The war involving Iran has disrupted oil markets, shipping and supply chains. It has not yet produced global drug shortages, but the disruption to supply chains raises the risk profile for hospitals that already operate in a fragile medication environment. The conflict has disrupted two critical logistics corridors, the Strait of Hormuz and major Gulf air hubs, with commercial activity through Hormuz down about 90% from prewar levels as of March 16 and Gulf air-cargo capacity down 79% in the early phase of the conflict. For U.S. health systems, the issue isn’t sourcing from Iran that is the problem, it is the stress to global transport networks, cold-chain routes and cost structures driven by oil prices that move medicines around the world.
The immediate clinical risk is concentrated in temperature-sensitive and time-sensitive products. Drugmakers are rerouting shipments of cancer therapies and other refrigerated medicines after strikes shut down or constrained cargo hubs in Dubai, Abu Dhabi and Doha. Executives told Reuters they are trucking some medicines from airports in Jeddah and Riyadh, while others are redirecting Europe-Asia cargo through China or Singapore. Experts warn those alternatives are harder to stand up quickly for cold-chain products, especially oncology biologics and other short-shelf-life therapies.
That is why this story should land with hospital leaders as an operational issue, not just a geopolitical one. Imminent U.S. shortages remain unlikely because of inventory buffers and largely uninterrupted Suez-linked flows, but the conflict is exposing deeper weaknesses: heavy reliance on a handful of transit hubs, fragile emergency supply systems and cold-chain bottlenecks. The same analysis warns that the first real pressure points are likely to show up where supply chains are already thin, including vaccines, insulin, biologics and cancer therapies.
Due to the globalized nature of pharmaceutical supply chains, the rising cost of oil due to the conflict means that cost pressure may arrive before shortage notices do. Consumers could see drug cost effects within four to six weeks because of higher air-cargo rates. The larger economic risk comes from rising oil prices, which can lift transportation and energy costs across manufacturing and distribution, putting pressure on margins even when goods are still moving.
This comes at a bad time for hospitals, because the baseline shortage picture is already strained. ASHP’s most recent national report says the U.S. ended 2025 with 216 active drug shortages, up slightly from the prior quarter, even though new shortages during 2025 fell to their lowest annual level since 2006. USP reported in 2025 that long-standing shortages accounted for more than 90% of all U.S. shortages and that the average duration of current shortages had climbed to more than four years. In other words, health systems are not absorbing this latest shock from a position of strength.
What hospital and health system leaders should do now
Hospital leaders should treat this as a medication resiliency drill with real stakes. Pharmacy, supply chain, oncology, perioperative and finance teams should be reviewing exposure to cold-chain drugs, mapping sole-source and limited-source products, and pressing wholesalers and manufacturers for route-specific contingency plans, especially for refrigerated oncology agents, insulin, vaccines and IV components. Trade reporting also suggests the conflict could create materials-driven shortages, including packaging and component constraints such as vial stoppers and IV-bag plastics, so the watch list should extend beyond finished drugs.
Leaders also should prepare for a slower-burn financial hit. If freight, insurance and energy costs stay elevated for weeks, the first signal may be higher acquisition costs, longer lead times and more frequent allocation management rather than a formal shortage declaration. That means health systems should update substitution protocols, revisit conservation strategies for vulnerable products, and make sure clinical leaders are prepared to adjust scheduling or treatment sequencing if temperature-sensitive shipments begin missing connections.
Key takeaway for hospital leaders
The central lesson is simple: this is not yet a nationwide U.S. drug shortage event, but it is absolutely a warning event. The Iran war is showing how quickly a geopolitical shock can squeeze the narrowest parts of the pharmaceutical supply chain, particularly air cargo, cold-chain logistics and already-fragile shortage categories. Hospitals that move early on inventory visibility, supplier accountability and clinical contingency planning will be in a better position if disruption lasts beyond the next several weeks