How Pharmacy's Newest Board Certification Pioneers Pain and Palliative Care

As pain management and palliative care grow increasingly complex, the pharmacy profession has taken a significant step forward with a new board certification dedicated to this specialty. Kasey Malotte, PharmD, BCPS, an advanced practice pharmacist in supportive care medicine at Cedars-Sinai Medical Center and the first pharmacist in the Los Angeles, California, area to earn the credential, discusses what distinguishes this certification, how it is being received by the field, and what it will take to build a specialty workforce capable of meeting the scale of patient need.

This interview was lightly edited for clarity.

Pharmacy Times: Can you introduce yourself?

Kasey Malotte, PharmD, BCPS: I’m Dr Kasey Malotte, a clinical pharmacist with focused training and practice in pain management and palliative care. I completed my PGY2 in pain management and palliative care at the University of Maryland, Baltimore, and have worked across inpatient and outpatient settings where pain, serious illness, and complex medication decision-making intersect.

Currently, I serve as an advanced practice pharmacist in supportive care medicine and core faculty for the hospice and palliative medicine fellowship at Cedars-Sinai Medical Center. I am also an affiliate faculty member for the University of Maryland, Baltimore, master of science in palliative care program. I’m proud to be the first pharmacist in the Los Angeles area to earn this new board certification, and one of only several dozen pharmacists nationwide in this inaugural group.

Pharmacy Times: What distinguishes the pain and palliative care Board of Pharmacy Specialties (BPS) certification from other pharmacy specialty certifications?

Malotte: What is distinct is that it formally recognizes pain management across serious illness, chronic disease, and complex symptom burdens as its own advanced practice area rather than a “subset” of general pharmacotherapy. Pain is one of the most common reasons people seek care, but the clinical situations we see are often nuanced: multimodal regimens, high-risk medication combinations, opioid stewardship, coexisting substance use disorders, renal/hepatic impairment, aging, mental health comorbidities, and goals-of-care decisions that shift over time.

A dedicated certification helps define a shared foundation of competencies and creates a clearer professional standard for pharmacists who function as pain and palliative care specialists within interdisciplinary teams. It is ultimately about improving access to thoughtful, evidence-based, patient-centered pain care, especially for those whose pain is complex or whose quality of life is significantly hindered.

Pharmacy Times: How does the certification prepare pharmacists to manage complex pain syndromes while balancing safety, quality of life, and patient-centered goals of care?

Malotte: At its best, board certification signals that a pharmacist has invested in a structured, comprehensive review of the evidence and clinical principles that underpin complex pain care—assessment, multimodal pharmacotherapy, monitoring and risk mitigation, deprescribing when appropriate, and aligning treatment plans with patient goals and function. That balance is the heart of pain and palliative care, which prioritizes the optimization of comfort and function while minimizing harm, and doing so in partnership with the patient and the care team.

I also see the certification as an important first step in a longer process. Because this is a new credential, it will benefit from ongoing refinement, so the assessment increasingly reflects the real-world clinical reasoning pharmacists use every day. This is especially relevant around individualized decision-making, interprofessional workflow, and the “gray areas” where safety, quality of life, and patient priorities must be carefully balanced.

Pharmacy Times: What feedback have you received from pharmacists who have pursued or earned the certification so far?

Malotte: The feedback has been encouraging about the need for the credential. Many pharmacists are excited to see pain management formally recognized as a specialty. At the same time, I have heard a consistent theme that, as with many inaugural exams, parts of the exam content felt more focused on broad knowledge sampling than on the practice standards and clinical decision-making depth that experienced pain and palliative care pharmacists routinely apply. That is valuable constructive feedback. Early cohorts are essentially helping shape what this credential will become. As the specialty grows, continued dialogue between test takers, content experts, and the board can help the exam blueprint and preparation resources evolve to better match the realities of specialty practice.

Pharmacy Times: Are there aspects of the certification process [eg, exam content, preparation resources, eligibility requirements] that have been particularly well received?
Malotte: The most well-received aspect is the fact that the specialty credential now exists. Pharmacists have wanted a clear professional “home” for pain management expertise for a long time. In terms of process, the eligibility framework is generally in line with other board certifications, which provides consistency across specialties.

Where I think there is an opportunity to strengthen the process is in how practice experience is defined and verified. Pain and palliative care specialization is fundamentally built on direct patient care and longitudinal clinical judgment—ideally through a dedicated inpatient consultation service, specialty outpatient clinic, or embedded palliative care practice—rather than indirect exposure where pain happens to be present. Clearer criteria and a robust review process would help ensure that the credential reliably reflects true specialty-level practice.

Pharmacy Times: What role does the Society of Pain and Palliative Care Pharmacists [SPPCP] play in supporting certified pharmacists through education, mentorship, and advocacy?
Malotte: SPPCP plays a key role because [it] brings together content experts who are deeply invested in education, training, and practice advancement, many of whom are residency program directors, faculty, and clinical leaders. As a smaller and highly specialized professional society, SPPCP [must] be strategic with resources, but it has consistently prioritized high-impact education and mentorship. That includes developing learning opportunities tailored to real clinical practice and connecting pharmacists across career stages who are building pain and palliative care services in very different health systems.

From an advocacy standpoint, SPPCP helps articulate what specialty-level pharmacist practice looks like and why it matters for patient outcomes. I would love to see increased recognition and investment—from larger professional societies and from certifying bodies—so that the content experts and training infrastructure in this area can keep pace with the clinical need.

Pharmacy Times: Looking ahead, are there plans to expand training opportunities, resources, or research tied to the certification?
Malotte: I think expansion is essential. Right now, the demand for high-quality pain management is far ahead of the available training pathways and specialty-specific educational resources. If we want this certification to carry real meaning, the profession needs a strong ecosystem around it: more structured training experiences, more accessible review and continuing education resources, and more outcomes-focused research demonstrating the value of pharmacist-led pain and palliative care interventions.

My hope is that we treat this credential as a foundation—not just an exam. The goal should be a well-supported specialty workforce that improves patient-centered outcomes: better symptom control, safer prescribing, fewer preventable adverse events, and care plans that reflect what matters most to each patient.