As the U.S. Federal Trade Commission (FTC) prepares to examine veterinary pharmaceutical distribution and prescription writing
in an early October workshop, the profession is grappling with how best to respond to challenges some veterinarians are experiencing
with retail pharmacists—and how to dispel potential misconceptions held by the government and some members of the public.
First order of business? Participate in the FTC workshop.
"We just want to provide as much accurate information as we can about veterinary prescription writing—that there are more
things that go into it than just jotting it down on a piece of paper and sending clients on their way," says Ashley Morgan,
DVM, assistant director of the American Veterinary Medical Association (AVMA) Government Relations Division. She hopes the
FTC will be convinced that legislation such as HR 1406—a bill that would have required veterinarians to provide written prescriptions
for clients—is unnecessary (see for more on HR 1406, the Fairness to Pet Owners Act).
Morgan says most veterinarians are happy to provide a prescription if requested by a client and that the proposed legislation
is flawed: For example, a written prescription is unnecessary if the veterinarian dispenses the medication himself or herself
or if an outside pharmacy takes the prescription over the phone or by e-mail. The AVMA also worries about the potential for
abuse if unused written prescriptions find their way into the wrong hands.
Supporters of HR 1406 claim that pet owners need to know they don't have to buy prescriptions directly from their veterinarian.
"They want to say veterinarians mark everything up 500 percent and then prevent the client from going elsewhere," Morgan says.
She hopes the FTC workshop will provide the opportunity to combat that perception. "Hopefully the FTC will realize there's
nothing nefarious going on," Morgan says.
The opportunity to speak before the FTC will also provide a forum to address problems brought to the attention of the AVMA
with retail pharmacies dispensing pet pharmaceuticals. "Some of the concerns we have with the nonveterinary retailers is that
they don't have a lot of training on veterinary pharmaceuticals," Morgan says. This apparent lack of knowledge prompted action
by the Oregon Veterinary Medical Association (OVMA) after members began sharing problems with pharmacists recommending dosage
changes or medication substitutions to clients.
Table 1 Veterinarians top 20 challenges
"It appears to be occurring at the big-box pharmacies, not at the mom-and-pop pharmacies," says Glenn Kolb, OVMA executive
director. The OVMA has heard of several instances specific to thyroid medication and insulin. In one such example, "the pharmacist
said they could switch to a different insulin they said was interchangeable—well, it wasn't."
Problems with phenobarbital dosages have also been reported. "The pharmacist might not change the dosage but might advise
the client to cut it in half if the dog is feeling lethargic," Kolb says. "That animal is getting subtherapeutic treatment
until hopefully the veterinarian figures out what's happening. There may be a lag time before the animal gets back on the
Kolb says veterinarians worry not just about subtherapeutic dosing and the health of their patients but client perception
that they're overdosing animals in general. "They (pharmacists) think the dosage is too high," he says. "They're equating
human medicine with animals. It's misleading for the veterinary client." The perception, Kolb says, is "that the veterinarian
is overmedicating the pet and that's wrong." To add insult to injury, it can end up costing the client more money once the
veterinarian identifies and corrects a pharmaceutical error to get the patient back on the road to recovery.
The risk of jeopardizing patient health and client relationships is frustrating to veterinarians, especially when communication
would prevent any such problems, Kolb says. "There's a concern that they (pharmacists) are making a decision without a basis
of knowledge," he says. "Dogs and cats are not little people."