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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 are a number of applications to submit and exams to pass before you can register in the US

There are a number of applications to submit and exams to pass before you can register in the US

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”.

You have to complete an English test if you want to register as a pharmacist in the US, no exceptions

3. Register online for the FPGEE and the test of English a s 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

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

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 componentand it needs notarising).

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

Other things to consider

I have not mentioned additional costs, such as:

  • Charges for issuing documentation, notary fees, textbooks/onlineresources, 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 aresimilar to those in the UK. In hospital pharmacy, working patterns incorporatevariable shift-work.

Working in US pharmacy is certainly a different andrewarding 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
When it can be takenBi-annually at dates set by NABP (usually April,September) Any time Any time Any time 
Style of examination250 multiple choice questions on anything fromundergraduate degree. Some familiarity is needed with US-specific pharmacy (eg,law, drug names, terminology, the healthcare model) Reading, writing, listening and speaking sections.Computerised test with a series of questions. 185 MCQs to test ability to measure pharmacotherapy and therapeutic outcomes, prepare and dispense medicines, and implement and evaluate information. Often in a scenario-based format. Similar in content to theUK registration assessment  90 MCQs. Combines federal- and state-specificquestions to test pharmacy jurisprudence knowledge 
Test centreAny Pearson VUE Test siteAny ETS Test siteAny Pearson VUE Test site  Any Pearson VUE Test site  
Length of examination 5.5 hours (30 minutes’ break in middle) Four hours (10 minute break in the middle) 4.25 hours (optional 10 minute break) Two hours (nobreak) 
Recommended study period 

(per textbook) 

At least four to six weeks, one or two chapters/dayfor four or five days/week. Learn trade and generic drug names for top 200drugs and review regularly  Depends on yourEnglish ability.Two months (four hours/day). Need to know top 200prescribed drugs tooTwo weeks (five hours/day)
Recommended revision guide 



The American Pharmacists Association complete review for the FPGEE , by Dick Gourley.
Reference guide for the foreign pharmacy licensing exam Q&A ’ 2nd edition, by Manan Shroff
A practice test is available through NABP ($50).  
The full practice test from ETS ($45) gives you a good idea of the (quite lengthy) examination  McGraw-Hill’s ‘NAPLEX review guide’ by Scott Sutton
Practice test  available through NABP for an additional $50

‘Guide to federal pharmacy law’ by Barry Reiss and Gary Hall

Further study


for state law are recommended by state board.

Cost ($1?£0.65)$800 for examination and $85 for ECE report. Approximately $400 for copies of reports to be sent to ECE and NABP, notary fees, postage and packaging, registration as intern and registration as pharmacist$160$421 (combined total for NAPLEX, MJPE, licensure application). May vary depending on state.$421 (combined total for NAPLEX, MJPE, licensure application). May vary depending on state.  
Pass mark  Scaled score of 75 (range 0–150)Speaking 26

Writing 24

Listening 18

Reading 21  

Scaled score of 75 Scaled score of 75  


Citation: Tomorrow's Pharmacist URI: 11128041

Readers' comments (5)

  • I am an Italian pharmacist, and I gained my RPh license in USA in 2008, and I am practicing since then! I started my process in 2001 ,as a CPhT and my journey was over after 7 years. It was difficult, expensive, and sometimes painful but I made I am facing another issue, I would like to pursue more education and "titles" but I seem not finding the correct way without being reminded " you aquired your education outside the USA" any suggestion?

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  • I am a pharmacist with a 3 year bachelor degree graduated in 1999. I have been trying to get my American registration for years. NABP allowed me to sit the FPGEE exam and TOEFL which I both passed and a few months ago they wrote to me saying that I am not eligible for certification because I have a 3 year degree.
    But why not telling me that 4 years ago before I spent so much time studying and spending lots of money. I tried to write to them asking them to give me an explanation but of course they ignored my question. They are so unprofessional
    and unfair. Is anyone in the same situation as me? Or does anyone have any suggestions of what to do next in order to get my licence? My husband works in USA and it looks like I will never practice pharmacy in Us. I am devastated .......I would love to hear from anyone who has any suggestions. Many thanks.

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  • hi, i am an indian having post graduate in clinical pharmacy(M pharm).i had done 4 year Bpharm +2 year M pharm ,currently am doing my MHA program in us. so if am going through above mentioned step will i get license. please give me an answer

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  • Hi,
    I am an Indian Pharmacist.In 2012 I came to know about this FPGEE.
    I started the application process with ECE.After 2 grueling years of sending letters to and fro to my Pharmacy board and ECE.I finally get my ECE report in 2015.Now the fees became $1200 for FPGEE.
    When I started the process it was $600.
    The report said that I have an equivalent to Master s in pharmacy in USA.
    Finally I submit my application for FPGEE to write this Oct.
    One week before the exam they declined my application saying -I lack experience in patient care in a clinical pharmacy practice setting.Since the fees was $1200 ,they said they refund only $750.
    The application process is frustrationg time consuming sending letters from this continent to the other.
    They should give ECE the power to decide whether a student can proceed for the exam or not.
    I could have gone and done some courses.
    4 years! I could have done something else.
    I was studying for this exam.
    One week before they decline my application.
    If NABP was evaluating it then why send all reports & certificates to ECE.??Because the $450 was evaluating fee of NABP.

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  • I am passing through the same situation. Don,t know what to do?
    I have B.Pharmacy (4 year course passed in 2006) plus one year Pharm.D upgrade (for B.Pharm Graduates-passed in 2014). But they have declined my application by stating the same reason " lack of experience in patient care in a clinical pharmacy practice".
    Any advice please?

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