Contours of the transatlantic regulatory landscape: A research agenda towards the reform of US state pharmacy board disciplinary functions

This paper identifies potential risks in American pharmacy regulation by comparing the disciplinary functions of US State Boards of Pharmacy (SBPs) with the reformed regulatory model of the United Kingdom’s General Pharmaceutical Council (GPhC) and Pharmaceutical Society of Northern Ireland (PSNI). We argue that the US system is susceptible to regulatory capture and bounded accountability because SBPs often lack a clear demarcation between governance and adjudication. In most US jurisdictions, disciplinary panels are dominated by practising pharmacists who may lack formal regulatory training and prioritise practitioners’ interests over public protection. Conversely, the UK model employs independently constituted Fitness to Practise Committees with equal lay representation and strict adherence to publicly transparent guidance. The significant fragmentation across the 50 US states is highlighted, noting that even the National Association of Boards of Pharmacy (NABP) lacks the statutory oversight powers of the UK’s Professional Standards Authority. To address these inconsistencies, we propose a mixed-methods research agenda. This includes a 50-state legislative comparison, a statistical analysis of penalties using the National Practitioner Data Bank (NPDB), and stakeholder interviews to understand how different legal frameworks influence disciplinary severity. Ultimately, the paper calls for the development of a more robust Model State Pharmacy Act to harmonise US regulation and reinforce the mandate of patient safety and public trust.