Home > National > Social Affairs

Hospitals face essential medicine shortages as drugmakers drop low-margin staples

Published: 05 Jun. 2026, 07:00

A syringe is seen at a drugstore in Bucheon, Gyeonggi on April 7. [NEWS1]

Korea's hospitals are bracing for a wave of shortages of essential medicines, the drugs that emergency and intensive-care teams reach for in life-and-death moments, as suppliers halt production of low-margin staples.

The clearest example is Ativan, the lorazepam injection given to children whose seizures will not stop. Its only manufacturer has ended production. Lidocaine and other basic injectables, along with antibiotics, anesthetics and cancer drugs used in hospitals every day, are now flashing supply warnings. Doctors warn that "a second Ativan crisis" could break out at any time.

A single point of failure

Since 2000, the government has designated essential medicines to prevent manufacturers from withdrawing them from the market. The weakness is that many of these drugs depend entirely on one producer, so when that company stops making them, often citing weak margins, a shortage becomes unavoidable.

A review by the JoongAng Sunday of 374 drugs with the same ingredients and formulations found that 231, or 61.8 percent, had only one manufacturer. That means more than six of every 10 essential medicines could lose their supply at any moment.

The risk is not confined to a few products. Many of the drugs in question are used daily in emergency rooms, intensive care units and operating theaters, including epinephrine injections for cardiac arrest and shock, the local anesthetic lidocaine and antibiotics for severe infections.

"When these drugs run short, it's like running out of bullets on the battlefield that is the emergency room," said Lee Hyung-min, a professor of emergency medicine at Hallym University Sacred Heart Hospital. "If the supply chain for essential medicines is shaken, the threat goes beyond a single hospital or ER and endangers the entire medical front line."

"During the shortage of the general anesthetic etomidate, we had to use other, similar drugs, but different drugs work through different mechanisms and in different ways," Lee continued. "Just as it's far easier to peel an apple with a paring knife than a kitchen knife, in an ER where every second counts, that small difference can decide whether a patient lives or dies."

Confiscated narcotics are displayed during a briefing on the results of a crackdown on medical institutions producing illegal propofol and other drug injections at the Seoul Central District Prosecutors’ Office in Seocho District, southern Seoul, on Nov. 20, 2024. [NEWS1]

A fundamental flaw

The Ativan case shows how the structural weakness plays out.

Ildong Pharmaceutical, the sole maker, said in January last year that it would stop production, citing falling profitability and aging facilities. More than a year passed without a clear fix, and anxiety in hospitals grew.

"As the risk of a halt grew, large hospitals that use the drug heavily even began stockpiling it," a pharmaceutical industry source said.

The Ministry of Food and Drug Safety recently designated Samjin Pharmaceutical as a new producer, but a supply gap appears unavoidable while the approval change is processed.

Substitutes are no real answer, according to Hong Ki-jeong, a professor of emergency medicine at Seoul National University Hospital.

"Even when there's a substitute, you end up using a drug that falls a little short, like driving an old car while everyone else drives a self-driving one," Hong said. "Without three essential drugs in particular, Ativan, lidocaine and saline, the emergency room would have to close its doors."

A pharmacy in central Seoul on March 2025 [YONHAP]

Prices frozen for decades

Behind the fragile supply chain lie years of low pricing, the medical community says.

Data from the office of Rep. Kim Sun-min of the National Assembly's Health and Welfare Committee show that about 30 percent of these drugs have had their price ceilings frozen for five years or more, and 57 items have not seen a single increase in over 20 years.

Alpha Acetaminophen, a basic acetaminophen tablet for colds, fever and pain, has had its price ceiling frozen at 11 won (less than 1 cent) since it was designated in 2000. Even the government incentive for making it is just 1 won.

These drugs are heavily relied on in the field but are barely profitable. Generics whose patents have expired have seen prices stagnate through repeated insurance cuts, even as the costs of raw materials, labor, logistics and meeting good manufacturing standards keep climbing.

"Repeated price cuts on older generics have locked in an ultra-low-price structure," a source at the Korea Pharmaceutical and Bio-Pharma Manufacturers Association said. "Costs keep rising while prices stay flat for years, so profitability inevitably falls."

The head of one small drugmaker put it bluntly: "Big companies can hold on with profits from other products, but for smaller firms, it's hard to keep making drugs that lose money."

Newborns at risk

The strain extends to injectables used in neonatal and pediatric intensive care. The maker of a steroid injection used to keep blood pressure up in newborns and critically ill children in shock recently said it would stop supplying the product from July. The Ministry of Food and Drug Safety said the manufacturer plans to resume production in November after equipment checks and that existing stock can cover demand for now.

"Without this drug, which is essential for the smallest premature infants, the result can be death," said Kim Han-suk, chairman of the Korean Pediatric Society.

Jang Yun-sil, president of the Korean Society of Neonatology, said the danger is particular to the very young.

"Newborns, by their nature, can't simply be switched to adult drugs," Jang said. "With the threat of production and import halts recurring and anxiety on the ground mounting, a government response is urgent."

Pediatric clinics also face persistent shortages of fever reducers, antibiotics, bronchodilators and treatments for intestinal infection.

"Does it make sense that we can't reliably supply children with a single essential drug that costs 400 or 700 won?" said Lee Hong-jun, vice president of the Korean Association of Children's Hospitals. "It's time to find a solution at the level of the national system."

Government steps in

The government has begun to respond. The Ministry of Health and Welfare said it would raise the price ceilings on these drugs by up to 10 percent and tighten oversight of at-risk products through new powers to designate them and a system of policy premiums. It also set aside 3.6 billion won to help companies build production facilities, four times last year's budget.

Still, doctors and drugmakers say short-term price increases and one-off support cannot undo problems that have built up for years. The increases remain small relative to prices set far too low, and the supply chain remains exposed because much of the raw pharmaceutical material comes from China and India.

"The criteria for being named a supply-stabilization leading company are set too high to match reality, so most companies see little real benefit," an executive at one drugmaker said.

"The essential-drug supply problem is a crisis that was foreseen long ago," Prof. Hong said. "Even drugs written into the textbooks take a long time to reach the field. Administration cannot keep pace with the front line, and the focus on the health insurance deficit drowns out voices on the ground."

Ministry of Health and Welfare [YONHAP]

The government is in a bind. Raising prices risks adding to health insurance costs and to what patients pay, while keeping prices low perpetuates the halts and shortages. The medical community, on the other hand, argues that the supply of essential medicines should not be left to individual companies' business decisions but managed as a national supply chain.

"Keeping medical fees and drug prices low is necessary, but it's time to ask seriously whether that is a goal worth meeting regardless of the crisis on the ground," Lee Hyung-min said. "We must not forget that essential medicines should be seen through the matter of life, not economics."

A source at the Korean Society of Health-System Pharmacists called for a permanent system.

"When instability is expected, it's urgent to build a standing framework in which the government, manufacturers and medical institutions respond together," the source said. "The European Union's recent decision to address essential-drug supply problems jointly at the member-state level is worth looking to."

This article was originally written in Korean and translated by a bilingual reporter with the help of generative AI tools. It was then edited by a native English-speaking editor. All AI-assisted translations are reviewed and refined by our newsroom.
BY HUR JUNG-YEON [[email protected]]