Pharmacists: Where do you want to practice?

Get the facts about the costs and requirements of licensure

As 13,000 new pharmacists graduate from the 129 schools and colleges of pharmacy in the United States this year, state boards of pharmacy will begin processing hundreds of applications for new pharmacist licenses.

The National Association of Boards of Pharmacy (NABP) represents boards of pharmacy in the United States, Canada, Australia, and New Zealand. They provide a plethora of services that have strengthened consumer protections by implementing and enforcing pharmacy and pharmacist standards, fighting prescription drug abuse and diversion, and battling against fraudulent online pharmacies. The NABP also coordinates the licensure and credentialing process for all new pharmacists and foreign graduates.

A pharmacist wishing to practice pharmacy in any U.S. state, territory, and in Washington, DC must have a valid license issued by the state board. A valid pharmacist license in at least one state or territory permits a pharmacist who practices in a federal system, including the Department of Defense (ie; Army, Navy, Air Force, Coast Guard), U.S. Public Health Service, or the Veterans Administration (VA), to practice in any state. Some states offer service members special licensure exceptions, such as fee waivers or continuing education requirement exceptions. Pharmacists who choose to work in industry, research, or roles that do not include dispensing or patient care may elect to not become licensed as a registered pharmacist (RPh) with their state boards.

For those who do seek licensure, what is the process and purpose of getting licensed? What costs should new graduates expect?

State licensure fees

First, a pharmacy graduate must apply to the state board of pharmacy for new pharmacist licensure in the state(s) they wish to practice. Fees vary from $35 (South Dakota) to $421 (Massachusetts). Candidates must clear queries of their name on national databases of criminal records and disciplinary action taken against healthcare providers such as the National Practitioner Data Bank (NPDB). They must also submit documentation of completion of required pharmacy internship hours, which vary from state to state; requirements range from 1,500 to 2,150 hours with some restrictions. Many states now also require fingerprinting and state or federal criminal background checks before authorization to test is granted. These fees range from an additional $16 to $165.

Graduates must then take and pass two exams. The first is the clinical National Pharmacist Licensure Exam (NAPLEX, $485). One primary state must be selected to receive the score; other states can be included by using the NABP’s Score Transfer, usually for an additional fee. The second is a state-specific law exam, the Multistate Pharmacy Jurisprudence Exam (MPJE, $210), testing the laws governing the practice of pharmacy. It is important to note that California, Arkansas, and Virginia have separate state law exams and do not use the MPJE. Pharmacists already licensed in another state looking to be licensed in another area, also known as licensure by reciprocity or endorsement, usually pay a different and higher application fee.

In addition, several states have some unique requirements for candidates for pharmacy licensure. For example, applicants for licensure in Alabama must complete an in-person interview with a board member. Other states require various additional fees and information from pharmacists who will dispense controlled substances, administer immunizations, and/or precept pharmacy students. These fees fund the state board’s programs and regulatory functions.

Role of state pharmacy boards

What do these state boards of pharmacy do? Individual state boards of pharmacy differ in their role and scope of regulatory power based on where they are located within the structure of the state government. Many are housed under the auspices of the state health department, but other boards are a subsection of the professional licensure division, alongside professions ranging from accountants to wrestlers. Some state boards are supported and funded entirely by licensing fees; others receive public funds.

Commonly, state boards will verify that pharmacies, pharmacists, interns, and technicians are adequately credentialed and licensed. The NABP’s CPE Monitor system has become the central collection point for pharmacists’ continuing education credit.  Continuing education (CE) requirements are a large component of pharmacist license renewal in each state. While some states require the submission of evidence of CE requirement completion at each renewal period, others enforce their requirements by random audit of a portion of licensees. The most standard requirement is 15 contact hours (1.5 continuing education units, CEU’s) per year.

Individual states may require that pharmacist CE be in a certain topic area, or may require that a certain number of hours be “live,” as opposed to passive or self-study courses. For example, in-state New Mexico pharmacists must have 1.0 CEU of live credit, 0.2 must be in the area of patient safety, and they must score greater than 80% on a 100-question law examination ($100) each biennial renewal period. Some state boards renew licenses on a rolling basis by birthdates or license numbers, while others have a single annual or biennial deadline.

State boards have other responsibilities, including responding to public complaints involving pharmacy. They may also send inspectors to pharmacies and clinics, regulate controlled substance prescribing and dispensing, and participate in other public health or epidemiologic activities. For example, Nevada’s Board of Pharmacy runs a cancer drug donation program as authorized by their state legislature. The Louisiana Board of Pharmacy permits and regulates durable medical equipment providers. Increasingly, boards of pharmacy participate in the Prescription Drug Monitoring Program (PDMP), which aims to reduce “doctor shopping” and filling multiple prescriptions for controlled substances by sharing certain prescribing data across pharmacies.

Pharmacy boards vs. associations

There may be some confusion about the difference between state boards of pharmacy and state pharmacy associations. State pharmacy associations primarily serve the needs of pharmacists and technicians, providing career advice, training, and pharmacist advocacy. For example, the Washington State Pharmacy Association provides training for pharmacists to administer and read tuberculin (PPD) skin tests for tuberculosis.

State boards exist to enforce regulations on pharmacies, providers, hospitals, wholesalers, and other stakeholders. State boards protect the public by ensuring that pharmacies and pharmacists meet regulatory and professional standards and hear public complaints if they fail to meet these standards. For example, the Massachusetts’ State Board of Pharmacy responded to recent serious safety incidents involving compounding pharmacies in their state by passing regulations that increased their oversight of such facilities.

State boards of pharmacy must find ways to adapt to a fast-changing pharmacy landscape. They face the difficult task of balancing increased regulatory, technologic, and programmatic demands with mounting financial and resource constraints. 

Maintaining your license

Many factors may play a role in where graduating pharmacists ultimately decide to live, seek licensure, and practice. The cost of maintaining licensure is certainly one of them (Table 1 and Table 2). Licensure costs may be a salary negotiation point for new pharmacists and it is important for the financial planning of the increasing number of students who are graduating with debt. These costs may especially matter to federal pharmacists, who have some degree of choice as to where to maintain their license.

As pharmacists today are more likely than ever to practice in multiple states throughout their career, boards of pharmacy should be clear, upfront, and transparent about the fees they charge and how they are spent. Professional pharmacy associations and national organizations would do well to gather, publish and review this important aspect of pharmacy practice going forward, as our colleagues in medicine and nursing do.

LT Quinn Bott is a pharmacist and commissioned officer in the U.S. Public Health Service, serving in the Federal Bureau of Prisons. Ayoung Kim is a PharmD candidate at Northeastern University in Boston, MA. Correspondence about this article can be directed to quinn.bott@gmail.com.