The tug of war between the states and the federal government has been going on since Thomas Jefferson and his friends sat down in Philadelphia to hammer out the U.S. Constitution. Today, some in pharmacy are calling for a new dialogue over whether the time has come to move the licensure and regulation of pharmacists and pharmacies from the states to a national entity to create uniform standards and allow pharmacists to relocate without the red tape.
As the profession continues to evolve, there is talk in some pharmacy circles about exploring other models of licensure and regulation, according to Philip Burgess, R.Ph., national director of pharmacy affairs for Walgreens, who is also a member of the Illinois board of pharmacy. Speaking only as a drugstore chain executive, he has called for the profession to begin a dialogue among all the stakeholders. "Clearly from a national chain perspective, national licensure would be a benefit for us," he said. "It would help us to have common standards, so we'd have one consistent set of pharmacy laws we all operated under. I think national licensure of pharmacy, pharmacists, and wholesalers would be embraced by the major players in the industry and be fought by the individual states."
Proponents caution that national licensure should not be confused with federal licensure. Burgess favors a national license that would travel with the pharmacist, as opposed to having one of Uncle Sam's minions issue that license. "I think the individual states would continue to have a lot of control in their own states," he said. "There would still be a definite role for boards of pharmacy with regard to administration and discipline and regulation to ensure compliance. But we'd be dealing with some broader national licensure so that pharmacists could freely move from state to state to practice pharmacy and not inhibit their ability to render patient care."
The recent havoc wrought by Hurricane Katrina highlights a licensure anomaly. Out-of-state pharmacists who wanted to volunteer to work in devastated areas or refugee centers were granted temporary licenses by state pharmacy boards. The National Association of Boards of Pharmacy stepped in to facilitate the emergency pharmacist licensure transfers in states hit by the hurricane and states sheltering storm refugees. Using its disciplinary clearinghouse, NABP ran the names of pharmacists granted temporary licenses through the database to be sure their licenses were in good standing.
"In the whole Katrina situation, it was clearly acknowledged that during an emergency, pharmacists licensed in another state could come in and assist to meet the needs of the patients," said Burgess. "If during an emergency, pharmacists can come in and do this, what are the implications for their being able to do this when it's not a state of emergency?"
Some in pharmacy want more uniformity and the ability to practice across state lines, which may lead to more federal preemption of the states, said Carmen Catizone, executive director of NABP. He also expects to see "some move toward some kind of national licensure and national recognition," but he's not sure how that would be accepted by the states.
"I think we've seen movement in the state boards themselves, with members saying they're amenable to some system but not convinced their own state legislatures are ready for this yet," Catizone told Drug Topics. "The idea that one cookie-cutter model would fit all the states just doesn't seem to sit well with state legislators who say their state is different. I don't think the states as a whole are ready to give up that prerogative, but the state boards of pharmacy clearly see that the practice as defined by a state border is not a real model anymore."
The biggest issues facing pharmacy boards would be how to ensure that pharmacists were accountable in the states where they practice, if the licensing process went to some sort of national system, said Catizone. Another stumbling block would be the loss of revenue some states would experience.
If the profession ever proceeds to national licensure and regulation of pharmacy, a logical choice for the organization to carry out the mandate might be NABP. The association already maintains the national disciplinary database used by states for reciprocity and has produced the model state pharmacy act and model rules to guide its member boards to more uniformity in rules and regulations. NABP has also created national volunteer vetting programs for Internet pharmacies and drug wholesalers, which give the public and the state pharmacy boards more confidence in the legitimacy of the providers that earn the NABP seal of approval.