Buying prescription drugs from outside the United States could become more common with millions of Americans unemployed and uninsured because of the coronavirus pandemic.

About two million Americans — 1.5% of adults — purchase medications outside the country to save money, according to a study by researchers at the University of Florida published online Wednesday in JAMA.

Researchers found that older adults, immigrants, and people with inadequate health insurance are most likely to turn to online pharmacies or drug stores outside American borders, where medications often cost a fraction of the domestic price. They say the pandemic, which has hit seniors and minorities hard and has financially strained thousands of families, could lead to more people turning to international pharmacies.

“With the economic and health consequences of COVID-19 disproportionately impacting minority and low-income populations, more people in those groups may be seeking an alternative way to meet their medication needs,” Young-Rock Hong, an assistant professor at the University of Florida College of Public Health and Health Professions and the study’s lead author, said in a statement.

Hong and his colleagues analyzed data from the 2015-17 National Health Interview Survey, which includes questions about medication use. According to their analysis:

  • Immigrants were more likely than U.S.-born adults to buy medication outside the country.
  • Hispanic survey respondents reported higher rates of international medication purchasing compared with white and non-Hispanic Black respondents, who were the least likely to buy medications outside the U.S.
  • Among adults under age 65, those who were uninsured or covered by Affordable Care Act marketplace plans were more likely to buy medication from outside the country compared with people with employer-sponsored health plans or Medicaid.
  • Seniors with traditional Medicare who did not have a prescription drug supplement plan bought medications internationally more often than seniors who had a supplemental plan or who were covered by a private Medicare Advantage plan, which typically includes drug benefits.

While not widely used as a means to buy affordable medication, according to the Florida study, international drug importation for personal use has gained attention in recent years as out-of-pocket health-care costs continue to soar — with prescription drugs accounting for a large share of patients’ costs.

People worried about health-care costs are more likely to delay appointments and ration or skip medication doses even when those medications were essential. A quarter of people with type 1 diabetes, for instance, ration insulin because of cost, according to T1 International, an advocacy group for reducing insulin prices.

Brand-name prescription medications are often much cheaper in other countries, and generics are often available for drugs that are only sold in brand-name form in the U.S.

The U.S. Food and Drug Administration prohibits the importation of prescription medication, but the rules have typically not been enforced for individuals buying small amounts of medication for personal use. Last July, the Trump administration said it would create a pathway to legalize drug importation for personal use from Canada.