ST. LOUIS, Oct. 06, 2026 (GLOBE NEWSWIRE) -- More than 550 million prescriptions in 2023 were filled for medicines with High or Severe supply-chain fragility, according to new analysis released today by the API Innovation Center (APIIC).
The findings come from APIIC’s National Fragility Index (NFI), the first benchmark designed to measure and track structural fragility across U.S. pharmaceutical supply chains. Introduced at an October 6th event for policymakers and industry leaders, the NFI provides a detailed view of vulnerabilities down to individual drug product codes and establishes a baseline for assessing impact of investments over time.
The initial NFI analysis covers more than 400 medicines across 131 treatment categories, revealing clear opportunities to pivot supply chains to increase national security and build upon existing U.S. manufacturing capabilities:
- 14 medicines rate Severe and 71 rate High, together accounting for approximately one in five medicines scored.
- At least 11 of the Active Pharmaceutical Ingredients (APIs) listed on the Administration for Strategic Preparedness and Response (ASPR) list of 86 essential medicines have a U.S. manufacturer, yet none are supplying U.S. drugmakers.
- Nearly six in ten of the medicines analyzed have experienced at least one recorded shortage, and among those medicines, the median average shortage has lasted over two years.
As federal agencies, private equity, and private organizations invest in domestic pharmaceutical manufacturing, the NFI provides a consistent framework for evaluating supply chain risks and tracking whether those investments reduce those risks. The NFI leverages multiple sources of supply chain intelligence into a single fragility score with higher scores indicating greater fragility, helping decision-makers compare risks, examine what drives them, and identify where action may have the greatest impact. Severe scores indicate the greatest structural vulnerabilities and the highest priority for immediate assessment and action. High scores warrant attention and considerations of near-term measures to reduce risk. Moderate and Low scores indicate progressively lower fragility, although neither means a supply chain is free of risk.
“We cannot know whether our investments are strengthening the drug supply unless we can measure the risks they are meant to address,” said Natalie de Graaf, vice president and general manager for Data Analytics, AI, and ML Solutions for National Security and Health Outcomes at APIIC. “The National Fragility Index gives decision-makers a starting point. It helps them see which supply chains need attention today and track whether their choices are making a difference.”
The NFI measures the fragility of U.S. medicine supply chains by analyzing the global manufacturing networks that support them. Built on pharmaceutical supply chain intelligence from APIIC partner QYOBO and other data sources, the index assesses factors including geopolitical condition, regulatory compliance, financial stability, manufacturing location and clinical impact. QYOBO provides unique visibility into the global manufacturing networks behind individual medicines, including APIs, key starting materials, manufacturing sites, supply dependencies, quality risks and shortages. Its analysis starts at the level of individual drug product codes that can be aggregated to show a broader view of a medicine’s supply chain. This detail allows decision-makers to distinguish among supply routes that may carry different levels of risk.
Pantoprazole, a widely used stomach-acid medicine with 34 million prescriptions filled in 2024, rates Severe on the index - the highest of its four levels. The NFI analysis found that the API comes from 36 suppliers across 12 countries and 29 parent companies, and APIIC identified no U.S. source among them. Just 5.6% of the pantoprazole dispensed domestically comes from a U.S.-based finished-dose manufacturer. It has gone into shortage five times since 2015,
Metoprolol, the most prescribed systemic beta-blocker in the U.S., with more than 58 million prescriptions filled in 2024, rates High on the index. Metoprolol has no domestic source of its API and has had two recorded shortages since 2015, lasting an average of nearly five years. APIIC is working to address this gap by advancing domestic production of metoprolol succinate’s API through its federally supported development program under the BioMaP Consortium in partnership with the HHS - Administration for Strategic Preparedness and Response - Center for Industrial Base Management and Supply Chain.
“For years, pharmaceutical companies have used our supply chain intelligence to make decisions with confidence,” said Dr. Markus Felgenhauer, Co-Founder and CEO of QYOBO. “We’re excited to bring that same intelligence to the public sector, giving policymakers a clear view of supply dependencies and manufacturing sites around the globe, so they can direct resources where they will strengthen the resilience of the U.S. drug supply and ultimately benefit American patients.”
The NFI is an early-warning instrument intended to guide policymakers on making targeted investment in domestic production and risk reduction. Manufacturers, healthcare purchasers and investors can use the analysis to guide sourcing and investment decisions, supporting more proactive efforts to protect patients’ access to medicines, and mitigate supply chain disruptions.
A fuller report on the NFI is expected at a later date.
About API Innovation Center
The API Innovation Center (APIIC) is a St. Louis, Missouri-based, 501(c)(3) nonprofit corporation and public benefit organization dedicated to strengthening U.S. health security by rebuilding domestic capability to develop and manufacture key starting materials, active pharmaceutical ingredients (APIs), and drug products for critical generic medicines. APIIC is leading the development of six clinically essential APIs and brings together government, industry, and academia through public-private partnerships to modernize manufacturing and activate underutilized U.S. production capacity. Through its data analytics capabilities, APIIC helps policymakers and industry leaders assess supply chain vulnerabilities, guide investments, and measure progress towards greater national health security. Our work is supported by grants from the State of Missouri, the Missouri Department of Economic Development, and a federal award from the Department of Health and Human Services’ Administration for Strategic Preparedness and Response. Visit apicenter.org to learn more.
Media Contact CSG for the API Innovation Center apiic@wearecsg.com
