Vaccine Services Update Karen Hess Vaccine Services Manager
February 19, 2009 Slide 2 Topics Providers NIS Vaccine Update
Electronic Vaccine Accounting Non-Compliance Policy Slide 3 Slide 4
2007 Co-CASA Rates Slide 5 Public vs. Private Recruitment Doses
Administered Percentage Slide 6 2007 NIS Texas vs. National
20074+DTaP3+Polio1+MMR3+Hib3+HepB1+Var 4:3:1:3:3: 1 2006 4:3:1:3:
3:1 US National
84.50.992.60.792.30.792.60.792.70.790.00.777.41.177.01.0 Texas
82.13.592.62.390.42.693.82.391.72.690.02.677.33.874.73.7 TX- Bexar
County 85.54.894.33.290.93.994.73.093.73.488.84.380.15.374.76.8 TX-
City of Houston
77.95.687.44.789.43.891.43.488.64.489.63.873.05.769.96.3 TX- Dallas
County 77.06.091.03.889.94.193.03.390.83.890.04.171.96.273.97.1
TX-El Paso County
81.85.791.24.790.34.893.64.292.94.391.14.777.46.268.85.9 TX- Rest
of State 83.45.193.73.390.63.894.33.392.23.890.23.878.75.676.15.3
Slide 7 2007 NIS PCV7 Results: Texas vs. National
20073+PCV4+PCV4:3:1:3:3:14:3:1:3:3:1:4 US National
90.00.875.31.277.41.166.51.3 Texas 90.62.575.74.077.33.868.54.4
TX-Bexar County 92.83.579.15.580.15.374.05.8 TX-City of Houston
88.84.071.65.973.05.764.16.2 TX-Dallas County
86.14.770.86.371.96.261.06.8 TX-El Paso County
88.75.269.36.977.46.263.17.1 TX-Rest of State
91.63.677.45.878.75.670.46.4 2006 Texas 85.03.265.84.274.73.7 Slide
8 TVFC Site Visits by Year Slide 9 Vaccines Shipped by Year Slide
10 Vaccines Shipped 2006-2008 Slide 11 Slide 12 Number of Vaccines
in the Routine Childhood and Adolescent Immunization Schedule
198519952008 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 7 10 16
Slide 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 Slide 14 Last Three Years In
Vaccine Releases As of 1/20/2009 3 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 19-65
year olds), FluMist (2-49 years) Slide 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 27- 45
years To be reviewed Meningococcal (Menveo)Novartis 11-55 years of
age Possible licensure in 2009 Slide 16 PedvaxHib Shortage
Improvement in the supply is not expected until summer 2009 The
booster dose of Hib vaccine usually administered at 12-15 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.
Slide 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 Slide 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 Slide 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 Slide 20
EC-33 Monthly Biological Report Legend: Yellow provider completes
Green pre-populated on the form Blue mathematical summation Slide
21 EC-33 Monthly Biological Report Legend: Yellow provider
completes Green pre-populated on the form Blue mathematical
summation Slide 22 Biological Order Form Slide 23 EVA - Next Steps
Request capital authority Contract out for bid Workgroup formed
Focus group and pilot testing Goal by September 2010 Slide 24
Provider Compliance Policy CDC Focus on Quality Certified
Thermometers Refrigeration/Freezer Units Fraud and Abuse Inventory
control Slide 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 Slide 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 Slide 27 Initial Problem
Identification SECONDARY EDUCATION FORMAL INTERVENTION TERMINATION
FROM TVFC REFERRAL TO OIG TERTIARY EDUCATION Extenuating
Circumstances Problem Resolved Non-Compliance Flow Chart Slide 28
Provider Compliance Policy Format Policy Definitions Procedures
Non-Compliance Identified During a On-Site Visit Non-Compliance
Identified by Other Means Slide 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 Slide 30 High Risk Questions Yes No Percentage Slide 31
Compliance Policy Feedback Operations Manual Appendix Gauge Success
CDC and HSR/LHD feedback Slide 32 Thank You
