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STATEMENT OF WORKVA INTEGRATED SERVICE NETWORK (VISN) 12 PHARMACY FIRST FILL PRESCRIPTION SERVICESPURPOSE: The Contractor shall provide pharmacy benefit management and prescription fill and dispensing services to Veteran beneficiaries of the Department of Veterans Affairs (VA) for Veteran Integrated Service Network (VISN) 12 Community-Based Outpatient Clinics (CBOCs). The contractor’s pharmacies and/or the contractor’s affiliated partner pharmacies shall fill and dispense original prescriptions written by VA practitioners. The contractor shall make arrangements with pharmacies that are located within a ten (10) mile radius of the VISN 12 facilities listed in Table A below. PERIOD OF PERFORMANCE: This contract shall be effective for a period of five years, from August 1, 2016 through July 31, 2021. REQUIRED TASKS: First time or emergency prescription medication fills and dispensing services shall include but not be limited to the following: Only new prescriptions shall be filled (except for the exceptions listed below). A new prescription is defined as a written prescription for a drug product and strength that has not been previously dispensed to the Veteran beneficiary in the previous 12 months. A repeat order for the same drug product within 12 months, even if transmitted as a new prescription order, is not considered a new prescription. Exceptions may be made for second courses of antibiotic therapy. In rare instances where refills may be necessary, there must be a pre-authorization by the Chief of Pharmacy Service at the CBOC’s responsible parent VA Medical Center and so noted on the invoice.Prescriptions filled by the Contractor’s pharmacies and/or the Contractor’s affiliated partner pharmacies will be in written form and in accordance with VA policy and procedures as well as applicable state and federal regulations.Only prescriptions from VA authorized practitioners shall be filled under this contract. Prescriptions will be written on VA prescription Form 10-2577F (see Form 10-2577F Sample) or locally developed prescription blanks and shall be hand carried by the beneficiary, faxed from a VA clinic practitioner, given verbally by VA clinic practitioner, or stamped with the words “Authorized VA First-Time or Emergent Prescription”. Prescriptions from non-VA authorized practitioners shall not be filled under this contract. Unless otherwise pre-authorized, prescription fills will be limited to a maximum of a fourteen (14) day supply.Prescriptions will be filled for legend drugs listed in the Department of Veterans Affairs Formulary of Drugs.Prescriptions filled under this contract will be, to the extent permitted by law, the least expensive drug product the pharmacy has in stock.Generic drugs will be dispensed whenever possible. 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 displayed on all labels for all medication.VA Standardization ListThe Drug Standardization List is a list of pharmaceutical products for which substitution is not permitted under normal circumstances. The intent is to provide Veterans with a consistent and reliable product for drugs where interchange may compromise therapeutic response or patient safety. Products are added to this list by vote of the VISN Pharmacist Executives and the Medical Advisory Panel. Decisions are based on reviews of therapeutic equivalency and/or patient safety data.The Contractor must comply with the below VA Standardization List.Substitution is allowed in rare circumstances when the Drug Standardization item is on back order or the patient is intolerant to the formulary product. VA practitioners should be alerted when it is necessary to dispense alternative products.VA Standardization List:Amiodarone: (Upsher-Smith brand Pacerone). Patients on Cordarone may continue. Patients receiving a generic amiodarone will be switched to the Pacerone product. Bioequivalence cannot be guaranteed when switching from one generic to another; therefore, additional monitoring may be required.Clozapine (Mylan). Clozaril may be continued on existing patients. There is no mandatory conversion. Cyclosporine (Gengraf) applies to transplant indication.Digoxin* (Lanoxin) Lamotrigine*,** (Cadista/Avkare) all strengths except chewable, XL and ODT applies to epilepsy indication.Levetiracetam*,** (Cedardale Distributors, LLC dba Gen-Source RX) applies to epilepsy indication.Levothyroxine (Synthroid)Mesalamine ER/CR capsules (Pentasa) has different gastrointestinal release characteristics from other mesalamine products, and therefore shouldn’t be substituted in patients with Crohn’s disease.Mycophenolate Mofetil*,** (Golden State Medical Supply/Mylan) applies to transplant indication.Phenytoin (Mylan) extended release capsules 100mg.PNV Prenatal Plus Multivitamin (Sancillo).Tacrolimus* (Prograf) applies to transplant iramate* (Golden State Medical Supply) applies to epilepsy indication.Warfarin* (Exelan).Zonisamide*,** (Mylan) applies to epilepsy indication.*Indicates national contract**Providers will have the ability to continue to prescribe the branded product; however, when Providers determine a generic is clinically appropriate the awarded product will be the mandatory source.The Contractor must have a minimum of one licensed pharmacy, and/or affiliated partner pharmacy, for which pharmacy prescription services are provided within a ten (10) mile radius of each of the CBOCs listed below:Table A: Parent VA Medical Center’s CBOCs and Pharmacy Service Point-Of-Contact (POC) Parent VA Medical CenterCBOC LocationWilliam S. Middleton Memorial VA Hospital2500 Overlook TerraceMadison, WI 537051670 South Blvd., Baraboo, WI 53913215 Corporate Dr., Suite B, Beaver Dam, WI 53916750 Kiwanis Dr., Suite 250, Freeport, IL 610322419 Morse Street, Janesville, WI 53545816 Featherstone Road, Rockford, IL 61108Parent Pharmacy Service POC: Andrea Hoven, 608-256-1901 ext. 11686Parent VA Medical CenterCBOC LocationTomah VA Medical Center*500 E. Veterans StreetTomah, WI 54660 8 Johnson St., Owen, WI 544602600 State Rd., La Crosse, WI 54601515 S. 32ND Ave., Wausau, WI 54401555 West Grand Ave. Wisconsin Rapids, WI?54495Medicine Service POC: Paulette Wheeler, 608-372-3971 ext. 63540Parent VA Medical CenterCBOC LocationClement J. Zablocki VA Medical Center*5000 W. National Ave.Milwaukee, WI 5329510 Tri-Park Way, Appleton, WI 549141205 North Ave., Cleveland, WI 53015141 Siegler St., Green Bay, WI 5430321425 Spring St., Union Grove, WI 53182Parent Pharmacy Service POC: William Stafford, 414-384-2000 ext. 41150Parent VA Medical CenterCBOC LocationOscar G. Johnson VA Medical Center 325 East H St. Iron Mountain, MI 49801787 Market St. Suite 9&10, Hancock, MI 49930629 W. Cloverland Dr. Suite #1, Ironwood, MI 49938509 Osborn Blvd, Sault Ste Marie, MI 49783 Suite 3061414 Fair Ave. Suite 285, Marquette, MI 498551110 10th Ave. Suite 101, Menominee, MI 49858639 West Kemp St., Rhinelander, WI 54501Parent Pharmacy Service POC: Andrew Jodocy, 906-774-3300 ext. 32481Parent VA Medical CenterCBOC LocationEdward Hines Jr. VA Hospital5000 S. 5th Ave.Hines, IL 60141161 S. Lincolnway St., North Aurora, IL 60542450 W. Dundee Rd, Elgin, IL 601201210 Eagle St, Joliet, IL 60432581 William Latham Dr., Suite 301, Bourbonnais, IL 609144461 N Progress Blvd, Peru, IL 6135410201 S. Cicero, Oak Lawn, IL 604535000 S. 5th Ave., Bldg. 200, Hines, IL 60141Parent Pharmacy Service POC: Jiajia Li, 708-202-8387 ext. 23825Parent VA Medical CenterCBOC LocationJames A. Lovell Federal Health Care Center3000 Green Bay Rd.North Chicago, IL 600641942 Dempster, Evanston, IL 602028207 22nd Avenue, Kenosha, WI 531433715 Municipal Drive, Mc Henry, IL 60050*Parent Pharmacy Service POC: John Becker, 224-610-4488Parent VA Medical CenterCBOC LocationVA Iliana Health Care System1900 E. Main StDanville, IL 618323035 East Mound Rd., Decatur, IL?62526501 Lakeland Blvd., Mattoon, IL?619387717 N. Orange Prairie Rd., Peoria, IL?616155850 South 6th St., Suite A, Springfield, IL?627033851 N. River Rd., West Lafayette, IN?47906*Parent Pharmacy Service POC: Delbert Siegmund, 217-554-4165If services are needed for new CBOCs in the VISN 12 service area, these additional locations may be added to this contract by mutual agreement of the Government and Contractor. Pharmacies authorized to fill prescriptions under the Contractor’s plan must agree to the following conditions:All information concerning VA beneficiaries shall be kept confidential and shall not be disclosed to any person, except as authorized in writing and according to all applicable laws.Representatives of the VA are authorized to visit the premises of any pharmacy filling VA prescriptions under the Contractor’s plan during business hours for the purpose of auditing and evaluation, which may include the inspection of clinical records.All adverse drug events reported to the Contractor’s pharmacies by Veteran beneficiaries of the VA, will be reported to the parent VA Medical Center’s Pharmacy Service within 12 hours. Adverse drug events include, but are not limited to, the following: dispensing errors, drugs allergies, and adverse drug reactions.Pharmaceutical care provided to Veteran beneficiaries under this contract shall meet all standards applicable to Medicaid recipients in the state where the services are being provided and standards set forth in the current Joint Commission accreditation manual for Ambulatory Care/Pharmaceutical Services.Patient waiting times for prescription dispensing shall be approximately 30 minutes, but shall not exceed two hours.All patients shall be offered counseling from a Pharmacist for each prescription filled. Counseling offered shall be consistent with the Wisconsin, Illinois and Michigan State Board of Pharmacy requirements as applicable, to ensure appropriate use and optimal outcomes from drug therapy. The counseling shall include, but not necessarily be limited to:Name, description and use of medication;Dose, dosage, form, and route;Special directions and precautions;Common side effects and action required if side effects occur;Techniques for self-monitoring drug therapy;Action to be taken if a dose is missed;Proper storage;What the patient can expect from the medication; andThe balance of the patient’s prescribed medication shall be mailed from the VA Pharmacy.The Contractor shall provide Registered Pharmacists who shall:Be registered in the State where service is provided;Collect, synthesize, and interpret patient prescription, and disease data;Check for factual and potential drug related problems including, but not limited to:therapeutic duplicationdrug-disease contraindicationsdrug-drug interactions (including interactions with over the counter drugs)incorrect drug dosagedrug-allergy interactionsIdentify, clarify, and resolve drug related problems with the prescription and patient;Be available to answer any drug related questions that a patient may have after the prescription is filled;Treat all patients with dignity, courtesy and respect; andProvide clinical pharmaceutical monitoring (i.e. anticoagulation) and medication management services as required and requested by the VA Great Lakes Healthcare SystemCritical Patient Safety Requirement for Verbal and Telephone Orders: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 VA practitioner and ensure the practitioner’s concurrence with the repeated order. Any and all changes or clarifications to a prescription order which require communication with the patient’s practitioner shall be confirmed by REPEATING THE ORDER, the change or clarification to ensure accuracy.The REPETITION OF THE ORDER” (Read Back) requirement is mandatory with no exceptions.The Contractor shall invoice the parent VA medical facility monthly for services rendered. The VA will randomly audit all invoices. Pharmacies accepting payment through the Contractor must make records available to VA auditors in a timely manner at the location where dispensed.All invoices will reference the following information:Contract Number and Purchase Order NumberDate of invoiceInvoice numberClaim period the invoice relates toRx cost per clinic locationNumber of Rx dispensed per clinic locationDispensing fee per RxTotal cost of invoicePatient nameThe last four digits of the patient’s Social Security NumberPrescription numberName of medication and NDC number of dispensed drugQUALIFICATIONSPersonnel assigned by the Contractor to perform the services covered by this contract shall have a full and unrestricted license in a State, Territory, or Commonwealth of the United States or the District of Columbia. The qualifications of such personnel shall also be subject to review by the VA Chief of Staff and approved by the VA Facility Director. Personnel assigned by the Contractor to perform the services covered by this contract shall be proficient in written and spoken English (38 USC 7402). REPORTING REQUIREMENTSThe Contractor shall provide a monthly summary for each CBOC to the CBOC’s respective responsible VA Medical Center Pharmacy Service POC detailing the following information for services provided:Patient Name and AddressLast four digits of the patient’s Social Security NumberDispensing PharmacyPrescription NumberDate of fillDrug (generic name)Drug StrengthQuantity DispensedNDC (National Data Code) Prescription CostDispensing feePrescriber NameName of approving official (clinic contact at VA Medical Center) if prescription was an approved exception to the VA VISN 12 emergent formulary drug list.Cumulative quarterly reports shall also be provided to the Contracting Officer’s Representative (COR), and the Contracting Officer (CO). Quarterly reports will include, in addition to the reports listed above, a controlled substance use report, and a non-formulary report.The CO requires a quarterly report comparing the dollar amount of drugs dispensed under the contract price compared to Average Wholesale Price (AWP).In addition, the Contractor shall provide trended dispensing information for the areas mentioned above, as requested by the VA Medical Center Pharmacy Service. All Contractor reports and non-verbal communications shall be submitted to the VA via secure, encrypted email. The contractor shall obtain VA PKI “partner” certificates from each CBOC’s parent VA Medical Center to allow this encrypted exchange. QUALITY ASSURANCE The Contractor shall provide, for quality control and performance improvement purposes, the following information: All medication errors and medication related incidents will be recorded, investigated and reported to the parent VA Medical Center by the Contractor on a quarterly basis. Medication errors or events that result in required hospitalization, clinical intervention or significant negative sequela will be reported to the parent VA Medical Center immediately.Customer complaints, suggestions, and compliments shall be recorded and reported to the parent VA Medical Center on a quarterly basis (or more frequently if a significant problem occurs).STATUTORY REQUIREMENTSServices required under this contract shall be performed in accordance with the following:Wisconsin, Illinois or Michigan State Board of Pharmacy; Pharmacy Law (as applicable)Code of Federal regulations, Title 21United States Code, Title 21RADIUS REQUIREMENT:The Contractor shall provide Pharmacy locations within a ten (10) mile radius of each VA Facility indicated in Table A above. The Contractor shall provide the name, address, and phone number of each pharmacy and the parent VA Medical Center shall approve the use of each facility.CONFIDENTIALITY AND SECURITY:The 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 laws and regulations pertaining to confidentiality and security statutes. The contractor shall be HIPAA (Health Insurance Portability and Accountability Act) compliant. Failure to comply with statutes regarding confidentiality and security of patient health information and/or individually identifiable information may result in financial sanctions.ISSUANCE OF PRESCRIPTION FILL AND DISPENSING REQUESTS: Only prescription orders from VA authorized practitioners through authorized local pharmacies are eligible for reimbursement under this contract. The Contractor and its pharmacies or its affiliated/partner pharmacies shall not require the patient to provide more information than the patient’s name, last four digits of the patient’s Social Security Number, and the patient’s date of birth. THE CONTRACOR, ITS PHARMACIES, OR ITS AFFLIATED/PARTNER PHARMACIES SHALL NOT REQUIRE THE PATIENT TO PROVIDE THE PATIENT’S FULL SOCIAL SECURITY NUMBER. CONTRACTING OFFICER’S REPRESENTATIVE (COR):The COR is responsible for facilitating communication between the Contractor and the Contracting Officer and for monitoring Contractor performance. The COR does not have the authority to change the terms and conditions of the contract.ADDITIONAL REQUIREMENTS: The services specified herein may be changed by written bi-lateral modification to this contract if agreed upon by both the Government and Contractor. In this instance, the VA Contracting Officer shall prepare the modification.The services to be performed by the Contractor shall be performed in accordance with VA policies and procedures and the regulations of the medical staff by laws of the VA facility.The parties agree that the Contractor, its employees, agents, and subcontractors shall not be considered VA employees for any purpose. ................
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