a

GAO

United States General Accounting Office

Report to the Chairman, Permanent 

Subcommittee on Investigations, 

Committee on Governmental Affairs, U.S. 

Senate

June 2004 INTERNET 

PHARMACIES

Some Pose Safety 

Risks for Consumers

GAO-04-820
www.gao.gov/cgi-bin/getrpt?GAO-04-820.

To view the full product, including the scope 

and methodology, click on the link above. 

For more information, contact Marcia Crosse 

at (202) 512-7119 or Robert J. Cramer at 

(202) 512-7455. 

Highlights of GAO-04-820, a report to the 

Chairman, Permanent Subcommittee on 

Investigations, Committee on 

Governmental Affairs, U.S. Senate 

June 2004

INTERNET PHARMACIES 

Some Pose Safety Risks for Consumers 

GAO obtained most of the prescription drugs it targeted from a variety of 

Internet pharmacy Web sites without providing a prescription. GAO 

obtained 68 samples of 11 different drugs—each from a different pharmacy 

Web site in the United States, Canada, or other foreign countries, including 

Argentina, Costa Rica, Fiji, India, Mexico, Pakistan, Philippines, Spain, 

Thailand, and Turkey. Five U.S. and all 18 Canadian pharmacy sites from 

which GAO received samples required a patient-provided prescription, 

whereas the remaining 24 U.S. and all 21 foreign pharmacy sites outside of 

Canada provided a prescription based on their own medical questionnaire or 

had no prescription requirement. Among the drugs GAO obtained without a 

prescription were those with special safety restrictions and highly addictive 

narcotic painkillers. 

GAO identified several problems associated with the handling, FDA approval 

status, and authenticity of the 21 samples received from Internet pharmacies 

located in foreign countries outside of Canada. Fewer problems were 

identified among pharmacies in Canada and the United States. None of the 

foreign pharmacies outside of Canada included required dispensing 

pharmacy labels that provided instructions for use, few included warning 

information, and 13 displayed other problems associated with the handling 

of the drugs. For example, 3 samples of a drug that should be shipped in a 

temperature- controlled environment arrived in envelopes without 

insulation. Manufacturer testing revealed that most of these drug samples 

were unapproved for the U.S. market; however, manufacturers found the 

chemical composition of all but 4 was comparable to the product GAO 

ordered. Four samples were determined to be counterfeit products or 

otherwise not comparable to the product GAO ordered. Similar to the 

samples received from other foreign pharmacies, manufacturers found most 

of those from Canada to be unapproved for the U.S. market; however, 

manufacturers determined that the chemical composition of all drug samples

obtained from Canada were comparable to the product GAO ordered. 

Some Internet pharmacies were not reliable in their business practices. 

Most instances identified involved pharmacies outside of the United States 

and Canada. GAO did not receive six orders for which it had paid. In 

addition, GAO found questionable entities located at the return addresses on 

the packaging of several samples, such as private residences. Finally, 14 of 

the 68 pharmacy Web sites from which GAO obtained samples were found to 

be under investigation by regulatory agencies for reasons including selling 

counterfeit drugs and providing prescription drugs where no valid doctorpatient relationship exists. Nine of these were U.S. sites, 1 a Canadian site, 

and 4 were other foreign Internet pharmacy sites. 

In commenting on a draft of this report, FDA generally agreed with its 

findings and conclusions. 

As the demand for and the cost of 

prescription drugs rise, many 

consumers have turned to the 

Internet to purchase drugs. 

However, the global nature of the 

Internet can hinder state and 

federal efforts to identify and 

regulate Internet pharmacies to 

help assure the safety and efficacy 

of products sold. Recent reports of 

unapproved and counterfeit drugs 

sold over the Internet have raised 

further concerns. 

GAO was asked to examine (1) the 

extent to which certain drugs can 

be purchased over the Internet 

without a prescription; (2) whether 

the drugs are handled properly, 

approved by the Food and Drug 

Administration (FDA), and 

authentic; and (3) the extent to 

which Internet pharmacies are 

reliable in their business practices. 

GAO attempted to purchase up to 

10 samples of 13 different drugs, 

each from a different pharmacy 

Web site, including sites in the 

United States, Canada, and other 

foreign countries. GAO determined 

whether the samples contained a 

pharmacy label with patient 

instructions for use and warnings 

on the labels or the packaging and 

forwarded the samples to their 

manufacturers to determine 

whether they were approved by 

FDA and authentic. GAO also 

confirmed the locations of several 

Internet pharmacies and identified 

those under investigation by 

regulatory agencies. 
Page i GAO-04-820 Internet Pharmacies

Contents

Letter 1

Results In Brief 5

Background 8

Most of the Targeted Prescription Drugs Were Purchased from 

Multiple Internet Pharmacies Without Providing a

Prescription 11

Most Problems Identified among Drug Samples Received from Other 

Foreign Internet Pharmacies 14

Some Internet Pharmacies Were Not Reliable in Their Business 

Practices 21

Concluding Observations 23

Agency and External Comments 23

Appendixes

Appendix I: Comments from the Food And Drug Administration 26

Appendix II: GAO Contact and Staff Acknowledgments 29

GAO Contact 29

Acknowledgments 29

Tables Table 1: Prescription Drugs Selected for Purchase from Internet 

Pharmacies 3

Table 2: Prescription Drugs Ordered and Received from Internet 

Pharmacies 11

Table 3: Prescription Requirements of Pharmacies from which We 

Obtained Samples 13

Table 4: Problems Observed Among Prescription Drug Samples 

Received 15

Figures Figure 1: Drug Sample Received Without Any Warnings or 

Instructions 16

Figure 2: Drug Sample Received Without Any Instructions in 

English 17

Figure 3: Drug Sample Shipped Improperly 18

Figure 4: Drug Samples Shipped in Unconventional Packaging 19

Figure 5: Drug Sample Received in Damaged Packaging 20
Contents

Page ii GAO-04-820 Internet Pharmacies

This is a work of the U.S. government and is not subject to copyright protection in the 

United States. It may be reproduced and distributed in its entirety without further 

permission from GAO. However, because this work may contain copyrighted images or 

other material, permission from the copyright holder may be necessary if you wish to 

reproduce this material separately.

Abbreviations

DEA Drug Enforcement Administration

FDA Food and Drug Administration

FDCA Federal Food, Drug, and Cosmetic Act

NABP National Association of Boards of Pharmacy

VIPPS Verified Internet Pharmacy Practice Sites
Page 1 GAO-04-820 Internet Pharmacies

United States General Accounting Office

Washington, D.C. 20548

A

June 17, 2004 Letr

The Honorable Norm Coleman

Chairman

Permanent Subcommittee on Investigations

Committee on Governmental Affairs

United States Senate

Dear Mr. Chairman:

As both the demand for and the cost of prescription medications have 

increased, the Internet has emerged as a growing marketplace for the 

purchase of prescription drugs. Internet pharmacies offer benefits for 

consumers, such as the convenience of shopping from home 24 hours a day 

and the ability to compare prices offered by multiple vendors. Various 

types of pharmacies offer prescription drugs over the Internet, including 

pharmacies that sell a wide range of drugs, require a patient to provide a 

prescription, and are sometimes associated with traditional chain drug 

stores, and other pharmacies that issue a prescription based on an online 

medical history questionnaire or have no prescription requirement.1

 

Like traditional pharmacies, Internet pharmacies are subject to state and 

federal statutes and regulations designed to ensure the safety and efficacy 

of the medications they dispense. However, the global nature of the 

Internet poses challenges for regulators. States have identified Internet 

pharmacies that do not comply with state pharmacy laws, but have 

reported difficulty locating, investigating, and taking action against the 

pharmacies when they are located beyond state borders.2

 Federal agencies 

have also taken steps to stop illegal sales of prescription drugs through 

Internet pharmacies, including by prosecuting Internet pharmacies that 

dispense medications without a valid prescription. The Food and Drug 

Administration (FDA) recently reported instances of drugs sold over the 

Internet that were improperly handled, such as improperly packaged drugs, 

drugs that were unapproved, and drugs that were not the authentic 

products consumers intended to purchase. Consumer complaints

1

 Throughout this report, we refer to each Internet Web site selling prescription drugs as an 

Internet pharmacy. 

2

 See U.S. General Accounting Office, Internet Pharmacies: Adding Disclosure 

Requirements Would Aid State and Federal Oversight, GAO-01-69 (Washington, D.C.: Oct. 

19, 2000). 
Page 2 GAO-04-820 Internet Pharmacies

regarding the business practices of some Internet pharmacies have raised 

further concerns associated with the use of Internet pharmacies to obtain 

prescription drugs. 

You asked us to assess:

1. the extent to which certain prescription drugs can be purchased over 

the Internet without a prescription; 

2. whether drugs sold by Internet pharmacies are handled properly, are 

FDA-approved, and authentic; and 

3. the extent to which Internet pharmacies are reliable in their business 

practices. 

To determine the extent to which certain prescription drugs can be 

purchased over the Internet, we attempted to place up to 10 orders for each 

of 13 drugs, each from a different online pharmacy. The 13 targeted drugs 

included top selling drugs, drugs with special safety restrictions or 

handling requirements, drugs that have been counterfeited in the past, and 

narcotics.3,4

 (See table 1.) We generally attempted to purchase each of the 

13 drugs with and without a prescription and produced our own 

prescriptions to enable us to do so. 5

 

3

 One of the drugs, Humulin N, is prescribed by physicians and is also available without a 

prescription. We included it among the drugs we ordered because of its special handling 

requirements.

4

 The Controlled Substances Act established a classification structure for drugs and 

chemicals used in the manufacture of drugs that are designated as controlled substances. 

Controlled substances are classified into five schedules on the basis of their medicinal 

value, potential for abuse, and safety or dependence liability. Schedule I is reserved for the 

most dangerous drugs that have no recognized medicinal use, while Schedule V is the 

classification used for the least dangerous drugs. We attempted to purchase Schedule II and 

Schedule III narcotics. See 21 U.S.C. §§ 811 and 812.

5

Due to the heightened regulation of controlled substances, we did not attempt to purchase 

narcotics from pharmacies that required patients to submit a prescription from their 

physicians. 
Page 3 GAO-04-820 Internet Pharmacies

Table 1: Prescription Drugs Selected for Purchase from Internet Pharmacies

Source: GAO analysis of information from drug manufacturers and the Drug Enforcement Administration.

a

Due to health risks associated with using this drug, there are special safety restrictions 

imposed on its use and distribution in the United States, such as a requirement that patients 

undergo certain medical tests and restrictions on the distribution of this drug to physicians 

with special training or expertise. Because of the health risks, FDA advises consumers not 

to purchase this drug over the Internet. 

We purchased drugs from Internet pharmacies that purported or appeared 

to be located in the United States, Canada, and other foreign countries.6

 We 

purchased drugs from Internet pharmacies with varying prescription 

requirements—some required purchasers to provide a prescription; some 

required purchasers to fill out an online medical history questionnaire, 

based on which a physician affiliated with the pharmacy issued a 

prescription; and some had no prescription requirement. We also 

purchased drugs from Internet pharmacies that are licensed online

Prescription drug Condition treated Remarks

Accutane® Acne Has special safety restrictionsa

Celebrex® Arthritis --

Clozaril® Schizophrenia Has special safety restrictionsa

Combivir® HIV --

Crixivan® HIV --

Epogen® Anemia Has special handling requirements

Humulin® N Diabetes Has special handling requirements

Lipitor® High cholesterol --

OxyContin® Pain Schedule II controlled substance, narcotic

Percocet® Pain Schedule II controlled substance, narcotic

Viagra® Male sexual 

dysfunction

--

Vicodin®/hydrocodone Pain Schedule III controlled substance, 

narcotic

Zoloft® Depression --

6

 We determined the location of Internet pharmacies from which we received drug samples 

based on information contained in the pharmacy Web sites and the return addresses and 

postmarks on the packages we received. Throughout this report, we refer to Internet 

pharmacies from countries other than the United States or Canada as “other foreign Internet 

pharmacies.”
Page 4 GAO-04-820 Internet Pharmacies

providers of prescription drugs.7 To identify the Internet pharmacies, we 

relied upon a list of Internet pharmacy Web sites compiled by a private 

consultant and provided to us by FDA; used Internet search engines, 

including Google, Yahoo, and Excite; and joined Internet pharmacy 

members-only Web sites, which provide enrolled members with lists of 

Web sites selling various prescription drugs. Because the universe of 

Internet pharmacies is not known, and because we obtained only one drug 

sample8

 from each pharmacy, our findings cannot be generalized. 

To assess whether the drug samples we received were handled properly, we 

identified whether the samples contained a pharmacy label9

 with patient 

instructions for use and whether warnings were included on the labels or 

along with the packaging. We define handling as the manner in which 

Internet pharmacies labeled, packaged, and shipped the prescription drug 

samples we received. In addition, we made other observations about the 

manner in which the drugs were handled and the condition of the 

packaging.10 To assess whether the drug samples we received were FDAapproved and authentic products, we forwarded the samples to 

manufacturers of the drugs that we ordered to make these determinations11

and identify any other safety concerns associated with the drugs or their

7

 We selected these Internet pharmacies from among those associated with large drugstore 

chains and those certified as Verified Internet Pharmacy Practice Sites (VIPPS) by the 

National Association of Boards of Pharmacy (NABP). VIPPS certification is voluntary and 

indicates that the pharmacy meets applicable state licensure requirements and certain other 

criteria established by NABP.

8

 This report uses the word “samples” to refer to our purchases of drugs from Internet 

pharmacies rather than to those drugs provided to practitioners and others for the purpose 

of promoting drug sales. See 21 U.S.C. § 353(c)(1)(2000). 

9

 The Federal Food, Drug, and Cosmetic Act defines “label” as the display of written, 

printed, or graphic matter upon the immediate container of any article and information 

required to be on the label must also be included on the outside container or wrapper, if any, 

of the retail package. See 21 U.S.C. § 321(k). 

10 We did not conduct a comprehensive review of the pharmacies’ compliance with all 

applicable federal and state laws and regulations. 

11 FDA has noted that chemical analysis of prescription drug samples may not always detect 

slight changes in the manufacturing process or different types or amounts of inactive 

ingredients, which can affect the comparability and thus therapeutic equivalence of drug 

samples. 
Page 5 GAO-04-820 Internet Pharmacies

handling.12 Where manufacturers commented on the adequacy of patient 

instructions for use or warnings, we relied upon their assessments rather 

than our own judgment. We did not disclose to the manufacturers 

information concerning the source of the drug samples we purchased, 

including whether the pharmacy purported to be located in the United 

States, Canada, or in another foreign country. 

To examine the reliability of the business practices of Internet pharmacies, 

we contacted Internet pharmacy customer service staff and several of the 

processing centers or brokers that handled the transactions. We also 

compared the return addresses of some drug samples received against the 

business addresses provided by the processing centers or brokers and 

listed on the Internet Web sites. Where the packaging of the drug samples 

received from foreign Internet pharmacies raised questions, we 

coordinated with Drug Enforcement Administration (DEA) to obtain 

information about the physical entity located at the return address on the 

package and the tenants or owners of the property. Finally, we obtained 

information from DEA and FDA regarding their ongoing investigations of 

organizations associated with the Internet pharmacies from which we 

purchased drugs. 

We conducted our work from January through June 2004 in accordance 

with generally accepted government auditing standards and in accordance 

with the standards of the President’s Council on Integrity and Efficiency.

Results In Brief We were able to obtain the majority of prescription drugs we targeted for 

purchase from a wide variety of domestic and foreign Internet pharmacies 

without providing a prescription. We obtained a total of 68 drug samples—

each from a different pharmacy in the United States, Canada, or other 

foreign countries—representing 11 of the 13 drugs we targeted for 

purchase.13 Drug samples received from other foreign pharmacies came 

from Argentina, Costa Rica, Fiji, India, Mexico, Pakistan, Philippines, 

Spain, Thailand, and Turkey. The samples included drugs with special 

12 We sent samples of the generic drug hydrocodone to the manufacturer of Vicodin for 

testing.

13 We did not obtain samples of 2 of the 13 drugs we targeted for purchase. We placed nine 

orders for one of the drugs but received none, and we identified no source from which to 

purchase the other drug in a manner consistent with our methodology’s protocols. 
Page 6 GAO-04-820 Internet Pharmacies

safety restrictions and addictive narcotic painkillers. Among the Internet 

pharmacies from which we obtained drugs, 5 U.S. and all 18 Canadian 

pharmacies required the patient to provide a prescription, whereas the 

remaining 24 U.S. and all 21 other foreign Internet pharmacies issued 

prescriptions based on their own medical questionnaires or had no 

prescription requirements. The availability and ease with which the drugs 

could be purchased varied by drug type. Top selling drugs such as 

Celebrex, Lipitor, Viagra, and Zoloft were readily available from multiple 

Internet pharmacies. Other drugs, such as those with special safety 

restrictions—Accutane and Clozaril—and narcotic painkillers—Percocet, 

OxyContin, and Vicodin—were offered for sale by fewer Internet 

pharmacies or were otherwise more difficult to obtain. 

We identified several problems associated with the handling, FDA-approval 

status, and authenticity of the 21 drug samples received from other foreign 

Internet pharmacies, but fewer problems among the U.S. and Canadian 

Internet pharmacies. None of the 21 samples from other foreign 

pharmacies included dispensing pharmacy labels that provided 

instructions for use, and only about one-third included warning 

information. Thirteen of the 21 samples displayed other problems 

associated with the handling of the drugs. For example, 3 samples of a 

drug that should be shipped in a temperature-controlled environment 

arrived in envelopes without insulation, and 5 samples contained tablets 

enclosed in punctured blister packs, potentially exposing the tablets to 

damaging light or moisture. Finally, manufacturers reported that most of 

the drug samples from other foreign pharmacies (19 of 21 samples) were 

unapproved for the U.S. market because, for example, the labeling14 or the 

facilities in which they were manufactured had not been approved by FDA; 

however, they reported that the chemical composition of all but 4 of the 

other foreign samples was comparable to the product we had ordered. 

Among the 4 exceptions, 2 samples were found to be counterfeit versions 

of the product we had ordered, containing a lesser amount of the active

14 The term “labeling” is broader than the term “label” and includes all labels and other 

written, printed, or graphic matter upon an article or its container or wrapper, or that 

accompanies the article. See 21 U.S.C. § 321(m). 
Page 7 GAO-04-820 Internet Pharmacies

ingredient, and 2 samples had a significantly different chemical 

composition than that of the product we had ordered.15 In contrast, all 47 

of the drug samples we received from U.S. and Canadian Internet 

pharmacies included dispensing pharmacy labels that generally provided 

patient instructions for use, 41 included warning information, and none 

displayed evidence of mishandling. Like the samples received from other 

foreign pharmacies, most of those from Canada were also unapproved for 

the U.S. market; however, manufacturers determined that the chemical 

composition of all were comparable to the product we had ordered. 

Finally, manufacturer testing identified 1 sample from a U.S. pharmacy that 

was inappropriately removed from the sealed manufacturer container and 

dispensed in a pharmacy bottle. 

Some Internet pharmacies—mostly other foreign pharmacies—were not 

reliable in their business practices. We did not receive six of the orders we 

placed and paid for, five of which were placed with other foreign Internet 

pharmacies and one of which was placed with a pharmacy whose location 

we could not determine. Also, we determined that several of the drug 

samples were sent from locations that raise questions, such as from private 

residences. We also observed Internet pharmacies that obscured details 

about the drugs sold, such as other foreign pharmacies from which we 

ordered brand name drugs, but then received a generic or foreign version 

of the drug. Finally, about 21 percent of the Internet pharmacies that sent 

us samples were found to be under investigation by DEA or FDA. Reasons 

for the investigations included allegations of selling adulterated, 

misbranded, or counterfeit drugs and providing prescription drugs where 

no valid doctor-patient relationship exists. Nine of these pharmacies were 

from the United States, one from Canada, and four from other foreign 

countries. 

We provided a draft of this report to FDA, which generally agreed with our 

findings and conclusions. We provided a draft of this report to DEA for a 

technical review and it informed us it had no comments. We also provided 

each manufacturer with segments of this draft report that related to its 

product(s). They provided technical comments, which we incorporated 

where appropriate.

15 Under federal law, counterfeit drugs include those sold under a product name without 

proper authorization, which falsely purport or are represented to be a particular product. 

See 21 U.S.C. § 321(g)(2). Counterfeit products may include products without the active 

ingredient, with an insufficient quantity of the active ingredient, or with the wrong active 

ingredient. 
Page 8 GAO-04-820 Internet Pharmacies

Background Three general types of Internet pharmacies sell prescription drugs directly 

to consumers. First, some Internet pharmacies operate much like 

traditional drugstores, selling a wide range of prescription drugs and 

requiring consumers to submit a prescription from their physicians before 

their orders are filled. In some instances, these Internet pharmacies are 

affiliated with traditional chain drug stores. Second, other Internet 

pharmacies may sell a more limited range of drugs, often specializing in 

certain lifestyle medications, such as those that treat sexual dysfunction or 

assist in weight control. These Internet pharmacies typically require 

consumers to fill out an online medical history questionnaire in place of a 

traditional examination by a physician, and issue a prescription after a 

physician affiliated with the pharmacy reviews the questionnaire. Still 

other Internet pharmacies dispense drugs without a prescription. 

In the United States, the practice of pharmacy is regulated by state boards 

of pharmacy, which establish and enforce standards intended to protect the 

public. State boards of pharmacy also license pharmacists and 

pharmacies.16 To legally dispense a prescription drug, a licensed 

pharmacist working in a licensed pharmacy must be presented a valid 

prescription from a licensed health care professional.17 The requirement 

that drugs be prescribed and dispensed by licensed professionals helps 

ensure patients receive the proper dose, take the medication correctly, and 

are informed about warnings, side effects, and other important information 

about the drug. 

16 Most states also license out-of-state pharmacies that dispense drugs to state residents, and 

some states regulate Internet pharmacies in a similar manner. See GAO-01-69. 

17 States also license health care professionals, grant them prescribing privileges, and 

outline standards of practice in state medical practice laws.
Page 9 GAO-04-820 Internet Pharmacies

Under the Federal Food, Drug, and Cosmetic Act (FDCA), as amended, 

FDA is responsible for ensuring the safety, effectiveness, and quality of 

domestic and imported drugs. To do so, FDA establishes standards for the 

safety, effectiveness, and manufacture of drugs that must be met before 

they are approved for the U.S. market. To gain approval, a drug 

manufacturer must demonstrate that a drug is safe and effective, and that 

the manufacturing methods and controls that will be used in the specific 

facility where it will be manufactured meet FDA standards. The same drug 

manufactured in another facility not approved by FDA—such as a foreignmade version of an approved drug—may not be sold legally in the United 

States. Drugs are subject to other statutory and regulatory standards 

relating to purity, labeling, manufacturing, and packaging.18 Failure to meet 

these standards could result in a drug being considered adulterated or 

misbranded and therefore illegal for sale, which could result in FDA 

enforcement action.19 

The FDCA requires that drugs be dispensed with labels that include the 

name of the prescriber, directions for use, and cautionary statements, 

among other things. A drug is considered misbranded if its labeling or 

container is misleading, or if the label fails to include required information. 

Prescription drugs dispensed without a prescription are also considered 

misbranded. In addition, if a drug is susceptible to deterioration and must, 

for example, be maintained in a temperature-controlled environment, it 

must be packaged and labeled in accordance with regulations and 

manufacturer standards. Drugs must also be handled to prevent 

adulteration, which may occur, for example, if held under unsanitary 

conditions leading to possible contamination.

18See, e.g., 21 U.S.C. §§ 351(b), 352(g), 352(h), 352(p), 355(d); 21 C.F.R. pts. 201 and 210 

(2003). Additional requirements apply to controlled substances under the Controlled 

Substances Act and DEA’s implementing regulations.

19 Other federal agencies also play a role with respect to the regulation of prescription drugs 

under various circumstances. See GAO-01-69. GAO is currently reviewing available data on 

the volume of prescription drugs entering the United States through the Postal Service and 

private couriers and the policies and practices of federal agencies charged with preventing 

unapproved prescription drugs from entering the country. 
Page 10 GAO-04-820 Internet Pharmacies

FDA-approved drugs manufactured in foreign countries, including those 

sold over the Internet, are subject to the same requirements as domestic 

drugs.20 Further, imported drugs may be denied entry into the United 

States if they “appear” to be unapproved, adulterated, or misbranded, 

among other things. While the importation of such drugs may be illegal, 

FDA has allowed individuals to bring small quantities of certain drugs into 

the United States for personal use under certain circumstances.21

Internet pharmacies pose challenges for regulators. State boards of 

pharmacy in many states have reported difficulty identifying Internet 

pharmacies located outside of their borders and have limited ability and 

authority to investigate and act against pharmacies that do not comply with 

state pharmacy laws when they are identified. In 2000, nearly half of the 

state boards had identified consumer complaints against Internet 

pharmacies or reported problems with Internet pharmacies not complying 

with state pharmacy laws. Additionally, state medical boards have reported 

receiving complaints about physicians prescribing drugs over the Internet 

without performing an examination of the patient.22 Federal agencies have 

taken steps to stop the illegal sales of prescription drugs and other 

substances by Internet pharmacies. For example, FDA has taken 

enforcement actions against Internet pharmacies; the Department of 

Justice has prosecuted Internet pharmacies and physicians for dispensing 

medications without a valid prescription; and DEA has investigated 

Internet pharmacies for illegal distribution of controlled substances. 

20 The recently enacted Medicare Prescription Drug, Improvement, and Modernization Act 

of 2003 directed the Secretary of Health and Human Services to create a system for the 

importation of prescription drugs from Canada upon certification that the implementation 

of the program would (1) pose no additional risk to the public’s health and safety and 

(2) result in a significant reduction in the cost of covered products to the American 

consumer. The act directed the Secretary to complete a study on drug importation from 

Canada within 1 year of enactment. See Pub. L. No. 108-173, §§ 1121, 1122, 117 Stat. 2066, 

2464-69 (to be codified at 21 U.S.C. §§ 384, 384 note).

21FDA guidelines indicate that agency officials may use their discretion to allow importation 

if (1) the intended use is identified, is not for a serious condition, and the product is not 

known to represent a significant health risk; or (2) if the intended use is unapproved and for 

a serious condition for which effective treatment may not be available domestically, and 

other conditions are also met. See Chapter 9 of FDA’s Regulatory Procedures Manual. 

http://www.fda.gov/ora/compliance_ref/rpm/default.htm. Downloaded June 10, 2004.

22 In 2000, 39 of 45 state medical boards responding to our survey indicated that a physician 

who issued a prescription on the basis of an online questionnaire would not satisfy the 

standard of good medical practice required under their states’ laws. See GAO-01-69.
Page 11 GAO-04-820 Internet Pharmacies

Most of the Targeted 

Prescription Drugs 

Were Purchased from 

Multiple Internet 

Pharmacies Without 

Providing a 

Prescription

We were able to obtain the majority of prescription drugs we targeted for 

purchase from a wide variety of domestic and foreign Internet pharmacies 

without providing a prescription. Five U.S. and all 18 Canadian pharmacies 

from which we obtained drug samples required a patient-provided 

prescription, whereas the remaining 24 U.S. and all 21 other foreign 

pharmacies from which we obtained samples either provided a 

prescription based on an online medical questionnaire or had no 

prescription requirement. Although we obtained samples of most of the 

drugs we targeted for purchase, some drugs, such as those with special 

safety restrictions and narcotics, were available from fewer sources or 

were more difficult to obtain. 

Samples of 11 of 13 Targeted 

Drugs Obtained from 

Internet Pharmacies

We obtained 1 or more samples of 11 of the 13 drugs we targeted, both with 

and without a patient-provided prescription. In total, we placed 90 

orders—each with a different Internet pharmacy in the United States, 

Canada, and other foreign countries—and received 68 samples. Drug 

samples we received from other foreign pharmacies came from Argentina, 

Costa Rica, Fiji, India, Mexico, Pakistan, Philippines, Spain, Thailand, and 

Turkey. Most of the drugs—45 of 68—were obtained without a patientprovided prescription. These included drugs for which physician 

supervision is of particular importance due to the possibility of severe side 

effects, such as Accutane, or the high potential for abuse and addiction, 

such as the narcotic painkiller hydrocodone. (See table 2.)

Table 2: Prescription Drugs Ordered and Received from Internet Pharmacies 

Drug ordered

Orders 

placeda

Drug samples 

receivedb

Drug samples obtained 

without a prescription 

provided by the patient

Accutane 10 6c 3

Celebrex 10 9 7

Clozaril 9 0 0

Combivir 6 5 1

Crixivan 6 6 2

Epogen 1 1 0

Humulin N 7 4 3

Lipitor 10 9 6

OxyContin 1 1 1
Page 12 GAO-04-820 Internet Pharmacies

Source: GAO.

Note: The samples were shipped by FedEx (24), UPS (3), the U.S. Postal Service (39), and other 

couriers (2). 

a

Does not include attempted orders that were not accepted. We did not reach our goal of placing 10 

orders for each drug because we could not always locate 10 sources from which we could purchase 

the drugs in a manner consistent with our methodology’s protocols. 

b

We did not receive a drug sample for every order placed. Reasons included the drug being out of 

stock, a requirement that physicians prescribing certain drugs be part of a registry, and pharmacy 

requests for follow-up information we could not provide. In several instances, we could not determine 

why an order placed was not received. 

c

Includes one sample we could not link to an order we placed. 

d

Although we placed orders for Vicodin, we did not receive any samples of the brand name version of 

the drug; all nine samples received were of the generic equivalent hydrocodone.

Although most of the samples we received were obtained without a patientprovided prescription, prescription requirements varied. Five U.S. and all 

18 Canadian pharmacies from which we obtained drug samples required 

the patient to provide a prescription. The remaining 24 U.S. pharmacies 

generally provided a prescription based on a general medical questionnaire 

filled out online by the patient. Questionnaires requested information on 

the patient’s physical characteristics, medical history, and condition for 

which drugs were being purchased. Several pharmacy Web sites indicated 

that a U.S.-licensed physician reviews the completed questionnaire and 

issues a prescription. The other foreign Internet pharmacies we ordered 

from generally had no prescription requirements, and many did not seek 

information regarding the patient’s medical history or condition. The 

process for obtaining a drug from many of these pharmacies involved only 

selecting the desired medication and submitting the necessary billing and 

shipping information. (See table 3.)

Percocet 0 0 0

Viagra 10 9 7

Vicodin/hydrocodone 10 9c,d 9

Zoloft 10 9 6

Total 90 68 45

(Continued From Previous Page)

Drug ordered

Orders 

placeda

Drug samples 

receivedb

Drug samples obtained 

without a prescription 

provided by the patient
Page 13 GAO-04-820 Internet Pharmacies

Table 3: Prescription Requirements of Pharmacies from which We Obtained 

Samples 

Source: GAO.

The Availability and Ease of 

Purchase Varied by Drug

While we obtained samples of most of the drugs we targeted for purchase 

on the Internet, certain drugs were more widely available and easier to 

purchase than others. The top selling drugs Celebrex (a pain reliever), 

Lipitor (a cholesterol-lowering drug), Viagra (a medication for male sexual 

dysfunction), and Zoloft (an antidepressant) were available from multiple 

pharmacies. We placed 10 orders for each of these four drugs with little 

difficulty. 

Other drugs were available from fewer sources or were more difficult to 

obtain. Some of our orders for drugs with special safety restrictions were 

more closely scrutinized. For example, one order we placed for Accutane 

was declined by a U.S. pharmacy. Accutane is an acne medication that may 

cause birth defects and serious mental disturbances leading to suicide 

among some users. The pharmacy indicated that it declined our order 

because the physician was not included on a national registry of qualified 

prescribers.23 Similarly, one U.S. and one Canadian Internet pharmacy 

declined our order for Clozaril. According to its manufacturer, patients 

taking Clozaril, an antipsychotic medication, must have ongoing blood tests 

to monitor for the development of a fatal blood disorder that can occur 

during treatment. The U.S. pharmacy that declined our order indicated that 

Clozaril should not have been offered for sale on its Web site, and the 

Canadian pharmacy indicated that more stringent prescription 

Prescription requirement

U.S. Internet 

pharmacies

Canadian 

Internet 

pharmacies

Other foreign 

Internet 

pharmacies

Prescription from patient’s 

physician must be provided 5 18 0

Web site provides prescription 

based on questionnaire 24 0 3

No prescription required 0 0 18

23 Risk management protocols developed by the manufacturer in agreement with FDA 

prohibit U.S. pharmacies from accepting electronic prescriptions for this drug.
Page 14 GAO-04-820 Internet Pharmacies

requirements prevented it from dispensing the drug to patients outside of 

Canada. 

Narcotic pain medications—OxyContin, Percocet, and Vicodin—were also 

less readily available. Despite extensive searching of Internet pharmacy 

sites, we found few that sold these drugs without a prescription. Other 

factors also hindered our ability to purchase these drugs. For example, 

some pharmacies that advertised the narcotics did not actually sell them. 

Rather, they attempted to substitute a different, often less potent and 

nonnarcotic drug once the order was placed. In addition, several 

pharmacies that offered narcotics required payment by means that were 

beyond our scope, such as check, bank transfers, or “e-gold” exchanges.24 

We were able to place orders for the generic version of Vicodin at several 

U.S. pharmacies; however, some of these pharmacies required not only an 

online medical questionnaire, but also a telephone consultation with a 

pharmacy-designated physician in order to obtain a prescription. Finally, 

we were able to place only one order for a drug purporting to be 

OxyContin, and only after locating the source by paying a membership fee 

and joining an Internet pharmacy drug club, which referred us to the site. 

Most Problems 

Identified among Drug 

Samples Received from 

Other Foreign Internet 

Pharmacies

We identified several problems associated with the handling, FDA-approval 

status, and authenticity of the 21 drug samples we received from other 

foreign Internet pharmacies. None included required pharmacy labels that 

provided patient instructions for use, and few provided warning 

information. Thirteen were shipped improperly, were packaged 

unconventionally, or arrived damaged. Manufacturers reported that most 

of the samples they reviewed at our request from other foreign pharmacies 

were not approved by FDA for the United States—although most had a 

comparable chemical composition to the product we ordered—and 4 were 

either counterfeit products or otherwise not comparable to the product we 

ordered. While most of the samples received from Canadian Internet 

pharmacies were unapproved for the U.S. market, they otherwise had a 

comparable chemical composition, and the samples from U.S. and 

Canadian pharmacies exhibited few problems otherwise. Table 4 

summarizes the problems we identified among the 68 samples we received. 

24 “e-gold” is a system where sellers and buyers can establish accounts and electronically 

exchange values or amounts of gold in order to complete Internet transactions.
Page 15 GAO-04-820 Internet Pharmacies

Table 4: Problems Observed Among Prescription Drug Samples Received

Source: GAO and drug manufacturers.

Notes:

Drug names indicated are those that GAO ordered. The samples we received were not the brand 

name drugs we ordered in all instances.

Drug samples do not add to 68 because some samples exhibited more than one problem.

All Drug Samples Received 

from Other Foreign 

Pharmacies Exhibited 

Problems Associated with 

Their Handling

None of the 21 prescription drug samples we received from other foreign 

Internet pharmacies included a dispensing pharmacy label that provided 

patient instructions for use, and only 6 of the samples came with warning 

information.25 Lack of instructions and warnings on these drugs leaves 

consumers who take them at risk for potentially dangerous drug 

interactions or side effects from incorrect or inappropriate use. For 

example, we received 2 samples purporting to be Viagra, a drug used to 

treat male sexual dysfunction, without any warnings or instructions for 

use. (See fig. 1.) According to its manufacturer, this drug should not be 

Pharmacy 

location

No pharmacy 

label with 

instructions 

for use 

(23 samples)

No warning 

information

(21 samples)

Improperly 

shipped or 

dispensed

(4 samples)

Unconventional 

packaging

(6 samples)

Damaged 

packaging

(5 samples)

Not approved 

for U.S. 

market 

(35 samples)

Counterfeit or 

otherwise not 

comparable to 

product ordered

(4 samples)

Canadian Celebrex (2)

Zoloft (2)

Accutane (3)

Combivir (3)

Crixivan (3)

Humulin N (1)

Lipitor (2)

Viagra (1)

Zoloft (3)

Other 

foreign

Accutane (3)

Celebrex (3)

Combivir (1)

Crixivan (2)

Humulin N (3)

 Lipitor (3)

OxyContin (1)

Viagra (2)

Zoloft (3)

Accutane (2)

Celebrex (3)

Crixivan (2)

Lipitor (3)

OxyContin (1)

Viagra (2)

Zoloft (2)

Humulin N (3) Accutane (1)

Celebrex (1)

Crixivan (2)

OxyContin (1)

Viagra (1)

Accutane (2)

Celebrex (1)

Crixivan (1)

Lipitor (1)

Accutane (2)

Celebrex (3)

Combivir (1)

Crixivan (1)

Humulin N (3)

Lipitor (3)

OxyContin (1)

Viagra (2)

Zoloft (3)

Accutane (1)

OxyContin (1)

Viagra (2)

U.S. Celebrex (1)

Zoloft (1)

Lipitor (1)

Zoloft (1)

Crixivan (1)

25 One of the samples we received from other foreign pharmacies included a dispensing 

pharmacy label; however, this label lacked patient instructions for use.
Page 16 GAO-04-820 Internet Pharmacies

prescribed for individuals who are currently taking certain heart 

medications, as it can lower blood pressure to dangerous levels. 

Additionally, 2 samples of Roaccutan, a foreign version of Accutane, 

arrived without any instructions in English. (See fig. 2.) As noted, possible 

side effects of this drug include birth defects and severe mental 

disturbances. Compounding the concerns regarding the lack of warnings 

and patient instructions for use, none of the other foreign pharmacies 

ensured patients were under the care of a physician by requiring that a 

prescription be submitted before the order is filled. 

Figure 1: Drug Sample Received Without Any Warnings or Instructions

Note: Sample purporting to be Viagra® arrived without any warning information or instructions for use.

Source: GAO.
Page 17 GAO-04-820 Internet Pharmacies

Figure 2: Drug Sample Received Without Any Instructions in English

Note: Sample of Roaccutan®, a foreign version of Accutane®, arrived without instructions for use in 

English.

We observed other evidence of improper handling among 13 of the 21 drug 

samples we received from other foreign Internet pharmacies. For example, 

three samples of Humulin N were not shipped in accordance with 

manufacturer handling specifications. Despite the requirement that this 

drug be stored under temperature-controlled and insulated conditions, the 

samples we received were shipped in envelopes without insulation. (See 

fig. 3.) Similarly, 6 samples of other drugs were shipped in unconventional 

packaging, in some instances with the apparent intention of concealing the 

actual contents of the package. For example, the sample purporting to be 

OxyContin was shipped in a plastic compact disc case wrapped in brown 

packing tape—no other labels or instructions were included, and a sample 

of Crixivan was shipped inside a sealed aluminum can enclosed in a box 

labeled “Gold Dye and Stain Remover Wax.” (See fig. 4.) Additionally, 5 

Source: GAO.
Page 18 GAO-04-820 Internet Pharmacies

samples we received were damaged and included tablets that arrived in 

punctured blister packs, potentially exposing pills to damaging light or 

moisture. (See fig. 5.) One drug manufacturer noted that damaged 

packaging may also compromise the validity of drug expiration dates. 

Figure 3: Drug Sample Shipped Improperly

Note: Despite the requirement that Humulin®N be stored under temperature-controlled and insulated 

conditions, samples we received were shipped in an envelope without insulation.

Source: GAO.
Page 19 GAO-04-820 Internet Pharmacies

Figure 4: Drug Samples Shipped in Unconventional Packaging

Note: Sample purporting to be OxyContin® was shipped in a plastic compact disc case wrapped in 

brown packing tape—no other labels or instructions were included.

Note: Sample of Crixivan® was shipped inside a sealed aluminum can enclosed in a box labeled “Gold 

Dye and Stain Remover Wax.”

Source: GAO.

Source: GAO.
Page 20 GAO-04-820 Internet Pharmacies

Figure 5: Drug Sample Received in Damaged Packaging

Note: Sample of Crixivan®, a moisture sensitive drug, arrived in punctured blister packs.

Most Drug Samples 

Received from Other 

Foreign Pharmacies Were 

Unapproved, Four Were Not 

Authentic

Among the 21 drug samples from other foreign pharmacies, manufacturers 

determined that 19 were not approved for the U.S. market for various 

reasons, including that the labeling or the facilities in which they were 

manufactured had not been approved by FDA.26 For example, the 

manufacturer of one drug noted that 2 samples we received of that drug 

were packaged under an alternate name used for the Mexican market. The 

manufacturer of another drug found that 3 samples we received of that 

drug were manufactured at a facility unapproved to produce drugs for the 

U.S. market. In all but 4 instances, however, manufacturers determined 

that the chemical composition of the samples we received from other 

foreign Internet pharmacies was comparable to the chemical composition 

Source: GAO.

26 The manufacturer of one of the remaining two samples determined it was approved for 

the U.S. market and the manufacturer of the other sample could not make a determination. 
Page 21 GAO-04-820 Internet Pharmacies

of the drugs we had ordered. Two samples of one drug were found by the 

manufacturer to be counterfeit and contained a different chemical 

composition than the drug we had ordered. In both instances the 

manufacturer reported that samples had less quantity of the active 

ingredient, and the safety and efficacy of the samples could not be 

determined. Manufacturers also found 2 additional samples to have a 

significantly different chemical composition than that of the product we 

had ordered. 

Drugs Received from 

Canadian and U.S. Internet 

Pharmacies Exhibited 

Fewer Problems 

All 47 of the prescription drug samples we received from Canadian and U.S. 

Internet pharmacies included labels from the dispensing pharmacy that 

generally provided patient instructions for use and 87 percent of these 

samples (41 of 47) included warning information. Furthermore, all samples 

were shipped in accordance with special handling requirements, where 

applicable, and arrived undamaged. Manufacturers reported that 16 of the 

18 samples from Canadian Internet pharmacies were unapproved for sale 

in the United States, citing for example unapproved labeling and packaging. 

However, the samples were all found to be comparable in chemical 

composition to the products we ordered. Finally, the manufacturer found 

that 1 sample of a moisture-sensitive medication from a U.S. pharmacy was 

inappropriately removed from the sealed manufacturer container and 

dispensed in a pharmacy bottle. 

Some Internet 

Pharmacies Were Not 

Reliable in Their 

Business Practices

We observed questionable characteristics and business practices of some 

of the Internet pharmacies from which we received drugs. Most, but not 

all, involved other foreign pharmacies. These included pharmacies that 

accepted payment but did not provide the drugs ordered, shipments of 

drugs with questionable return addresses, pharmacies that obscured 

details about the drugs sold, and pharmacies that were under investigation 

by regulatory agencies.
Page 22 GAO-04-820 Internet Pharmacies

We ultimately did not receive six of the orders we placed and paid for, 

suggesting the potential fraudulent nature of some Internet pharmacies or 

entities representing themselves as such.27 The six orders were for 

Clozaril, Humulin N, and Vicodin, and cost over $700 in total. Five of these 

orders were placed with non-Canadian foreign pharmacies and one was 

placed with a pharmacy whose location we could not determine. We 

followed up with each pharmacy in late April and early May of 2004 to 

determine the status. Three indicated they would reship the product, but 

as of June 10, 2004, we had not received the shipments. Three others did 

not respond to our inquiry.28 

We determined that at least eight of the return addresses included on 

samples we received from other foreign Internet pharmacies were shipped 

from locations that raise questions about the entities that provided the 

samples. For example, we found a shopping mall in Buenos Aires, 

Argentina, at the return address provided on a sample of Lipitor. 

Authorities assisting us in locating this address found it impossible to 

identify which, if any, of the many retail stores mailed the package. The 

return address for a sample of Celebrex was found to be a business in 

Cozumel, Mexico, but representatives of that business informed authorities 

that it had no connection to an Internet pharmacy operation. Finally, the 

return addresses on samples of Humulin N and Zoloft were found to be 

private residences in Lahore, Pakistan.

Certain practices of Internet pharmacies may render it difficult for 

consumers to know exactly what they are buying. Some non-Canadian 

foreign Internet pharmacies appeared to offer U.S. versions of brand name 

drugs on their Web sites, but attempted to substitute an alternative drug 

during the order process. In some cases, other foreign pharmacies 

substituted alternative drugs after the order was placed. For example, one 

Internet pharmacy advertised brand name Accutane, which we ordered. 

The sample we received was actually a generic version of the drug made by 

an overseas manufacturer. 

27 NABP has reported receiving complaints from consumers who state they have provided 

payment to various Internet pharmacies, but have not received the products ordered.

28We received no notice from federal agencies indicating that our drug samples had been 

seized, nor did the Internet pharmacies we contacted about unreceived shipments indicate 

they had received such notification.
Page 23 GAO-04-820 Internet Pharmacies

About 21 percent of the Internet pharmacies from which we received drugs 

(14 of 68) were under investigation by regulatory agencies. The reasons for 

the investigations by DEA and FDA include allegations of selling controlled 

substances without a prescription; selling adulterated, misbranded, or 

counterfeit drugs; selling prescription drugs where no doctor-patient 

relationship exists; smuggling; and mail fraud. The pharmacies under 

investigation were concentrated among the U.S. pharmacies that did not 

require a patient-provided prescription (9) and other foreign (4) 

pharmacies. One Canadian pharmacy was also included among those 

under investigation. 

Concluding 

Observations 

Consumers can readily obtain many prescription drugs over the Internet 

without providing a prescription—particularly from certain U.S. and 

foreign Internet pharmacies outside of Canada. Drugs available include 

those for which patients should be monitored for side effects or where the 

potential for abuse is high. For these types of drugs in particular, a 

prescription and physician supervision can help ensure patient safety. In 

addition to the lack of prescription requirements, some Internet 

pharmacies can pose other safety risks for consumers. Many foreign 

Internet pharmacies outside of Canada dispensed drugs without 

instructions for patient use, rarely provided warning information, and in 

four instances provided drugs that were not the authentic products we 

ordered. Consumers who purchase drugs from foreign Internet 

pharmacies that are outside of the U.S. regulatory framework may also 

receive drugs that are unapproved by FDA and manufactured in facilities 

that the agency has not inspected. Other risks consumers may face were 

highlighted by the other foreign Internet pharmacies that fraudulently 

billed us, provided drugs we did not order, and provided false or 

questionable return addresses. It is notable that we identified these 

numerous problems despite the relatively small number of drugs we 

purchased, consistent with problems recently identified by state and 

federal regulatory agencies.

Agency and External 

Comments

In commenting on a draft of this report, FDA generally agreed with our 

findings and conclusions and made suggestions to clarify or expand upon 

its contents (see app. II). FDA commented that, while the draft report 

noted Internet pharmacy Web sites purported or appeared to be from 

various countries, the draft did not demonstrate that the drug samples we 

received were actually sent from those countries, such as by discussing 
Page 24 GAO-04-820 Internet Pharmacies

return addresses and postmarks on the samples. FDA suggested we 

indicate the methods we used to determine the samples’ origins. We 

modified the report to indicate that we determined the location of the 

Internet pharmacy Web sites from which we received drug samples based 

on information contained in the pharmacy Web sites and the return 

addresses and postmarks on the packages we received. FDA also 

commented that our finding that certain unapproved drugs were 

chemically equivalent to the brand name products we ordered was 

misleading. FDA noted that chemical equivalence testing may not always 

determine whether a drug is comparable in all respects to the FDAapproved drug and therefore fully therapeutically equivalent. We relied on 

manufacturers to determine whether the drug samples we received were 

comparable to their own FDA-approved brand name version of the drug, 

and manufacturers conducted a range of tests to make this determination. 

Nevertheless we modified the final report to note the potential limitations 

to chemical equivalence testing. FDA also made several observations 

about the practices of Internet pharmacies and provided technical 

comments, which we incorporated where appropriate. 

We also provided a draft of this report to DEA for technical comments and 

to ensure information we reported did not compromise its ongoing 

investigations. The agency responded that it had no comments. 

Finally, we provided segments of the draft report to the manufacturer of 

each drug sample we received. Each manufacturer reviewed the segments 

of the draft report relating to its own product(s), and provided technical 

comments, which we incorporated as appropriate.

As agreed with your office, unless you publicly announce this report’s 

contents, we plan no further distribution until 30 days after its issue date. 

At that time, we will send copies to the Acting Commissioner of FDA, the 

Administrator of DEA, and others upon request. In addition, this report 

will be available at no charge at the GAO Web site at http://www.gao.gov.
Page 25 GAO-04-820 Internet Pharmacies

Please call Marcia Crosse at (202) 512-7119 or Robert Cramer at (202) 512-

7455 if you have any questions. Another contact and other major 

contributors are listed in appendix I.

Sincerely yours,

Marcia Crosse

Director, Health Care—Public Health and Military Health Care Issues 

Robert J. Cramer 

Managing Director, Office of Special Investigations
Page 26 GAO-04-820 Internet Pharmacies

Appendix I

Comments from the Food And Drug Apendxies

Administration ApendxiI
Appendix I

Comments from the Food And Drug 

Administration

Page 27 GAO-04-820 Internet Pharmacies
Appendix I

Comments from the Food And Drug 

Administration

Page 28 GAO-04-820 Internet Pharmacies
Page 29 GAO-04-820 Internet Pharmacies

Appendix II

GAO Contact and Staff Acknowledgments ApendxiI

GAO Contact Randy M. DiRosa, (312) 220-7671

Acknowledgments Major contributors to this report were Margaret Smith, Corey HouchinsWitt, Andrew O’Connell, Ramon Rodriguez, Julian Klazkin, Helen 

Desaulniers, Robert Copeland, and Harold Lewis. 

(290339)
GAO’s Mission The General Accounting Office, the audit, evaluation and investigative arm of 

Congress, exists to support Congress in meeting its constitutional responsibilities 

and to help improve the performance and accountability of the federal government 

for the American people. GAO examines the use of public funds; evaluates federal 

programs and policies; and provides analyses, recommendations, and other 

assistance to help Congress make informed oversight, policy, and funding 

decisions. GAO’s commitment to good government is reflected in its core values of 

accountability, integrity, and reliability.

Obtaining Copies of 

GAO Reports and 

Testimony

The fastest and easiest way to obtain copies of GAO documents at no cost is 

through the Internet. GAO’s Web site (www.gao.gov) contains abstracts and fulltext files of current reports and testimony and an expanding archive of older 

products. The Web site features a search engine to help you locate documents 

using key words and phrases. You can print these documents in their entirety, 

including charts and other graphics.

Each day, GAO issues a list of newly released reports, testimony, and 

correspondence. GAO posts this list, known as “Today’s Reports,” on its Web site 

daily. The list contains links to the full-text document files. To have GAO e-mail this 

list to you every afternoon, go to www.gao.gov and select “Subscribe to 

e-mail alerts” under the “Order GAO Products” heading.

Order by Mail or Phone The first copy of each printed report is free. Additional copies are $2 each. A check 

or money order should be made out to the Superintendent of Documents. GAO 

also accepts VISA and Mastercard. Orders for 100 or more copies mailed to a single 

address are discounted 25 percent. Orders should be sent to:

U.S. General Accounting Office

441 G Street NW, Room LM

Washington, D.C. 20548

To order by Phone: Voice: (202) 512-6000 

TDD: (202) 512-2537 

Fax: (202) 512-6061

To Report Fraud, 

Waste, and Abuse in 

Federal Programs

Contact:

Web site: www.gao.gov/fraudnet/fraudnet.htm

E-mail: fraudnet@gao.gov

Automated answering system: (800) 424-5454 or (202) 512-7470

Public Affairs Jeff Nelligan, Managing Director, NelliganJ@gao.gov (202) 512-4800

U.S. General Accounting Office, 441 G Street NW, Room 7149 

Washington, D.C. 20548
United States

General Accounting Office

Washington, D.C. 20548-0001

Official Business

Penalty for Private Use $300

Address Service Requested

Presorted Standard

Postage & Fees Paid

GAO

Permit No. GI00