Your cheap prescriptions from Canada may stop at the border next month — a customs rule, not a drug law, is closing the door

Diamantina Cavazos, a 38-year-old project manager in Dallas, pays about $10 a week for Xifaxan, an antibiotic her insurer will not cover, by ordering it from abroad. According to reporting published this week, she expects that to become about $1,100 a week once a new customs rule takes effect. Nothing about her illness or her drug is changing. The paperwork at the border is.

If you, a parent or a neighbor fill prescriptions through a Canadian mail-order pharmacy, you have less than a month to plan. The rule starts on October 22, and some pharmacies are already cutting back.

What is actually changing

For decades, small packages worth little money could enter the U.S. by mail without much paperwork. No licensed customs broker, no bond to cover unpaid duties, no formal entry filing. That is how a 90-day supply of pills from a pharmacy in Manitoba or British Columbia landed in an Ohio mailbox.

In June, CBP issued a rule ending that exemption for FDA-regulated drugs mailed from any country, including Canada, India, the UK, Australia and Turkey. From October 22, each shipment needs a licensed broker, a financial guarantee and extra electronic filings. CBP says the goal is to protect tariff revenue and to stop traffickers from hiding fentanyl and counterfeit goods in small parcels.

Nothing in the rule says "Americans may no longer buy drugs from Canada." It does not have to. A broker and a bond are routine for a truckload of auto parts. For a $60 bottle of pills sent to one retiree, they can cost more than the medicine. It is a ban with an invoice instead of a law.

Why pharmacies say it could be a full stop

"There will be just a full stop of anything coming into the States," Tim Smith, general manager of the Canadian International Pharmacy Association, told reporters. Most mail from Canada is handled by one Utah company, Zonos, which acts as the importer of record for major postal systems. The whole channel depends on a few links that were never built for this kind of paperwork.

Some pharmacies are already writing to customers. Northwest Pharmacy in British Columbia says that after October 9 it will accept orders "on a case-by-case basis for a short period." Ken Hunter, who directs the Campaign for Personal Prescription Importation, described a membership surge of 20,000 in two weeks as "an avalanche of fear and concern."

This is also the second hit in about a year. In August 2025, mail-order patients started paying customs fees for the first time on packages that used to cross duty-free.

Who gets hurt

The people who import drugs are not bargain hunters. Reporting on the rule describes them as mostly "cash-strapped, uninsured or underinsured people, many senior citizens on fixed incomes." They are people whose plan denied a drug, whose Medicare Part D deductible resets every January, or whose brand-name drug has no generic here.

The price gap is real. A 90-day supply of the blood thinner Eliquis costs less than $600 through a Canadian pharmacy, compared with about $1,200 through U.S. retail discount platforms. Nobody moved that gap. The rule only makes it harder to reach.

Not affected: medicine you buy in person while traveling and carry home yourself. The FDA also says it will keep reviewing personal imports case by case under its existing guidance. That guidance tolerates limited supplies of unapproved foreign drugs for serious conditions with no U.S. treatment. For most people buying a cheaper version of a drug that is sold here, it will not help.

What to do before your next refill

• Refill now if you can. If your pharmacy will ship a 90-day supply before October 22, that buys you time to find a U.S. option. Ask whether they are still taking orders.
• Price the drug in the U.S., three ways. Your plan's copay, a discount card price and the manufacturer's patient-assistance program. Our guide to discount cards shows how to compare them.
• Ask your doctor about a generic or a covered alternative. Sometimes a drug in the same class is on your plan's list at a fraction of the cost. See generic vs. brand.
• Appeal a denial. If you import because your plan refused the drug, file a formal exception request. Plans reverse more denials than people expect.
• Use U.S. mail order for maintenance drugs. Your plan's own mail-order pharmacy often costs less for 90-day supplies. Our mail-order pharmacy guide covers how it works.

Washington has spent years promising to bring the price of drugs closer to what Canadians pay. Next month, it will instead make it much harder to buy them at Canadian prices. For two million people, the drug stays the same, and the bill does not.