Getting drugs at your Vet vs. Retail Pharmacies and Wholesalers

       I hope you are sitting down as you read this article because I have shocking news.  Are you ready?  Ok here it is:

Things are cheaper at retail Pharmacies and Wholesalers.

I’ll give you a minute to process this information…

       Now that I’ve gotten some of the sarcasm out of my system, let us proceed to the point of this article.  Recently, the CBC wrote a piece (and featured it on the news) titled “Pet medicine much cheaper from pharmacies and wholesalers”.  After reading the article, as well as the comments left by other readers, I started feeling frustrated with (what seems to be) the general opinion that the veterinary community is nothing but a bunch of uncompassionate, money-grubbing jerks.  I could write a novel about how wrong this perception is, but for the sake of being concise, I will attempt to confine myself to the issue of the costs of drugs in the vet clinic vs. pharmacies and wholesalers.

Before I get started, there are a few things that I will mention later in the article that I’m just going to define now:

1) Veterinary-Client-Patient Relationship (VCPR)àThis is the foundation of   

effective veterinary medicine and animal care, and is required by law.  A valid VCPR can only exist if the veterinarian knows your pet well enough to be able to diagnose and treat any medical conditions your animal develops; the only way this can happen is if the veterinarian has seen your pet in person, and if the relationship is maintained by regular veterinary visits to monitor your pet’s health.  Your part of the VCPR is allowing your vet to take responsibility for medical judgments about your pet, asking questions to make sure you understand, and following your vet’s instructions.  Your vet’s part of the VCPR is to make those judgments, accept responsibility for your pet’s care, advise you on the benefits and risks of different treatment options, keep a written record of everything he/she does regarding your pet’s health, and help you know how to get emergency care if the need should arise.  If a VCPR is not present, or is not maintained, then it would be illegal and unethical for your vet to either prescribe or recommend treatment without recently examining your pet; a VCPR cannot be established or maintained online, via email, or over the phone.     

2) Compounded MedicationsàThese are pharmaceuticals that have been formulated or reformulated into an different form.  For example, a pill that gets crushed up and mixed with a flavoured suspending agent to turn it into a liquid medication has been compounded.

3)Extra-label/Off-labelàUsing a drug “off-label” means that the drug is properly licensed and manufactured, but not for the ailment or species for which private practitioners intend to use them.

4) Drug Identification Number (DIN)à This is an 8 digit number assigned by Health Canada to a drug prior to it being marketed. It uniquely identifies all drug products sold in a dosage form and is located on the label of prescription and over-the-counter drug products that have been evaluated and authorized for sale in Canada.  It also uniquely identifies the following product characteristics: manufacturer; product name; active ingredient(s); strength(s) of active ingredient(s); pharmaceutical form; route of administration.

          The main point that the CBC article makes is that veterinary drugs and supplies can be purchased for a cheaper price at wholesalers (like Costco) and at retail pharmacies.  Although they very briefly mention a veterinary clinic’s increased overhead and a pharmacy’s/wholesaler’s ability to stock more than a vet clinic would ever need to, they certainly do not go into depth about it.   I would like to attempt to give you the whole picture, not just a fraction.

First of all, I’d like to point out that EVERYTHING is cheaper at a wholesaler; the whole point of a store like Costco is that you can buy in bulk at a cheaper price.  What many people don’t realize is that places like Costco can sell their products for less than what the vet clinic pays just to get the products in stock.  Furthermore, clinics keep very little in stock compared to pharmacies and wholesalers, which increases the cost of shipping.  On top of that, clinics have to make sure to cover their overhead, which is HUGE, and substantially more than in any retail pharmacy or wholesaler.  It includes (but is not limited to) consumable supplies, anesthetic machines, x-ray equipment, lab machines, maintenance for everything, as well as staffing the hospital with qualified personnel.  Contrary to popular belief, this overhead is not covered by exam fees and surgeries; the cost of overhead in most clinics is spread over everything the clinic offers, including pharmaceuticals and prescription fees.  The CBC article fails to mention the price of prescription fees, perhaps because you pay them no matter where you go. 

Another thing you are paying for at a vet clinic is the expertise of the vet and their staff, phone consultations and follow-ups regarding how your pet is doing on the prescribed treatment plan, and help if you are having trouble getting meds into your pet, or if you need clarification on how to do so.  No one at a wholesaler has that kind of training, and pharmacists know next to nothing about treating non-humans; even if your vet has prescribed a human drug for your pet, the pharmacist, unless they are also a trained veterinarian, knows nothing about how the dosing works with animals (because it is often wildly different between humans and other species), nor do they know about how the drug interactions change between species.  If you take any prescription, whether it’s for you or your pet, legally, pharmacists are allowed to change the dose and even the type of drug.  As far as that goes, I’ll say simply this: pharmacists are not trained in veterinary medicine, and even if they were, they have no access to the pet’s medical records so they do not know what is an appropriate treatment plan.  Your vet does.  If you fill your prescriptions at your vet clinic, you know without a doubt that you are getting the appropriate drug and dose for your pet.

While you can certainly get some medications for your pet from the pharmacy, there are some veterinary exclusive drugs that you can only get through your vet.  But that’s just another example of money hungry vets, right? Wrong. 

Let me give you a brief summary of how a drug gets licensed for use (bear with me, it’s a little boring).  All drugs, whether for humans or other species, are governed by the same federal regulatory authority; this means that they must undergo stringent testing to demonstrate safety and efficacy for the specific species and disease that it is meant to treat.  Once it has passed all that testing, it is granted a DIN, and the product then must be manufactured according to the approved practices.  In other words, just because a drug has been approved for use in humans, does not mean it has been sufficiently evaluated for its effects on animals, and vice versa. So why doesn’t the vet just use human drugs because they are cheaper for the owner?  A vet often uses drugs off-label because the veterinary market is small, so sometimes the drug they need isn’t available for animals; however, in doing so, the vet places his/her veterinary license on the line.  If the drug causes an adverse reaction in the pet, then it’s the veterinarian’s fault for using a drug off label. 

If your vet does decide to write a prescription for something you can get at the pharmacy, they’ll still charge you a prescription writing fee.  Many people view this "nickel-and-diming" as unfair because they feel like they are paying for the 10 seconds of time that it takes to scribble on a piece of paper.  In actuality, that fee is not for the prescription itself; it’s for the time it takes to read and analyze the file of the pet in question, to decide if that drug is appropriate, to do research into how (or if) that drug will affect any other drugs that your pet is currently on, and to do research into the risks involved in that specific drug for whatever species it’s being used for, not to mention all the follow-up afterwards.  This can take anywhere from 30 minutes to over an hour for complicated cases, and the people in veterinary medicine, just like any other profession, deserve to get paid for that time and effort.

Some drugs are approved for both human and non-human use.  For example, meloxicam (commonly known in my world as Metacam) is a non-steroidal anti-inflammatory that we use for pain control and to bring down fevers.  I don’t pretend to know what it’s used for in human medicine, but I would guess the same thing; however, clinics do not usually write prescriptions for Meloxicam to be filled at the pharmacy.  This is not because we want to squeeze your wallets, it’s because Meloxicam made for humans often does not come in a small enough dose for a dog or a cat.  After all, a pill made for a 60kg person would be an incredible overdose for a 3kg cat.  You can compound a medication to make the dose suitable for a 3kg cat, but compounding changes the form of the drug, thereby bypassing the federal regulations for manufacturing that drug; this means that the potency, efficacy, and stability of the drug is no longer guaranteed, and once again, the vet assumes 100% responsibility.

So ask yourself this: Is saving $100, or even $20, worth risking my pet’s well-being if there is a more expensive but species appropriate drug available?  Is it worth my vet losing their license?  I would say a very emphatic “NO”.

The last point I’ll make regards the very last line of the article, which really burned my bacon.  It’s another topic that I could write a novel on, and it’s one that doesn’t apply exclusively to drug costs, but it’s one that I feel needs to be addressed; it’s also one that I, personally, feel very strongly about.  The article finishes with quotes from one of their interviewees who mentions the “lack of regulation” to make veterinary care more affordable, and then closes off with this gem: “in the meantime, [he] recommends finding a compassionate vet.”  I’m going to write this in big, bold capital letters to make it very clear:

LOW PRICES DO NOT EQUAL COMPASSION

It’s true that the CVMA publishes guidelines about how much to charge, and it’s also true that they are simply guidelines, and individual clinics can charge whatever they deem necessary.  The cold hard truth is that vet clinics are businesses that need to make money in order to function.  I, and my fellow veterinary professionals, do this job because we love it.  The fact that we get to help animals every single day makes our less-than-amazing wages and salaries more acceptable.  Just to make a point: many technicians get paid on par with, or less than, some baristas at Starbucks, and vets graduate with a debt load that is just as large as human doctors, but most get paid less than half of what a human doctor makes; in other words, we are NOT in this for the money.  Many clinics also have funds in place to help people in emergency situations, not to mention the fund-raising that many do for worthy causes like the SPCA; in other words, we ARE compassionate people who will try to help out in any way we can. 

          I do encourage people to do some research (through reliable internet sources, not just random chat-room/blogger/I-have-an-axe-to-grind-webpage information), tour the clinics, and meet the vets so a discussion about standards of care can take place.  That being said, I also beg people to remember that low prices do not equal better care, and that includes prices related to pharmacy costs.

          Ultimately, it is up to you, the owner/pet parent.  If you know your cat requires $150.00 of drugs per month to stave off kidney failure, you have to plan for that.  Pet insurance is an invaluable asset here, as are the PetCard Finance companies.  Many people have set up bank accounts specifically to save for their pet’s care. 

          To sum up: Yes drugs are cheaper at retail pharmacies and wholesalers, but you may not be getting safe, species appropriate drugs, and you don’t get the veterinary expertise and care that your pet deserves.  As an added bonus, by buying your pet’s medications at the vet clinic, you support the clinic and the people who love and care for your pet.       

~By: Lisa Horne