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. ROG-
ERS 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.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Pharmacy Education 
Aid Act of 2003’’. 
SEC. 2. FINDINGS. 
Congress makes the following findings: 
(1) Pharmacists are an important link in our 
Nation’s health care system. A critical shortage of 
pharmacists is threatening the ability of pharmacies 
to continue to provide important prescription related 
services. 
(2) In the landmark report entitled ‘‘To Err is 
Human: Building a Safer Health System’’, the Insti-
tute of Medicine reported that medication errors can 
be partially attributed to factors that are indicative 
of a shortage of pharmacists (such as too many cus-
tomers, numerous distractions, and staff shortages). 
(3) Congress acknowledged in the Healthcare 
Research and Quality Act of 1999 (Public Law 106–
129) a growing demand for pharmacists by requiring 
the Secretary of Health and Human Services to con-
duct a study to determine whether there is a short-
age of pharmacists in the United States and, if so, 
to what extent. 
(4) As a result of Congress’ concern about how 
a shortage of pharmacists would impact the public 
health, the Secretary of Health and Human Services
published a report entitled ‘‘The Pharmacist Work-
force: A Study in Supply and Demand for Phar-
macists’’ in December of 2000. 
(5) ‘‘The Pharmacist Workforce: A Study in 
Supply and Demand for Pharmacists’’ found that 
‘‘While the overall supply of pharmacists has in-
creased in the past decade, there has been an un-
precedented demand for pharmacists and for phar-
maceutical care services, which has not been met by 
the currently available supply’’ and that the ‘‘evi-
dence clearly indicates the emergence of a shortage 
of pharmacists over the past two years’’. 
(6) The same study also found that ‘‘The most 
striking evidence of a pharmacist shortage stems 
from demonstrably increased vacancy rates, difficul-
ties in hiring, and unprecedented increases in the 
volume and range of activities demanded of today’s 
pharmacist.’’
(7) The study found that ‘‘The factors causing 
the current shortage are of a nature not likely to 
abate in the near future without fundamental 
changes in pharmacy practice and education.’’ The 
study projects that the number of prescriptions filled 
by community pharmacists will increase by 20 per-
cent by 2004. In contrast, the number of community
pharmacists is expected to increase by only 6 per-
cent by 2005. 
(8) Regarding access to pharmacy services in 
rural areas, the study found that ‘‘Remoteness, iso-
lation from other professionals, lower economic re-
turns, reduced opportunities for advancement, and 
other rural practice characteristics remain obstacles’’ 
to attracting pharmacists. 
(9) In June 2002, the American Hospital Asso-
ciation’s Commission on Workforce for Hospitals 
and Health Systems released a report entitled ‘‘In 
Our Hands: How Hospital Leaders Can Build A 
Thriving Workforce’’. The report included a finding 
that 46 percent of our Nation’s hospitals are experi-
encing a shortage of pharmacists, with hospitals 
averaging a vacancy rate for pharmacists of 12.7 
percent. 
(10) The demand for pharmacists will increase 
as prescription drug use continues to grow. 
SEC. 3. HEALTH PROFESSIONS PROGRAMS RELATED TO 
THE PRACTICE OF PHARMACY. 
Part E of title VII of the Public Health Service Act 
(42 U.S.C. 294n et seq.) is amended by adding at the end 
the following:
‘‘Subpart 3—Pharmacy Workforce Development 
‘‘SEC. 781. LOAN REPAYMENT PROGRAM FOR PHARMACISTS 
SERVING IN CRITICAL SHORTAGE FACILI-
TIES. 
‘‘(a) IN GENERAL.—In the case of any individual—
‘‘(1) who has received a baccalaureate degree in 
pharmacy or a Doctor of Pharmacy degree from an 
accredited program; 
‘‘(2) who obtained an educational loan for phar-
macy education costs; and 
‘‘(3) who is licensed without restrictions in the 
State in which the designated health care facility is 
located; 
the Secretary may enter into an agreement with such indi-
vidual who agrees to serve as a full-time pharmacist for 
a period of not less than 2 years at a designated health 
care facility, to make payments in accordance with sub-
section (b), for and on behalf of that individual, on the 
principal of and interest on any loan of that individual 
described in paragraph (2) which is outstanding on the 
date the individual begins such service. 
‘‘(b) MANNER OF PAYMENTS.—
‘‘(1) IN GENERAL.—The payments described in 
subsection (a) may consist of payment, in accord-
ance with paragraph (2), on behalf of the individual 
of the principal, interest, and related expenses on
government and commercial loans received by the in-
dividual regarding the undergraduate or graduate 
education of the individual (or both), which loans 
were made for—
‘‘(A) tuition expenses; 
‘‘(B) all other reasonable educational ex-
penses, including fees, books, and laboratory ex-
penses, incurred by the individual; or 
‘‘(C) reasonable living expenses as deter-
mined by the Secretary. 
‘‘(2) PAYMENTS FOR YEARS SERVED.—
‘‘(A) IN GENERAL.—For each year of obli-
gated service that an individual contracts to 
serve under subsection (a) the Secretary may 
pay up to $35,000 on behalf of the individual 
for loans described in paragraph (1). In making 
a determination of the amount to pay for a year 
of such service by an individual, the Secretary 
shall consider the extent to which each such de-
termination—
‘‘(i) affects the ability of the Secretary 
to maximize the number of agreements 
that may be provided under this section 
from the amounts appropriated for such 
agreements;
‘‘(ii) provides an incentive to serve in 
areas with the greatest shortages of phar-
macists; and 
‘‘(iii) provides an incentive with re-
spect to the pharmacist involved remaining 
in the area and continuing to provide phar-
macy services after the completion of the 
period of obligated service under agree-
ment. 
‘‘(B) REPAYMENT
SCHEDULE.—Any ar-
rangement made by the Secretary for the mak-
ing of loan repayments in accordance with this 
subsection shall provide that any repayments 
for a year of obligated service shall be made not 
later than the end of the fiscal year in which 
the individual completes such year of service. 
‘‘(3) TAX LIABILITY.—For the purpose of pro-
viding reimbursements for tax liability resulting 
from payments under paragraph (2) on behalf of an 
individual—
‘‘(A) the Secretary shall, in addition to 
such payments, make payments to the indi-
vidual in an amount equal to 39 percent of the 
total amount of loan repayments made for the 
taxable year involved; and
‘‘(B) may make such additional payments 
as the Secretary determines to be appropriate 
with respect to such purpose. 
‘‘(4) PAYMENT
SCHEDULE.—The Secretary 
may enter into an agreement with the holder of any 
loan for which payments are made under this section 
to establish a schedule for the making of such pay-
ments. 
‘‘(c) PREFERENCES.—In entering into agreements 
under subsection (a), the Secretary shall give preference 
to qualified applicants with the greatest financial need. 
‘‘(d) REPORTS.—
‘‘(1) ANNUAL
REPORT.—Not later than 18 
months after the date of enactment of the Pharmacy 
Education Aid Act of 2003, and annually thereafter, 
the Secretary shall prepare and submit to Congress 
a report describing the program carried out under 
this section, including statements regarding—
‘‘(A) the number of applicants and con-
tract recipients; 
‘‘(B) the amount of loan repayments made; 
‘‘(C) which educational institution the re-
cipients attended;
‘‘(D) the number and practice locations of 
the loan repayment recipients at health care fa-
cilities with a critical shortage of pharmacists; 
‘‘(E) the default rate and actions required; 
‘‘(F) the amount of outstanding default 
funds of the loan repayment program; 
‘‘(G) to the extent that it can be deter-
mined, the reason for the default; 
‘‘(H) the demographics of the individuals 
participating in the loan repayment program; 
and 
‘‘(I) an evaluation of the overall costs and 
benefits of the program. 
‘‘(2) 5-YEAR REPORT.—Not later than 5 years 
after the date of enactment of the Pharmacy Edu-
cation Aid Act of 2003, the Secretary shall prepare 
and submit to Congress a report on how the pro-
gram carried out under this section interacts with 
other Federal loan repayment programs for phar-
macists and determining the relative effectiveness of 
such programs in increasing pharmacists practicing 
in underserved areas. 
‘‘(e) APPLICATION OF CERTAIN PROVISIONS.—
‘‘(1) IN GENERAL.—The provisions of section 
338C, 338G, and 338I shall apply to the program
established under this section in the same manner 
and to the same extent as such provisions apply to 
the National Health Service Corps Loan Repayment 
Program under subpart III of part D of title III, in-
cluding the applicability of provisions regarding re-
imbursements for increased tax liability and bank-
ruptcy. 
‘‘(2) BREACH OF AGREEMENT.—An individual 
who enters into an agreement under subsection (a) 
shall be liable to the Federal Government for the 
amount of the award under such agreement (includ-
ing amounts provided for expenses related to such 
attendance), and for interest on such amount at the 
maximum legal prevailing rate, if the individual fails 
to provide health services in accordance with the 
program under this section for the period of time 
applicable under the program. 
‘‘(3) WAIVER OR SUSPENSION OF LIABILITY.—
In the case of an individual or health facility making 
an agreement for purposes of subsection (a), the 
Secretary shall provide for the waiver or suspension 
of liability under paragraph (2) if compliance by the 
individual or the health facility, as the case may be, 
with the agreement involved is impossible, or would 
involve extreme hardship to the individual or facility,