Contributor: Rachael Waterson, PharmD Educational Pearls:  Drug shortages have been an ongoing issue since the 2000’s. Improvement was being made; however, several factors have exacerbated the drug supply more recently. According to the US Food and Drug Administration (FDA) Report there are 163 drugs currently on the drug shortage list. Of the 40 drugs critical to treating COVID-19, 18 are on this list.  In comparison, according to the American Society of Health-Systems Pharmacists (ASHP), the current drug shortages have limited 29 of the 40 drugs deemed critical to treating COVID-19 patients.  COVID-19 has had an impact on the supply and demand for pharmaceuticals and has exposed the vulnerability of the US drug supply chain. The demand for drugs that are specific to treating COVID-19 patients have increased, while supply has been impacted due to closed factories, shipping delays, trade limitations, and export bans. Supply has been further limited due to COVID-19 heavily affecting 2 of the 3 main drug manufacturer areas of the world, India and Italy.  In order to combat drug shortages, the US federal government developed a contract with a company to make generics in short supply during the pandemic. There is also current discussion about creating an “America First” program to increase domestic production of active pharmaceutical ingredients.  How pharmacists combat drug shortages:  Re-assess the definition of need; need vs convenience of a medication. Look to see if there is another product, manufacturer, vial size, or drug concentration of that exact medication that can be substituted.  Substitution of a similar drug if possible.  Placing restrictions as to which patients can receive medications, who can prescribe medications and medication use dependent on location in the hospital.    References:    American Society of Health-System Pharmacists. (2020). Drug Shortages. ASHP. https://www.ashp.org/Drug-Shortages?loginreturnUrl=SSOCheckOnly.  FDA Drug Shortages. accessdata.fda.gov. (2020, October). https://www.accessdata.fda.gov/scripts/drugshortages/.   Summarized by Emily S Mack, MSBS, OMS III | Rachael Waterson, PharmD