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Vaccine Services Update Karen Hess Vaccine Services Manager February 19, 2009.

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Presentation on theme: "Vaccine Services Update Karen Hess Vaccine Services Manager February 19, 2009."— Presentation transcript:

1 Vaccine Services Update Karen Hess Vaccine Services Manager February 19, 2009

2 Topics Providers NIS Vaccine Update Electronic Vaccine Accounting Non-Compliance Policy

3

4 2007 Co-CASA Rates

5 Public vs. Private Recruitment Doses Administered Percentage

6 2007 NIS Texas vs. National DTaP3+Polio1+MMR3+Hib3+HepB1+Var 4:3:1:3:3: :3:1:3: 3:1 US National 84.5± ± ± ± ± ± ± ±1.0 Texas 82.1± ± ± ± ± ± ± ±3.7 TX- Bexar County 85.5± ± ± ± ± ± ± ±6.8 TX- City of Houston 77.9± ± ± ± ± ± ± ±6.3 TX- Dallas County 77.0± ± ± ± ± ± ± ±7.1 TX-El Paso County 81.8± ± ± ± ± ± ± ±5.9 TX- Rest of State 83.4± ± ± ± ± ± ± ±5.3

7 2007 NIS PCV7 Results: Texas vs. National PCV4+PCV4:3:1:3:3:14:3:1:3:3:1:4 US National 90.0± ± ± ±1.3 Texas 90.6± ± ± ±4.4 TX-Bexar County 92.8± ± ± ±5.8 TX-City of Houston 88.8± ± ± ±6.2 TX-Dallas County 86.1± ± ± ±6.8 TX-El Paso County 88.7± ± ± ±7.1 TX-Rest of State 91.6± ± ± ± Texas 85.0± ± ±3.7

8 TVFC Site Visits by Year

9 Vaccines Shipped by Year

10 Vaccines Shipped

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12 Number of Vaccines in the Routine Childhood and Adolescent Immunization Schedule Measles Rubella Mumps Diphtheria Tetanus Pertussis Polio Hib (infant) HepB Varicella Pneumococcal disease Influenza Meningococcal disease HepA Rotavirus HPV Measles Rubella Mumps Diphtheria Tetanus Pertussis Polio Hib (infant) HepB Varicella Measles Rubella Mumps Diphtheria Tetanus Pertussis Polio

13 Vaccines Currently Available through the TVFC Program DTaP Hepatitis B Hepatitis A Hib Human Papillomavirus Influenza Polio Varicella MMR Meningococcal Pneumococcal Conjugate Combination Vaccines DTaP/Hepatitis B/Polio DTaP/Polio/Hib Hepatitis B/Hib MMR/Varicella Rotavirus Td Tdap

14 Last Three Years In Vaccine Releases As of 1/20/ Newly Licensed Vaccines in 2006 Gardasil®, Zostavax®, RotaTeq® 2 Newly Licensed Vaccines in 2007 Menactra (2-10 years) FluMist® (5-49 years) 4 Newly Licensed Vaccines in 2008 Kinrix®, Pentacel®, Rotarix®, BOOSTRIX® (for year olds), FluMist® (2-49 years)

15 New Vaccines VaccineManufacturerAge Indications**FDA licensure Rotavirus (ROTARIX®) GlaxoSmithKline (GSK) 2 and 4 months of age Licensed 4/3/08 DTaP/IPV (KINRIX) GlaxoSmithKline (GSK) 4 to 6 years of age Licensed 6/24/08 Hib/DTaP/IPV (PENTACEL)Sanofi Pasteur 2, 4, 6, and 15 to 18 months of age Licensed 6/23/08 HPV (Cervarix) GlaxoSmithKline (GSK) Data not available Possible licensure in 2009 HPV (Gardasil® )Merck application to expand HPV vaccine to years To be reviewed Meningococcal (Menveo)Novartis years of age Possible licensure in 2009

16 PedvaxHib ® Shortage Improvement in the supply is not expected until summer 2009 The booster dose of Hib vaccine usually administered at months of age should be deferred except for children at increased risk of Hib disease asplenia sickle cell disease immunodeficiency (including HIV infection and cancer) American Indian children Alaska Native children Note: DSHS distributes the 3 dose ActHib ® product only.

17 Hib TVFC Maximum Stock Levels and Pentacel® Currently providers are limited to a 60-Day supply of Hib based on previous usage Pentacel® (DTaP-IPV/Hib) counts as part of that 60-day allocation A dose of Pentacel = A dose of Hib

18 Recombivax HB® Shortage Hib Shortage Hib Hepatitis B/Hib DTaP/Polio/Hib Hep B Shortage Hepatitis B/Hib DTaP/Hepatitis B/Polio January 2009, Merck experienced a supply interruption in the U.S. for the adult formulation of their hepatitis B vaccine, Recombivax HB®. Pediatric Shortage possible

19 Electronic Vaccine Accounting (EVA) CDC New Vaccine Ordering System New reporting elements On-line ordering and reporting for all TVFC providers. Vaccine Choice Legislation Increase Brand Options Add presentation (syringes, vials) Simplify ordering Create recommended order Auto mathematical calculation features Pre-population of previously entered inventory information (lot number, NDC, expiration date) Automated reminder

20 EC-33 Monthly Biological Report Legend: Yellow – provider completes Green – pre-populated on the form Blue – mathematical summation

21 EC-33 Monthly Biological Report Legend: Yellow – provider completes Green – pre-populated on the form Blue – mathematical summation

22 Biological Order Form

23 EVA - Next Steps Request capital authority Contract out for bid Workgroup formed Focus group and pilot testing Goal by September 2010

24 Provider Compliance Policy CDC Focus on Quality Certified Thermometers Refrigeration/Freezer Units Fraud and Abuse Inventory control

25 VFC Provider Identified Previous compliance issues Formal Intervention To Correct Previous Issues Same Issue 4 years or less Between issues Referral to external agency for further fraud and abuse investigation Termination from VFC Program Tertiary Education And Follow-up More than 4 years Between issues Tertiary Education And Follow-up Different Issue Research Referral to external agency for further fraud and abuse investigation Tertiary Education And Follow-up No Formal Intervention Secondary Education And Follow-up Extenuating Circumstances Secondary Education And Follow-up Tertiary Education And Follow-up Referral to external agency for further fraud and abuse investigation Correct Issue And Close No Previous Compliance Issues Secondary Education And Follow-up Correct Issue And Close Hierarchy of VFC Provider Education Primary-Routine, orientation, updates Secondary- Moderate compliance issues- Tertiary- Serious compliance issues immediate & Significant actions must occur to correct situation 3 Research must occur through out all steps of algorithm and is defined as contacting other internal or external agencies that may include but not limited to legal counsel, Medicaid, licensing board or excluded provider list

26 Provider Compliance Policy Purpose Consistent process when handling TVFC compliance issues Identify high risk non-compliance issues Protect TVFC from potential fraud and abuse Prevents re-occurrence with sufficient training, education, and documentation Identifies need to refer providers to the Texas State Office of Inspector General (OIG), or terminate from the TVFC program

27 Initial Problem Identification SECONDARY EDUCATION FORMAL INTERVENTION TERMINATION FROM TVFC REFERRAL TO OIG TERTIARY EDUCATION Extenuating Circumstances Problem Resolved Non-Compliance Flow Chart

28 Provider Compliance Policy Format Policy Definitions Procedures Non-Compliance Identified During a On-Site Visit Non-Compliance Identified by Other Means

29 10 High Risk Questions 12. Vaccines provided regardless of inability to pay 14. Administration fee is less than or equal to the maximum fee 48a. Appropriate refrigerators/freezers are used to store vaccine 50a. Refrigerator/freezer temperature log is available for the last three months 50d.From the logs provided, all recorded refrigerator temperatures are within the recommended range. 51c.From the logs provided, all recorded freezer temperatures are within the recommended range. 55. A physical inventory of vaccine is done monthly 57.The loss/gain is less than 5% 59.TVFC vaccines can be distinguished from private stock 61a. All clients are screened for eligibility

30 High Risk Questions Yes No Percentage

31 Compliance Policy Feedback Operations Manual Appendix Gauge Success CDC and HSR/LHD feedback

32 Thank You


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