of transparency reduces panic. But most companies don’t offer that. You have to ask.

How to Prepare for the Next Shortage

You can’t control the supply chain-but you can control your response.

• Keep a list of all your medications, including dosages and why you take them. Share it with your pharmacist and a family member.
• Ask your doctor now: “If this drug runs out, what’s my backup?” Don’t wait until you’re out of pills.
• Use mail-order pharmacies. They often have larger stock and can ship ahead.
• Sign up for alerts from the FDA Drug Shortage page. It’s free and updated daily.
• Know your insurance’s formulary. Check it every 3 months-rules change fast during shortages.

When to Seek Help Immediately

If you’re on insulin, chemotherapy, seizure meds, or heart drugs, and you can’t find your medication for more than 48 hours, contact your doctor or go to an urgent care center. Don’t wait. Your body doesn’t pause for supply chain issues.

Pharmacists are now trained to help. Eighty-nine percent of major pharmacy chains have dedicated shortage support lines. Use them. They can check inventory across multiple locations, contact distributors, and even help you get samples from manufacturers.

Remember: a shortage doesn’t mean you’re out of options. It means you need to be more proactive. The system is broken-but you’re not powerless.