The substantive challenges posed by illegitimate Internet-based pharmacies require coordinated federal-, private-, and practitioner-level approaches. At the federal level, increased enforcement of existing federal laws is needed. Either through coordination with existing private pharmacy verification services or independently, a regularly updated national registry of certified online pharmacies should be developed to assist federal regulators, law enforcement, financial institutions, and Internet service providers in identifying and shutting down illegitimate online pharmacies. Meeting these goals is costly and labor-intensive and cannot be accomplished without additional federal funding, as acknowledged recently by Senators Charles Schumer (D, New York) and Jay Rockefeller (D, West Virginia) (19). Federal oversight to ensure that financial institutions, postal carriers, Internet service providers, and Internet search engines comply with these efforts is necessary, as is coordination among these entities to address the substantial number of pharmacy Web sites that are outside of U.S. jurisdiction.