As far back as he can remember, Peter Payne has lived with anxiety.
Up until recently, Payne, who is 81 and lives in Strafford, paid the Canadian company Planet Drugs Direct for three-month supplies of Trintellix, a medication that eases his clinical anxiety, at an average of $67 per month. He takes the medication once a day in pill form.
Planet Drugs Direct sourced the drug from countries outside the U.S. that offer it at lower rates. Payne’s medication often came from Canada, but it has also been delivered from Turkey, India and the United Kingdom, countries where medication costs much less than in the U.S.
Starting in January, people like Payne will have a much harder time securing the relief he has searched for so long. New regulations from U.S. Customs and Border Protection will limit Americans’ ability to import personal drug prescriptions across the Canadian border — something around four million do every month.
In July 2025, President Donald Trump signed Executive Order 14324, indefinitely suspending the de minimis administrative exemption for imports worth less than $800, which has existed for more than two decades.
If Payne bought his prescription domestically, he would pay $514 each month, a reduced price he would get with his Medicare coverage for a tier 3 drug.
“I can’t afford $514 a month in perpetuity,” he said.
‘A sigh of relief’
As a young adult, Payne resisted the idea that his anxiety was clinical. He was a somatic therapist by trade, and the use of psychiatric drugs challenged his beliefs. In his 40s, though, he admitted that the anxiety defining his daily life needed medical treatment.
Payne turned to doctors and began to try different prescription medications to alleviate his anxiety. First, he took SSRI drugs, which boost the neurotransmitter serotonin. He tried three of them before moving on to an SNRI, a drug category that works by targeting both serotonin and norepinephrine, collectively affecting mood, energy level, appetite, sleep, focus and attention. His second SNRI, which he started taking late in middle age, finally gave him some relief.
“My quality of life improved immensely,” Payne said.
He stayed on his SNRI for 20 years. He dealt with the side effects. SNRI and SSRI drugs, used to treat anxiety, depression and other related disorders, can cause nausea, dizziness and headaches. They can contribute to sleep problems and changes in appetite. Payne gained some weight, and decided he could live with that. But what he eventually realized his medication was doing, which he could not stomach, was dulling his sense of feeling human.
“The feeling in your heart that you get when deeply moved by something disappeared,” Payne said.
After two decades on the SNRI, Payne had a hard time weaning off of his medication, but considered it crucial. In his 70s, he turned to other methods of dealing with anxiety: He tried meditation; he took psychedelics. Nothing worked. After four years of trying to feel better without medicine, Payne, at this point nearing 80, sought a new psychiatrist.
The doctor recommended another drug: Vortioxetine, brand name Trintellix. An atypical antidepressant, vortioxetine also targets serotonin but in a different way from SSRIs and SNRIs, directly modulating five serotonin neurotransmitters, something other antidepressant drugs do not do. The FDA approved Trintellix in 2013; its generic equivalent does not yet exist.
For Payne, the drug has worked wonders. He has been taking it for roughly two years.
“It was like breathing a sigh of relief,” he said. “Finally, I have something that works for me.”
‘Life-or-death situation’
About a decade ago, a small organization called the Campaign for Personal Prescription Importation began its work. Although the de minimis exemption wasn’t yet at risk of being lifted, activists came together to advocate for patients seeking more affordable prescription drug options.
“It was really developed as a way to counter what big pharma was talking,” Ken Hunter, executive director of the campaign, said.
Hunter explained that these drugs cost less in other countries because many foreign governments use prescription price controls that the U.S. does not.
Now, the Campaign for Personal Prescription Importation leads a national effort to stop what is effectively a ban on personal prescription imports. The eight-person team behind the campaign is mobilizing its 180,000 members nationwide to write letters and call their representatives.
Trump’s executive order cites the flow of fentanyl from Canada to the U.S. as its primary reasoning.
“I have received additional information and recommendations from various senior officials regarding, among other things, Canada’s lack of cooperation in stemming the flood of fentanyl and other illicit drugs across our northern border,” reads the text of Executive Order 14324.
Customs originally planned to implement the new regulations on Oct. 22, but pushed the start date to Jan. 20, 2027, to give “importers, brokers, and logistics providers additional time to update their processes,” according to a CBP press release. Hunter, however, believes his campaign’s efforts caused the 90-day delay announced by Customs earlier this month.
The anticipated increase in prescription costs for patients who currently order from abroad is not a minor one. Many of them are elderly or disabled and order multiple prescriptions from Planet Drugs Direct or similar companies. For these patients, several hundred dollars per prescription could add up to several thousand. Most people simply cannot afford that. In some cases, patients even rely on drugs from other countries that have not yet been FDA-approved and are therefore completely unavailable in the U.S.
“It’s going to be a life-or-death situation,” Hunter said.
The Upper Valley is in a unique geographic position: People like Payne could, in theory, drive to Canada to buy their prescriptions and bring them back across the border. But only Payne himself could make the trip; he couldn’t legally send a relative or a friend, according to Hunter. And at 81, frequently driving more than 200 miles round-trip to pick up medication is not ideal — if it’s even feasible at all.
When Payne heard that his access to Trintellix had been compromised, he reached out to Planet Drugs Direct and asked for help. The company sent him all the medication his prescription covered: A two-year supply. Payne paid for it out of pocket, and now boxes of pills cram a drawer in his house.
Unwilling to give up his ability to feel, he sees no other way forward.
