Millions of Americans are about to lose access to significantly cheaper prescription medications than the ones they can get in the U.S. Next month, the Food and Drug Administration is closing a loophole that has allowed people in the U.S. to import their prescriptions from “gray market” foreign mail-order pharmacies, mostly in Canada.
They’re called gray market pharmacies because their shipments to the U.S. are technically illegal, but customs hasn’t taken steps to enforce the law as it stands. The federal government will begin enforcing the law to crack down on illegal contraband that has taken advantage of low-value foreign shipments that can slip through the border without formal declarations or searches.
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According to a new Wall Street Journal report, patients are hurrying to stock up on their daily prescriptions before the new rule takes effect on Oct. 22. That’s when the Trump administration will start putting medications mailed from abroad through a more rigorous screening process — one that’s technically already in place, but often unenforced.
The new rules
The government made it harder to get prescriptions from other countries last year. In August 2025, patients who order medication by mail had to start paying customs fees on shipments that used to be delivered for free.
Starting next month, personal prescription drug imports will be screened by a company called Zonos. They’ll check every package against the FDA’s import criteria and decide whether it passes muster.
Until now, the FDA has mostly allowed personal shipments to go through, as long as the medication was personally used to treat a serious illness with no good U.S. treatment, isn’t marketed to American consumers, carries no unusual safety risk and comes with a doctor’s note for a 90-day supply or less, according to the Journal. The report says those requirements were rarely checked on packages worth less than $800 because of a decades-old customs exemption for low-value mail.
“There will be just a full stop of anything coming into the States,” Tim Smith, the general manager of the Canadian International Pharmacy Association, told the Journal. “These are cash-strapped, uninsured or underinsured people; many senior citizens on fixed incomes.”
A Department of Health and Human Services spokesperson told the Journal the Food and Drug Administration would continue to evaluate personal imports on a case-by-case basis.
Who it’s impacting
A 2020 study in JAMA Network Open found that more than two million Americans who take prescription drugs bought them from outside the U.S. to save money.
The Journal profiled Diamantina Cavazos, a Dallas-based project manager, who said she’s been ordering her prescription for a painful gut condition from a Canadian online pharmacy for the past two years. She’s been paying about $10 a week for her medication — compared to the $1,100 a week it would cost in the U.S. because her insurance won’t cover it.
Fear No Fact.
Almost 16% of total health care expenditures, amounting to roughly $73 billion, is spent on prescription drugs for adults, according to Georgetown University’s Health Policy Institute.
Ken Hunter, the executive director of the Campaign for Personal Prescription Importation, said in the two weeks after Zonos started notifying shipment companies about the upcoming rule change, membership in his group surged by 20,000 people. In that time, Hunter said CPPI has helped send 28,000 letters from concerned Americans to members of Congress.
Hunter said many Americans rely on cheaper imports for the medications they’ll need for the rest of their lives. For example, he said, the blood thinner Eliquis is one of the most commonly ordered drugs. He said a 90-day supply from Canada costs less than $600, which is almost half the U.S. price.
Hunter said many people have told him they will either cut their doses or skip pills, or go without their medications entirely once the rules change.
“It is just such an avalanche of fear and concern out there,” he told the Journal.
