Medication Alternatives: What to Do During a Shortage

When your prescription runs out and the pharmacy says they don’t have it-again-you’re not alone. In 2025, over 1,900 prescription drugs were in short supply across the U.S. and Australia, from common antibiotics like amoxicillin to life-saving insulin and cancer treatments. These aren’t temporary glitches. Many shortages last over a year. Some have been going on since 2022. And if you’re relying on one of these drugs, waiting isn’t an option.

Why Medication Shortages Keep Happening

It’s not just bad luck. Most shortages come from a broken system. Eighty-five percent of generic drugs are made by just five manufacturers. If one factory has a quality issue, a power outage, or a supply chain delay, it can knock out half the country’s supply of a drug overnight. That’s what happened with insulin in early 2025. Semglee, a cheaper biosimilar to Lantus, suddenly disappeared from shelves. Pharmacies didn’t know why. Patients didn’t know where to turn.

The FDA started monthly inspections of critical drug factories in January 2025. That helped cut new manufacturing shortages by 15%. But it doesn’t fix the root problem: too few suppliers, too little backup. Even when a drug is approved, companies often stop making it because it’s not profitable enough. That’s why you’ll see shortages of cheap, old drugs like acetaminophen injection or chemotherapy agents-precisely the ones people need most.

What You Can Do Right Now

The first thing to do? Don’t stop your medication. Stopping cold turkey can make your condition worse-or even be dangerous. Instead, follow these steps:

1. Check the FDA Drug Shortage Database. It’s free, updated daily, and lists current shortages with possible alternatives. Type in your drug name. If it’s listed, you’ll see what substitutes are approved.
2. Call your pharmacy-multiple times. Don’t just call your local store. Try mail-order pharmacies, hospital pharmacies, and even pharmacies in neighboring suburbs. One patient in Sydney spent three days calling seven pharmacies before finding Semglee for their child.
3. Ask your pharmacist about alternatives. Most major pharmacy chains now have pharmacists trained specifically for shortage situations. They know which drugs are interchangeable and which require a new prescription.
4. Talk to your doctor about switching. Not all alternatives are the same. For example, if you’re on Semglee, Lantus can often be swapped in without a new script because they’re biosimilar. But Toujeo or Tresiba? Those need a new prescription. Your doctor can help you pick the safest option.
5. Check your insurance. During shortages, insurers often change their formularies. Blue Cross NC removed prior authorizations for Lantus in March 2025. Call your insurer or log in to your account. You might be able to get a substitute at no extra cost.

When Alternatives Aren’t Perfect

Sometimes, there’s no exact substitute. That’s where things get tricky. For example, during the amoxicillin shortage, doctors started prescribing azithromycin instead. But azithromycin doesn’t work the same way. It’s less effective for some infections and can cause more stomach upset. In hospitals, doctors began using alteplase for pulmonary embolisms because they couldn’t get the usual clot-busting drugs. Usage jumped from under 6% to nearly 28% in some places. But studies show it’s not as reliable for every case.

For chronic conditions like autoimmune diseases, shortages can force dose reductions. One study found that patients taking sarilumab cut their monthly dose from 84 mg to just 28 mg during a shortage. Treatment duration dropped from 104 days to just one day in some cases. That’s not ideal. But it’s better than stopping completely.

What’s Being Done to Fix This

Some states are stepping up. Hawaii’s Medicaid program now allows doctors to prescribe drugs approved in other countries-like Canada or the EU-if U.S. supplies run out. That’s a big deal. It means you might get a version of your drug made in Germany or France. But it requires special FDA waivers and isn’t available everywhere yet.

New Jersey proposed letting pharmacists hand out emergency insulin supplies without a prescription during shortages. California, New York, and Massachusetts are stockpiling critical drugs like medical abortion pills and chemotherapy agents in case federal policies block access.

The biggest hope? Real-time data. Right now, the FDA database tells you if a drug is in shortage. But it doesn’t tell you if your local pharmacy has any left. New York is working on a searchable online map that shows which pharmacies have stock. Pilot programs in 47 major health systems using real-time inventory tools have cut the time to find alternatives by 28%. That’s life-changing when you’re running out of insulin.

What Patients Are Saying

Reddit threads from r/pharmacy in March 2025 are full of stories. One user, DiabeticDad87, wrote: “I called 7 pharmacies over 3 days. One said they had Semglee-but it was expired. Another said they’d get it next week. I cried in the parking lot.”

But not all stories are bad. A Sterling Institute survey found that 68% of patients who talked to their doctor about alternatives successfully switched without problems. Many found relief through mail-order pharmacies covered by insurance. Others reached out directly to drugmakers. Pfizer gave out exact timelines for amoxicillin restocks-helping families plan ahead.

The scary part? 32% of patients just stopped taking their meds. Some ran out of money. Others got frustrated. Some didn’t know what else to do. That’s the real danger-not the shortage itself, but the silence around it.

How to Stay Ahead of the Next Shortage

Shortages aren’t going away. But you can prepare:

• Ask your doctor now: “What’s my backup if this drug runs out?” Get it in writing.
• Keep a 30-day supply on hand if possible. Some insurers allow early refills during shortages.
• Sign up for drugmaker alerts. Companies like Eli Lilly and Novo Nordisk send out shortage updates via email.
• Know your state’s rules. Some let pharmacists switch drugs without a new script. Others don’t.
• Use your pharmacist. They’re not just the person who hands you the bottle. They’re your best ally in a shortage.

When to Seek Help

If you’re running out of a critical drug-like insulin, seizure medication, or chemotherapy-and you can’t find a replacement within 48 hours, call your doctor’s office after hours. Many clinics have on-call pharmacists or emergency protocols. If you’re in Australia, contact your local hospital pharmacy. They often have emergency reserves.

Don’t wait until you feel sick. Don’t assume someone else will fix it. Your health is your responsibility-and you have more power than you think.