Cancer centers across the US are deep into a severe shortage of ifosfamide, a decades-old chemotherapy drug critical for treating sarcomas and testicular cancers. First flagged by the FDA in June 2026 after manufacturing contamination problems at a German facility, the shortage has left hospitals with only weeks of supply — and no clear end in sight, with the European Medicines Agency projecting disruptions into 2027. Oncologists are now doing what they describe as their "worst nightmare": bedside rationing, deciding which patients get access to a drug that could be curative.

The crisis mirrors the 2023 cisplatin and carboplatin shortage, and experts say the root causes haven't changed. The US market for generic sterile injectables is structurally broken — dominated by single-source foreign manufacturers, squeezed by razor-thin margins, and governed by purchasing contracts that reward low price over supply reliability. Proposed legislative fixes, including a bipartisan Senate bill to incentivize supply-resilient purchasing, stalled amid hospital lobbying. Proposed tariffs on imported generics could make things worse by squeezing already-thin manufacturer margins further.

By the Numbers:

• 38% — share of ifosfamide orders filled for Premier-contracted hospitals
• 60% — proportion of 2026 drug shortages involving injectable drugs
• ~1% — generic sterile injectables with more than one approved manufacturing facility (vs. ~20% for branded drugs)
• $358,247 — FDA fee to submit an abbreviated new drug application, a barrier to new domestic suppliers

Why it matters: Recurring chemo shortages aren't just a supply chain inconvenience — they force clinicians to ration potentially curative treatments, delay care, and substitute inferior regimens. Without structural reform to how generic drugs are priced, purchased, and manufactured, experts warn these crises will keep coming.