If you buy your prescriptions from a Canadian pharmacy, you’ve probably gotten the email by now. Maybe several. They all say roughly the same thing: The U.S. government is about to cut you off, so order now and stock up.
The deadline in those emails is real. On Oct. 22, part of a new U.S. Customs and Border Protection (CBP) rule takes effect that could make it much harder to get medicine mailed to you from another country.
But notice who’s sounding the alarm and what they want you to do about it. The people urging you to buy a year’s supply are the same people who sell it.
I’ve been writing about money for more than 35 years, and one rule has never let me down: When the warning and the sales pitch come from the same place, slow down. Here’s what’s actually changing, and six things to do about it.
What the new rule says
This rule grew out of a much bigger fight: Washington’s crackdown on cheap, duty-free overseas packages, the kind that made Temu and Shein household names. CBP published it in the Federal Register on June 24.
Most of it deals with collecting duties on low-value mail. The part that matters for your medicine is easy to miss. Starting Oct. 22, mail shipments that fall under another federal agency’s rules, like the FDA’s, lose access to the simpler customs process and need formal entry instead.
Formal entry is the heavyweight paperwork importers use for commercial cargo. The filer has to be the owner or buyer of the goods, or a licensed customs broker, and needs a customs bond.
CBP is also launching a voluntary electronic alternative, a test program it calls Entry Type 13. Whether small foreign pharmacies can realistically use it is anybody’s guess.
Translation: The rule doesn’t say “no more Canadian prescriptions.” But a pharmacy mailing a $90 bottle of pills to a retiree in Ohio may decide the new hoops cost more than the sale is worth. CBP’s own cost analysis lists possible short-term pauses in postal shipments among the rule’s downsides.
So the pharmacies may be right that the pipeline slows down or dries up. What I haven’t found is any FDA or CBP announcement of the blanket ban their emails describe.
The part nobody’s emails mention
Here’s the uncomfortable truth: Having prescriptions mailed to you from Canada was never really legal. The Congressional Research Service notes that federal law generally doesn’t allow individuals to import prescription drugs for their own use.
What millions of Americans have relied on is enforcement discretion. The FDA’s personal importation policy, which generally tolerates no more than a three-month supply, was designed for people seeking treatments not available here, according to CRS — not as a route to cheaper versions of drugs sold at your corner pharmacy.
In practice, small packages mostly got through anyway. That’s a gray market, not a right, and gray markets can close with one paperwork change.
So why do so many people take the chance? Because U.S. prices are absurd. A RAND study sponsored by the Department of Health and Human Services found brand-name drug prices here in the U.S. were more than four times the average in 33 other wealthy countries. Even after rebates, they were over three times higher.
If you’ve been shopping abroad, don’t feel guilty. Blame a system that made it the rational choice.
Now, here’s what to do before Oct. 22.
1. Don’t panic-buy a year’s supply
The “stock up now” pitch has three problems. First, you’re tying up hundreds or thousands of dollars in medicine you won’t take for months. Second, drugs have expiration dates, and a bottle that expires in your closet is money down the drain.
Third, and most important, the FDA’s tolerance has generally stopped at about a three-month supply. A giant order is exactly the kind of package that gets a second look.
And if that package gets caught up in the new customs process after Oct. 22, you could end up out both the money and the medicine.
2. If you do order, stick to a 90-day supply
If you depend on a Canadian pharmacy for a drug you can’t afford here, placing one normal refill now is reasonable. Keep it to a 90-day supply, the ceiling the FDA has long used.
Before you pay, get the pharmacy to spell out, in writing, what happens to your money if the package is held or turned back at the border. A refund policy that exists only on the phone isn’t a policy.
3. Ask your doctor about a generic
This is the cheapest fix on the list and the most overlooked. That same RAND study found the U.S. pays less than other countries for unbranded generics — roughly a third less on average.
In other words, if a generic version of your drug exists, ordering it from Canada may save you little or nothing. If there’s no generic, ask whether another drug in the same class would work as well. Doctors often don’t think about price unless you bring it up.
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4. Check the drugmaker’s direct price and TrumpRx
More drugmakers now sell directly to consumers at cash prices. In February, the Trump administration launched TrumpRx, a government website that doesn’t sell medicine itself but steers you to manufacturers’ direct prices and pharmacy coupons. It debuted with more than 40 drugs, including Ozempic and Wegovy.
Pull up the direct price for your drug and compare it with what you’ve been paying in Canada, shipping included. It’s five minutes of work, and it might surprise you.
5. Shop cash prices, not just your copay
The price of the same prescription can vary widely from one pharmacy to the next, and your insurance copay isn’t always the cheapest option. Discount cards and cash-price pharmacies sometimes beat it.
If you want to see what’s out there, you can compare prescription savings options here.
And if convenience was part of Canada’s appeal, several U.S. pharmacies will still mail your meds at no charge. We rounded them up in “11 Pharmacies That Still Deliver Prescriptions for Free (Including Costco).”
6. Use the help you’re already entitled to
If you’re on Medicare, your out-of-pocket costs for drugs covered by your Part D plan are capped at $2,100 this year. Once you hit that, you pay nothing more for covered drugs through the end of the year.
Here’s the catch: Medicine you buy from a Canadian pharmacy doesn’t go through your plan, so it doesn’t count toward that cap.
Medicare open enrollment runs Oct. 15 through Dec. 7. If Canada has been your workaround for a drug your plan covers poorly, that’s your chance to find one that covers it better.
Not on Medicare? Many drugmakers run patient assistance programs that provide medicine free or at a steep discount to people who qualify based on income. Your doctor’s office often knows which programs exist and may even have the forms.
The bottom line
The Oct. 22 deadline is real. If you rely on Canada for an expensive drug, it deserves your attention now, not on Oct. 21.
But the right move is a plan, not a panic buy. Get a normal refill if you need one, then use the next few weeks to line up a backup: a generic, a direct price, a cheaper pharmacy or a better Part D plan.
And stay tuned. Rules like this often get clarified or delayed once real people start losing access to their medicine. If that happens, I’ll let you know.
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