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Polling Place: Writing Prescriptions for Internet Pharmacies

Mary Ann Vande Linde, DVM

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You Have Asked...

How do you respond when clients ask for a prescription so that they can purchase a pharmaceutical or other product via the Internet?

Our Readers Say...

Communicate with Clients
When we get a request to write or sign authorization for a prescription for a client, we first make sure that the animal has been examined within the last year and that appropriate diagnostic tests have been run-e.g., heartworm testing for heartworm prevention. Those that do not meet with such requirements are declined. If the requirements are met, we (receptionist or technician) call the clients and tell them what we charge for the same product. (You can check product cost on the PetMed Express Web site and usually we are equal or less expensive.) We offer to pay postage for mailing the product to the client if they think it is inconvenient to come by the clinic. Most clients are surprised to find that our prices (we double our cost) are so competitive. There are a few clients who still wish to get their products from other places, and we gladly sign the prescription and fax it back.

I think all clinics should communicate with their clients instead of just "signing off." Most of our clients appreciate our effort. We do not want to lose any client over a prescription issue. I think it is important that we as a profession realize that our main source of income is for professional services and not product sales. Our focus now and, even more importantly, in the future should be on providing the professional services our clients want, need, and are willing to pay for!
Bob Shoup, DVM
Catoosa, Oklahoma

Let the Client Choose
My prescription policy is the same as my policy for dispensing medications from my clinic: If there is a valid doctor/patient relationship, and the medication is warranted; then it is the client's choice. However, if the criteria that I would apply for dispensing from my clinic are not met, I will not write a prescription. When I explain to the client that neither the medication nor prescription can be issued, they realize it is not a conflict of interest, but a legal and ethical one.
Douglas S. Hagler, DVM
Lake City, Florida

Convenience & Cost
When a client requests a prescription for mail-order or Internet pharmaceuticals, I gently probe them about their reasons. Usually the two responses I receive are cost and convenience. I point out that if they analyze the costs, the differences are negligible, as I monitor their prices. If the issue of convenience arises, I gladly offer to mail them the medications-if we have current records on the pet.

I also point out that the drugs that we prescribe are those certified by either the FDA or USDA, and that because this may not be the case with a number of Internet pharmacies, many lawsuits have been filed by a number of states against them for providing foreign (usually European or Australian) products. I also inform clients that when these companies first started, I actually welcomed them: I might not have to maintain such large stocks to receive price breaks, and the money freed up could be used to provide better equipment and services. When the lawsuits began emerging, I realized that it is important to continue providing these products through my clinic.

If clients still want to proceed with Internet purchases, providing their records are in current status, I usually comply with the request. I do remind them that they get what they pay for, and they pay for what they receive.
Roger E. Kendrick, DVM
Mansfield, Texas

Compare & Compete
I ask such clients if they feel they are getting a better price on pharmaceuticals, even with shipping fees. Once they include these fees, the pharmaceutical price is very similar. If they still insist, I'll match the price after shipping fees are included.

For clients that continually outsource for pharmaceuticals, we charge a prescription fee of $15. The clients are also informed that "free advice" will no longer be offered in regard to their pet's care. It is a tough world, and we should be paid for our time and our knowledge.
Robert Bessert, DVM
Fruita, Colorado

A Polite Refusal-with Reasons
I politely explain that I do not do so because of: 1) many prior instances of abuse of prescriptions by Internet companies, 2) the often cited use of poor quality drugs, 3) the fact that sales of these items helps me keep my other fees as low as possible, and 4) I'm unwilling to give control of medications to someone I don't even know.
Amy Rebecca Senicz, DVM
Harpersville, Alabama


What the expert says ...
Discount Internet Drug Pharmacy vs. In-House Veterinary Pharmacy

What are Internet pharmacies? They are major volume discount drug suppliers. You have heard the names: PetMed Express, Drs. Foster & Smith, and Savemax, Inc. A recent article in Consumer Reports brought them even more attention. These suppliers order products from various sources, even our own colleagues, then develop marketing plans for reaching potential pet owners in their homes. Their products are advertised on TV or in a direct-mail catalog, and pet owners see that they can get the same drugs that they purchase in their veterinarian's office, maybe for a different price. The client thinks, "convenience" and perhaps "savings."

Caretakers vs. Sales Makers
Which is best for the pet: to purchase products from an Internet pharmacy or from a veterinarian? Which will help pets live longer, healthier lives? Who will assure that the product is what it's supposed to be? Here are some of the facts:

• Discount drug suppliers are facing numerous lawsuits because of mislabeling, mishandling, or the sale of expired drugs. See Aids & Resources, back page, for a list of Web sites you can visit for information.

• Drug manufacturers do not support or guarantee drugs not sold directly through a veterinarian. If a dog contracts heartworms while on year-round medication sold by a veterinarian, the manufacturer will pay for the cost of treatment. If purchased from a discounter, the client is on his or her own.

Pet owners need to be made aware of the risk associated with purchasing through an Internet pharmacy. If they think the saving of dollars outweighs the risk, then they can ask for a written prescription.

Complying with Law
What's important for us to know as veterinarians? We have to comply with the law. We must have a client-patient relationship before a prescription is filled. According to the Food and Drug Administration (FDA), this relationship exists when:

• The veterinarian assumes responsibility for making medical judgments regarding the health of the pet and the need for treatment, and the client agrees to follow the instructions.

• The veterinarian has sufficient knowledge of the circumstances to initiate at least a general or preliminary diagnosis because he or she has recently seen and been personally acquainted with the keeping and care of the animal.

• The practicing veterinarian is readily available for follow-up questions and care.

Practicing veterinarians must develop a plan for clients and help them to be compliant. We have to make it easy to purchase products, send home reminders on when to give medications, know what medications are best, do long-term medication testing, follow the FDA guidelines for prescribing, keep pharmacy licenses active, and stay current with the continuing education requirements of the state pharmacy board. We have to keep accurate records, written daily and updated in our computer systems, and keep medication information in our patients' charts so we know what has been prescribed and what complications could arise. Our health care team needs to be trained in our policies and monitoring protocols.

Developing & Stating Our Policy
Our hospitals need policies relating to Internet pharmacies, including a letter or document stating: 1) what the hospital can and will do in terms of providing convenience and quality of care and 2) how Internet pharmacies work. We can provide the service of mailing a medication to our clients, make the medication available through our own personal Web sites, and price the medication comparably. In fact, the veterinary hospital's medications often cost less. We can do cost comparisons, offer the manufacturer's guarantee, and make sure that our clients are 100% satisfied and that their pets are responding well. We can assure clients that their medications have been inspected and approved by the FDA; have been packaged to FDA specifications; and assure them that if their pet has any reaction to prescribed medications, we will know exactly what was given and can assist immediately.

Responding to Change
The Internet pharmacies have shown veterinarians that we need to value the time our clients spend with us and make every interaction the best it can be. We have many products, programs, and services, and our clients must be educated to the peace of mind and quality of life our services provide. An Internet pharmacy policy, paired with the ability for clients to order from their personal veterinarian online is a part of the future. By taking steps such as these you can foster strong relationships with your clients in this time of change. You can weather the change; learn from the business practices of others; and be the best you can be for the pet, pet owners, health care team, and your business.

I welcome your questions. Please direct them to my e-mail, [email protected] 


INTERNET PHARMACIES • Mary Ann Vande Linde

http://www.avma.org/onlnews/javma/may02/s020515b.asp
http://www.lvma.org/novartis_animal_health_files_sui.htm
http://www.canantvet.com/pm_express.htm

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

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