Nonpharmacist Membership on Boards of Pharmacy Continues to Expand

In the United States, the practice of pharmacy is governed at the state level. Each state has different laws, rules, and regulations that direct the profession. The 50 states, and most US territories, have a board of pharmacy (BOP), although some may use a different name. These BOPs are tasked with enforcing their state’s practice act, writing and maintaining relevant administrative rules and regulations, overseeing licensure, and administering disciplinary action to those who violate pharmacy law or rules. In short, the members of the BOP control and shape the profession.

Given that pharmacy as a profession has a heavy regulation burden, with the word counts of statutes and regulations far exceeding those of nursing and medical professions, those who govern the profession must be highly qualified, unbiased, and able to represent the profession holistically.¹

BOP Membership Composition

A health sector meeting in a conference room. Image Credit: © PZPIXEL.AI - stock.adobe.com

As with everything else in pharmacy, how often the composition of the BOP changes varies by state. Generally, laws on BOP membership may remain the same for decades until an update is made to address a sunset clause, changes in political or cultural viewpoints, or an urgent need to protect public health. In 2025, the state of Alabama is set to pass an update to its pharmacy practice act, HB123.² Many of the changes set to modify HB123 are meant to update outdated language and alter penalties that may be imposed by the state’s BOP.However, the statute contains a complete overhaul in the BOP composition and the process for candidate nomination and appointment.

Currently, the Alabama BOP (ALBOP) comprises 5 licensed pharmacists who serve 5-year terms, with one member’s term expiring and another starting each year. Three of the members (from chain, independent, and hospital practices) are appointed by the governor upon receiving a list of nominees from the state’s 2 pharmacy organizations. The other 2 members are considered “at large” and are appointed by licensed pharmacists who vote from a slate of candidates provided by the state pharmacy association.

The new law increases the ALBOP composition to 9 members who must be from different congressional districts. Six of the members must be licensed pharmacists from specified practice settings with 1 at-large pharmacist member. A pharmacy technician and a nonpharmacy public member would round out the board composition. What may at first seem to be a dramatic transformation in fact brings the ALBOP into greater alignment with other states.

BOP Size

BOP composition throughout the United States is diverse in size, composition, and requirements for membership. The actual size of state BOPs is 5 to 17 members, with a median of 8. Although nationally 74% of the 422 BOP seats are designated for pharmacists, states differ broadly in how many pharmacists vs nonpharmacists may be tasked with governing the profession. Louisiana has the largest board, and 16 of the 17 members are pharmacists. In contrast, Washington has the second largest BOP, but one-third of the 15 members are nonpharmacists. Although such a percentage of nonpharmacist members may seem significant, 14 other states have similar or larger proportions. California has the lowest rate of pharmacists on its BOP, with only 53% of seats composed of pharmacists. Before 2025, only Alabama and Mississippi had BOPs composed entirely of pharmacists.

Pharmacy Technicians and Specific Pharmacist Practice Settings

Alabama becomes the 21st state to have at least 1 pharmacy technician on the BOP. As the role of the technician continues to expand, their inclusion on a BOP is both practical and resourceful. Technicians are foundational to pharmacy operations, and having a technician-designated seat allows the board to make better-informed decisions in areas that affect a large constituency of professionals overseen by the BOP; it also fosters better collaboration and collegiality within the profession.³

Technicians serve in key leadership roles within the boards, and their involvement helps increase the inclusion of pharmacy technicians in key task forces and working groups focused on topics relevant to technicians.³ They also provide a much-needed perspective during disciplinary hearings, particularly those involving their peer technicians.

It is important to recognize that pharmacists have become more diverse in practice settings over the past century. Each setting has its unique caveats and considerations that may not be fully understood by those who have not practiced in that environment. Twenty-four states designate at least 1 seat on their BOP for a pharmacist who practices in a specific setting. Delaware, Minnesota, and Ohio laws require only that the BOP composition be diverse in practice setting representation. The other 21 states are more explicit in who can be considered for designated seats. All 21 reserve a seat for a hospital pharmacist, and 15 mandate seats for pharmacists from community pharmacy (chain and/or independent). Alabama will join 4 other states (California, Maryland, Massachusetts, and Missouri) that reserve a BOP seat from the long-term care setting.

The new Alabama BOP allocates 1 seat for a pharmacist from either a nuclear, home infusion, compounding, or consultant setting. Currently, only California and Massachusetts laws specify a seat for a compounding pharmacist, and Maryland is the only other state to require a pharmacist from the home infusion sector specifically. Should a nuclear pharmacist be appointed, they would be the only such pharmacist serving in a designated seat in the country. Alabama also joins Massachusetts in having a rarer seat designated for a faculty member from a school or college of pharmacy (academia). Interestingly, Georgia and Wyoming take the opposite viewpoint; their laws explicitly prohibit anyone working for a college or school of pharmacy from serving on their board. Only Alabama and Maryland laws specifically designate a seat for an at-large member. However, all the pharmacists’ seats in the 26 states without designated seats under the law should be considered at large.

Public or Nonpharmacy Members on the BOP

Currently, 47 states have at least 1 BOP member who represents the public and cannot be trained in, practicing, or have a financial interest in the profession. Implementation of HB123 would leave only Mississippi and New York without a public member. California leads the country in the number of public members, at 6, but most states have only 1 or 2.

The role of a BOP is to ensure the welfare and safety of the public regarding pharmacy practice. The public member of a board provides a niche role in helping to fulfill that responsibility. They provide a consumer perspective not influenced by professional interest or biases, allow for representation from all stakeholders (and specifically patients and families), and integrate additional public accountability into regulatory decisions.^4-6 Although many states exclude candidates with a pharmacy background, a background in health care broadly has been described as beneficial because it provides a degree of familiarity useful for understanding the complexities of regulation and the needs and nuances of the issues encountered during board service.⁶ This level of understanding can help public members better assert themselves as advocates for public and patient interests.⁶

However, public members are not the only people outside the pharmacy profession who may be BOP members. Two states, New Jersey and Pennsylvania, designate additional BOP seats to specified state government employees or appointees, and Wyoming law requires 1 member to be a physician, dentist, or veterinarian.

Political Appointments and Input From State Pharmacy Organizations

Every state has at least 1 member whose seat is a political appointment. North Carolina is unique because only the public member of the BOP is appointed by the governor, whereas the licensed pharmacists in the state vote upon the remaining seats (all pharmacists without required practice settings). Overwhelmingly, governor appointments are the most common method of BOP membership for pharmacists, and they occur in 45 states. Pharmacists in Rhode Island and Utah are approved by the governor following appointments from a state administrative official. Nebraska and New York BOP members are appointed by other government boards.

With the passing of HB123, Alabama’s appointments will be the most complex in the country. Two of the 7 pharmacists will be appointed by the governor (hospital and chain), the lieutenant governor (independent and academia), and the speaker of the House (specialty and at large), respectively, and the president pro tempore of the Senate appoints the nonhospital institutional pharmacist and the pharmacy technician. The governor is also responsible for appointing the public member.

Where nominations for appointments come from is largely undefined in pharmacy law. Candidates from 10 states are nominated by 1 or more state pharmacy organizations. Although this has and will continue to occur in Alabama, the state will be the first where the pharmacy schools are explicitly involved in the nomination process. This provides an opportunity to involve professionals who might not otherwise be identified but who possess unique perspectives that can benefit the BOP.

Geographic Requirements

Every state requires pharmacist BOP members to have an active license to practice, but almost half of the states do not have an explicit residency requirement. Of the states that do, 21 either are nonspecific in duration of residency required or allow for state residency for 1 year or less. Alabama will be the eighth state to make residency location within a state a qualifier for BOP service. Geographic distribution provides an opportunity for diversity that addresses the perspectives and needs of rural, suburban, and urban areas and integrates unique vantage points of a geographic region, which could have substantial variation depending on state size. These opportunities are still possible within states without regional considerations for BOP membership. Still, they are not guaranteed, and it is possible for an entire geographic demographic to lack representation on the board.

Why the BOP Composition Matters

Pharmacists behind the pharmacy counter. Image Credit: © Cristina - stock.adobe.com

Pharmacy is a profession, and professions should have contributory sufficiency in their governance.⁸ Pharmacy law at the federal and state levels is generally broad. Although it may contain some explicit aspects, most of the more detailed and specific items that govern pharmacy practice are found in the administrative codes that are written and enforced by applicable agencies, such as the BOP with the weighted authority of law.

Some practice areas follow a consistent framework throughout the country, such as minimum qualifications to practice and requirements with federal law and rules. But much of pharmacy practice is left to the opinion and interpretation of the select few serving on the BOP.

It is important to note that no data suggest that a particular board size, specific composition, or membership process results in better outcomes, improved patient and public health, improved legal compliance, or reduced professional negligence. However, the BOP must meet the needs of those it serves. It influences the degree of regulatory burden imposed on the profession, which affects practice across different settings. The BOP also determines the outcome of disciplinary hearings held when allegations of professional legal violations or misconduct are brought forth, and their determination can have lifelong impacts. In short, the BOP sets professional standards and serves as a self-policing agency within pharmacy.⁷

Fortunately, pharmacy on the whole consists of professionals with high standards and ethics. Less than 0.5% of pharmacist licenses experience disciplinary action, and malpractice payments for pharmacists are rare, at 0.01% of licenses.⁸ Still, the maintenance of this expectation requires a highly functional overseeing body that has the trust and respect of its stakeholders. The BOP needs to operate as a cohesive team with the freedom to make decisions without undue outside pressure, including from their practice interests or those of people who may have contributed to the nomination or appointment process. Further, representation of all of pharmacy across a state helps ensure diverse perspectives, equitable attention to issues, and fairer board outputs.

Although most pharmacists—and pharmacy technicians—will never serve on a BOP, they should be aware of how the membership process works, a process that is outlined by individual state law. Law can be influenced through individual and collective advocacy. As the profession evolves, societal norms and expectations change, and the composition and contributions of a BOP must keep pace. If and when a change in the process is proposed or needed, the profession’s members need to voice their consent or provide rationale modifications to lawmakers. Otherwise, we risk the autonomy of self-regulation that our profession has maintained for centuries.

REFERENCES

1. Adams AJ. Regulating pharmacy practice: analysis of pharmacy laws in ten states. Innov Pharm. 2020;11(4):10.24926/iip.v11i4.3344. doi:10.24926/iip.v11i4.3344

2. Underwood K, Wilcox JM. HB123 engrossed. Alabama Legislature. February 4, 2025. Accessed June 6, 2025. https://alison.legislature.state.al.us/files/pdf/SearchableInstruments/2025RS/HB123-eng.pdf

3. Burk R. Pharmacy technicians serving on state boards: expanding roles and shaping the future. Pharmacy Times. 2025;91(1). Accessed May 2, 2025. https://www.pharmacytimes.com/view/pharmacy-technicians-serving-on-state-boards-expanding-roles-and-shaping-the-future

4. Citizen Advocacy Center. Rationale and criteria for public members on state health professional boards. Patient Safety Action Network. April 2017. Accessed May 2, 2025. https://www.patientsafetyaction.org/wp-content/uploads/2022/02/Rationale-and-Criteria-for-Public-Member.pdf

5. Irvin S, Rosenfield L. Value of a public member on an organization’s board. OR Today. October 1, 2023. Accessed May 2, 2025. https://ortoday.com/value-of-a-public-member-on-an-organizations-board/

6. Johnson DA, Arnhart KL, Chaudhry HJ, Johnson DH, McMahon GT. The role and value of public members in health care regulatory governance. Acad Med J Assoc Am Med Coll. 2019;94(2):182-186. doi:10.1097/ACM.0000000000002481

7. Wideman RM. The attributes of a profession. Max Wideman's PM Wisdom. August 31, 1987. Accessed May 2, 2025. http://www.maxwideman.com/papers/spectrum/attributes.htm

8. Adams AJ, Adams J. Does increased state pharmacy regulatory burden lead to better public safety outcomes? Innov Pharm. 2021;12(1):10.24926/iip.v12i1.3598. doi:10.24926/iip.v12i1.3598