A new study provides a closer look at a much-debated issue in the U.S. pharmacy market: Americans who buy prescription drugs from Canada.

The Canadian International Pharmacy Association (CIPA) polled about 2,700 American customers, and 64% of respondents said they purchase some or all of their health maintenance medications from a non-U.S. pharmacy because of the costs of filling the prescriptions. Another 22% reported that medications are not covered under their insurance plan.

Rising medication costs, unsurprisingly, are a chief reason for prescription purchases north of the border. Twenty-five percent of survey respondents acknowledged that lack of money has kept someone in their household from filling prescriptions during the last year. About 30% reported having to skip doses, split pills or take similar actions to curtail their use of prescribed medications because of high costs.

On average, customers surveyed reported spending $250 per month per prescription to order a 90-day supply of prescription medications for personal use and saving about $246, or 50%, per month by importing their medications from Canadian pharmacies.

The CIPA survey also revealed that respondents fear health consequences without the option to buy less expensive prescription medicines from Canada. Approximately 32% say they would only be able to fill some medications, and another 11% would not be able to buy any of their medications. The association noted that earlier reports have highlighted the issue of patients going off medications or rationing and the resulting harm to health, along with the costs to the health care system. What’s more, CIPA said, since many who import medications from Canada are seniors on Medicare, nonadherence and the resulting health implications and costs are a burden to the U.S. taxpayer.

A majority of respondents (86%) reported their age as 55 years or older. Additionally, 57% say their health insurance is self-funded and that they must fully cover the costs of their medications.

“Importing prescriptions from safe international pharmacies is the only choice many Americans have to afford their prescribed medications,” stated CIPA general manager Tim Smith. “CIPA member pharmacies provide a safe alternative for Americans on fixed-incomes to take their maintenance medications to manage their health.

CIPA is an association of licensed retail pharmacies that sell 90-day supplies of pharmaceuticals and maintenance medications (no controlled substances) to Canadians and Americans with a valid prescription. Member pharmacies display the CIPA verification seal on their website. The CIPA verification seal indicates that a pharmacy follows an array of best practices, including requiring a valid prescription for each order (verified with the patient’s doctor), quality controls, transparency about the pharmacy with contact information listed on their websites, and maintenance of patient privacy and confidentiality. CIPA said that since its launch in 2002, its member pharmacies have served more than 10 million U.S. patients and maintained a 100% safety record.