Why do NAPLEX Pass Rates Keep Falling?

The last time NAPLEX first-time pass rates exceeded 96% was in 2008.¹ Since then, the US has seen a 63.2% increase in new pharmacy schools. This leads many to believe low-quality students are being enrolled. What else could cause first-time pass rates to dip? Some blame the ACPE for allowing poor performing schools to remain open (the ACPE accredits pharmacy schools). While others blame the NABP’s exam updates (the NABP writes the NAPLEX). No matter the cause, NAPLEX first-time pass rates need to increase.

In 2008, eighty-seven pharmacy schools existed.¹ In 2023, 142 schools existed, and the first-time pass rate was 77.5%.^1,2 The first-time pass rate has not surpassed 90% since 2015 when 92.6% of students passed.¹ That means since 2015, less than 90% of students have passed the NAPLEX on their first try. In 2022 and 2023, around 23% of students needed to take the exam at least twice.³ Someone or something is failing students.

A 2019 study reviewed the NAPLEX first-time pass rates in 2014, 2015, and 2016.⁴ They chose these years since the NAPLEX underwent major changes in 2015 and 2016. They compared schools based on various characteristics. First-time pass rates were significantly higher in public schools and in those established before 2000. In 2016, 4-year traditional programs had significantly higher pass rates than 3-year programs. There was no statistical difference between single and multiple campus schools. Schools with a higher residency match rates had higher first-time pass rates. The study concluded that not all schools are seeing dramatic drops in first-time pass rates.⁴ This implies that a select group of schools is pulling the national average downward.

A 2022 study investigated if school-provided NAPLEX preparatory programs boosted first-time pass rates.⁵ The study received survey responses from 44% of schools. The survey asked questions about options for students. Fifty schools provided some sort of preparatory program. Of these fifty, most required students complete the program. Students needed to complete the program during their final year of school. Most schools offered a third-party program. The study found that offering a preparatory program did not improve pass rates.⁵ The study discovered that schools with more than fifty graduating classes had significantly higher pass rates than schools with five or less.⁵ This finding supports the notion that well-established schools perform better.

A 2021 systemic review tried to determine which factors predict NAPLEX success.⁶ The review’s articles varied in their comparators. Current literature lacks consistent data measurements when studying NAPLEX success. The studies reviewed student age, PCAT performance, GPAs, academic progression, and school age. Students likely to fail were older, attended a newer school, required remediation, or had poor PCAT performance. The reviewers did not find a correlation between pre-pharmacy GPA and NAPLEX success. The review found that higher pharmacy school GPAs were predictive of NAPLEX success.⁶ The included studies were far from uniform. Thus, it is not helpful for making concrete conclusions.

A study by Ried et al, found that pre-2000 schools had higher pass rates than post-2000 schools.¹ Why do older schools have better first-time pass rates? I am not aware of any studies that have investigated this phenomenon. Some surmise that older schools have acquired more resources. These resources include IPPE/APPE sites and faculty.¹ This is not to say that all newer schools provide a poor education. NAPLEX pass rates are an outcome metric and do not provide a full assessment of a school’s quality.

The same study by Ried et al also reviewed how updates to the NAPLEX affected first-time pass rates.¹ The exam underwent drastic changes in 2015 and 2016. In 2015, the exam shifted to more clinical assessment and drug recommendation questions. In 2016, the exam increased from 185 to 250 questions and from 4.5 to 6 hours. In 2015 and 2016, NAPLEX first-time pass rates plummeted compared to 2014. In 2014 the mean first-time pass rate was 94.8%. The rate in 2015 was 92.1% and was 86.2% in 2016.¹ The study found that the exam updates had a significant impact on decreasing scores. The researchers argued that newer schools are not to blame for lower pass rates. However, in 2016 the school with the highest pass rate was 98.9% and the school with the lowest pass rate was 59%. While the exam had an impact, there were schools that fared worse than others. The rate did recover to 90% in 2018 but stayed in the high eighties until 2021.^1,3.

The NABP last updated the NAPLEX in January 2021.⁷ The NAPLEX first-time pass rate in 2020 was 88.2%, but this dropped to 81.3% in 2021, 77.1% in 2022, and 77.5% in 2023.^1,3 Was the exam too easy before 2015 or were the updates too difficult? Are schools not educating students to the NABP’s standards? The highest pass rate for a school in 2015 was 100% and was 98.9% in 2016. The maximum rate for some schools recovered to 100% in 2017-2020.¹ The lowest pass rate for a school in 2015 was 69.4% and stayed < 60% from 2016-2020.¹ The high performing schools took a dip in 2016, and it was likely due to the exam update. The lower performing schools dipped in 2016 and have yet to recover.

Researchers need to determine why first-time pass rates are falling. I would like to see studies trying to decipher why older schools perform better. Do the older schools exceed ACPE accreditation standards? I imagine elevating the standards would increase first-time pass rates. Either way, something needs to change to help students.

References

1. Ried L, Hunter T, Bos A, Ried D. Association between accreditation era, North American Pharmacist Licensure Examination testing changes, and first-time pass rates. Am J Pharm Educ. 2023;87(3):345-355. doi: 10.5688/ajpe8994. 
2. PharmCAS Applicant Data Report 2022-2023. American Association of Colleges of Pharmacy (AACP). 2023. Accessed September 9, 2024. https://drugchannelsinstitute.com/files/2022_23%20PharmCAS_Applicant_Data_Report.pdf
3. North American Pharmacist Licensure Examination^® Passing Rates for 2021-2023 Graduates. NABP. January 26, 2024. Accessed September 9, 2024. https://nabp.pharmacy/wp-content/uploads/NAPLEX-Pass-Rates-2023.pdf
4. Williams J, Spivey C, Hagemann T, Phelps S, Chisholm-Burns M. Impact of pharmacy school characteristics on NAPLEX first-time pass rates. Am J Pharm Educ. 2019;83(6):1366-1372. doi: 10.5688/ajpe6875.
5. Fiano K, Attarabeen O, Augustine J, et al. Association between NAPLEX preparation program characteristics and first-time pass rates. Am J Pharm Educ. 2022;86(6):714-721. doi: 10.5688/ajpe8760.
6. Park S, Phillips J, Pavuluri N. Systematic review of predictors of success for the North American Pharmacist Licensure Examination. Am J Pharm Educ. 2021;85(10):1085-1100. doi: 10.5688/ajpe8591.
7. NABP Staff. NAPLEX blueprint improvements coming in January 2021. NABP: National Association of Boards of Pharmacy. Published October 8, 2020. Accessed September 26, 2024. https://nabp.pharmacy/news/blog/naplex-blueprint-improvements-coming-in-january-2021/