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The FTC Workshop on Pet Medications: One Vet's Perspective
by Dr. Jan V. Ginsky, MVMA President-Elect

The proposed federal legislation HR 1406, the Fairness to Pet Owners Act, would require veterinarians to provide a written prescription for all medications prescribed. It was not passed by Congress this year, but that’s not the end of the story. On October 2, 2012 the FTC held a workshop to examine the issue of “Competition & Consumer Protection Issues in the Pet Medications Industry.”

Although the atmosphere seemed biased in favor of legislation HR 1406, the veterinary industry opposing it was given a voice. AVMA President, Dr. Douglas Aspros, gave an introductory overview of the veterinary profession, and Dr. Paul Pion of the Veterinary Information Network (VIN) gave an overview of the pet medications industry. Attendees then moved into panel discussions for the bulk of the day. The three panel discussions were:

1. Distribution of Pet Medications

2. Portability of Prescription Pet Medications

3. Lessons Learned from the Contact Lens Industry

Panelists favoring HR 1406 represented the ASPCA, Walmart, pharmacy associations, generics manufacturers, Drs. Fosters & Smith (online pharmacy), and compounding pharmacies. Veterinarians and others opposed to HR 1406 were well represented by: Dr. Aspro, Andrew Bane, PhD (COO of VetSource, Inc), Mark Cushing (Council for the American Veterinary Distributors Association), Adrian Hochstadt (Assistant Director AVMA State Legislative and Regulatory Affairs), Dr. Wendy Hauser (Managing DVM of Coal Creek Veterinary Hospital, Centennial, CO), Dr. Clarke Newman (OD, Representative of the American Optometric Association), Dr. Link Welborn (DVM, Chair AVMA Veterinary Economics Strategy Committee), and Kent McClure (General Counsel, Animal Health Institute).

Early in the day Mark Cushing pointed out that HR 1406 did not succeed in Congress this year because, despite a call for public support of the bill by its backers, there was no outcry from pet owners. He called it “a solution in search of a problem”as consumers are already aware from the media of alternate sources of medications, know that they may ask for prescriptions, and are already provided prescriptions from their veterinarians on a regular basis. It was interesting to learn that HR 1406 is modeled after legislation requiring prescriptions for contact lenses and elimination of restricted distribution practices, that resulted due to anti-trust issues. However, the issue in the contact lens industry was that prescribers would limit prescriptions if the manufacturers sold their products to other retailers, which is not the issue in the veterinary industry where manufacturers choose to sell only to veterinarians.

The overwhelming issue of the day was not about prescription portability, but that outside outlets want a piece of the $7 billion that is spent per year on pet medications, and they want manufacturers to be required to sell to those outlets. Catalogue and online pharmacies, manufacturers of non-branded generics, and compounding pharmacies want to have access to pet medications without the current limitations of acquiring the product third party through the “grey market”. Their panelists argued that if they received the medications directly they could lower the cost to the consumer. It was pointed out, however, by Drs. Pion and Welborn that the revenue from medications in a veterinary practice helps limit the cost of other services, and that without pharmacy revenues overall costs would rise, causing veterinary care to become less affordable across the board. They also noted that competition to keep prices down already exists: veterinary clinic mark-ups have come down, and many (if not most) clinics price-match or often charge less for pharmaceuticals than alternate sources.

The panel regarding lessons from the contact lens industry debated data presented by James Cooper (PhD, Director Research and Policy Law & Economics Center, George Mason University School of Law, and formerly with the FTC) that demonstrates that the legislation removing the limits on distribution of contact lenses did not have an effect on pricing. The panel determined that there is no evidence to support that Bill HR 1406 would lower costs.

For veterinarians the real heart of the matter is the risk to our patients.

Dr. Clarke Newman (AOA) discussed how the contact lens legislation has led to risk for the consumer. Lenses are sometimes sold with no prescription, or with expired prescriptions. The contact lens industry has also seen an increase in adverse events when the products are purchased through alternative channels.

Dr. Elaine Blythe (Pharm D), who teaches veterinary pharmacology to pharmacy students, discussed that 20-25% of the pharmacy schools have didactic courses in veterinary pharmacology, although as elective courses, and that there is education available online. While she considered this adequate, since pharmacists are not required to learn veterinary pharmacology, requiring veterinarians to trust them with their patients’ medication/prescription needs may be putting the cart in front of the horse. There are numerous accounts of veterinary prescriptions being changed (in terms of drug, dose, or renewal) by pharmacists without the prescribing veterinarians’ knowledge or approval. As pointed out by Kent McClure (AHI), there is a much greater scope and complexity to veterinary pharmacology than exists in the contact lens industry. Veterinary pharmacology impacts multiple organ systems in multiple species with multiple breed variations, utilizing a wide variety of medications.

In the veterinary patient inappropriately-filled prescriptions, and the lack of an intimate patient knowledge outside the veterinary-patient relationship, can lead to serious consequences, including death.

What can we do moving forward?

The FTC did not come to any conclusions on October second, but are going to review and discuss the issues over the next few months. We don’t know what that will mean for HR 1406, or for veterinarians, but there are some actions that we can take in the meantime to protect our patients.

I recommend monitoring the results of written prescriptions:

1. After providing a written script to be filled outside the veterinary clinic, follow up with your client to make sure that the prescription has been filled. Why?

   1. In their intention to find a better deal, they may delay or never fill a necessary prescription.

   2. In situations where alternate sources don’t provide the product right away, whether due to manufacturer back-orders or an inability to obtain a product through grey-market channels, if clients aren’t instructed to look elsewhere, they may wait, believing that the medication will come to them soon. This can mean that patients go without needed medications for extended periods of time. (Dr. Foster, of Drs Foster & Smith, commented that they are holding prescriptions for medications that they aren’t currently able to obtain).

2. When a client receives a prescription from an alternate source, instruct them to make sure that what they receive is what was written on the prescription.

3. If a client informs you that a prescription has been changed (drug and/or dose), or if you discover that a medication has been dispensed without a current prescription, REPORT THIS TO THE STATE PHARMACY BOARD!

   1. It is illegal for a pharmacist to change a doctor’s prescription without contacting the prescribing doctor for approval.

   2. It is illegal for a pharmacist to fill an expired prescription.

4. Educate your clients about the risks involved with on-line pharmacies. (The FDA has resources that can help you educate your clients.)

5. Keep a record of prescription errors from alternate channels.

Remember, you have the right to fight for your business, and especially for the well-being of your patients!

We will keep an eye out for any updates or actions by the FTC, and on the issue of HR 1406. Watch for notices in your e-mail or on the MVMA website (www.mdvma.org).

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