Sunday, March 16, 2014

Fairness To Pet Owners Act, H.R 4023, Where Do You Stand?

It is a dirty little hushed secret that the laws in this country can be made based on the amount of influence and money you throw at our elected officials. If you think I am being cynical or pessimistic take a long look around. We have been trying to break away from foreign oil dependency for over 30 years. We can put  a man on the moon within a decade of proclaiming it a mission, but we can't produce an electric car for four decades? Or, figure out a way to provide healthcare to our own citizens even though we are by far the most medically advanced nation in the world? Poverty, well, it is alive and well in the richest (debatable term these days I agree), country in the world. Drug companies, car companies, insurance companies, "fill in the blank" companies, if they get big enough, rich enough, they get powerful enough to bankroll huge numbers of lobbyists to strategize, schmooze, woo, and cohort with our elected officials to manipulate our consumer landscape. Every well formed successful company has an account in place and available for the single purpose of placing dollars in front of people who can influence.

I was a part of a union for a decade. Every quarter my dues were collected (or my ability to ascertain a job was nullified), and every quarter it was expected that I contribute something to the political action fund. If you asked any of us worker ants where that money went to we would either regurgitate a union provided script, or we would shake our heads and plead the fifth. If you want to believe in the fairness of a democratic system then lobbyists and PAC's seem somewhat counter intuitive.

The road to getting better.
 I received a Facebook request from a fellow veterinarian the other day asking me to use the link provided to appose "HR 4023." I replied back asking "Why?"

What followed was a short dialogue about protecting our revenue streams and influencing the democratic process to benefit us, the veterinarian, the veterinary hospitals, the very small majority.

I own a small animal hospital. It is a business. I understand as much or more than anyone else how a private practice makes money, stays alive, continues to provide a service for the members of not only the community that I serve but also for the families of my employees.

One of my favorite patients, in front of our pharmacy.

Until a few years ago the veterinary pharmacy was considered the cash cow of our business. Benchmarks for revenue streams generated by our pharmacy were supposed to be about 33% of our total revenue. The pressure from price matching our 'routine services' like spays, neuters, examinations and vaccinations were widely available by cold calling and requesting prices. But the pharmacy was the golden egg. Once you got in the door you never asked about comparison prices from the clinic down the street, nor could you go down the the human pharmacy and buy your dogs de-wormer there. We had that part of the business locked down and you were at the mercy of the clinic you walked into.

The main hallway at Jarrettsville Vet.

I remember when I was in vet school in rural Virginia in 2001. It was pretty common knowledge that the old practice one town over was by far the cheapest option in the county. As a poor vet student I drove the 20 minutes past the seven other closer clinics to go to ole doc's practice. I wasn't a client there, I had never brought a pet there, but when I asked for a sedative for my cat the receptionist went to the back put two pills in a small envelope and said "33 cents." Clearly ole doc was not a member of the new generation of veterinarians attempting to run their practice as a business, or providing contributions to the veterinary political action funds. Ole doc was my first take home lesson on running a profitable business. There is a fair price for everything, but drugs should cost more than gum. Not to mention the whole legal muck of prescribing them to a patient after the client-patient relationship has been established. What if my cat weighed a pound?, or had a heart condition? Or was a figment of my imagination..Ole doc was popular among the locals but a medical malpractice field day.

Jarrettsville Vet's front desk.
Every single person who owns a small business feels the pressure of big companies nibbling at our heels. Can I compete with Wal-Marts four dollars prescriptions? Heck, some pharmacies give the meds away for free! How do I compete with trying to match prices with companies who can buy the drugs in such ginormous volumes that I can't buy them for as cheaply as they can sell them? The answer is I cannot. They are so big that they are in a league of their own. Shoot, their league is so big I am not even in the same universe.

Another happy customer.

The first sign of our pharmacies impending demise came when the once "veterinary exclusive" flea and tick products (aka our bread and butter) went OTC. You could find Advantage at PetsMart. Why go out of your way and spend more at the vets office? Once these flood gates opened (and by the way Bayer the manufacturer of Advantge/Advantix had massive rocketed increases in sales, very, very smart move on their part and met by very happy shareholders), everyone else started producing flea and tick products for sale in stores. Remember the guidelines for producing and selling a product for pets is far more relaxed than it is for human use. (All your product has to NOT do is kill or harm them. Does it have to work?,,no).

Once the grocery store shelves started carrying the most popular flea and tick preventatives vets got worried. The veterinary market responded by making "veterinary exclusive track and trace" products. Diverters would be found  and banished from ever selling the exclusive drugs in the future. What happened?, well, many of us now carry and sell products that you can only buy within our walls. The cheap stuff like bargain old antibiotics, we let some of those slip through our doors with prescriptions to Wal-Mart.

1-800-PetMeds became the next villain in the conservancy of our pharmacy. Once again they could buy huge volumes of product and undercut our ability to match them. Never mind the massive marketing campaign about how much more convenient and cheap your pets meds were from them. They too made record sales (damn, why didn't I think of this?). The faxes vomited out requests like parvo puppies. There were multiple daily requests and many practices just decided to let those dollars go rather than pick up the phone call the client and discuss what the value of their choices might cost. Me, well, I call every single owner, and I match every single request (that I can, and if I can't we discuss why, and who the heck this pharmacy is that they found on the internet?). I don't win them all, but I care enough about my clients and the safety of their pets to have a discussion.

Lola, recovering from her spay surgery.

When the request came from my colleague to appose the Fairness To Pet Owners Bill, or H.R. 4023, which essentially requires every veterinarian to provide a written script for every drug we prescribe, I asked her to explain to me why I should appose this? The answer I got back, "I have had human pharmacies change scripts (I believe this will be resolved soon to help insure everyone's safety, and we ALL need to write legibly or else who's fault is it?). I also think that for the most part this will force the cost of other things in vet med to go up. I know we aren't supposed to make our money on the drugs we sell but at least in a smaller practice like mine I have to."

Is there truth in those words. Yes, of course. If my ability to earn a profit is impacted by a loss in the sales of any part of my clinic I will have to adjust prices elsewhere.

All hands on deck.

But we vets are consumers too. Would we want to be going to the grocery store and find that we can only buy bread from one store? Or go to our doctor and be told that we can only buy our prescription from them? Wouldn't that store and that doctor naturally increase the price of the bread or the medication if they were the only game in town?

Let's expand this out to our ability to buy a gallon of gas, or fuel oil to heat our homes, or medicines for our kids. How is it any different?

Is it right or just to influence the people who are supposed to be governing for fairness among all of the citizens so that the minority benefits?

When I visited the AVMA (American Veterinary Medical Association, thankfully a whole lot nicer and more honest than the last Union I worked for), their reasons for asking their members to oppose H.R. 4023 are, "It is burdensome and unnecessary to require a written prescription be provided, regardless of whether or not the client is having the prescription filled by the veterinarian. Clients already have the flexibility to fill a prescription at their veterinary clinic or off-site at a pharmacy of their choice.  The AVMA is supportive of a client’s right to choose where they have their prescription filled."

Me, my vote, well, I have to maintain a profitable business, it will happen by adjusting prices as any responsible business owner does, but I am also a consumer. Wouldn't it be nice if we all made decisions to benefit each other?

My prediction?, That convenient pharmacy in the back of my clinic is on the endangered species list. It will shrink and disappear and I will have to charge more for my ridiculously underpriced spays and neuters (which I am banking Wal-Mart won't want a piece of,,at least for a few more decades). We veterinarians are going to have to learn how to market ourselves so that our clients and communities see the value in our services, because the goods, well, they are a hot commodity and likely will be squeezed to the point that we willingly (or not so willingly) will have to surrender them.

Dr. Morgan performing an ultrasound.

Me, I am providing exemplary care in a diversity of services (acupuncture, ultrasound, orthopedic surgeries, high quality dentistry and the most welcoming family like compassionate setting imaginable,,bring it on Wal-Mart and 1-800-PetMeds!

Me and Preston
If you have a pet related question, or want to just read stories about other pets, or share your pet with the rest of the world you can find me, and all of the above, at Or you can find me in person at the clinic Jarrettsville Vet, or on Twitter @FreePetAdvice.


  1. First, I am no longer in private practice. When I was in private practice (solo equine) I dispensed minimally. Inventory is expensive. Instead, I called prescriptions in to CVS or Walmart. I sent clients to the local tack shop to purchase OTC products. Really and truly, dispensing was a tiny fraction of my business... but I absolutely oppose "Fairness to Pet Owners". Why? Because it would increase the number of inane conversations veterinarians would have with compounding pharmacies wanting to change prescriptions (to cover yourself legally, always write "No Substitutions") in order to "legally" sell clients illegally compounded medications. Ditto conversations with shady on-line pharmacies wanting to substitute I-Chon for Adequan, for example. Ditto repeated conversations with clients wanting the veterinarian to research the absolute cheapest pharmacy. I would love it if an actual veterinary pharmacy selling veterinary pharmaceuticals purchased legally vs. via the gray market existed, but that is far from the reality of what I've seen: lots of compounded drugs, some obtained illegally, and a few counterfeited.

    It's a bad law requiring a lot of paperwork and sponsored by Wal-Mart besides. I'm not going to impose that on my colleagues still in practice.

    1. Hello Jenna,

      Thank you for your comment and perspective. I wouldn't be surprised at all if Wal-Mart was sponsoring the bill, and I agree with your frustrations about trying to maintain that our clients get the prescription we intend for them to have exactly as we intend it.

      Thank You for reading, and for taking the time to add your thoughts.


  2. It's a difficult time for private practice veterinary pharmacies. I'm always grateful when a client decides to purchase medications from my hospital, but I try to be understanding when they choose to go elsewhere. There's no use fighting the trend anyway; we can't go back to 20 years ago.

    My only real concern is that the addition of non-prescription pet meds on supermarket and box store shelves has disrupted our ability to communicate with owners about the risks and benefits of any particular medication. When I ask if any flea or tick prevention is used, frequently the response is "oh, I don't know, we get it from Costco; I can't remember the brand." Sometimes they're surprised to learn that Frontline doesn't cover intestinal parasites. Or you meet the owner who splits the single Advantage dose between two dogs. Then there are the horror stories of cats with permethrin toxicity.

    I totally respect the notion that vet meds exist in a free market, and owners like the convenience of ordering them online or the neighborhood big box store. However, I also wish I could be involved with decision making on what meds to use, because I have a lot of knowledge and experience I would like to share, which the employees at these stores selling OTC pet meds don't have.

    1. Hello,

      Thank you for adding your perspective. I agree with much of it and I appreciate your taking the time to comment on this.