ABSTRACT Counterfeit and unapproved drugs pose serious health risks to patients in the United States. High-profile cases, such as the incident concerning the counterfeit version of the oncology drug Avastin, demonstrate that there are major incentives such as demand, convenience, high profit, and low legal risks for rogue wholesale distributors to sell unapproved and counterfeit drugs. Wholesale drug distributors play a significant role in ensuring prescription medications are delivered safely and efficiently to health care practitioners and pharmacies. While the U.S. drug supply chain is one of the most secure and sophisticated in the world, there are networks of rogue wholesale drug distributors that target physicians and medical practices by advertising prescription drugs for sale at deeply discounted rates. Buying drugs from unlicensed sources puts patients at risk of consuming medications that may be unapproved, counterfeit, contaminated, or ineffective. It is critical that physicians be aware of the patient health risks and potential legal consequences of purchasing drugs from illegal sources. State medical boards can help address this issue given their important role of public protection in the licensing and oversight of the practice of medicine. The regulatory community serves as a key information hub and can provide targeted communication channels to educate physicians.