Vaccine Ordering and Budget Management Investing Your Precious

Vaccine Ordering and Budget Management: Investing Your Precious Vaccine Resources National Immunization Conference Kansas City, MO March 6, 2007 Lance E. Rodewald, MD Director, Immunization Services Division National Center for Immunization and Respiratory Diseases

Pressures on Section 317 Vaccine Budgets § Factors increasing pressure – New vaccines – Vaccinating new populations § Factors decreasing pressure – No more supplanting of VFC – Delegation of FQHC authority for VFC – New Section 317 vaccine funding – Billing insurance appropriately § What is the net pressure change?

VFC and Section 317 Vaccine Funding to Immunization Programs

Governors on Vaccine Budget Spending Rate § Factors impeding spending rate – Inventory limits – Inventory reduction – Centralized inventory and distribution § Factors enhancing spending rate – New vaccines – New providers § Bursts of spending will be difficult

Immunization Program Roles § Previous grantee roles – Manage program vaccine inventories – Manage provider orders § Previous CDC role – Monitor grantee vaccine budgets § Future CDC role – Manage national vaccine inventory – Monitor grantee vaccine budgets § Future grantee role – Manage provider orders

What Will This Mean? § Grantee spending will occur via provider orders § Spending controls will be at provider level § Bolus spending will no longer be possible § Spending will have to be planned carefully and cannot change suddenly

A Concrete Example § Scenario – – – Grantee with 500 VFC providers Section 317 budget remaining = $2 M Date: September 15 § In 2005 – Purchase vaccines to spend down the funding – Give the vaccines to providers as needed § In 2008 – Identify providers that could a total or $2 M in vaccine – Likely to be unable to find that much need and capacity in such a short time

The Net Effect § Spending monitoring and management critically important § Inability to bolus-spend will require well -timed course corrections if spending is not going according to plan § Unspent vaccine budget at end of FY is a very real possibility

Status of Spending One Third of Way into FY 2007 § One quarter of VFC funds spent § One fifth of Section 317 funds spent § At this rate – Tens of millions of Section 317 dollars will be unspent on September 30 – Last FY, $42 M of Section 317 funds were unspent at end of FY

Policy Decisions § Last September 30 th – Section 317 budgets re-awarded to same grantee § This September 30 th – What to do with unspent Section 317 budget? § Re-award to same grantee § Gather and award to all grantees (as with ops) § Compete funds to identify grantees who can reach populations § Award to other CDC programs