Medication Alternatives: What to Do During a Drug Shortage

When your prescription runs out and the pharmacy says they don’t have it-again-you’re not alone. Drug shortages aren’t rare anymore. They’re routine. In 2025, over 1,900 prescription drugs were in short supply across the U.S., with many of them stuck in shortage for over two years. Insulin, antibiotics, cancer meds, even basic painkillers like acetaminophen injections-none are safe from disruption. The system isn’t broken. It’s been strained for years. But that doesn’t mean you’re helpless. There are real, actionable steps you can take when your medication disappears from the shelf.

Know What’s Going On

The first thing to do when you hear your drug is unavailable? Check the FDA Drug Shortage Database. It’s free, updated daily, and lists every active shortage with official alternatives. You don’t need to be a doctor to use it. Type in your drug name, and it will tell you if there’s a shortage, how long it’s been going on, and what other drugs might work as substitutes. For example, when Semglee (a biosimilar insulin) ran out in March 2025, the FDA listed Lantus as a direct substitute-no new prescription needed. That’s critical. Many people don’t realize some alternatives are legally interchangeable.

But the FDA list doesn’t tell you if your local pharmacy has stock. That’s where you need to call around. Don’t stop at one. Call your usual pharmacy, then three others, including mail-order services. One patient in Melbourne spent three days calling seven pharmacies before finding Semglee for their child. Mail-order pharmacies often have larger inventories and can ship directly to your home. Insurance coverage may even cover delivery.

Talk to Your Doctor-Before It’s Too Late

Don’t wait until your last pill is gone. If you hear rumors of a shortage, or your pharmacy flags a potential issue, call your doctor now. A good provider will have a plan. For insulin users, switching from Semglee to Lantus is straightforward because they’re biosimilars-same effect, same safety profile. But if you’re on Toujeo or Tresiba, those require a new prescription. Your doctor can adjust your plan before you run out.

It’s not just insulin. During amoxicillin shortages, some doctors switched patients to azithromycin. But that’s not a simple swap. Azithromycin works differently. It’s not better-it’s just available. And it can cause different side effects, like stomach upset or changes in gut bacteria. Your doctor knows the risks. They’ll weigh whether the alternative is safe for you, not just the general population.

For chronic conditions like autoimmune diseases, shortages can be even more dangerous. Sarilumab, a drug used for rheumatoid arthritis, saw usage drop by over 60% in some countries during its shortage. Patients got fewer doses. Treatment duration shrank from months to days. That’s not just inconvenient-it’s risky. If your drug is in short supply, ask your doctor: Is there a therapeutic alternative? Can we adjust the dose? Can we stretch the supply with a different schedule?

Understand What Counts as a Real Alternative

Not all substitutes are created equal. There’s a big difference between a biosimilar and a completely different drug.

• Biosimilars (like Semglee and Lantus) are nearly identical to the original. They’re approved as interchangeable. You can switch without your doctor’s input in many cases.
• Therapeutic equivalents (like switching from one antibiotic to another) have the same effect but different chemistry. They may have different side effects or dosing schedules.
• Non-equivalent alternatives are drugs that treat the same condition but work differently. These require careful review. For example, using a different blood thinner during an alteplase shortage might not work the same way for a stroke patient.

Ask your pharmacist: Is this a direct swap? Or is it a workaround? If they can’t answer clearly, ask for a printed handout or a reference to the FDA’s classification. You have a right to know if what you’re being given is truly equivalent-or just the next best option.

State-Level Help Is Real-And You Can Use It

Some states have stepped in to fill gaps. Hawaii’s Medicaid program now allows pharmacists to dispense foreign-approved versions of drugs during shortages. That means if your usual drug isn’t available, your pharmacist might legally give you the same medicine made in Europe or Canada-approved by other regulators but not yet cleared by the FDA. It’s not available everywhere, but it’s happening.

New Jersey is considering letting pharmacists hand out emergency insulin supplies without a prescription during shortages. California, New York, and Massachusetts are stockpiling critical drugs like abortion medications and chemotherapy agents, just in case federal rules cut off supply. These aren’t just political moves-they’re public health safeguards. Check your state’s board of pharmacy website. If you’re in one of these states, you may have more options than you think.

Pharmacists Are Your Secret Weapon

Most people think pharmacists just hand out pills. They’re wrong. Today, 89% of major pharmacy chains have dedicated shortage navigators. These are pharmacists trained to find alternatives, check insurance coverage, and contact manufacturers for timelines. Call your pharmacy and ask: “Do you have someone who helps with drug shortages?”

They can:

• Check inventory across multiple locations
• Order from regional distributors
• Verify if your insurance covers a substitute
• Get you a temporary supply while you wait

One woman in Sydney ran out of her thyroid medication. Her pharmacist called three states, found a batch in Brisbane, and arranged for it to be shipped overnight. It cost extra-but she didn’t go without.

What Not to Do

Thirty-two percent of patients in a 2025 survey admitted they stopped taking their medication during a shortage. That’s dangerous. Skipping doses of insulin, blood pressure meds, or seizure drugs can lead to hospitalization-or worse. Don’t cut pills in half unless your doctor says it’s safe. Don’t take someone else’s leftover pills. Don’t order from unverified online pharmacies. The FDA has shut down hundreds of fake sites selling counterfeit drugs during shortages.

Also, don’t assume your insurance will cover the alternative. During the Semglee shortage, 57% of Blue Cross NC patients were confused about coverage changes. Some formularies removed prior authorizations. Others added new restrictions. Call your insurer. Ask: “If I switch to [alternative drug], will it be covered? Do I need pre-approval?”

What’s Being Done-and What’s Coming

The FDA has started inspecting critical drug factories every month instead of every quarter. Since January 2025, that’s cut new manufacturing shortages by 15%. That’s progress. Some health systems are testing real-time software that alerts doctors the moment a drug is running low. In pilot programs, it cut the time to find an alternative by 28%. That’s huge.

But the root problem remains: too many generic drugs made by too few companies. Eighty-five percent of generics come from just five manufacturers. One factory shuts down-hundreds of drugs vanish. Until that changes, shortages will keep happening.

For now, your best defense is knowledge, communication, and persistence. Know your drug. Know your options. Know your pharmacist. And don’t give up until you get answers.