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Inventory. Order. Receive. Document. Administe r. Protection. Where Did My Vaccine Go? Connecting the Vials. 2012 Regional Immunization Workshops Presenters: Glenda Anderson, Caroline Helton, Mary Ivers. Goal.

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  1. Inventory Order Receive Document Administer Protection Where Did My Vaccine Go? Connecting the Vials 2012 Regional Immunization Workshops Presenters: Glenda Anderson, Caroline Helton, Mary Ivers

  2. Goal To ensure vaccine availability and efficacy through appropriate vaccine storage, handling, and accountability

  3. Workshop Objectives • Identify how CDC and NCIP changes will affect the vaccine delivery system. • Describe vaccine allocation and shipment processes • Describe appropriate vaccine storage and handling best practices • Identify strategies to increase vaccine accountability • Describe the benefits of the NCIR Benchmark Report

  4. CDC – NCIP & You • Funding Restrictions • Promotional Items • Food & Beverages

  5. CDC-NCIP & YouOctober 1st • Provider Agreements • Elimination of vaccine for Insured patients • Vaccines currently offered universally for children • VFC-Eligible children only • Vaccines currently available for adults • NO insurance only

  6. Vaccine Coverage ChangesWhy? • Affordable Care Act • Elimination of funding for vaccination of Insured patients

  7. NCIP Vaccine Coverage • VFC-Eligible • Underinsured • Private insurance no vaccine coverage • Select vaccines • Cap on coverage • Underinsured children • FQHCs, RHCs, LHDs, accessible providers

  8. Insured • Has a co-pay • Has a deductible • Health Choice • Seeing a doctor outside of network • Insurance doesn’t cover the full cost of vaccine • Underinsured • No wellness • Does not cover vaccines • Does not cover specific vaccines • Met a wellness cap

  9. Private Dose to Underinsured • Cannot replace with a state supplied dose • May bill the patient • Educate the patient that vaccines are available at no cost at other locations • Absorb the cost

  10. Adult Vaccines at Any NCIP Provider10-1-2012 • No Insurance • Hepatitis B if started before 19 – completed by 20 years of age • Meningococcal for 1st year college students living in dorms • MMR = 2 doses for those entering college • Td for college entry • Tdap

  11. Adult VaccinesGiven at LHDs • NO insurance • Twinrix (FQHC & RHC also) • Hepatitis B for refugees • 1 dose of MMR (FQHC & RHC) • 2 doses of MMR for women of childbearing age • Td (FQHC &RHC) • or Tdap (if indicated) • Td available for wound management in emergency departments

  12. Exceptions for All NCIP Providers • DT will remain universal • Hepatitis B birth dose remains universal

  13. Exceptions at Local Health Departments Only • Close contacts of a person with acute or chronic hepatitis B infection (any age) • Post-exposure

  14. 2012-2013 Flu • 6 months through18 • VFC Eligible only • Close contacts of infants (universal) • 19+ • Insured, underinsured, no insurance • Attending NC College or university • Close contacts of infants • NO LAIV for adults

  15. ConfusionVaccine Supply • Vaccine in inventory prior to October 1st • Use with current coverage criteria (July 24, 2012) • Ends December 31, 2012 or expired • No stockpiling • Vaccine received after October 1st • New restrictions coverage criteria • Referring underinsured • Tdap universal for all ends 12-31-2012

  16. Vaccines are Expensive • By age 2 - $856.44 • Before school entry add $148.56 • Adolescents add $530.53 • TOTAL = $1,535.35 Costs as of 7-6-2012

  17. The Vaccines for Children (VFC) Program offers all ACIP recommended vaccines, at no cost, to eligible children through VFC-enrolled doctors.

  18. The VFC Program... • covers vaccines recommended by the Advisory Committee on Immunization Practices (ACIP); • saves parents and enrolled providers out-of-pocket expenses for vaccine; • provides cost savings to states through bulk purchase of vaccine at lower prices using CDC’s contracts and eliminates state-to-state variations in price;

  19. The VFC Program... • eliminates or reduces vaccine cost as a barrier to vaccinating eligible children; • reduces the practice of referring children from the private sector to the public sector for vaccination.

  20. Vaccine Management Business Improvement Project Centralized Distribution - The centralized distribution of vaccine from two or three locations eliminates the need for multiple state and local depots. It reduces storage risk and distribution costs, while allowing more visibility into vaccine supply. The centralized distribution contract is held at the Federal level.

  21. Vaccine Management Business Improvement Project Vaccine TrackingSystem - Vaccine Tracking System (VTrckS) is the new vaccine management technology system currently under development. It is a resilient, recoverable, standardized enterprise system that will replace several legacy systems used at CDC, and by state and local grantees. It will include web-based provider ordering technology with automated grantee approval; however, grantees will have overall control of the level of visibility and usage by their providers.

  22. Spend Plan

  23. Allocations • Limited Supply • Production Shortages • Outbreaks • Pandemics

  24. How Do You Allocate Vaccine to 1,300 Hungry Providers? Order-Driven Process Most vaccines are allocated monthly Provider orders are shipped weekly Why is it so difficult to predict the amount of vaccine needed from week to week?

  25. Requires ordering changes • Submission of inventory • Use of NDC number for product identification • Integrated with NCIR May 2013

  26. What is a National Drug Code (NDC)? • Universal product identifier for human drugs • Listing maintained by the Food and Drug Administration (FDA)

  27. CDC Price List Vaccine Box Vaccine Vial/Syringe Where do I find the NDC?

  28. Bi-Monthly ~ 6 orders/year

  29. Receiving Vaccine

  30. McKesson Distribution Process

  31. Shipping Schedule

  32. Distribution of Flu Vaccine As vaccine becomes available, we make every effort to ship vaccine to as many different providers, provider types, provider sizes, and geographical locations as possible Shipments will be small in August and September Vaccine will not sit at McKesson if there is a North Carolina provider in need. Don’t let vaccine sit in your refrigerator if there are children in need.

  33. Fast Turn-Around for Flu

  34. New Changes to the NCIR • Client Comments – All parent refusals will be saved for each client • Updated the email address displayed on homepage • Partially Accept order now pre-populates reason • New flags on the Manage Order screen

  35. Why the Change? • May 2012 – new ordering system to be implemented by CDC • Physical inventory count will be captured in the NCIR, includes reconciliation • Replenishment system for ordering vaccine • Possible Temperature Log system

  36. Ordering Vaccine

  37. Changes to the NCIR

  38. Before You Place Your Order Unaccepted Transfers Expired Inventory (still in inventory for over one month) An order has been processed within 14 days

  39. Red flag when you have transfers from Vaccine Distribution

  40. Red flag when there is expired inventory still in your inventory for over one month

  41. Red flag when provider has placed an order within the last 14 days

  42. Red flag used for the multiple status’ of an order • Status definitions • Pending • In Process • Shipped • Denied • Backorder • Rejected • Accepted orders are also considered within the 14 day window.

  43. Ordering Tier Chart Order Frequency Annual Vaccine Doses Monthly 6,000 or more Quarterly 200 – 799 As Needed 199 or less Order Frequency Doses Per Year Monthly 6,000 or more Bi-monthly 800 – 5,999 Quarterly 200 - 799 199 or less As Needed Use this chart to determine when you should order by the doses shipped each year.

  44. Varicella Cost • $ 61.50 • $ 68.35 • $72.49 • $81.02 CDC pricelist can be viewed by using this link http://www.cdc.gov/vaccines/programs/vfc/awardees/vaccine-management/price-list/index.html

  45. Receipt of Vaccine The office of Bad Nurse and Wurse Nurse

  46. Waiting for the arrival of Vaccine… Everyone knows it’s coming Most recent vaccine order Don’t place a second order Should arrive within 10 business days

  47. Upon Arrival… Check condition of gel packs Refrigerate/Freeze vaccine IMMEDIATELY! Compare vaccine received to vaccine invoice and to the order form

  48. Refrigerator Labels

  49. Accepting / Adding Vaccine to inventory

  50. Steps to accepting your order When you vaccine shipment has been delivered Login to the NCIR Click on Manage Transfers, then click on the Inbound Transfer Open box and separate each vaccine by tradename and lot number Go through the packing list and verify that the order dose amount is correct

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