[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 648 Reported in Senate (RS)]






                                                       Calendar No. 370
108th CONGRESS
  1st Session
                                 S. 648

                          [Report No. 108-189]

     To amend the Public Health Service Act with respect to health 
        professions programs regarding the practice of pharmacy.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             March 18, 2003

Mr. Reed (for himself, Mr. Enzi, Mr. Johnson, Mr. Warner, Ms. Landrieu, 
Ms. Collins,  Mr. Inouye, Mr. Roberts, Mr. Lautenberg, Mr. Cochran, Ms. 
 Mikulski, and Ms. Stabenow) introduced the following bill; which was 
 read twice and referred to the Committee on Health, Education, Labor, 
                              and Pensions

                            November 6, 2003

                Reported by Mr. Gregg, with an amendment
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

_______________________________________________________________________

                                 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 Representatives of the 
United States of America in Congress assembled,

<DELETED>SECTION 1. SHORT TITLE.</DELETED>

<DELETED>    This Act may be cited as the ``Pharmacy Education Aid Act 
of 2003''.</DELETED>

<DELETED>SEC. 2. FINDINGS.</DELETED>

<DELETED>    Congress makes the following findings:</DELETED>
        <DELETED>    (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.</DELETED>
        <DELETED>    (2) In the landmark report entitled ``To Err is 
        Human: Building a Safer Health System'', the Institute of 
        Medicine reported that medication errors can be partially 
        attributed to factors that are indicative of a shortage of 
        pharmacists (such as too many customers, numerous distractions, 
        and staff shortages).</DELETED>
        <DELETED>    (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 conduct a study to determine whether there is 
        a shortage of pharmacists in the United States and, if so, to 
        what extent.</DELETED>
        <DELETED>    (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 Workforce: A Study in Supply and 
        Demand for Pharmacists'' in December of 2000.</DELETED>
        <DELETED>    (5) ``The Pharmacist Workforce: A Study in Supply 
        and Demand for Pharmacists'' found that ``While the overall 
        supply of pharmacists has increased in the past decade, there 
        has been an unprecedented demand for pharmacists and for 
        pharmaceutical care services, which has not been met by the 
        currently available supply'' and that the ``evidence clearly 
        indicates the emergence of a shortage of pharmacists over the 
        past two years''.</DELETED>
        <DELETED>    (6) The same study also 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 percent by 2004. In contrast, the number of 
        community pharmacists is expected to increase by only 6 percent 
        by 2005.</DELETED>
        <DELETED>    (7) The demand for pharmacists will increase as 
        prescription drug use continues to grow.</DELETED>

<DELETED>SEC. 3. HEALTH PROFESSIONS PROGRAM RELATED TO THE PRACTICE OF 
              PHARMACY.</DELETED>

<DELETED>    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:</DELETED>

     <DELETED>``Subpart 3--Pharmacy Workforce Development</DELETED>

<DELETED>``SEC. 781. LOAN REPAYMENT PROGRAM.</DELETED>

<DELETED>    ``(a) In General.--In the case of any individual--
</DELETED>
        <DELETED>    ``(1) who has received a baccalaureate degree in 
        pharmacy or a Doctor of Pharmacy degree from an accredited 
        program; and</DELETED>
        <DELETED>    ``(2) who obtained an educational loan for 
        pharmacy education costs;</DELETED>
<DELETED>the Secretary may enter into an agreement with such individual 
who agrees to serve as a full-time pharmacist for a period of not less 
than 2 years at a health care facility with a critical shortage of 
pharmacists, to make payments in accordance with subsection (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.</DELETED>
<DELETED>    ``(b) Manner of Payments.--</DELETED>
        <DELETED>    ``(1) In general.--The payments described in 
        subsection (a) may consist of payment, in accordance with 
        paragraph (2), on behalf of the individual of the principal, 
        interest, and related expenses on government and commercial 
        loans received by the individual regarding the undergraduate or 
        graduate education of the individual (or both), which loans 
        were made for--</DELETED>
                <DELETED>    ``(A) tuition expenses;</DELETED>
                <DELETED>    ``(B) all other reasonable educational 
                expenses, including fees, books, and laboratory 
                expenses, incurred by the individual; or</DELETED>
                <DELETED>    ``(C) reasonable living expenses as 
                determined by the Secretary.</DELETED>
        <DELETED>    ``(2) Payments for years served.--</DELETED>
                <DELETED>    ``(A) In general.--For each year of 
                obligated service that an individual contracts to serve 
                under subsection (a)(3) 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 determination--</DELETED>
                        <DELETED>    ``(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;</DELETED>
                        <DELETED>    ``(ii) provides an incentive to 
                        serve in areas with the greatest shortages of 
                        pharmacists; and</DELETED>
                        <DELETED>    ``(iii) provides an incentive with 
                        respect to the pharmacist involved remaining in 
                        the area and continuing to provide pharmacy 
                        services after the completion of the period of 
                        obligated service under agreement.</DELETED>
                <DELETED>    ``(B) Repayment schedule.--Any arrangement 
                made by the Secretary for the making 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.</DELETED>
        <DELETED>    ``(3) Tax liability.--For the purpose of providing 
        reimbursements for tax liability resulting from payments under 
        paragraph (2) on behalf of an individual--</DELETED>
                <DELETED>    ``(A) the Secretary shall, in addition to 
                such payments, make payments to the individual in an 
                amount equal to 39 percent of the total amount of loan 
                repayments made for the taxable year involved; 
                and</DELETED>
                <DELETED>    ``(B) may make such additional payments as 
                the Secretary determines to be appropriate with respect 
                to such purpose.</DELETED>
        <DELETED>    ``(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 payments.</DELETED>
<DELETED>    ``(c) Preferences.--In entering into agreements under 
subsection (a), the Secretary shall give preference to qualified 
applicants with the greatest financial need.</DELETED>
<DELETED>    ``(d) Reports.--</DELETED>
        <DELETED>    ``(1) Annual report.--Not later than 18 months 
        after the date of enactment of the Pharmacy Education Aid Act, 
        and annually thereafter, the Secretary shall prepare and submit 
        to Congress a report describing the program carried out under 
        this section, including statements regarding--</DELETED>
                <DELETED>    ``(A) the number of enrollees, loan 
                repayments, and recipients;</DELETED>
                <DELETED>    ``(B) the number of graduates;</DELETED>
                <DELETED>    ``(C) the amount of loan repayments 
                made;</DELETED>
                <DELETED>    ``(D) which educational institution the 
                recipients attended;</DELETED>
                <DELETED>    ``(E) the number and placement location of 
                the loan repayment recipients at health care facilities 
                with a critical shortage of pharmacists;</DELETED>
                <DELETED>    ``(F) the default rate and actions 
                required;</DELETED>
                <DELETED>    ``(G) the amount of outstanding default 
                funds of the loan repayment program;</DELETED>
                <DELETED>    ``(H) to the extent that it can be 
                determined, the reason for the default;</DELETED>
                <DELETED>    ``(I) the demographics of the individuals 
                participating in the loan repayment program; 
                and</DELETED>
                <DELETED>    ``(J) an evaluation of the overall costs 
                and benefits of the program.</DELETED>
        <DELETED>    ``(2) 5-year report.--Not later than 5 years after 
        the date of enactment of the Pharmacy Education Aid Act, the 
        Secretary shall prepare and submit to Congress a report on how 
        the program carried out under this section interacts with other 
        Federal loan repayment programs for pharmacists and determining 
        the relative effectiveness of such programs in increasing 
        pharmacists practicing in areas with a critical shortage of 
        pharmacists.</DELETED>
<DELETED>    ``(e) Breach of Agreement.--</DELETED>
        <DELETED>    ``(1) In general.--In the case of any program 
        under this section under which an individual makes an agreement 
        to provide health services for a period of time in accordance 
        with such program in consideration of receiving an award of 
        Federal funds regarding education as a pharmacist (including an 
        award for the repayment of loans), the following applies if the 
        agreement provides that this subsection is 
        applicable:</DELETED>
                <DELETED>    ``(A) In the case of a program under this 
                section that makes an award of Federal funds for 
                attending an accredited program of pharmacy (in this 
                section referred to as a `pharmacy program'), the 
                individual is liable to the Federal Government for the 
                amount of such award (including amounts provided for 
                expenses related to such attendance), and for interest 
                on such amount at the maximum legal prevailing rate, if 
                the individual--</DELETED>
                        <DELETED>    ``(i) fails to maintain an 
                        acceptable level of academic standing in the 
                        pharmacy program (as indicated by the program 
                        in accordance with requirements established by 
                        the Secretary);</DELETED>
                        <DELETED>    ``(ii) is dismissed from the 
                        pharmacy program for disciplinary reasons; 
                        or</DELETED>
                        <DELETED>    ``(iii) voluntarily terminates the 
                        pharmacy program.</DELETED>
                <DELETED>    ``(B) The individual is liable to the 
                Federal Government for the amount of such award 
                (including 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.</DELETED>
        <DELETED>    ``(2) Waiver or suspension of liability.--In the 
        case of an individual or health facility making an agreement 
        for purposes of paragraph (1), the Secretary shall provide for 
        the waiver or suspension of liability under such subsection if 
        compliance by the individual or the health facility, as the 
        case may be, with the agreements involved is impossible, or 
        would involve extreme hardship to the individual or facility, 
        and if enforcement of the agreements with respect to the 
        individual or facility would be unconscionable.</DELETED>
        <DELETED>    ``(3) Date certain for recovery.--Subject to 
        paragraph (2), any amount that the Federal Government is 
        entitled to recover under paragraph (1) shall be paid to the 
        United States not later than the expiration of the 3-year 
        period beginning on the date the United States becomes so 
        entitled.</DELETED>
        <DELETED>    ``(4) Availability.--Amounts recovered under 
        paragraph (1) with respect to a program under this section 
        shall be available for the purposes of such program, and shall 
        remain available for such purposes until expended.</DELETED>
<DELETED>    ``(f) Definition.--In this section, the term `health care 
facility' means an Indian Health Service health center, a Native 
Hawaiian health center, a hospital, a pharmacy, a Federal qualified 
health center, a rural health clinic, a nursing home, a home health 
agency, a hospice program, a public health clinic, a State or local 
department of public health, a skilled nursing facility, an ambulatory 
surgical center, or any other facility determined appropriate by the 
Secretary.</DELETED>
<DELETED>    ``(g) Authorization of Appropriations.--For the purpose of 
payments under agreements entered into under subsection (a), there are 
authorized to be appropriated such sums as may be necessary for each of 
fiscal years 2004 through 2008.</DELETED>

<DELETED>``SEC. 782. PHARMACIST FACULTY LOAN PROGRAM.</DELETED>

<DELETED>    ``(a) Establishment.--The Secretary, acting through the 
Administrator of the Health Resources and Services Administration, may 
enter into an agreement with any school of pharmacy for the 
establishment and operation of a student loan fund in accordance with 
this section, to increase the number of qualified pharmacy 
faculty.</DELETED>
<DELETED>    ``(b) Agreements.--Each agreement entered into under 
subsection (a) shall--</DELETED>
        <DELETED>    ``(1) provide for the establishment of a student 
        loan fund by the school involved;</DELETED>
        <DELETED>    ``(2) provide for deposit in the fund of--
        </DELETED>
                <DELETED>    ``(A) the Federal capital contributions to 
                the fund;</DELETED>
                <DELETED>    ``(B) an amount equal to not less than 
                one-ninth of such Federal capital contributions, 
                contributed by such school;</DELETED>
                <DELETED>    ``(C) collections of principal and 
                interest on loans made from the fund; and</DELETED>
                <DELETED>    ``(D) any other earnings of the 
                fund;</DELETED>
        <DELETED>    ``(3) provide that the fund will be used only for 
        loans to students of the school in accordance with subsection 
        (c) and for costs of collection of such loans and interest 
        thereon;</DELETED>
        <DELETED>    ``(4) provide that loans may be made from such 
        fund only to students pursuing a full-time course of study or, 
        at the discretion of the Secretary, a part-time course of 
        study; and</DELETED>
        <DELETED>    ``(5) contain such other provisions as are 
        necessary to protect the financial interests of the United 
        States.</DELETED>
<DELETED>    ``(c) Loan Provisions.--Loans from any student loan fund 
established by a school pursuant to an agreement under subsection (a) 
shall be made to an individual on such terms and conditions as the 
school may determine, except that--</DELETED>
        <DELETED>    ``(1) such terms and conditions are subject to any 
        conditions, limitations, and requirements prescribed by the 
        Secretary;</DELETED>
        <DELETED>    ``(2) in the case of any individual, the total of 
        the loans for any academic year made by schools of pharmacy 
        from loan funds established pursuant to agreements under 
        subsection (a) may not exceed $35,000, plus any amount 
        determined by the Secretary on an annual basis to reflect 
        inflation;</DELETED>
        <DELETED>    ``(3) an amount up to 85 percent of any such loan 
        (plus interest thereon) shall be canceled by the school as 
        follows:</DELETED>
                <DELETED>    ``(A) upon completion by the individual of 
                each of the first, second, and third year of full-time 
                employment, required by the loan agreement entered into 
                under this subsection, as a faculty member in a school 
                of pharmacy, the school shall cancel 20 percent of the 
                principle of, and the interest on, the amount of such 
                loan unpaid on the first day of such employment; 
                and</DELETED>
                <DELETED>    ``(B) upon completion by the individual of 
                the fourth year of full-time employment, required by 
                the loan agreement entered into under this subsection, 
                as a faculty member in a school of pharmacy, the school 
                shall cancel 25 percent of the principle of, and the 
                interest on, the amount of such loan unpaid on the 
                first day of such employment;</DELETED>
        <DELETED>    ``(4) such a loan may be used to pay the cost of 
        tuition, fees, books, laboratory expenses, and other reasonable 
        education expenses;</DELETED>
        <DELETED>    ``(5) such a loan shall be repayable in equal or 
        graduated periodic installments (with the right of the borrower 
        to accelerate repayment) over the 10-year period that begins 9 
        months after the individual ceases to pursue a course of study 
        at a school of pharmacy; and</DELETED>
        <DELETED>    ``(6) such a loan shall--</DELETED>
                <DELETED>    ``(A) beginning on the date that is 3 
                months after the individual ceases to pursue a course 
                of study at a school of pharmacy, bear interest on the 
                unpaid balance of the loan at the rate of 3 percent per 
                annum; or</DELETED>
                <DELETED>    ``(B) subject to subsection (e), if the 
                school of pharmacy determines that the individual will 
                not complete such course of study or serve as a faculty 
                member as required under the loan agreement under this 
                subsection, bear interest on the unpaid balance of the 
                loan at the prevailing market rate.</DELETED>
<DELETED>    ``(d) Payment of Proportionate Share.--Where all or any 
part of a loan, or interest, is canceled under this section, the 
Secretary shall pay to the school an amount equal to the school's 
proportionate share of the canceled portion, as determined by the 
Secretary.</DELETED>
<DELETED>    ``(e) Review by Secretary.--At the request of the 
individual involved, the Secretary may review any determination by a 
school of pharmacy under subsection (c)(6)(B).</DELETED>
<DELETED>    ``(f) Information Technology.--The Secretary may make 
awards of grants or contracts to qualifying schools of pharmacy for the 
purpose of assisting such schools in acquiring and installing computer-
based systems to provide pharmaceutical education. Education provided 
through such systems may be graduate education, professional education, 
or continuing education. The computer-based systems may be designed to 
provide on-site education, or education at remote sites (commonly 
referred to as distance learning), or both.</DELETED>
<DELETED>    ``(g) Requirement Regarding Education in Practice of 
Pharmacy.--With respect to the school of pharmacy involved, the 
Secretary shall ensure that programs and activities carried out with 
Federal funds provided under this section have the goal of educating 
students to become licensed pharmacists, or the goal of providing for 
faculty to recruit, retain, and educate students to become licensed 
pharmacists.</DELETED>
<DELETED>    ``(h) Definitions.--For purposes of this 
section:</DELETED>
        <DELETED>    ``(1) School of pharmacy.--the term `school of 
        pharmacy' means a college or school of pharmacy (as defined in 
        section 799B) that, in providing clinical experience for 
        students, requires that the students serve in a clinical 
        rotation in which pharmacist services (as defined in section 
        331(a)(3)(E)) are provided at or for--</DELETED>
                <DELETED>    ``(A) a medical facility that serves a 
                substantial number of individuals who reside in or are 
                members of a medically underserved community (as so 
                defined);</DELETED>
                <DELETED>    ``(B) an entity described in any of 
                subparagraphs (A) through (L) of section 340B(a)(4) 
                (relating to the definition of covered 
                entity);</DELETED>
                <DELETED>    ``(C) a health care facility of the 
                Department of Veterans Affairs or of any of the Armed 
                Forces of the United States;</DELETED>
                <DELETED>    ``(D) a health care facility of the Bureau 
                of Prisons;</DELETED>
                <DELETED>    ``(E) a health care facility operated by, 
                or with funds received from, the Indian Health Service; 
                or</DELETED>
                <DELETED>    ``(F) a disproportionate share hospital 
                under section 1923 of the Social Security 
                Act.</DELETED>
        <DELETED>    ``(2) Pharmacist services.--The term `pharmacist 
        services' includes drug therapy management services furnished 
        by a pharmacist, individually or on behalf of a pharmacy 
        provider, and such services and supplies furnished incident to 
        the pharmacist's drug therapy management services, that the 
        pharmacist is legally authorized to perform (in the State in 
        which the individual performs such services) in accordance with 
        State law (or the State regulatory mechanism provided for by 
        State law).</DELETED>
<DELETED>    ``(i) Authorization of Appropriations.--For the purpose of 
carrying out this section, there are authorized to be appropriated such 
sums as may be necessary for each of the fiscal years 2004 through 
2008.''.</DELETED>

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 Institute of Medicine 
        reported that medication errors can be partially attributed to 
        factors that are indicative of a shortage of pharmacists (such 
        as too many customers, 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 conduct a study to determine whether there is a 
        shortage 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 Workforce: A Study in Supply and Demand for 
        Pharmacists'' 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 increased in the past decade, there has been 
        an unprecedented demand for pharmacists and for pharmaceutical 
        care services, which has not been met by the currently 
        available supply'' and that the ``evidence clearly indicates 
        the emergence of a shortage of pharmacists over the past two 
        years''.
            (6) The same study also 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 percent by 2004. In contrast, the number of community 
        pharmacists is expected to increase by only 6 percent by 2005.
            (7) Regarding access to pharmacy services in rural areas, 
        the study found that ``Remoteness, isolation from other 
        professionals, lower economic returns, reduced opportunities 
        for advancement, and other rural practice characteristics 
        remain obstacles'' to attracting pharmacists.
            (8) 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 FACILITIES.

    ``(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 pharmacy 
        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 individual 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 subsection (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 accordance with paragraph (2), on 
        behalf of the individual of the principal, interest, and 
        related expenses on government and commercial loans received by 
        the individual regarding the undergraduate or graduate 
        education of the individual (or both), which loans were made 
        for--
                    ``(A) tuition expenses;
                    ``(B) all other reasonable educational expenses, 
                including fees, books, and laboratory expenses, 
                incurred by the individual; or
                    ``(C) reasonable living expenses as determined by 
                the Secretary.
            ``(2) Payments for years served.--
                    ``(A) In general.--For each year of obligated 
                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 
                determination--
                            ``(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 
                        pharmacists; and
                            ``(iii) provides an incentive with respect 
                        to the pharmacist involved remaining in the 
                        area and continuing to provide pharmacy 
                        services after the completion of the period of 
                        obligated service under agreement.
                    ``(B) Repayment schedule.--Any arrangement made by 
                the Secretary for the making 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 providing 
        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 individual 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 payments.
    ``(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, 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 contract 
                recipients;
                    ``(B) the amount of loan repayments made;
                    ``(C) which educational institution the recipients 
                attended;
                    ``(D) the number and practice locations of the loan 
                repayment recipients at health care facilities 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 determined, 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 Education Aid Act, the Secretary 
        shall prepare and submit to Congress a report on how the 
        program carried out under this section interacts with other 
        Federal loan repayment programs for pharmacists 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, 
        including the applicability of provisions regarding 
        reimbursements for increased tax liability and bankruptcy.
            ``(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 (including 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, and if enforcement of 
        the agreements with respect to the individual or facility would 
        be unconscionable.
            ``(4) Date certain for recovery.--Subject to paragraph (3), 
        any amount that the Federal Government is entitled to recover 
        under paragraph (2) shall be paid to the United States not 
        later than the expiration of the 3-year period beginning on the 
        date the United States becomes so entitled.
            ``(5) Availability.--Amounts recovered under paragraph (2) 
        with respect to a program under this section shall be available 
        for the purposes of such program, and shall remain available 
        for such purposes until expended.
    ``(f) Definition.--In this section, the term `health care facility' 
means a facility with a critical shortage of pharmacists as determined 
by the Secretary.
    ``(g) Authorization of Appropriations.--For the purpose of payments 
under agreements entered into under subsection (a), there are 
authorized to be appropriated such sums as may be necessary for each of 
fiscal years 2004 through 2008.

``SEC. 782. PHARMACY FACULTY LOAN REPAYMENT PROGRAM.

    ``(a) Establishment of Program.--The Secretary shall establish a 
program under which the Secretary will enter into contracts with 
individuals described in subsection (b) and such individuals will agree 
to serve as faculty members of schools of pharmacy in consideration of 
the Federal Government agreeing to pay, for each year of such service, 
not more than $35,000 of the principal and interest of the educational 
loans of such individuals.
    ``(b) Eligible Individuals.--An individual is described in this 
subsection if such individual--
            ``(1) has a baccalaureate degree in pharmacy or a Doctor of 
        Pharmacy degree from an accredited program; or
            ``(2) is enrolled as a full-time student--
                    ``(A) in an accredited pharmacy program; and 
                    ``(B) in the final year of a course of a study or 
                program, offered by such institution and approved by 
                the Secretary, leading to a baccalaureate degree in 
                pharmacy or a Doctor of Pharmacy degree from such a 
                school.
    ``(c) Requirements Regarding Faculty Positions.--The Secretary may 
not enter into a contract under subsection (a) unless--
            ``(1) the individual involved has entered into a contract 
        with a school of pharmacy to serve as a member of the faculty 
        of the school for not less than 2 years; and
            ``(2) the contract referred to in paragraph (1) provides 
        that--
                    ``(A) the school will, for each year for which the 
                individual will serve as a member of the faculty under 
                contract with the school, make payments of the 
                principal and interest due on the educational loans of 
                the individual for such year in an amount equal to the 
                amount of such payments made by the Secretary for the 
                year;
                    ``(B) the payments made by the school pursuant to 
                subparagraph (A) on behalf of the individual will be in 
                addition to the compensation that the individual would 
                otherwise receive for serving as a member of such 
                faculty; and
                    ``(C) the school, in making a determination of the 
                amount of compensation to be provided by the school to 
                the individual for serving as a member of the faculty, 
                will make the determination without regard to the 
                amount of payments made (or to be made) to the 
                individual by the Federal Government under subsection 
                (a).
    ``(d) Applicability of Certain Provisions.--The provisions of 
sections 338C, 338G, and 338I shall apply to the program established in 
subsection (a) to the same extent and in the same manner as such 
provisions apply to the National Health Service Corps Loan Repayment 
Program established in subpart III of part D of title III, including 
the applicability of provisions regarding reimbursements for increased 
tax liability and regarding bankruptcy.
    ``(e) Authorization of Appropriations.--For the purpose of carrying 
out this section, there are authorized to be appropriated such sums as 
may be necessary for each of fiscal years 2004 through 2008.

``SEC. 783. DEFINITIONS.

    ``In this subpart:
            ``(1) School of pharmacy.--The term `school of pharmacy' 
        means a college or school of pharmacy (as defined in section 
        799B) that, in providing clinical experience for students, 
        requires that the students serve in a clinical rotation in 
        which pharmacist services (as defined in section 331(a)(3)(E)) 
        are provided at or for--
                    ``(A) a medical facility that serves a substantial 
                number of individuals who reside in or are members of a 
                medically underserved community (as so defined);
                    ``(B) an entity described in any of subparagraphs 
                (A) through (L) of section 340B(a)(4) (relating to the 
                definition of covered entity);
                    ``(C) a health care facility of the Department of 
                Veterans Affairs or of any of the Armed Forces of the 
                United States;
                    ``(D) a health care facility of the Bureau of 
                Prisons;
                    ``(E) a health care facility operated by, or with 
                funds received from, the Indian Health Service; or
                    ``(F) a disproportionate share hospital under 
                section 1923 of the Social Security Act.
            ``(2) Pharmacist services.--The term `pharmacist services' 
        includes drug therapy management services furnished by a 
        pharmacist, individually or on behalf of a pharmacy provider, 
        and such services and supplies furnished incident to the 
        pharmacist's drug therapy management services, that the 
        pharmacist is legally authorized to perform (in the State in 
        which the individual performs such services) in accordance with 
        State law (or the State regulatory mechanism provided for by 
        State law).''.




                                                       Calendar No. 370

108th CONGRESS

  1st Session

                                 S. 648

                          [Report No. 108-189]

_______________________________________________________________________

                                 A BILL

     To amend the Public Health Service Act with respect to health 
        professions programs regarding the practice of pharmacy.

_______________________________________________________________________

                            November 6, 2003

                       Reported with an amendment