Written for Bayside Dog Owners Group and Bayside Cat Lovers Melbourne by a highly respected Veterinary Practitioner who, at this stage, wishes to remain anonymous
Rather than from your vet? Surely this means my vet is “ripping me off”!!? 🤬🤔😾
Hi Everyone, A recent post about prescription medications (and several others in the past that have raised similar concerns) prompted me to write out a more comprehensive explanation from the perspective of the vets, that might provide a greater understanding of the situation.
Please note I have asked Kate to post this anonymously for me as a vet "on the inside" so I can be as objective as possible and not worry about upsetting any pet owner or vet colleague!
This is a long post, but if you can bear to read it right through, I assure you that you will be amongst the most knowledgeable of all pet owners in Australia on the subject of prescription medications and the ins and outs of purchasing them! Prescription medications are regulated in Australia by the Therapeutic Goods Administration (TGA) and the vets professional actions in prescribing and supplying these medications are supervised by the Veterinary Practitioners Registration Board of Victoria. When you purchase online, or over the counter from a pharmacy, you are required to provide a written prescription from your vet. The pharmacy or online supplier doesn’t have to cover the prescription cost, you do! So their cost for supplying the medication is immediately cheaper. A lot cheaper. Then there is the question of “buying in bulk”. Whilst not all, many pet medications are also human medicines. An organisation such as Chemist Warehouse might purchase 10,000 bottles (or even 100,000 !!) of the same item in 1 single order. Your local clinic might purchase 3! This bulk ordering has two major advantages to the pharmacy: Firstly, it means that Chemist Warehouse can place the order DIRECTLY with the manufacturer, and cut out the distributor (and thus get it for a cheaper standard price), and secondly, by placing it directly with the manufacturer, can in addition, negotiate an even lower price, which is not possible or available to your local vet clinic. Your local clinic is required to purchase through a wholesale distributor. They unfortunately do not negotiate on prices. (It would be like a pet owner trying to negotiate the price of a bag of pet food in Coles!) Coles can purchase it in bulk from, say, Purina, but you have to purchase it from Coles, which acts as the distributor and adds a margin so as to generate their income. When a pet owner purchases the medication directly from the vet clinic, the purchase price includes the prescription fee, so a comparison of prices from a pharmacy (in person or online) versus what the clinic charged is not a valid comparison. The pet owner needs to subtract the prescription fee to compare the two options. The online pharmacy may also add on a delivery fee, which should also be included in the comparison. This is usually not displayed until you "checkout" from your online shopping cart. When a pet owner contacts their vet to request a prescription, the vet on duty needs to review the clinical notes and authorise the prescription. They may need to research what human equivalents are available, and in what strengths. They also need to ensure the human medication does not contain anything harmful to the pet. Sadly, there have been serious incidents in the past where well-meaning pharmacists supplied generic medication, without the in-depth veterinary knowledge that there were ingredients in the particular medication that were harmful to the pet. It is of course understandable that a pharmacist is not an expert in the metabolism and medicine of multiple non human species! One other noteworthy aspect for the vet is the ease of writing a prescription versus printing off a label to stick on the bottle! This sounds frivolous, but is very relevant! Veterinary Practice Software is very much geared towards supplying the medication (and thus printing a label) rather than formatting a written prescription. 15 years ago, it was extremely rare to write prescriptions for owners to fill in pharmacies. Using my own software as an example, I can select a patient, type the first 2 or 3 letters of any medication, put the quantity and type the dosage instructions in about 15 seconds. Even less if the patient is already selected (which is often the case if I am performing a consultation with them.) The label then prints automatically. In contrast, writing a prescription might mean reformatting a generic document on the system, looking up dosage options and available formulations online or in hard copy reference texts, phoning the relevant pharmacy to see what options they have in stock (and which is the best cost option for the owner), and then finally printing and signing the document. There is sadly another reason why us vets remain uncomfortable with supplying written prescriptions: there have been numerous incidents of clients copying or misusing the script for further supplies. For this reason, many clinics now send through written scripts directly to the pharmacy, requiring more administration time and costs. In the case of online pharmacies, they require the original copy, thus requiring the vet to spend time organising the postage, and a member of staff physically walking the envelope to the post box. Has anyone noticed that all the online pharmacies seem to be in NSW? The reason is that these type of online suppliers are not permitted in Victoria. I looked into why they were permitted in NSW and was surprised to learn that a number of them were operating outside the regulations, and that the NSW health authorities were taking action to close them down. As vets we are concerned that disreputable businesses operating outside the law are unlikely to be conscientious about keeping important medication at the correct temperature, monitoring the temperature control of their delivery service (and disposing of all medication when the fridge stops working in the event of a power failure, rather than just selling it anyway.) When we write a prescription, we require professional indemnity insurance to cover that prescription for many years (at least for the life of the pet, and potentially even beyond that in the event of a board complaint.) Professional insurance for medical services is unfortunately extremely expensive and this cost is included in the prescription fee. It is interesting to note that a human doctor can prescribe but is not allowed to supply. A pharmacist can supply, but is not permitted to prescribe. Only a registered veterinary surgeon is trusted to both prescribe AND supply prescription medication. It is a privilege & responsibility that I and my fellow veterinarians take very seriously, and do not ever wish our conduct to jeopardise the community trust placed in us. The Veterinary Practitioners Registration Board of Victoria requires vets to comply with a number of mandatory parameters in order to prescribe to our patients, and we must ensure that we meet these requirements without exception, however officious it might seem to an owner. Significant disciplinary action including loss of registration to practice as a vet can occur if we do not. The vet's actions can also be referred for criminal prosecution, as happened not so long ago to a vet in rural Victoria who decided to ignore these requirements. In another incident, a vet was asked to supply a sedation drug to assist in the shearing of Rams. This is routine, and I personally have dispensed this to many sheep farmers over the years. However, in this instance, the vet felt that something was amiss, and refused the request, and was so concerned about the strange situation that she took her concerns to the police. The wife of this farmer promptly went to a different clinic, who decided not to follow the strict protocols of the board, and supplied the sedation. The wife is now in prison for murder, as this was the intent of obtaining the medication. (There is a book recently published about the case: The Widow of Walcha). No doubt, the second vet who did supply the sedation bitterly regrets that decision. Not all veterinary medications are human medications. In recent years there have been some fantastic developments in veterinary pharmacology, and some incredibly effective animal-only medications have become available . These are generally not available from a human pharmacy. Do vet clinics rely on income from medication? In short, yes, it forms part of our clinic income. If the income ceases, we would ultimately have to increase other fees (such as for consultations and surgery) in order to be able to pay our bills to keep the clinic open. This is not about greed, it is about covering all the usual costs of any small business to keep the doors open: paying the business loan, paying the staff wages, the electricity bill and so on. If one form of income decreases, another needs to be increased in order to pay the bills! I know of two clinics that are closing in Melbourne due to not being able to cover their costs. Some vet clinics that offer late opening or emergency after hours services, and EVERY emergency centre/ specialist vet centre has no choice other than to maintain a full and comprehensive dispensary. If it's overnight, and the patient needs it, it needs to be on hand ready. They cannot wait 'til the morning for the owner to take their written prescription to the pharmacy. Stocking a full dispensary means that medications do reach expiry and need to be thrown out. This raises costs and ends up in higher fees ultimately being passed on to the owners. I hope as a pet owner that this has given you a greater understanding of the background when it comes to prescription medication for your pet. Thanks for lasting right through with me! Best Wishes, from “The Inside Vet”