Starting October 22, Americans will no longer be able to order many of their everyday medications from foreign pharmacies at a fraction of the U.S. price, under new federal enforcement tied to Customs and Border Protection and FDA import rules. The change threatens to upend a decades-old workaround that millions of patients, especially retirees on fixed incomes, have quietly relied on to keep prescription costs manageable.
Tim and Jan Brooks of the Kansas City area recently received notice from their Canadian pharmacy that the new rules would end their ability to order medications from outside the United States, according to KSHB 41 Kansas City. Tim Brooks takes the blood thinner Eliquis, which he said costs more than $200 per month when purchased locally, but which he had been paying about $200 for a three-month supply through his Canadian pharmacy. “The new rules will eliminate pretty much all medications coming from outside the country,” Tim Brooks said, per the station's report.
The couple's experience reflects a much broader pricing gap. A 90-day supply of commonly prescribed blood thinners like Eliquis costs less than $600 through Canadian pharmacies, roughly half the retail price offered through domestic U.S. discount drug platforms, according to Newsmax. Jan Brooks said Canadian pharmacy orders have provided about three months of medication for approximately the cost of one month in the United States, and that the new rules will place a significant burden on people unable to adjust their budgets, the same report notes.
The Regulatory Mechanism Behind the Cutoff
The shift traces back to a U.S. Customs and Border Protection interim final rule published on June 24, 2026, which indefinitely suspended duty-free de minimis entry exemptions for international mail shipments and set October 22, 2026 as the compliance deadline for packages subject to other federal agency oversight, according to the Federal Register. CBP also launched a new electronic postal entry pathway called Entry Type 13 on September 22, requiring detailed electronic data, a licensed customs broker, and financial guarantees for international mail shipments valued at $2,500 or less, per U.S. Customs and Border Protection.
International postal systems have relied on clearance firm Zonos as their primary customs broker of record, but under FDA personal importation policy guidance, brokers will be barred after October 22 from acting as importers of record for medications already commercially sold in the U.S., according to the Canadian International Pharmacy Association. That restriction effectively closes the pipeline for individual prescription orders, even though federal regulators had for years allowed many small shipments from licensed Canadian pharmacies to pass through without enforcement, KSHB reports. The Canadian International Pharmacy Association represents licensed Canadian mail-order pharmacies that have supplied American consumers for over 25 years using individual doctor-reviewed prescriptions and postal delivery networks.
A Legal Gray Area Decades in the Making
Section 804(j)(1) of the Federal Food, Drug, and Cosmetic Act directs federal regulators to focus enforcement against personal drug importation on cases presenting a “significant threat to public health,” granting regulators discretion when imports are for individual use, according to PharmacyChecker. That statutory gray zone is what allowed the personal mail-order pipeline to operate for decades even though federal law technically prohibits personal drug importation.
State-level efforts have taken a different path. In January 2024, Florida became the first state authorized by the FDA under Section 804 to establish a bulk Canadian drug importation program for state health agencies, though operational implementation faced repeated delays and extensions through mid-2026, according to KFF. But while politicians and states have focused on those bulk wholesale imports, millions of individual senior citizens and underinsured patients have relied instead on foreign mail-order pharmacies to lower out-of-pocket costs on critical drugs such as blood thinners.
Who Gets Hit Hardest
The new restrictions could increase medication costs for an estimated two to four million Americans, KSHB reports. That figure sits alongside separate national data: approximately 2.3 million U.S. adults purchase prescription drugs from foreign mail-order pharmacies each year to save money on essential healthcare expenses, according to research published in JAMA Network Open and cited by Becker's Hospital Review.
The new rules are expected to affect older Americans the most, per the KSHB report. A survey conducted by the Campaign for Personal Prescription Importation found that 89% of surveyed people importing medications from foreign pharmacies were over age 65, according to the same report. That demographic skew tracks with broader affordability data: a March 2026 poll from KFF found that 59% of U.S. adults worry about affording prescription drug costs, and 43% reported taking cost-saving measures in the past year, such as skipping doses or leaving prescriptions unfilled, due to high prices.
Supporters and Critics Split on the Rule
Policy supporters said the policy protects American drug manufacturing and ensures tighter oversight of imported medications, according to KSHB's reporting. Policy critics countered that the policy highlights why many Americans seek affordable medicine outside the United States in the first place.
Tim Brooks put it more bluntly, saying pharmaceutical companies can charge as much as the market will bear and that this is ethically wrong, per the station's account. Several international mail-order pharmacies have already announced schedule cutoffs as early as October 2 to stop dispatching U.S.-bound prescription orders, aiming to prevent shipments from being impounded or destroyed at the border after October 22, according to CheapoMeds.
Whether Congress or federal agencies will grant emergency enforcement discretion for personal maintenance medications before the deadline remains an open question, one that PharmacyChecker notes advocates are actively pressing. For patients like the Brookses, the countdown to October 22 now means deciding how to absorb a major price jump or risk going without medication they depend on.
