Thursday, December 26, 2013

Just Because It's Not Illegal Doesn't Mean That It Isn't Unethical?

I received this letter last week.

From a company called Blue Ridge Pharmaceutical Distribution Inc., asking me to buy "veterinary exclusive" drugs under my name so they can be sold to other stores. It is called being a "diverter" and it is heavily  frowned upon among other vets and especially among the drug companies and distributors that we buy our drugs from.

Here is the dilemma; Vets are licensed by the FDA allowing us to buy prescription drugs. One person in each veterinary hospital  holds an FDA license that allows them to purchase prescription drugs from either the drug manufacturer or a distributing company. It is all very closely and tightly regulated and insures that prescription drugs are kept safely in the hands of those trained to prescribe them and those in need of them. Seems pretty fair so far, right? Except, when you have a small tightly regulated system that system becomes ripe for taking advantage of. If the drug companies keep their highly sought after and desperately needed drugs in the hands of a few they can more easily control the cost.

"Yes, Virginia it is always about the money."

How do the big box stores like Wal-Mart, Rite Aid, CVS, and Dr.'s Foster and Smith (all of those names were supplied by Blue Ridge as examples),  get those "veterinary exclusive" products? Well, that's where my letter comes in. "Diverters" are told which drugs to buy, they buy just enough to not set off an red flags, and then those drugs sent to the diverting distribution company.

How do diverters benefit? Well, they are paid about 3- 5% of whatever they buy. Easy money, right? (Always beware of easy money).

The cost?, well, if you are caught the drug companies and distributors can refuse to sell anything to you in the future.

If you own a veterinary hospital that is self inflicted suicide.

How does it affect consumers? The waters get a little muddy with that question.

The drug companies will tell you that you are best served by buying your drugs and products from "approved" vendors. Is there credibility to this? Absolutely. If your dog needs an antibiotic you want to know that your dogs antibiotic was handled and stored properly and that it has not expired, or worse, that it came from somewhere or someone with any mal-intent. Your drugs integrity and functionality is dependent on being what it labeled to be, how it was handled, and how old it is. Having that drug pass through the fewest number of hands helps.

For my clients, I want to know everything about the drug their pet receives, so that if there is a problem I can identify and resolve it quickly. You also have a much better chance of getting some assistance for your pet if the product came from your vet.

The diverting distributors will tell you the following; (and I quote from the representative I spoke with from Blue Ridge);

  • "We buy from vets because these products are only available from vets." (First red flag),
  • "We sell to local businesses." ( In truth they sell to anyone and everyone),
  • "The products that our buyers sell are still cheaper than what vets sell it for." (They have no idea what any vet sells anything for. In some cases I am sure that the diverted product is cheaper, but in many cases I would guess that the cost of these products is very competitive to anyone else's).
  • "People won't get prescriptions filled at their vets because it's cheaper to get it filled elsewhere." Cheaper is not equivalent to value as I have already described above. Although, I strongly encourage every client talk to their vet about their pets treatment options. Why are they choosing this drug? Is there a generic equivalent? How do these differ? Etc.. Be honest when you talk to your vet. Perception of expense and perceived value are important topics to discuss with your pets healthcare provider.
  • The Blue Ridge representative reminded me many times that they are "a licensed distributor" and that "I wouldn't be doing anything illegal because every prescription still needed a valid doctors prescription."
  • He also made  few other less than accurate statements, like, "Pfizer (we were using them as the example) doesn't care as long as they make money."
  • And, "as long as everyone is making money no one cares, and we order within your normal order amounts so no one notices." (Flurry of waving red flags!).
  • His closing statement was "All of the drugs that we purchase are still regulated and still need a prescription. This insures that people can get affordable drugs."

The last statement bothered me.

Is the problem that drugs are too expensive? Yes, there are quite a few very good drugs that are very expensive. Why are they expensive? Well, that's likely a long heated debate. Do drug companies make tons of money? Yes. Do people and pets benefit enormously from having very good drugs, Undoubtedly.

But what is expensive for me, may not be expensive for someone else. These decisions are best made with your vet. No veterinarian wants to lose a client or business because of perceived excessive expense. An estimate for all goods and services can save many relationships. Talk to your vet/clients about every dollar we/you are asking them to spend. And remember that we are all consumers and those dollars will go to where a consumer perceives the best value.

As for me, I am keeping my nose out of the "easy money" arena. Not that I am on the side of the drug companies or distributors, but because I need them to help my patients. But, I am happy to write a prescription for any client after we have discussed what they are getting and how much they are actually getting it for.

As for the long term viability of my in-house pharmacy, truth be told I think it will disappear over the next few decades as having fallen under the pressure of ever tightening government scrutiny and regulations, lobbying by the behemoths of the consumer world (Wal-Mart will inherit the earth eventually), and our inability to maintain a competitive cost to the giants in our collective sandbox.

Our doctors in our pharmacy.

If you have any pet related questions you can find me anytime at Pawbly, or on Twitter @FreePetAdvice.
Questions are always welcome and always free.

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