Starting Oct. 22, prescription drugs mailed to Americans from Canadian pharmacies will no longer slip through customs with little paperwork, and that change could cut off one of the cheapest ways millions of people buy their medicine.

The change comes from U.S. Customs and Border Protection. For years, packages worth under $800 could pass through customs more easily under what is known as the de minimis exemption. As of Oct. 22, that exemption will be indefinitely suspended, and medications mailed from outside the U.S. will require additional data and a bond guarantee.

In plain terms, a 90-day supply of pills mailed to someone’s home will now be treated like a commercial import. The paperwork calls for detailed information ordinarily handled by commercial importers and customs brokers, not a pharmacy mailing a prescription to a patient. Companies that move these packages through the mail are concluding they cannot meet the new requirements for ordinary personal orders.

The rule was not written with Canadian drugs in mind. It covers international mail of all kinds, from textiles to toys, and is meant to collect tariffs and keep illegal drugs out of the country. But the people likely to feel it most are those buying cheaper medicine across the border, who could face delays, refused packages or far more trouble getting their medications delivered.

The numbers are large. Roughly 2.3 million Americans buy their drugs abroad, according to a 2020 JAMA Network study, or about 1 in every 150 Americans. Ken Hunter, executive director of the Campaign for Personal Prescription Importation, puts the number of people affected closer to 4 million. Most are older: nearly 9 in 10 people who buy from Canadian pharmacies are 65 or older, according to his group.

The price gap is why they buy there. Hunter’s group studied 10 of the most commonly imported medications in August. One example is Eliquis, a blood thinner. A three-month supply of 180 5-mg pills costs $565 from a mail-order Canadian pharmacy, compared with roughly $1,017 from Amazon’s pharmacy arm or $1,029 through GoodRx. That means a patient switching to a U.S. source would pay nearly double, about $450 more every three months, or roughly $1,800 more a year for one drug.

For some patients the jump is even steeper. Herb Kolodny, a 79-year-old Connecticut resident who orders four heart and lung medications from Canada, said one drug that costs him about $17 a month would run about $500 to $600 in the U.S. That’s roughly 30 times the price.

Costs were already climbing before the rule. Susan Hooper, 75, of Toledo, Ohio, has been on oxygen for 14 years and buys two daily medications through a Canadian pharmacy that she says are not available in the U.S. After new tariffs on Canada in August, her airway medication theophylline went from $85 with shipping to $141, about two-thirds more. Her Foradil asthma inhaler went from $151 to $273, close to double. She said she has been rushing to stockpile before the deadline.

Pushback is coming from both parties. More than 70 Democrats, led by Reps. Mark Pocan and Jan Schakowsky, wrote to Health and Human Services Secretary Robert F. Kennedy Jr., Homeland Security Secretary Markwayne Mullin and the heads of the FDA and CBP, urging them to delay the new procedures for prescription medicines unless they can guarantee that genuine personal-use drugs will still get in.

Three Florida Republicans, Reps. Aaron Bean, Gus Bilirakis and Scott Franklin, also wrote to the administration. They noted that Floridians, unlike people in border states, cannot simply drive to Canada to buy their drugs. Florida built its own federally approved program to import Canadian drugs, but that effort has stalled.

The administration says it is working on prices from another direction. White House spokesperson Allison Schuster said President Donald Trump remains committed to lowering prescription drug costs, pointing to his most-favored-nation pricing deals with drug companies. The administration has also launched TrumpRx, a discounted-drug website. Federal data from this summer showed U.S. prescription drug prices down 3.1% from a year earlier, the steepest yearly drop since 1963. Hunter said those programs do not cover every drug for every patient, which is why many still rely on Canada.

The rule is not locked in. The administration could drop it, change it or choose not to enforce it before Oct. 22. CBP did not respond to requests for comment.

For now, patients who import their medicine have less than two weeks. Pharmacists are advising them to talk with their doctor or pharmacist before changing any medication, compare prices at U.S. discount programs, and contact their members of Congress if they want the rule paused.

JBizNews Desk | Washington, D.C.

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