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A Canadian online pharmacy company that figured prominently in a scandal several years ago over a counterfeit cancer medicine sold to U.S. doctors has been fined $34 million, a penalty that a nonprofit advocacy group with ties to the pharmaceutical industry called a “slap on the wrist.”

Companies controlled by Canada Drugs had sold $78 million in mislabeled and unapproved medicines, including two counterfeit batches of the Avastin cancer treatment, that were made in several countries, according to federal prosecutors. The version of Avastin that was sold to U.S. doctors in 2011 did not contain any active ingredient. The brand-name medicine is marketed by Roche.

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Although the infractions did not involve sales to consumers, the episode sparked high-profile concern over counterfeit medications among regulators and policymakers, since a growing number of Americans were already purchasing lower-cost medicines from foreign pharmacies online.

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