What you need to know when filling prescriptions for Fido and Fluffy.
Filling a prescription for a patient named “Rover” or “Fluffy,” or other animals, is not unusual at The Compounding Center in Leesburg, VA.
Owner Cheri Garvin, BSPharm, told Drug Topics that “we’ve definitely been seeing an increase in requests for veterinary medications.”
While veterinarians still dispense most of the medications they prescribe, things are changing. “Veterinarians are carrying less stock,” Garvin said, so they rely on a local pharmacist to prepare custom prescriptions for pets. Veterinary offices generally don’t carry the ingredients needed to compound medications, she added.
“There’s definitely been a growth in the number of pet prescriptions filled in human pharmacies,” said Elaine Blythe, PharmD, Associate Professor of Veterinary Pharmacology at St. Matthew’s University School of Veterinary Medicine, Grand Cayman Island, British West Indies. “Veterinarians are increasingly outsourcing prescriptions for most chronic and preventative conditions to the local pharmacy. This allows veterinarians to have less of an investment in inventory. The value of a veterinarian is in their diagnostic skill set, not in retailing prescription medication,” she said.
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While dispensing veterinary prescriptions allows pharmacists to expand their horizons, prescriptions for animals raise questions. What type of challenges do pharmacists face when their patients are small and fluffy, or big and smooth-haired, for that matter? How are pharmacists satisfying state mandates to provide patient counseling?
Most state pharmacy acts require pharmacists to counsel all patients; this includes pet owners. At The Compounding Center, “We counsel patients who pick up pet medications the same way we counsel those who pick up human prescriptions,” said Garvin. “We ask if they have any questions for the pharmacist.” In some cases, though, she said a sit-down counseling intervention is necessary. For example, if a dose for a Chihuahua is tiny and needs to be measured in a syringe, “we want to make sure the client knows how to correctly do the measuring.”
It’s important that pharmacists understand pet medications before dispensing them, Garvin continued. Feline medications are commonly compounded into transdermal formulations for administration into the cat’s ear, since cats are notoriously hard to get a pill into. But some drugs, such as prednisone, are not effective in this formulation. Additionally, transdermal medication can lead to a thinning of the skin on the cat’s ear. “These formulations are best used short-term, not for long-term chronic conditions,” Garvin said.
At Ladue Pharmacy in St. Louis, MO, pharmacist Jeff Kleine, PharmD, told Drug Topics that pet owners picking up pet meds are counseled no differently than those picking up human meds. Most of the veterinary meds dispensed are compounded.
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There is also some seasonality with pet prescriptions. “For example, we dispense a larger number of antianxiety medications for dogs around the Fourth of July,” Kleine said.
While pet meds currently constitute only a small amount of the pharmacy’s overall volume, Kleine said, “It would be helpful for pharmacists to have more training in this area.”
“Many pharmacists feel a gap in their knowledge base–they are educated to counsel patients on human diabetes, but not for canine or feline diabetes,” agreed Blythe.
Pharmacists need to receive more education on veterinary drugs because “any pharmacist who works in retail for any amount of time will receive a prescription for a pet patient,” said Blythe. This is true, she said, among both chains and independents, although independents are more likely to be involved in the compounding of veterinary drugs. Online pharmacies, too, need to have the knowledge to safely and accurately dispense veterinary products.
To date, said, Blythe, “roughly 35 schools of pharmacy in the United States offer didactic courses in veterinary medicine.” Additionally, three schools-University of Wisconsin, North Carolina State University, and Purdue University-offer residencies in veterinary pharmacy.
A pioneer in the education of pharmacists in veterinary medicine, Blythe developed an online course in 2001 that is offered through the University of Florida School of Pharmacy, where she serves as an adjunct. “This is a convenient way for both practicing pharmacists and pharmacy students to be educated in the field of veterinary medicine,” she said. Credits from the course may be transferred back to the student’s home school. Since its inception, about 3,000 students have completed the course.
Blythe has also developed continuing education courses in veterinary medicine for chain drugstores, including Target and Costco. “These chains said ‘We can do this. We can provide pet meds, but first, we need to educate our pharmacists,’” Blythe said.
At Walgreens, spokesperson Allison Mack told Drug Topics that “Walgreens pharmacies are able to dispense many of the commonly used prescription drugs for dogs and cats. Pets are a part of the family, and we cater to pet owners by offering a number of benefits through our Prescription Savings Club, which offers discounted pricing on common human medications often prescribed for pets,” said Mack.
“Our pharmacists may use various clinical resources that are specific to pets since animals respond differently to drug therapies than humans. They also work closely with veterinarians whenever they have a question on a pet prescription,” said Mack.
The market for veterinary medicine is a healthy one. According to a 2015 White Paper from the Federal Trade Commission (FTC), 65% of Americans currently own a pet, and retail sales of veterinary prescription medications are expected to top $10 billion by 2018. Additionally, 36 states have adopted laws, regulations, or policy statements that specifically or implicitly require veterinarians to provide their clients with a written prescription upon request. Veterinarians who don’t comply could face disciplinary action, according to the American Veterinary Medical Association, and such discipline could extend to veterinarians in states that haven’t enacted a specific law.
Pet owners want convenience and cost-competitiveness when purchasing prescriptions for their pets, noted the FTC at a workshop. Irwin Rashkover, CEO of Animal Med Express, a company that supplies pharmacies with veterinary products, said the pharmacy is where the consumer can find the best price. “The vet would usually charge a mark-up of 100% to 200%,” he said. “The pharmacy can mark up their price from Animal Med Express to what the local market will bear. We suggest a conservative mark-up of 25% plus.” Dispensing pet medications can increase a pharmacy’s bottom line, he said.
Pharmacies should inform their customers that they can fill prescriptions for pets, Rashkover said. A retail pharmacy should have in-store advertising and should provide this information through their phone messaging system.
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Rashkover noted that the market for veterinary meds will expand since pets, like humans, are living longer. For example, he said, a cat in kidney failure can live for years on fluid therapy. And like humans, animals are taking a greater number of medicines for chronic conditions.
As the market expands, veterinarians and pharmacists are fostering collaborative relationships. “We spend a fair amount of time having good conversations with vets, said Garvin. “We often put our heads together and problem-solve. And over time, an ongoing relationship tends to develop,” she concluded.