Q--COMPOUNDING MEDICATION SERVICES FOR THE VA MEDICAL CENTER TENNESSEE VALLEY

This is a Combined Synopsis/Solicitation for commercial items prepared in accordance with the format in FAR 12.6, as supplemented with additional information included in this notice. This announcement constitutes the only Solicitation; quotes are being requested and a written Solicitation will not be issued. Solicitation number VA249-15-Q-0485 is issued as a Request for Quotation (RFQ). The solicitation document and incorporated provisions and clauses are those in effect through Federal Acquisition Circular. This requirement is a Total Small-Business Set Aside only qualified offers may submit bids. The NAICS is 446110 and the small business size standard is $27.5. In order to be considered for a government award, the firm must be registered in SAM @ www.sam.gov. Description of Services: The government anticipates awarding a Firm Fixed Price award. The bases of award will be Lowest Price Quote. The Government will award a contract resulting from this solicitation to the responsible offeror whose offer conforms to the solicitation requirements and will provide the best value to the government. The Tennessee Valley Healthcare System (Murfreesboro and Nashville Campuses) VA Medical Center is seeking compounding medication Services with a Base Year plus Four (4) one-year option periods to renew. The Offeror is required to provide specialty distributed sterile and non-sterile compounded products on an as needed basis by the Department of Veterans Affairs Medical Center; hereinafter called VA, Tennessee Valley Healthcare System (TVHS). The contracted compounding pharmacy shall provide those products for which are not available from commercial source and are pursuant to a valid VA TVHS patient-specific prescription. The preparation of all sterile products shall be in compliance with United States Pharmacopoeia (USP) Chapter standards and federal, state, and other regulatory requirements as described herein. See Statement of Work. Period of Performance: Base Year with four (4) one-year option periods to renew. Place of Performance: Tennessee Valley - Nashville Campus, 1310 24th Avenue South, Nashville TN 37212 and Alvin C. York Campus, 3400 Lebanon Pike, Murfreesboro, TN 37212 Quote Submission: Contractor shall submit their quote on company letterhead and shall include unit price, total , unit qty and item description as specified above, as offered discounts, proposed delivery time, name, address, and telephone number of the offeror, firm's DUNS# and ORCA document in SAM at www.sam.gov, terms of any express warranty, unit price, overall total price, applicable shipping charges, completed copy of 52.212-3 Offerors Representations and Certifications- Commercial Items, and ORCA document. All prospective bidders must include appropriate references which must include all applicable company information. PLEASE NOTE: That all prospective bidders must have accreditation through the Pharmacy Compounding Accreditation Board (PCAB) and submit documentation indicating such. All quotes received without this documentation will not be considered. The offeror shall provide sufficient evidence that they possess adequate resources, capability, experience, responsibility and integrity to meet the technical capabilities to comply with the requirements of the resulting contract. The offeror must provide past performance evidence. Past performance will be evaluated on an "acceptable" or "unacceptable" basis using the ratings in the table below based on the answers to the above capabilities questionnaire. The past performance evaluation results is an assessment of the offeror's probability of meeting the minimum past performance solicitation requirements. This assessment is based on the offeror's record of relevant and recent past performance information that pertain to the products and/or services outlined in the solicitation requirements. Past performance information may be obtained through other sources known to the VA and the Federal Government. In the case of an offeror without a record of relevant past performance or for whom information on past performance is not available or so sparse that no meaningful past performance rating can be reasonably assigned, the offeror may not be evaluated favorably or unfavorably on past. Therefore, the offeror shall be determined to have unknown past performance. In the context of acceptability/unacceptability "unknown" shall be considered "acceptable." All questions regarding this solicitation must be submitted to the Contract Specialist in writing by e-mail to [email protected] no later than 8:00 AM CST, May 12, 2015. All responses to questions will be incorporated into a written amendment posted to the Federal Business Opportunities website (www.fbo.gov). Amendments to this Solicitation: Offerors are encouraged to monitor the Federal Business Opportunities website with respect to this solicitation because any amendments to this Solicitation will be posted on that website (www.fbo.gov). All Quotes regarding this solicitation must be submitted to the Contract Specialist in writing by e-mail to [email protected] no later than 8:00 AM CST, May 13, 2015. The subject line must specify VA249-15-Q-0485 - Service for Compounding Medications - TVHS. Quote/Proposal should be broken down as such: Base Year 05-15-2015 - 05-14-2016 $ Option Year 1: 05-15-2016 - 05-14-2017 $ Option Year 2: 05-15-2017 - 05-14-2018 $ Option Year 3: 05-15-2018 - 05-14-2019 $ Option Year 4: 05-15-2019 - 05-14-2020 $ Total For Base & Option Years $ Solicitation document and incorporated FAR and VAAR provisions and clauses apply to this acquisition: 52.204-7, Central Contractor Registration - title is now System for Award Management [SAM]. 52.204-9, Personnel Identity Verification of Contractor Personnel (Jan 2011) 52.212-1, Instructions to Offerors-Commercial 52.212-2, Evaluation-Commercial Items 52.212-3, Offeror Representations and Certifications-Commercial Items 52.212-4, Contract Terms and Conditions-Commercial Items 52.212-5, Contract Terms and Conditions Required To Implement Statutes or Executive Orders-Commercial Items 52.217-8, Option to Extend Services 52.217-9 Option to Extend the Term of the Contract 52.219-6, Notice of Total Small Business Set-Aside 52.219-14, Limitations on Subcontracting (Nov 2011) 52.233-3, Protest after Award 52.222-3, Convict Labor 52.232-19, Availability of Funds for the Next Fiscal Year 52.232-33, Payment by Electronic Funds Transfer-Central Contractor Registration 52.232-39, Unenforceability of Unauthorized Obligations 52.232-40, Providing Accelerated Payments to Small Business Subcontractors (Dec 2013) 852.203-70, Commercial Advertising 852.203-71, Display of Department of Veterans Affairs Hotline Poster (Dec 1992) 852.232-72, Electronic Submission of Payment Requests 852.237-70, Contractor Responsibilities 852.270-1, Representatives of Contracting Officers Full text can be obtained at www.arnnet.gov/far DISCLAIMER AND IMPORTANT NOTES: The government is in no way obligated to do business with or enter into the award a contract to any firm or its affiliates or otherwise pay for the information provided in this synopsis. STATEMENT OF WORK FOR THE OUTSOURCING OF COMPOUNDED PRODUCT PREPARATION The contractor shall provide specialty distributed sterile and non-sterile compounded products on an as needed basis by the Department of Veterans Affairs Medical Center; hereinafter called VA, Tennessee Valley Healthcare System (TVHS). The contracted compounding pharmacy shall provide those products for which are not available from commercial source and are pursuant to a valid VA TVHS patient-specific prescription. The preparation of all sterile products shall be in compliance with United States Pharmacopoeia (USP) Chapter standards and federal, state, and other regulatory requirements as described herein: A. DUTIES AND RESPONSIBILITES Specific Regulatory Compliance 1. The outsourcer shall have a state pharmacy license available where the compounding center resides. 2. If located outside the state of Tennessee, the outsourcer shall be licensed to ship to Tennessee. 3. If the outsourcer prepares a significant number of non patient-specific preparations (>5% of the outsourcer's volume, the outsourcer shall be registered as a drug manufacturer with the Food and Drug Administration (FDA). 4. If the outsourcer prepares non patient-specific controlled substance preparations, the outsourcer shall be registered as a drug manufacturer with the Drug Enforcement Administration (DEA). 5. All pharmacists working for the outsourcer shall be licensed in the state where they are practicing. 6. If required in the state where the compounding center resides, all pharmacy technicians shall be licensed or registered in the state where they are practicing. 7. The outsourcer meets or exceeds state required pharmacist-to-pharmacy technician ratios for the state in which the compounding center is located. 8. If an FDA-approved product is commercially available (not on backorder), the outsourcer shall never compound the same drug formulation using non-sterile powders or other components. 9. When no commercial source exists to prepare admixtures, the outsourcer shall use USP grade bulk ingredients obtained from a current Good Manufacturing Practice (cGMP) compliant supplier. The outsourcer shall additionally be able to provide a certificate of analysis and potency testing of all bulk ingredients used. 10. The outsourcer shall have the required minimum amount of product liability insurance as outlined by VA TVHS. 11. VA TVHS shall be covered by the outsourcer's product liability insurance in the event of any harm directly related to any product compounded by outsourcer's facility. 12. The outsourcer shall meet American Society of Health System Pharmacists (ASHP), National Institute for Occupational Safety and Health (NIOSH), and USP chapter guidelines for handling hazardous agents. 13. The outsourcer shall be able to provide pedigree information that documents that they do not purchase products outside of traditional drug distribution networks or through secondary wholesalers. 14. If a commercial product component of a preparation is on backorder, the outsourcer shall be able to provide a certificate of analysis, potency testing, and proof that all other requirements are met (e.g., higher level clean room) for High Risk Level Compounding per USP . 15. The outsourcer shall immediately disclose any disciplinary or punitive action by any regulatory agency (e.g., FDA warning letter, state board of pharmacy). 16. The outsourcer shall be able to provide quality control history and quality assurance trend reports upon request. Quality and Patient Safety Measures 17. The outsourcer shall provide documentation that confirms staff competency (garbing and hand hygiene, aseptic technique and related practices, and cleaning and disinfection procedures) is evaluated prior to compounding of actual drug preparations. 18. The outsourcer shall provide documentation that confirms that the outsourcer tests aseptic techniques by preparing media fill units per USP chapter standards. 19. The outsourcer shall provide documentation that confirms that pharmacists and pharmacy technicians are pre-qualified using media fills before compounding of actual drug preparations. 20. The outsourcer's staff shall be required to undergo re-qualification using media fills at a minimum of an annual basis 21. At any time a positive media fill occurs, the outsourcer shall perform a comprehensive investigation to identify the root cause. The outsourcer shall then institute corrective and preventative action. 22. The outsourcer shall provide customers with substantial evidence that supports extended expiration dating for compounded sterile preparations when BUD limits in USP are exceeded. 23. The outsourcer shall perform studies to determine extended expiration dates, using evidence-based and validated stability testing procedures, for compounded sterile preparations for which no extended expiration evidence exists. 24. The outsourcer shall be able to verify that staff members are complying with gowning, gloving, and glove-tip processes that are consistent with USP chapter standards. 25. The outsourcer shall perform routine surface microbiological and fungal environmental monitoring to minimize contamination on a minimum of a weekly basis. 26. The outsourcer shall perform comprehensive investigations of out-of-limit findings, as recommended by USP chapter , to determine root cause, followed by corrective and preventative actions on a minimum of a weekly basis. 27. The outsourcer shall perform nonviable and viable particle testing in primary engineering controls (e.g., laminar flow workbench, biological safety cabinet) and room air according to USP chapter standards (on a minimum of a weekly basis). 28. The outsourcer shall have a policy in place that requires validation of new or changed facilities, equipment, processes, container types, for sterility, and repeatability. 29. The outsourcer shall be able to provide documentation that confirms that sterile media used are certified by the manufacturer to be sterile and guaranteed to not promote growth. 30. The outsourcer shall provide detailed reports on the incidence of any positive media test results and the follow-up retests after corrective action is completed. 31. In assigning expiration and beyond-use dating, the outsourcer shall follow evidence-based and validated stability testing procedures to evaluate each preparation (drug, diluent and device/container) for : i. potency at room temperature or refrigerated temperature as applicable. ii. stability, based on a range of extreme temperatures per USP chapter guidelines, to ensure stability and determine the impact on the preparation (e.g. evaporation, precipitation, degradation, concentration). iii. chemical characteristics such as pH, particulate matter, color, sterility (container closure integrity testing). 32. The outsourcer shall provide a minimum guaranteed shelf life upon delivery. 33. The outsourcer shall have documented processes and procedures (including shipping validation studies) to ensure that preparations leaving the site retain their integrity and stability through the shipping cycle. Medication Administration Safety Features 34. The outsourcer shall provide readily accessible information regarding status of latex, bis (2-ethylhexyl) phthalate (DEHP), and preservatives in the preparations they prepare. 35. The outsourcer shall strive to provide quality packaging ad labeling in accordance with cGMP (e.g. drug name differentiation in the form of TALL MAN lettering, visual cues to differentiate drug names and concentrations, auxiliary labeling to indicate contraindicated routes of administration). 36. The outsourcer shall offer tamper-evident options which may include overwrap, shrink wrap, tamper-evident foil, and/or tamper-evident caps. Service 37. The outsourcer shall be able to compound products in the containers types (e.g., syringes, minibags, pump-specific cassettes) to meet the needs of VA TVHS. 38. The outsourcer shall have business continuity plans in place in the event of a natural or man-made disaster or public health emergency. 39. The outsourcer shall be able to compound medications for intrathecal administration. 40. The outsourcer shall be able to compound controlled substances. 41. The outsourcer shall be able to provide guaranteed timeframes for compounded sterile preparations. 42. The outsourcer shall be able to provide next day delivery, trackable by signature-receipt. 43. The outsourcer's current production capacity shall be able to meet the requirements of VA TVHS. 44. The outsourcer shall have a mechanism to respond to customer service issues or questions 24 hours a day, 7 days a week. 45. The outsourcer shall have clinical expertise as documented/verified by PCAB accreditation in the area of products provided. 46. As of July 1, 2015, the outsourcer shall meet all requirements of and be in full compliance with the new Drug Supply Chain Security Act (DSCSA). The outsourcer shall be required to comply with the provisions of the DSCSA for the tracing of products through the pharmaceutical distribution supply chain and all documentation requirements therein. B. PROCEDURES: 1. Service Hours: i. Compounding services shall be available for a minimum of 5 days (40 hours) per week. 2. Ordering of Compounding Products: i. All orders for compounded products will be initiated pursuant to a valid prescription from a VA TVHS provider for a product that is NOT commercially available and/or cannot be currently obtained from a commercial source. ii. Compounding prescription orders will be transmitted to the contractor via facsimile from the VA TVHS pharmacy service, except for controlled substances where a signed hard copy is required. 3. Order Processing/Preparation: i. All products will be labeled with the following information: a. Drug name(s), strength(s), and amount(s) b. Beyond use date (and time if applicable) c. Manufacturer's lot numbers for all ingredients d. Patient's name e. Patient's location (if currently inpatient) or address f. Directions for use and any applicable cautionary statements, either on the label or attached as an accessory label 4. Order Delivery: i. The compounded product(s) shall be delivered to VA TVHS prior to the designated due date. ii. For all orders considered "URGENT," the contractor shall make all reasonable efforts to prepare and deliver the preparation as quickly as possible C. TERM OF THE TASK ORDER: This task order is effective from the date of award and the terms of this contract shall be reviewed and amended, as necessary, at a minimum of an annual basis. This contract is subject to the necessity of compounding services pursuant to a valid patient-specific prescription for which there are no commercially available alternatives. D. REGULATIONS/STANDARDS: The contractor must perform the required work in accordance with all applicable USP , American Society of Health-System Pharmacists, National Institute for Occupational Safety and Health (NIOSH),and Joint Commission standards. E. HHS/OIG: To ensure that the individuals providing services under the task order have not engaged in fraud or abuse regarding Sections 1128 and 1128A of the Social Security Act regarding federal health care programs, the contractor is required to check the Health and Human Services - Office of Inspector General (HHS/OIG), List of Excluded Individuals/Entities on the OIG Website (www.hhs.gov/oig) for each person providing services under this task order. Further the Contractor is required to certify in its proposal that all persons listed in the contractor's proposal have been compared against the OIG list and are NOT listed. During the performance of this task order the Contractor is prohibited from using any individual or business listed on the List of Excluded Individuals/Entities. F. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA) Contractor must adhere to the provisions of Public Law 104-191, Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the National Standards to Protect the Privacy and Security of Protected Health Information (PHI). As required by HIPAA, the Department of Health and Human Services (HHS) has promulgated rules governing the security and use and disclosure of protected health information by covered entities, including the Department of Veterans Affairs (VA). In accordance with HIPAA, the Contractor may be required to enter into a Business Associate Agreement (BAA) with VA. VA has recognized Locum Providers as entities that do not require a BAA with their contractors as long as they are conducting health care on VA's behalf - Pharmacist qualifies as a medical service - therefore, no BAA is required. G. CONFIDENTIALITY OF PATIENT RECORDS The Contractor, as a VA provider, will assist in the provision of health care to patients seeking such care from or through VA. As such, the Contractor is considered as being part of the Department health care activity. Contractor is considered to be a VA provider for purposes of the Privacy Act, Title 5 U.S.C. 552a. Further, for the purpose of VA records access and patient confidentiality, Contractor is considered to be a VA contractor for the following provisions: Title 38 U.S.C. 5701, 5705, and 7362. Therefore, Contractor may have access, as would other appropriate components of VA, to patient medical record information including patient treatment information pertaining to drug and alcohol abuse, HIV, and sickle cell anemia, to the extent necessary to perform its contractual responsibilities. However, like other components of the Department, and not withstanding any other provisions of the task order, the Contractor is restricted from making disclosures of VA records, or information contained in such records, to which it may have access, except to the extent that explicit disclosure authority from VA has been received. The Contractor is subject to the same penalties and liabilities for unauthorized disclosures of such records as VA. H. RECORD KEEPING The Pharmacy office shall have a recordkeeping system of monthly prescriptions compounded by the contractor. The Pharmacy office will be responsible for verifying all work performed by the contractor. The monthly listing of prescriptions compounded will be submitted by the COR's to the Chief, Pharmacy Service's office. Additionally, the responsible Pharmacy Supervisor will monitor through observation that the contractor is performing the duties as described in the contract. I. VA PAYMENT: Contractor will be required to furnish an itemized invoice listing for the period of service covered. Invoices may be submitted as of the last day of each month, but no later than the 10th day of the following month services were provided. All invoices shall reference the appropriate obligation number and be sent to the following address: Invoices are to be submitted to: Department of Veterans Affairs - VA FSC FMS-626 PO Box 149971 Austin TX 78714-8971 A copy of all invoices submitted to the Austin FSC shall also be provided to the Chief, Fiscal Service (04), VA Medical Center, Tennessee Valley Healthcare System, 3400 Lebanon Pike, Murfreesboro, TN 37129. QUALITY ASSURANCE SURVEILLANCE PLAN (QASP) Compounded Product Preparation, Tennessee Valley Healthcare Services (TVHS) Murfreesboro and/or Nashville, TN Contract Number: Contract Description: Furnish Patient-Specific Compounded Product Preparation Pharmacy services to the VA TVHS in accordance with the SOW. Contractor Name: 1.PURPOSE This Quality Assurance Surveillance Plan (QASP) provides a systematic method to evaluate performance for the stated contract. This QASP explains the following: " What will be monitored " How monitoring will take place " Who will conduct the monitoring " How monitoring efforts will be documented This QASP does not detail how the contractor accomplishes the work. Rather, the QASP is created with the premise that the contractor is responsible for management and quality control actions to meet the terms of the contract. It is the Government's responsibility to be objective, fair and consistent in evaluating performance. This QASP is a 'living document' and the Government may review and revise it on a regular basis. However, the Government shall coordinate changes with the contractor. Copies of the original QASP and revisions shall be provided to the contractor and Government officials implementing surveillance activities. 2. GOVERNMENT ROLES AND RESPONSIBILITIES The following personnel shall oversee and coordinate surveillance activities: a. Contracting Officer (CO) - the CO shall ensure performance of all necessary actions for effective contracting, ensure compliance with the contract terms, and shall safeguard the interests of the United States in the contractual relationship. The CO shall also assure that the contractor receives impartial, fair, and equitable treatment under this document. The CO is ultimately responsible for the final determination of the adequacy of the contractor's performance. Assigned CO: , Contracting Officer Organization: Department of Veterans Affairs, VISN 9 Network Contracting Office b. Contracting Officer's Representative (COR) - the COR is responsible for technical administration of the contract and shall assure proper Government surveillance of the contractors performance. The COR shall keep a quality assurance file. The COR is not empowered to make any contractual commitments or to authorize any contractual changes on the Government's behalf. Assigned CORs: Steven Clause, TVHS Pharmacy Associate Chief and Reinaldo Mercado, TVHS Pharmacy Associate Chief c. Other Key Government Personnel: Diane Shackelford, TVHS Pharmacy Chief and Program Manager 3. CONTRACTOR REPRESENTATIVES The following employees of the contractor serve as the contractor's program manager for this contract: a. Program Manager: b. Other Contractor Personnel: 4. PERFORMANCE STANDARDS: Performance standards define desired services. The Government performs surveillance to determine if the contractor exceeds, meets or does not meet these standards. The Skills required in the Statement of Work (SOW) include performance standards. The Government shall use these standards to determine contractor performance and shall compare contractor performance to the Acceptable Quality Level (AQL). Contracted company will follow and meet all USP , American Society of Health-System (ASHP), FDA and DEA standards and requirements in addition to all requirements of this Statement of Work. BELOW IS A EXPLANATION FOR EACH CATEGORY. ________________________________________________________________________________________________________________________ Acceptable Method of Task ID Indicator Standard Quality Surveillance Incentive Level ________________________________________________________________________________________________________________________ Patient Care 1 Incident Reports/ Medication errors are to be No greater than 2 Reports signed If less than Quality of Care Medication Events minimized/eliminated by Managers acceptable, as occur company may not be used in future. ________________________________________________________________________________________________________________________Patient Care 2 Quality Citations Quality citations by State No more than 1 Published citations If less than Quality of Care or other regulatory agencies citation acceptable, should not occur and are company may addressed promptly when not be used in they do occur future. ________________________________________________________________________________________________________________________ Quality of Care 3 Patient and/or staff Patient/staff complaints No greater than 2 Complaints If less than Customer Satisfaction complaints reported are to be minimized/ received by acceptable, to Managers eliminated Managers as company may occur not be used in future. ________________________________________________________________________________________________________________________ Timeliness 4 Reports/observations Contract company No greater than 2 Complaints If less than of untimliness will provide requested instances received by acceptable, product at the requested Managers as company may time and place occur not be used in future. ________________________________________________________________________________________________________________________ Patient Care 5 PCAB Accreditation Contract company Zero instances PCAB website If less than will maintain PCAB acceptable, accreditation at all times company will not be used in future. __________________________________________________________________________________________________ J. REFERENCES 1. Outsourcing Sterile Products Preparation: Contractor Assessment Tool. Downloaded from: http://www.ashpfoundation.org/sterileproductstool. 2. Pharmaceutical compounding- sterile preparations (general information chapter 797). In: The United States pharmacopeia. 27th rev., and the national formulary, 22nd ed. Rockville, MD: The United States Pharmacopeia Convention, 2004:2350-70.