Thursday, August 21, 2014

Human Pharmacist Are Not Veterinary Pharmasist

Have You Seen This?? - In surveys, 10% of veterinarians said outside pharmacies have filled pet prescriptions INCORRECTLY!!  With 99,720 veterinarians as reported by the AVMA 2013 market Research statistics, that is at least 9,000 medical mistakes by human pharmacists filling pet medications.  What we don't yet know, are the exact numbers each veterinarian that has seen this problem have had.  It is likely much more problematic than we know.

Click here for AVMA Article
But the pet owner says, we (in the veterinary industry) only care about the money we get from selling pharmaceuticals.  Yes, the revenue generated by pharmacy sales does help to provide some financial resources to run and maintain our hospital and pay our staff.  My office exam is $43.00 for a sick pet.  Let's compare that to my child's doctor appoint for an illness not too long ago.  He bills the the insurance company $180.00.  Then, after insurance negotiated fees are applied I owe $125.00.  The  pharmaceuticals we sell through our in-house pharmacies do provide us revenue to help keep our exam fees low.  The human physician only has his exam time to produce revenue so his fees are higher, and understandably so.  So yes, revenue from pharmaceutical sells are one factor to keeping our offices operating, but more importantly, to maintain veterinary care as one of the best bargains in all medical services fields.

The truth is, though some hospitals rely too heavily on prescriptions and flea and tick products to maintain the financial health of their practice, most veterinarians are charging fair fees, and are as competitive as possible while still allowing us to keep our doors open to serve our clients.  However, large box store pharmacies have purchasing power that veterinary offices just cannot compete with.  As a practice owner, I would love to shed the hassle, expense, and frustrations of keeping an in-house pharmacy, but we simply can't.  

Human pharmacist are not veterinary pharmacist.  They receive little to no training on animal physiology, and the differences between human and pet dosing.  A continuing education course for a few hours will not provide them the resources to understand the pharmacological do's and don'ts that 4 years of veterinary school and use of the medications teaches veterinarians.  To ensure a pets safety, owners should seek absolutely no advice about pharmaceutical use from a pharmacist, rather only the veterinarian that prescribed the medication--the one that understands the safety and proper dosing of the medication.  The safety measures built into most pharmacy systems to identify safe drug dosing and interactions are built for people.  To my knowledge, I have not seen one pharmacy system that has built in safety alerts that are relevant to the use of medication in pets. Simply put, there are few pharmacists qualified to make alterations or substitutions to any prescription written by a veterinarian.  As a veterinarian, I ask pharmacists to refer questions back to us, and simply admit your ignorance and follow the directions on the RX slip.  If there are questions contact us to ensure the safety of our mutual patient.

So what is a veterinarian to do if he can not trust his patients medications will be filled as ordered?  We keep it in house.  We, as a profession, keep it close to ensure the safety of our patients.  To be sure the medications our pets need are readily available when they need it and not misused.  The next time you are upset that your veterinarian is making it hard to get a medication refill because they insist on an exam, recheck blood work, or whatever the case may be, the first thought should not be, "all they want is my money.". Veterinarians and our staff will tell you few of us are in this profession for is lucrative financial rewards.  Your first thought should be, "they are looking out for the safety and well-being of my pet...maybe there is a reason for the requested exam before refill of medications is approved."  Because that is likely the truth of the matter. 

I have seen what these mistakes can do, and it can be life threatening. Clients of our office enjoy the fact that we often do provide written scripts for human generics when appropriate and simple. There are a handful of medications we use daily that fall into that description, but we also always offer the owner a veterinary labeled drug if possible first.  Though if there are budget restraints, we are happy to provide a prescription for a cheaper human generic if appropriate.  In the summer of 2013, one of my associate veterinarians prescribed an antibiotic for a pet.  My vet knew the pet had already had allergic reactions to Cephalexin in the past, so he scripted a different class of antibiotics. A prescription was written to help the owners afford the medication.  The owner had the medication filled and the pharmacist substituted the script with Cephalexin.  The owner, unaware of the substitution, gave her pet the medication and the pet wound up spending several days in the emergency pet clinic for a severe allergic reaction to the medication. Complaints were made but not much was done to rectify the situation.   

My advise to pet owners considering filling medications by outside pharmacies follows:
  1. If your budget allows, fill you pets scripts with your veterinarian--with a veterinarian labeled medication. These are developed specifically for pets and their unique needs.  Plus, more often than not, labels are designed to make administration as easy as possible.  
  2. Avoid internet purchase of medications, unless offered through your veterinarian.  Online pet pharmacies have become big business.  They strip away billions of dollars out of the veterinary community that could be used to update facilities, pay staff better benefits and salaries, etc.  Don't be fooled!  They are in the business of making money too, and is it worth saving a few dollars to send your money to some large corporation out of state?  Buy local.  The benefits of buying local far outweigh the savings that you think you are getting. When online services are offered by your veterinarian, those are often a collaboration between your local veterinary office and one of their distributors.  With this model, the veterinarian has more access and control to ensure the safety of your pet.  These services can be very convenient to owners, and allows us to reduce overhead by keeping pharmacy stock to only what is needed.  With this collaboration, instead of the hospital ordering and shipping the medication to their office to have you come by and pick up later, the order is drop shipped to the owner on behalf of the veterinary hospital.  This keeps middle men, grey markets, and possible expired or unsafe medications out of the loop.  Then, the revenue generated can be used by your pets veterinary hospital to help support its operations.  In our office that revenue is not much, but its is ear marked for new equipment purchases so that we can offer more services to our clients, improve the level of care we can provide.
  3. If you must get medications from outside your veterinarians office, shop local. It is easier to complain face to face to get an issue resolved than through the internet or a phone call.  If possible, consider using a small local pharmacy over a large retail pharmacy.  
  4. Make sure you know what the medications cost at your vets office before you shop around.  Don't assume your vets office is more expensive.  We find that our pricing is very competitive, usually within a few dollars.  Is the time running all over town and waiting hours for a prescription to be filled or making an online order and waiting days to get it shipped worth a few dollars savings?
  5. Be sure to note what the prescription was written for, how much, and instructions before leaving it with the pharmacist, then compare that to what is filled.  In our office, we print that information on the invoice so  the clients can be assured the medication filled is exactly as we prescribed.
  6. If there are any questions, ask your veterinarian rather than your pharmacist, for those reasons listed above.
  7. Comply with recommended testing and exams. Veterinarians are required to have, by law, a doctor/client/patient relationship prior to prescriptions being authorized and filled. Veterinarians have certain legal and ethical responsibilities to ensure the pet needs the medications, safe and proper dosing are being used, and that the drug is being used for the proper pet. Examination of your pet is critical for us to honor our legal obligation to ensure a proper doctor/client/patient relationship. Beyond the safety concerns, with out examination of your pet we can not be sure that the pet is still in your position, and that medications are not being used for another pet or purpose.  Some medications require us to perform periodic blood testing to ensure they are being used safely, effectively, and not causing more harm than good.  Without those tests, we may have to decline a refill for concern that continued use could be causing harm to your pet.  
  8. Understand, we as a whole, are not trying to be complicated or greedy.  Most in this profession are focused on keeping your pets healthy and happy.      
The trend of owners having pet prescriptions filled by human pharmacies is here to stay, unless state veterinary boards start to address the issue of non trained personal dispensing pharmaceutics to pets. Until pharmacy schools begin training pharmacist for this new role in their jobs we all need to be diligent and watchful of the medications being given to our patients.