Association Between Accreditation Era, North American Pharmacist Licensure Examination Testing Changes, and First-Time Pass Rates.

To estimate whether first-time pass rates on the North American Pharmacist Licensure Examination (NAPLEX) have been influenced by the number of pharmacy programs founded since 2000, the programs' accreditation era, and the changes to the blueprint as well as changes to the testing conditions and passing standards implemented by the National Association of Boards of Pharmacy (NABP) beginning in 2015. This was a retrospective, observational cohort study using publicly published data. The number of programs and pass rates were collected from 2008 to 2020. Programs reporting pass rates from 2016 to 2020 were eligible. Accreditation era was defined as programs accredited before or after 2000. Pass rates were categorized into NAPLEX tests administered before or after 2015. Statistical analyses were conducted for comparisons. Pass rates were initially found to decline as the number of programs rose. First-time pass rates of programs accredited before 2000 were higher than pass rates of programs accredited after 2000 every year after 2011. Only 40% of the programs accredited after 2000 exceeded the national average between 2016-2020. Blueprint changes implemented in 2015 and the changes to testing conditions plus passing standards implemented in 2016 had a greater effect on pass rates than the number of programs or applicants. Programs accredited after 2000 generally had lower first-time NAPLEX pass rates. Even so, blueprint changes and changes to the testing conditions plus passing standards instituted by the NABP were more important predictors of the decline of first-time NAPLEX pass rates. Stakeholders should collaborate and embrace best practices for assessing practice-ready competency for licensure.