Customs Rule Taking Effect Oct. 22 Threatens Mail-Order Drugs From Canada for Millions of Americans

A customs rule meant to collect tariffs and stop illegal drugs could end up blocking some Americans from buying their medicine in Canada. It takes effect Oct. 22.

The U.S. Customs and Border Protection rule suspends the de minimis exemption indefinitely. That exemption let shipments valued under $800 clear customs more easily. Medications mailed from outside the U.S. will now require additional data and a bond guarantee.

The rule is not written for prescriptions. It covers a swath of goods, from textiles to toys, that used to enter duty-free and will now face added fees and registration requirements. It does not specifically target Canadian drugs and applies to international mail generally.

But people who buy cheap medicine across the border stand to feel it most. The practical consequence could be delays, refusals or substantially more difficulty getting prescriptions delivered.

Who buys drugs abroad

A 2020 study by JAMA Network found roughly 2.3 million Americans buy their drugs abroad. Many medications have already increased in price since customs rules went into effect in August 2025. The Oct. 22 compliance date includes importation rules that could eliminate the ability to import personal prescriptions.

Susan Hooper, a 75-year-old from Toledo, Ohio, has been on oxygen for 14 years. She takes two daily medications bought through a Canadian pharmacy that are not available in the U.S.

"The issue is a matter of life and death for me," Hooper said.

The opposition

Democrats and some Republicans have objected to the rule, with the cost of living a top issue for voters ahead of the midterm elections. Critics argue it will hurt patients seeking affordable medicine.

Ken Hunter, executive director of the Campaign for Personal Prescription Importation, which advocates for Americans who access Canadian drugs, says these patients may not benefit from the administration's pricing moves.

"There has been a lot of talk of lowering drug prices, but in many cases it doesn't cover all drugs for all people for all conditions," Hunter said.

Hunter warned that costs will explode for some medications. His organization's August study of 10 of the most commonly prescribed medications imported from Canada found, for example, that a three-month supply of 180 5-mg Eliquis pills would cost $565 from a mail-order Canadian pharmacy, versus roughly $1,017 from Amazon's pharmacy arm or $1,029 from GoodRx.

The rule's stated purpose is to collect tariffs and keep illegal drugs out of the country. Both aims are legitimate functions of a border agency. The conflict is that a rule covering low-value shipments of everything from textiles to toys also sweeps in a 75-year-old's package from a Canadian pharmacy.

Three Florida Republican members of Congress, Reps. Aaron Bean, Gus M. Bilirakis and C. Scott Franklin, wrote to the administration last month expressing concern about how the rule would affect constituents who, unlike residents of border states, cannot easily travel to Canada to buy drugs. A group of more than 70 Democrats sent a letter asking health and immigration enforcement officials to pause the rule unless they could assure that prescription medicines for personal use would be able to enter the U.S.

CBP representatives did not respond to requests for comment.

The administration's drug-price record

President Donald Trump has made lowering drug prices a centerpiece of his healthcare agenda. He has struck multiple most-favored-nation deals with pharmaceutical companies and launched the discounted-drug website TrumpRx.

Federal data from this summer showed U.S. prescription drug prices down 3.1% from a year earlier. That is the steepest year-over-year drop since 1963. Trump has sought to take credit, though experts say factors beyond his policies likely contributed more.

White House spokesperson Allison Schuster said in a statement that Trump "remains dedicated to lowering the cost of prescription drugs," citing the most-favored-nation deals.

Neither TrumpRx nor the most-favored-nation deals are described as replacing what Canadian pharmacies supply to a patient like Hooper, whose two medications are not available in the U.S.

What comes next

The rule is on the calendar for Oct. 22, and the suspension has no end date. The Trump administration could drop the rule, alter it or decide not to enforce it.

Lawmakers on both sides of the aisle have demanded answers on how the administration will protect access to affordable care for people who get their drugs from across the border. Hooper said she will find a way to manage through the change, and that in the meantime she has been rushing to stockpile.