A Synthesis of Recommendations to Strengthen the Department of Defense Pharmaceutical Supply Chain

Background: A secure pharmaceutical supply chain is essential for the U.S. Department of Defense (DoD). An inability to obtain high-quality essential medicines for our nation’s warfighters constitutes a significant national security concern. Access to safe, high-quality essential medicines is vital for both military operational readiness and ensuring that the Military Health System (MHS) is able to support its 9.5 million beneficiaries. This study aims to identify recommendations regarding the DoD pharmaceutical supply chain and categorize them according to the Doctrine, Organization, Training, Materiel, Leadership, Personnel, Facilities, and Policy (DOTMLPF-P) framework to identify potential areas within the framework that are critical to the success of the supply chain to facilitate actionable discussion to address pharmaceutical supply chain concerns that impact national security. Materials and Methods: We performed a narrative literature review of all recently published government publications relating to the DoD pharmaceutical supply chain. Selected publications identified challenges with the potential to impact or currently impacting the DoD pharmaceutical supply chain and documented recommendations for improvement. To categorize recommendations, we used the DOTMLPF-P framework developed by the DoD as part of the Joint Capabilities Integration Development System to identify and address capability shortfalls or gaps. Results: We identified 11 publications and reports and 36 recommendations, for inclusion in this assessment that were published between 2021 and 2024. Twenty-three recommendations were categorized into 2 or more categories. Key recommendations included increased transparency, specifically sourced manufacturers and suppliers, avoidance of suppliers and manufacturers from adversarial nations, increased domestic supply capacity, and interagency collaboration. Conclusions: Challenges identified by this study are highly complex and require interagency collaboration, thus a whole-of-government approach is needed to strengthen the DoD pharmaceutical supply chain.