Q--CONTRACT PHARMACY SERVICES

Sample Pharmacy Statement of Work DESCRIPTION OF SERVICES 1. General Procedure: This request for _______ (RFP/RFQ) is to provide pharmacy benefit management services to veteran beneficiaries as required by the Department of Veterans Affairs Lebanon, PA for the VA Community Based Outpatient Clinics and Emergency Department (listed below). The contract shall be effective for one (1) base year with the Government's option to exercise four (4) one-year renewal periods. Estimated (or desired) start date of this contract is +/- June 1, 2008. 2. SPECIFICIATIONS: First time or emergency medication shall include, but not limited to the following: a. All prescriptions filled must be written on VA prescription blanks (VA form 10-2577F) only. Or other prescription blank that has been authorized in writing by the VA Contracting Officer b. Prescriptions will be filled and dispensed only for drugs that are on the VA National Formulary as listed at http://www.pbm.va.gov/NationalFormulary.aspx to include representative NDCs. Exceptions to the VA National Formulary will be submitted to the contractor after award. Any other drug not on this list requires prior approval from the VA. i. Non-formulary and "non-emergent" medications (i.e. Viagra, any expendable stock /supply items [non drug products], cosmetics, over-the counter medications, nutritional supplements, vitamins or herbal supplements) as identified by not being on the provided VA Formulary are not to be dispensed by the pharmacy without prior authorization. ii. In order for a non-formulary medication to be dispensed, CBOC provider will call VA COTR (or designee) for prior approval. VA COTR (or designee) will then call Contractor Designee to have a prior authorization input into the system, allowing the medication to be dispensed for the veteran. iii. The VA formulary will be updated as necessary and provided to the Contractor Designee. VA will provide drug name, strength and form(s) for each drug to be added along with the representative NDC number. c. Medications shall be dispensed with a maximum 14-day supply (unless repackaging is not an option example: of insulin, oral inhalers, etc.) d. Antibiotic prescriptions shall be dispensed in a quantity up to a 14-day supply when authorized by the physician. e. Medications shall be dispensed in the generic form unless otherwise stipulated by the VA Lebanon Pharmacy Service. A product is not considered a generic equivalent unless the strength, quantity and dosage are the same as the brand name. The generic name must be indicated on the drug label for all medications. f. Those medications that must be dispensed by brand name only are: Coumadin, Dilantin, and Synthroid. g. Medications shall be dispensed in appropriate vessels, consistent with federal guidelines and Pennsylvania State Law. h. No refills of prescriptions will be authorized. The contractor shall fill ONLY NEW PRESCRIPTIONS. A new prescription is defined as a written prescription for a drug product and strength that has been written as a new prescription by the provider and has a new, unique prescription number. i. NO PRESCRIPTIONS WILL BE MAILED! j. VA reserves the right to add or delete areas of services based on patient demand. Changes in service areas shall be addressed in a written bilateral modification to this contract issued by the Contracting Officer k. All patients shall be offered counseling from a Pharmacist for each prescription filled. Counseling offered shall be consistent with the Pennsylvania State Board of Pharmacy requirements to ensure appropriate use and optimal outcomes from drug therapy. The counseling shall include, but is not limited to: i. Name, description and use of medication ii. Dose, dosage, form, and route iii. Special directions and precautions iv. Common side effects and action required if side effects occur v. Techniques for self-monitoring drug therapy vi. Action to be taken if a dose is missed vii. Proper storage viii. What the patient can expect from the medication ix. The balance of the patient's prescribed medication shall be mailed from the VA Pharmacy l. Pharmacy Services covered by this contract shall be furnished by the contractor Monday through Friday, 8:00 a.m. to 6:00 p.m. (Additional hours required for Lebanon, PA location as stated below in 4.b.) m. The contractor shall provide Registered Pharmacists who shall be (but not limited to): i. Registered in the State of Pennsylvania. ii. Collects, synthesize, and interprets patient prescription, and disease data iii. Checks for factual and potential drug related problems, including (but not limited to): (1) therapeutic duplication (2) drug-disease contraindications (3) drug-drug interactions (including interactions with over the counter drugs) (4) incorrect drug dosage (5) drug-allergy interactions iv. Identify, clarify, and resolve drug related problems with the prescriber and patient. v. Be available to answer any drug related questions that a patient may have after the prescription is filled. vi. Treat all patients with dignity, courtesy and respect. vii. Provide clinical pharmaceutical monitoring (i.e. anticoagulation) and medication management services as required and requested by the VA San Diego Healthcare System. n. Waiting times for prescription dispensing shall be 30 minutes on average, but shall not exceed two hours. o. Upon contract award, VA will provide contractor designee with all the provider names for each VA facility location and their respective DEAs that are being used (or will notify if a provider does not use a DEA). VA DEA numbers may be utilized for some providers at some locations. 2. CRITICAL PATIENT SAFETY REQUIREMENT verbal and telephone orders: A. In the event of a circumstance that requires a telephone order to be taken, the Pharmacist taking the order shall Repeat the Order (also known as Read Back) to the prescriber and assure their concurrence with the repeated order. Any and all changes or clarifications to a prescription order which require communication with the patient's provider shall be confirmed by 'REPEATING THE ORDER, the change or clarification to assure accuracy. 3. PRICING Prices will be based on a discount from MediSpan Average Wholesale plus any additional Administrative and/or Dispense fees. 4. LOCATIONS: a. Pharmacies should be open during regular business hours and include some evening and weekend hours. b. The contractor will provide service in the Lebanon, PA area for the Emergency Department of the Lebanon VA Medical Center. This service could be any day of the week and should maintain as many open hours each day as possible. Although 24/7 coverage would be best, if this service is not available, the longest available service should be used. 1 Lebanon VA Medical Center 1700 S. Lincoln Ave. Lebanon, PA 17042 2 Camp Hill CBOC 25 North 32nd St. Camp Hill, PA 17011 Estimated Monthly Volume = 100 Estimated Monthly Volume = 250 3 York CBOC 2251 Eastern Blvd. York, PA 17402 4 Reading CBOC 145 North 6th St. Reading, PA 19610 Estimated Monthly Volume = 50 Estimated Monthly Volume = 50 5 Lancaster CBOC 1861 Charter Lane Green Field Corporate Center Suite 118 Lancaster, PA 17605 Estimated Monthly Volume = 50 Estimated Monthly Volume = Total Estimated Monthly Volume for all VA Facility Locations: 500 5. RADIUS REQUIREMENT: The contractor shall provide Pharmacy locations within a five (5) mile radius of each VA Facility. The contractor shall provide the name, address, and phone number of each pharmacy and the VA shall approve the use of at least one pharmacy per VA facility site. 6. REPORTING REQUIREMENTS a. Contractor shall provide a monthly summary (for each contracted Pharmacy or CBOC) to the VA Pharmacy Service detailing the following information for services provided: " Patient Name and Address " Medication Name and Strength " Quantity Dispensed " NDC (National Data Code) " Prescription Number " Prescription Cost " Prescriber Name " Days Supply c. Invoices are to be sent to ______________, (provide complete address, email and phone number) by the 10th day in the following month. Invoices must include date dispensed, patient's name, patient's last four of SSN, provider name, drug, strength, quantity, and total charge. The contractor shall provide for quality control/performance improvement purposes the following information: i. All medication errors and medication related incidents will be recorded and investigated and reported to the VA on a quarterly basis. Medication errors or events that result in required hospitalization, clinical intervention or significant negative events will be reported to the VA immediately. ii. Customer complaints/suggestions/compliments shall be recorded and reported to the VA on a quarterly basis (or more frequently if a significant problem occurs). 7. STATUTORY REQUIREMENTS Services required under this contract shall be performed in accordance with the following: " Pennsylvania State Board of Pharmacy; Pharmacy Law " Code of Federal regulations, Title 21 " United States Code, Title 21 8. CONFIDENTIALITY AND SECURITY Contractor shall ensure the confidentiality and security of all patient information and shall be held liable in the event of breach of confidentiality. The Contractor shall comply with the provisions of the Privacy Act of 1974 (5 USA 522a), Confidentiality of Drug Abuse, Alcohol Abuse, Sickle Cell Anemia and HIV/AIDs Treatment Records (38 USC 7332) and Confidentiality of Medical Quality Assurance Records (38 USC 5705). The Contractor shall comply with all pertaining confidentiality and security statutes. Contractor shall be HIPAA (Health Insurance Portability and Accountability Act) compliant. Failure to comply with statutes regarding confidentiality and security of patient health information/Individually identifiable information may result in financial sanctions. 9. NATIONAL HOLIDAYS: Listed below are the ten national holidays: New Year's Day January 1 Martin Luther King 's Birthday Third Monday in January President's Day Third Monday in February Memorial Day Last Monday in May Independence Day July 4 Labor Day First Monday in September Columbus Day Second Monday in October Veterans Day November 11 Thanksgiving Day Fourth Thursday in November Christmas Day December 25 When one of the holidays falls on Sunday, the following Monday shall be observed as a national holiday. When a holiday falls on a Saturday, the preceding Friday is observed as a national holiday by U. S. Government Agencies. Also included would be any day specifically declared by the President of the United States of America as a National holiday.