"The State of Delaware is a member of MMCAP (Minnesota Multi-State Contracting Alliance for Pharmacy) and the awarded vendor will be required to utilize MMCAP to procure and obtain all drugs and pharmaceuticals on behalf of the State of Delaware and its patients.  The awarded vendor will not be allowed to join MMCAP, but will act as an agent of the State of Delaware in procuring items via MMCAP.  All items obtained via MMCAP must be for the use of the State of Delaware and its patients only. " 1 Q: What is contractor and what is vendor owned? A: "Shelving, refrigerator, tabletops, file cabinets, desks are state owned. Computers are vendor owned." 2 Q: Do all of the orders come in via fax? A: "Emily Bissell and Governor Bacon fax them, this facility is picked up. " 3 Q: "That fax machine, is it state owned?" A: "Yes, it is state owned." 4 Q: You provide the physical space and utilities? A: Yes. The physical space and utilities are provided by DHCI. 5 Q: The refrigerator staying? A: "It is used for vaccines, yes." 6 Q: Drugs on the pallets in the walkway are they for public health service? A: Yes. 7 Q: Is it norm to store drugs in the hallway? A: Any there is because they are part of the pharmacy. 8 Q: Tell me about the computer system. What software system/package do you use? A: QS1. 9 Q: A) Is your server here? B) Is there a firewall? C) Do you have issues with automatic update? A: "A) Yes. B) Yes, there is a firewall. C) Yes." 10 Q: Is there any compatibility requirements? A: "We are not in our computer now, Right now it is not with their ADL system." 11 Q: Careplans/Caretracker? A: We use ADL. 12 Q: Is that a requirement or a future goal? I know that your state looked at EMAR. A: "We have looked at that, however with the sate fiscal situation it was decided to for go the EMAR at this time." 13 Q: Do pharmacy techs fill the order? A: Yes. 14 Q: Do you reorder by barcode? A: "No, it is a 7 day cycle they don't reorder except what is sent in bulk." 15 Q: A) What about PRN? B) Double Peel? A: A) They write what they need or call what they need. B) Currently the labels aren't bar-coded and they don't need to peel to off. 16 Q: Always been cassette fill? A: Yes. 17 Q: All the bins stay? A: Yes. 18 Q: If some of the equipment goes down whose responsibility is it fix? A: The states responsibility. 19 Q: Disposal of medical waste? A: The states responsibility. 20 Q: The phone system? A: The states responsibility. 21 Q: "The hood does not meet the requirements. It needs to be larger, Will the state buy a larger one to meet the requirements?" A: "The current hood meets current requirements according to the division of professional regulation board of pharmacy If the regulation should change or the hood fails to meet compliance standards, Replacement would be negotiatable with successful bidder or explore other options to purchase those pharmaceuticals offsite." 22 Q: Are you doing piggies? Pick lines? A: "No, not a lot. Primarily we run pick lines for antibiotic therapy. We have one and they will be discontinuing that shortly." 23 Q: IV usage? A: "We have had four in the past, and 2006 was our peak. ( Keystone did note they read in our answers that the facility would be responsible for tubing and pumps)" 24 Q: What about enteral? Does pharmacy have anything to do with enteral? A: Those supplies are ordered through Materials Management. 25 Q: Treatment Care and Ostomy Care? A: Those supplies are ordered through Materials Management. 26 Q: Glucose Monitoring? A: Those supplies are ordered through Materials Management. 27 Q: "Insulin syringes, is that done through here? " A: Yes. 28 Q: "Is that for ""all"" syringe requirements?" A: "Yes, that is for ""all"" syringes." 29 Q: "Currently you are procuring through the state, as you are looking at other options are there areas that you would want to keep. Such as syringes." A: Could be negotiated. 30 Q: Are your licenses under the State Hospital? A: Pharmacy has a separate pharmacy license. 31 Q: Under Cardinal or the State Hospital? A: DHCI. 32 Q: Items required by the board of Pharmacy that have to be within the pharmacy such as scales. A: The state provided. 33 Q: "Pharmacy required state materials that have to be in scale weight measurement, do you compound here?" A: "Sure, haven't had any requests, just ointments. Just need to have the capability. The frequency isn't often." 34 Q: Medical records management are all POS's 30 days? A: Some are 60 days. 35 Q: MAR & TAR? A: Are 30 days. 36 Q: TPN? A: We don't have the capability. and we don't have the policy to manage TPN. 37 Q: Turn around time for PRN for readmission? A: Here at DHCI is 10 minutes. Other two site is next day. 38 Q: Cut off time? A: If fax by 9:00 a.m. then a noon delivery. 39 Q: Does this meet the need? A: Currently for EPB and GBH. 40 Q: Back up emergency? A: "Yes, twice daily delivery." 41 Q: Primary Packing? A: "By unit dose, we cold seal." 42 Q: You really don't have great space for blister packaging? A: "Currently no, more space will be available when renovation is completed." 43 Q: You have large quantities of Public Health? A: Yes. 44 Q: Desks stay? A: Yes. 45 Q: Possible to network computers? A: "No, you would have to log onto state email through the internet." 46 Q: May I see one of your forms? A: Yes. 47 Q: Explain your desire for form? A: All forms are negotiable. 48 Q: "Printer, are they networked?" A: yes. 49 Q: Is it supported by the state? A: No. 50 Q: Need your own? A: Yes. 51 Q: How many computers? A: Eleven and nine printers. 52 Q: They fill off the Computer? A: "Right now because we use a 7 day cycle fill, the computer prints and labels are generated and they get 100 labels." 53 Q: Can I touch a blister pack? A: Yes. 54 Q: Are there any other services being provided by this pharmacy? A: "Division of Children Youth and Families has a contract with the pharmacy to provide drugs to the children s detention centers, Stevenson house, New Castle County Detention Center and Ferris School. We have been supplying this for a year. The children go to an infirmary and pick up their meds in a blister pack of either 30 or 15 (the blister pack is cold seal). The quantity is whatever is ordered. We provide them with an extra label, in case the child gets released." 55 Q: You do not intend to have any of this in the new contract? A: "No, a separate contract and has been added recently. What they are doing in there now is they are filling prescriptions for the Public Health Clinics" 56 Q: "The Public Health, Mechanism of favorable pay. Which we were discussing, Are they receiving bulk items?" A: All drugs are 340b pricing. 57 Q: You are licensed as an outpatient? A: The facility is licensed as an outpatient facility. 58 Q: The entire pharmacy? A: "Yes, the entire pharmacy." 59 Q: The packaging for Public Health is either vial or unit observed TB treatment? A: "We don't actually have any of those you can see. We do use unit dose packaging for direct observed. Pat further explained TB medication breakdown and it's packaging. How each item in the bag is Ziploc bag is individually labeled. The big bag has the total amount in it. They reorder, we send extra labels." 60 Q: "The clarity, What is the deciding factor to clarify I am sending a bulk bottle or individual?" "These are prescriptions, If it is for a patient we pack it as an outpatient prescription. If it is a standing order we will fill it as a vial or as stock we follow those rules. And will be labeled appropriately." 61 Q: And delivery there once a day? A: "To children and youth services- one time a day; Public health clinics two times a week; TB patients, school based - two times a week and Kent one time a month." 62 Q: State employed couriers? A: Yes. 63 Q: Pharmacy couriers? A: "Yes, RFP is written and clarified that pharmacy vendor will provide all courier services." 64 Q: How many staff do you have? A: Was answered in previous questions. 65 Q: You must have ancillary staff to do billing? A: Our pharmacy techs do this. 66 Q: How many techs do you have? A: "Seven , maybe." 67 Q: How many pharmacist? A: "Six, You would have to verify. I don't want to be wrong. There are so many allotted per the FTE you would need to see the answers given previously." 68 Q: Your Pharmacy Director? A: That would be Pat Carroll-Grant 69 Q: 32.0 hour a week you work? A: ".9 LTC .2 whatever adds up to 40.0 hours a week, The vendor pharmacy sends separate billing." 70 Q: The staffing pattern will require clarification. A: "Currently, the bidder needs to make a proposal to the amount of staffing that will be needed to do this job." 71 Q: May I see an MAR? A: Sure.( A copy can be seen by viewing attachment B) 72 Q: Do you have a desire for change in the new year? Are the forms functioning well for you? A: "The forms are functional, I have seen some that are darker in print." 73 Q: "You hand write new admissions you have standing orders, so would a possibility of looking at what your standing routine, would each facility yourself, Bacon and Bissell have different standing admission orders?" A: "The standing orders are not the same. Bissell and DHCI do have standing orders and Bacon does not, and the preprinted forms are only used by DHCI." 74 Q: Is that also provided by the pharmacy? A: No 75 Q: Will that be a contractor responsibility A: Yes. 76 Q: Is this the same form for a TAR and a MAR? A: No. 77 Q: Do you want to continue this way? A: "We currently put them in different binders, I am not married to what forms we use." 78 Q: Is it possible to have a copy of an 8020 of last month? A: See attachment D 79 Q: Is it possible to have revenue report? A: See attachment E 80 Q: Is it possible to have a copy of the 12 month purchase report? A: See attachment D 81 Q: Is it possible to have the average number of scripts per residents? A: "Average number of scripts is 10 not including floor stock, example: multi-vites & docusate." 82 Q: "Is it possible to have the average number of anti-psychotic, PRN's etc.?" A: Information can not be pulled separately. 83 Q: Is it possible to have the summary of tracking? A: See attachment D 84 Q: Is it possible to have the number of patients on hospice? And is Hospice providing their drugs? A: "Drugs were billed to patients Part D, except ABHR. We bill to Hospice. When we have a contract." 85 Q: "Uninsured, is the pharmacy billing private pay?" A: "Private pay clients have the cost of meds in the daily per diem they will not be charged separately. We have 10 uninsured in LTC, DHCI has seven, EPB has two and GBH has one." 86 Q: Are you doing a 30 day over view on every patient regardless of level of skill? A: "Yes, the consult pharmacist does provide chart review on a monthly basis." 87 Q: Do you have a formulary? A: See attachments C. 88 Q: "When you go to do an exchange or fill a need now, Are you sending those with a tech or a courier?" A: "Here at DHCI we send a tech, upstate we send a courier." 89 Q: You have a 340b status with Public Health? A: "Yes, we are a 340b provider, We provide 340b pricing to eligible people which include Family Planning, Women's Reproductive Health, STD, TB & Ryan White eligible residents that live here at DHCI. " 90 Q: So your inventory is separated? A: Yes. 91 Q: A) How many units? B) How many residents per unit? C) And how many med carts will be needed as asked before and not answered? A: "A) DHCI has 7 units. Bissell has 2 units and Bacon 3 units. C) DHCI needs 14 carts plus one spare. Bissell's needs 4 plus one spare and Bacon needs 6 plus one spare. B) Resident census for DHCI is CB1 33, CB2 38, CB3 25, CB4 32, CB5 28, PN1 41, PS133. Resident census for Bissell is Main 2 39, Main 3 44. Bacon census is North 1 30 , North 2 30 and South is 30. " 92 Q: Med carts will need to fit into med room correct? A: Yes. 93 Q: How many med carts and what type do you desire for your staffing pattern? A: I think we need two per unit with two spares. 94 Q: "Again for Bacon and Bissell you would want to accommodate staffing pattern, regulation for locking it." A: Yes. 95 Q: "The summary report, does it list the average number of scripts per patient? " A: I will have to check. Actually it lists the average number of scripts per patient it just doesn't list the average number of drugs. 96 Q: How many scripts are filled for the clinic patients? A: Approximately 700 a month. 97 Q: " I know you purchase from the multi state consortium, Do you have any back up vendor and what is your policy in regards if there is a drug shortage?" A: If the drug is not available through the multi state consortium we will purchase through a local pharmacy and then consult the physician for a replacement if needed. 98 Q: " Would you expect a vendor pharmacy to send the drug if prior authorization is required for the drug, What is your expectation on receiving that drug?" A: "The medical staff is flexible if notified of prior auth, they would try to use something else if available. They would pharmacy to provide without getting authorization." 99 Q: Are you Medicare billing now? A: "Yes, Part D." 100 Q: Are you looking at trying to reconcile that issue at the end of the month? A: "No, we retrospective bill." 101 Q: Your QS1 system is which system? A: It is prime care. 102 Q: "Is it capable, Is prime care completely capable to meet your needs, are you using any outside software system other than that?" A: The finance department documents on part A bills how much we paid for client medications. The facility must pay for these medications. 103 Q: "The state finance department, so are they dialing into your system and pulling the data out of your system?" A: "No, we provide them with a hard copy." 104 Q: Who are they billing Part A? A: Reference response for answer 103. 105 Q: Part a skilled? A: Reference response for answer 103. 106 Q: Your PDP Contracts? A: A handful. 107 Q: You are losing a ton of revenue? A: "No, Not all clients have PDP's. Some have only Medicaid, Private or are uninsured." 108 Q: What specific PDP plans have contract to bill? A: "Of the many companies we contract with, we only use the ones that have premiums within the Medicaid limit and or provide the better service. Those companies would be Medco Medicare PrescriptionPlan Value, Silver Script Value, MedicareRx Rewards Standard, AARP MedicarRx Saver, Community CCRx Basic." 109 Q: "The process upon admission and getting them enrolled, Is the pharmacy involved at all? Pharmacy provides the list of drugs, " A: If they come in and are already enrolled in a PDP we already take it is not a problem. If they come in with no plan or a plan that we don't take then the finance dept. and social services try to work out something. Not a problem unless the premium is higher than Medicaid allows. 110 Q: "Do you have an outside, 3rd party claim?" A: QS1 electronic. 111 Q: Is there a problem with that? being an inbound/outbound system. A: Some private insurance companies do not allow us to bill as we do not bill immediately when 30 day supply is distributed. We do not distribute 30 day supply. Do carts weekly. 112 Q: Do you immediately know what is going to be rejected and what is going to be paid? A: Yes. 113 Q: You have figured out how to get around that firewall? A: "Yes, for the claims." 114 Q: "Totes, for delivering?" A: Actually those belong to The Division of Children and Youth Services. That is not addressed in the RFP. 115 Q: I am looking for stacks of totes somewhere. A: You mean to deliver blister cards? We don't have those. 116 Q: Your delivery system? A: "The RFP is asking for a new delivery system, which is the blister pack system." 117 Q: Please show me your storage area for narcotics? A: I'll be happy to show you. 118 Q: You guys.. Cardinal.. Couldn't you have asked for a better safe? A: "It is the states safe and the states room. We do pack controlled substances into blister cards now for LTC, we partial fill we don't fill a 30 day supply." 119 Q: In the med cart what are the medications that should be locked up? A: The diversion issue with the 7 day supply we have when we deliver regular control we have the nurse sign to accept and keep them in the drawer. With a PRN schedules they keep them in the Narc drawer. Any controlled II they keep in the Narc drawer. 120 Q: "What is your desire for your new system? Do you want to lock all levels of controls with blisters, you will have more drugs on carts." A: All three facilities are in agreement we will lock all levels of controlled medication. 121 Q: Treatment carts? A: Currently not pharmacy and we chose to leave that out of the RFP. 122 Q: What orders are the vendor pharmacy required to enter? A: We are required to enter everything. 123 Q: Other than this form are there any other forms you want? A: Diet for tube fed supplements. 124 Q: What are C.N.A's signing? A: "Flow sheets, which are produced from the facilities ADL care plan program" 125 Q: Behavior monitoring? A: It is a separate form provided by materials management. 126 Q: You provide them with flow sheets? A: Yes. 127 Q: Would it be possible to print that? A: "Yes, I think that we have a test patient." 128 Q: What is your quantity of forms? A: "Approximately 4,000 a month." 129 Q: Who owns the emergency boxes? A: The state. 130 Q: Satellite boxes- exchange everyday? A: "No, Monday, Wednesday and Friday." 131 Q: Can we provide a list of drug inventory and quantity for the satellite pharmacy and emergency boxes? A: See attachments A. 132 Q: "What is the transition going to be if the vendor changes, Are you going to let your inventory run down? We would like a clear answer." A: We are flexible and it will probably require an in-service. 133 Q: "What are your goals, you can't roll all three facilities into blister cards at one time?" A: "We are flexible, it is going to be a transition. " 134 Q: What is the plan for the empty room under construction? A: Office space for the pharmacy. 135 Q: Will pharmacy have this room? A: "Yes, as office space." 136 Q: Will the state provide the vendor with adequate space to blister pack? A: When renovation is complete and when offices are moved to the new room under construction there should be adequate room in pharmacy area to blister pack. 137 Q: "What are the state requirements for storing, shredding and archiving paperwork (pharmacy records) onsite?" A: "At this point federal regulation record retention of 10 years for Medicare Part D. There is space onsite for storing. The state has guidelines for shredding, storing and archiving depending on the type of record." 138 Q: During annual inspection are drugs on pallets in the hallway normal storage? A: "Yes, the hallway is part of the pharmacy." 139 Q: Is there plan to allow for shelving for better storage for drugs in hallway of pharmacy? A: Currently no plan but will work with new vendor to work with Maintenance and Restoration to update the area. 140 Q: When you are saying employee health and dental in this building; is this with Bacon and Bissell too? Any other offsite? A: "If they have employee health and dental. We currently do 2 visits per year to the Public Health clinic, we currently don't do anything for school based or for State University. However, I think the RFP is requiring additional site visits to Delaware State and school based. All school based units are JACAHO. They have nurse practitioner at the high schools. They are funded by the state and are contractual. They are hospital; affiliated. That formulary is basically what the state can pay for." 141 Q: Can the Public Health clinic continue education in-services and the school based in-services be combined? A: No. Primarily because the Public Health clinics have different needs than the school based health clinics needs. 142 Q: "In the RFP you are asking for 12, 1hour nursing in-services in LTC each month . How is this done?" A: In the past pharmacy provided documentation to staff development and in the answers to the earlier questions it states they are no longer going to do this. 143 Q: "For your med carts if you had a preference, do you want the type you slide a card and swipe or punch in a code?" A: The swipe. 144 Q: If they had to they could lock a cart and keep it out ? A: Yes.