Navigating Cancer Drug Shortages & Access

This page is for people whose cancer treatment is affected by a drug shortage or an access problem such as an insurance denial. It explains what a shortage is, what your team does about it, and what to ask.

Being told a drug in your treatment plan is in short supply is unsettling in a particular way. You accepted a plan and arranged your life around it. Now the ground has moved, for reasons that have nothing to do with you or your cancer. It helps to know what a shortage actually is. It helps to know what your team is doing about it, and what you can usefully ask.

A shortage means supply is not meeting demand. It does not mean your hospital forgot to order. The FDA says shortages can happen for many reasons, including manufacturing and quality problems, delays, and discontinuations.

The FDA keeps a public Drug Shortage Database. When a drug is listed as current, the FDA says it is aware of the supply problem and is working with the manufacturers on it. It describes its role as working closely with manufacturers to prevent or reduce the impact of shortages. Patients and providers can report a new shortage through an FDA portal. The FDA does not make drugs itself.

Cancer centers often hear about a shortage before patients do. What happens next depends on the drug and your situation. Your team may suggest a different drug, a change in timing, or another approach. For people in NCI-sponsored clinical trials, NCI says the plan may include delays or changes to treatment when a drug is unavailable, with oversight of the study.

Not every change is equal. Some alternatives are a close match. Others may differ in side effects or in how well they work. Ask your oncologist which one applies to you. You are entitled to a clear answer.

Ask directly. Ask for specifics rather than reassurance:

• Is my treatment affected now, or is this a precaution?
• What is the alternative, and how does its evidence compare with the original plan?
• Does this change my chance of benefit, or mainly the side effects and logistics?
• Does it change my schedule, my monitoring, or how long treatment lasts?
• Is a delay safer than a substitution for my cancer, or the reverse?
• Would treatment at another center or through a clinical trial be an option?
• When will you know more, and who will call me?

A useful question is what happens if the shortage runs another two months. That makes the backup plan clear.

Sometimes a drug is available but hard to get. The cause may be insurance denials, copays you cannot meet, or a drug that is not on your plan's formulary (its list of covered drugs). The drug exists. The route to it is blocked.

These problems have their own ways through. If an insurer refuses to pay, you can ask for an internal appeal, and then an external review by an independent party. HealthCare.gov says urgent cases can be sped up. NCI says social workers can suggest programs that help pay for treatment. Hospital financial counselors can help with payment plans and reduced rates. Drug makers also run assistance programs that provide free or low-cost drugs to eligible patients. Ask your team which apply to you.

If cost is the barrier, tell your team early. NCI advises this so you can look at options together. Our questions to ask before treatment begins covers cost questions worth raising at the start.

Shortages are a failure of the drug supply system. You did not cause them and you cannot fix them. What you can do is stay informed about your own plan. Keep asking what the alternative is and why. And ask who on your team is working on the access side.

• U.S. Food and Drug Administration — Drug Shortages
• National Cancer Institute (DCTD) — Managing Drug Shortages During Clinical Trials
• National Cancer Institute — Managing Cancer Costs and Medical Information
• HealthCare.gov — How to Appeal an Insurance Company Decision