By: Carolina Vargas, PharmD Candidate c/o 2024, Zoha Khalid, PharmD Candidate c/o 2024, and Nashfa Zaman, PharmD Candidate c/o 2024

Graduating from pharmacy school is a monumental achievement, marking the culmination of years of hard work and dedication. However, this milestone comes with financial burdens that aspiring pharmacists must be prepared for. This article will explore the various expenses associated with graduating from pharmacy school, taking licensure exams, and obtaining pharmacist registration.

The path of the future pharmacist commences with the graduation ceremony, a momentous occasion celebrating the successful completion of pharmacy school. However, there is a cost for this celebratory event. For 2024 St. John’s University, College of Pharmacy and Health Sciences graduates, participation requires the purchase of academic attire from Herff Jones for $128.95, which covers the cap, gown, hood, and shipping. This cost is unavoidable for students who wish to attend graduation after many years of hard work!

Following commencement, pharmacy graduates must tackle the next crucial step of passing the North American Pharmacist Licensure Examination (NAPLEX) and the Multistate Pharmacy Jurisprudence Examination (MPJE) to obtain pharmacist licensure. The NAPLEX application fee stands at $100, while the examination fee itself will increase from $475 to $520 as of March 1st, 2024, per the (National Association of Boards of Pharmacy (NABP).¹ St. John’s students must also send an electronic copy of their official transcript to NABP at a cost of $6. Similarly, the MPJE, which tests knowledge of pharmacy law and regulations, imposes its own fees. The MPJE costs $100 for the application fee, and as of March 1st, 2024, the separate examination fee will increase from $150 to $170.² This cost is required separately in each jurisdiction for those planning to practice in multiple states. Furthermore, for those seeking licensure in multiple jurisdictions, there is an optional score transfer fee of $75 per jurisdiction.³

To assist students in exam preparation, there are a variety of required and optional review materials available for both the NAPLEX and MPJE. In addition to their tuition, St. John’s students must pay $499 for their UWorld Subscription, which offers NAPLEX review courses, mock exams, and the RxPrep book to help them prepare for the licensure exam. Shipping expenses and state taxes vary depending on delivery method and location. There is also the option to take a pre-NAPLEX exam for $75 and a pre-MPJE for the same cost to help candidates prepare.^{4, 5}

After taking these exams, most candidates receive their results approximately seven business days after taking each exam. In case there is suspicion of a scoring mistake, candidates may request an independent manual rescore of their responses to ensure the correctness of their scores. Rescores for both the NAPLEX and MPJE incur a $200 fee.³ In the unfortunate event of failing a licensure examination, the full application and examination fee must be paid again – $620 for the NAPLEX and $270 for the MPJE.

After successfully passing the NAPLEX and MPJE, the final step is licensure. For students planning to practice in New York, the licensure and first registration fee amount to $339.⁶ Accordingly, the entire expenditure is estimated to be $1,930 for a St. John’s pharmacy graduate who wishes to practice in New York, attends graduation, purchases the pre-test materials for both examinations, and passes both on their first attempt.

However, there are exceptions for those who serve in the armed forces or those who experience emergencies on test day. Examination fee discounts can be as much as 100% for members of the armed forces, veterans, and officers currently deployed from the United States (U.S.) Public Health Service, as well as 50% for spouses of these individuals.³ Additionally, students facing unforeseen circumstances such as a death in the immediate family, serious illness or hospitalization, serious injury or accident, or jury duty are eligible to reschedule for a fee of $170 for NAPLEX and $100 for MPJE. This fee only covers the cost of rescheduling the exam, and if emergency requests are denied, the full examination fee would be required again.³

On the other hand, graduates pursuing post-graduate training incur additional costs associated with residency applications and interviews. The American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting is an annually held conference that offers a unique platform for knowledge exchange and networking in the field. Highlighting the various benefits of such an event, it is also crucial to consider applicable costs associated with attending ASHP Midyear. Early Bird Registration, available until October 20th, provides reduced rates of $345 for ASHP members and $495 for non-members. Regular/onsite registration remains an option from October 21st onward, with ASHP members paying $375 and non-members paying $540.⁷ Students aiming to benefit from ASHP member discounts can join for $54 in their first year, but it’s worth noting that membership costs increase in subsequent years. Beyond registration, attendees must also consider expenses for travel, accommodation (upwards of $150 per night), food, and miscellaneous commute expenses.⁸ Pharmacy graduates applying to postgraduate residency programs must consider additional expenses, including a $110 initial applicant fee for up to four programs, with each additional program incurring a $43 fee, as well as a $160 fee for participation in the National Matching Services for Phase I and Phase II of the match.⁹

The accessibility of expenses associated with graduating from pharmacy school, including postgraduate training such as fellowships and residencies, poses a significant hurdle for many aspiring pharmacists. Beyond tuition and material costs, pursuing advanced training through fellowships or residencies often entails additional expenses, including application fees, travel for interviews, and potential relocation to another city or state. These costs can accumulate quickly, and the stipends offered during postgraduate training are less than a pharmacist’s first job earnings. As a result, the financial strain of pursuing further education and specialization in pharmacy can deter talented individuals from pursuing these valuable opportunities. This financial barrier not only limits the career options of aspiring pharmacists but can also impact the overall diversity and accessibility of the profession. Addressing these financial challenges is crucial to ensuring that the pharmacy workforce remains diverse, highly skilled, and well-prepared to meet the evolving needs of healthcare.

When considering post-graduate opportunities, recent graduates face a complex financial landscape marked by accumulating student loan debt and the potential for lucrative salaries upon graduation. According to the 2022 American Association of Colleges of Pharmacy (AACP) Graduating Student Survey, graduates reported owing an average of $170,444, with the average amount borrowed for private pharmacy school attendance being reported at $201,169.¹⁰ While this is a large burden to bear, pharmacists also have the potential to earn relatively high, with an average salary of about $132,750.¹¹ Salary fluctuations occur depending on factors such as experience, location, and specialization, resulting in a range of $79,950 to $164,230. In New York State, entry-level pharmacists with less than one year of experience are paid on average $48.31 hourly with an annual income of $100,490.¹²

This income potential can help graduates in managing and eventually repaying their loans, but the debt burden can remain significant, especially when considering the rising cost of education. If students wish to pursue higher education through post-graduate year one (PGY1) residency, the salary is significantly lower, ranging from $48,145 to $67,215 with a median salary of $56,584 in the U.S.¹³ Furthermore, choosing to defer loans during residency leads to accruing compound interest alone, increasing the original loan amount by $9,810 per year for someone owing $150,000 at an interest rate of 6.54% for direct unsubsidized loans and a higher rate of approximately $11,310 at a 7.54% interest for direct parent loan for undergraduate students (PLUS) loans for graduate students. Considering the reduced pay rates and the impending obligation to repay loans, it is evident that such factors ultimately influence one’s professional decisions.

In summary, the path to becoming a licensed pharmacist requires a substantial financial commitment. Aspiring pharmacists must be ready to meet the costs associated with graduation ceremonies, examination fees, and the licensure process. By comprehending and adequately planning for the expenses tied to completing pharmacy school and obtaining licensure, students can commence their pharmacy careers with security and confidence.

References

1. NAPLEX. National Association of Boards of Pharmacy. Accessed January 8, 2024. https://nabp.pharmacy/programs/examinations/naplex/
2. MPJE. National Association of Boards of Pharmacy. Accessed January 8, 2024. https://nabp.pharmacy/programs/examinations/mpje/
3. NAPLEX/MPJE 2024 Candidate Application Bulletin. National Association of Boards of Pharmacy; 2024. Accessed January 8, 2024. http://read.nxtbook.com/nabp/bulletin/naplex_mpje_bulletin/cover.html
4. Pre-NAPLEX. National Association of Boards of Pharmacy. Updated January 4, 2024. Accessed January 8, 2024. https://nabp.pharmacy/programs/practice-exams/pre-naplex/
5. Pre-MPJE. National Association of Boards of Pharmacy. Updated January 4, 2024. Accessed January 8, 2024. https://nabp.pharmacy/programs/practice-exams/pre-mpje/
6. License application forms for pharmacists. New York State Education Department Office of the Professions. Accessed January 8, 2024. www.op.nysed.gov/professions/pharmacist/license-application-forms.
7. Meeting Registration. ASHP Midyear Clinical Meeting and Exhibition. Accessed January 8, 2024. https://midyear.ashp.org/register
8. Travel. ASHP Midyear Clinical Meeting and Exhibition. Accessed January 8, 2024. https://midyear.ashp.org/travel
9. Register for the Match. National Matching Services Inc. Accessed January 8, 2024. http://natmatch.com/ashprmp/applicants/register.html
10. American Association of Colleges of Pharmacy Graduating Student Survey. 2022 National Summary Report. August 2022. Accessed January 8, 2024. https://www.aacp.org/sites/default/files/2022-08/2022-gss-national-summary-report.pdf
11. Pharmacists. Occupational Outlook Handbook. Bureau of Labor Statistics, U.S. Department of Labor. Updated September 6, 2023. Accessed January 8, 2024. https://www.bls.gov/ooh/healthcare/pharmacists.htm
12. 2023 Pharmacist Salary in New York. Pharmacy Technician Guide. Updated 2023. Accessed 14 Oct. 2023.www.pharmacytechnicianguide.com/Pharmacist-Salary-New-York/
13. Pharmacy Resident Salary. Salary. Accessed 6 Feb. 2024. www.salary.com/research/salary/posting/pharmacy-resident-salary

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