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 1,900 prescription drugs were in short supply across the U.S. and U.K., including critical medicines like insulin, antibiotics, and chemotherapy drugs. This isn’t a one-time glitch. It’s a growing crisis. And if you’re relying on one of these drugs, you need to know what to do now, not when the shelves are empty.

Why Medication Shortages Happen

It’s not just bad luck. Most shortages come from a few broken parts of the system. A single factory making 85% of a generic drug can shut down over a tiny quality issue-and suddenly, millions are left without their medicine. Manufacturing delays, raw material shortages, and companies quitting unprofitable drugs all add up. The FDA says nearly half of all shortages since 2020 were caused by production problems, not demand spikes.

For example, Semglee (a biosimilar insulin) vanished from shelves in early 2025. Patients didn’t suddenly need more insulin. The problem? One manufacturer couldn’t meet quality standards. And because so few companies make these drugs, there was no backup.

What You Can Do Right Away

Don’t wait until your last pill is gone. Start acting as soon as you hear about a shortage-or if your pharmacy says they’re out.

• Check the FDA Drug Shortage Database-it’s free, updated daily, and lists approved alternatives. Type in your drug name and it will show you what else is available.
• Call multiple pharmacies, including mail-order services. Some small independent pharmacies or hospital pharmacies may still have stock when big chains don’t.
• Ask your pharmacist. Most major chains now have pharmacists trained specifically to help during shortages. They can check inventory across regional networks and even contact distributors on your behalf.

One patient in Nottingham spent three days calling seven pharmacies before finding Semglee. But another found it on the first try-because their pharmacist had access to a regional inventory system. Don’t assume your local store has the full picture.

Therapeutic Alternatives: Are They Safe?

Not all substitutes are created equal. Some drugs have direct, FDA-approved replacements. Others don’t. The key is understanding the difference.

For insulin, Semglee and Lantus are considered interchangeable. That means your pharmacist can swap them without a new prescription-no doctor visit needed. But Toujeo or Tresiba? Those are different formulations. Switching to them requires a new prescription and often a dose adjustment.

Antibiotics are trickier. When amoxicillin ran low, doctors started prescribing azithromycin instead. But it’s not the same. Azithromycin works differently, has different side effects, and can contribute to antibiotic resistance if used inappropriately. Never switch antibiotics on your own.

For chronic conditions like rheumatoid arthritis or multiple sclerosis, alternatives might mean switching to a different class of drug. Sarilumab, for example, saw usage drop by 67% in the U.K. during its shortage. Patients were moved to other biologics-but only after careful review by their specialist. These switches aren’t quick fixes. They require monitoring.

Insurance and Formulary Changes

Even if a drug is medically appropriate, your insurance might not cover it. During the Semglee shortage, Blue Cross NC changed its formulary to allow Lantus without prior authorization. But not all insurers did the same.

• Call your insurer. Ask: “Is there an alternative drug on my plan’s formulary for [your drug]?”
• Ask if they’ve waived prior authorizations or step therapy requirements.
• Request a temporary exception. Many insurers will approve a non-formulary drug for 30-90 days during a shortage.

One survey found 57% of patients were confused about coverage changes during shortages. Don’t assume your co-pay will stay the same. Always confirm before filling a new prescription.

What About Foreign-Made Drugs?

In 2025, Hawaii’s Medicaid program started allowing drugs approved in Canada, the U.K., or the EU to be used during shortages. These aren’t knockoffs-they’re the same pills made in the same factories, just sold under different names.

The FDA has special rules (Section 804) that let these drugs enter the U.S. under emergency conditions. But this isn’t something you can do on your own. You need a doctor’s prescription and a pharmacy that’s licensed to import them.

Some patients have turned to overseas online pharmacies. That’s risky. The FDA warns that many of these sites sell counterfeit or expired drugs. Stick to U.S.-licensed pharmacies-even if they’re sourcing from abroad under official channels.

What You Should Never Do

During shortages, people do desperate things. Here’s what you must avoid:

• Splitting pills-unless your doctor says it’s safe. Many drugs aren’t designed to be split. Insulin, for example, can’t be divided without losing accuracy.
• Skipping doses-even for a few days. Stopping blood pressure, seizure, or diabetes meds can cause serious harm.
• Buying from unverified websites-over 70% of online pharmacies selling prescription drugs are illegal. Many sell fake or contaminated products.
• Using someone else’s prescription-even if it’s the same drug. Dosage, formulation, and medical history make this dangerous.

A 2025 survey found 32% of patients stopped their meds during a shortage. Half of them ended up in the ER or hospital. Don’t be one of them.

How to Prepare for the Next Shortage

Shortages aren’t going away. The FDA says 63% of current shortages will last longer than 18 months. Here’s how to build resilience:

• Keep a 30-day supply of critical meds if your doctor allows it. Some insurers cover extra refills during shortages.
• Know your alternatives. Ask your doctor now: “If this drug becomes unavailable, what are my options?”
• Sign up for alerts. The FDA, ASHP, and Wolters Kluwer all offer free email alerts for drug shortages.
• Build a relationship with your pharmacist. They’re your best ally during these times. Tell them you’re on a high-risk medication and ask to be notified if it goes out of stock.

Patients who took these steps had a 68% success rate switching to alternatives. Those who waited until the last pill was gone? Only 21% found a safe solution.

When to Call Your Doctor

You don’t need to figure this out alone. Contact your provider if:

• You can’t find your medication after calling 3+ pharmacies
• Your pharmacy says an alternative is available but you’re unsure if it’s right for you
• You’ve had to skip doses or change your routine
• You’re experiencing new side effects after switching

Doctors aren’t just prescribing-they’re coordinating. Many now work with hospital pharmacists and regional drug networks to find solutions before patients are left stranded.

Final Thought: You’re Not Alone

Drug shortages feel isolating. You might think you’re the only one struggling. But thousands are in the same boat. The system is broken. But you have power. You can ask questions. You can demand alternatives. You can use the tools available-FDA database, pharmacist support, insurer exceptions-to keep yourself safe.

The goal isn’t to fix the supply chain overnight. It’s to make sure your health doesn’t suffer while we wait for it to get better.