Drug Shortages Explained: How Pharmacists Keep You Safe

Brad

Welcome back to MedTalk by Galloway-Sands Pharmacy. I'm Brad, one of your community pharmacists here in Southport.

Kassidy

And I'm Kassidy. Today we're tackling a question we hear almost every week: why did my medication suddenly change?

Brad

Yeah, it usually starts with a worried face at the counter. Somebody opens their bag, looks at the bottle, and says, Brad, these pills look different. Did you give me the wrong thing?

Kassidy

Or my favorite one, kind of half joking but half serious, Kassidy, are y'all experimenting on me? This is not what I got last month.

Brad

We laugh with them, but honestly, that reaction makes a lot of sense. If you rely on a medicine every day, any surprise is scary. So we wanted to pull back the curtain and explain what's going on behind those changes.

Kassidy

A lot of the time, that different-looking pill, or that new manufacturer name on your label, is tied to something bigger: national drug shortages. That sounds like a Washington D.C. problem, but it shows up right here in Brunswick County as, sorry, we had to switch your brand, or your refill is delayed.

Brad

And before we go any further, I want to say this really clearly. We are not casually swapping things around. Pharmacists are legally and ethically required to keep you safe. Any time Kassidy or I make a change, there is a lot of thought, checking, and double-checking behind it.

Kassidy

Exactly. We’re going to walk you through how we go from that big national picture you might see on the news, down to the moment when your bottle looks a little different. We’ll talk about what drug shortages really are, why they’re happening, how pharmacists handle substitutions, and what you can do so you don’t run out or skip doses.

Brad

So if you’ve ever stood at the counter thinking, I did not sign up to be a guinea pig, this episode is for you. By the end, our goal is that you understand why things change, what’s actually changing, and how we’re working behind the scenes to keep your treatment safe and continuous.

Kassidy

Alright Brad, let’s start with the basics. When people hear drug shortage, they might picture empty shelves everywhere. But what does a shortage actually mean from the pharmacy side?

Brad

Good question. So nationally, organizations like ASHP—the American Society of Health-System Pharmacists—and the University of Utah track shortages. Recently, they reported over two hundred active drug shortages in the U.S. at any given time. That’s not two or three products; that’s hundreds.

Kassidy

And a lot of those shortages didn’t just pop up yesterday. The data show many of them started back in 2022 or later and just keep dragging on. So even if the number of new shortages slows down a bit, patients still feel the impact from the long-standing ones.

Brad

Exactly. And here’s the key point: one shortage can touch a huge number of people. If a commonly used blood pressure medicine, or a sterile IV fluid, or a pain medicine is short, that’s not just one patient, that’s thousands or even millions of folks across the country.

Kassidy

What kinds of medicines are we talking about? A lot of the shortages you see in national reports involve hospital drugs—injectables, things used in surgery, emergency rooms, cancer care. Sterile fluids, for example, have been a big focus in recent surveys.

Brad

Right. Another big group is controlled substances—like some medications used for chronic pain or ADHD. The data show a noticeable chunk of active shortages fall into that controlled category. So when you hear about someone struggling to get their monthly ADHD prescription filled, that’s not just their pharmacy being difficult; it’s often a true supply problem.

Kassidy

And it trickles down to what we see in Supply and Southport. For you as a patient, a national shortage looks like the pharmacy saying, we’re waiting on the wholesaler, we can only give you part of your prescription today, or we had to switch you to the same medicine from a different manufacturer.

Brad

Sometimes it’s subtle. Maybe your refill is ready a day later than usual. Sometimes it’s more obvious, like we can only give you ten tablets now and we’ll call you when the rest come in. Or, this is still your blood pressure medication, but the tablet looks different because it’s from another company.

Kassidy

And from our side, we see that in our ordering system. We go to place an order, and the screen basically tells us, not available, or backordered, or limited quantity. So we’re constantly adjusting our orders and our inventory just to keep folks on their therapies.

Brad

So to sum up this part: drug shortages aren’t a theoretical thing. The national data confirm they’re real and ongoing, and they show up in your life as delays, partial fills, or your medication looking or being labeled a little differently. It’s a system-wide issue that lands right at your kitchen table.

Kassidy

So the next logical question is, why is this happening? Because I know from the patient side, it can feel like, how does a whole country run out of something as basic as a generic blood pressure pill or a common antibiotic?

Brad

Yeah, it seems wild. There are a few big pieces. First, manufacturing and quality issues. A lot of our medicines, especially low-cost generics and sterile injectables, are made in a relatively small number of plants. If one of those plants has a quality problem and has to pause production, the whole supply chain feels it.

Kassidy

And those aren’t small problems either. If the FDA or another regulator says, hey, you’ve got to fix something in your process, that can slow or stop production for months. Meanwhile, demand doesn’t just hit pause. People still need their medications every day.

Brad

Then you add in supply chain shocks. Think about when there’s a tough flu season and everybody’s suddenly looking for oseltamivir, the antiviral a lot of people know as Tamiflu. National data have flagged that kind of surge in demand as a stress point. All of a sudden, instead of a slow, predictable use, you’ve got a spike.

Kassidy

And it’s not just illness surges. Weather events, transportation issues, even geopolitical factors overseas where ingredients are made—those can all ripple down. We’ve seen storms disrupt production of critical fluids and injectables, leading to new shortages.

Brad

Another part that doesn’t get talked about enough is the economics. A lot of common generics are very low-cost, which sounds great, but it means the profit margin for manufacturers is thin. So there may only be a couple of companies making a particular drug. If one company stops, there isn’t a big line of others ready to jump in and pick up the slack.

Kassidy

It’s kind of like if all of Brunswick County decided we only needed one grocery store for milk because we’re all trying to keep costs super low. That’s fine… until that one store’s cooler breaks. Now everyone’s out of milk, and there’s no backup.

Brad

That’s a great analogy. And on the policy side, national groups are talking about how to build more resilience into the drug supply chain—things like diversifying where drugs are made, or having better stockpiles. But those changes take time. In the meantime, the reality is: we’re working with a fragile system.

Kassidy

So when you hear that your med is on backorder or there’s a shortage, it’s usually not because somebody forgot to order it. It’s a combination of quality checks, manufacturing capacity, cost pressures, and sudden shifts in demand, all happening behind the scenes.

Brad

And that’s why the pharmacist’s role becomes so important. We can’t control the factory in another state or country, but we can control how we respond: how we find safe alternatives, how we communicate with your doctor, and how we keep you on therapy without putting you at risk.

Kassidy

Let’s talk about that behind-the-counter piece, because this is where a lot of the work happens that patients never see. Brad, what does it look like on your screen when a shortage hits?

Brad

So, picture this: I go to order your usual medication from our wholesaler, and instead of a normal confirmation, I see backordered, allocation only, or unavailable. At that point, the detective work starts. We might check alternative strengths, different package sizes, or another manufacturer of the same drug.

Kassidy

And we’re not doing that blind. We use shortage data from our wholesaler, guidance from ASHP, sometimes FDA updates, and real-time feedback from what we’re seeing day-to-day. It can change week to week, honestly.

Brad

Once we know the usual product is in short supply, step two is substitution decision-making. Best case scenario, we can get the exact same active ingredient, same dose, from a different manufacturer. So chemically it’s the same medication, just a different company name and often a different pill shape or color.

Kassidy

If we can’t get the same exact strength, sometimes we look at combining strengths to equal your dose, or changing to a different strength with adjusted directions—like two of the 25 milligram tablets instead of one 50 milligram, for example. Every one of those changes goes through checks in our software and our own brains.

Brad

Then there’s what we call therapeutic interchange—switching to a different medication in the same class, or a close cousin, when the original just isn’t available. That’s not something we do on our own. That involves your prescriber, clinical guidelines, and making sure it’s appropriate for your specific conditions.

Kassidy

The phone calls you sometimes hear us making behind the counter? A lot of those are us saying, hey, Dr. Smith, this particular strength or product is on shortage; can we safely use this alternative for Ms. Jones? We want that documented approval so everyone’s on the same page.

Brad

And every change creates extra safety work. We update your profile, verify the new NDC number, adjust any automatic refill settings, and make sure the label clearly matches what’s in the bottle. If it’s a different manufacturer, we may add a note so whoever checks you out can tell you, your pill looks different, here’s why.

Kassidy

On top of that, we often have to tweak our automation—things like pill counters or cabinets—and our electronic records. National surveys have pointed out that managing shortages adds to workload for pharmacy teams, and we feel that every day. But it’s important workload, because it keeps errors low while the products are moving around on us.

Brad

So when you see that different pill or you get that phone call about a change, just know there’s usually been a chain of checks, phone calls, and system updates behind it. It’s not random. It’s us doing everything we can to make sure you stay on a safe, effective therapy even when the supply chain isn’t cooperating.

Kassidy

Okay, let’s get into what patients really care about at the counter: I’m holding this bottle, it looks different—what actually changed here?

Brad

The most common scenario is, same drug, different look. If you’re on a generic medication, there are often multiple companies that make it. They all have to meet FDA standards to prove they’re equivalent to the brand name, but they don’t have to match each other in color or shape.

Kassidy

So one month your lisinopril might be a small pink tablet. Next month, it might be white and oval. The label on your bottle will still say lisinopril 20 milligrams, same directions, but the imprint on the pill could be different because it’s from another manufacturer.

Brad

From a safety and effectiveness standpoint, the active ingredient and the dose are what matter most, and those have to meet strict FDA requirements. But I totally understand that visually, that change can be jarring. That’s why we always say, if something looks different, ask us. We’d rather answer that question ten times a day than have you go home and not take it because you’re unsure.

Kassidy

Sometimes there are also differences in the inactive ingredients—the fillers, dyes, or binders. For most people, that’s no big deal. But if you have allergies or sensitivities, tell us. We can often look for a manufacturer that doesn’t use a certain dye, for example.

Brad

Now, that’s all in the category of cosmetic or manufacturer changes. A bigger deal is when the actual therapy changes. Maybe your usual ADHD medication is in true short supply, and your prescriber agrees to switch you to another medication in the same general category. That’s not just a different-looking pill—that’s a different drug, and we treat that with a lot more counseling and monitoring.

Kassidy

Exactly. Same thing in blood pressure or diabetes care. Switching within a class or to a different class altogether can be the right move when something’s unavailable, but that’s a clinical decision. We’ll talk with your prescriber, we’ll make sure the new dose fits you, and we’ll tell you what to watch for—like changes in blood pressure readings, blood sugar, side effects, all of that.

Brad

So what should you look at when you pick up your prescription? Number one, look at the drug name and strength on the label. Does it match what you expect—like amlodipine 5 milligrams once daily? If the name or strength looks different, ask us to walk you through it.

Kassidy

Number two, look at the directions. If you used to take one tablet daily and now the directions say half a tablet, or two tablets, that’s something we should explain so you feel comfortable. Sometimes we intentionally change directions when we use a different strength because of a shortage.

Brad

And then, absolutely, look at the pill itself. If it doesn’t match what you remember, don’t just assume it’s wrong or right—ask. A simple question like, is this the same medicine, just from a different company, is exactly what we want to hear from you.

Kassidy

Also great questions are: why did we change, is there anything new I should watch for, and what should I do if I don’t feel right on this one? We’d rather spend that extra two minutes at pickup than have you skip doses because you’re unsure or worried.

Brad

Let’s finish with the part you can control: how to protect yourself from gaps in therapy during all this.

Kassidy

Number one is planning ahead. Don’t wait until you’re down to the last pill to call in a refill, especially for chronic medications like blood pressure meds, heart meds, inhalers, or controlled substances. Give us a few days’ notice if you can.

Brad

That’s huge. If we know you’re due in three or four days and we see a supply issue, we’ve got a little window to troubleshoot—maybe order from a different warehouse, or talk to your prescriber about an alternative. If you call when you’ve got one tablet left, our options shrink fast.

Kassidy

Number two, communicate any travel or schedule changes. If you’re going out of town, tell us ahead of time so we can try to fill early if it’s allowed by your insurance. During shortages, moving a fill by a week can be the difference between having medicine in your suitcase or scrambling in another state.

Brad

Another big tip is to know your medication’s names—both brand and generic if possible. If you only know, I take the little white pill, and then the little white pill changes, that’s scary. But if you know, I’m on lisinopril, and you see that same name on the label even if the pill looks different, that’s reassuring.

Kassidy

Keeping an up-to-date medication list is part of that. It doesn’t have to be fancy—a note in your phone or a card in your wallet with the name, strength, and how you take it. That helps us, your doctors, and any other pharmacy if you ever have to use one.

Brad

Which brings up another point: try to have one primary pharmacy when you can. When all your medications go through the same place, it’s easier for us to see the big picture, catch interactions, and spot when a shortage in one drug might affect something else you’re taking.

Kassidy

And please, please make sure we have your current phone number and that you actually pick up if we call. A lot of what we’re talking about today—substitutions, partial fills, changes in plan—works best when we can reach you quickly and talk it through before you run out.

Brad

I also want to encourage a partnership mindset. Drug shortages are frustrating for everybody—you, us, your prescribers. But we’re on the same team. If something changes, don’t assume the worst. Call us, stop by, ask the questions. We’d much rather adjust a plan with you than find out later you just stopped taking your medication.

Kassidy

Skipping doses because you’re unsure, or because you hit a delay and didn’t reach out, can cause more harm than the shortage itself. So think of us as your shortage translators. If you get a message from your insurance or you see something on the news and you’re confused, bring it in. We’ll help sort it out.

Brad

So to wrap up: drug shortages are real, they’re being tracked nationally, and they do drive a lot of those changes you see in your prescriptions. But behind each change, you’ve got pharmacists like Kassidy and me working hard to keep your therapy safe and uninterrupted.

Kassidy

And you’re not powerless in this. Planning ahead, asking questions, keeping your info up to date—those are simple steps that make a big difference. If something about your medication ever surprises you, don’t panic alone. Call us at Galloway-Sands, come see us at Supply or Southport, and let’s talk it through together.

Brad

Alright, that’s it for this episode of MedTalk by Galloway-Sands Pharmacy. Thanks for spending a little time with us today.

Kassidy

Take care of yourselves, take your meds safely, and we’ll be back soon with more conversations to help make healthcare a little less confusing.

Brad

We’ll see you next time. Bye, everybody.

Kassidy

Feel free to contact us with any questions you might have, we are here to support every one of your health needs. Supply Location: 58 Physicians Drive North West #5, Supply, North Carolina, Open 9 AM – 6 PM, you can call us at (910) 754-7200 and Southport Location: 1513 N Howe St #8, Southport, North Carolina, Open 9 AM – 6 PM, and you can call at (910) 454-9090. Have a nice day everyone!