Does Pharmacy Need to Modernize its Approach to Licensure?

By David Witmer posted 08-21-2015 12:05


A recent editorial titled “A license to be a florist? How occupational rules can be a burden on workers” in the Washington Post caught my eye. The Editors write in support of recommendations contained in a recent White House White Paper from President Obama’s economic team that discusses the economic burden of inconsistent state licensing requirements. The report titled “Occupational Licensing: A Framework for Policymakers” makes for interesting reading and has implications for pharmacy.

The report itself makes little reference to pharmacy, but there are implications for our profession and it is interesting to examine how other professions are approaching harmonizing requirements and simplifying rules for professionals who work across state lines. The cumbersome process of reciprocation can create challenges especially for residency programs. The increasing role of telepharmacy in serving rural locations and increasing utilization of centralized mail service pharmacy are also not well served by a model that expects pharmacists to maintain a separate license in every state where patients are served.  And of course mergers of hospitals, health systems, and other health care service entities continue on a record pace. The lack of harmonization of laws and regulations make it difficult for leaders to fashion and deploy consistent and effective care models across the country when local requirements in different states unnecessarily restrict the roles of pharmacists or pharmacy technicians.

The report describes nursing’s approach of state compacts that allow nurses in 25 states to maintain a license in their state of residence but to practice in another state that recognizes this Nurse Licensure Compact (NLC). Nurses working across state lines are accountable for following state laws in the state in which they are practicing but maintain only one “multistate” license. I was intrigued to learn that medicine has also now also adopted a similar model, the Interstate Medical Licensure Compact (IMLC), which is now in place in nine states. Medicine’s approach is somewhat different in that it still requires licensure in each state but makes it easier to obtain multiple licenses at once. It has the disadvantage of still requiring separate fees for each license.

The report particularly emphasizes the burdens on our nation’s military personnel and their families who frequently move from state to state as they change duty assignments. The report specifically recommends a variety of best practices.  A few of these include:

  1. Harmonizing regulatory requirements as much as possible and implementing inter-State compacts that recognize licenses from other States to increase the mobility of skilled workers;
  2. Allowing practitioners to offer services to the full extent of their current competency, to ensure that all qualified workers are able to offer services; and
  3. Minimizing procedural burdens of acquiring a license.

It seems we are overdo in the profession of pharmacy to recognize that in a more mobile world where technology allows practice across multiple states from a single site it is time to consider new models to obtain and maintain licensure. Hopefully we can learn from work done in medicine and nursing and modernize our approach to licensure.

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09-18-2015 14:16

Thanks David, This topic was on the agenda for one of the Councils this week. I will be interested to see what the Council thought about this. Also as mergers continue and health systems grow I see opportunities for health systems to play a bigger role in advocacy in this area. Several of the health systems have been very active in the provider status campaigns. It will take a village!

09-05-2015 23:34

I agree with your thoughts on licensing (and also on credentialing) David.
One thought: It seems unlikely to drive a grassroots effort to simplify licensing because there's no incentive at the state level; why would they give up the cash flow? This is one area where ASHP and APhA can really make a difference for members by organizing an effort.