I went back to school a few years ago and was shocked at the price of textbooks. Luckily, another student informed me that a US Supreme Court decision allowed us to buy textbooks from India. I paid 15 USD for a book that would have cost 600 USD from a US supplier. I guess medications are still allowed cartel pricing for some reason.
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I will post detail later as time permits but the precis is that the situation does not look good. I have run down several paths with the idea in mind that we might be able to construct, sponsor, or facilitate a mechanism by which we could continue our gero experimentation more-or-less as we do now, even if the price is higher. Every path seems to have a logical or a practical dead-end. There are a few possibilities at the margin that I will post.
My take at the moment is that we have to wait to see the extent to which the FDA chooses to implement their newfound and long sought power. These regulations are clearly FDA-focused. Customs is not the issue. If they were to ignore small batches or rapamycin or acarbose, as they might, a path may develop. An HHS spokesperson told the WSJ that FDA will keep evaluating personal imports case by case. If they intend to exert their full power we are virtually helpless. The regulation is very clear that price is not a factor in applying the test of availability in the US and virtually everything most of us purchase in India is available in the US, even if at 100x the price. Not good. Perhaps I missed something that someone else has found.
As for Canada with an Rx, at present the Canadian association has indicated that they will not try to navigate the necessary to provide the US with access. In part, this position is likely a reflection on how poorly Trump is treating some of our oldest and most loyal friends. This could change if the market equation were to look favorable – we can play a part in that with letter writing.
Part of the year I live close to Canada and the other part close to Mexico. I’ll be investigating personal importation.
A political solution may be our best bet. There is a relevant precedent from that period. A September 2026 Republican letter asks whether CBP has abandoned its October 2006 policy on personal importation from international pharmacies. In 2006, CBP backed off a seizure campaign under congressional pressure. On October 1, 71 House members led by Pocan and Schakowsky asked HHS, FDA, DHS, and CBP to delay implementation for prescription medicines unless they can assure that genuine personal-use medicines won’t be blocked. CBP’s own cost analysis lists possible short-term pauses in postal shipments among the rule’s downsides. Our group should consider setting up one of the newer forms of automated congressional letter writing so we can immediately flood the offices of our Senators and Congresspeople with letters. This has worked in the past.
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Some references:
- Federal Register – Indefinite Suspension of the De Minimis Exemption for Mail Shipments (June 24, 2026)
- Thomson Reuters – CBP suspends de minimis for mail
- Troutman – Navigating CBP’s new international mail entry process
- FreightFigures – Postal informal entry October 22 compliance date
- Zonos – FDA import rules for medicines and health products
- SAN – Trump admin closing loophole (summarizing WSJ)
- PharmacyChecker – statement urging FDA to preserve enforcement discretion
- PharmacyChecker – Dallas woman / WSJ coverage
- Urban Milwaukee – Pocan/Schakowsky letter
- STAT – Republican letter to administration (PDF)
- Money Talks News – 6 things to do before Oct. 22
- Swarajya – India resumes postal services to US with DDP system
- ShopAppy – postal operator restriction prediction
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Signatories of Congressional letter endorsed by the Campaign for Personal Prescription Importation, Just Care USA, National Association of Letter Carriers, Prescription Justice, and Social Security Works.
I think we need to send letters to these 71 people, thanking them for their efforts.
Mark Pocan (WI-02)
Jan Schakowsky (IL-09)
Yassamin Ansari yassamin-ansari) (AZ-03)
Becca Balint becca-balint) (VT-01)
Nanette Barragán nanette-barragan/) (CA-44)
Brendan Boyle brendan-boyle) (PA-02)
Nikki Budzinski nikki-budzinski) (IL-13)
Janelle Bynum (OR-05)
Salud Carbajal salud-carbajal) (CA-24)
André Carson andre-carson) (IN-07)
Greg Casar greg-casar) (TX-35)
Judy Chu judy-chu) (CA-28)
Yvette Clarke yvette-clarke) (NY-09)
Steve Cohen steve-cohen) (TN-09)
Sharice Davids sharice-davids) (KA-03)
Madeleine Dean madeleine-dean) (PA-04)
Diana DeGette diana-degette) (CO-01)
Suzan DelBene suzan-delbene) (WA-01)
Chris Deluzio chris-deluzio) (PA-17)
Mark DeSaulnier mark-desaulnier) (CA-10)
Maxine Dexter maxine-dexter) (OR-03)
Lloyd Doggett lloyd-doggett) (TX-37)
Veronica Escobar veronica-escobar) (TX-16)
Dwight Evans dwight-evans) (PA-03)
Lois Frankel lois-frankel) (FL-22)
Maxwell Frost maxwell-frost) (FL-10)
Robert Garcia robert-garcia) (CA-42)
Sylvia Garcia sylvia-garcia) (TX-29)
Chuy García (IL-04)
Jimmy Gomez jimmy-gomez) (CA-34)
Adelita Grijalva adelita-grijalva) (AZ-07)
Val Hoyle val-hoyle) (OR-04)
Jonathan Jackson jonathan-jackson) (IL-01)
Pramila Jayapal pramila-jayapal) (WA-07)
Robin Kelly robin-kelly) (IL-02)
Timothy Kennedy (NY-26)
Ro Khanna ro-khanna) (CA-17)
Raja Krishnamoorthi raja-krishnamoorthi) (IL-08)
Greg Landsman greg-landsman) (OH-01)
Rick Larsen rick-larsen) (WA-02)
George Latimer george-latimer) (NY-16)
Teresa Leger Fernandez teresa-leger-fernandez) (NM-03)
Sam Liccardo (CA-16)
Stephen Lynch stephen-lynch) (MA-08)
John Mannion (NY-22)
Doris Matsui doris-matsui) (CA-07)
Kristen McDonald Rivet kristen-mcdonald-rivet) (MI-08)
Morgan McGarvey morgan-mcgarvey) (KY-03)
Jim McGovern jim-mcgovern) (MA-02)
Joe Morelle (NY-25)
Seth Moulton seth-moulton) (MA-06)
Eleanor Holmes Norton eleanor-holmes-norton) (DC-01)
Alexandria Ocasio-Cortez alexandria-ocasio-cortez) (NY-14)
Jimmy Panetta jimmy-panetta) (CA-19)
Chris Pappas chris-pappas) (NH-01)
Chellie Pingree chellie-pingree) (ME-01)
Mike Quigley mike-quigley) (IL-05)
Delia Ramirez (IL-03)
Emily Randall emily-randall) (WA-06)
Andrea Salinas andrea-salinas) (OR-06)
Brad Schneider brad-schneider) (IL-10)
Adam Smith adam-smith) (WA-09)
Marilyn Strickland marilyn-strickland) (WA-10)
Thomas Suozzi thomas-suozzi) (NY-03)
Mark Takano mark-takano) (CA-39)
Rashida Tlaib rashida-tlaib) (MI-12)
Jill Tokuda jill-tokuda) (HI-02)
Paul Tonko paul-tonko) (NY-20)
James Walkinshaw (VA-11)
Debbie Wasserman Schultz debbie-wasserman-schultz) (FL-25)
and Frederica Wilson frederica-wilson) (FL-24)
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The Canadian pharmacies we use are telling us they will not be able to continue because of the increased costs, need for a custom broker etc. Maybe they will figure out a workaround.
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Additionally, of the Indian sellers I’ve been in contact with, the one who was willing to take the most risks previously has already announced his posture moving forward. He will only offer medications for which you can provide a current prescription from the doctor, and he will only provide three months at a time. That, combined with the high shipping costs from India, is likely to be helpful to virtually no one.
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Just wondering, as a future plan B.
Is it realistic to think I can go to Mexico and bring back 600 sirolimus pills at a time? I live in Texas. It is not that far…Any thoughts?
Seems likely to be a strategy… but you’ll need to talk to pharmacies in advance, make sure they have it (or pre-order) and likely go to one in a major city, as rapamycin is a specialty drug (only currently used by transplant patients), so harder to get than most medications. If I was to do this, I would look at where organ transplants are done in Mexico, then target pharmacies around those hospitals.
A quick Google Gemini prompt to identify the hospitals in Mexico that do organ transplants:
In Mexico, all organ procurement and solid organ transplantation programs are strictly regulated under the General Health Law (Ley General de Salud) and licensed by COFEPRIS under the supervision of the Centro Nacional de Trasplantes (CENATRA).
While Mexico maintains over 400 authorized transplant establishments nationwide (the majority performing corneal and renal grafts), solid organ programs (kidney, liver, heart, and lung) cluster within major academic medical centers and specialized regional hospitals.
Below is the distribution of the principal active solid-organ transplant hospitals in Mexico, categorized and prioritized by geographical proximity to the United States border.
Tier 1: Direct Border Zone (< 15 km from US Border)
Hospitals situated directly on the border with active programs—primarily renal transplantation and organ procurement.
| Hospital | City | Proximity to US Border | Primary Organ Program(s) | System / Sector |
|---|---|---|---|---|
| Hospital General Regional No. 1 (IMSS) | Tijuana, Baja California | ~5 km (San Ysidro / Otay) | Kidney | Public (IMSS) |
| Hospital General de Tijuana | Tijuana, Baja California | ~3 km (San Ysidro) | Kidney (Living/Deceased donor) | Public (IMSS-Bienestar / ISESALUD) |
| Hospital Ángeles Tijuana | Tijuana, Baja California | ~3 km (San Ysidro) | Kidney | Private |
| Hospital General de Mexicali | Mexicali, Baja California | ~4 km (Calexico) | Kidney | Public (ISESALUD) |
| Hospital General de Ciudad Juárez | Ciudad Juárez, Chihuahua | ~4 km (El Paso) | Kidney | Public (Servicios de Salud de Chihuahua) |
| Hospital Ángeles Ciudad Juárez | Ciudad Juárez, Chihuahua | ~8 km (El Paso) | Kidney | Private |
| Hospital CHRISTUS MUGUERZA Reynosa | Reynosa, Tamaulipas | ~12 km (McAllen / Hidalgo) | Kidney, Cornea | Private |
Tier 2: Near Border & Northern Hubs (~100 to 450 km from US Border)
These centers serve as major northern referral networks with comprehensive multi-organ programs (liver, heart, lung, and kidney).
Sitio Web “Acercando el IMSS al Ciudadano”
| Hospital | City | Distance to Nearest Port of Entry | Primary Organ Program(s) | System / Sector |
|---|---|---|---|---|
| Hospital General del Estado “Dr. Ernesto Ramos Bours” | Hermosillo, Sonora | ~270 km (Nogales) | Kidney, Liver | Public (SS) |
| Hospital CIMA Hermosillo | Hermosillo, Sonora | ~270 km (Nogales) | Kidney | Private |
| UMAE Hospital de Cardiología No. 34 (IMSS) | Monterrey, Nuevo León | ~220 km (Laredo / McAllen) | Heart, Lung | Public (IMSS) |
| UMAE Hospital de Especialidades No. 25 (IMSS) | Monterrey, Nuevo León | ~220 km (Laredo / McAllen) | Kidney, Liver | Public (IMSS) |
| Hospital Universitario “Dr. José Eleuterio González” (UANL) | Monterrey, Nuevo León | ~220 km (Laredo / McAllen) | Kidney, Liver | Academic / Public |
| Hospital Zambrano Hellion (TecSalud) | San Pedro Garza García (Monterrey Metro), NL | ~225 km (Laredo / McAllen) | Kidney, Liver, Multivisceral | Private / Academic |
| CHRISTUS MUGUERZA Hospital Alta Especialidad | Monterrey, Nuevo León | ~220 km (Laredo / McAllen) | Kidney, Lung, Heart | Private |
| Hospital Central del Estado | Chihuahua, Chihuahua | ~370 km (Presidio / Ojinaga) | Kidney | Public (SS) |
| UMAE Hospital de Especialidades No. 71 (IMSS) | Torreón, Coahuila | ~380 km (Eagle Pass / Del Rio) | Kidney | Public (IMSS) |
| Sanatorio Español La Laguna | Torreón, Coahuila | ~380 km (Eagle Pass / Del Rio) | Kidney | Private |
| UMAE Hospital de Especialidades No. 2 “Luis Donaldo Colosio” (IMSS) | Ciudad Obregón, Sonora | ~520 km (Nogales) | Kidney | Public (IMSS) |
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Wow! Many thanks for the info. I sure hope we don’t need Mexico as a plan B but great advice on making it work. 
Or, I’m thinking a different strategy wrt. Mexico. This especially applies if you have a friend in Mexico (doesn’t everyone have a friend in Mexico?), even an American expat friend. Skip the whole pharmacy thing, and order and pay for your meds as usual with the Indian vendors, just have it shipped to your friend in Mexico, or even a rented shipping address in Mexico close to the border. Then, when the package arrives, you go pick it up, no fuss, no muss. Now, this is just a thought, I have not checked the policy around importing medications into Mexico, but in principle, if possible, this might work, whereas it wouldn’t be as simple to do with Canada as Canada has some pretty gnarly medication import rules - too bad as that too is within driving distance from the US.
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Very easy to buy bulk sirolimus in Mexico, just use MercadoLibre.
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By “bulk sirolimus” you mean powder, correct?
No, just pills in large quantities.
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When I lived in Phoenix full time, I had friends who made occasional trips to Nogales, parked on the US side and walked over to have lunch and save a few hundred on their pharma at a local drug store. Scripts were not required for common drugs. No one seemed to have any problems returning but I suspect that the US border return will now involve more thorough inspections than before. I should say ‘any inspections’ because no one was inspected on the return unless you were suspicious or on their list. One might imagine that older adults will be subjected to heightened inspections.
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Mexico is not a US state LOL. I’d much rather have stuff imported and stopped at customs than go to Mexico and get caught bringing stuff into USA. They look for any small excuse to put those nice handcuffs on your wrist LOL. I have a bit off experience and they can be very detailed sometimes. at least when you import and gets confiscated no one will show up at your door and arrest you for such a minute thing. It’s simply too costly for them to come at your house for a silly $300 infraction, whereas at the border they spend $zero, they love it when they catch people doing silly things no matter how small the amount. It just makes their jobs more fun LOL.
The only way mexico would work is if you are so close to the border that its no problem making trips every month or so. Otherwise save yourself having to hire a lawyer and having to pay a $5000 retainer to get your ass out of trouble. someone i know got their ass kicked and it was for some petty shit, i think like couple liters of alcohohol but the main issue became when he answered their most common question wrong e.i. lying to a police officer/law enforcement officer, actually two questions they allways ask? 1. Are you bringing any ilegal substance to the USA, and 2. Have you bought anything and bringing it back to USA?
I’d love to know how any of you would respond to those questions after you had bought your 500 Rapa, and couple 100 modafinil LOL
Now, I doubt you’d be in deep trouble but you could very easy be paying a nice fat $3500-$5000 to get things straighten out. No thank you, much rather lose $200 that $5000
so, I’d like to borrow a quote from this old favorite of mine @ 0:12 (for those that want to bring meds into USA from mexico): “yes, Very, Very bad” LOL
My growing sense of this is that our best and possibly only hope is for all of us to contract our senators and congress people.
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That is the best approach
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It would seem to me there are much bigger legislative priorities that don’t get touched and you are going against a very big donor group. While 70 something reps have signed onto supporting importing, that isn’t near enough to actually pass a bill.
My big workaround plan is pushhealth or something similar. For expensive meds, you can probably still import 90 day supplies. Ideally getting overdose prescriptions and drag the 90 to 360.
A lot of what I take is very cheap in the US, it is more the difficulty of prescriptions. DORAs are a challenge for cost and importing. But I believe they are cheap all over the world.
We may need a thread on various countries and what can be done beyond the driving options. Like maybe I am traveling to Japan next summer, what can I get and how? Or Europe or Thailand etc. Obviously India is probably best but few outside of those with family or work reasons travels to India often. I know a lot of people with family there but wouldn’t ask them to carry back meds. I’ll go there in the next 3 years and could plan on bringing it shipping up to a 5 year supply.
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