State boards of pharmacy strive to reshape state regulation of wholesale distributors to maintain the security and integrity of the US medication distribution system. Despite being faced with a complicated situation of illegal importation of drugs, erosion of state and national borders, and a complete disregard for US federal and state laws by entities engaged in the production and distribution of counterfeit drugs, the National Association of State Boards of Pharmacy (NABP) and state boards of pharmacy are working to develop and implement more stringent laws and regulations for the licensure and regulation of wholesale distributors. In citing incidences of counterfeit drugs from a global perspective and efforts that NABP has taken to implement the Prescription Drug Marketing Act of 1988, this discussion will highlight NABP’s recent efforts to monitor counterfeit and adulterated drugs entering the US drug distribution system, recommendations emanating from NABP’s Task Force on Counterfeit Drugs and Pedigree Requirements, and its Verified-Accredited Wholesale Distributors program.