Getting Rid Of Prescriptions

I have to admit that vets haven't done a good job of structuring their business model.  For several generations we have relied on product and prescription sales as a large part of our revenue.  In the past this has been great for business.  But in recent years many products have become over-the-counter (Advantage, Frontline, and others) and human pharmacies have been selling very cheap generic prescriptions.  Veterinary practices haven't kept up with changes in medications and business and are hurting from this.

Today I received an email from our state veterinary medical association about a recent article from consumer advocate Clark Howard.  He suggests getting a written prescription from the vet and having it filled cheaper at a large pharmacy.  The VMA appeared to go into panic mode, making some bold comments to members:  

Pet owner cautions-
•    Studies show that pet owners who leave the veterinary clinic with their prescription are more likely to follow the treatment recommended by the veterinarian.
•    Animal pharmacology has many complicated aspects for which human pharmacists are not trained:

o    Many drugs have side effects that might be particular to a breed
o    Drug interactions vary from animal to humans
o    Generics often do not have the same efficacy on animals as humans. Your veterinarian knows what works best for your pets, but a drug store pharmacist most likely will not know this and offer the generic to the consumer.

•    Prescription medications, including heartworm and many flea and tick products, are available only by a prescription from your veterinarian. Pharmacies or retail stores that sell these products directly to consumers are in violation of the law.

When your pets' prescriptions are filled at the clinic-
•    They are guaranteed to be the specific medication and dosage prescribed
•    The veterinarian can forewarn pet owners about side effects -- and if necessary to stop dosage
•    The veterinarian can know what other medications your pet is taking to avoid any potentially harmful drug interactions
•    Refills - the veterinarian is the best resource to determine if the prescribed medications are in fact working or if it is necessary to readjust and/or switch medications

While several of those points may be valid, I also think that this is an attempt to protect the business of veterinarians rather than looking out for the best interest of the client and pet. And I really can't agree with that attitude.

Please don't get me wrong, here.  I manage a business and am all about making a profit.  I also want to make sure that my clients get the best and appropriate medication.  I agree that human pharmacists don't have enough training in the effects of medications on animals.  I don't apologize for our mark-ups on medications because we have considerable overhead that human pharmacies don't.  But I think this is an unfortunate attempt to save an outdated business model.

Human doctors perform exams, interpret lab results, make diagnoses, perform surgery and other medical procedures, and write prescriptions.  The doctors don't actually sell the medications themselves, and so can concentrate only on the actual medical procedures.  Veterinarians, on the other hand, have built a considerable part of their practices on products rather than medical services.  As these products have become cheaper and easier to get from sources other than the vet, they have seen revenues fall.  I certainly saw a big drop in my clinic when the Bayer flea products officially went over-the-counter. Vets have also seen a drop because of cheaper medications available through internet pharmacies.  And many vets have fought tooth-and-nail to keep these prescriptions in-house, either matching prices or refusing to write the prescriptions.

There are some medications that simply aren't available in human pharmacies because they are veterinary-only drugs and have no human equivalent.  Often times dosages are quite different, such as levothyroxine (a thyroid supplement) only being up to 0.2mg for humans, which only treats a 20 pound dog.  These things will always need to be available through vets simply because they can't get them anywhere else.

But vets really need to change how they practice.  Cheap prescriptions and internet pharmacies are not going away, despite the wishes of some of my colleagues.  We need to get rid of things that people can get easily and more cheaply somewhere else.  I've started phasing out medications like cephalexin and amoxicillin where I simply can't compete with the prices of large chain pharmacies.  Basically, anything that someone can get by going to Wal-Mart, CVS, or Walgreens I try not to carry.  I'm also happy to write a prescription when the client asks for one, as that's certainly their right and by honoring the request I help build trust.  The focus should be on the true medicine and surgery, things that they can't get anywhere else.  We need clients to see us as actual doctors and not people who want to push a given product on them.  Though I don't agree with every aspect of the structure of the business of human medicine, I do think this is one area where we can learn from them.

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