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A U.S. Customs and Border Protection rule is set to suspend the under-$800 de minimis exemption for international mail beginning Oct. 22, adding data and bond requirements to low-value shipments. It does not specifically target Canadian medicines, but patients and advocates warn that the changes could delay or obstruct access to lower-cost drugs ordered from abroad.
A U.S. Customs and Border Protection rule scheduled to take effect Oct. 22 will suspend a customs exemption for low-value international shipments, potentially making it harder for Americans to receive prescription drugs ordered from Canadian pharmacies. The rule applies broadly to international mail, not specifically to Canadian medicines, but patients and advocates say added data, bond and fee requirements could disrupt shipments and raise costs.
The rule ends the de minimis exemption, which previously allowed shipments valued below $800 to pass through customs with fewer requirements. Under the change, medications mailed from outside the United States will require additional shipment data and a bond guarantee. The measure applies to a range of goods, from textiles to toys, and is intended to collect tariffs and prevent illegal drugs from entering the country.
The practical effect on personal prescriptions is not yet established. The report says the requirements could mean delays, refusals or greater difficulty getting medicines delivered; it does not establish that all Canadian drug shipments will be blocked or that every patient will pay more. A 2020 study published in JAMA Network Open estimated that about 2.3 million Americans bought drugs abroad. That figure describes the study’s estimate, not a confirmed count of people who will be affected by the rule.
Ken Hunter, executive director of the Campaign for Personal Prescription Importation, cited his organization’s August comparison of 10 commonly prescribed imported medicines. He said a three-month supply of apixaban (Eliquis)—180 five-milligram pills—cost $565 from a Canadian mail-order pharmacy, compared with roughly $1,017 through Amazon’s pharmacy and $1,029 through GoodRx. These are the prices in the group’s comparison, not a guarantee of current prices for every patient or pharmacy.
Prescription Access and Out-of-Pocket Costs
For people who rely on medicines purchased abroad, the rule could affect both access and affordability. If a shipment is delayed or cannot clear customs under the new requirements, patients may need to seek another supply. Whether that is feasible depends on the specific medicine, its availability in the United States and the patient’s coverage and finances.
The issue also complicates the administration’s stated effort to lower prescription costs. White House spokesperson Allison Schuster said President Donald Trump remains committed to reducing drug prices and cited agreements with pharmaceutical companies. Advocates counter that such measures may not cover every medicine or every patient’s needs. The competing positions do not establish what will happen to individual patients once the rule takes effect.
The debate has drawn concern from lawmakers in both parties. Their requests reflect a practical question for constituents: whether personal-use medicines will be treated in a way that preserves access while customs officials apply the new shipment rules.
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The Exemption and Drug-Price Debate
The de minimis threshold had allowed qualifying shipments worth less than $800 to enter with fewer customs procedures. The scheduled suspension changes the requirements for low-value international mail generally; it is not a policy written specifically around Canadian pharmacies. The stated aims include collecting tariffs and preventing illegal drugs from entering the country.
The change comes as the administration has made drug prices a prominent part of its health-care agenda, including most-favored-nation agreements with drug companies and the TrumpRx discount-drug website. Federal data from this summer showed U.S. prescription drug prices were 3.1% lower than a year earlier, the steepest year-over-year decline since 1963, according to the report. The report also says experts caution that factors beyond the president’s policies may have contributed; the decline does not show that every medicine became cheaper or that imported-drug costs fell.
Patients interviewed by MedPage Today described relying on Canadian pharmacies for medicines they said were unavailable or less affordable in the United States. Susan Hooper, a 75-year-old Toledo resident who has used oxygen for 14 years, said she takes two daily medicines purchased from Canada. She also said the price of her Canadian-purchased theophylline rose after additional tariffs on Canada were imposed in August. The source material ends before providing her new price, so the amount of that reported increase cannot be stated.
““The Trump administration continues working to ensure Americans have access to low-cost pharmaceuticals across the board.””
— Allison Schuster, White House spokesperson
How Personal Prescriptions Will Clear
It remains unclear whether the administration will drop, revise or decline to enforce the rule, or how customs officials will apply its new requirements to medicines for personal use. CBP representatives did not respond to the report’s request for comment. The source material does not specify what bond costs or other fees patients might face, how much processing time could increase, or whether particular categories of prescription shipments will be exempt.
It is also not known how many of the estimated 2.3 million people who bought medicines abroad in 2020 still do so, how many depend on Canadian pharmacies, or how many would be affected by the October change. The cited price comparison covers 10 medicines and does not determine what any individual patient will pay. Hooper’s reported theophylline price increase is incomplete in the source material, which cuts off before giving the new price.
October Start and Agency Response
The rule is scheduled to take effect Oct. 22. Before then, the administration could change the policy or its enforcement, and lawmakers are seeking assurances about access to personal-use prescriptions. The Florida lawmakers’ letter and the request from more than 70 Democrats put pressure on federal health and customs officials to explain how those shipments will be handled.
Patients and pharmacies will need clearer information on required shipment data, bond arrangements, fees and how to address a package delayed or refused under the new process. Until agencies provide details or enforcement begins, the scale of any disruption—and whether patients will face higher costs, delivery delays or both—remains unsettled.
Key Questions
What changes on Oct. 22?
The scheduled rule suspends the under-$800 de minimis exemption for international shipments. Medications mailed from outside the United States will require additional data and a bond guarantee.
Does the rule ban drugs from Canada?
No specific ban on Canadian medicines is described in the report. The rule applies broadly to international mail, though patients and advocates warn the new requirements could make some Canadian prescription shipments harder to receive.
Will every patient who orders from Canada pay more?
That is not established. The report describes possible delays, refusals and added difficulty, but does not provide a confirmed fee schedule or show that all patients will see higher costs.
Could the rule still change?
Yes. The report says the administration could drop the rule, alter it or decide not to enforce it. The final handling of personal-use medicines remains unclear.
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