Advocacy in Action: March 2026
April 7, 2026
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CSHP is pleased to share an update on the key advocacy and pharmacy practice initiatives that the Professional Practice team has been focused on over the past month.
Drug Shortages Case Management
Drug Discontinuations and Potential Shortages
Insulin Regular Vials
No changes. Update (Feb. 18): Supply gap in March / April will be avoided.
Eli Lilly will discontinue Humulin R® 100 units/mL (3 mL and 10 mL vials) by April 30, but a February resupply is secured. Novo Nordisk will continue producing Novolin GE Toronto® vials, with additional supply expected in April. With the Mxyredlin® IV insulin shortage resolved and increased Novo Nordisk production, a March/April supply gap is not expected.
Regular insulin vials are essential for IV hospital use (e.g., hyperkalemia, beta‑blocker or calcium channel blocker overdose, DKA). Pens and cartridges are unsuitable, and ISMP advises against withdrawing insulin from cartridges due to safety risks. CSHP and partners are preparing guidance for managing potential future vial shortages. To support planning for these changes, please note the following upcoming discontinuations and alternatives:
- Eli Lilly will discontinue the following by April 30:
- Humulin® 30/70 (10 mL vial)
- Humulin® N (10 mL vial)
- Humulin® R (10 mL vial)
- Cartridge and KwikPen® formats will remain available.
- Vial alternatives include:
- Novolin® GE 30/70
- Novolin® GE NPH 100 units/mL
- Novolin® GE Toronto 100 units/m L
Supply Updates
Oseltamivir (Tamiflu®) powder for suspension
No changes. Update (Feb. 4): Supply constraints ongoing, importing foreign supply.
Oseltamivir suspension is expected to remain in very short supply for the rest of this flu season due to higher‑than‑anticipated demand. Capsule supply is still expected to meet overall needs, though available buffers have narrowed since late December and early January. Health Canada is working to import foreign supply of the oral suspension and will continue to closely monitor capsule availability. For mitigation strategies, refer CSHP and CPhA guidance on conserving oseltamivir capsules.
Tier 3 Shortages
Phenytoin 100 mg Capsule and 50 mg Tablet Shortage – NEW !
Phenytoin 100 mg capsules and Phenytoin 50 mg Chewable tablets are expected to remain shortage until early-to-late May.
The following products being affected:
Guidance to support management of this shortage has been published jointly by CSHP, CPhA, and medSask and is available here.
Benzathine Penicillin G (Bicillin L-A®) Injection
Update (March 16): Further resupply delayed until the end of May.
The Tier 3 shortage of Pfizer’s benzathine penicillin G (Bicillin L‑A® 1,200,000 IU / 2 mL), has been extended, with a new expected resupply date of May 29, 2026.
Health Canada has also extended the exceptional importation of Portuguese‑authorized Lentocilin S® 1200 (benzathine benzylpenicillin 1,200,000 IU / 4 mL) until May 15, 2026. While it contains the same active ingredient and is given intramuscularly, it differs from Bicillin L‑A® in formulation, reconstitution, and presentation.
For further guidance, please refer to this Health Product Risk Communication and PHAC’s guidelines for Interim Syphilis Treatment.
Cyclophosphamide Injection
Update (March 30, 2026): Intravenous cyclophosphamide is anticipated to remain in critical shortage until at least May/June.
All three manufacturers—Baxter, Sterimax and Andone—are reporting current or anticipated shortages affecting all vial sizes, with available supply expected to last until the end of April.
In response to this extended shortage, the following supply updates are available:
- Baxter: (CIVA) can reconstitute premade bags if individual institutions can secure their own supply.
- Marcan: Canadian product launch of both 1- and 2-gram vials expected by the end of May.
- Andone: UK-authorized vials have arrived and have been distributed to most hospitals.
- Sterimax: US-authorized 1-gram vials expected in May.
- Sandoz: US-authorized 1- and 2-gram vials of supply proposals are pending.
Health Canada is also investigating importation of Septa’s Mexican supply.
CSHP, CPhA, and CAPhO, have developed a clinical resource to help pharmacists and other healthcare professionals manage this shortage. The resource is available here.
Ropivacaine Hydrochloride Injection
No changes. Update (Feb. 11): Extended shortage dates.
Both Ropivacaine® (Fresenius Kabi) and Naropin® (Aspen Pharmacare) have reported shortages of ropivacaine hydrochloride bags and ampoules. Fresenius Kabi’s supply issue has been resolved, but Naropin® 10 mg/mL (10 mL ampoules) remains delayed until the end of May. To mitigate the shortage, South African‑authorized Aspen 10 mg/mL ropivacaine 10 mL ampoules have been imported, and Health Canada is exploring options for additional foreign‑authorized supply as needed.
Vasopressin (Vasopressin®) Injection
No changes.
Vasopressin® (Fresenius Kabi) Injection 20 units/mL (1 mL vial) is expected to enter a shortage starting in March. While Sandoz markets a 20 units/mL, 5 mL vial (Sandoz Vasopressin) and can meet some demand on a mL basis, its larger vial size may lead to product wastage. Heath Canada has added Vasopressin® to the Tier 3 shortage list and is exploring foreign‑authorized supply options.
Pegaspargase (Oncaspar®) – RESOLVED
Update (March 2026): removed from Tier 3 status
Although initially classified as a Tier 3 shortage in November 2024, the supply issue has since been resolved.
Strategic Collaborations
Letter to NAPRA regarding sterile compounding as an entry-to-practice competency standard
CSHP co‑signed a campaign letter to the National Association of Pharmacy Regulatory Authorities (NAPRA) and provincial/territorial regulators, alongside numerous pharmacy, health system, education, and industry partners with the following organizations:
- Association des pharmaciens des établissements de santé du Québec
- Alberta Health Services
- Black Pharmacy Professionals of Canada
- Canadian Association of Pharmacy in Oncology
- Canadian Association of Pharmacy Students and Interns
- Canadian Association of Pharmacy Technicians
- Canadian Council for Accreditation of Pharmacy Programs
- Canadian Pharmacists Association
- Canadian Pharmacy Technician Educators Association
- Covenant Health Canada
- Critical Compounding Resources
- Galenova Inc.
- Mohawk Medbuy Corporation
- Northwest Telepharmacy Solutions
- Neighbourhood Pharmacy Association of Canada
- Professional Compounding Centers of America
- Pharmacy Technician Society of Alberta
- Pharmacy Technicians of British Columbia
- Quess 360
The letter requested the reconsideration of regulators regarding the the proposed removal of sterile compounding as an entry-to-practice competency for pharmacy technicians. It emphasized how essential hands-on sterile compounding skills are for patient safety in high-risk medication preparation.
Signatories highlighted that the elimination this requirement would create misalignment with existing accreditation standards (such as those set by Canadian Council for Accreditation of Pharmacy Programs), increase variability in graduate preparedness, shift training burdens to healthcare organizations, and potentially worsen workforce shortages and access to care.
Overall, the letter suggests regulators consider maintaining sterile compounding as a foundational competency for pharmacy technicians, re-engage stakeholders, and ensure changes do not compromise patient safety, workforce sustainability, or equitable healthcare access.
ISMP Canada Medication Safety Self-Assessment (MSSA) – Hospital Advisory Panel
CSHP has joined an advisory panel with the Institute for Safe Medication Practices Canada (ISMP Canada) to support the revision of the Medication Safety Self‑Assessment for Hospitals (MSSA‑Hospital). The primary goals are to develop, validate, and implement an updated, evidence‑informed assessment by the spring.
The revised MSSA‑Hospital will incorporate comprehensive medication safety strategies and highlight key areas of vulnerability linked to harmful medication incidents. The updated assessment is expected to be available this May.
Consultations
CSHP has participated in the following consultations:
- NAPRA Model Documents for PRA Use – Non-Sterile & Sterile Compounding Model Standards & Approach to Competence Consultations | Submitted: March 15, 2026.
We are continuing to work on our response for the following consultations. Members are invited share their feedback to inform CSHP’s national response by sending feedback to [email protected].
To catch up on CSHP advocacy news, click here.
Have a question about Advocacy in Action or CSHP's advocacy and consultation work?
Reach out to our professional practice team!