The stability of generic drug supplies for American prescriptions is under threat due to geopolitical tensions in the Strait of Hormuz. Nearly half of all generic prescriptions in the U.S. are sourced from India, which relies heavily on the strait for importing crude oil—a key raw material for drug production—and for shipping finished medicines to the United States. However, current supplies of common medications, including those for diabetes, high blood pressure, statins, and antibiotics, remain secure for the time being, as most pharmaceutical distributors maintain 30 to 60 days of inventory as a buffer against supply disruptions.
President Donald Trump is pressuring allies, including NATO partners and China, to help safeguard vessels transiting this globally vital shipping route. The risk of rising oil prices, drug shortages, and shipment delays is increasing.
Iran’s potential blockade of the Strait of Hormuz represents a military strategy with far-reaching consequences for the global economy. Such a move would not only drive up oil prices but also disrupt supply chains for metals, manufacturing, agriculture, and food pricing. According to supply chain experts, at some point, Iran’s attempts to control the strait could also impact the medicine cabinets of American households. The critical question is how long existing generic drug inventories can last before U.S.–Iran tensions escalate into a major public health issue for America.
The connection between this Middle Eastern maritime choke point and the American pharmacy counter may seem indirect, but it is more immediate than most consumers realize. Roughly 47% of generic prescriptions in the U.S. come from India, which depends on the Strait of Hormuz for about 40% of its crude oil imports, according to Rohit Tripathi, Vice President of Manufacturing Strategy at RELEX Solutions, a Finnish supply chain planning software firm.
“That oil eventually translates into petrochemicals used throughout the pharmaceutical manufacturing process. So even if American consumers don’t buy medicines directly from the Gulf region, they are at the end of a supply chain that passes through the strait,” Tripathi explained.
Many raw materials needed for drug production in India first pass through logistics hubs in the Gulf region. Chemical ingredients produced in China are often consolidated by distributors in Dubai and other parts of the UAE before being shipped to Indian pharmaceutical companies.
“Even when ingredients are shipped directly from China to India, production remains heavily dependent on petrochemical supplies from the Gulf,” said Steve Buro, Chief Supply Chain Strategist at supply chain analytics firm Infios. “A disruption in the Strait of Hormuz could quickly ripple through the global pharmaceutical supply chain and ultimately affect U.S. consumers.” He added that the situation could soon manifest as shortages and higher costs for critical medications in the U.S.
“Fuel costs affect the price of all goods, but generics will be hit hardest because they operate on the thinnest margins,” said Dr. Mark Hahn, former dean of the University of Nevada, Las Vegas School of Medicine and current hematology division chief. He noted that glycerin, a common pharmaceutical excipient, is a petroleum derivative that would be affected if oil supplies remain constrained. Similarly, acetaminophen has traditionally been produced from phenol derived from petroleum.
“I’m particularly concerned about generics, which make up 90% of U.S. prescriptions but yield very low profits for manufacturers,” said Dr. William Feldman, associate professor of medicine at UCLA’s David Geffen School of Medicine. “India and China are the largest suppliers of generics to the U.S. A prolonged or expanded conflict could raise costs for generic drugmakers, leading to higher prices and/or shortages for patients.”
U.S. Treasury Secretary Scott Bessent stated in a Monday morning CNBC interview that the United States is permitting Iranian oil tankers to pass through the Strait of Hormuz to maintain supplies for countries like India.
Tripathi noted that recent supply chain disruptions and rising freight costs serve as early warning signals, though the situation is not yet at a critical stage. “There are early signs in the freight markets, with reports of rising air cargo costs on some routes from India and increased concern among manufacturers about potential stock pressures,” he said. Should the strait remain closed for an extended period, shortages would begin to emerge.
According to Buro, air freight costs on certain routes from India have surged by 200% to 350%. Because most pharmacies and wholesalers operate with minimal inventories for generics, he warned that prolonged disruptions could affect consumers within four to six weeks. Commonly used medications for diabetes, hypertension, statins, and antibiotics would be among the first to experience shortages or delays, potentially followed by temperature-sensitive therapies, including some cancer treatments.
The longer the conflict continues, the more likely it is that consumers and healthcare systems will face price increases and supply interruptions, said Amanda Chora, Senior Vice President and Chief Supply Chain Officer at Stanford Health Care. Her concerns extend beyond medications: in addition to acetaminophen and antibiotics, supplies such as insulin syringes, hand sanitizer, nitrile exam gloves, and ointments—all reliant on petroleum or its by-products—are at risk. Rising oil prices would directly increase production costs for these items.
Maritime shipping also presents challenges: delays not only raise the cost and time of transporting finished drugs, but also complicate the shipment of temperature-sensitive products. While some require specialized refrigerated containers, many still rely on simple cooling packs that need ice replenishment or battery replacement every few hours to prevent spoilage. Refrigerated ships operate under strict time limits, and cancellations or route changes have left some containers stranded at ports of origin or transit hubs, where there may be insufficient power to maintain large volumes of chilled goods. Empty containers are also stuck in the Middle East, unable to return to Asia for reloading. A shortage of containers means Indian exporters may have to compete for limited shipping space.
“This creates a domino effect: full containers can’t move, goods in transit need continuous refrigeration, and manufacturers may struggle to secure the specialized equipment needed for their next shipments,” Buro explained. Some shipping companies could even declare force majeure, absolving them of liability for delays or damage caused by the disruption.
From India to Ohio: No Cause for Panic Yet
Time is the critical factor in the medical supply chain. Tripathi noted that most manufacturers and distributors currently hold 30 to 60 days of buffer stock, so the initial two to four weeks should be manageable. Once buffer supplies are depleted, the most vulnerable drugs will be high-volume, low-margin generics with already tight supply chains: common antibiotics like amoxicillin, blood pressure medications such as metoprolol, diabetes drugs like metformin, statins, and ordinary pain relievers.
Yet in Germantown, Ohio—a town of about 5,000 people located thousands of miles from the Strait of Hormuz—the mood remains calm. Katie Perry, an independent pharmacy owner and pharmacist, reports that operations are normal. She cited the U.S. Strategic National Stockpile as a backstop and noted that the COVID-19 pandemic prompted many pharmacies to build more resilient supply chains. If one supplier runs short, alternatives are usually available.
Catherine Jaeger, U.S. spokesperson for the Indian Pharmaceutical Alliance, a trade group for the Indian generic drug industry, said consumers are not likely to face empty medicine shelves in the short term. “There is no risk at present. The industry has navigated COVID-19, the Red Sea crisis, and the conflict in Ukraine. Everyone is doing their utmost to manage disruptions,” she stated, adding that most companies stockpile three to six months of medicines and have robust contingency plans.
Major Indian generic drugmakers—including Sun Pharma, Dr. Reddy’s Laboratories, and Lupin Pharmaceuticals—have not issued individual statements on the conflict, instead allowing industry associations to offer reassurance. Lupin did announce plans to invest $250 million in a new manufacturing facility in Cole Springs, Florida, focused on respiratory medications.
Perry said her customers have not expressed concern about war-related drug shortages. “They’re more worried about conflicts between pharmacy benefit managers, pharmacies, and consumers,” she noted. She has experienced supply shocks before, such as when a wholesaler’s warehouse caught fire last year, forcing her to source from other suppliers. “Unexpected events happen every day.”
For now, pills remain on the shelves. The question experts are watching is: How long will that last?
“The region is a critical transit point for pharmaceutical goods,” Buro said.
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