By Sarah Rall, PharmD

Traditionally, immunization purchasing is an area that can be a bit of a struggle for pharmacy, and with flu season fast approaching, it is certainly a topic at the forefront of many DoPs’ minds. Attendant to immunization purchasing are a variety of challenges, including complicated scheduling, changing recommendations, supply problems, and complex contracting practices. However, there are measures that can be taken to make this seemingly daunting task much more manageable.

Contract Negotiation
Negotiating contract terms is an important aspect of your influenza vaccine purchasing plan. Vaccines can be purchased through most group purchasing organizations (GPOs), although it is also possible to contract directly with many influenza vaccine manufacturers. Using your GPO contract can save time and may result in better pricing, especially if your flu vaccine order is small. However, by using your GPO’s contracts, you may not get access to the product that best suits your institution’s specific needs. Either way, both cases generally present opportunities to negotiate lower prices and shipping guarantees.

If you are looking to contract with manufacturers directly, begin the process by sending out RFPs to all relevant manufacturers; make sure they know you are serious about purchasing from one company and are willing to walk away should you not get an offer that meets your institution’s needs. Also, make it clear that you want their best offer up front, so as to avoid wasting time going back and forth haggling over price and business terms. Finally, do your research; know what your GPO is offering for price and terms, as well as what the price and terms are outside of the contract. In some cases, these contracts will be tied to the purchase of other products and immunizations provided by the manufacturer, so it is important to keep this in mind when examining different supplier options.

At the Marshfield Clinic, we place a higher premium on shipping guarantees than price when making supplier decisions. While price should be a consideration, if you do not have the vaccines ready to go on time, you risk wasting them, as people may go elsewhere to be vaccinated. On top of losing money from unused vaccines, resources spent on planning and marketing influenza campaigns will be wasted as well. Not to mention the time squandered on the phone explaining to your colleagues why you do not have the vaccine when the local grocery store does.

Pre-booking
When to place your order for the influenza vaccine is another critical component of your purchasing plan. These vaccines take months to produce and vaccine manufacturers are hesitant to take on the risk of producing product they will be unable to sell. As a result, vaccination pre-booking generally takes place in January or February—a time when most health systems are still administering vaccine. This early booking date makes it challenging to predict how much vaccine to acquire for the next season. For the upcoming flu season, the Marshfield Clinic purchased almost 100,000 doses of seasonal influenza vaccine for our 45 different locations. In order to help predict usage, we generate reports that track usage and administration trends.

In addition, we also take the following steps to ensure the correct amount is ordered:
•Determine how many doses have been given during the current season

•Calculate the number of doses remaining in the system (subtract amount given from amount purchased)

•Figure out if immunization administration is slowing, and, if so, determine the rate by comparing immunizations given per week

•Check immunization rates in key populations and compare to the system’s goals. The key populations include:

• Children six months to five years of age
• Five to 18 years of age
• 50 to 64 years of age
• 65+
• Any new CDC recommended age group

•Review reported influenza rates for the area to see if influenza cases are
starting to increase

•Check with patient care managers and nurses from internal medicine, urgent care, family practice, pediatrics, and obstetrics to ascertain how much vaccine they think will be needed for the remainder of the season

•Monitor the CDC for any indication of changing recommendations

•Check with influenza vaccination coordinators to see if they will be planning any new campaigns or marketing strategies, and get an idea of what their goals are for immunization rates for the upcoming season

Although determining your pre-book quantity may seem more like guess work than science, by following these guidelines, you should be able to come up with a quantity that is easily defendable. The good news is that as the influenza vaccine market has become more saturated with manufacturers, they are more willing to allow reductions in orders from pre-booked estimates, and returns of unused portions for credit.

Product Selection
With additional vaccine manufacturers entering the market, more seasonal influenza product has become available. While this increased competition has resulted in better terms and prices for health systems and hospitals, it also means more choices to sort through.
Initially, you will need to determine which type of vaccine is best for your facility—Live Attenuated Influenza Vaccine (LAIV) or Trivalent Inactivated Vaccine (TIV). Your choice should be based on the population you serve and your provider preference, keeping in mind that the indications for LAIV are much narrower than for TIV.

Should you select TIV, the next choice is whether to purchase from more than one manufacturer, and which manufacturer(s) to use. When evaluating manufacturers, the following factors should be considered: the populations that you serve, the need for pre-filled syringes, and the demand for preservative-free formulations. Different manufacturers have different age indications and inactive ingredients, including preservatives. As these factors can change, it is recommended that you check with the CDC or FDA for the most up-to-date information.

Since our health system serves all ages, historically we have selected a product indicated for all age groups to decrease the likelihood of medication errors and increase flexibility of product use and movement throughout our system. In addition, we do order a portion of our vaccine in the preservative-free formulation to afford this option to our patients and providers.

Deciding whether to use more than one vaccine manufacturer is a difficult choice as there are advantages and disadvantages with either approach. By splitting your order you can ensure that you will receive at least a portion of your vaccine in the event that one manufacturer has production problems. The downsides of using more than one manufacturer include a decrease in contracting leverage and an increased risk of medication errors caused by staff confusion. Either way, if you have pre-booked any flu vaccine with a manufacturer that has production problems, you will be short of vaccine and need to scramble to find more.

Should you find yourself in a situation where you do not have enough vaccine, check with other local institutions to see if they have any vaccine available for purchase or repayment when your vaccine arrives. Also, check with your influenza manufacturer representatives as they can often direct you to other sources (eg, manufacturers, distributors, other health systems) with available product.

Conclusion
Given that immunizations generate high demand and account for a large
percentage of a health system’s budget, it is important to develop an influenza purchasing plan that meets the needs of your system. While creating a plan can present many hurdles, taking the time to learn about your vaccine purchasing options and assess the needs of your hospital will help you to make a purchasing choice that satisfies the demands of your community and saves you money in the long run.

Sarah Rall, PharmD, is the director of pharmacy purchasing and supply at the Marshfield Clinic in Marshfield, Wisconsin. She supervises the entire pharmaceutical supply chain, collaborates with providers to develop best practice guidelines, and manages Marshfield’s relationship with GPOs, vendors, and manufacturers. Prior to her current position, Sarah served as manager of the Urgent Care Pharmacy at Marshfield Clinic for seven years. Sarah is active in the Pharmacy Society of Wisconsin, and the American Society of Health-System Pharmacists.

Digital Edition

PP&P is now available online in the exact layout and appearance of the print edition, and includes more interactive features, such as the ability to access websites and request information with the click of a mouse.  To view this article in the digital edition, CLICK HERE.