1. What is this Maze Called “VOFA” and How Do I Navigate it?

2. Definitions VOFA : Vaccine Ordering and Forecasting Application Spend Plan: An output of VOFA but used interchangeably with VOFA. Primary Account (line of credit)  VFC funds for all vaccines,  317 funds for all vaccines except 317 direct ship  State or local funds you anticipate spending Secondary Account (line of credit)  317 direct ship (e.g. varicella, zoster)

3. VOFA’s Purpose A planning tool to help CDC determine and/or correct request to OMB for VFC funding Helps grantees manage vaccine under centralized distribution  Manage through the doses not the dollars (manage the need)

6. VOFA Inputs 317 Schedule  317 eligible population from PES  Adult population from Census  No predetermination of baseline doses needed State/local schedule  State/local eligible population from PES  Adult population from Census  No predetermination of baseline doses needed ARRA schedule  Used 317 eligible population from PES  Adult population from Census

7. VOFA Outputs and Uses Contracts and Inventory  Helps us meet “bona fide needs” test of federal appropriations law (ARRA funded vaccines)  Used to determine how much to put on contracts  When providers anticipated to order  Used to determine how much of each brand and packaging type to have at McKesson

8. VOFA Outputs and Uses (cont.) Funding  How much and when  “Hard” quarterly targets  “Soft” annual targets Tracking purposes (reports, spend plan)  How to apportion funds among funding sources  How much vaccine to replenish

9. VOFA Focus Areas for Program Managers

10. ARRA Vaccine funds must be spent by the end of federal fiscal year 2010 Recommend weekly or bi-weekly review by vaccine manager and reconciliation of planned to actual orders  CDC Vaccine Monitors will email and/or call bi- weekly  Will begin process of contacting grantees who are underspending ARRA in next few weeks  Have developed protocol for shifting funds to grantees that can use ARRA vaccine $

11. VFC maximum doses VFC doses start with eligible population  In order to get more than the maximum you need to demonstrate an increase in the eligible population. Grantee can request limited catch-up to cover VFC eligible population  Maximum allowable catch-up for VFC determined annually  Consider a variety of things such as expected availability of vaccines and whether active catch-up campaigns would be going on

12. VFC Maximum Doses (cont.) 2010 monitoring process will include thresholds that trigger more intensive follow-up  based on maximum doses and funding  important to understand that this will cause faster expenditure of 317 funds

13. 2009 VFC Vaccine Dose Requests DTaPHepAHepBHibHPVMCVMMRPCV7PolioRTVTdapVZV Mean 4.83.8 3.92.72.12.33.9 2.3 4.0 Median 4.63.13.4 2.51.92.23.7 2.22.13.6 Min 3.81.92.73.20.90.81.73.33.51.21.01.7 Max 10.110.613.410.26.46.03.96.27.85.2 13.8 Criteria >5>5>5>5>4>4>4>4>4>4>3>3>3>3>4>4>4>4>3>3>3>3>5>5 # of Grantees 1181217868 1151310

14. 2009 Funding Requests and Purchases Total Requested (includes flu) Total Purchases (includes flu) Difference VFC317VFC317VFC317 $3,156,312,513$251,847,789$2,806,405,266$220,069,503$349,907 247$31,778,286

15. Updating with actual purchases and monthly VOFA updates In 2010 VOFA is updated monthly with actual purchases from prior month Grantees must review and make adjustments in all funding sources, including VFC  remember VFC entitlement is based on eligible children  grantees that need more VFC vaccine will need to work with CDC to review data, including VFC-eligible population  CDC may need to adjust maximum allowable for certain vaccines  We will work with grantees to review, discuss and make adjustments where need is demonstrated and will make every effort to be reasonable

16. Updating with actual purchases and monthly VOFA updates (cont) Monitors will be proactive in making sure that grantees are contacted before they reach dose limits in VFC and funding limits in 317, state/local  This will also help with prematurely exceeding funding in all sources

17. Replenishments Grantees should attend to state replenishments and agreed upon replenishment schedules established with monitors  We recognize there is uncertainty  If there are any changes please notify us ASAP and we will work with you  Changes in budget available  Changes in ability to actually spend it

18. Replenishments (cont.) Where possible, grantees should use “debit” model of replenishment: buy vaccine in advance and draw down on credit  Helps to fully expend state dollars  Limits possibility of continuing to order beyond funding availability

19. Monitoring Reports Monitoring reports critical to helping you make needed changes Attend to areas that monitor notes in his/her email and adjust Reports show funds in various views  Primary/secondary  VFC, 317, S/L, ARRA

20. Monitoring Reports (Cont.) Attending to funds available will ensure you will not run out funds  Remember that while orders are placed in Vacman at provider level, the doses roll up to totals by vaccine  Consider tracking the provide orders placed every month against VOFA spend plan Attend to direct ship!!!  Varicella, zoster and other direct ship vaccines are assigned funding source at order.  Fund source is assigned as is planned in VOFA spend plan

21. Upcoming VOFA Updates PedvaxHIB availability High Risk Adult Hepatitis B amounts MMR-V Change in packaging Hepatitis B from 5 dose syringes to 10 dose syringes

22. Report issues Please contact us the moment you find monitoring report discrepancies System is complex Sometimes the only way we know changes have been made to data warehouse is missing is by hearing from you Solution may not be quick because we are dependent upon other systems/groups at CDC

23. Final Take Home Points Please update your VOFA with actual data monthly and then make adjustments as necessary to ensure you are not overspending Make sure you have programmed your ARRA funds through August 2010  Try to purchase all ARRA funded adult purchases by June 30, 2010 Please make sure you have a spend plan for all vaccines you intend to order

24. Questions? Need more information, please contact: Melissa Ely Moore 404-639-8557 mmoore5@cdc.gov