Millions of Americans who purchase lower-cost medicines from Canada could face new difficulties as U.S. customs procedures become more demanding. The changes could increase the cost of medicines received by mail from abroad and make it harder for some patients to maintain their supplies.

Under rules introduced by U.S. Customs and Border Protection, certain additional customs requirements must be met from October 22, 2026.

The prospect has raised particular concern among older people, patients with chronic conditions and those whose health insurance does not provide enough help with medicines that cost substantially more in the United States.

More than 2.3 million Americans have purchased medicines abroad

A study published in JAMA Network Open in 2020 estimated that approximately 2.3 million Americans purchased medicines outside the United States to save money.

The study used data from 2015 to 2017, so the estimate is not a current count. Nor does it mean that all those people bought their medicines in Canada: it includes purchases in other countries.

Nevertheless, the high U.S. prices of some medicines have encouraged patients to purchase them in Canada and elsewhere for many years.

What is the new U.S. customs rule?

The de minimis exemption provided duty relief for certain imported goods valued at US$800 or less.

This exemption made customs procedures relatively straightforward for low-value shipments sent to the United States from abroad.

The U.S. administration has suspended the exemption, citing objectives that include preventing illegal imports and collecting applicable customs duties.

Most provisions of the official rule published on June 24, 2026 took effect on July 24. October 22 is the compliance deadline for specified additional customs entry and documentation requirements.

Under the changes, some medicine packages sent to the United States from abroad may require further documentation, customs entries and financial bond guarantees.

These requirements could raise administrative costs. Some packages may be delayed or encounter difficulties obtaining customs clearance.

The rules do not target medicines sent from Canada alone. They are broader customs changes applying to a range of goods arriving through international mail.

US$565 from Canada — more than US$1,000 in the United States

The difference between Canadian and U.S. medicine prices is central to the issue.

Ken Hunter, executive director of the Campaign for Personal Prescription Importation, which advocates for Americans who obtain lower-cost medicines from Canada, said his organization compared the prices of ten commonly imported medicines.

He cited Eliquis, a prescription medicine used to prevent and treat dangerous blood clots.

According to Hunter, a three-month supply comprising 180 tablets of 5 mg each was available from a Canadian mail-order pharmacy for approximately US$565.

He said the same quantity cost approximately US$1,017 through Amazon's pharmacy in the United States and US$1,029 through GoodRx.

That comparison indicates a price difference of more than US$450 between the Canadian supply and the U.S. alternatives.

These are prices reported in a particular comparison. Actual patient costs may vary with insurance coverage, pharmacy and available discounts.

The organization's concern is that difficulties obtaining foreign medicines could force some patients to pay higher U.S. prices.

A 75-year-old patient has already seen her costs rise

Susan Hooper, a 75-year-old resident of Toledo, Ohio, illustrates the concerns facing patients who depend on imported medicines.

Associated Press reported that Hooper, who has used oxygen for 14 years, obtains two medicines through a Canadian pharmacy that are not available in the United States.

She said the cost of Theophylline, which relaxes the airways, had risen from US$85 including shipping to US$141.

She also reported that the cost of Foradil, used for asthma and other breathing problems, had increased from US$151 to US$273.

Hooper attributed those increases to U.S. tariffs on Canada.

Concerned that the new customs procedures could create further difficulties, she said she was trying to obtain medicines in advance.

Concern from both parties in Congress

Members of the U.S. Congress have also expressed concern about the possible consequences of the customs changes.

Florida Republican representatives Aaron Bean, Gus Bilirakis and C. Scott Franklin wrote to the administration about the issue.

They pointed out that residents of distant states such as Florida cannot easily travel to Canada to purchase medicines, unlike some Americans living near the border.

They urged officials to prevent unintended harm to patients seeking relief from high medicine prices.

More than 70 Democratic members of Congress also wrote to the U.S. administration.

They asked for the new procedures to be paused unless officials could assure them that prescription medicines sent from abroad for personal medical use would continue to enter the country.

Their position is that obtaining more information about incoming packages should not cost people access to affordable medicines.

White House says it is working to lower medicine prices

U.S. President Donald Trump has made lower medicine prices a major element of his administration's healthcare policy.

His administration has pursued pricing agreements with manufacturers, efforts to link U.S. prices to lower prices in other countries, and the TrumpRx prescription discount website.

Federal data showed prescription medicine prices in summer 2026 were 3.1 percent lower than a year earlier.

This was described as the largest year-over-year decline since 1963. However, experts said several factors could have contributed and that the decline could not be attributed entirely to the president's policies.

White House spokesperson Allison Schuster said the president was continuing efforts to ensure Americans could obtain lower-cost medicines.

Is buying medicines from Canada legal in the United States?

There is also an important legal dimension to this issue.

Under U.S. Food and Drug Administration rules, importing medicines from abroad for personal use is generally subject to restrictions.

Purchasing medicines from abroad that are not approved in the United States may be illegal in many circumstances.

However, limited exceptions and enforcement discretion exist in certain personal-importation circumstances.

A separate government framework also permits U.S. states and tribal authorities to seek authorization to import certain medicines from Canada.

It is therefore inaccurate to say that all medicines purchased from Canada are lawful, or that the new customs rule will impose a complete ban on every medicine.

What happens after October 22?

As the compliance deadline approaches, Americans obtaining medicines from abroad are concerned about possible interruptions to their supplies.

Even delays can pose serious problems for patients with chronic conditions who need medicines every month.

Reports indicate that the U.S. administration could change the rules or provide exceptions in their enforcement.

As of October 8, however, no official confirmation of a comprehensive exemption for Americans purchasing medicines from Canada for personal use had been reported.

While the government continues its efforts to reduce U.S. medicine prices, concerns remain that new customs procedures could disrupt foreign supply routes that have helped patients obtain more affordable treatment.

The administration's next decisions will be important for medicine costs and continued access to treatment among patients who depend on Canadian pharmacies.