Importing from Canada

Expensive drugs in America

Drugs sold in countries where their governments negotiate with pharmaceutical companies, such as Canada and the United Kingdom, tend to be far cheaper than in the United States.

The public knows this and they are demanding our leaders do something.

Can I order online from Canada myself?

Technically no. Prescriptions cannot be mailed into the United States by foreign e-pharmacies.

However, FDA officials use "enforcement discretion" when it comes to small orders for personal use. That generally means orders of up to a 90-day supply.

Knowing which pharmacies are legitimate requires some effort.

♦ That said, Canada has an accrediting organization for licensed pharmacies. There are currently 50 accredited pharmacies listed. A complete list with web address can be found here.

Action at state level

Update October 2026

♦ The FDA approved Florida's program back in January 2024. The feds have extended it several times since. Florida still hasn't imported a single drug.

The state has sunk tens of millions of dollars into the effort, including $50 million paid to set up a warehouse for the medicines. Critics put the total at $132 million. Lawmakers have been debating whether to keep paying for it or pull the plug.

♦ In June 2026, Colorado became the second state approved. Colorado thinks it can beat Florida to actually delivering drugs. Maine, New Hampshire and New Mexico have also applied.

Even with FDA approval, states still have hoops to jump through. Each drug needs its own FDA sign-off before it can be imported. The state has to test the drugs for quality and make sure the labels meet FDA standards.

♦ States are trying to do what the federal government has failed to do. They are passing legislation to allow the importing of prescription drugs in the hope that prices will come down.

The state plans create a middleman. Most people are hoping for the right to import directly.

• It is not clear who would be helped by these efforts, especially if a middleman takes a cut. They will also need to survive court challenges from the pharmaceutical industry and their allies.

Washington's track record

♦ In July 2021, the Biden administration issued an executive order directing the FDA to work with states to import prescription drugs from Canada.

The public has been clamoring for years for CMS to be given the right to negotiate drug prices for Medicare participants. The drug industry, with the support of Republicans in Congress, was able to prevent this for a long time.

♦ In August 2022, President Biden signed the Inflation Reduction Act. It contains a provision for CMS to negotiate some prescription drugs for Medicare beneficiaries. Those first negotiated prices finally kicked in January 2026. It's a start.

♦ The first Trump administration talked the talk but never walked the walk.

President Trump dropped his plan to ban rebates that drugmakers pay to pharmacy benefit managers in 2019. It came back as a rule in late 2020, and Congress has kept it on ice ever since. Then there was the idea to make pharmaceutical companies list their prices in television ads. That one went down in flames when BigPharma sued and won.

All state plans need a green light from the HHS Secretary. Back then that was Alex Azar, a former drug company executive who once called importation a "gimmick." His HHS did finally write the rules in 2020.

And guess where Azar landed? He's now chairman of the board at LifeScience Logistics, the company Florida is paying millions to run its import warehouse. The warehouse that still hasn't imported anything.

♦ Round two, Trump signed more executive orders. One told the FDA to make state import plans easier to approve. Another promised "most favored nation" pricing and imports from more countries. Colorado did finally get approved in 2026.

But two states approved and zero drugs on pharmacy shelves isn't exactly walking the walk.

Who's running things now

♦ Robert F. Kennedy Jr. heads HHS. Any state plan still has to get past his department. Who is going to write the rules? BigPharma will definitely try to put their fingers on the scale.

• The FDA is a revolving door. Commissioner Marty Makary resigned in May 2026 and Kyle Diamantas is running the agency in the meantime. A permanent nominee is waiting on the Senate. We'll have to wait and see if the next one helps or hinders.

Pharma to control the flow

U.S. drugmakers argue against imports, saying they would put the safety of the U.S. drug supply at risk. Knowing they cannot prevent imports forever, they hope to control the flow of imported drugs by helping to set the rules of the game.

♦ Pharmaceutical companies are in a position to withhold supply. In doing so, they could cause both Canadian and import prices to go up.

They're already playing hardball. When Colorado reached out to 23 drugmakers about its program, only four would even talk. None wanted to take part.

The industry is also trying to scare Canadian officials into thinking that U.S. importers would drain the drug supply in Canada. They are encouraging Canada to push back on Americans importing from Canada. Have Canada be the bad guy.

There is a fear that drug companies will retaliate against Canadian pharmacies that sell medicines to U.S. buyers. The threat is real. In the past, some large manufacturers threatened to penalize internet pharmacies that shipped cheaper drugs to the U.S. Some pharmacies were even forced to report shipment details.

Canada is not happy

Back in 2005, Canada threatened to block drug exports and never did. This time they meant it.

In November 2020, days before the U.S. import rule kicked in, Canada banned bulk exports of any drug that could cause a shortage at home. A year later they made it permanent. Their message is pretty clear: we like you, but we're not your pharmacy.

♦ Canada's prices are cheaper than the U.S. but they tend to be more than what most Europeans pay.

"There's no question that Americans are paying too much for drugs", says Amir Attaran, a health-law specialist at the University of Ottawa. "But ... tapping out your neighbor is a nasty, rotten thing to do."

What to expect

It is not likely that we will see any broad reining in of drug prices in the near future. The GOP continues to resist anything that even remotely resembles real price controls.

Medicare beneficiaries are getting some help now that negotiated prices have kicked in. Everyone on private or employer-sponsored health plans still has to wait.

Follow the money

Seventy-two senators and 302 members of the House of Representatives cashed checks from the pharmaceutical industry ahead of the 2020 election. That's more than two-thirds of Congress.

While we wait for Washington, you might like to read the article Buying Prescriptions Online.