Opinion
Article
Op-Ed: Why Pharmacy Needs to Move Towards Universal Licensing Recognition
Author(s):
Key Takeaways
- Pharmacists face barriers to interstate practice due to a fragmented licensure model, unlike nurses with the Nurse Licensure Compact.
- Universal Licensing Recognition (ULR) allows pharmacists to practice across states without additional licenses, enhancing workforce mobility.
Unlike other professionals such as nurses and physicians, pharmacists remain tethered to a fragmented state-by-state licensure model that creates unnecessary barriers to care.
In an increasingly interconnected health care landscape, the ability of pharmacists to practice across state lines is critical. Yet, unlike other professionals such as nurses and physicians, pharmacists remain tethered to a fragmented state-by-state licensure model that creates unnecessary barriers to care. Although models such as the Nurse Licensure Compact (NLC) have successfully expanded mobility for nurses across over 40 states, pharmacists must still navigate complex and redundant licensing processes that slow down workforce mobility, hinder access to care, and increase costs.1
Universal licensing recognition would modernize the pharmacy legislation | Image credit: Kzenon | stock.adobe.com
A move toward universal licensing recognition (ULR) within states would modernize the profession by allowing a pharmacist licensed in one participating state to practice in all others without additional licenses. This reform would reduce regulatory inefficiencies, increase patient access, and improve workforce flexibility without compromising public safety. ULR is the most efficient and market-friendly model for professional licensure. Instead of requiring states to enter a formal compact, ULR eliminates the need for separate applications and automatically recognizes out-of-state licenses. In states that have already adopted ULR, workers can begin practicing immediately upon moving to a new state, if they are in good standing with their previous state board. Arizona, the first state to implement ULR in 2019, has since recognized over 8000 out-of-state licenses across various professions.2 Limitations to Arizona’s model include state specific exams and fees. Other states that have followed suit—including Iowa, Idaho, and Utah—have seen increased workforce participation and economic growth.
The Challenge: A Licensing Model That No Longer Fits the Profession
Pharmacists today work in a broad range of settings, from community and hospital pharmacies to telehealth, primary care, mail-order services, and more. Pharmacists may need to practice across state lines, yet the current licensing framework creates administrative burdens without a clear public safety benefit or published evidence to back it.
Currently, pharmacists who wish to work in most states must3,4:
- Apply for individual licenses in each state, often requiring redundant burdensome fees and applications
- Pay for and pass a different state-specific jurisprudence exam in each state (other than Arkansas, Idaho, Michigan, and Vermont), even though pharmacy laws are standardized at the federal level and these exams have shown no published evidence correlated to protecting patient safety
- Wait days, weeks, or months for approval before they can begin working in a new state
The Federal Trade Commission (FTC) has identified these barriers as obstacles to workforce mobility and patient access. The FTC has specifically noted that “state licensure can pose significant hurdles” for professionals needing to move or provide telehealth services.3,5 In today’s digital health care environment, licensure should enable—not obstruct—innovation and access.
The Nursing Model: A Profession-Specific Example
Nursing has historically demonstrated a functional, effective model which exhibits an archetype of profession specific compacts. The Nurse Licensure Compact (NLC), first adopted in 1999, allows nurses in compact states to practice in all participating states under a single license.1 The model is simple and has been compared to driver licensure. A nurse licensed in their home state is automatically recognized in other compact states, although each state retains disciplinary authority, ensuring that violations are enforced consistently. State boards collaborate through a shared database, preventing unsafe practitioners from evading accountability.
The NLC has successfully expanded workforce mobility while maintaining state authority over professional standards. Although the initial thought of a Pharmacy Licensing Compact (PLC) would follow this same framework, there is a better solution: universal licensure recognition. A compact requires states to opt in, which means it could take years—if not decades—for full national adoption. The NLC has been in place since 1999, yet 20 states still have not joined, showcasing a gap.3 If the pharmacy profession follows the same trajectory, pharmacists in non-compact states would remain trapped in the same regulatory tape.
Why Universal Licensure and Not a Pharmacy Licensing Compact?
One major difference to note up front is that a licensing compact is profession-specific (i.e. NLC only applies to nurses), whereas ULR within a state applies to all occupations with licensure requirements. The Table compares ULR to licensing compacts.
Table 1: Comparing Universal Licensure to Licensing Compacts
If ULR were applied to pharmacists, it would mean that a pharmacist licensed in one state could immediately begin working in another without needing additional applications or licensing fees. Furthermore, remote pharmacists could operate in any state without needing separate approvals and state boards would still retain disciplinary oversight, ensuring patient safety remains a priority. Practice advancements and movement towards adoption of standard of care alongside full practice authority would be streamlined, and job growth, technology innovation, and access to care for patients could result.
Notable benefits of ULR include immediate workforce mobility without waiting for state board approvals; applicability to all states that adopt it (not just those in a compact); elimination of administrative burdens; streamlined occupational licensing for all licensees within a state (not just health care); and encouraged economic growth, mobility of licensees, and reduced hiring bottlenecks.
Still, there are some criticisms of ULR. These include the lack of nationwide consistency without federal changes; resistance from licensing organizations due to perceived reduced oversight and collection of certain fees; and potential additional state-level requirements. States may impose some requirements such as requiring a pharmacist to establish residency, passing jurisprudence exams, or collecting unnecessary fees before eligibility is confirmed.
Why Universal Licensing Recognition Is the Superior Model
Both the PLC and ULR aim to modernize pharmacy licensure, but ULR offers the cleanest, most efficient path to true license portability. The PLC is an improvement over the status quo, but it still forces pharmacists to wait for states to opt in. ULR eliminates unnecessary regulatory steps and allows immediate reciprocity for pharmacists in good standing. Finally, state boards retain oversight under both models, meaning that public safety is not compromised in either system.
What’s Next?
To ensure pharmacy moves toward the most effective, free-market licensure model, advocates can take the following steps:
- Support or introduce ULR bills in state legislatures, following the examples of Idaho and Iowa.
- Encourage state boards of pharmacy to work with legislators to ensure ULRs includes pharmacists.
- Use data from existing ULR states to demonstrate the economic and workforce benefits of adopting universal recognition.
- Work with state and national associations to move the discussion toward ULR versus licensing compacts.
A PLC is a step in the right direction, but ULR is the true solution to breaking down barriers in pharmacy practice. The pharmacy profession has long needed a licensing model that works for pharmacists, employers, and—most importantly—patients. The fastest, most effective way forward is through ULR. The time to act is now.
