Starting Oct. 22, U.S. Customs and Border Protection is indefinitely suspending the de minimis exemption that let low-value shipments under $800 pass through customs more easily. The change applies to all international mail, but it is especially concerning for American patients who order prescription drugs from Canadian pharmacies: those packages will now require additional data and a bond guarantee, making delays, refusals, or higher costs more likely.
The impact could be substantial. A 2020 study in JAMA Network Open estimated that roughly 2.3 million Americans buy prescription drugs abroad. The advocacy group Campaign for Personal Prescription Importation said a three-month supply of the blood thinner Eliquis costs $565 from a Canadian mail-order pharmacy, compared with about $1,017 from Amazon Pharmacy or $1,029 from GoodRx. Patients already report stress: Susan Hooper of Toledo, Ohio, who has been on oxygen for 14 years and takes two medications not available in the U.S., said the issue is 'a matter of life and death for me.'
The rule has drawn bipartisan pushback. Three Republican members of Congress from Florida wrote to the administration expressing concern, and more than 70 Democrats asked officials to pause the rule unless they can guarantee personal-use medicines will still enter the U.S. The White House says the administration remains dedicated to lowering prescription drug costs, but the controversy comes as federal data show U.S. drug prices fell 3.1% year over year this summer—a drop experts attribute largely to factors beyond the president's policies.