A long-standing cross-border arrangement that has allowed millions of Americans to fill prescriptions through Canadian and other international pharmacies at a fraction of U.S. prices is set to end next month, following a change to U.S. trade rules.
Starting Oct. 22, the Trump administration will close the so-called de minimis duty exemption, which had allowed low-value imports, including personal prescription orders, to enter the United States without tariffs, prepaid duties or customs paperwork. U.S. President Donald Trump signed an executive order eliminating the exemption in July 2025, and a new U.S. Customs and Border Protection policy governing international mail shipments takes effect next month.
The Canadian International Pharmacy Association, a nonprofit trade group representing licensed Canadian pharmacies, said in a statement that the arrangements used to deliver most personal prescription orders to American patients will no longer be workable. The association said Americans should expect that virtually all routine personal prescription orders mailed from licensed Canadian and international pharmacies will be unable to reach them unless the arrangements change.
Why Washington Is Ending the Exemption
The Trump administration has said the de minimis exemption was being exploited to facilitate illegal drug shipments and to help importers evade tariffs, which it says has hurt domestic businesses. According to the White House, the number of such shipments for certain countries nearly tripled to 309 million by June 2025, up from 115 million for all of 2024.
For decades, Americans have turned to Canada and other countries for lower-cost prescription drugs. Ken Hunter, executive director of the Campaign for Personal Prescription Information, a U.S. patient advocacy nonprofit, said millions of prescriptions cross the border every year and that the policy change will leave many patients unable to order medications they have relied on.
Impact on Patients and Prices
A study by the Campaign for Personal Prescription Information found average savings of 65% for American consumers on 10 commonly prescribed drugs purchased through Canadian pharmacies. An August survey by the group found a three-month supply of the blood thinner Eliquis cost $566 from Canadian pharmacies, compared with $1,017 from Amazon and $1,029 from GoodRx in the United States.
One patient affected is Denise Litman, 72, of the Connellsville area in Pennsylvania, who has been filling her prescription for apixaban, the generic version of Eliquis, through a Canadian pharmacy. Litman said her primary care doctor told her he can no longer forward her prescription there, and she is now awaiting word from her cardiologist on whether he will continue writing the prescription for the Canadian pharmacy. Litman said she has been paying about $83 for a three-month supply of the generic drug, which is not available in the U.S., and now faces a domestic price of about $500 for a one-month supply.
Eliquis is the most commonly prescribed anticoagulant in the U.S., with about 5.35 million Americans taking the drug in 2024, according to ClinCalc, a clinical decision platform. While the U.S. Food and Drug Administration has given tentative approval to a generic version of the drug, patent protection held by manufacturer BMS/Pfizer for the brand-name version in the U.S. is expected to last until at least 2028, delaying generic competition and lower domestic prices.
The change comes as the U.S. Senate Health, Education, Labor and Pensions Committee holds a hearing on Trump’s nominee for FDA commissioner, Dr. Heidi Overton, whom Trump has said is expected to help lower drug costs.
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