The indictment's highlights include allegations that some of the drugs sold to doctors by CanadaDrugs.com—ones used to treat cancer—were counterfeit, and that $78 million worth of medication was shipped to the U.S. as part of the scheme. In some cases, prosecutors claim, cancer drugs that were meant to be kept cold were not, and CanadaDrugs tried to cover up that fact.
But only one of the people charged in connection with the case, Ram Kamath of Illinois, has actually been arrested so far. Kamath, who is charged with a single count of conspiracy to smuggle goods into the U.S. was freed without bond, and recently was allowed to take a cruise to Alaska.
The allegations against Kamath are significantly less serious than the ones made against other defendants, and he faces the least possible maximum sentence, of five years in prison. He is accused primarily of agreeing to store temporarily a small amount of drugs in his refrigerator on behalf of Canada Drugs after the company told him they were recalling that shipment.
"He's pleaded not guilty and we're going to trial," said Kamath's defense lawyer, Michael Ettinger. "He's innocent."
Ettinger called Kamath, who is due to be arraigned in Montana next week, a "hard-working, honest guy." He noted that Kamath had helped design a planned drug importation program for the state of Illinois under then-Gov. Rod Blagojevich in 2004.
The other 13 people and companies charged are outside the U.S. It's not clear when, or even if, they will be extradited to face the felony charges that include smuggling, conspiracy and money laundering in federal court in Montana.
Also, Canada Drugs and its executives were not charged with selling prescription medication to individuals for personal use in the U.S., a practice the company continues to this day, and which advocates say help get millions of sick people much-needed drugs at prices that are much less than they would pay at an American pharmacy.
It is not clear that the prosecution will put a dent in such online retail sales by Canada Drugs, or any other pharmacy that exports prescription drugs to the U.S, even though it is technically illegal for Americans to import drugs from international pharmacies.
An American lawyer for Canada Drugs did not return a request for comment.
The U.S. Food and Drug Administration, which is playing a key role in the prosecution, declined to comment. A spokeswoman for federal prosecutors in Montana did not have an immediate comment when contacted by CNBC.
Critics of international online pharmacies are hailing the prosecution as a step in the right direction of protecting customers. But the company where Kamath worked as a consultant, PharmacyChecker.com, which verifies the legitimacy of online pharmacies, argues that the case is being used "to discredit safe personal drug importation."