What The NAPLEX 2022 Pass Rate Tells Us About 2023

I’ve followed the NAPLEX exam since I graduated in 2009. The NAPLEX was relatively easy from my experience and the experience of many of my classmates. The pass rate that year was an indicator that the NAPLEX was not very difficult. That is not the case anymore. Just looking at the California Board of Pharmacy website, they reported a pass rate of nearly 98% in 2009 while the NAPLEX 2022 pass rate was down to 84%. The national pass rate is now only 80% for the NAPLEX exam.

Why is the NAPLEX 2022 Pass Rate so low?

I have a few theories and would be interested to hear yours as well so feel free to leave a comment below.

  1. INFORMATION OVERLOAD. My first theory is that there are more drugs on the market with no signs of slowing down. Processing all that information and trying to decipher what is and isn’t essential is daunting. I’ve seen the RxPrep book and it is full of good information but the amount of information in there is ridiculous. It is no wonder why students feel lost in preparing for the exam.
  2. PHARMACY SCHOOLS CAN’T BE AS PICKY AS THEY USED TO BE WITH CANDIDATE SELECTION. There is no doubt that the profession of pharmacy is dogged on the internet. Retail pharmacy is no longer the desirable job it was when I was deciding to choose pharmacy as a profession. Most of the pharmacists I know want nothing to do with retail pharmacy. This destroys the morale of any prospective pharmacy student leading to a reduction in candidates for pharmacy school. A smaller pool means less qualified candidates who likely have lower grades (as a whole) and do worse on standardized exams. The number of NAPLEX first attempts went down from 14,081 to 12,548 in just 2 YEARS. That is a BIG downward trend.
  3. PHARMACY SCHOOLS AREN’T DOING A GOOD ENOUGH JOB. Pharmacy schools are an easy place to point the finger. As you can see below, there were several schools that had pass rates in the 60s with even a few down in the 50s.
NAPLEX 2022 Pass Rate – PDF From NABP

Preparing for the 2023 NAPLEX Exam? Here’s What I Have Learned

I want to make the poor 2022 NAPLEX pass rates a thing of the past. I’ve spent countless hours researching what candidates discuss online regarding the NAPLEX exam and here’s what I have learned. In addition, I precept numerous students every year on rotation who are preparing for the NAPLEX.

Know the Basics

You will be asked questions about diabetes, hypertension, asthma, COPD, hyperlipidemia, and many other common disease states where medications are a mainstay of therapy. Know the medications used to treat these disease states inside and out. For topics like oncology and HIV, I would strongly encourage you to know the most commonly used medications and their major adverse effects and drug interactions.

Pay Attention To Math, Compounding, and Statistics

These sections are often fairly straightforward from the research I have done as long as you put in the time. Dedicate a significant percentage of your study time to doing math problems and the compounding and handling of medications. These two sections make up 25% of your exam! Statistics is another topic that shouldn’t sneak up on you. If you know it, you can significantly increase your chances of passing.

Don’t get Bogged Down in a Rare Disease State

I know it is tempting to want to memorize every new medication for plaque psoriasis. I personally wouldn’t go down this rabbit hole. Your time is best spent elsewhere. Know the top 2 (maybe 3) medications that are most commonly used to treat rare conditions and move on with your life. You could be asked about a new medication for a specialized disease state, but do you think it will be more than one? I would be surprised.

Tie Concepts Together and Keep It Simple

Anticholinergic medications like diphenhydramine should be avoided in dementia because they block acetylcholine. Acetylcholinesterase inhibitors seek to increase the amount of acetylcholine in the brain. Anticholinergics blunt the effects of acetylcholinesterase inhibitors like donepezil and rivastigmine. We have drugs that oppose each other’s effects, so you can anticipate that they would cause opposite adverse effects to a significant extent.

Diphenhydramine EffectsDonepezil Effects
ConfusionUsed for Dementia
Urinary RetentionUrinary Frequency/Incontinence

There are numerous other medications that follow this concept such as beta-agonists versus beta-blockers or dopamine agonists versus dopamine antagonists. Knowing one can help you understand the other.

Know Brand Names

It sucks when you don’t know a brand name and you are asked a question about it. I still remember that feeling! I remember thinking “I probably know this answer if they gave me the generic name.” Don’t be caught off guard by that. We have some free questions if you want to assess your skills and more in our full NAPLEX Study Packages.

For whatever reason, the NAPLEX is no longer a gimmie with 1 in 5 failing this exam. Our study materials have been helpful for numerous candidates if you are interested in checking them out. PRO TIP – If you buy the NAPLEX Nuggets 2023 Book, there is a 30% off discount code contained within the book for our All Access Passes that include video courses and nearly 2,000 practice questions. This more than pays for the cost of the book!

Hopefully, these strategies will help you prepare for the 2023 NAPLEX board exam so you don’t become one of the 20% who needs to retake the exam!


  1. Ed Talbott

    The embedded NABP pdf appears to be blocking about 3 paragraphs on my browser – not sure why. I was able to read it by selecting the text and pasting to Notepad but others might not be able to do this. I tried a couple different browsers.

    • Eric Christianson

      Thank you! I think I fixed it now!

  2. James Farrell

    Hi Eric.
    You have keen insight into this situation and your advice should be heeded by NAPLEX candidates.
    It’s very easy to get sucked into the ‘rabbit holes’ while preparing.
    I really liked your comparison grid for diphenhydramine and donepazil… really shows in a very concise way the diametrically opposing effects.
    Keep up your hard work.
    I appreciate all of your posts.

  3. Michelle Knight, PharmD

    The class of 2022 was the first class that had a full dyadic year in COVID mode. Because every time a student was exposed, per guidelines, they had to sit out of class and try to pick up enough information through Teams, or Facetime, etc. Professors’ time was stretched even further because of makeup tests, quizzes, etc. Because these students went out for rotations (their 4th year) during COVID, there wasn’t any time for catch-up in the classroom. (I’m not sure if the class of 2023 had any non-COVID time before 4th-year rotations…)

    For class 2024, with quarantine restrictions eased and eventually lifted before their rotation year, I believe they will be up to par.

  4. SLF
  5. Avi

    Hi Eric. I graduated in 2002 and have worked at hospital settings since then. One of my co-workers is also a professor at my old school and he had this to say about the recent admission.
    As you noted the interest in pharmacy as a profession has plummeted. This is mainly due to the impression that retail work has left. As such, the school does not have a pick of students. The requirements to enter the professional phase of the school has been lowered…a lot. The school is more concerned about filling their 200 seats and collecting tuition than ensuring that the students can handle the course load.
    But here is the kicker. If more than 15% of the class drops out or get kicked out, the school looses their accreditation!
    So basically what happens is that during the first year a very large number of students fail their courses/put on probation/and then kicked out. They can only kick out the worst students without passing the 15% mark. This means that after 15% are kicked out, they can’t kick out anyone else. At that point the school has a 50/50 mix of students. 50% who enter the next professional year are good students who did well the first year. The other 50% are low performing students who have no business being in pharmacy school but the school can’t kick them out of the program.
    So these are the students that take the NAPLEX.


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Written By Eric Christianson

February 26, 2023

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