Vet medicine costs rip off!!

Energize

Shoshannah wrote: »

As for the legislation, it really does exist. Honest. We're not making it up for s**ts and giggles.


From the Veterinary Medicines Regulations 2013:


And this is from the RCVS Code of Professional Conduct, by which vets in the UK must abide:


More information here: http://www.vmd.defra.gov.uk/mswd/cascade.aspx

The use of human or generic medications is not banned in veterinary medicine, but vets must use a veterinary branded product (where one exists) as a first line, unless they can justify otherwise.

What you are quoting does not support your original assertion. In actual practice my experience is that vets prescribe off label with as much impunity as human doctors do. I had never had a problem getting a prescription for a generic form of a veterinary drug, and most of the vets I've dealt with don't even bother to ask for horse passports because ethical practice and treating the patient is more important than following a code of conduct that will never have repercussions for them if they don't follow it to the letter. Quoting a mere code of conduct is a poor excuse for unethical practices such as prescribing expensive brand name drugs and then charging even more for them than other pharmacies do.

I fear however that until we eliminate conflicts of interest such as dispensing practices, that such inhumane practices will be endured by the animal owners unfortunate enough to deal with such vets.

Shoshannah wrote: »

Your idea of malpractice is different to the VMD's then.

Yes my idea of proper practice is prescribing drugs based on the clinical evidence, done in the patients best interest. Vets prescribing drugs they know to be ineffective are not practicing medicine, the same goes for vets offering alternative therapy treatments like homeopathy that are proven ineffective.

You missed my question asking whether you have knowledge of the inner workings of veterinary practice with which to back up your comments. I assume, by your ignorance of the Cascade, you do not - please correct me if I am wrong.

I don't respond to irrelevant troll bait, so assume away.

22cuddles

Can I ask, going slightly off topic, why if the Cascade system exists and a medicine licensed for humans can only be prescribed under the cascade system, vets still tell their customers to buy over the counter medicines e.g. piriton for their pets. I appreciate it's partly cost but if it's against the law for a pharmacy to sell the item for use in an animal I don't get why there isn't more guidance about of from the RCVS. I'm a pharmacist and we'd certainly be getting more flack from the GPhC if we knowingly sold human medicines for animal use (as opposed to dispensing against a prescription under the cascade system).

Shoshannah

Energize wrote: »

What you are quoting does not support your original assertion. In actual practice my experience is that vets prescribe off label with as much impunity as human doctors do. I had never had a problem getting a prescription for a generic form of a veterinary drug, and most of the vets I've dealt with don't even bother to ask for horse passports because ethical practice and treating the patient is more important than following a code of conduct that will never have repercussions for them if they don't follow it to the letter. Quoting a mere code of conduct is a poor excuse for unethical practices such as prescribing expensive brand name drugs and then charging even more for them than other pharmacies do.

I fear however that until we eliminate conflicts of interest such as dispensing practices, that such inhumane practices will be endured by the animal owners unfortunate enough to deal with such vets.



Yes my idea of proper practice is prescribing drugs based on the clinical evidence, done in the patients best interest. Vets prescribing drugs they know to be ineffective are not practicing medicine, the same goes for vets offering alternative therapy treatments like homeopathy that are proven ineffective.

I don't respond to irrelevant troll bait, so assume away.

Oh dear - let it be known that you are the first in the conversation to cry 'troll'.

I assure you - I am no more a troll than you are. Why should I have to back up my comments while you do not? I mentioned the prescribing Cascade, as did albacookie. You asked for evidence of the legislation behind it. I provided it.

You now seem to be suggesting that it does not back up my point. What else can I physically say or do to prove these facts to you?

I have not said that the prescription of generic or human medications is forbidden in veterinary medicine. It is not. I said that, where a veterinary branded product exists, this LEGALLY has to be used first unless you can justify your actions for doing otherwise.

Whether or not the vets you know/have heard of work by this is up to them and does not change the rules. The VMD is starting to come down on this sort of thing much more often now. And I know of vets who have been struck off for incorrectly filling in horses' passports - the evidence for that is widely available on the RCVS Disciplinary Committee's lists, so is far from anecdotal.

There are cases where what you consider 'ethical' practice and practice 'by the book' clash - of course there are - but the two are not always mutally exclusive. And in any case, you seem to be blaming the vets themselves where blame, if it should be apportioned at all, lies at the doors of the VMD for the restrictions they impose on prescribing.

If one thinks vets should all practice outside their Code of Conduct, one can hardly blame them for choosing not to. It's their RCVS registration, their job, and their livelihood.

I am not saying that I don't personally think generics / human medications should not be used. Far from it. I have already cited an example of a situation in which I believe a generic medication is superior to the veterinary option in my 'irrelevant' example of H2-blockers in a previous post. I am only explaining - or trying to, anyway - that the use of such medications is regulated and not the free-for-all some of us wish it was.

Did you read the link I posted? Let me quote from it for you, in case you did not. I have highlighted in bold the points I consider pertinent to this... um... 'debate'.

The cascade has been largely unchanged since 1995. The concept provides a veterinary surgeon (and only a veterinary surgeon) with an important derogation from the general restrictions on the use of veterinary medicines.

Outside of a veterinary surgeon's prescription, the use of medicines must be strictly in accordance with the conditions of the marketing authorisation and the label directions should be closely followed. When the European legislation was drafted it was recognised that the veterinary market for medicines is small in comparison to that for human medicines and therefore it is likely that there would be many diseases where veterinary medicines would be unavailable. Thus, when there is no suitable medicine available, the cascade permits veterinary use of medicines intended for other clinical indications or species, specifically under the direction of a veterinary surgeon, thus recognising that the veterinarian is best placed to take the risk management decision associated with the use of an unauthorised medicine.

The Issue:
Prior to the revision of the European Directive and the subsequent production of the Veterinary Medicines Regulations 2005, use of the cascade by veterinary surgeons had become considerably lax, to the extent that human authorised products were being used routinely despite the availability of suitable authorised veterinary products. Where the only consideration being applied is the cost of the medication and particularly where no clinical judgement is being applied, the cascade derogation does not and has never permitted this.

At that time veterinary surgeries were openly stocking and prescribing human generic products as a routine when the law stated clearly that the use of the cascade provisions should be exceptional and the decision to use the cascade should be taken for each individual patient for the primary reason of avoiding unacceptable suffering.


The production of the new Veterinary Medicine Regulations provided the opportunity for the guidance associated with the legislation to be revised and this was done to clearly exclude the routine use of human generic products where a suitable veterinary medicine is authorised.

Previous Guidance:
Previous VMD guidance had suggested the use of human generics might be acceptable in the exceptional circumstance where the health and welfare of an animal could be compromised because the owner lacked funds. However, the way this was being implemented by the profession had become a significant problem and certainly not within the spirit of the legislation or guidance. In fact the guidance statement was being generally interpreted as a loophole allowing the use of human generics routinely and these products were being promoted and encouraged by being freely available through the veterinary distribution and supply chain.
As a result the guidance note, not the legislation, has been redrafted to address this problem and the VMD has, as part of its responsibilities, made sure this change has been highlighted and has sought to make clear the consequences of failing to observe the law on veterinary medicine use.

Accountability:
It is worth stressing the prescribing veterinary surgeon's duty to ensure they understand the risks of resorting to the cascade in all its forms; their duty to ensure their client is made aware of the risks; and the need to take due precaution to reduce those risks as far as possible. The advice from the VMD setting out the likelihood of prosecution where a veterinary surgeon does not follow the cascade rules is not intended to be a threat but an attempt to make veterinary surgeons aware that, should they be challenged about a prescribed medication, their defence could be heard in a court of law. For it is the courts that will ultimately interpret the legislation and the most likely route to the courts will arise through a challenge from an aggrieved client. At all times therefore, a veterinary surgeon should be prepared to defend their prescription by demonstrating compliance with the law and acceptability of their clinical choice through support from peer or expert opinion. Such defence may not be readily available where a human generic product has been used instead of the authorised veterinary medicinal product.


The VMD does have a role to ensure that the legislation is enforced. We prefer to do this through advice and education in the first instance. The use of human generic medicines where suitable authorised veterinary medicines are available is not consistent with the cascade provisions and clearly contravenes the law.

Enforcement/Seizure:
Where illegal products are discovered it is now common practice for our inspectors to seize and destroy them without compensation. A Seizure Notice will also be issued and published. Where repeated contravention occurs this may lead to prosecution depending on the seriousness of the offence. However, in its enforcement of the legislation, the VMD will not generally seek to question the clinical judgement of the veterinary surgeon.

Rationale for use of authorised veterinary medicines:
The underlying tenet supporting the use of human generics by a small number of veterinary practices appears to be the assumption that they are equivalent to an authorised veterinary medicine. This assumption can be flawed for a number of reasons. In authorising a veterinary generic product the application will be supported by data derived from bioequivalence studies comparing the performance of the generic product to an authorised pioneer product in the target species. Human generic products lack this data comparison with the authorised veterinary product they would displace and as far as VMD is aware such data will not exist. Proof of bioequivalence is an essential step in the authorisation process for generics. If two products are proven to be bioequivalent this provides evidence to demonstrate that in-vivo they behave sufficiently similarly to be confident that the two products will be equally efficacious.

There are many examples of where the VMD has authorised veterinary generic products and all of them are supported by suitable data as a basis for this scientific proof. Authorisation however, cannot be achieved using, a visual comparison of labels, anecdotal information, assumption of equivalence or a history of apparently satisfactory past use.

There are other reasons why the use of an authorised veterinary product is preferable which veterinary surgeons should consider.

1. Medicines not authorised for veterinary use represent an undefined risk to the patient, owner, consumer and environment.
2. Should an adverse reaction occur any approach to a human generic company is unlikely to generate an adverse reaction report to the VMD.
3. Product recalls for a human generic product may omit the veterinary user as this is not a recognised sales route.
4. Contacts with the pharmaceutical company marketing human medicines (this is the address on the label) are likely to be met with a lack of knowledge on veterinary use.
5. Contact with and support from the pioneer company for advice is inappropriate.
6. There is no underlying assurance provided for animal use of a human generic by a supporting regulatory process.

In short safety and efficacy of the human generic medicine in animals is an assumption, not a fact backed by science, and decision making in modern veterinary practice is intended to be science based.

The reporting of veterinary adverse reactions following human medicine use is unreliable for a variety of obvious reasons. For example, the small number of adverse reaction reports in animals to human medicines is likely to be due to failure to report rather than lack of adverse reactions, especially where the use of a human generic medicine is illegal.

The VMD has reported on the trends in the reports we have received related to human medicine use and veterinary history demonstrates the fact that adverse reactions do occur when human medication has been used in animals.

An example used to challenge the VMD's advice on the use of human generics was isoflurane as an inhalation anaesthetic. This product is used as a vapour and is formulated virtually as a pure substance and so it is likely that there would be insignificant differences between active ingredients from any source. It is therefore hardly a good benchmark for other generic formulations and as a result the data required to prove equivalence is relatively simple to provide. It is important to remember that impurities present in the same active substance from different manufacturers may differ (albeit at very low levels in pharmaceutical grade products) by virtue of the different production and purification processes employed and humans and animals do not always behave in the same way when exposed to such impurities.

When considering commonly used formulated pharmaceutical products, due account has to be taken of possible differences in the chemical and physical properties of the active substance that could cause a deviation from the expected efficacy and safety of the final formulation (isomerism, crystal morphology, solubility and stability are examples). In addition, there are other excipients in formulations to consider as capable of affecting the quality, efficacy and safety of medicinal products. It is well known that small changes in formulation, be they for oral, topical or parenteral administration, can considerably affect the efficacy and safety of a medicine, as well as its shelf-life. For authorised veterinary medicines all these elements are examined during the assessment process at the VMD. We do not make assumptions about similar formulations and it is unwise for veterinary surgeons to do so.

Shoshannah

22cuddles wrote: »

Can I ask, going slightly off topic, why if the Cascade system exists and a medicine licensed for humans can only be prescribed under the cascade system, vets still tell their customers to buy over the counter medicines e.g. piriton for their pets. I appreciate it's partly cost but if it's against the law for a pharmacy to sell the item for use in an animal I don't get why there isn't more guidance about of from the RCVS. I'm a pharmacist and we'd certainly be getting more flack from the GPhC if we knowingly sold human medicines for animal use (as opposed to dispensing against a prescription under the cascade system).

There is no veterinary anti-histamine in existence, so where one is indicated in an animal vets can only prescribe the human versions, such as Piriton.

It is a tricky one, and I don't envy the position of pharmacists in these situations. A vet could write a prescription for Piriton for an animal owner to give to their pharmacist, but it's not a prescription medication and the owner could be forgiven for considering the prescription fee a superfluous cost.

They may as well get it OTC...

You can bet your bottom dollar, however: if one of the drug companies decided to package up chlorphenamine with a clever brand name for use in dogs and sell it at three times the price, vets would be obliged to use that product first. :doh:

bugslet

rustyboy21 wrote: »

Bugslet and Chucknorris, I don't think anyone on here is saying you MUST have insurance. If you have the means to pay for any medical intervention, without causing hardship to yourself, then that is fine.

Anyone that remarks that this cost shouldn't be passed on, really does need their own head seeing to. No work sector would do this, you have to factor in your costs always.

I know Rusty, it was more the comment that people that don't have insurance fall into a type:(, hence the explanation that I don't conform to that stereotype and the personal reasons why I choose not tohave pet insurance, which happened to coincide with chucks reasons.

I quite agree that pet insurance has a value and everyone has to decide which is the best option for them and the health of their pet.

Absolutely agree also with your last paragraph.

chucknorris

rustyboy21 wrote: »

Bugslet and Chucknorris, I don't think anyone on here is saying you MUST have insurance. If you have the means to pay for any medical intervention, without causing hardship to yourself, then that is fine.

Damn, if only I had said something like:

chucknorris wrote: »

Of course insurance is important if you might not be able to pay for the worst case scenario, but that isn't a factor for my dog.

Wait a min....I did! That quote was from my post!

mrs_tree

Have recently been through this sad nightmare with my 8 year old previously totally healthy boy. The only thing I wanted to add to the post was that I also looked online to see if there was anything I could do about the frightening costs. I went back to the vets and asked about buying drugs online and they said they would price match for me.
I had to provide them with a print out of the cheapest price I could get for Vetmedin etc and they supplied at that price, plus they charged me a prescription charge. It worked out about half what I was originally paying.
It's worth asking your vet if they will do the same.
Wish you all the best with your dog.