U.S. Delay Leaves Questions About Personal Prescription Drug Imports

A three-month delay has eased immediate concern about personal prescription medicine shipments entering the United States, but patients and pharmacies still don’t know how the new customs process will affect those orders. The rule was scheduled to begin Oct. 22 and is now set for Jan. 20. The delay notice cited the risk of disrupting some international mail, without specifically addressing medicines.

The rule requires detailed information about the contents of international parcels, along with tariff payments processed through a licensed customs broker. It applies even to low-value packages that previously avoided tax and extensive paperwork. The added steps could raise costs and complicate shipments. Whether medicine parcels will be admitted under the new process remains unclear.

What the delay does and doesn’t resolve

U.S. law generally bars importing most prescription medicines approved for sale in the country. Since 2003, however, authorities have allowed limited personal imports of legal medicines in some circumstances, with parcels rarely inspected. A 2022 Food and Drug Administration estimate said about one in every 2,000 medicine packages entering through customs was typically checked.

The new data requirements could give customs and medicine regulators more visibility into each package. They are intended to support tariff collection and help identify illegal drugs, but they also require shippers to post a bond and submit complex information for every parcel. That raises a practical question: with a shipment’s contents now easier to identify, will it be allowed through under existing rules?

Ken Hunter, who leads an advocacy group for personal prescription imports, said patients sent at least 109,000 letters asking the FDA to clarify that the rule would not stop these shipments. The agency has not provided clear criteria for which personal imports it will accept. A logistics company that serves international mail said it plans to keep shipping medicines, but cannot promise that packages will reach patients. Its broker said the FDA might take a lenient or strict approach.

In response to questions, a customs spokesperson said medicine shipments remain under FDA jurisdiction. A spokesperson for the health department said the FDA would continue reviewing personal imports case by case. Neither response explained how the new parcel information would affect those decisions.

Why patients rely on overseas pharmacies

The uncertainty matters because some people turn to overseas pharmacies after finding that a prescribed medicine costs more than they can manage at home. The scale is difficult to pin down: a 2020 study estimated that 2.3 million Americans regularly imported medicines, while other surveys have reported larger figures. A recent KFF survey found that about four in 10 Americans had skipped or changed prescribed medicine use because of cost in the past year.

Patients interviewed for the report described substantial price differences. Leslie Waters, a retired computer scientist in San Jose, California, said a 90-day supply of Eliquis, a blood thinner also called apixaban, would cost him $486 in the United States. He said he pays $57, including shipping, for a 90-day supply from a Canadian pharmacy. Waters lives on a monthly Social Security payment of $1,886.

Roland Hofferber, a retired supply chain engineer in Muscatine, Iowa, said he had 23 days of Jardiance, or empagliflozin, left in early October. He takes it to slow chronic kidney disease. He reported that a three-month supply would cost $641 in the United States, while a generic version from an Indian pharmacy costs him $54. He worried he might have to reduce or stop taking it if another shipment did not arrive.

These accounts illustrate the financial pressure behind personal importing, but they don’t establish that every overseas product or pharmacy is safe or appropriate. The article describes patients seeking medicines prescribed by their doctors; it does not provide a comparison of pharmacy quality or verify the products in individual shipments.

Pharmacies prepare for possible disruption

Before the delay, Tim Smith, general manager of the Canadian International Pharmacy Association, said its 51 member pharmacies had urged hundreds of thousands of U.S. customers to place orders early. The pharmacies feared that parcels might stop arriving once the rule took effect. A logistics provider had earlier told clients it expected personal prescription packages might no longer be allowed through, then said it would continue shipping while it waited to see how the agencies handled them.

Bill Hepscher, whose Canadian Medstore operates six Florida storefronts that help patients obtain imported medicines, said customers were calling in alarm about whether they could continue getting drugs such as Eliquis. He said about half of his clients buy from Canada, while others use pharmacies in Australia, New Zealand, the United Kingdom, or Turkey. His company’s busiest year was 2025, which he attributed to changes in insurance coverage and higher costs for older adults and people in high-deductible plans.

State programs designed to bring in lower-cost medicines from Canada have not yet delivered drugs, according to the source. For now, individual patients remain the main focus of the dispute. The report also noted that brand-name medicine shipments have faced tariffs since summer 2025.

What patients can watch for

The Jan. 20 start date gives shippers and agencies more time, but it does not settle how personal prescriptions will be treated. Advocacy groups described the delay as a short-term reprieve, with the underlying uncertainty still in place. Patients who depend on an imported medicine may want to discuss supply concerns and affordable options with their doctor or pharmacist, especially if a shipment is delayed. The next practical signal will be clearer guidance on which packages can enter and how the new paperwork will be applied.

The customs notice on the delay announced the revised start date. Background on personal imports is available from an analysis of enforcement discretion, and information about the import program appears on the FDA’s program page.