Drug shortage count rises for the second straight quarter. Four carboplatin manufacturers are in constrained supply simultaneously.
Active drug shortages in the U.S. climbed to 223 in Q1 2026, the second consecutive quarterly increase, per the American Society of Health-System Pharmacists' April 2026 report [ASHP Q1 2026 Drug Shortage Report]. Five quarters of decline preceded this. That trend is now moving the other direction.
Why it matters: Carboplatin is the clearest example of where the formulary is breaking down right now. Accord is on back order with no estimated release date. Fresenius Kabi estimated an early-May 2026 release. Pfizer is releasing on weekly allocation. Apotex discontinued its product in early 2026 [ASHP Drug Shortage Detail: Carboplatin, May 2026]. Four manufacturers in constrained supply simultaneously on a single drug is not a minor disruption. It is a formulary compliance event that lands in a procurement director's lap before it lands in a physician's chart. Controlled substances are running at 15% of all active shortages [ASHP Q1 2026], which means OR scheduling and anesthesia purchasing are absorbing pressure alongside the oncology formulary, not instead of it.
By the numbers:
223 active drug shortages, Q1 2026 [ASHP, April 2026]
323 active shortages in Q1 2024, the all-time high [ASHP]
15% of current shortages involve controlled substances [ASHP Q1 2026]
~47% of U.S. generic drug volume supplied by India [Becker's, April 2026]
11 new drugs entered shortage between January and February 2026, across heart failure, hypertension, and oncology categories [VytlOne, March 2026]
Between the lines: The tariff environment is what makes this cycle harder to track than the 2024 peak. Michael Ganio, PharmD, senior director of pharmacy practice and quality at ASHP, told Becker's last August: "If the price is not allowed to rise... the manufacturer may choose just to stop making the drug, but they may never disclose that the reason for discontinuing it is because of tariffs" [Becker's Hospital Review, August 2025]. A 10% baseline tariff on pharmaceutical imports has been active since February 24, 2026, with a planned increase to 15% [VytlOne, citing Reuters, March 2026]. Manufacturers on low-margin generics have no room to absorb that spread, and the FDA discontinuation database does not require a cause. The ASHP list is already a lagging indicator. Add undisclosed tariff-driven exits and the number you see today understates what your next contract cycle is walking into. The trigger to act is not a new ASHP listing: it is your primary supplier moving a product to allocation or pushing an estimated release date past 60 days. That is when the secondary sourcing window is open. After a listing, it is usually closed. Ganio has noted that committed volume contracts, where a GPO guarantees volume to a manufacturer in exchange for supply certainty, are one of the structural tools that reduce this exposure [Pharmacy Practice News, July 2025]. If your GPO has not surfaced that conversation on your highest-risk generic injectables, it is worth raising.
What's next: ASHP formally asked the White House to exempt medications and APIs from tariffs in February 2025. No exemption has been granted [ASHP, February 2025]. Q2 2026 data will either confirm a third consecutive quarterly increase or show a plateau. The window to build secondary sourcing relationships and update par levels on your top ASHP-listed injectable categories is before that report, not after.