Advancing multi-state licensing is vital in the age of telehealth

The COVID-19 pandemic has placed increasing pressure on healthcare professionals over the past 2 years. As the virus mutates and variants emerge, demands for COVID-19 drug treatment and vaccinations have increased, resulting in an acute shortage of pharmacists and pharmacy technicians.

Since the start of the pandemic, patient access to care has been limited for many reasons, including canceled appointments (particularly elective procedures and preventive care visits), reductions in transportation options, and the fear of going to health care facilities.1 Healthcare providers, including technicians, quickly implemented telehealth solutions that enabled patients to receive many healthcare services without leaving their homes. Less than 1% of paid Medicare visits were made via telehealth before the COVID-19 public health emergency was declared in March 2020. A year later, more than 43% of those visits were made at the help of telehealth technologies.2

Pharmacy employees who use telehealth to serve patients in multiple states face many challenges, such as obtaining licenses to practice in each of those states. Pharmacists and technicians must retain their original licenses and must generally be licensed in the state or territory where their patients are located when an encounter occurs, regardless of where the pharmacist or technician may be. find physically.

State discrepancies in continuing education requirements, licensing exams, and license renewal periods further complicate the process. In 2020, the American Society of Health-System Pharmacists (ASHP) House of Delegates passed a Policy on Interstate Pharmacist Licensing, which states in part that “ASHP advocates interstate pharmacist licensing to expand pharmacists’ mobility and ability to practice, especially during emergencies, and to improve their ability to practice in multiple states, which is particularly important for telehealth pharmacy practice.3

In 2021, the American Pharmacists Association (APhA) evaluated Pharmacy’s multi-state practice policies. The APhA House of Delegates subsequently passed policy statements that urge “state boards of pharmacy to reduce onerous administrative and financial requirements for licensing while continuing to ensure patient safety.” . The statements also note that the APhA “calls for the development of a profession-wide consensus on licensing requirements for pharmacists and pharmacy personnel to support contemporary pharmacy practice.”4

The Public Readiness and Emergency Preparedness Act allows the US Department of Health and Human Services (HHS) to issue a variety of statements during a public health emergency.5 APhA leaders reached out to HHS officials to advocate for the ability to facilitate multi-state licensing in emergencies where pharmacy workers in one part of the country are needed to support supply pharmacy services in other regions.

In 2019, Idaho became the first state to adopt a mutual recognition pathway for pharmacist licensing. Pharmacists licensed in a state that enters into a Mutual Recognition Agreement with the Idaho Board of Pharmacy do not need to be licensed or registered in Idaho to practice pharmacy or provide pharmacy services to state residents.6 A Mutual Recognition Agreement can be entered into by other states as long as they have similar licensing requirements, require fingerprint criminal background checks, and provide the same multi-state practice privileges to Idaho certified technicians, trainees and pharmacists.6 However, as of February 2022, several states had reviewed Idaho’s proposal, but none had yet entered into mutual recognition agreements, according to Jennifer Adams, PharmD, EdD, FAPhA, FNAP, associate dean for academic affairs at the ‘Idaho State University College of Pharmacy in Boise. .

Other health professions have taken steps to enable licensing and practice in multiple states. In these cases, state licensing agreements provide an expedited path to licensing for providers practicing in multiple states. For example, a nursing licensing pact has been in place for over 15 years with 34 member states. For doctors, an interstate agreement on medical licensure was agreed between 29 states and became operational in 2017.
A licensing agreement for physiotherapists also started in 2017 with 21 Member States.4 These streamlined systems allow licensees to obtain licenses in other states efficiently and quickly. However, one problem with license agreements is that state licensing authorities may suffer a loss of revenue because they issue fewer licenses than they would if the agreements did not exist. This loss of income may reduce their ability to provide appropriate monitoring and services
to licensees.

The National Association of Boards of Pharmacy (NABP) has taken steps to enable its member boards to harmonize regulations on the practice of pharmacy and address the need for pharmacy employees to be licensed in several states, especially in an emergency. In April 2020, NABP launched the Emergency Passport Program, which allows participating states to authorize interns, pharmacists, and technicians to practice in other states on an emergency and temporary basis.7 The program allows trainees, pharmacists, and technicians practicing in another state to be effectively granted emergency or temporary licensure at no cost to participants by NABP.

Twenty states, including Idaho, have participated in the Emergency Passport Program, and as of February 2022, NABP has processed more than 62,000 applications. More than 57,000 of those applications have been approved by participating states, according to Al Carter, PharmD, RPh, executive director of NABP.

Seeing an increased need for pharmacies and pharmacy employees to provide services in all states in non-emergency situations, NABP launched the Verify program in April 2022.8 This program, which is currently only accepted by North Carolina, provides a way to verify that pharmacist applicants are in good standing in all licensing states, allowing for the issuance of a specific credential to the State.8 This credential has practice authority through a state regulatory or statutory credential and allows pharmacists to provide services such as remote medication order entry and verification in any state.

NABP will charge applicants $50 per year to participate in the program.8 The “NABP wants to establish a platform for consistent processes and procedures across all states,” Carter said.

Multistate licensing of pharmacy employees and development of interstate pharmacy practice credentials can help redistribute the pharmacy workforce and prevent acute staffing shortages. National and state pharmaceutical associations can work with pharmacy employers and state regulators to remove many of the barriers that prevent pharmacy employees from providing services in multiple states.

Improving pharmacy practice in multiple states will provide many benefits, including assured continuation of care, expanded access to care for patients in rural areas or living on state borders, faster speed for transfer and reciprocity of pharmacist licenses, increased access to drugs, lower cost for patients. pharmacy professionals who hold licenses in multiple states, and a reduced burden on pharmacies and pharmacist professionals.

About the authors

Jisu eo, PharmD, BsPharmworks in the Advance Pharmacy Practice Experience: Community rotation program at Beth Israel Lahey Health in Boston, Massachusetts.

David Zgarrick, PhD, MRSis a professor in the Department of Pharmacy and Health Systems Sciences at the School of Pharmacy at Northeastern University in Boston, Massachusetts.


1. Reduced access to care. CDC. August 6, 2021. Accessed February 22, 2022.

2. Executive decree on improving access to rural health and telehealth. National Administration of Archives and Documents. August 3, 2020. Accessed February 24, 2022.

3. Political positions. American Society of Healthcare Pharmacists. Accessed February 22, 2022.

4. Political Reference Committee House of Delegates Report 2020-2021. American Association of Pharmacists. 2021. Accessed February 22, 2022.

5. Public Preparedness and Civil Protection Act. US Department of Health and Human Services. Accessed February 24, 2022.

6.Bill No. 10. Idaho State Legislature. 2019. Accessed February 23, 2022.

7. NABP Emergency Passport Program. National Association of Boards of Pharmacy. 2020. Accessed February 23, 2022.

8.NABP Check. National Association of Boards of Pharmacy. Accessed May 4, 2022.,current%20proof%20of%20your%20status.

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