2024–2025 House of Delegates
Report of the Policy Reference Committee
v Pharmacy Jurisprudence Competency Assessment
v Advancing Health Equity
Committee Members
Veronica Vernon, Chair
Jennifer Adams
Glen Gard
Cory Holland
Christopher Johnson
John Kirtley
Gina Moore
Traci Poole
Ex Officio
Brandi Hamilton, Speaker of the House
Mary Klein, Speaker-elect of the House
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This report is disseminated for consideration by the APhA House of Delegates and does not represent the position of the Association. Only those statements adopted by the House are considered official Association policy.
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Overall Charge and Duties
The APhA House of Delegates Policy Reference Committee reviewed feedback provided directly via email and from two open hearing webinars that took place on December 11, 2024, and December 18, 2024. The committee then met on December 11, 2024; December 18, 2024; and January 6, 2025, to develop the following recommendations. Proposed amendments will become primary language acted on by the House of Delegates and are shown in red font (deletions are struck through and proposed additions are underlined).
The APhA House of Delegates Policy Reference Committee presents the following report:
Topic #1 – Pharmacy Jurisprudence Competency Assessment
The APhA Policy Reference Committee recommends adoption of the following as written.
1. APhA affirms pharmacy personnel must have knowledge and understanding of laws, regulations, and policies that affect their roles in the practice of pharmacy.
(Refer to Summary of Discussion items: 1–10)
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Comments: The Policy Reference Committee recommends adopting the proposed statement as written, reaffirming the universally recognized importance of pharmacy personnel’s jurisprudence knowledge.
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The APhA Policy Reference Committee recommends adoption of the following as written.
2. In the interest of protecting public health and safety, APhA supports the assessment of knowledge regarding pharmacy laws, regulations, and policies as a component of pharmacist licensure or registration.
(Refer to Summary of Discussion items: 1–8, 11–14, 16–26, 38–39)
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Comments: The Policy Reference Committee recommends adoption as written. The committee considered questions around the explicit mention of intent, “in the interest of protecting public health and safety,” and deliberated on the utility of this specification. The committee recognizes that, while public health and safety is important, there could be other reasons to support assessment of pharmacy jurisprudence. However, the committee ultimately opts to retain this language to acknowledge the focus on public health and safety by state boards of pharmacy. The committee also considered comments related to the use of “assessment” and determined that it was intentionally inclusive of all possible assessment types.
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The APhA Policy Reference Committee recommends adoption of the following as written.
3. To mitigate barriers to licensure, APhA advocates for state boards of pharmacy to work with relevant parties to design and implement optimal methods for assessing minimum pharmacy jurisprudence competency.
(Refer to Summary of Discussion items: 1–8, 15–29, 31–32, 38–39)
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Comments: The Policy Reference Committee recommends adoption as written. The committee acknowledged delegate comments in support of collaboration among relevant parties to implement optimal assessment methods.
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The APhA Policy Reference Committee recommends adoption of the following as written.
4. APhA encourages National Association of Boards of Pharmacy (NABP) to collaborate with pharmacy educators to formulate measurable competency statements for use in developing pharmacy jurisprudence assessments.
(Refer to Summary of Discussion items: 1–8, 16–18, 23–26, 29–39)
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Comments: The Policy Reference Committee recommends adoption as written. There was discussion around a potential amendment to list additional parties (e.g. state boards of pharmacy) among those to collaborate on competency standards. The committee opted against this proposed amendment, as NABP members currently author these competency statements.
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The APhA Policy Reference Committee recommends adoption of the following as written.
5. APhA advocates for ongoing, timely, and transparent quality assurance and control for jurisprudence assessments.
(Refer to Summary of Discussion items: 1–8, 16–18, 24–26, 29, 31–32, 36, 38–43)
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Comments: The Policy Reference Committee recommends adoption as written. The committee found this statement to be representative of the committee and delegates’ position.
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The APhA Policy Reference Committee recommends adoption of the following as written.
6. APhA encourages state boards of pharmacy to publicly communicate when changes in laws, regulations, and policies will be reflected in jurisprudence assessments.
(Refer to Summary of Discussion items: 1–8, 17–18, 26, 38–40)
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Comments: The Policy Reference Committee recommends adoption as written. The committee found this statement to be representative of the committee and delegates’ position.
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The APhA Policy Reference Committee recommends adoption of the following as written.
7. APhA encourages boards of pharmacy to provide free, timely, and readily accessible educational updates regarding changes in pharmacy laws, regulations, and policies.
(Refer to Summary of Discussion items: 1–8, 26, 38–41, 44–47)
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Comments: The Policy Reference Committee recommends adoption as written. The committee found this statement to be representative of the committee and delegates’ position, noting that timely communication of law updates is critical to effective jurisprudence assessments and was emphasized in delegate feedback.
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Topic #2 – Advancing Health Equity
The APhA Policy Reference Committee recommends adoption of the following as written.
1. APhA affirms health equity as a core value of the profession of pharmacy and supports policies and practices that advance equitable access to care.
(Refer to Summary of Discussion items: 1–14)
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Comments: The Policy Reference Committee recommends adoption as written. There was consideration of amendments to include “pharmacoequity”; however the committee found “health equity” to be most inclusive to all aspects of health care which pharmacists may influence, including socioeconomic status. The committee also considered whether to explicitly mention investments to advance equitable access to care. While important, the committee considers investments to be captured by “policies and practices.”
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The APhA Policy Reference Committee recommends adoption of the following as written.
2. APhA calls on pharmacists to uphold the Oath of the Pharmacist to promote inclusion, embrace diversity, and advocate for justice to advance health equity.
(Refer to Summary of Discussion items: 1–12, 15–16)
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Comments: The Policy Reference Committee recommends adoption as written. The committee considered a proposed amendment to add the phrase “for all individuals” at the end of the proposed statement, however determined this to be unnecessary in conveying the intent.
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The APhA Policy Reference Committee recommends adoption of the following as written.
3. APhA commits to prioritizing the elimination of systemic barriers that prevent pharmacy professionals from performing their critical role in ensuring health equity.
(Refer to Summary of Discussion items: 1–11, 16–21)
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Comments: The Policy Reference Committee recommends adoption as written. The committee found this statement to be representative of the committee and delegates’ position on the association’s role in ensuring health equity. The committee considered what prioritization might look like and considered specifying such actions within the policy but opted against specifying this in the proposed statement to include all implementation opportunities.
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The APhA Policy Reference Committee recommends adoption of the following as amended.
4. APhA supports efforts to empower pharmacy professionals as advocates for marginalized groups who have been marginalized and are facing health inequities.
(Refer to Summary of Discussion items: 1–11, 16–17, 19–25)
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Comments: The Policy Reference Committee recommends adoption as amended, to represent contemporary and people-centric language. The committee considered alternatives to the language “marginalized groups,” referencing resources such as the CDC Guiding Principles for Inclusive Communication and HHS National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care to land on the most appropriate language for describing the intended individuals and communities. The committee ultimately opted for an amendment to “groups who have been marginalized and are facing health inequities.”
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The APhA Policy Reference Committee recommends adoption of the following as written.
5. APhA advocates for the inclusion of pharmacy professionals’ expertise in all efforts to ensure individuals and communities have equitable opportunities to attain their full potential for health and well-being.
(Refer to Summary of Discussion items: 1–11, 15–17, 26–30)
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Comments: The Policy Reference Committee recommends adoption as written. The committee considered comments received around the inclusion of “full potential” for health and well-being and determined that this language was intentional to conveying the goal of optimizing patient outcomes while ensuring equitable opportunities.
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Summary of Discussion
Pharmacy Jurisprudence Competency Assessment
1. The committee reflected on APhA’s distinct role as an association representing all of pharmacy compared to other parties and colleagues, recognizing the extent of its influence and membership in the area of pharmacy law assessment. (all)
2. The committee’s use of the term “jurisprudence” refers to the study, knowledge, or science of law, as defined by relevant authorities on the subject such as Cornell Law School. Additionally, the committee’s intent by this word choice is to include the broader philosophy of law. The committee intentionally does not name specific existing pharmacy law assessments such as the Multi-State Pharmacy Jurisprudence Exam (MPJE) in its proposed statements, to be inclusive. (all)
3. When referring to regulatory and legislative language within these proposed statements, the committee opted for the phrase “laws, regulations, and policies” to be consistent with standardized APhA policy language. The term “policies” in this case refers to relevant federal and state policies which are included within required pharmacy law exam competencies (i.e., certain FDA policies, state Medicaid handbook). (all)
4. The committee discussed the broad intent and goals of a pharmacy law exam, which is to be a timely minimal competency assessment of knowledge and understanding of pharmacy law before practicing. (all)
5. The rationale behind state-specific pharmacy law exams was explored. The differences and similarities between federal and state law competencies were outlined. Additionally, the importance of the autonomy of the states to create a model that meets the needs of their state and variations in scope of practice were considered. (all)
6. The committee discussed a lack of consistency and transparency between the composition of federal and state law specific questions on the law exams among different states. (all)
7. When developing proposed policy, the committee reviewed existing APhA policy and determined that the proposed new statements are complementary to the following:
a. 2024, 2012 Contemporary Pharmacy Practice (JAPhA. 57(4):441; July/August 2012) (Reviewed 2017) (Reviewed 2024) Statement 5- APhA supports the establishment of multistate pharmacist licensure agreements to address the evolving needs of the pharmacy profession and pharmacist-provided patient care.
b. 2021 Multi State Pharmacy Practice (JAPhA. 61(4):e14-e15;July/August 2021) (Reviewed 2023) (all)
8. The committee reviewed relevant policy statements on the subject of high-stakes pharmacy law exams, such as the American Association of Colleges of Pharmacy (AACP), which states that AACP recommends the removal of a stand-alone examination of federal and/or state pharmacy law as a requirement for licensure. The committee also reviewed policy from American Society of Health-System Pharmacists, which affirms the importance of pharmacy law knowledge and advocates for removal of a stand-alone examination of federal or state pharmacy law as a requirement for licensure to increase interstate practice flexibility and ongoing education of the pharmacy workforce on pertinent federal and state pharmacy laws. (all)
9. Regarding statement one, the committee deliberated whether to specify states and territories of licensure and practice. For example, the committee brought up several circumstances in which it would be possible for one to have an active license in one state but not ever intend to practice within that jurisdiction. The committee opted to remove this language, as it is implied by “laws, regulations, and policies that affect their role in the practice of pharmacy” that this should include all relevant states and territories. (1)
10. The committee used the term “pharmacy personnel” with the intent to include student pharmacists, pharmacy technicians, clerks, and others working in a pharmacy with regards to who must have knowledge and understanding of the laws, regulations, and policies that affect the practice of pharmacy. This language is also standard across existing APhA policies. This discussion occurred to clarify the difference in timing of exam administration (e.g., Arkansas student pharmacists take prior to APPE year) and the possibility of the statement being read as excluding a particular group from having to have this knowledge. (1)
11. The committee discussed the importance of limiting pharmacy law exam questions to those related to public safety and health, and to exclude content less relevant to pharmacy practice or the business of pharmacy. (2)
12. The committee opted to lead statement two with “in the interest of protecting public health and safety,” in an effort to capture the intended focus and protection of the public while diverting from traditional policy statement composition. (2)
13. When discussing the importance of knowledge and understanding of pharmacy law, the committee deliberated whether this concept is unique to pharmacists only or should include student pharmacists, clerks, and other pharmacy personnel. The committee recognized that only pharmacists take a standalone law exam, and certified pharmacy technicians are assessed in law as part of the technician certification process. (2)
14. The committee discussed whether “pharmacist” or “pharmacy personnel” should be utilized. The committee decided to use pharmacist because they did not want to require other pharmacy personnel to be required to be assessed on pharmacy laws, regulations, and policies. The committee also brought up student pharmacists taking the pharmacy law exam during school, but this point was deemed moot as the assessment would still be a part of licensure. (2)
15. The committee discussed the concept of high-stakes law exams, which the committee defined as an assessment with significant consequences for the test taker which may pose an unreasonable barrier to licensure, such as whether they earn a license by a certain date. The committee discussed the intentional barrier set by law exams as the minimum competency to ensure pharmacists know the laws, but not excessive to which it becomes a burden to becoming licensed when otherwise qualified. Excessive or unreasonable barriers refer to examinations set to a standard more difficult than minimum competency (3).
16. The committee debated whether a high-stakes law exam is the best method to ensure patient safety and comprehension of pharmacy laws. The committee discussed the timing of the administration of the exam (ex. during academic years vs. postgraduation), the content of the exam, and the standards utilized in creating the content of the exam including the 2025 Accreditation Standards and Key Elements for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree established by ACPE. (2–5)
17. When discussing the pharmacy law exam as licensure criteria to enter the profession, the committee discussed passage rates for various states and the concept that pharmacy law exams are intended to demonstrate a minimal competency of understanding. The committee noted potential correlation between exam intent and passage rates; if the intent is to assess minimal pharmacy law competencies and knowledge, passage rates should generally be reflective of this intent, as opposed to developing an assessment with the intent of a lower passage rate. (For example, the committee does not consider a 50% passage rate to be reflective of a minimum competency exam). (2–6)
18. The committee discussed the concept of utilizing the passage of a pharmacy law exam as a barrier to licensure. When looking at licensure portability, the committee investigated whether there were relevant differences between requiring passage of a pharmacy law exam at the initial licensure stage and the reciprocal licensure stage. (2–6)
19. The committee also reviewed whether the use of continuing education requirements or exam alternatives could be utilized in place of a pharmacy law exam at the reciprocal licensure stage. The committee ultimately opted not to specify reciprocal licensure or initial licensure in its statements, focusing more on broad language that encompasses initial licensure and reciprocity. (2–3)
20. The committee intentionally focused proposed statements on improvements to the existing pharmacy law assessment process, as opposed to recommending elimination of the assessments as a whole. (2–3)
21. The committee recommends the exploration of alternative jurisprudence assessment models, as determined by the relevant parties of each individual state, as the current methods need to be improved upon. Such alternatives to the exam include, but are not limited to, a universal or uniform pharmacy law exam, take-home pharmacy law exams, continuing education requirements related to pharmacy law, state-specific learning modules, open-note pharmacy law exams, incorporation of federal law competencies in the NAPLEX, and combinations of these alternatives in place of the stand-alone high-stakes pharmacy law exam. There was also discussion related to the complete elimination of the pharmacy law exam as part of the requirement of licensure. The committee considered different language beyond evaluation of the existing assessment practices, with the intention of encouraging action toward better practices. The committee considered describing these models as “alternatives” in the proposed policy language but opted to emphasize the intent of optimizing the model by emphasizing the design and implementation of “optimal” methods. Additionally, the committee wanted to use a term that was viewed as a compromise between stronger statements that APhA opposes or supports a stand-alone high-stakes pharmacy law exam and encourage change. (2–3)
22. When discussing relevant parties to explore alternatives to a stand-alone high-stakes pharmacy law assessment, the committee highlighted state boards of pharmacy and other relevant national organizations like the NABP. The committee also reviewed the concept of conducting jurisprudence assessments and remediation, if needed, prior to commencing advanced pharmacy practice experiences or following graduation from the pharmacy degree program. (2–3)
23. The committee recommends collaboration between relevant parties to explore alternatives to the stand-alone exam and supporting state boards of pharmacy in choosing their methods of assessment. There are opportunities for greater collaboration between those developing the assessments and teaching jurisprudence content in the PharmD curriculum. Concern was expressed over the material taught not aligning with the assessment if there is not open conversation between these groups, a clear blueprint, and clear competency statements. The committee recognizes this as the assessments are important in the licensure process. (2–4)
24. The committee stated that alternative methodologies may also include alternative timelines in the administration of a pharmacy law assessment. The committee considered different models in which the pharmacy law assessment is timed either prior to graduation or immediately following. In some states, candidates take the pharmacy law assessment during their didactic pharmacy education rather than having to wait until after graduation. Similarly, the committee discussed models in which knowledge of pharmacy law competencies may be reassessed and kept up to date. The committee is not in favor of repeated high-stakes assessments. (2–5)
25. The committee discussed the importance of the test administrator who provides assessment takers, educators, and schools and colleges of pharmacy with more relevant, in-depth, actionable data regarding the pharmacy law assessment. (2–5)
26. The committee discussed ways to empower the states to explore the needs of their pharmacists and develop jurisprudence assessment models that reflect those specific needs. The states individually are in the best position to analyze those needs and to provide the necessary resources and tools to aid their pharmacists in assessing competency regarding state-specific law. (2–7)
27. For statement three, the committee debated the appropriate verb to utilize—advocate and encourage were considered. The committee ultimately selected “advocate,” to imply more direct action would occur through the association. (3)
28. The committee was intentional with their language to mitigate barriers to licensure, as opposed to entirely removing them, recognizing a need for some level of barrier to ensure competence. In other words, the committee is supportive of guardrails that are not necessarily hurdles. (3)
29. The committee discussed that the current “Multistate Pharmacy Jurisprudence Competency Statements” do not include broad input from those teaching pharmacy law courses in schools and colleges of pharmacy. What are currently labeled as competency statements for the MPJE would be more appropriately labeled a topical blueprint, as they do not meet the definition of competency statements. (3–5)
30. The committee made a distinction between learning objectives (which describe what broadly must be taught in a pharmacy law course) versus competency statements (which refer to the expected points of assessment and skill for pharmacy practice). The committee referred to standard definitions of a competency statement and recognizes the intent for competency statements to clarify the observable and measurable behaviors and knowledge. (4)
31. There was also discussion about the composition of questions on pharmacy law exams and a need for transparent percentages of federal law questions versus state law questions. Additionally, the committee discussed opportunities to optimize creation of high-quality and effective pharmacy law exam questions. (3–5)
32. The committee emphasized a need for consistent transparency in the reporting of exam scores to the exam takers and pharmacy educators, to best facilitate continuous improvement. As of now, the direct connection from MPJE competencies and curricular structures at schools of pharmacy are not directly relatable. (3–5)
33. The committee noted that NABP is included explicitly in statement four regarding the competency statements because the organization establishes these statements. (4)
34. The committee stressed the utility of pharmacy law competency statements for state boards of pharmacy, pharmacy educators, and test takers. (4)
35. The committee discussed the intent of competency statements. The committee recognizes competency statements should include blooms taxonomy verbiage to create clear expectations for the assessment takers and reviewed the following references:
a. Competency Statements | Multistate Pharmacy Jurisprudence Examination (NABP.pharmacy)
b. MPJE Blueprint and Competency Statements (uworld.com)
c. ACPEStandards2025.pdf (acpe-accredit.org) (4–5)
36. The committee had a robust discussion on the applicability of existing pharmacy law assessment competencies, noting opportunities to better align curricular outcomes with competency statements. (4–5)
37. Regarding statement four, the committee discussed preferred qualities for pharmacy law assessment competency statements—such as clear, transparent, meaningful, relevant, aligned, specific, outcomes-based, actionable and applicable pharmacy law assessment competency statements. The committee opted for including “measurable” because the gap seems to be that the competency statements are too vague and broad to assist faculty in ensuring that students are being educated with these competencies. (4)
38. The committee examined opportunities available for optimizing the existing pharmacy law exam. The committee explored methods to ensure that the questions were updated regularly and were representative of the entire profession instead of specific areas of practice. Additionally, the committee discussed the quality control protocols that are in place or that could be put in place to ensure the pharmacy law exam is of high quality. More specifically, relationships between NABP, state boards of pharmacy, and schools and colleges of pharmacy were mentioned as key in assuring high-quality assessments. (2–7)
39. When discussing best practices of a pharmacy law assessment, the committee discussed the importance of assessment questions assessing current laws, regulations, and policies, as opposed to outdated content. (2–7)
40. The committee discussed the need for timely and transparent updates to law assessment content given how quickly pharmacy laws can change. Additionally, the committee highlighted the need for clear timelines of when those laws would go into effect each year and when those laws will be included in the assessment. (5–7)
41. The committee discussed inclusion of “psychometrically sound” to describe the jurisprudence assessment. It was agreed upon that “psychometrically sound” and “good/fair” are not synonymous when describing the quality of an assessment. The committee opted not to include this term within statement five because a psychometrically sound question does not necessarily equate to a high-quality question. (5–7)
42. For statement five, transparency is needed on the controls in place to measure the effectiveness of the examination. Transparency was included because the committee felt the reporting metrics are important for practitioners, academics, and test takers to be aware of. (5)
43. Quality assurance is the process that ensures a product or service meets the expectations of the customer, while quality control concerns the procedures that ensure a product or service adheres to a defined set of quality criteria. While quality assurance is a proactive approach that seeks to prevent defects, quality control is reactive and focuses on looking for defects in the final product. The committee opted to include both quality assurance and quality control, as they consider both the proactive and reactive assessments to be necessary. (5)
44. The committee discussed the importance of schools and colleges of pharmacy collaborating with the state boards of pharmacy to ensure that student pharmacists and practitioners can better prepare for the assessments that are currently being administered. (7)
45. When specifying the communication of law changes, the committee intends for this communication to be publicly available for exam takers, in addition to the colleges of pharmacy, and other practitioners. In addition to sharing this information, the committee discussed the importance of the providers of the assessment informing those parties about when the last test was updated (i.e., specifying the date of when a pharmacy law assessment or relevant laws, regulations, and policies were last updated). (7)
46. There was discussion as to whether the education resources be freely accessible, as in no charge, or readily accessible, as in available. The committee noted that freely accessible could be burdensome on those creating resources both financially and from a bandwidth perspective. Regarding the freely available resources, the committee recognizes that laws and regulations are publicly available, but they may not be easily found or interpreted. The committee was intentional to specify this benefit as “free of charge,” to ensure optimal access to this timely information, consistent to the missions of boards of pharmacy. The committee called upon the boards of pharmacy to provide these updates or utilize the schools or colleges of pharmacy in their state to provide updates or education if the board is not equipped to do so. (7)
47. The committee also discussed sensitivities of the inclusion of federal law in these freely available resources, recognizing that some states may not have the same permissions or authorities to include federal laws, regulations, and policies in such resources. (7)
Summary of Discussion
Health Equity in Pharmacy Practice
1. The committee broadly defines health equity as the achievement of optimal health outcomes for all patients, referencing authorities in this field such as the U.S. Department of Health and Human Services (HHS), which defines health equity as “the consistent and systematic treatment of all individuals in a fair, just, and impartial manner, including individuals who belong to communities that have been denied such treatment.” The committee also considered definitions from the World Health Organization, which notes “equity is the absence of unfair, avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically or by other dimensions of inequality (e.g. sex, gender, ethnicity, disability, or sexual orientation). Health equity is achieved when everyone can attain their full potential for health and well-being.” (all)
2. The committee reflected on prior discussions on health equity during the 2024 House of Delegates, to inform the overall need and intent to explore health equity in APhA policy and how related APhA policy is intended to be interpreted and applied. The committee’s intent is that these proposed policies may result in the most actionable implementation of health equity values by the association. (all)
3. The committee considered the utility of a preamble as a framing device to help guide the construction of policy related to health equity. This would minimize the need to address communities or patient populations within policies and allow for the focus to be on the policies themselves. This preamble would need to stand the test of time without the need for constant amending throughout the years. Additionally, because a preamble would not technically serve as a policy, a preamble would not be as actionable and effective. Thus, the committee opted to draft stand-alone statements and opted to defer a preamble to Board discussion and development if there is determined need. (all)
4. The committee’s intent is to address APhA’s role in pursuing health equity, pharmacists’ responsibility in managing inequities, advocacy for pharmacist involvement in decisions affecting heath equity, and acknowledgement of patient barriers to health equity. In addition, the committee seeks to present clear goals to guide the Association toward tangible health equity outcomes. (all)
5. The committee recognizes that social determinants of health (SDOH) impact patients’ ability to access care, and it is a responsibility of pharmacy professionals to be aware of and address SDOH to achieve health equity. (all)
6. In the course of developing its proposed policy statements, the committee was mindful of potential unintended consequences or sensitivities from certain parties such as employers when diversity, equity, and inclusion (DEI) concepts or similar terms are used. The committee discussed that APhA can provide support to pharmacists without affecting their employment status or imposing burdensome requirements on the pharmacy workplace. The committee asserts that pharmacists should be empowered to help minimize health inequities, and APhA has a professional responsibility to provide support to its members. (all)
7. Regarding the role of pharmacists in ensuring that all patients have equitable opportunities, there was discussion about the importance of pharmacists having a role in this but also ensuring that they are not solely responsible. There was discussion of the extent of pharmacists’ role in patient care, noting this expands beyond patient medication management. (all)
8. There was debate around the optimal verb to utilize in each policy statement, such as whether to “demand” or “insist” on certain principles. The committee sought to strike a balance between strong and flexible language. There was discussion about whether the term “demand” may be too strong a word to encourage collaboration with relevant parties. (all)
9. The committee was intentional to avoid listing any qualifiers for people and settings to implement health equity in proposed policy language. The intent is that health equity is implied and expected for all patients and implemented by all pharmacy practices. (all)
10. The committee recognizes a history of comments shared in the House which may have disenfranchised others. In response to this history, the committee seeks to convey a sense of welcoming for everyone to share their input and perspectives when it comes to health equity but doing so in a way that does not use potentially offensive language or have potential for damaging misinterpretations. (all)
11. The committee also considers religion, patient identities, and beliefs to be included in considerations of health inequities but ultimately decided not to use an explicit list. The committee was intentional not to include a definition of health equity in the proposed statements, to be most broad, inclusive, and evergreen in implementation. (1–5)
12. In discussions of the pharmacists’ role and responsibility, the committee referenced the Oath of a Pharmacist, noting not only that pharmacists are bound to the commitments made in this Oath, but also recognizing mention of health equity in the Oath. The committee also recognizes that, while many of the principles may be universal, pharmacists are the only pharmacy personnel obligated to this Oath, recognizing that not all pharmacy personnel take the oath of a pharmacist, statements regarding professional duty to maintain the oath are directed to the pharmacist. Regarding statement two, there was discussion as to the verb to utilize. The verb “affirms” was mentioned to be used as it is their obligation per the Oath of a Pharmacist. The phrase “calling on” pharmacists to act is not strong enough language but does provide an action for pharmacists to review this obligation. There was also discussion to utilize the term “obligation” or “oath.” The committee recommends regular reading of the Oath of the Pharmacist. Regular readings were suggested to occur at the House of Delegates and general session at APhA’s Annual Meeting & Exposition. (1, 2)
13. For statement one, the committee contemplated adding an additional verb after “promote” or replacing “promote” with “advance.” The committee decided to utilize “advance” rather than “promote,” opting for a more active verb. (1)
14. The committee discussed inclusion of whom statement one is referring to when it comes to the core value. They ultimately decided to direct this core value to the entire profession of pharmacy. (1)
15. There was discussion around the use of the word “demand” in statements two and five as it would not be appropriate to use the word “demand” because there are pharmacists that want to be involved in ensuring health equity but do not have the resources or ability to act. There was disagreement centered around the notion that APhA cannot call on its members to action and rather should provide support. (2, 5)
16. The committee discussed opportunities for where pharmacy personnel could intervene, including those around pharmacists’ expertise of medications. There was further discussion about whether pharmacists should be utilized rather than pharmacy personnel because the needs discussed could be accomplished by others within the pharmacy sphere. The opposite point was also brought up that pharmacists are trained as medication experts, which is why the pharmacy expertise should be reserved for the pharmacist. The committee ultimately selected pharmacy professionals because “pharmacy personnel” is inclusive of other ancillary staff, and the committee specifically seeks to include pharmacists, pharmacy technicians, and student pharmacists. (2–5)
17. For statement four, the aim is to empower pharmacists who do not feel they are able to advocate for marginalized groups to do so. Whether that be through tools, resources, or other forms of support, the committee wants APhA to show support to those pharmacists who may not feel currently empowered to overcome barriers to promote health equity. This statement would provide support to those pharmacists who, for example, fear employment backlash from their efforts to promote health equity. Another form of empowerment would be through self-awareness of aspects of health equity. Potentially offensive language or misinterpretation of policy can be mitigated with efforts to educate oneself on health inequities and will help pharmacists feel more knowledgeable and confident in weighing in and making changes for patients in a positive manner. (3, 4, 5)
18. When considering the appropriate verb choice for prioritizing the elimination of systemic barriers, the committee determined that “encouraging” these practices would be too passive for the intent. The committee also considered “requiring” this practice but determined this to fall outside the scope of the intent to focus on providing resources so that those who did not have them are better equipped. The committee leaned toward language such as “commits” or “seeks out,” which emphasizes the onus on individual pharmacists to pursue these principles, as reaffirmed within the Oath of a Pharmacist. (3)
19. When discussing pharmacists’ role in health equity, the committee reflected on curricular needs of student pharmacists. The committee considered inclusion of a statement around the development of education to implement social determinants of health but recognized this was already covered by existing APhA policy. (3, 4)
b. 2021 Diversity, Equity, Inclusion, and Belong (JAPhA. 61(4):e15; July/August 2021) (Reviewed 2023)
20. When creating opportunities and professional development related to health equity topics, the committee emphasized the importance of an inclusive and welcoming space for pharmacy professionals to learn about health equity. (3, 4)
21. The committee considered an opportunity to consolidate two ideas into one statement—both the elimination of systemic barriers and empowerment of pharmacy professionals to feel safe to advocate on behalf of marginalized groups and minimize inequities. The committee ultimately opted for two separate statements, noting that the two concepts were different and important enough to stand alone. (3, 4)
22. There was discussion for inclusion of “providing educational opportunities and professional development” to have APhA assist in the creation of opportunities and ways for pharmacists to develop as leaders in health equity. There was discussion about whether the intent of this statement was to have APhA commit to creating these resources. One intent was to ensure members are empowered to access resources to become leaders in health equity. The discussion then went on to be that pharmacists should be reminded of their duty and that APhA should support efforts to empower pharmacists to act in this manner. (4)
23. While the committee emphasized the importance of advocating for marginalized groups, they did not want to explicitly list examples of specific marginalized groups to be most inclusive, and not potentially limit or overlook a group. (4)
24. The committee made a point to specifically advocate for marginalized groups in the proposed policy, as opposed to unintentionally softening the statement with broader language such as “all patients.” This intentional focus is a direct result of the tendency of prior House discussions to overgeneralize and potentially overlook additional needs of marginalized groups. (4)
25. The committee recognizes that both individuals and communities have the potential to be marginalized, and thus pharmacy professionals have a role in advocating for health equity across both categories. The committee recognizes that not all those who experience health inequities may be considered a marginalized group. Ultimately, the committee decided to include marginalized group wording within statement five to draw focus to these groups. (4)
26. For statement five, the committee discussed whether the term “all” should be included before efforts or if the efforts should be more tailored to provide guidance on policies directly affecting health equity. The committee discussed that all policies relate to health equity in some way and that pharmacists have the opportunity to intervene when appropriate whether that be at the local, state, or federal level. (5)
27. When describing the intended audience for achieving health outcomes, the committee considered phrasing this as “everyone” having an equitable opportunity to attain their full potential for health and well-being. While this would certainly be inclusive, the committee noted this could potentially be misinterpreted as being self-serving, to refer solely to the association itself. As an alternative, the committee considered and opted for language to include all individuals and communities. (5)
28. There was additional deliberation around what is meant by “opportunities,” noting the relationship between equitable opportunities and equitable achievement of positive health outcomes. Opportunities may include equitable access to medications, pharmacist clinical services, and other pharmacy services. The committee opted not to include specific examples in statement five to be all encompassing. The committee left the statement deliberately vague as its intent was to be aspirational, in terms of facilitating pharmacists' involvement in opportunities and efforts outside the pharmacy sphere within the health equity space. (5)
29. The committee agreed that health equity has not been achieved and views statement five as an evergreen statement that gives APhA direction to stay engaged in whatever practices are most appropriate at that specific time. (5)
30. There was discussion of whether to specifically list relevant parties in implementing health equity—such as specific nationally recognized organizations, employers, schools of pharmacy, boards of pharmacy, regulators, etc. The committee opted to keep this broad, to be most inclusive. (5)