How could the customs changes affect people ordering medicines from overseas?

Patients ordering prescriptions from Canada or other countries could face delivery delays, rejected shipments or additional costs. The rule applies to international shipments generally and does not specifically target medicines from Canada.

Why do some Americans buy prescription medicines from overseas?

Some Americans use international pharmacies because their prices may be lower than those offered by domestic suppliers. A 2020 JAMA Network study estimated that approximately 2.3 million Americans bought medicines abroad.

What should patients do if they rely on medicine shipped from overseas?

They should contact their prescribing clinician and pharmacist before their current supply runs low. They can discuss suitable domestic alternatives, possible financial assistance and ways to avoid interruptions in treatment.

Should patients stop or change their medication because of potential delivery problems?

No. Patients should not stop taking prescribed medicines, change their doses or substitute treatments without professional advice. Anyone struggling to obtain an essential prescription should seek medical guidance promptly.

'A Matter of Life and Death': New Drug Import Rule Sparks Fears Among American Patients

Q: What is changing for low-value international shipments entering the US?

From 22 October 2026, the US is expected to suspend the de minimis exemption for qualifying international shipments valued below $800 (approx. £605). Affected shipments will face additional documentation requirements and a bond guarantee.

For Susan Hooper, a 75-year-old woman from Toledo, Ohio, access to affordable medication is more than a financial concern. After living on oxygen for 14 years, she relies on two daily medicines purchased through a Canadian pharmacy because they are unavailable in the United States.

Now, a change to US customs rules has left her worried about how she will obtain the treatments she needs.

'The issue is a matter of life and death for me,' Hooper told The Associated Press (AP).

From 22 October 2026, new customs requirements are expected to affect certain low-value international shipments entering the US. The new requirements could make it harder for some Americans to receive prescription medicines by post from Canada and other countries, potentially causing delivery delays or refusals.

Some patients have already reported higher prices following earlier tariff changes.

For patients who depend on regular medication to manage chronic conditions, the uncertainty raises an important question: what happens when essential treatment becomes harder to obtain?

Why Are Patients Worried About the New Rule?

The change involves the suspension of the de minimis exemption, which previously allowed qualifying international shipments valued below $800 (approx. £605) to enter the US with fewer customs requirements.

Under the new arrangements, affected shipments will face additional documentation requirements and a bond guarantee. Although the change applies to international shipments generally rather than specifically targeting medicines from Canada, patients who order prescriptions from overseas could encounter delays, rejected deliveries, or additional costs.

The potential impact extends beyond individual households. Approximately 2.3 million Americans bought medicines abroad, according to a 2020 study by JAMA Network. Some turn to international pharmacies because their prices are lower than those available through domestic suppliers.

For people who need medication every day, even modest price differences can accumulate over time.

How Much Could Prescription Medicines Cost?

Ken Hunter, executive director of the Campaign for Personal Prescription Importation, highlighted the price difference for Eliquis, a blood thinner used to prevent and treat dangerous blood clots.

According to figures he shared with the AP, a three-month supply of 180 tablets containing 5 milligrams each costs approximately $565 (approx. £427) through a Canadian mail-order pharmacy. The same supply was priced at about $1,017 (approximately £769) through Amazon Pharmacy, compared with $1,029 (approximately £778) using GoodRx pricing.

These figures illustrate the potential financial burden for some patients, although actual prices vary by pharmacy, insurance coverage, and individual circumstances.

Higher medication costs can be particularly difficult for people managing chronic illnesses, who may need prescriptions for years or throughout their lives. When treatment becomes unaffordable, some patients may struggle to maintain their usual medication routines.

However, patients should not assume that importing a medicine is automatically lawful or that a shipment will be permitted through customs. Importation rules can be complex, and medicines obtained from overseas may not have undergone the same regulatory checks as products approved for sale in the US.

What Should Patients Do Next?

Patients who rely on medicines from overseas should contact their prescribing clinician and pharmacist before their current supply runs low. They can discuss whether an alternative available through a domestic pharmacy is suitable, whether financial assistance is available, and how to avoid interruptions in treatment.

Anyone experiencing difficulties obtaining an essential prescription should seek medical guidance promptly rather than waiting until their supply runs out.

Patients should not stop taking prescribed medicines, change their doses, or substitute treatments without professional advice. This is particularly important for people managing respiratory conditions, cardiovascular disease and other illnesses that require consistent treatment.

For Hooper and others in similar circumstances, the concern goes beyond customs paperwork. It is about whether they can continue obtaining the medicines they depend on without facing costs they may struggle to afford.