U.S. Customs and Border Protection suspended the de minimis exemption indefinitely starting October 22, 2026. Medications mailed from outside the U.S. will require additional data and a bond guarantee under the new rule.

The de minimis exemption previously allowed shipments valued under $800 to pass through customs more easily. The rule is intended to collect tariffs and prevent illegal drugs from entering the U.S., and it applies to low-value shipments of goods beyond drugs, including textiles and toys.

Roughly 2.3 million Americans buy their drugs abroad, according to a 2020 study by JAMA Network. Ken Hunter, executive director of the Campaign for Personal Prescription Importation, said the rule threatens access to affordable medicine for those who rely on imports due to high domestic prices.

"There has been a lot of talk of lowering drug prices, but in many cases it doesn’t cover all drugs for all people for all conditions," Hunter said. The Campaign for Personal Prescription Importation conducted a study in August looking at 10 of the most commonly prescribed medications imported from Canada. Hunter noted that a three-month supply of 180 5-mg pills of Eliquis costs $565 from a mail order Canadian pharmacy, compared to roughly $1,017 from Amazon’s pharmacy arm or $1,029 from GoodRx.

"I’ve had so many of our members calling me and telling me, ‘I don’t know what I’m going to do,’" Hunter said. "We really need someone to step forward and say, ‘We really need this to stop.’"

Susan Hooper, a 75-year-old Toledo, Ohio resident, said the issue is a matter of life and death for her. Hooper has been on oxygen for 14 years and takes two daily medications purchased through a Canadian pharmacy that are not available in the U.S. She said her Theophylline medication used to cost $85 with shipping and now costs $141 because of tariffs imposed in August, while her Foradil bronchodilator for asthma used to cost $151 and now costs $273.

Allison Schuster, a White House spokesperson, said "the Trump administration continues working to ensure Americans have access to low-cost pharmaceuticals across the board." Federal data from summer 2026 showed that U.S. prescription drug prices were down 3.1% from a year ago, the steepest year-over-year drop since 1963.

A group of more than 70 Democrats sent a letter to health and immigration enforcement officials last week asking them to pause the new rule unless they could provide assurances that prescription medicines meant for personal use would be able to enter the U.S. "Americans should not lose access to affordable medicines simply because the government has better information about packages entering the country," the letter from Democrats said.