{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T09:02:47Z","timestamp":1789549367707,"version":"build-2803163510"},"reference-count":41,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pharmacol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Drug shortages pose significant challenges to healthcare systems globally, including China. In October 2019, China\u2019s State Council launched a national strategy (D2019-47) to mitigate drug shortages. We aimed to characterize the supply status of medicines included in the National Drug Shortages List (NDSL), and assess changes associated with the local and national implementation periods of D2019-47.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective interrupted time-series study using monthly procurement and delivery data from 31 centralized drug procurement service centers in China from April 2019 to June 2022. Fifty-two eligible molecule-formulation drug markets were included. Four periods were defined: pre-pandemic, COVID-19 lockdown, local implementation of D2019-47 (intervention 1), and national implementation of D2019-47 (intervention 2). Level and slope changes represented the immediate outcome change and the difference between post- and pre-intervention monthly trends, respectively. Outcomes were overall delivery rate (national supply status), worst-three delivery rate (supply status in the three lowest-supplied provinces), shortage frequency (shortage occurrences), and shortage coverage (geographic spread). Subgroup analyses were performed for currently resolved, price-driven (insufficient supply incentives), and production-driven shortages (manufacturing issues).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The mean monthly overall delivery rate was 87.3% in period 1, decreased to 78.5% in period 2, and increased to 89.6% in period 4, with similar patterns in other outcomes. Intervention 1 was associated with a level increase in overall delivery rate (4.7%, 95% CI: 2.4\u20137.1) and a subsequent slope increase (1.2%, 95% CI: 0.7\u20131.8), while the other indicators showed no significant changes. After Intervention 2, changes in slopes were mainly observed, including a decrease in overall delivery rate (\u22120.2%, 95% CI: \u22120.4 to 0.0), an increase in overall shortage frequency (4.1, 95% CI: 1.7\u20136.5), and an increase in overall shortage coverage (0.1, 95% CI: 0.1 to 0.1), with these changes observed primarily in price-driven markets.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Overall delivery rates for NDSL medicines in China exceeded 75% from April 2019 to June 2022. Following intervention 1, the overall delivery rate improved, whereas most other aggregate shortage indicators showed no significant level or slope changes. Following intervention 2, additional improvement was limited, with adverse slope changes observed for several indicators. Regional disparities also persisted. These findings suggest that complementary strategies may be needed to sustain improvements and address persistent regional and market-specific supply vulnerabilities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphar.2026.1888875","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T08:05:20Z","timestamp":1789545920000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Drug supply changes associated with a key policy on drug shortages in China: evidence from an interrupted time-series study"],"prefix":"10.3389","volume":"17","author":[{"given":"Shuchen","family":"Hu","sequence":"first","affiliation":[{"name":"Department of Pharmacy Administration, School of Pharmacy, Xi\u2019an Jiaotong University","place":["Xi\u2019an, China"]},{"name":"School of Pharmaceutical Sciences, Zhengzhou University","place":["Zhengzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingyu","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Administration, School of Pharmacy, Xi\u2019an Jiaotong University","place":["Xi\u2019an, China"]},{"name":"Center for Drug Safety and Policy Research, Xi\u2019an Jiaotong University","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingchen","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Administration, School of Pharmacy, Xi\u2019an Jiaotong University","place":["Xi\u2019an, China"]},{"name":"Center for Drug Safety and Policy Research, Xi\u2019an Jiaotong University","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haoqi","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Administration, School of Pharmacy, Xi\u2019an Jiaotong University","place":["Xi\u2019an, China"]},{"name":"Center for Drug Safety and Policy Research, Xi\u2019an Jiaotong University","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyong","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Administration, School of Pharmacy, Xi\u2019an Jiaotong University","place":["Xi\u2019an, China"]},{"name":"Center for Drug Safety and Policy Research, Xi\u2019an Jiaotong University","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingnan","family":"Tao","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Administration, School of Pharmacy, Xi\u2019an Jiaotong University","place":["Xi\u2019an, China"]},{"name":"Center for Drug Safety and Policy Research, Xi\u2019an Jiaotong University","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fei","family":"Xue","sequence":"additional","affiliation":[{"name":"Xi\u2019an No.3 Hospital, the Affiliated Hospital of Northwest University","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Fang","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Administration, School of Pharmacy, Xi\u2019an Jiaotong University","place":["Xi\u2019an, China"]},{"name":"Center for Drug Safety and Policy Research, Xi\u2019an Jiaotong University","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caijun","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Administration, School of Pharmacy, Xi\u2019an Jiaotong University","place":["Xi\u2019an, China"]},{"name":"Center for Drug Safety and Policy Research, Xi\u2019an Jiaotong University","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1007\/s10602-016-9215-9","article-title":"Rent seeking and the economics of corruption","volume":"27","author":"Aidt","year":"2016","journal-title":"Const. Polit. Econ."},{"key":"B2","doi-asserted-by":"publisher","first-page":"290","DOI":"10.3390\/healthcare9030290","article-title":"The impact of COVID-19 on essential medicines and personal protective equipment availability and prices in Saudi Arabia","volume":"9","author":"Aljadeed","year":"2021","journal-title":"Healthcare"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2957","DOI":"10.1111\/bcp.15853","article-title":"Drug shortages. Part 2: trends, causes and solutions","volume":"89","author":"Aronson","year":"2023","journal-title":"Br. J. Clin. Pharmacol."},{"key":"B4","volume-title":"Drug Shortages Statistics","year":"2026"},{"key":"B5","doi-asserted-by":"publisher","first-page":"E898","DOI":"10.1503\/cmaj.1095886","article-title":"Temporary fixes to chronic drug shortages leave Canada vulnerable","volume":"192","author":"Basky","year":"2020","journal-title":"Can. Med. Assoc. J."},{"key":"B6","unstructured":"COVID-19 outbreak: authorities implement city lockdown for epidemic control as death toll surges\n          \n          \n          2020"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1124","DOI":"10.1016\/j.jval.2021.12.017","article-title":"Do medicine shortages reduce access and increase pharmaceutical expenditure? A retrospective analysis of Switzerland 2015-2020","volume":"25","author":"Blankart","year":"2022","journal-title":"Value Health"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1216","DOI":"10.1016\/S1470-2045(21)00452-6","article-title":"Shortage of cancer drugs in Mexico","volume":"22","author":"Das","year":"2021","journal-title":"Lancet Oncol."},{"key":"B9","volume-title":"Pharmaceutical Benefits Scheme (PBS): Designated Brands","year":"2025"},{"key":"B10","doi-asserted-by":"publisher","first-page":"100728","DOI":"10.1016\/j.lanwpc.2023.100728","article-title":"The scarcity of medications in the Western Pacific","volume":"31","year":"2023","journal-title":"Lancet Reg. Health West Pac"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1783","DOI":"10.1093\/cid\/ciaa216","article-title":"Critical national shortage of cefazolin in Japan: management strategies","volume":"71","author":"Honda","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"B12","volume-title":"Drug Shortages in China: Trends, Pricing Drivers, Policy Evaluation and Optimization","author":"Hu","year":"2025"},{"key":"B13","doi-asserted-by":"publisher","first-page":"e018960","DOI":"10.1136\/bmjgh-2025-018960","article-title":"The association between drug shortages and prices across 74 countries: uncovering global access inequities","volume":"10","author":"Hu","year":"2025","journal-title":"BMJ Glob. Health"},{"key":"B14","doi-asserted-by":"publisher","first-page":"481","DOI":"10.1016\/S0140-6736(20)30354-8","article-title":"Europe faces worsening medicine shortages","volume":"395","author":"Hyde","year":"2020","journal-title":"Lancet"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1463","DOI":"10.1111\/poms.12697","article-title":"Mitigating the U.S. drug shortages through pareto improving contracts","volume":"26","author":"Jia","year":"2017","journal-title":"Prod. Operations Manag."},{"key":"B16","doi-asserted-by":"publisher","first-page":"2326","DOI":"10.1287\/mnsc.2020.3857","article-title":"Alleviating drug shortages: the role of mandated reporting induced operational transparency","volume":"67","author":"Lee","year":"2021","journal-title":"Manag. Sci."},{"key":"B17","doi-asserted-by":"publisher","first-page":"29","DOI":"10.3969\/j.issn.1674-2982.2021.01.005","article-title":"Analysis of the impact from the \u201ctwo-ballot system\u201d policy on drug supply in Shandong Province","volume":"14","author":"Li","year":"2021","journal-title":"Chin. J. Health Policy"},{"key":"B18","doi-asserted-by":"publisher","first-page":"63","DOI":"10.3969\/j.issn.1672-3384.2024.11.012","article-title":"Analysis and suggestions on the allocation and shortage of nervous system drugs in public medical institutions in China from 2017 to 2021","volume":"22","author":"Li","year":"2024","journal-title":"Clin. Medicat. J."},{"key":"B19","doi-asserted-by":"publisher","first-page":"1145","DOI":"10.7507\/1672-2531.201902090","article-title":"Construction of tracking assessment methods of resolution execution of WHO essential medicine accessibility","volume":"19","author":"Lin","year":"2019","journal-title":"Chin. J. Evidence-Based Med."},{"key":"B20","doi-asserted-by":"publisher","first-page":"480","DOI":"10.1177\/1536867X1501500208","article-title":"Conducting interrupted time-series analysis for single- and multiple-group comparisons","volume":"15","author":"Linden","year":"2015","journal-title":"Stata J."},{"key":"B21","doi-asserted-by":"publisher","first-page":"4038","DOI":"10.3390\/jcm11144038","article-title":"Antidepressant drugs and COVID-19: a review of basic and clinical evidence","volume":"11","author":"Mas","year":"2022","journal-title":"J. Clin. Med."},{"key":"B22","doi-asserted-by":"publisher","first-page":"6009","DOI":"10.3390\/ijerph18116009","article-title":"Impact of the first wave of the COVID-19 pandemic on HIV\/AIDS programming in Kenya: evidence from kibera informal settlement and COVID-19 hotspot counties","volume":"18","author":"Muhula","year":"2021","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"B23","unstructured":"Opinions on reforming and promoting the supply mechanism for shortage drugs\n          \n          \n          2017"},{"key":"B24","unstructured":"Notice on the management rules of the national shortage drug list"},{"key":"B25","unstructured":"Notice on the release of the national shortage drug list"},{"key":"B26","unstructured":"Temporary importation scheme for clinically needed medications\n          \n          \n          2022"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1957","DOI":"10.3969\/j.issn.1003-3734.2020.17.008","article-title":"Investigation and analysis on the status of drug shortage in 17 pediatric hospitals in China","volume":"29","author":"Ni","year":"2020","journal-title":"Chin. J. New Drugs"},{"key":"B28","doi-asserted-by":"publisher","first-page":"0000012","DOI":"10.5301\/maapoc.0000012","article-title":"Trends in United States drug shortages for medications used in gastroenterology","volume":"1","author":"Patel","year":"2017","journal-title":"Med. Access @ Point Care"},{"key":"B29","doi-asserted-by":"publisher","first-page":"e0215837","DOI":"10.1371\/journal.pone.0215837","article-title":"The impacts of medication shortages on patient outcomes: a scoping review","volume":"14","author":"Phuong","year":"2019","journal-title":"PLoS One"},{"key":"B30","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1186\/s40545-023-00646-w","article-title":"State of the European Union\u2019s early notification obligation for drug shortages: enforcement and compliance in eight European countries (2020\u20132022)","volume":"16","author":"Ravela","year":"2023","journal-title":"J Pharm Policy Pract"},{"key":"B31","doi-asserted-by":"publisher","first-page":"100637","DOI":"10.1016\/j.rcsop.2025.100637","article-title":"Can a national storage obligation for medicines prevent shortages? Evidence from the Finnish experience","volume":"19","author":"Ravela","year":"2025","journal-title":"Explor Res. Clin. Soc. Pharm."},{"key":"B32","doi-asserted-by":"publisher","first-page":"438","DOI":"10.1186\/s12913-023-09295-w","article-title":"Drug shortages in China: a cross-sectional study","volume":"23","author":"Song","year":"2023","journal-title":"BMC Health Serv. Res."},{"key":"B33","volume-title":"The Antitrust Guidelines for the Active Pharmaceutical Ingredients","year":"2021"},{"key":"B34","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1007\/s40258-016-0276-8","article-title":"Delivery of essential medicines to primary care institutions and its association with procurement volume and price: a case study in Hubei Province, China","volume":"15","author":"Tang","year":"2017","journal-title":"Appl. Health Econ. Health Policy"},{"key":"B35","unstructured":"Covid-19 in India: vaccine shortages are leading to discrimination in access\n          \n          \n          2021"},{"key":"B36","unstructured":"Guidelines for strengthening employment stability in response to the COVID-19 pandemic\n          \n          \n          2020"},{"key":"B37","volume-title":"Opinions on Promoting the National Essential Medicines Policy","year":"2018"},{"key":"B38","unstructured":"Opinions of further ensuring supply and stabilizing prices of the shortage drugs\n          \n          \n          2019"},{"key":"B39","doi-asserted-by":"publisher","first-page":"428","DOI":"10.13493\/j.issn.1672-7878.2021.03-035","article-title":"Influence of zero stock management based on drug group purchasing organization mode on hospital drug supply and pharmacy management","volume":"18","author":"Wong","year":"2021","journal-title":"Anti-Infection Pharm."},{"key":"B40","first-page":"180","article-title":"Medicines shortages: global approaches to addressing shortages of essential medicines in health systems","volume":"30","year":"2016","journal-title":"WHO Drug Inf."},{"key":"B41","doi-asserted-by":"publisher","first-page":"44","DOI":"10.19960\/j.cnki.issn1005-0698.2020.01.008","article-title":"Monitoring and analysis shortage of drugs in 22 medical institutions in Xinjiang uygur autonomous region by early warning model","volume":"29","author":"Zhao","year":"2020","journal-title":"Chin. J. Pharmacoepidemiol."}],"container-title":["Frontiers in Pharmacology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2026.1888875\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T08:05:32Z","timestamp":1789545932000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphar.2026.1888875\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,16]]},"references-count":41,"alternative-id":["10.3389\/fphar.2026.1888875"],"URL":"https:\/\/doi.org\/10.3389\/fphar.2026.1888875","relation":{},"ISSN":["1663-9812"],"issn-type":[{"value":"1663-9812","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,16]]},"article-number":"1888875"}}