How to gain your licence to practise as a pharmacist in the US

British pharmacist Hannah Weekes tells you what you need to do in order to register as a pharmacist in the US and provides useful advice to help smooth your journey.

I moved to Boston, Massachusetts, in July 2012 to follow my husband who has a research position at Harvard. Before that, I was a hospital pharmacist in the UK and, despite having researched the possibility of becoming a pharmacist in the US, I was not sure if it was for me. To be honest, I found the idea of the whole process daunting.

There were multiple, sometimes ambiguous documents and application forms at every stage. There are examinations to pass, an internship to complete and even an English test (no exceptions). I am therefore writing this article to convey my experience, which will hopefully make the process simpler to understand.

Before relocating, I read various websites that recommended working as a volunteer as a gateway to paid employment in the US. It is now increasingly popular, sometimes mandatory, for undergraduates of any degree in the US to have completed some volunteering.

I volunteered in two hospitals in Boston while studying for the Pharmacy Technician Certification Board examination (this, retrospectively, turned out to be a great way to get into pharmacy). After registering to practise as a certified pharmacy technician in the state of Massachusetts, I began applying for jobs in the field.

I started to network and explore lots of avenues. My lucky break came when I approached a pharmacy manager at one of my volunteering hospitals. I was invited for interview and subsequently offered a pharmacy technician II position. I started working and was encouraged to gain full pharmacy licensure. This is where things became complicated.

Hint about jobs

Pharmacy technician positions in hospitals are graded as I, II or III depending on experience. A pharmacy technician I position would usually mean someone who is not trained to work in the clean (intravenous products) room whereas a level II is. Grade III roles are usually specialist or supervisory.

The journey to registration

1. Apply to Education Credential Evaluators (ECE) to gain recognition of equivalence of your foreign qualifications.

The essence of the application is to demonstrate that your foreign undergraduate training is equivalent to that of someone educated in the US. You may be able to complete this step before leaving the UK. The ECE requires two copies of the following:

  • official university transcript
  • proof of degree
  • proof of A-Levels (or equivalent). The difference between the US and UK pharmacy programmes is a six-year (doctoral) degree, versus the UK’s five-year (master’s) degree. A-Levels (or equivalent) are considered similar to some US foundation year undergraduate courses.

Every application is considered on an individual basis and, as well as proof of my A-level results, I also submitted evidence of my postgraduate diploma as further support. It is worth checking with the National Association of Boards of Pharmacy (NABP) in advance to see what it recommends (NB: the only way to communicate with it is in writing or by fax).

IMPORTANT NOTE: If you graduated after 1 January 2003, you must have completed a five-year curriculum. To be eligible for FPGEC entry as a UK pharmacy graduate you must at least have the following:

  • Two years of “A”-Levels which equates to US completion of high school level work and completion of one year undergraduate work/pre-pharmacy coursework completed at the university level as part of admission into the university’s pharmacy programme
  • Four-year MPharm, which equates to US bachelor of pharmacy degree.

This combination generally equates to a five-year US programme.

Coursework and internships completed after graduation are generally not considered (ie, UK preregistration year).

Post-baccalaureate degrees will generally not be considered except on a case-by-case basis when the coursework and degree demonstrate a candidate obtained satisfactory experience in patient care in a clinical pharmacy practice setting.

With regard to any other qualification considered to be equivalent to “A”-Levels or if a candidate did a BPharm degree he or she would need to check if this was satisfactory with the ECE. Bear in mind that any questions cannot generally be answered simply and usually will require the full evaluation and hence submission of documents to confirm eligibility. 

Hint about job applications

I would suggest networking or establishing as many informal contacts as possible by using social media, such as Linkedin, friends of friends and so forth. Bear in mind the recruitment process can take a while and often there is no closing date on job advertisements. After an interview, perhaps email to say how much you enjoyed meeting everyone and how keen you are on the position.

2. Apply to the NABP to start the Foreign Pharmacy Graduates Equivalency Committee certification process

The NABP requires a single copy of your pharmacy registration document (in my case a letter that I requested from the General Pharmaceutical Council).

Records sent to the ECE and NABP from the issuing education institution (either directly or via you) must be in a sealed envelope with the issuing body’s stamp over the seal.

An application with demographic information also needs to be endorsed by a US-based notary. Once the NABP receives a satisfactory general evaluation report from the ECE it will then send you an authorisation to test letter (ATT) allowing you to sit the Foreign Pharmacy Graduate Equivalency Examination (FPGEE).

Studying pharmacy in the US 

In the US, the standard time to achieve graduation in pharmacy is six years and the qualification gained is a PharmD (doctor of pharmacy). Most pharmacy programmes require an undergraduate course in a more general subject for at least two years before starting the four-year pharmacy programme (occasionally there is an accelerated three-year option available if there is no summer vacation).

However, because pharmacy school places are increasingly competitive, more students are completing a four-year bachelor’s degree before applying to pharmacy school. A foreign graduate, once licensed, can use the post-nominal “RPh”.

3. Register online for the FPGEE and the test of English as a foreign language internet-based test (TOEFL ibt)

The FPGEE is held bi-annually at a Pearson VUE Test Centre. The TOEFL ibt is available regularly at an Educational Testing Service Centre. It is best to apply in plenty of time for maximal choice of venue (see Table 1 for further details). These examinations can be done in any order. If English is not your first language, you might want to study for the FPGEE first.

4. Register as a pharmacy intern with the state board of pharmacy and start recording hours

This can be done as soon as you are approved to sit the FPGEE (NB: you do not have to pass the test first). You will need to find a pharmacist who will be your preceptor at your internship facility and register as a pharmacy intern with the state board of pharmacy. (In some states registration is franchised to a third party, Professional Credential Services.)

Once registered, start “recording” 500 to 1,500 intern hours (depending on the state). For example, in Massachusetts, it is acceptable to claim 1,000 hours worked in pharmacy with 500 personal study time (a maximum of eight hours in a pharmacy and four hours study per day).

5. Take the FPGEE and the TOEFL ibt

Results for the FPGEE can take around eight weeks to arrive. Results for the TOEFL ibt are available online within 10 days. Note that, once you have sat both of these tests, your entire portfolio undergoes final evaluation by the FPGEC (which can take up to 10 weeks) before you are issued with a certificate.

Hint about immigration

I came to the US on a J-2 (spouse) visa.US J-1 visas are for non-immigrants approved to participate in work- and study-based exchange visitor programmes. A J-2 visa holder requires an employment authorisation document to work (which can take three to five months).

US H1-B non-immigrant visas are for skilled, educated individuals employed in specialised occupations. The H1-B visa enables foreign workers to work temporarily for a specific employer. There are more information on

– J-1 visas

http://jobsearch.about.com/od/workvisas/a/j-1-visa.htm

Hint about immigration I came to the US on a J-2 (spouse) visa.US J-1 visas are for non-immigrants approved to participate in work- and study-based exchange visitor programmes. A J-2 visa holder requires an employment authorisation document to work (which can take three to five months). US H1-B non-immigrant visas are for skilled, educated individuals employed in specialised occupations. The H1-B visa enables foreign workers to work temporarily for a specific employer. There are more information on – J-1 visas

-H1-B visas

http://jobsearch.about.com/od/workvisas/a/h-1b-visa.htm

6. Submit records of internship hours to the state board of pharmacy/PCS once completed

This has to be done before applying for the North American Pharmacy Licensure Examination (NAPLEX) and Multistate Jurisprudence Pharmacy Examination (MJPE). Use the appropriate form and be prepared to submit proof of worked hours, such as payslips, should you be further audited.

7. Once approved, apply for and take the NAPLEX and the MJPE and apply for pharmacy licensure

Note that eligibility to take these examinations also varies according to state and your local board needs to issue another ATT first. In Massachusetts there is a combined form for the NAPLEX, MJPE and pharmacy licensure (again there is a demographic component and it needs notarising).

An MJPE must be passed in every state a candidate wishes to practise in, since pharmacy law varies from state to state.

Other things to consider

I have not mentioned additional costs, such as:

  • Charges for issuing documentation, notary fees, textbooks/online resources, postage and packaging and any examination repeat fees.
  • Financially supporting yourself while applying for jobs. Pharmacists’ salaries are higher in the US but pharmacy technician and intern salaries are similar to those in the UK. In hospital pharmacy, working patterns incorporate variable shift-work.

Working in US pharmacy is certainly a different and rewarding experience. If you plan carefully you will be all set. Good luck!

In my next article I will compare the differences inpharmacy practice between the US and UK.

Table 1: Further details about various examinations

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Citation
Tomorrow's Pharmacist, TP, 2013;()::DOI:10.1211/PJ.2021.1.82997