Expert Q&A: How NABP Is Modernizing Language Requirements for International Pharmacists

The National Association of Boards of Pharmacy (NABP) convened a task force in November 2025 to evaluate the English-language proficiency requirements within its Foreign Pharmacy Graduate Examination Committee (FPGEC) certification program, which foreign-trained pharmacists must complete to pursue licensure in the US. The task force recommended 2 key changes: allowing candidates to combine their best section scores from multiple test sittings over a rolling 2-year period, rather than requiring all 4 sections to be passed in a single attempt, and accepting the Occupational English Test (OET) as an alternative to the Test of English as a Foreign Language Internet-Based Test (TOEFL iBT), given its focus on health care–specific communication.

In an interview with Pharmacy Times, Jasmina Bjegovic, PharmD, chief officer for examination services from the NABP, emphasized that protecting public health remains the program's central priority, noting that strong English communication skills are essential for safe pharmacy practice, including patient counseling, medication error prevention, and team-based care. She also highlighted that requiring the TOEFL iBT before the FPGE exam—implemented in 2020—led to a substantial improvement in pass rates, rising from 74% in 2020 to 91% in 2025, demonstrating the value of English proficiency standards in producing qualified pharmacist candidates.

Pharmacy Times: Can you introduce yourself and explain your current role?

Jasmina Bjegovic, PharmD: Hi, everyone. My name is Jasmina Bjegovic. I am the chief officer of exam services with the National Association of Boards of Pharmacy, also known as NABP. I have been here for 4 years, and I am a pharmacist by training. I oversee all of our examinations—both our high-stakes examinations that are used for pharmacist licensure, as well as our practice exams. I also have the privilege of overseeing our Foreign Pharmacy Graduate Examination Committee program, also known as FPGEC, as well as our team of psychometricians and our ADA program for testing candidates. Prior to joining NABP, I spent over 20 years with Walgreens pharmacy.

Pharmacy Times: For readers who may not be familiar with the FPGEC certification process, can you explain what it is and why English-language proficiency is a requirement for foreign pharmacy graduates seeking licensure in the US?

Bjegovic: The National Association of Boards of Pharmacy provides the Foreign Pharmacy Graduate Examination Committee, or FPGEC, program as a means of documenting the educational equivalency of a candidate's foreign pharmacy education. In the FPGEC certification process, candidates provide documents verifying their educational background and licensure or registration in the country where they have been practicing pharmacy, which must then be verified and authenticated. Awarding the certification allows graduates of schools of pharmacy outside the US to partially fulfill the eligibility requirements of pharmacist licensure in states that accept the certification. English proficiency is primarily established through this formal licensure process. The Test of English as a Foreign Language Internet-Based Test, or the TOEFL iBT, is an English-language proficiency standardized exam that NABP utilizes as a part of the FPGEC requirement. It tests the candidate's general linguistic ability, which is a baseline measurement of the candidate's eligibility to take the other required high-stakes assessments — first the Foreign Pharmacy Graduate Equivalency Exam [FPGE], and then the NAPLEX [North American Pharmacist Licensure Examination] and the jurisprudence exam—to gain entry into the practice of pharmacy in the US. Upon demonstrating English proficiency and obtaining FPGEC certification and successfully passing other required licensure exams, a pharmacist license is granted by the board of pharmacy. English proficiency must be assessed early in that pharmacist journey, although foreign-born individuals who attend an ACPE-accredited PharmD program in the US are not required to take the TOEFL iBT. They must pass all curricular requirements before successful conferral from the program, which is delivered in English.

Pharmacy Times: The TOEFL iBT has been the sole accepted English proficiency exam for foreign pharmacy graduates for years. Why did NABP feel it was time to take a fresh look at that requirement?

Bjegovic: Safeguarding public health is central to our mission at NABP, and the reevaluation of requirements is an integral component of that effort. In 2025, a resolution was presented at the NABP annual meeting, which requested that NABP convene a task force to review the use of the TOEFL as a requirement for FPGEC certification. The task force met in November of 2025 to evaluate the current requirements for FPGEC certification, review the use of the TOEFL as a requirement, and recommend any changes to the program, if necessary. Even as assessment tools and requirements have changed over time, the task force acknowledged the regulator's view that English proficiency is essential for pharmacy practice in the US.

Pharmacy Times: The speaking section seems to be where most candidates struggle. What are some of the concerns about whether that portion of the test truly reflects what it means to communicate effectively as a pharmacist?

Bjegovic: This portion of the English proficiency test requires examinees to speak into a computer microphone instead of engaging in a live interpersonal conversation where additional contextual cues, such as body language, would typically be available. This testing method ensures consistency while reducing the possibility of bias or subjectivity that may be introduced through such interactions. During this subsection of the exam, the individuals administering the test should not be able to influence how candidates perform. With the TOEFL iBT, computerized scoring is performed centrally, allowing for more uniformity in scoring. The effectiveness of properly conveying the message you are articulating is an essential component of effective and safe pharmacy practice and lies at the foundation of protecting public health. While academic qualifications and clinical acumen are essential, strong English communication skills are equally critical for the safe and effective practice of pharmacy in the US. Pharmacists need communication skills to participate in team-based care, ensure patient safety, prevent medication errors, build trust with patients, integrate with the care team, and perform clinical tasks.

Pharmacy Times: One change the task force is recommending is allowing candidates to combine their best section scores from multiple test sittings rather than passing all 4 sections in a single attempt. How could that shift make a difference for candidates?

Bjegovic: As an alternative to requiring an overall cumulative score that combines the passing scores of all 4 sections, it was recommended that candidates use their best score from each section across multiple testing sessions during a rolling 2-year period. Permitting candidates to rely on their highest score from each specific test date supports a more comprehensive assessment of their demonstrated proficiency. It also strikes a balance by reducing barriers while ensuring and maintaining the integrity of the requirements, purpose, and effectiveness.

Pharmacy Times: The task force is also recommending that the Occupational English Test be accepted as an alternative to the TOEFL iBT. What makes that test worth considering, and how does it differ from what's currently required?

Bjegovic: The Occupational English Test, or OET exam, focuses on the type of English used by medical and health care professionals in a more clinical-based environment, rather than limiting its scope to a more academic framework. Accepting OET exam scores allows for an alternative English language proficiency exam option for FPGEC applicants, rather than providing a singular exam to satisfy the program-specific requirement.

Pharmacy Times: There's an inherent tension here—rigorous language requirements protect patients, but they may also keep otherwise qualified pharmacists out of the workforce at a time when shortages are a real concern. How does the task force think about that tradeoff?

Bjegovic: Although there may be structural constraints within the workforce, protecting public health is of utmost priority and lies at the foundation of the FPGEC program, overseen by NABP. The continual maintenance and reevaluation of program requirements—with particular respect to the English language proficiency requirement—lead to the integral pathway of safe, high-quality patient care. Above all else, striking the appropriate balance is critical while achieving the respective equilibrium between patient care and safeguarding the public health within the systemic workforce capacity. While reducing the pool of potential practicing pharmacists because they do not meet FPGEC program requirements may be viewed as contributing to workforce shortages in certain areas, only applicants who meet licensure requirements and are qualified to practice in the US are eligible to be issued a license by a board of pharmacy.

Pharmacy Times: What would you want foreign pharmacy graduates, state boards, and pharmacy employers to take away from this report and its recommendations?

Bjegovic: Boards of pharmacy using the FPGEC certification for individual candidates make licensure decisions after confirming that an individual is fit to practice. Once a pharmacist licensee demonstrates that they are fit to practice, employers must then evaluate an applicant's communication in the context of their specific workplace to determine whether they are fit for the purpose. Upon demonstrating English proficiency and obtaining FPGEC certification and successfully passing other required licensure exams, a pharmacist license is granted by the board of pharmacy. The pharmacist can then seek employment in any practice setting where they meet the qualifications. The candidate experience was at the forefront of the conversation with the task force members, and NABP plans to implement these changes to support the candidate's journey toward licensure in the US. Ultimately, the recommendations outlined in the report aim to strengthen systems in ways that protect and promote the health of the public while ensuring policies remain responsive to the evolving needs and challenges within the pharmacy workforce of the US and all related sectors. Effective communication is the cornerstone of safe and high-quality health care delivered by pharmacists.

Pharmacy Times: Is there anything you would like to add?

Bjegovic: Starting in 2020, NABP began requiring candidates to pass the TOEFL iBT before being eligible to take the FPGE, compared to previously, when candidates could take the FPGE first. While this change was followed by a decrease of approximately 50% in the number of FPGE test candidates, it also led to a substantial and sustained increase in FPGE pass rates and ultimately in licensure as a pharmacist. Pass rates increased from 74% in 2020 to 91% in 2025, as the pool of qualified FPGE candidates improved significantly.