Tennessee VFC Highlights and Updates Robert H. Brown VACCINE FOR CHILDREN (VFC) PROGRAM VFC Highlights and Updates Robert H. Brown Vaccine For Children Program Manager 2010 Annual Immunization Spring Review 13-16 April 2010

Tennessee VACCINE FOR CHILDREN (VFC) PROGRAM VFC Protocol

VFC Protocol Highlights VACCINE FOR CHILDREN (VFC) PROGRAM Section A - Enrollment/ Annual Re-Enrollment: To enroll/re-enroll (annually) as a VFC program provider, the following forms must be completed: -VFC Provider Enrollment form (PH-3349, Revised 11/08), which has two pages -VFC Provider Profile form (PH-3348, Revised 10/08) -Emergency Vaccine Storage and Handling Plan form (PH-3800, Revised 10/08) -Initial (One-Time Only) Varicella Order and Provider Survey (Enrollment Only) NOTE: PRACTICES WITH MULTIPLE SITES MUST ENROLL EACH SITE AS A SEPARATE VFC PROGRAM PROVIDER.

This area summarizes the VFC Protocol in which the provider acknowledges the program requirements and agrees to abide by them. VFC Provider Enrollment form (PH-3349, Revised 11/09), which has two pages

VFC Provider Profile form (PH-3348, Revised 11/09) Identifies the status of the provider in the VFC Program The provider estimates the number of patients served in their facility for a one year period The provider indicates the source used to determine the number of VFC eligible children VFC Provider Profile form (PH-3348, Revised 11/09)

VFC Protocol Highlights VACCINE FOR CHILDREN (VFC) PROGRAM Section B - Requirements to Participate in the VFC Program: All provider changes must be communicated to the VFC Program: - Change of address, telephone, or fax - Change in VFC contact person - Change in the number of VFC eligible children - Additions/deletions of physicians to provider site Section B states all the requirements to participate in the VFC Program which a provider agrees to. However, as a reminder you must notify the VFC Program with any changes that take place in your practice immediately. Changes can be faxed or emailed to Becky Loveless our Provider Enrollment Clerk. In some cases vaccines have been compromised because of the wrong Provider address in our system. Next Slide All changes can be faxed or emailed to Becky Loveless

VFC Protocol Highlights VACCINE FOR CHILDREN (VFC) PROGRAM Section C - Eligibility Criteria Categories: IN ALL VFC Sites: Persons who are 18 years of age or younger, and meet one or more of the following categories: Uninsured (b) Enrolled in or eligible for TennCare (Medicaid) (c) American Indian or Alaskan Native Section C states the Eligibility Criteria Categories that children have to meet before they can receive VFC vaccines. Children 18 years of age or younger which meet one or more of the following categories: Before I continue going over the categories, I want to make it clear that children who meet these categories can be seen at ALL VFC Sites (a) Uninsured (b) Enrolled in or eligible for TennCare (Medicaid)- which means children having both Private and TennCare insurance can receive VFC vaccines, because they are eligible or enrolled in TennCare. (c) American Indian or Alaskan Native We’ve had some questions about CoverKids. CoverKids (part of the CoverTN program) are fully insured under the State Child Health Insurance Program (SCHIP) and NOT VFC eligible. Only TennCare is VFC eligible. Next Slide Note: CoverKids are fully insured and NOT VFC eligible.

VFC Protocol Highlights VACCINE FOR CHILDREN (VFC) PROGRAM Section C - Eligibility Criteria Categories cont: ONLY IN VFC FQHCs, RHCs and Health Departments Sites: (d) Underinsured Children are eligible only in FQHCs, RHCs and Health Departments The following conditions are defined as “underinsured” A child who has commercial (private) health insurance but the coverage does not include vaccines, A child whose insurance covers only selected vaccines (VFC-eligible for non-covered vaccines only) A child whose insurance caps vaccine coverage at a certain amount. Once that coverage amount is reached, the child is categorized as underinsured. The last category that a child could meet would be Underinsured which can only be seen in VFC Federal Qualified Health Center, Rural Health Clinic and Health Departments. Children are defined as “underinsured” under the following conditions: A child who has commercial (private) health insurance but the coverage does not include vaccines A child whose insurance covers only selected vaccines (VFC-eligible for non-covered vaccines only) A child whose insurance caps vaccine coverage at a certain amount. Once that coverage amount is reached, the child is categorized as underinsured. Next Slide

VFC Protocol Highlights VACCINE FOR CHILDREN (VFC) PROGRAM Section D - Vaccine Accountability: Vaccine Doses Accountability Report (VDAR) (PH-3350 Rev 10/08): Submit monthly even if vaccines were not administered during month. Report must be completely filled out with all the proper information. The VFC Program no longer has the ability to ship vaccine as an “emergency” rush order but additional orders can be requested, if necessary. I will be talking more about Vaccine Management a little further in this presentation, but I just want to touch on a few points in this Section of the protocol title Vaccine Accountability. To maintain accountability the program uses the Vaccine Dose Accountability Report which the Provider submits monthly even if vaccines were not administered during the month. The report must be completely filled out with all the proper information. Partially completed reports may be returned, which could delay vaccine shipment. The VFC Program no longer has the ability to ship vaccine as an “emergency” rush order but additional orders can be requested, if necessary. Contact the VFC Program as soon as you realize you will not have enough vaccine to last until your next shipment. Next Slide

VFC Protocol Highlights VACCINE FOR CHILDREN (VFC) PROGRAM Section D - Vaccine Accountability: As of January 1, 2010 Tennessee’s Vaccines for Children (VFC) has fully adopted the CDC policy for “Two Directional Borrowing” which means the borrowing of VFC vaccines for private patients or privately purchased vaccines for VFC patients. Borrowing should only occur when there is a lack of appropriate stock vaccine due to unexpected circumstances such as: Delayed vaccine shipment New staff that calculated ordering time incorrectly Vaccine spoiled in-transit to provider Next Slide Note: VFC vaccine cannot be used as a replacement system for a provider’s privately purchased vaccine inventory.

VFC Protocol Highlights VACCINE FOR CHILDREN (VFC) PROGRAM Section D - Vaccine Accountability: When borrowing vaccines the provider must follow these guidelines: Providers must notify VFC Program Document all borrowed vaccine on the CDC VFC Vaccine Borrowing Report Form The borrowing reports must be kept as part of the VFC program records and be made available to the VFC staff during the VFC Site Visit. Next Slide Note: VFC-enrolled providers are expected to maintain an adequate inventory of vaccine for both their VFC and non-VFC-eligible patients.

VFC Vaccine Borrowing Report The Guidelines and Direction for use of this form must be followed The provider must document all borrowed vaccine on the CDC VFC Vaccine Borrowing Report Form Next Slide VFC Vaccine Borrowing Report

VFC Protocol Highlights VACCINE FOR CHILDREN (VFC) PROGRAM Section E - Proper Vaccine Storage and Handling: After January 1, 2009, all VFC providers can no longer use dorm style units or combination units with single thermostats as the primary storage unit. Providers may use separate refrigerators and freezers or combination unit with separate thermostats for refrigerator and freezer section. This section will be covered in detail this afternoon, but I did highlight some important information I want you to know as a VFC Provider. After January 1, 2009, all VFC Providers can no longer use dorm style units or combination units with single thermostats as the primary storage unit. Providers may use separate refrigerators and freezers or combination unit with separate thermostats for refrigerator and freezer sections. By July 1, 2009 VFC Providers without an acceptable storage unit will have shipment suspended. Next Slide

VFC Protocol Highlights VACCINE FOR CHILDREN (VFC) PROGRAM Section H- Non-Compliance with VFC Program Protocols: TIP has adopted CDC guidelines for responding to provider non-compliance with VFC Program Protocol identified during VFC site visits. Section I - Request for Inactivation in the VFC Program: Section H-TIP has adopted CDC guidelines for responding to Provider non-compliance with VFC Program Protocol identified during VFC site visits. Section I- A VFC provider may request to withdraw from the VFC Program at any time by submitting the request in writing along with a completed Vaccine Transfer Form (PH-4023). Vaccines will be picked up by a regional VFC representative. Next Slide A VFC provider may request to withdraw from the VFC Program at any time by submitting the request in writing along with a completed Vaccine Transfer Form (PH-4023). Vaccines will be picked up by a regional VFC representative.

Tennessee Vaccine Management VACCINE FOR CHILDREN (VFC) PROGRAM Vaccine Management is very important because millions of dollars are spent to provide vaccines. The next few slides I will be going over changes to forms that we use to maintain accountability throughout the VFC program. Next Slide

Pre-filled (PF) syringe gives the provider a choice Allows provider to order the amount vaccine requested The Vaccine Dose Accountability Report which the Provider submits monthly is submitted even if vaccines were not administered during the month. This report provides the program with information from left to right of the form indicating what brand of vaccine being requested for the next shipment by checking the box. We have added the option to select prefilled syringes to the brands that offer them. The next column shows how many doses have been used since last report. The following two columns beside it shows the current number of doses on hand to include the expiration date. The program uses a one for one replenishment system by looking at the doses administered or used. This works in most cases but to help the program and the provider we added the column circle in red which is labeled, “Number of doses requested this order,” which allows the provider to tell us what they desire in quantity. Adding this column has helped us greatly to replenish Provider orders. You can find this form and others posted on Tennessee Web Immunization System (TWIS) which Brian K. Moore will cover this afternoon. As a reminder orders for Hib are placed on Fridays of each week assigned to each practice (alphabetical by county). For Health Departments the forms are different and the only thing added was the new vaccines (Pentacel, Kinrix and Rotarix) Next Slide Vaccine Doses Accountability Report (PH-3350, Rev 11/09) must be submitted monthly.

Section B for Health Department Staff Only Recipient must complete the transfer section and fax to the VFC Program The Vaccine Transfer form was developed to maintain accountability of vaccines being transferred from one location to another. The form is used to request the transfer of excess vaccine to another VFC participant. The request should be submitted a minimum of 2 months or 8 weeks out. The form is broken down in three Sections A,B and C. Section A- is for the Provider that is requesting vaccines to be transferred. Section B- is for health department only meaning a VFC Field Rep and appointees. Section C- is for the recipient to complete and fax to the VFC program. As a reminder- Request should be submitted 8 weeks out and all transfers must be reported. Next Slide Vaccine Transfer Form (PH-4023)

Expired or Wasted Vaccine Report (PH-3589, Rev 11/09) The Expired or Waste Vaccine Report- is used for vaccine management and accountability, but is also used as a packing list for expired vaccines being returned to McKesson. The original goes back w/vaccines and a copy stays w/Provider and then faxed to VFC program. The form is also used to track wasted vaccines (give an example) and should be faxed to the VFC program at least monthly. Waste vaccine should always be discarded in the proper Sharps container and not returned to McKesson. Remember to return only spoiled or expired vaccines, in their original vials or pre-filled syringes no needles and always Keep two boxes to Transfer or Return Expired vaccines. The only update to the form was the corrected NDC# for Flu vaccine and New vaccines which was added to the program. Finally, it is very important to notify the VFC program on compromised vaccines caused by shipment. There is a two hour window to report compromised vaccine to McKesson. More information on returning vaccine to McKesson will be discussed in State Perspective on Storage and Handling Briefing in the afternoon session. Next Slide This area was updated with the corrected NDC# for Flu Vaccine and New Vaccines Return to McKesson only spoiled or expired vaccines, in their original vials or pre-filled syringes.

Economic Order Quantity (EOQ) VACCINE FOR CHILDREN (VFC) PROGRAM Updates Economic Order Quantity (EOQ) Vaccine Inventory Management (VIM)

Economic Order Quantity (EOQ) VACCINE FOR CHILDREN (VFC) PROGRAM Economic Order Quantity (EOQ) In 2010 the Tennessee Vaccines For Children (VFC) Program will began implementing the next phase of vaccine distribution, Economic Order Quantity (EOQ). EOQ is an effort by CDC to implement best practices for vaccine ordering. It strives to balance order size, order frequency, and storage & handling costs with a goal of improving vaccine flow nationwide. EOQ assigns ordering tiers for providers based on annual volume of publicly–funded vaccine ordered.

Ordering Guidelines of EOQ VACCINE FOR CHILDREN (VFC) PROGRAM Ordering Guidelines of EOQ The EOQ guidelines places providers in four categories based on their annual volume of doses ordered per year to determine the number of times a provider should order vaccine. High volume 6000 doses/year Monthly 12 times a year Med volume 800-5999 doses/year Bi-monthly 6 times a year Low volume 200-799 doses/year Quarterly 4 times a year Very low volume 0-199 doses/year As is no change

VACCINE FOR CHILDREN (VFC) PROGRAM Goals of EOQ The goal of EOQ is to improve vaccine flow and NOT to run out of vaccines. To help ensure you do not run out of vaccines. Note: No matter when your scheduled order date is, if you are running out of vaccines, place an order.

Vaccine Inventory Management (VIM) VACCINE FOR CHILDREN (VFC) PROGRAM Vaccine Inventory Management (VIM) VFC vaccine Ordering Inventory control and Reconciliation

Tennessee VFC Program Operations Vaccine replenishment status requests VACCINE FOR CHILDREN (VFC) PROGRAM VFC Program Operations Robert Brown (615) 532-8513 Robert.Brown@tn.gov Vaccine replenishment status requests Madelyn Ragland (615) 253-6915 Madelyn.Ragland@tn.gov Provider Enrollment and Short-Dated Vaccines Reporting Becky Loveless (615) 253-4072 Rebecca.Loveless@tn.gov Here our contact information if you need any help or additional information about the program.