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Their anxiety is complicated by the tight secrecy surrounding where pharmaceuticals are made, so even experts aren’t certain where or how a supply problem has occurred.

“Sometimes, months or years later, we figure it out,” said Erin Fox, who directs the Drug Information Service at the University of Utah. “But it’s rare.”

The consolidation, driven by cost-cutting, drug company mergers and outsourcing of manufacturing, has prompted hospital pharmacists and health policy experts to fear that one misstep could spell disaster for patients.

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