Availability

At its core, availability is dependent on whether medications are reliably manufactured and efficiently distributed. Even in the United States, availability remains a fragile link in the access chain. Most active ingredients are produced by only a few facilities. A single factory shutdown — whether driven by capacity constraints, quality failures, or regulatory action — can cascade across the nation, leaving hospitals and pharmacies scrambling for supply. And many patients live in “pharmacy deserts” where getting a medication may take hours of travel. In these moments, a medication may be technically approved, clinically appropriate, and even affordable, but still functionally out of reach.

These system failures show up in very personal ways for patients and clinicians. It might look like: a parent calling multiple pharmacies to track down ADHD medication for a child; an oncologist forced to alter a chemotherapy regimen because a foundational drug is unavailable. These disruptions erode trust in the health system and carry real clinical consequences: delayed treatment, compromised patient care, increased medication errors, and preventable hospitalizations. For many patients, especially those managing chronic or complex conditions, a missed refill or abrupt therapy switch can mean the difference between stable health and clinical deterioration.

Notably, federal assessments show that roughly one-third of recent U.S. drug shortages involve essential medicines, with low-cost generics being the most vulnerable. When manufacturing becomes financially unsustainable, producers may scale back or exit the market entirely, leaving clinicians and patients without reliable therapeutic options. Among these, low-cost sterile injectables make up a disproportionate share of shortages. These are the critical medicines used daily in operating rooms, intensive care units, and oncology clinics—settings where any delay or substitution can have life-threatening consequences. And when these essential injectables fall into shortage, the disruptions last far longer than average, often persisting four years or more.

These statistics underscore just a few of the real issues people face relative to availability, and the impact that even one of these issues can have in terms of access.

When thinking about availability, we must consider the full ecosystem. Without resilient manufacturing, diversified supply chains, sustainable market dynamics, and equitable distribution, essential medicines often fail to reach the people who need them most regardless of insurance coverage or clinical need, underscoring how availability remains a core access issue.