The Hidden Cost of Cheap Drugs

I am now going to put on my kid gloves.  I don’t actually know what those are, but I know one is supposed to put them on when handling a delicate topic.  Or so the saying goes. 

This is definitely a delicate topic.  Mucho controversial.  Even here in the practice between us doctors.

I am going to keep my opinion out of this one (yes, it will be hard) and try to stick to the facts as I understand them. 

Saturday we had another angry client yelling at the receptionists.  The reason this time (and several times before) is our policy on online pharmacies. 

Dr. Sharp maintains the policy that we do not write prescriptions for online pharmacies. We will match the prices on items sold at Petmeds.com. 

That’s it.  Non negotiable. 

This particular client was angry that a) we wouldn’t write him a script to buy his heartworm pills online and b) we wouldn’t match the price of the off-brand pharmacy he wanted to buy them at (it was cheaper than our cost). 

At the moment, there is no law (in Texas) that says we have to write the script. 

That could be changing, there is a bill called the “Fairness to Pet Owners Act” , backed by (surprise, surprise: WalMart) that could change that. The law would require DVM’s to provide scripts for all prescriptions for clients to fill wherever they want.

 The AVMA has issued a statement opposing the bill (here’s a VIN article on the topic: http://news.vin.com/vinnews.aspx?articleId=19967 ) 

So, the reasons we give to not write the scripts include

  • We don’t know where those pharmacies are getting their drugs (are they the real thing or counterfeit?)
  • Drugs may be expired, or from a foreign country and may not be dosed properly
  • The manufacturers won’t honor the guarantees on the products

The flip side of that is that clients take the same risks buying their human drugs on-line. 

The biggest threat to the veterinary profession (uh oh, this is my opinion, darnit) comes from something I learned from my human veterinarian.

Well, she’s not a vet, she’s our family doctor, but that is the closest thing to a vet on the human side. 

I love her, she’s a great doc. We have a mutually beneficial relationship, she’s my doc and I’m her vet.  We text each other whenever our “kids” (hers are canine, mine are human) have issues. 

Once, her husband was picking up her dogs after surgery and he about had a coronary over the cost of services.  He said he could do all the same stuff in his office (he’s the office manager) for a fraction of the cost.

This was news to me.  I thought things that happened on the human side (procedures, office visits, etc) were generally exorbitantly expensive.  I thought all doctors were filthy rich. Being unable to bite my tongue, I expressed this sentiment to him.

With much exasperation and hand gesturing (he’s latin American, we are a very dramatic people) he exclaimed that that is not so in family practice.  They have to see hundreds of patients a day to just break even.  Their fee schedule is capped by the insurance companies (or the government?). 

Did you catch that? It may not have actually been hundreds of patients a day (we latin Americans tend to exaggerate).  OK, just texted my doc: she said 26-32 patients.  Given her work schedule, that averages to about 5 patients an hour.   

I generally see two patients an hour. 

Point is:  in family practice, in order to make money they have to see a large volume of clients.  No pharmacy revenue in human med to offset their fees.  They can’t raise their fees, so therefore they have to see more clients to make up for it.

Here’s the thing, if everyone starts getting their drugs from sources other than the vet, the vet will lose a huge chunk of his or her revenue. 

(Duh)

However, the vet still has to make a living, pay his staff, pay for the overhead, etc. 

I don’t know what percentage of our revenue comes from pharmacy sales, I’m going to guess half.  So say we lose half our revenue.  What do you think we will have to do to make that up?

Raise fees.  A lot. 

And if that’s not enough, perhaps be forced to see more clients.  Office visits will become our main revenue source.  Those leisurely hour-long visits when your pet is sick could likely be replaced by brief 15 minute problem-oriented ones.  Just the facts please…

I don’t know about you, but one of my favorite things about the job is spending time, getting to know the pets, clients etc as individuals.  Running clients through like cattle does not appeal to me. 

Will the quality of care suffer? Probably. 

I’m all for getting a good deal, I know times are a changin’  and in all likelihood I think our pharmacy as a revenue source may very well go the way of the dinosaur. 

Are cheaper drugs worth the cost of more expensive office visits and fees in general?  Less personal care?  Possibly less thorough care? 

Seems like a lot to pay.

 

 

 

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7 thoughts on “The Hidden Cost of Cheap Drugs

  1. The biggest drawback that I see is that one doesn’t know the source of the medication when buying from any ol’ website. As you stated, they could be expired or they could be from some off-the-wall manufacturing company.

    My vet doesn’t hesitate to write or call in a script, but many times I prefer to get the prescription from the vet clinic. First of all, I can start my critter on meds right away (think: antibiotics). The second reason is simply convenience as well as the vet having a record of exactly what was dispensed and what the instructions are.

    As an aside: There’s one pharmacy chain that I will never again use because they not only fouled up the instructions for a chemo pill, but gave me the incorrect dosage. I told everyone I knew and, strangely enough, most people had a similar story. I was horrified to find they were STILL using that pharmacy for their human children’s prescriptions.

    It’s hard to imagine being on an assembly line at the vet clinic like some human doctors do. So much of practicing medicine is having the time to listen. Perhaps human doctors should take a lesson or two from the vets and start their own pharmacies.

  2. I both agree and disagree with you on this ( can I do that )..
    The AVMA states that in the Principles of Veterinary Medical Ethics of the AVMA in Section 3 (c)
    Dispensing or prescribing a prescription product requires a VCPR.
    Veterinarians should honor a clients request for a prescription in lieu of dispensing.

    So having said that why is up then up to the Vet to tell a client where they can fill or not fill the script?

    There are some very legitimate online Pet pharmacies. They are members of Vett Vipps (Veterinary-Verified Internet Pharmacy Practice SitesCM) and members of NAPB (National Association of Boards of Pharmacy).

    There are also human pharmacies where many pet meds can be purchased as well at certainly lower costs.
    The idea that a pharmacist is not familiar with the dose a dog or cat would need it absurd.. they can read a script and fill it.. They spend 4 yrs in Pharmacy school learning to do that, how many Veterinary clinics hire a pharmacist to fill their scripts? I am betting it is done for the most part by a Vet tech.

    Should vets have to inform every client that they can have a script and have them sign off on it etc.. no that is over kill. There doesn’t need to be extra work involved.

    Now having said all that the only medication I buy online is Percorten V and I do that with my Vets blessing. Anything else I need I get it from my Vet, I believe in supporting their business. Percorten in Canada is very expensive, much more so than in the US. I buy it at a safe online pharmacy in the US that guarantees their products and has a pharmacist on staff. I know literally hundreds ( not exaggerating ) of people who also buy their percorten at the same place. They sell their percorten for $150 a vial because they price match. This is a drug that dogs need to live yet I have seen Vets mark this drug up to $500 a vial and more in a few cases. Sorry but that kind of markup on a drug that an animal will die without is just wrong.

    So do I think a Vet should give a script if they are asked, yes I do. Here in Nova Scotia Vets give scripts if they are asked for them and yet most people still get their meds from the Vet.

    If Vets would honour what the AMVA already states in their Principles of Veterinary Medical Ethics there would be no need for legislation.

    1. You just stuck your finger in the area where I really worked hard to withhold my opinion 😉 The hard-fast policy is my boss’. I am not the practice owner, he is. Therefore, in order to keep my job, I have to bite my tongue (really hard) and support the clinic position on the issue. . I’ll just say I agree with all your points 🙂

  3. I got tired of fighting those Rx battles… Now we treat it as an ‘informed consent’ dealio: I’ll write the script, the client has to hear our lecture about how that wonderful bargain at PetMedExpress may not be that great a deal after all.
    (so far I haven’t had to clean up after any disasters but ya never know)

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