Washington, D.C.—As most veterinarians are all too aware, the circumstances that determine where and how pet owners acquire medications is currently in a state of upheaval. And nowhere was this more apparent than at a workshop hosted by the U.S. Federal Trade Commission (FTC) here on Oct. 2, an event that drew a crowd of passionate advocates, curious onlookers and stakeholders with anywhere from thousands to millions at risk.
One of the central questions being asked by the FTC was whether federal legislation such as HR 1406, the Fairness to Pet Owners Act, which would require veterinarians to write a prescription for every medication they prescribe, is necessary to ensure that consumers have as much choice in their purchasing decisions as possible—and, as a result, the lowest prices resulting from robust competition.
Veterinarians and their representatives responded with a resounding “no.” The practicing veterinarians who were present insisted that they and their colleagues are already writing prescriptions on many occasions—when they don’t stock a certain medication, for instance, or when there would be significant savings to a client.
They are writing prescriptions on request, in compliance with the American Veterinary Medical Association (AVMA) ethics code, and proactively, they say. If they didn’t, their state veterinary boards would crack down on them for unprofessional conduct. “How many complaints have state veterinary boards received regarding veterinarians not releasing prescriptions?” asked Link Welborn, DVM, who practices in Tampa, Fla. “I’m not aware that it’s happening.”
Mark Cushing, an attorney representing the American Veterinary Distributors Association (AVDA), called HR 1406 “a solution in search of a problem.” He says the bill’s supporters launched a vigorous social media campaign urging consumers to contact their representatives in support of the Fairness to Pet Owners Act—which didn’t happen. “If this had been a problem, pet owners would have stormed Congress,” Cushing says. “What Congress came to recognize is that there is no problem, so this legislation is not necessary.”
Despite veterinarians’ willingness to write prescriptions, they did maintain that they’re uniquely qualified, through extensive training and experience in pharmacology across species, to dispense medication. “When I write a prescription, I don’t know if the prescription is filled, how it’s filled or what my client is told,” says Wendy Hauser, DVM, of Coal Creek Veterinary Hospital in Centennial, Colo. “I fail to see how that helps my clients and patients.”
Alternatively, when a veterinarian does the dispensing, he or she can demonstrate administration, often giving the first dose in the hospital, as well as counsel the client and monitor side effects in a way a human pharmacist cannot. What’s more, panelists during the workshop said, human pharmacists are prone to errors a veterinarian would never make—in one case, a Dachshund was given 61 units of insulin instead of 6 units and had to be euthanized, says Paul Pion, DVM, DACVIM, president of the Veterinary Information Network.
David Miller, RPh, insists that that shouldn’t be happening. “If a pharmacist is making an error, there’s a way to address that—report it to the state board of pharmacy,” he says. “It’s illegal. A pharmacist cannot change a dose or make a substitution without consulting the prescribing clinician.”
Some workshop participants were adamant that pet owners need to be given the piece of paper with the prescription—every time, no questions asked—because asking for it puts them in an uncomfortable situation. “The white coat can be intimidating, and it unduly influences consumers’ purchasing decisions,” says Nate Smith, a former retail strategist for Walmart. Plus, he says, it’s an inherent conflict of interest for any doctor to have the ability to prescribe along with the ability to sell—in fact, this is something human medicine has separated in order to eliminate the possibility of prescribing a certain product in order to profit financially.
Of course, as could have probably been predicted in a complex issue where government, private enterprise and patient safety converge, there was more up for discussion during the FTC workshop than prescription portability. Receiving at least as much attention from FTC officials and participants was the practice of restricted distribution, in which a drug manufacturer decides to make its product available only to a select group—in this case, veterinarians.
This practice, which manufacturers utilize presumably to keep their products in the hands of the licensed professionals most qualified to prescribe and dispense them, has several domino-effect consequences. The most notable of these is the “gray market,” in which veterinarians buy large quantities of product from manufacturers and resell them to online and brick-and-mortar retail pharmacies (a process that is not, incidentally, illegal in states where a veterinarian is able to obtain a license as a wholesale distributor).
Workshop participants had little good to say about product diversion and the gray market. For one, it increases the possibility of counterfeit or diluted products making their way to consumers. Miller owns a compounding pharmacy and says he is required by the U.S. Food and Drug Agency (FDA) to use a commercial product in formulations when available. Since he can’t get that commercial product from the manufacturer, he must obtain it from a veterinarian.
“That opens the issue of product integrity,” he says. “How was that product handled, and is it what it is? If we have treatment failure when a medication is given, we don’t know why without reassurance of product integrity. So I want to buy directly from the manufacturer or a licensed and regulated wholesaler.”
In addition to doubts surrounding product integrity, retailers don’t like the gray market because of inefficiency in acquiring the product—more “touches” along the supply chain and additional time before the product hits shelves. Or, in some cases, retailers are simply unable to acquire the product in quantities sufficient to meet customer demand.
“You cannot have prescription portability without medication availability,” says Race Foster, DVM, co-founder of Drs. Foster and Smith, who says he has a “pile of prescriptions” he can’t fill because manufacturers won’t make certain products available, despite his online pharmacy being fully licensed and veterinary-accredited. “This is not a veterinarian problem; it’s a problem with the drug companies who are restricting distribution.”