August 16, 2026
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Q: I ordered a refill of my prescription and was told that it is on a long-term back-order and that the staff is working on a solution. Why is this happening and how long will that take?
A: Let’s first talk about what a ”back-order” means for those of you who are unsure. When a manufacturer cannot supply enough of the medication to meet the demand, the wholesalers (the drug distribution centres that supply the pharmacies) and, therefore, the pharmacies are unable to order the product, resulting in a back-order situation.
If it seems as though every time we turn around another medication is on back-order, you are not imagining it. Drug shortages have become a persistent problem in Canada, and they create considerably more work behind the scenes at the pharmacy than most people realize.
A drug can be listed as being in shortage even when some pharmacies still have stock, albeit dwindling. The pharmacy may need to reduce your supply until the medication is, once again, available or another option is found. In other cases, the medication may be completely unavailable. Health Canada reports that shortages can result from manufacturing problems, quality issues, difficulty obtaining raw materials, shipping or distribution delays, unexpected increases in demand, recalls, and even discontinuation of a product.
Unfortunately, there are some additional vulnerabilities in Canada's drug supply. Canada represents only a small portion of the global pharmaceutical market, and many of the medications we use are manufactured elsewhere. In some cases, a product or an ingredient may come from only one supplier making it an issue across the board. According to Health Canada, manufacturing problems alone account for 65 per cent of reported shortages. Health Canada also reports that the consolidation of manufacturing has reduced the industry's ability to withstand disruptions which has not helped the situation.
So what happens when one of the medications you are requesting happens to be on the long list of back-orders? You will be happy to hear that we don't simply look at the shelf and say, "Sorry, it's back-ordered." We investigate further, which has proven to be particularly time-consuming for pharmacies. We first check the wholesaler to learn if there is an expected date of return of the medication. In an ideal world, the product would be available in a matter of days and nothing more needs to happen. However, the trend we are seeing, recently, is the back-order situation is lasting for months. When this happens, after repeated sighs and stating “not another medication on this list,” we get to work seeking alternatives.
In general, each time we are made aware of yet another prescription we cannot satisfy, we need to:
Peruse the wholesaler website for further details of the back-order situation and possible date of return. If it is within days, we can, generally, manage by giving a small supply of medication in the interim. Often, the expected date of return is unknown or months away.
Peruse the wholesaler for the most seamless options, such as other doses available of the same medication.
Review the indication for the prescription as some medications have several uses. Knowing the indication helps us to determine other possible replacements.
Peruse the wholesaler for other similar options (different medication in same category) to ensure its availability.
Review the profile for the patient's history (what has been tried before), allergies, medical conditions, drug plan (will an alternative be covered on the plan?) to help determine a suitable solution.
Adapt (if able) and fax the patient's health-care provider to inform/request possible solutions
Await a response from the health-care provider in cases where we cannot adapt the prescription
As you might guess, going through these steps to determine the best solution takes a considerable amount of time. Especially when you consider just how many medications are on back-order and the number of times each day we have to find a suitable alternative.
As mentioned earlier, there are circumstances in which we can adapt a prescription without obtaining an entirely new prescription. There are a few scenarios that fall into this category such as:
The strength of your prescription is unavailable but other strengths are. You would be asked to take a different quantity (two tablets or one-half of a tablet) to get the correct dose of the original prescription.
Nothing is available in the prescribed dosage form but other dosage forms are. There are a few examples of this type of adaptation:
Changing from liquid to capsule/tablet as we did when many suspension forms of antibiotics were back-ordered.
Changing from injection to tablet as was the case a couple of years ago when Ozempic first was on back-order and we adapted the prescription, in some cases, to the oral tablet form.
It's important to point out that pharmacists are not simply changing the medication because we think another one would work. There are specific rules governing what constitutes an appropriate adaptation, and the pharmacist remains responsible for ensuring that the adapted therapy is safe and appropriate for that particular individual.
As you may be aware, Ontario pharmacists can prescribe medications for a growing list of minor ailments, and we can initiate, renew and adapt prescriptions within the authority provided by provincial legislation. But that does not mean we can substitute any medication we believe is therapeutically similar.
There is an important difference between adapting a prescription and therapeutically substituting one medication for another.
Therapeutic substitution means replacing the prescribed medication with one containing a chemically-different active ingredient that is considered therapeutically equivalent. In Ontario, that remains outside the pharmacist's current authority. Though we may have done research to learn what alternatives might be appropriate in your situation, a new prescription will need to come from your health-care provider.
Another common question we get asked, is why some back-order situations last so long?Unfortunately, there isn't always a simple answer. A manufacturer may experience a production problem, have difficulty obtaining an ingredient, experience a quality-control issue or face increased demand. Even after the manufacturing problem has been corrected, the product will need to move through the supply chain before it reaches wholesalers and pharmacies.
If you are wondering if there is anything you can do on your end, one of the best habits to get into is to request a refill for your medication five to seven days before you run out. This gives us time to investigate the supply situation and, if necessary, contact your prescriber. We realize that some medications have strict refill dates and some drug plans are sticky with allowing early refills, but five to seven days early is generally acceptable.
Please also resist the temptation to stockpile medications. Buying more than you need can make supply problems worse. Health Canada recommends purchasing only what is needed and consulting a pharmacist or health-care provider before disposing of older medication that may be in shortage.
Drug shortages are a problem affecting the entire health-care system. Until the underlying supply issues are resolved, pharmacists and their teams will continue doing what we can to keep you supplied with the medications you need, while working within the rules designed to keep those medication changes safe.
For more information about this or any other health-related questions, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination. Also check the website at www.gordon-pharmasave.com/ and the Facebook page at www.facebook.com/GordonPharmasave/.
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