Opening Before the Permit
A first-time owner has leased a storefront in Concord and plans to open a community pharmacy on Monday. The Board of Pharmacy has received the application but has not issued the pharmacy permit. The owner has already stocked shelves, configured the dispensing software, and scheduled staff. The pharmacist-in-charge's New Hampshire license is active, but her Maine license lapsed last month. Two technicians are scheduled: one with an active New Hampshire registration, and one whose registration expired 12 days ago. A pharmacy intern is also scheduled; the intern is registered but has not completed the final practical examination. The owner wants to open, fill cash prescriptions, and bill insurance while the permit is pending. He also wants the expired-registration technician to work 'just at the register' and the intern to counsel patients when the pharmacist is busy. The pharmacist-in-charge is unsure whether any of this is allowed and asks for a compliance plan before Monday. The storefront has a secure vault and a working refrigerator, but no separate counseling room.
1. May the pharmacy open and dispense while the permit application is pending? Explain the licensing principle and the risks.
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No. A pharmacy permit is a facility license, and dispensing prescription drugs before it is issued is unlicensed pharmacy operation. The pharmacist's active personal license does not authorize an unpermitted facility. The 'cash only' or 'insurance will catch up' workaround does not cure the defect; it can support grounds for discipline against the pharmacist-in-charge and the owner, and it may jeopardize the pending application. The correct sequence is: obtain the permit, post it with the pharmacist license and technician registrations, then begin dispensing. Preparing the store, stocking, and training staff are generally permissible, but receiving or dispensing prescriptions is not. The pharmacist-in-charge should document in writing that operations must wait for the permit and should not allow the owner to pressure staff into filling prescriptions. If the Board has questions about the application, the pharmacist should contact the Board directly rather than assume approval by silence.
2. Evaluate the status of the two technicians and the intern. What duties, if any, can each perform on Monday?
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The technician with active registration may perform technician duties under the required pharmacist supervision. The technician whose registration expired 12 days ago may not perform pharmacy technician functions. A cashier-only role can sound harmless, but in a pharmacy the register is often part of the dispensing workflow, and a lapsed registrant should not be placed in a position where prescription handling, patient identification, or drug selection occurs. The safer course is to remove that person from the pharmacy until registration is renewed. The intern is registered and may perform intern duties only under pharmacist supervision. Registration does not make the intern an independent practitioner, and the intern should not counsel patients alone simply because the pharmacist is busy. The pharmacist must be available to supervise, verify prescriptions, and provide counseling. The practical examination status should be verified with the Board and the school, but it does not convert the intern into a pharmacist.
3. What should the pharmacist-in-charge do before opening, and what should be documented?
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Before opening, the pharmacist-in-charge should confirm that the pharmacy permit has been issued and is posted; confirm active licensure and registration for every pharmacist, technician, and intern scheduled; and create a staffing plan that keeps an appropriately licensed pharmacist on duty whenever pharmacy services are provided. The expired technician should be told in writing not to perform technician duties until renewed. The intern should have a written supervision plan. The pharmacist should document the owner's request to open early, the compliance advice given, and the owner's response. This protects the pharmacist and creates a record if the Board later investigates. If the owner insists on opening, the pharmacist should refuse to participate and may need to notify the Board. Opening without a permit is not a business risk to be balanced against revenue; it is a licensing violation with patient-safety and disciplinary consequences.