The Canadian prescription drug lifeline for thousands of Americans may be in jeopardy.
New US Customs and Border Protection regulations starting October 22 will disrupt or even halt mail-order prescription deliveries from Canada and elsewhere to US patients, patient advocates say.
“This is an emergency,” warned Lucia Mueller, president of PharmacyChecker.com, which verifies international pharmacies and compares drug prices, in an interview.
If Customs doesn’t work with the FDA to find a way to allow the drugs across the US border, she said, “People will ration or skip their meds.”
Here are six things to know:
Feds Are Changing the Rules
The Wall Street Journal reported that as of October 22, medications mailed from other nations will need to “go through a customs process requiring a licensed customs broker and a financial guarantee — a bar few individual mail-order prescriptions have ever had to clear.”
Advocates are most concerned about Canada, home to many online mail-order pharmacies that serve US customers.
The potential elimination of access to Canadian drugs appears to be an “unintended consequence” of a Trump administration move to crack down on imports, said Mariana Socal, MD, PhD, associate professor of health policy and management at Johns Hopkins Bloomberg School of Public Health in Baltimore.
The White House claimed it targeted international mail to prevent illegal drugs from coming into the country.
Currently, the federal government allows exceptions for individual patients to import specific drugs from Canada to manage chronic conditions, Socal said.
Mueller said she’s concerned that the new international mail procedures could undermine a channel through which Americans have for decades obtained lower-cost prescription medicines from licensed pharmacies abroad. American medications on average cost more than twice their Canadian equivalents.
People in the US often turn to prescription drugs from Canada because they’re uninsured or underinsured, Socal said.
“It’s not patients with the most resources who are doing this,” she said. “It’s the individuals with the least ability to pay.”
Tim Smith, general manager of the Canadian International Pharmacy Association in Winnipeg, Manitoba, Canada, which certifies 51 online pharmacies, said his understanding is that customs will eliminate the existing flexibility.
“We have been given no indication that there is going to be anything but enforcement,” Smith said.
There’s also worry that the new requirements imposed on Canadian pharmacies will cause prices to go up even if their shipments are allowed to enter the US.
Little Communication, Actual Impact Unclear
Federal officials don’t appear to have sent out any statements explaining whether mail-order prescription deliveries from Canada will be stopped or limited.
The FDA, US Customs and Border Protection, the Department of Health and Human Services, and the Department of Homeland Security didn’t reply to Medscape Medical News requests for comment.
Patients Fear What Comes Next
In the worst-case scenario feared by patients and patient advocates, the importation of prescription drugs will be cut off completely, leaving US customers in the lurch.
Mueller said she is “overwhelmed and profoundly shaken” by messages from worried patients.
She said one wrote her: “I would have to choose food and live with uncontrolled diabetes and a chance of blood clots any time. Buying my two main medications from foreign pharmacies has probably saved my life.”
As Smith explained, US clinicians write prescriptions for drugs that are sent to online Canadian pharmacies. The pharmacies work with Canadian physicians who conduct assessments and then write prescriptions themselves if appropriate. The drugs are then dispensed and sent to patients in the US.
The US Market for Foreign Drugs Is Big
Current data about the number of US customers who get drugs from Canada or other countries is scarce. However, a 2020 JAMA Network Open study estimated that 2.3 million people in the US bought prescription medicine from abroad. The groups most likely to buy their drugs abroad were aged 65 years or older, uninsured, Hispanic, lower income, and in poor health.
Canadian pharmacies sell maintenance medications, such as those that prevent blood clots and treat high cholesterol and diabetes, said Smith, the Canadian online pharmacy representative. Members of his organization don’t sell controlled substances, and the average delivery is worth less than $200, he said.
What about medications like cancer drugs that can cost hundreds of thousands of dollars in the US?
“That’s not a part of the world that [our] members live in at all,” Smith said.
Foreign Drugs Can Be Much Cheaper
US customers who are underinsured or uninsured — or who can’t afford their copays — can save big money by using online Canadian pharmacies or international pharmacies with a Canadian storefront.
Many “Canadian” online pharmacies are actually prescription referral websites that have dispensing pharmacies located not only in Canada but across the world, Mueller said.
Drug prices can vary widely between US and international pharmacies. Mueller noted that the lowest US pharmacy price for the anticoagulant apixaban (Eliquis) is $5.53 per tablet vs the lowest online international pharmacy price of 70 cents.
Price gaps are even larger for the type 2 diabetes drug empagliflozin (Jardiance, $11.21 vs $1.08 per tablet, respectively) and the anticoagulant rivaroxaban (Xarelto, $19.56 vs 81 cents per tablet, respectively), she said.
Lawmakers Are Speaking Up
About 71 members of the US House, all Democrats, signed an October 1 letter calling on the federal government to “delay any implementation of new procedures with respect to prescription medicines unless you can provide clear assurances that your agencies will not prevent genuine prescription medicines clearly intended for personal use and not appearing to present an unreasonable risk from entering the United States.”
They add that they support the Customs “goal of using better data to identify and intercept high-risk shipments.”
For now, Mueller said, “This is a life-and-death situation. We are advising patients that if they’re having trouble filling prescriptions due to cost, they speak to their prescribing clinician about therapeutic equivalents and investigate coupons and patient assistance programs.”
The sources cited in this article had no relevant disclosures.
https://www.medscape.com/viewarticle/us-crack-down-mail-order-canadian-drug-imports-what-you-need-2026a10011qs
