The United States Pharmacopeia (USP), a nonprofit organization that sets quality standards for medicines, has issued a new report highlighting concerns about the U.S. drug supply chain. The report focuses on a group of 100 important medications—both for short-term and long-term use—that are at risk of shortages or disruptions. These risks are mostly due to bottlenecks in the production process, especially in the early stages where raw materials are sourced. While not all of these drugs are currently in short supply, their production chains are vulnerable, which could lead to future problems. According to the U.S. Food and Drug Administration (FDA), about 30% of these medications are already experiencing shortages. Many of the drugs on this list are considered essential by health organizations like the World Health Organization (WHO) and the FDA. They include treatments for conditions like ADHD, diabetes, heart disease, cancer, and severe infections, as well as hospital medications, chemotherapy drugs, steroids, and anesthetics. A significant portion of these vulnerable drugs—63%—are injectable medications. This is because injectables are more complex to manufacture compared to oral medications like tablets and capsules, which make up 22% of the list. The biggest concern highlighted in the report is that nearly half (48%) of these drugs rely on at least one key starting material (KSM) that is made in only one country. KSMs are the basic chemical ingredients used to create active pharmaceutical ingredients (APIs), which are then used to make the final medicines. Even if a drug is manufactured in multiple countries, if all manufacturers depend on the same KSM source, any problem—such as export restrictions, natural disasters, or regulatory changes—can disrupt the entire supply chain at once. This is why USP emphasizes that diversifying KSM sources is critical to preventing shortages. The report also notes that no single type of medication is uniquely affected; however, three new drugs have been added to the list due to hidden geographic concentration risks. These include Tamiflu (oseltamivir) capsules, famotidine injection (used to reduce stomach acid), and metoprolol tartrate injection (for high blood pressure), because each of these drugs relies on a KSM produced in a single region. This latest update follows a previous report from last year, which assessed drugs based on their essentiality, demand, and supply chain vulnerabilities at the finished dose stage. The new report aims to show that even if a drug has multiple manufacturers for the final product or the API, the supply chain is still vulnerable if the KSMs come from a single source. The COVID-19 pandemic exposed how spread out and fragile many medicine supply chains are. Recent U.S. trade policies have also pushed for more domestic production of healthcare products to reduce reliance on imports. For example, the Trump administration recently announced a 100% tariff on certain patented pharmaceuticals, though there are exceptions and conditions. The goal of this policy is to encourage more manufacturing in the U.S. Large drugmakers that have agreed to work with the administration on pricing and manufacturing have been exempt from these tariffs until 2029. Companies can also qualify for a lower 20% tariff by committing to move some of their production to the U.S. Many major drug companies have already invested heavily in U.S. manufacturing, which may help reduce the impact of these tariffs. However, smaller and medium-sized drugmakers and biotech companies might struggle more with these changes because they have fewer resources to invest in new production facilities. The Midsized Biotech Alliance of America (MBAA) has expressed concern that this policy creates an unfair system that favors larger companies over smaller ones.