Falling pass rates on the North American Pharmacist Licensure Examination signal an emerging crisis for a growing number of pharmacy schools

Abstract

The North American Pharmacist Licensure Examination (NAPLEX) is a major assessment metric for graduates pursuing licensure and the institutions from which they graduated. Before 2014, the mean NAPLEX first-time pass rate was roughly 95% every year. Mean pass rates have fallen dramatically since then to less than 80%, with many schools currently unable to achieve a 70% pass rate. Such a drastic decline in NAPLEX performance constitutes a crisis for many schools. Changes to the exam blueprint, administration, and scoring provide a partial explanation for the decline, but the issue of cause ultimately comes down to one simple question: What has changed over the last 10 years that is making it more difficult for graduates to pass NAPLEX on the first attempt? The effects of excessive academic expansion, beginning in 2000, cannot be overlooked. The newest schools, established after 2009, and accelerated (3-year) programs, many of which are also new, appear to be particularly vulnerable. In 2023, 16 pharmacy schools had first-time pass rates below 65%. Nine (56%) of those schools opened after 2009 and seven (44%) were accelerated programs. Newer schools have had to compete for a limited supply of qualified faculty, administrators, preceptors and experiential training sites, while also striving to meet enrollment targets amid a dwindling applicant pool. The ability to overcome the NAPLEX crisis depends on first establishing a more effective process of assessing NAPLEX results—one that measures the right metrics in the right way—and upholds fair, but rigorous, quality standards. Stakeholders need access to actionable information and the most relevant, useful data available. The purpose of this article is to provide evidence that the Academy is facing a legitimate crisis and offer four recommendations by which assessment and understanding of the crisis can be enhanced.