Should vets dispense drugs or write prescriptions?

Recently I wrote a post about the cost of prescription drugs for horses (How to keep prescription drug costs for horses under control). One of my suggestions was to get your vet to write prescriptions which you can have filled at one of the myriad online pharmacies.

But what if your vet will only fill the prescriptions themselves? There’s been a recen thread on the Chronicle of the Horse Forums that talks about the pros and cons of having your vet supply your horses drugs.

I asked about getting a prescrption for Adequan and explained that I can’t do the shots at the clinic because I’d have to rent a truck/trailer to haul down each time (and the barn owner is perfectly capable and does a good job with IM shots) and she agreed to write a prescription and let me do my own only if I bought it from them!

Apparently this problem is common.

I have complained to my vet about his drug prices. Everyone in his office just shrugs at me. But his mark ups are out of sight! $65/vile of Adequan. $95/1K bottle of Isoxuprine. $38/100ml bottle of Dex which is 7 bucks at valley vet. I am perfectly happy to pay more for drugs from the vet but I mean really….three and four times more than they are for sale everywhere else. I think it is really a bad business decision. The mark up should be just low enough to make me never get my drugs somewhere else. They have called in a prescription for me so I could include it in my Smartpak. I am going to investigate whether it is legal for them to refuse. I don’t like saying things like that to my vet though as in “it is illegal for you to refuse”. I mean we should like and respect one another…

As my vet said once, chiding me for buying cheap isoxuprine from the barn manager, “You may save a few bucks, but she’s not coming in the middle of the night to save your horse.”

the main reason why I switched to the vet I currently use is because I got tired of getting brought to the cleaners for simple Rx stuff (um try 600.00 for a loading dose of Adequan!) and then them refusing to write a script so I can understand the OP’s frustration at the same time.

This is one of my pet peeves too. My (former) vet has a ridiculous markup on some of her meds….

$100/1 bottle Isoxsuprine (~$30 at Valley Vet)
$100/1 bottle Acetyl-D-Glucosamine (~$50 at Heartland)

I tried to get a box of Adequan from my horse’s Oregon vet and they wanted to charge me $900!!!! I was like… holy ridiculous mark up! Called my local vet and got it for $340, and they even shipped it for me.

My vet doesn’t have a problem with writing a ‘script. He does charge $20 for a year long prescription but most of the time I save that much right off the bat. I do buy drugs from him when I don’t have them on hand and can’t them quickly enough. SMZs? I try to have them around, but I’ll pay the convenience price if I need them that day. Same with most other drugs.

I’ve spoken to my veterinary practice about some of their charges because I probably would buy from them if the prices were close enough. In some cases I’m buying the drug for less than my vet pays because I buy from the large on-line pharmaceutical companies who are able to pass along their volume discounts.

So what are the reasons why some people believe in buying only from their vet?

I discussed this with my vet a while ago. My vet also being my best friend in the world. She explained that she did the work up, the exams, the films, etc. for me and my horse and that because of the time she put in, I should get the meds from her rather than a discount house. She obviously makes money from the sale of the meds and also it helps them keep tabs on what is going into their clients’ horses in the way of medications. She can look up my horse’s record any time and see that he got a full Adequan series on such a date and therefore should/shouldn’t get more now. ETC. Also, when you buy from a discount house, you have no way of knowing if the drug has expired.

As my vet said once, chiding me for buying cheap isoxuprine from the barn manager, “You may save a few bucks, but she’s not coming in the middle of the night to save your horse.”

I guess my feeling is that I’m already paying my vet for the work up, the exams and the films. Actually, my vet would like me to be able to afford the medications that my horse needs and has never tried to make me feel guilty about buying drugs elsewhere. My small animal vet goes even further: she dispenses only emergency meds — she actually has done the research and recommends the least expensive place to buy meds and phones in the prescription with no ‘script fee.

The American Veterinary Medical Association says vets should provide prescriptions if asked.

Quoted from that site:
“Q: A client asked me to write a prescription rather than dispense a prescription drug out of my clinic. What are my rights and responsibilities?
A: The AVMA developed a position statement to guide your actions. The AVMA encourages veterinarians to honor client requests to prescribe rather than dispense a drug when a veterinarian-client-patient relationship exists and the veterinarian has determined that the drug is medically necessary. If the veterinarian does not have a veterinarian-client-patient relationship or does not believe the drug is medically indicated, the veterinarian should not write the prescription.

If the veterinarian has determined that dispensing the drug from the clinic may be best for the patient or client, the veterinarian may wish to explain the reasons for this to the client. If, however, the client prefers a prescription to a dispensed drug, veterinarians should honor client requests to prescribe rather than dispense a drug. The client has the option of filling a prescription at any pharmacy.

Some state regulations require a veterinarian to provide a prescription rather than dispense a drug when requested by the client. None of these laws require the veterinarian to write a prescription in the absence of a veterinarian-client-patient relationship or if the drug is not medically indicated. Veterinarians should ascertain state requirements by contacting the Board of Veterinary Medicine in the state(s) in which they are licensed. Also, depending upon the state, Board of Pharmacy regulations may also apply to veterinarians as handlers of prescription drugs. Therefore, veterinarians should make themselves aware of any pertinent Board of Pharmacy regulations in their state. State veterinary medical associations work on your behalf to monitor state issues that affect veterinary medicine and may be a very helpful resource.”

So, what do all of you think?

5 thoughts on “Should vets dispense drugs or write prescriptions?

  1. Thank you for opening up this discussion. I have been following your posts for a couple of weeks now and the issue of Rx drugs caused me to pause and think about my own practice.

    Right or wrong, our practice has a similar mark-up policy as you mention. None of the vets at the clinic-aside from the owner;)- has a problem writing a Rx for clients to find cheaper drugs. For me, I see it as better for the client/veterinarian relationship to try to keep the horse owner’s expenses to a minimum wherever I can. I think it helps build trust in the relationship.

    That being said, there is another reason for the veterinary mark-up….liability. I have great concern over where my clients buy drugs and how they use them after they obtain them. I cannot legally write a prescription for an animal I have not examined. By law, anything I prescribe I am responsible for. If a horse has a reaction to the medications, I am liable. Additionally, by law, the medications I prescribe are for use in the horse that the prescription was written for, not the whole barn. If a horse has a reaction to meds and the meds were not prescribed for that horse, the owner is likely out of luck as to liability coverage. However, I am sure if this were to happen, and the drug in question had my name on it, the state veterinary board would be interested in knowing why there was excess medications prescribed and my license (and livelihood) would be at stake.

    As I mentioned before, writing a Rx is a good trust-builder. However, if there is ever abuse of that trust-ie. barn sharing of prescription drugs, I will withdraw the courtesy. I am not willing to risk my career on illegal activities that are the result of trying to save a couple of bucks.

    I think a more extensive description of a veterinarian’s responsibilities for prescription drugs can be found in the following link:

    Thanks again for the discussion!

    1. Thank you for your thoughtful reply. The issue of liability is an important one for horse owners to consider.

      I think you nailed it when you said that writing an Rx is a trust builder. I would never administer a drug to my horse without discussing it first with my vet and always, always contact him at the first sign of any problem so we can develop a plan. I hope that my vet understands that I would never arbitrarily give any horse a drug that we had not discussed and he had not recommended.

      However, I think that having Banamine, Bute and SMZs on hand is useful for a barn. Certainly at commercial barns the barn managers generally have these types of drugs available and when your horse turns up with cellulitis or a mild colic on a Sunday evening, it’s helpful to have them without incurring an emergency vet call.

  2. Great perspective from the other side of the coin! I haven’t dealt with this with my horse vet, but I have a dog with a lot of health issues and have had this issue with them. A vet that I had a long term relationship with was actually prescribing me hundreds of dollars of antibiotics (among other things) that I could get free at the grocer. Another vet told me about it. Guess who now gets my business? For the record, if it had been a short term thing I wouldn’t have cared so much. My dog was on medications for over 5 months and I spent hundreds of dollars. It sickens me that they wouldn’t give me AT LEAST the antibiotics scrip.

  3. I have encountered both sides of this issue as well, although my practice is small animal. By law we are required to prescribe only the amount required to treat a specific patient – and most generally the online pharmacies won’t break up certain units. For instance, a pet may need only 3 tablets, and the pharmacy sells them in quantites of 6 or 12 or whatever. Or say a horse needs an actual quantity that is a partial bottle of dex – legally a vet should only write an rx for that amount but the pharmacy won’t break a bottle and sell only a partial.
    The biggest drug expense and markup for a veterinarian is the overhead to keep the inventory on hand – time spent ordering and stocking; also it costs money just sitting on the shelf “waiting” to be sold – but its more convenient for the majority of owners. It costs a lot of money to keep various sizes and adequate quantities of drugs on the shelves. Then there is time spent pulling the record, documenting the need for the drug, and the quantities, etc; plus having someone fill and label the prescription, perhaps package in vial or with ice-packs. And 2 years minimum recordkeeping.
    And if your animal has a reaction, or there is a drug failure, or a recall, your veterinarian has the records and will usually intervene. Try getting that kind of help from an online pharmacy. Their guarantee is almost always limited to a refund of the money paid for the pharmaceutical, not to pay for cost of treatment if the animal gets ill. Most vaccine manufacturer’s guarantee their products effectiveness if provided by the veterinarian because they believe the product has been properly stored and used. If there is documentation it was given according to the label, they will pay to treat the illness.
    Having said that, I often recommend we call prescriptions in to Wal-mart or other pharamcies for pets on lifetime meds, like human heart medications or diabetic supplies because they are readily accessible and prescriptions can be as cheap as $4.oo. There is no way I can compete with that – and its a lifetime issue for the pet owner!
    I have a client who put it this way, “I know I could buy this cheaper online, but what if losing the income puts you out of business? That’s not worth the savings.” So like human docs, we could scrub all the drugs off the shelves and just write precriptions for meds, but then other fees would have to go up…do we really want to be like human offices?
    Tough decisions in a tough economy. Interesting topic.

  4. You may have opened Pandora’s Box on this one, but it has needed saying for a very long time (in both equine and human medicine). People shouldn’t be taken advantage of with outrageous mark-ups. Prescription drugs are uniform and should have uniform prices. Let’s keep going on this one!

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