The Prime Vendor Program

Transcription

1 RYAN WHITE CARE ACT ADAP Technical Assistance Conference Call The Prime Vendor Program Thursday, September 21, :00-4:00 p. m. Eastern Time Arranged jointly by: Division of Service Systems (DSS) Health Resources Services Administration (HRSA) and John Snow, Inc. (JSI) Report prepared by: John Snow, Inc. 44 Farnsworth Street Boston, MA (617)

2 TABLE OF CONTENTS EXECUTIVE SUMMARY.. 3 SUMMARY OF PRESENTATIONS.. 4 CONFERENCE CALL PRESENTATIONS Captain William Matthews, Project Officer for the 340B Prime Vendor Program, Office of Pharmacy Affairs Mr. Larry Stepp, National Director of Government Sales, Bergen Brunswig Drug Company Ms. Nancy Abraham, AIDS Activities Section, Illinois Department of Public Health Mr. Joseph May, HIV/AIDS Program, Florida Department of Health.. 9 SUMMARY OF QUESTIONS AND ANSWERS.. 11 CONCLUSION APPENDICES I. UPDATES FROM HRSA II. III. TELECONFERENCE PARTICIPANTS PRESENTING STATE INFORMATION The Prime Vendor Program 2

3 EXECUTIVE SUMMARY Introduction This report summarizes the information presented during the conference call on September 21, 2000, entitled The Prime Vendor Program. This call was the twenty-third in a series of nationally broadcast technical assistance conference calls focusing on State-operated AIDS Drug Assistance Programs (ADAPs). Under a contract with HRSA s HIV/AIDS Bureau, Division of Training and Technical Assistance, John Snow, Inc. (JSI) collaborated with the Division of Service Systems (DSS) to arrange this teleconference series. The call began with a welcome by moderator Dan Schreiner, Financial Analyst, DSS/ADAP Branch. A summary of DSS and ADAP updates given by CAPT Hilda Douglas, Deputy Director DSS, and CDR Jo Ann Spearmon, Chief, ADAP Branch/DSS is attached in Appendix 1. Following the updates, presentations were made by: Captain William Matthews, Project Officer for the Prime Vendor Program, Office of Pharmacy Affairs; Mr. Larry Stepp, National Director of Government Sales, Bergen Brunswig Drug Company; Ms. Nancy Abraham, AIDS Activities Section of the Illinois Department of Public Health; and Mr. Joseph May, HIV/AIDS Program, Florida Department of Health. A question and answer period moderated by Dan Schreiner followed the agenda presentations. Mr. Schreiner and CAPT Douglas brought the call to a close. A list of teleconference participants is presented in Appendix II. Basic information on the presenting State ADAP is found in Appendix III. The Prime Vendor Program 3

4 SUMMARY OF PRESENTATIONS Captain William Matthews, Project Officer for the Prime Vendor Program, Office of Pharmacy Affairs Captain Matthews clarified the purpose of the Office of Pharmacy Affairs and its role in the Prime Vendor Program. He indicated that participation in the program is technically voluntary but is an expectation articulated in notices sent by Dr. Joseph O Neill, Associate Administrator, HIV/AIDS Bureau, and Dr. Claude Earl Fox, Administrator, Health Resources and Services Administration (HRSA). Mr. Larry Stepp, National Director of Government Sales, Bergen Brunswig Drug Company Mr. Stepp explained that Bergen Brunswig Drug Company is the contractor for the 340B Prime Vendor Program. He outlined the benefits of the 340B Prime Vendor Program as enhancing the overall efficiency of pharmacy operations and reducing costs to State ADAPs and clients. As outlined in the Federal Register notice, ADAPs must assess whether participation in the 340B Prime Vendor Program will save money. If they are unable to do so, they may face negative consequences. Mr. Stepp detailed the background and capabilities of Bergen Brunswig to provide Prime Vendor Program services to ADAPs and further outlined the potential cost savings that can be obtained through participation in the program. Ms. Nancy Abraham, AIDS Activities Section, Illinois Department of Public Health Ms. Abraham explained that as of May 1, 2000, the Illinois ADAP has participated in the 340B Prime Vendor Program as the result of a competitive bidding process for a wholesale drugpurchasing agent. Bergen Brunswig was instrumental in effecting a seamless transition, the Aculine software has been well received, and the Illinois ADAP believes it will benefit from the combined purchasing power of multi-state ADAPs. The current savings of approximately $200,000 a year will allow the Illinois ADAP to provide additional client services. Mr. Joseph May, HIV/AIDS Program, Florida Department of Health Mr. May explained why Florida s ADAP Program has opted to continue with the Florida State Prime Vendor and not participate in the Federal Prime Vendor Program at this time. The Florida Department of Health, Bureau of Pharmacy Services, annually awards a statewide pharmaceutical contract to minimize the costs of drugs purchased by all State agencies and institutions. The contract has resulted in very competitive pricing for all drugs purchased by the State, including those drugs purchased through the ADAP Program. The current contract specifies ADAP drugs to be priced at the Section 340B price ceiling minus 1.12 percent. By pooling all drug purchases made by the State, the best price is obtained and benefits all drug purchasing programs, including the HIV/AIDS program. Should ADAP be excluded from the 340B Prime Vendor purchases, Florida s collective buying power would be reduced and overall State costs for pharmaceuticals and other services would likely rise, potentially reducing the level of pharmaceuticals provided to State residents. At the time that the national Prime Vendor Program became available, Florida had no assurance that participation in the 340B Prime Vendor Program would provide any additional The Prime Vendor Program 4

5 cost savings. As the 340B Prime Vendor Program becomes more established, Florida will continue to assess whether additional savings can be obtained by participation in the national 340B Prime Vendor Program. The Prime Vendor Program 5

6 CONFERENCE CALL PRESENTATIONS Captain William Matthews, Project Officer for the Prime Vendor Program, Office of Pharmacy Affairs The Office of Pharmacy Affairs is the new name for what many knew as the Office of Drug Pricing. The name changed several months ago because the duties of the office expanded to include virtually anything that covers the practice of pharmacy. The office continues to maintain the administration of Section 340B of the Veterans Health Care Act, of 1992, under which State ADAP programs are eligible for special pricing for pharmaceuticals that they purchase. The program is limited to direct purchase States. The 340B Prime Vendor Program has been very successful, and as of September 9, 1999, is required by law. The program has grown nicely to date. It was mentioned earlier that the 340B Prime Vendor Program is voluntary, and while technically this is true, a notice from Dr. Claude Earl Fox, Administrator, HRSA, articulates that participation is a grant expectation. An additional letter from Dr. O Neill encourages participation in this program. Captain Matthews and Mr. Larry Stepp see this conference call as an opportunity to answer questions about the 340B Prime Vendor Program. Mr. Larry Stepp, National Director of Government Sales, Bergen Brunswig Drug Company Mr. Stepp s presentation addressed the following topics: An overview of the Prime Vendor Program An introduction to Bergen Brunswig Drug Company Specific elements of the Prime Vendor agreement A status summary Overview of the Prime Vendor Program Mr. Stepp began by referencing the notices mentioned by Captain Matthews. The Prime Vendor Program is a HRSA program. It implements the last part of the 340B statute. The Bergen Brunswig Drug Company is the program contractor. The Prime Vendor Program is designed to maximize the benefits of the Prescription Drug Program to clients and State ADAP programs. The 340B Prime Vendor Program will improve and expand State ADAP pharmacy services and enhance the effective management of pharmacies, while saving money on the purchase of pharmaceuticals. State ADAPs must implement cost-saving strategies to purchase medications as a means to ensure additional client access. The Office of Pharmacy Affairs 340B Drug Discount Program is a cost-saving strategy to purchase medications. State ADAPs are also eligible to participate in the 340B Prime Vendor Program. Purchasing pharmaceuticals through the 340B Program will result in additional discounts of 20 to 50 percent off of regular drug market prices. The benefits to all participants will be greatest when the largest number of eligible health providers register with the Office of Pharmacy Affairs and become Prime Vendor customers. The Prime Vendor Program 6

7 Dr. Fox, Administrator, HRSA, has taken action to ensure that HRSA grantees use the 340B Drug Pricing Program whenever it helps them to get better value for their budget dollars. Grants awarded during fiscal year 2000 to organizations eligible to participate in the program included a statement directing them to verify that their drug acquisition practices meet cost effective requirements. Mr. Stepp read from the Federal Register notice: If your organization purchases or reimburses outpatient drugs, an assessment must be made to determine whether the organization s drug acquisition practices meet the Federal requirements regarding cost effectiveness and reasonableness. If your organization is eligible to be a covered entity under 340B of the Public Health Service Act, and the assessment shows that participating in the 340B Drug Pricing Program and its Prime Vendor Program is the most economical and reasonable manner of purchasing or reimbursing recovery of outpatient drugs, failure to participate may result in negative audit findings, cost disallowance, or grant funding offset. About Bergen Brunswig Drug Company Bergen Brunswig Drug Company is a national healthcare distribution company that has been in the healthcare business for 112 years. Last year, Bergen Brunswig s revenue was $21 billion. It is a Fortune 500 company (within the top 200 of the Fortune 500), and is listed on the New York Stock Exchange. Bergen Brunswig has 32 national distribution sites across the country. Next day service is available to all 50 States. The 340B Prime Vendor contract was awarded to Bergen Brunswig in September The agreement is for two years with an option to extend the agreement to three additional one-year periods. This Prime Vendor agreement is for all eligible entities. The State ADAP programs are one of the four largest groups, in addition to hospitals, hemophilia treatment centers, and the community health centers. As the Prime Vendor Program contractor, Bergen Brunswig provides consolidated, integrated drug sales and distribution on a next day basis from the time of order. Price negotiation services are the second charge held by Bergen Brunswig. As the Prime Vendor, Bergen Brunswig is responsible for achieving lower product costs and negotiating with manufacturers to establish discounts below existing 340B prices. Prime Vendor customers have free access to Aculine, the Windows-based, point and click software program. Aculine provides order entry and purchase orders, order confirmations, and an electronic catalog that displays all descriptions and prices. It is available at no charge to Prime Vendor Program participants. The rest of the value program package includes: an order entry terminal, optional price stickers for products, and bar-coded shelf labels. On a fee-for-service basis there are additional added value programs from Bergen Brunswig. They include the indigent Patient Assistance Program, which is an Internet-based software program, that organizes all of the requirements for free pharmaceuticals from the manufacturers, all of the forms and where to submit them, and all of the rules for retrieving free pharmaceuticals for clients that qualify. In addition, there are other value-added The Prime Vendor Program 7

8 programs such as pharmacy consulting services, patient satisfaction surveys, clinical information services, and unit of use repackaging services available from Bergen Brunswig on a fee-for-service basis. The Prime Vendor Agreement Membership in the 340 Prime Vendor Program currently consists of 210 sites. The membership has increased 26 percent in The State of Illinois ADAP program joined the Prime Vendor in May Prime Vendor sales are increasing at a 22 percent rate. Current purchases are $88 million on an annual basis. The sales rate will exceed $100 million in fiscal year As part of the responsibility for price negotiations, Bergen Brunswig completed a request for proposal in the summer of Seventeen thousand item bids were sent out, and 2,600 items below the current 340B pricing have been received in return. Those prices were added to a file for all Prime Vendor Program participants effective September 1. Initial cost comparisons show potential cost savings of $35 million annually to the entire Public Health Service membership with a 38 percent price reduction, where a bid was received (below the current 340B price). The largest savings in numbers of drugs on this file are multi-sourced generic drugs (e.g., drugs to treat opportunistic infections). Summary In summary, HRSA and the Prime Vendor Program took State ADAPs beyond conventional distribution with operations that can raise productivity and cost effectiveness in the purchase of pharmaceuticals. The Prime Vendor provides proven distribution experience, powerful solutions and guaranteed savings, using technology that allows electronic ordering and receipt of confirmations, and the best discounts available below the existing ceiling price. Ms. Nancy Abraham, AIDS Activities Section, Illinois Department of Public Health Ms. Abraham described the Illinois ADAP s recent transition to and participation in the national Prime Vendor Program. Bergen Brunswig won the Illinois ADAP wholesale contract through an invitation to bid process. The State of Illinois requires a service contract for amounts greater than $25,000. The contract is awarded based on a bidding process. The contract is usually a one-year contract renewable for two additional one-year terms. Illinois Central Management Services, the State s purchasing agent, posted the invitation for bids for the drug wholesale provider for ADAP during March Through this process, the lowest bid must be accepted unless there is just cause to believe that the bidder cannot provide the service. The new contract with the Prime Vendor became effective May 1. The ADAP contract that is usually in place by April 1 was delayed in an attempt to gain more information about the Prime Vendor option. The Illinois ADAP was able to amend the previous wholesaler s contract for an additional month to transition to the new vendor. The Prime Vendor Program 8

9 The Illinois ADAP had some concerns about the switch to a new wholesale drug provider. The primary concern was the changeover of the hardware and software used for ordering the drugs for inventory. The Illinois ADAP drugs are ordered from the wholesale drug company and shipped to Stadtlander s Pharmacy in Pittsburgh, Pennsylvania to be dispensed to clients. The transition to Bergen Brunswig went better than anticipated. Bergen Brunswig provided on-site training to assure a seamless transition to the new drug ordering system. The Illinois ADAP is especially pleased with the Aculine software. The Aculine software allows the Illinois ADAP to order drugs, check current contract prices, and to track any price changes. The Illinois currently keeps a two-to-four week maximum inventory in stock at Stadtlander s. This ADAP inventory is segregated electronically and reorders are placed once per week. The drugs and quantities needed are reordered using a handheld bar code reader. Stadtlander s sends the order electronically via a modem to the ADAP office where it is reviewed and then forwarded to Bergen Brunswig. Many ADAPs have long awaited the opportunity to benefit from the combined purchasing power of multi-state ADAPs to gain a better price for HIV-related treatments and therapies. The Prime Vendor Program provides the opportunities for such purchasing power but only if many State ADAPs that purchase drugs directly from a wholesaler participate in this option. Illinois hopes to benefit from using the Prime Vendor Program by receiving the lowest price available for the ADAP drugs purchased without sacrificing quality of service. The $20 million contract with Bergen Brunswig will provide approximately an additional $200,000 in savings, or about 1 percent. This savings will allow Illinois to stretch limited resources and provide more services to clients. Mr. Joseph May, HIV/AIDS Program, Florida Department of Health Mr. May discussed Florida s ADAP Program and how it relates to the Florida Pharmaceutical Prime Vendor Program. Mr. May began by recapping that the ADAP cost savings strategy on the national level has recently centered on participation in the Office of Pharmacy Affairs Section 340B Drug Discount Program. Florida s central pharmacy and the Florida ADAP Program have participated in the 340B Drug Discount Program for many years. This has been accomplished through both Public Health Service and nominal pricing opportunities, as well as a statewide Prime Vendor contract. When the pharmaceutical wholesaler, or Prime Vendor for the 340B Drug Discount Program was selected, Florida followed this development with much interest. Florida was one of the first States to negotiate for a State Prime Vendor and has operated under this arrangement for over ten years. The Florida Department of Health, Bureau of Pharmacy Services, awards a statewide pharmaceutical contract annually to minimize the costs of drugs purchased by all Florida State agencies and institutions. In 1998, it awarded the State Prime Vendor contract to Benley Western Drug Company, saving the State $1 million annually on reduced handling fees alone. Bergen Brunswig was one of the State s wholesalers participating in the 1998 competitive Prime Vendor bid. This agreement resulted in very competitive pricing for all drugs purchased by the State, including ADAP. The current contract specifies ADAP drugs to be priced at the Section 340B The Prime Vendor Program 9

10 price ceiling minus 1.12 percent. By including all drugs purchased by the State, the best price is obtained and benefits the HIV/AIDS program. Should Florida s large ADAP be removed from consideration, it is doubtful that the current competitive pricing would have been secured, thereby causing prices for other pharmaceuticals purchased by the State to increase. Because the exact cost savings from the new Prime Vendor were not known, and Florida had recently executed a cost-effective contract for a State Prime Vendor, the State chose not to participate in the national ADAP Prime Vendor contract. The State will continue to study the national Prime Vendor contract and evaluate any potential cost savings to ADAP. While Florida s contract with the State Prime Vendor is five years with a five-year renewal option, there is a 30- day cancellation clause that may be invoked by either party. The value of all drugs purchased under the statewide Prime Vendor contract ranges from $120 to $150 million annually. With ADAP comprising approximately $70 million of this amount, there is still a huge amount of funding that may be impacted by any changes to Florida s current purchasing agreement. In summary, to minimize overall drug costs, Florida made the decision to purchase the bulk of its prescription drugs through a single State Prime Vendor. Should ADAP be excluded from the Prime Vendor purchases, Florida s buying power would be reduced and overall State costs for pharmaceuticals and other services would likely rise, potentially reducing the level of pharmaceuticals provided to the citizens of Florida. Further, Florida had no assurance that participation in the 340B Prime Vendor Program would provide any additional savings. For these reasons, Florida s ADAP program has therefore opted to continue with a State Prime Vendor and not participate in the Federal Prime Vendor Program at this time. The Prime Vendor Program 10

11 QUESTIONS AND ANSWERS 1. A caller from the Montana State Department of Health commented that the State ADAP is not able to participate in the Prime Vendor Program because it does not use generic drugs. The formulary covers only patented antiretrovirals. However, the caller asked if it would be possible for Bergen Brunswig to provide their invoice as close to the first of the month as possible, in order to allow for the timely filing of ADAP Monthly Reports (AMRs), which are due on the tenth of the month. The caller also asked for clarification regarding participation in the 340B pricing and the Prime Vendor Program pricing can one be part of both automatically and is there any documentation regarding enrollment in the Prime Vendor Program? Mr. Stepp indicated that he would request earlier mailing of the monthly invoices to assist in the AMR compliance issue. He further clarified that those States that currently purchase from Bergen Brunswick and use the 340B Program are automatically members of the Prime Vendor Program and have access to both the 340B pricing and the pricing that has been negotiated below 340B for the Prime Vendor Program. If an agency currently purchases from Bergen Brunswig and is accessing the PHS pricing, that qualifies the agency as a member of the Prime Vendor Program. There is no enrollment documentation for this, as it is essentially automatic. 2 A caller from the Colorado Department of Health asked three questions. Does Bergen Brunswig have a toll-free line for clients to call with questions for the pharmacists? Mr. Stepp answered that if clients need communication, they are best directed to their pharmacists and their physicians. Does Bergen Brunswig have any type of adherence program or materials that can be provided to clients? Currently Colorado benefits in terms of adherence from the pharmacy they use because the pharmacy tracks how many medications are being sent to clients so that they can follow-up with clients and see where they are. Does Bergen Brunswig have any type of adherence monitoring or even any type of pamphlets or materials for clients? Mr. Stepp answered that Bergen Brunswig can design patient satisfaction surveys, but it does not have a tremendous amount of client-based information. Bergen Brunswig focuses on the pharmacist and the pharmacy with information directed to them as opposed to the clients. Captain Matthews added that the Office of Pharmacy Affairs would be happy to help with patient compliance. Agencies may call The office is presently working with a number of States with clinical pharmacy programs. Drug survey compliance is one of the things that the office is trying to measure and would, therefore, be happy to work on that issue. Does Bergen Brunswig charge an administrative fee? If so, what is it, and how is that determined? Mr. Stepp answered that within the agreement for Prime Vendor there is a distribution fee that covers Bergen Brunswig s costs for shipping, warehousing and packaging the pharmaceuticals. The Prime Vendor Program 11

12 It is based on monthly dollar volume. Copies of the agreement can be obtained either from Mr. Stepp or the Office of Pharmacy Affairs. 3. Dan Schreiner introduced a question that had been submitted prior to the conference call. The question came from New Hampshire: Is the Prime Vendor Program applicable to States that do not purchase drugs directly? Jo Ann Spearmon responded by stating that at the present time, the Prime Vendor Program is an option for State ADAPs that participate in the 340B Direct Purchase option only. 4. Dan Schreiner asked another question that had been submitted from Massachusetts: Will States be required to participate in this program in the future? Jo Ann Spearmon answered that States are required to implement a cost-savings mechanism to purchase medications to ensure a continuous supply of current and emerging therapies for their clients throughout the year. Prime Vendor is a cost-saving mechanism that State ADAPs and other covered entities can use to purchase medications. State ADAPs are required to conduct a cost benefit analysis to determine the most cost effective mechanism for purchasing medications. This analysis should not only include the costs of the medication but also all administrative costs and fees associated with purchasing and distributing drugs. If it is determined that the plan and the program is not the most cost effective mechanism for purchasing drugs, and a State has a mechanism in place or is considering a mechanism that is more cost effective, choosing the other option should not result in a negative audit finding. 5. A caller from South Carolina provided information on the price of Kaletra. He stated that the average wholesale price is $ for a bottle of 180. The caller also asked if it would be possible to fax Mr. Stepp a list of drugs so that he could compare the Bergen Brunswig Prime Vendor Program pricing to the South Carolina State Prime Vendor Program and the Public Health Service pricing that is already being used. Mr. Stepp responded that he needed further details from the caller in order to provide the pricing comparison and that they could handle that information following the conference call. 6. A caller from the Indiana State Department of Health asked for further clarification of Dr. O Neill s letter and Dr. Fox s letter. The State is under the impression that it is already maximizing its ADAP funds by purchasing high-risk insurance coverage for its clients. In fact, Indiana s ADAP enrollment, since it was afforded the latitude to use ADAP funds to purchase this insurance, has gone from 400 health insurance clients to well over 1,000 health insurance clients. Indiana only needs to buy drugs through the ADAP program for a period of up to three to four months. A new contract is going into place for the ADAP program that covers these clients during the pre-existing condition period, and the States expect to achieve average wholesale The Prime Vendor Program 12

13 price minus 14 percent in pricing. Voluntary rebates are being requested under the 340B program. Is that going to be enough to meet the expectations of HRSA? Dan Schreiner answered that Indiana is fine and that the State already participates in the 340B rebate program. The Prime Vendor Program 13

14 CONCLUSION Dan Schreiner concluded the call by noting that all listeners will receive a report summarizing the call. He restated the request for participants to complete the conference call evaluation form and fax it to Emma Ansara, JSI Technical Assistance Coordinator, at Hilda Douglas thanked all of the participants and presenters for joining the call. The Prime Vendor Program 14

15 APPENDIX 1: UPDATES FROM HRSA Hilda Douglas, Deputy Director, DSS and Jo Ann Spearmon, Chief, ADAP Branch, DSS, gave the following updates during the September 21, 2000, conference call. Updates from Hilda Douglas, Deputy Director, DSS The Title II application guidance for 2001 has been sent to all State Agency Directors and ADAP Coordinators. A copy is available on the HRSA web site at DSS will be working with the National Alliance of State and Territorial AIDS Directors to arrange a conference call sometime in October to answer questions. There are strong indications that the Ryan White CARE Act reauthorization may be completed prior to the submission date of the grant. DSS may ask for additional information. HRSA has undertaken an initiative to attempt to reduce pharmacy purchases through participation in the 340B Drug Pricing Program and its Prime Vendor Program. ADAP participation in this Prime Vendor Program may offer some cost-saving opportunities, however, participation in the Prime Vendor is not mandatory, it is an option. The current conference call is an effort to provide information so that each State can make its own decision. Updates from Jo Ann Spearmon, Chief, ADAP Branch, DSS Staff Update: A new ADAP Public Health Analyst, Lieutenant Commander Alexander Koziak, is now on staff. Lieutenant Commander Koziak is a registered pharmacist who previously worked at George Washington University Hospital where he was the Director of the Office of Human Research. He will be the ADAP representative for the following States: Connecticut, Illinois, Iowa, Kansas, Maine, Michigan, Minnesota, Missouri, Nebraska, New Hampshire, Ohio, Washington D.C., and Wisconsin. Alex has been contacting ADAP Coordinators in the above-listed States to introduce himself and to assist the programs with any questions or issues that they might have. New Protease Inhibitor: On Friday, September 15, the FDA approved a new protease inhibitor. The trade name for this drug is Kaletra. It is manufactured by Abbott Laboratories. This drug is a combination of lopinavir and ritonavir. Kaletra is indicated in combination with other anti-retroviral agents for the treatment of HIV infection. This drug is metabolized by the cytochrome P4503A system. As with other drugs metabolized by the system, several drug interactions may occur. Therefore, it is very important to find out about drugs that should not be taken with Kaletra. Kaletra drug interactions: The labeling for the product contains several categories of medications with which this product should not be co-administered or be administered with dosage adjustments. The most common side effect associated with Kaletra is moderate to The Prime Vendor Program 15

16 mild diarrhea. As with other protease inhibitors, patients may also experience a redistribution or accumulation of body fat. Additionally, pancreatitis has been observed in patients receiving Kaletra, including those who developed mild triglyceride elevations. The recommended dosage for this product is three capsules twice daily with food. The cost of the product has not been announced by Abbott Laboratories as yet. If State ADAPs decide to add this product to their formulary, please let DSS know by including this information on your ADAP Monthly Report (AMR) submission. AMR Quarterly Reports: State ADAPs should have received the next set of quarterly AMR standard reports. These reports highlight data submitted from the first quarter for FY 2000 (April through June). The reports graphically illustrate client utilization and trends for individual State ADAPs. The reports also include projections for utilization and expenditures throughout the remainder of FY 2000 and for FY The projections are based on actual data reported in the January through June 2000 AMR submission period. Submissions indicate a continuation of the current rate of utilization growth and expenditures. If DSS has not received AMR data for a particular month, the standard report will be missing information. AMR Data: There are still State ADAPs that are several months behind in submitting their AMR data. ADAP staff will call to help answer any outstanding questions and to determine if technical assistance is needed so the information may be submitted in a timely manner. AMR submission became a condition of grant award on April 1, 1999, and data must be submitted by the tenth of each month. Drug pricing information must be submitted on a quarterly basis. Failure to meet this condition of grant award may jeopardize a State s continued eligibility to receive any additional funding or carryover under the grant. The Revised AMR Form: The form has been completed and DSS is now awaiting OMB clearance. It will be easier for grantees to submit their AMR data by having the AMR form put on the web for web-based data reporting. This process should be completed before the end of the year. The ADAP Flexibility Policy: Dr. Joseph O Neill, Associate Administrator, HIV/AIDS Bureau, signed the final Flexibility Policy on July 26. The Flexibility Policy allows State ADAPs to redirect a reasonable portion of their ADAP funds for services that enhance the ability of eligible people with HIV/AIDS to gain access to medications, adhere to medication regimens, and monitor their progress in taking HIV-related medications. The ADAP Branch, in conjunction with the Office of Policy and Program Development, is preparing a list of frequently asked questions as a reference for State ADAPs along with the application process for submitting requests to use ADAP funds in a flexible manner. These resource tools should be received in the very near future. The ADAP Interactive Bulletin Board: The ADAP Branch is in the process of developing an electronic bulletin board as an ADAP discussion forum. This forum will be a medium for access to information between HRSA and State ADAPs, as well as between the State ADAPs themselves, to address special issues and concerns. The ADAP Forum The Prime Vendor Program 16

17 will be piloted in October, and DSS will forward the process for accessing the ADAP Forum to State ADAPs in the very near future. HRSA s Prime Vendor Program: This program is designed to maximize the benefits of a prescription drug program to clients and to State ADAPs. If a program is currently participating in the Office of Pharmacy Affairs Section 340B Drug Discount Program direct purchase options, the program is eligible to participate in the Prime Vendor Program to purchase medication. It is hoped that the information from this conference call will help to guide decisions regarding the most cost effective methods of purchasing medications for State ADAPs. The Prime Vendor Program 17

18 APPENDIX II: TELECONFERENCE PARTICIPANTS From the Division of Service Systems, HIV/AIDS Bureau, Health Resources and Services Administration: CAPT Hilda Douglas, Deputy Director, DSS CDR Jo Ann Spearmon, Chief, ADAP Branch/DSS Mr. Dan Schreiner, Financial Analyst/ Moderator, DSS Ms. Bridgette Patterson, Program Analyst, DSS From John Snow, Inc. (Ryan White C.A.R.E. Technical Assistance Contract) Ms. Deb Label, Administrative Coordinator Ms. Emma Ansara, Technical Assistance Coordinator State Grantee Presenters CAPT William Matthews, Project Officer for the Prime Vendor Program, Office of Pharmacy Affairs Mr. Larry Stepp, National Director of Government Sales, Bergen Brunswig Ms. Nancy Abraham, AIDS Activities Section of the Illinois Department of Health Mr. Joseph May, HIV/AIDS Program, Florida Department of Health The Prime Vendor Program 18