High Total Failures of the North American Pharmacist Licensure Examination (NAPLEX) Warrant Monitoring of Professional Pharmacy Programs

From 2021 to 2023, 7,978 graduates of pharmacy programs failed the North American Pharmacist Licensure Examination (NAPLEX®) on the first attempt. Presently, the Accreditation Council for Pharmacy Education (ACPE) monitors programs with a passage rate of ≥2 standard deviations (SD) below the national mean pass rate. In 2023, this should lead to monitoring seven programs that produced 140 failures out of the total of 2,472 failures (5.7%). In our view, this is neither equitable nor demonstrative of sufficient accountability. Analysis of failure counts among the 144 programs reported by the National Association of Boards of Pharmacy (NABP) demonstrates a distribution curve highly skewed to the right. Evaluation of average failure counts across all programs suggests that schools with absolute failures ≥2 SD higher than the average number of failures should be identified for monitoring, in addition to those falling ≥2 SD below the national mean pass rate. Based on the 2023 data, this additional criterion corresponds to ≥35 failures/program. This threshold would prompt monitoring of 18 programs and 36.5% of the total failures. Of the seven programs that will be monitored based on the current ACPE criteria, only one would be captured by the ≥35 failure method of selection; the remaining six contribute 85 total failures to the pool. Thus, if both criteria were to be applied, i.e., ≥35 failures and ≥2 standard deviations below the national mean pass rate, a total of 24 programs would be monitored (16.6% of the 144 programs), that contribute 987 (39.9%) of the total failures.