Where do this psychiatrist’s patients turn for affordable medicine if the U.S. stops access via international mail order?

Question:

“Hello, I'm a psychiatrist in San Antonio, TX. I'm urgently in need of help and information. I have many patients getting meds from Canada. The online pharmacy they use sent out an urgent notice that the US government is shutting down mail delivery. Do you have any advice or information on where these patients can get their meds?”*

Our Answer:

First off, we’re sorry you and your patients are having to endure this uncertainty. 

There is no new explicit prohibition on personal prescription drug importation in the U.S. Customs and Border Protection (CBP) rule taking effect October 22. However, there may be serious cause for concern about how the new procedures will affect Americans who rely on personal prescription drug importation.

According to the Campaign for Personal Prescription Importation, the organization has been advised that the planned implementation of the rule by CBP and the U.S. Food and Drug Administration (FDA) will effectively prohibit shipping prescription medicines to individuals in the United States:

CBP is taking a new stance claiming personal prescription importation doesn’t comply with FDA guidelines – even though FDA has permitted personal medicine importation for decades.”

FDA's currently published personal importation guidance provides for enforcement discretion, stating that FDA personnel may consider allowing the importation of medications for personal use under certain circumstances.

The way CBP and FDA implement the new international mail process could severely curtail — or potentially prevent — Americans from receiving personal-use prescription drug shipments through international mail.

Why Personal Prescription Drug Importation Matters

For decades, Americans facing high prescription drug prices have obtained medicines from licensed pharmacies abroad.

In 2024, the late David Mitchell, founder of Patients For Affordable Drugs, described personal importation as a “safety valve” after his Medicare Part D plan would not cover the blood thinner Eliquis without first requiring him to try another medication.

In 2023, Crystal Griffith, a 75-year-old registered nurse, wrote about her necessity to order “several drugs [including Zoloft and Feldene] from Canada, the UK, New Zealand, and Israel over many years due to the inability to afford USA prices and being denied coverage under Medicare Part D.”

A doctor in Florida, Dr. Berge Markarian, used personal importation to pay just $35 for his type 2 diabetes medication through international mail order compared to $1,600 in the United States.

A pediatric nurse, Sue M., heard about ordering from Canada through co-workers and friends who had relatives who ordered their medications from international mail order pharmacies:

With my new, much lower income, I knew I had to do something different or I wouldn’t be able to pay for either my medications or my basic daily needs.”

The prospect of losing prescription drug importation raises a very practical question for clinicians like this psychiatrist: What happens to patients who are only able to take their meds because they found a price they could afford abroad?

What happens to Sue? What happens to Dr. Markarian? What happens to Crystal?

So now what are patients supposed to do?

The answer depends on the prescription. If you are having trouble affording your prescription in the United States, please send an inquiry to Ask PharmacyChecker with the name of your drug so we can point you toward more specific affordability and price-comparison resources. 

We typically offer this guidance: 

Patients who rely on an international pharmacy because they cannot afford the U.S. price of their prescribed medicine should speak with their healthcare provider about continuity of treatment and available alternatives. Patients should not ration medication, stop treatment, or substitute medications without consulting their prescribing clinician or healthcare team.

Depending on the medication, patients and their clinicians can investigate generic or therapeutically appropriate alternatives, U.S. pharmacy discount coupons, lower-cost U.S. mail-order pharmacy options, manufacturer patient assistance programs, and insurance formulary or coverage alternatives.

On PharmacyChecker.com, we compare prescription drug prices among U.S. pharmacy discount coupons, U.S. mail-order pharmacies, and accredited international online pharmacies. For many medications, an affordable domestic option may be available, especially if you are prescribed a generic.

For others, there simply may not be a comparably affordable U.S. option, which is why the reported plans for implementing the new rule could prove particularly dangerous for patients.

Clinicians, Caregivers, and Patients Should Make Their Voices Heard

PharmacyChecker is urging FDA to preserve reasonable, risk-based enforcement discretion for prescription medicines clearly intended for an individual patient's personal use and that do not appear to present an unreasonable public health risk.

The Campaign for Personal Prescription Importation has created a tool for patients, clinicians, and others to contact members of Congress about protecting access to personal prescription drug importation.

*This question was slightly edited for publication to redact the psychiatrist’s name and the name of the pharmacy his patients use.