I 

108TH CONGRESS 

1ST SESSION H. R. 3591

To amend the Public Health Service Act with respect to health professions 

programs regarding the practice of pharmacy. 

IN THE HOUSE OF REPRESENTATIVES 

NOVEMBER 21, 2003

Mrs. CUBIN (for herself, Mr. JOHN, Mr. PICKERING, Mr. SIMPSON, Mr. ROGERS of Michigan, and Mr. MCGOVERN) introduced the following bill; 

which was referred to the Committee on Energy and Commerce 

A BILL

To amend the Public Health Service Act with respect to 

health professions programs regarding the practice of 

pharmacy.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,
2

•HR 3591 IH 

1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Pharmacy Education 

3 Aid Act of 2003’’. 

4 SEC. 2. FINDINGS. 

5 Congress makes the following findings: 

6 (1) Pharmacists are an important link in our 

7 Nation’s health care system. A critical shortage of 

8 pharmacists is threatening the ability of pharmacies 

9 to continue to provide important prescription related 

10 services. 

11 (2) In the landmark report entitled ‘‘To Err is 

12 Human: Building a Safer Health System’’, the Insti13 tute of Medicine reported that medication errors can 

14 be partially attributed to factors that are indicative 

15 of a shortage of pharmacists (such as too many cus16 tomers, numerous distractions, and staff shortages). 

17 (3) Congress acknowledged in the Healthcare 

18 Research and Quality Act of 1999 (Public Law 106–

19 129) a growing demand for pharmacists by requiring 

20 the Secretary of Health and Human Services to con21 duct a study to determine whether there is a short22 age of pharmacists in the United States and, if so, 

23 to what extent. 

24 (4) As a result of Congress’ concern about how 

25 a shortage of pharmacists would impact the public 

26 health, the Secretary of Health and Human Services 
3

•HR 3591 IH 

1 published a report entitled ‘‘The Pharmacist Work2 force: A Study in Supply and Demand for Phar3 macists’’ in December of 2000. 

4 (5) ‘‘The Pharmacist Workforce: A Study in 

5 Supply and Demand for Pharmacists’’ found that 

6 ‘‘While the overall supply of pharmacists has in7 creased in the past decade, there has been an un8 precedented demand for pharmacists and for phar9 maceutical care services, which has not been met by 

10 the currently available supply’’ and that the ‘‘evi11 dence clearly indicates the emergence of a shortage 

12 of pharmacists over the past two years’’. 

13 (6) The same study also found that ‘‘The most 

14 striking evidence of a pharmacist shortage stems 

15 from demonstrably increased vacancy rates, difficul16 ties in hiring, and unprecedented increases in the 

17 volume and range of activities demanded of today’s 

18 pharmacist.’’

19 (7) The study found that ‘‘The factors causing 

20 the current shortage are of a nature not likely to 

21 abate in the near future without fundamental 

22 changes in pharmacy practice and education.’’ The 

23 study projects that the number of prescriptions filled 

24 by community pharmacists will increase by 20 per25 cent by 2004. In contrast, the number of community 
4

•HR 3591 IH 

1 pharmacists is expected to increase by only 6 per2 cent by 2005. 

3 (8) Regarding access to pharmacy services in 

4 rural areas, the study found that ‘‘Remoteness, iso5 lation from other professionals, lower economic re6 turns, reduced opportunities for advancement, and 

7 other rural practice characteristics remain obstacles’’ 

8 to attracting pharmacists. 

9 (9) In June 2002, the American Hospital Asso10 ciation’s Commission on Workforce for Hospitals 

11 and Health Systems released a report entitled ‘‘In 

12 Our Hands: How Hospital Leaders Can Build A 

13 Thriving Workforce’’. The report included a finding 

14 that 46 percent of our Nation’s hospitals are experi15 encing a shortage of pharmacists, with hospitals 

16 averaging a vacancy rate for pharmacists of 12.7 

17 percent. 

18 (10) The demand for pharmacists will increase 

19 as prescription drug use continues to grow. 

20 SEC. 3. HEALTH PROFESSIONS PROGRAMS RELATED TO 

21 THE PRACTICE OF PHARMACY. 

22 Part E of title VII of the Public Health Service Act 

23 (42 U.S.C. 294n et seq.) is amended by adding at the end 

24 the following: 
5

•HR 3591 IH 

1 ‘‘Subpart 3—Pharmacy Workforce Development 

2 ‘‘SEC. 781. LOAN REPAYMENT PROGRAM FOR PHARMACISTS 

3 SERVING IN CRITICAL SHORTAGE FACILI4 TIES. 

5 ‘‘(a) IN GENERAL.—In the case of any individual—

6 ‘‘(1) who has received a baccalaureate degree in 

7 pharmacy or a Doctor of Pharmacy degree from an 

8 accredited program; 

9 ‘‘(2) who obtained an educational loan for phar10 macy education costs; and 

11 ‘‘(3) who is licensed without restrictions in the 

12 State in which the designated health care facility is 

13 located; 

14 the Secretary may enter into an agreement with such indi15 vidual who agrees to serve as a full-time pharmacist for 

16 a period of not less than 2 years at a designated health 

17 care facility, to make payments in accordance with sub18 section (b), for and on behalf of that individual, on the 

19 principal of and interest on any loan of that individual 

20 described in paragraph (2) which is outstanding on the 

21 date the individual begins such service. 

22 ‘‘(b) MANNER OF PAYMENTS.—

23 ‘‘(1) IN GENERAL.—The payments described in 

24 subsection (a) may consist of payment, in accord25 ance with paragraph (2), on behalf of the individual 

26 of the principal, interest, and related expenses on
6

•HR 3591 IH 

1 government and commercial loans received by the in2 dividual regarding the undergraduate or graduate 

3 education of the individual (or both), which loans 

4 were made for—

5 ‘‘(A) tuition expenses; 

6 ‘‘(B) all other reasonable educational ex7 penses, including fees, books, and laboratory ex8 penses, incurred by the individual; or 

9 ‘‘(C) reasonable living expenses as deter10 mined by the Secretary. 

11 ‘‘(2) PAYMENTS FOR YEARS SERVED.—

12 ‘‘(A) IN GENERAL.—For each year of obli13 gated service that an individual contracts to 

14 serve under subsection (a) the Secretary may 

15 pay up to $35,000 on behalf of the individual 

16 for loans described in paragraph (1). In making 

17 a determination of the amount to pay for a year 

18 of such service by an individual, the Secretary 

19 shall consider the extent to which each such de20 termination—

21 ‘‘(i) affects the ability of the Secretary 

22 to maximize the number of agreements 

23 that may be provided under this section 

24 from the amounts appropriated for such 

25 agreements; 
7

•HR 3591 IH 

1 ‘‘(ii) provides an incentive to serve in 

2 areas with the greatest shortages of phar3 macists; and 

4 ‘‘(iii) provides an incentive with re5 spect to the pharmacist involved remaining 

6 in the area and continuing to provide phar7 macy services after the completion of the 

8 period of obligated service under agree9 ment. 

10 ‘‘(B) REPAYMENT SCHEDULE.—Any ar11 rangement made by the Secretary for the mak12 ing of loan repayments in accordance with this 

13 subsection shall provide that any repayments 

14 for a year of obligated service shall be made not 

15 later than the end of the fiscal year in which 

16 the individual completes such year of service. 

17 ‘‘(3) TAX LIABILITY.—For the purpose of pro18 viding reimbursements for tax liability resulting 

19 from payments under paragraph (2) on behalf of an 

20 individual—

21 ‘‘(A) the Secretary shall, in addition to 

22 such payments, make payments to the indi23 vidual in an amount equal to 39 percent of the 

24 total amount of loan repayments made for the 

25 taxable year involved; and 
8

•HR 3591 IH 

1 ‘‘(B) may make such additional payments 

2 as the Secretary determines to be appropriate 

3 with respect to such purpose. 

4 ‘‘(4) PAYMENT SCHEDULE.—The Secretary 

5 may enter into an agreement with the holder of any 

6 loan for which payments are made under this section 

7 to establish a schedule for the making of such pay8 ments. 

9 ‘‘(c) PREFERENCES.—In entering into agreements 

10 under subsection (a), the Secretary shall give preference 

11 to qualified applicants with the greatest financial need. 

12 ‘‘(d) REPORTS.—

13 ‘‘(1) ANNUAL REPORT.—Not later than 18 

14 months after the date of enactment of the Pharmacy 

15 Education Aid Act of 2003, and annually thereafter, 

16 the Secretary shall prepare and submit to Congress 

17 a report describing the program carried out under 

18 this section, including statements regarding—

19 ‘‘(A) the number of applicants and con20 tract recipients; 

21 ‘‘(B) the amount of loan repayments made; 

22 ‘‘(C) which educational institution the re23 cipients attended; 
9

•HR 3591 IH 

1 ‘‘(D) the number and practice locations of 

2 the loan repayment recipients at health care fa3 cilities with a critical shortage of pharmacists; 

4 ‘‘(E) the default rate and actions required; 

5 ‘‘(F) the amount of outstanding default 

6 funds of the loan repayment program; 

7 ‘‘(G) to the extent that it can be deter8 mined, the reason for the default; 

9 ‘‘(H) the demographics of the individuals 

10 participating in the loan repayment program; 

11 and 

12 ‘‘(I) an evaluation of the overall costs and 

13 benefits of the program. 

14 ‘‘(2) 5-YEAR REPORT.—Not later than 5 years 

15 after the date of enactment of the Pharmacy Edu16 cation Aid Act of 2003, the Secretary shall prepare 

17 and submit to Congress a report on how the pro18 gram carried out under this section interacts with 

19 other Federal loan repayment programs for phar20 macists and determining the relative effectiveness of 

21 such programs in increasing pharmacists practicing 

22 in underserved areas. 

23 ‘‘(e) APPLICATION OF CERTAIN PROVISIONS.—

24 ‘‘(1) IN GENERAL.—The provisions of section 

25 338C, 338G, and 338I shall apply to the program 
10

•HR 3591 IH 

1 established under this section in the same manner 

2 and to the same extent as such provisions apply to 

3 the National Health Service Corps Loan Repayment 

4 Program under subpart III of part D of title III, in5 cluding the applicability of provisions regarding re6 imbursements for increased tax liability and bank7 ruptcy. 

8 ‘‘(2) BREACH OF AGREEMENT.—An individual 

9 who enters into an agreement under subsection (a) 

10 shall be liable to the Federal Government for the 

11 amount of the award under such agreement (includ12 ing amounts provided for expenses related to such 

13 attendance), and for interest on such amount at the 

14 maximum legal prevailing rate, if the individual fails 

15 to provide health services in accordance with the 

16 program under this section for the period of time 

17 applicable under the program. 

18 ‘‘(3) WAIVER OR SUSPENSION OF LIABILITY.—

19 In the case of an individual or health facility making 

20 an agreement for purposes of subsection (a), the 

21 Secretary shall provide for the waiver or suspension 

22 of liability under paragraph (2) if compliance by the 

23 individual or the health facility, as the case may be, 

24 with the agreement involved is impossible, or would 

25 involve extreme hardship to the individual or facility,
11

•HR 3591 IH 

1 and if enforcement of the agreements with respect 

2 to the individual or facility would be unconscionable. 

3 ‘‘(4) DATE CERTAIN FOR RECOVERY.—Subject 

4 to paragraph (3), any amount that the Federal Gov5 ernment is entitled to recover under paragraph (2) 

6 shall be paid to the United States not later than the 

7 expiration of the 3-year period beginning on the date 

8 the United States becomes so entitled. 

9 ‘‘(5) AVAILABILITY.—Amounts recovered under 

10 paragraph (2) with respect to a program under this 

11 section shall be available for the purposes of such 

12 program, and shall remain available for such pur13 poses until expended. 

14 ‘‘(f) DEFINITION.—In this section, the term ‘health 

15 care facility’ means a facility with a critical shortage of 

16 pharmacists as determined by the Secretary. 

17 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—For the 

18 purpose of payments under agreements entered into under 

19 subsection (a), there are authorized to be appropriated 

20 such sums as may be necessary for each of fiscal years 

21 2004 through 2008. 

22 ‘‘SEC. 782. PHARMACY FACULTY LOAN REPAYMENT PRO23 GRAM. 

24 ‘‘(a) ESTABLISHMENT OF PROGRAM.—The Secretary 

25 shall establish a program under which the Secretary will 
12

•HR 3591 IH 

1 enter into contracts with individuals described in sub2 section (b) and such individuals will agree to serve as fac3 ulty members of schools of pharmacy in consideration of 

4 the Federal Government agreeing to pay, for each year 

5 of such service, not more than $35,000 of the principal 

6 and interest of the educational loans of such individuals. 

7 ‘‘(b) ELIGIBLE INDIVIDUALS.—An individual is de8 scribed in this subsection if such individual—

9 ‘‘(1) has a baccalaureate degree in pharmacy or 

10 a Doctor of Pharmacy degree from an accredited 

11 program; or 

12 ‘‘(2) is enrolled as a full-time student—

13 ‘‘(A) in an accredited pharmacy program; 

14 and 

15 ‘‘(B) in the final year of a course of a 

16 study or program, offered by such institution 

17 and approved by the Secretary, leading to a 

18 baccalaureate degree in pharmacy or a Doctor 

19 of Pharmacy degree from such a school. 

20 ‘‘(c) REQUIREMENTS REGARDING FACULTY POSI21 TIONS.—The Secretary may not enter into a contract 

22 under subsection (a) unless—

23 ‘‘(1) the individual involved has entered into a 

24 contract with a school of pharmacy to serve as a 
13

•HR 3591 IH 

1 member of the faculty of the school for not less than 

2 2 years; and 

3 ‘‘(2) the contract referred to in paragraph (1) 

4 provides that—

5 ‘‘(A) the school will, for each year for 

6 which the individual will serve as a member of 

7 the faculty under contract with the school, 

8 make payments of the principal and interest 

9 due on the educational loans of the individual 

10 for such year in an amount equal to the amount 

11 of such payments made by the Secretary for the 

12 year; 

13 ‘‘(B) the payments made by the school 

14 pursuant to subparagraph (A) on behalf of the 

15 individual will be in addition to the compensa16 tion that the individual would otherwise receive 

17 for serving as a member of such faculty; and 

18 ‘‘(C) the school, in making a determination 

19 of the amount of compensation to be provided 

20 by the school to the individual for serving as a 

21 member of the faculty, will make the determina22 tion without regard to the amount of payments 

23 made (or to be made) to the individual by the 

24 Federal Government under subsection (a). 
14

•HR 3591 IH 

1 ‘‘(d) APPLICABILITY OF CERTAIN PROVISIONS.—The 

2 provisions of sections 338C, 338G, and 338I shall apply 

3 to the program established in subsection (a) to the same 

4 extent and in the same manner as such provisions apply 

5 to the National Health Service Corps Loan Repayment 

6 Program established in subpart III of part D of title III, 

7 including the applicability of provisions regarding reim8 bursements for increased tax liability and regarding bank9 ruptcy. 

10 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.—For the 

11 purpose of carrying out this section, there are authorized 

12 to be appropriated such sums as may be necessary for 

13 each of fiscal years 2004 through 2008. 

14 ‘‘SEC. 783. DEFINITIONS. 

15 ‘‘In this subpart: 

16 ‘‘(1) SCHOOL OF PHARMACY.—The term ‘school 

17 of pharmacy’ means a college or school of pharmacy 

18 (as defined in section 799B) that, in providing clin19 ical experience for students, requires that the stu20 dents serve in a clinical rotation in which pharmacist 

21 services are provided at or for—

22 ‘‘(A) a medical facility that serves a sub23 stantial number of individuals who reside in or 

24 are members of a medically underserved com25 munity (as so defined); 
15

•HR 3591 IH 

1 ‘‘(B) an entity described in any of sub2 paragraphs (A) through (L) of section 

3 340B(a)(4) (relating to the definition of covered 

4 entity); 

5 ‘‘(C) a health care facility of the Depart6 ment of Veterans Affairs or of any of the 

7 Armed Forces of the United States; 

8 ‘‘(D) a health care facility of the Bureau 

9 of Prisons; 

10 ‘‘(E) a health care facility operated by, or 

11 with funds received from, the Indian Health 

12 Service; or 

13 ‘‘(F) a disproportionate share hospital 

14 under section 1923 of the Social Security Act. 

15 ‘‘(2) PHARMACIST SERVICES.—The term ‘phar16 macist services’ includes drug therapy management 

17 services furnished by a pharmacist, individually or 

18 on behalf of a pharmacy provider, and such services 

19 and supplies furnished incident to the pharmacist’s 

20 drug therapy management services, that the phar21 macist is legally authorized to perform (in the State 

22 in which the individual performs such services) in 

23 accordance with State law (or the State regulatory 

24 mechanism provided for by State law).’’.

Æ