UKH

Our new rescue dog is having a really hard time adjusting - we think there was significant maltreatment in her past life.  It's largely a noise phobia.  We're getting great support from our vet and from The Dogs' Trust, where she came from.

We've tried several different drugs to help her settle, and the likelihood is that she is going to be on Clomicalm (clomipramine) for the rest of her life.  The thing is, this is £8/day.  We have a decent insurance policy on her - we can claim £7k/year, renewing every year - but it has a hard limit of six month for behavioural claims.  I'm in the process of arguing with them whether a noise phobia classes as 'behavioural'...

If they insist it is, then we're not covered for this.  So, what is the current thinking about buying medication from online veterinary pharmacies?  I can get it for around 1/4 of the price.  But a) how can one tell if these pharmacies are genuine - can anyone recommend ones they trust? and b) am I screwing my vet over?

I know in the past that received wisdom was that vet practices need the income they get from filling prescriptions to stay afloat.  But my vet has hinted that it's not such a big deal these days and they'd be prepared to give me a prescription to fill elsewhere.

All advice gratefully received...

It's no worse than going to Specsavers for a free eye test then buying online from Glasses Direct.  Unless you feel you want to help that business, of course.

The reality is that the business models of both opticians and vets needs to change - you need to pay a fair price, with profit on top, for each product/service you choose to use from them.  And they'll only learn to do that if it hits them in the wallet not to do it.  Cross-subsidy of one product/service from the other really doesn't work in these days of Internet sales.

(This also means that "bricks and mortar" shops selling things like outdoor equipment probably need to start charging for their professional advice and not loading it onto the products!)

Don't know about dogs, but for horses this is now the normal way of obtaining  long-term prescription medicines. Indeed, I've heard of insurance companies refusing to pay the vet prices and insisting that medicines are obtained on-line. I've used 365Vet with no problems. Another big company is Viovet.

We're in a similar situation with one of our pets, our vet advised us to go on line and put in the meds name and purchase from a UK site, we did, very prompt service as well.

Hope this helps.

Adrian

I have been using Petmeds online for a while. At first I was nervous about asking the vet for a prescription but you pay them the £30 and they seem quite happy to give it to you. I don’t know if the meds are similar but they would only give a prescription for 3 months for what I needed so that adds up to £120 a year but the savings are worth it.

The vets know this is going to happen as individual practices are never going to get the sort of bulk discount online shops get.

Big Pharma engage in all kinds of ethically dubious behaviour to increase profits and give cuts to various people. Shopping around to reduce your own costs as a result is absolutely fair. Shopping online in the U.K. for identical drugs is the easiest and safest way, but if it is still silly money it is quite possible to go further still... read on...

There  are many different but basically similar meds in the same category. A common tactic is for only one to be trialled for a particular use (eg dogs), strongly marketed, and the price hiked for that one. You could try something else that is out of patent -  it might work just as well or better, it might not. Vet could advise.

And I know of human patients who have been prescribed a drug at a low dose for one condition, when it was horribly expensive for that condition, but a different condition had a treatment with a dose of four times as much of the same drug, at the same cost per day. Therefore they invested in a pill cutter... You might be able to do something similar with a different formulation. Again, talk to a vet if unsure. I am not a vet.

Thanks, all!  I suspect that my idea that you 'ought' to get the meds from the vet is very out of date.  

We need 20mg tablets; I see that 80mg ones are available for more or less the same price, and I do have a pill cutter...

I always used to get the dog's meds from my vet because I appreciated how patient they were with my dog (who was a rescue with a deep hatred of the vet and who used to thrash around and generally make a right nuisance of herself most visits) and I wanted to support them.

In the last couple of years of her life she was on a pretty expensive drug that they give humans for Alzheimers to slow down the onset of doggy dementia. The vet was not particularly close to home (no one local) so I asked if they could post it regularly and they said no, I would have to come in every month and collect them.

So I said sorry but I'll have to get it online and they had no issue giving me a prescription and just seeing the dog maybe once or twice a year.

I really don't see any morality themes in this dilemma. The drug has been around for a long time in mental health....pretty outdated nowadays but was very commonly used in the past. Microdosing for a dog may be tricky but id be looking up if the 'dog friendly' version is actually any different to the tricyclic used to help with depression in adults. I may.be completely wrong but it must be pretty cheap to buy somewhere....it really has been around for decades!

You should be fine if you check that the online pharmacy is registered with the Veterinary Medicines Directorate. I use Animed Direct but it's a good idea to check prices at a few places to see what's best. Your vet will charge you for writing out a prescription - mine charges £12. Depending on the drug, you are likely to be able to get a number of repeats on the prescription too up to a maximum of 6 months worth. The company you order from will hold the prescription for you and have a record of the repeats and will let you know when you need a new prescription. Good luck with arguing that noise phobia isn't just a behavioural issue

Unfortunately it may not be legal for the vet to prescribe a human generic version of the medication.

Veterinary medications are licensed as a distinct class and if a veterinary licensed product is available for a particular condition then we have to prescribe that one unless there is a sound clinical (not financial) reason to do so.

This can be very annoying as frequently human generics are used, and if the treatment is widely used then a drug company may opportunistically get a veterinary license which forces vets to use there product over a human generic.

Re vets and mark ups - Neil is quite correct about how pricing models should shift - but this is an old story in the industry, and quite a lot of this has already occurred.  Prices from vets are frequently higher than online pharmacies as overheads are greater, but most significantly because the wholesale price to the vet is often greater than the price to the consumer via an online pharmacy.

Re trusting online pharmacies - they should be regulated by the VMD - make sure they are registered as such, and based in the UK.

Good on you for rescuing your dog. Viovet has always been good. I think I also use animeds direct. Never had any trouble at all. Upload your prescription ( you'll need a scanner or get the vet to email you a signed copy.)

Put it this way... My vet charges me £17 for  writing a prescription and I STILL save big money on my dogs grass allergy/skin condition medication for a six month supply. It's about a third of the cost than getting it through the vet. If you get prescription only worming tablets etc get that put on the same script for further savings. My vet is fine with me doing it. They'd rather a happy animal at the end of the day and for repeat prescription medication it is entirely fair enough. One off medication (antibiotics, eardrops etc...) I'll usually get it through the vet.

Incidentally... How much of a difference does the anxiety medication make? Might look into going down that route for our girl too...

Thanks, all.

The reason I wondered about the ethics of it was that I remember that (20 or more years ago) it was felt that you were depriving the vet surgery of a necessary source of income if you went elsewhere, and there was an expectation that you supported your vet by buying through them.  But it does seem this is a thing of the past now!  I guess this is why they charge for giving you a prescription - to make up that lost income.  Fair enough.

Apparently a generic for this was released in November 2019; I'll see if I can find someone selling that for animals.  I'm sure there'll be not a jot of difference between the human and animal forms but I'll have to buy animal.

lorentz - yes, it's making a significant difference.  She was on Pexion at first, which made a HUGE difference to her fear but that's only licensed for short term use.  So we're weaning her off that (this is not a great process - every time we've cut the amount of Pexion she's had a bad few days) and allowing the tricyclic to take over.  

The prescription fee will not replace the mark up in the 'old' pricing model - rather its a reflection that writing a prescription takes time - and so its a feature of the 'new' pricing model - charging for professional time. Likely the vet will make less on this then they would with the old model, things like suregry and consults will cost more to compensate.

Yep.....appreciate that you are working within professional standards and prescribing practice....im sure there are lots that vets need to do that the customer doesn't see.

Slight thread hijack and it may be just my experience but we pay far less to the vets who come out to the horses than to the small animal practice....I've never really.understood why....maybe its the overheads of having a surgery based premises...

if its legal, do it

It may not be legal for the vet to prescribe an alternative generic, but do bear in mind that you could have a nice chat with the vet about it and then buy the generic from an overseas site that doesn’t require a prescription. Not ideal, because you are depriving the vet of their prescription fee and going to somewhere unregulated ie potentially untrustworthy, but many of my human friends manage just fine on stuff from such overseas pharmacies. I’m not talking about the dodgy and risky drugs which are illegal to import (Usually painkillers) and expensive stuff, but for cheap generics I don’t think it’s worth their while getting fakes when the real thing is getting churned out in India for pennies, and nobody I know has ever had quality problems, nor is it illegal to buy this way. Worth considering if the patient otherwise  might go without healthcare.

The global medicines industry is a complete mess.

Please don't recommend getting prescription drugs without prescription. It is illegal and it is an offence to import a veterinary medicine that’s not authorised for use in the UK unless it’s under an import certificate issued by the VMD.

I’ve never had a problem with VioVet. 

High Syv_k, couple of pointers.

1. New drug prices in the U.K.  are negotiated based on cost benefit calculation called the QALY, the drug tariff rate is set based on this whether the drug company likes it or not. This is at a national level through NICE. You are unlikely to find what the NHS actually pays for the drug as that weakens their negotiation stance for alternatives.
2. In the situation it’s negotiated at the local level by CCG’s, no sane Trust senior or chief pharmacist would accept a whack fee for a drug.
3. In the U.K. you pay £9 per prescription item so given the context of the above, if the price is set falsely high and you only get £9 off the patient the Trust or GP’s are going to have to find the money from somewhere else which means greater scrutiny.
4. If the NHS can pay less for a drug by using generic suppliers then they absolutely do this, they will not pay over the odds for something.
5. If you think I’m talking nonsense look into value based procurement which is a solution to a problem of the NHS’s own making. Continued adversarial price negotiations to year on year lower prices on manufacturers are forcing them to leave the market thus causing monopolies for the ones who stick around, poorer health outcomes for patients and longer waiting times. VBP now takes into consideration upstream, downstream and social care considerations into the cost benefit analysis to set a fairer and more long term sustainable price for healthcare goods.

- a medical device/ drug developer and advisor to NHS R&D wing the NIHR.

Could be - road vet is quite a cheap thing to set up - you can do equine work with a car and pretty much nothing else, no support staff, just work from home.

once you get into being able to do anything other than field surgery costs start to increase significantly. 

Alas the Veterinary situation is rather more higgeldy piggeldy!

& Svk ah re-read with less haste! Apologies!

I see no morality issue in at all.

 
Here we are  communicating with each other on-line.  And I'd guess that most of us have bought stuff on-line and many of those people have probably even checked out the real thing in a real shop beforehand to make sure it was what they wanted.

I guess you could also ask whether it was morally better to buy an product  from a smaller retailer than a much cheaper larger retailer.

My 13 year old springer spaniel was diagnosed with diabetes 2 years ago after numerous expensive tests etc, for one bottle of canine insulin that lasts on average 20 days depending on blood sugar readings, the cost from the vet was £63 per bottle. I researched online and found a company called ‘Pet drugs online‘ (ingenious..) and One bottle of the exact same stuff is £23. With it needing to be kept cold my minimum delivery costs are £5.99 and you have to obtain a prescription from a vet which varies from vet to vet and mine charge £19.50 they allow 3 bottles per prescription therefore, although still expensive is far cheaper. 

I also bought my own monitor to do his blood sugar reading which you need to buy strips for.

I could be wrong as my knowledge is of humans more than animals,   but the import certificate is only for vets wishing to supply a prescription drug, as supply of prescription drugs within the U.K. is obviously regulated. Certainly for a private citizen, it is legal to receive non-controlled prescription drugs for personal use in healthcare, so I don’t know what law they would be breaking if it was for their dog rather than them.

I don’t think you are talking nonsense at all. NHS procurement leaves us in a far better situation than a free for all, and far better than the craziness in America where the state of Utah is regularly flying its employees to Mexico to pick up their prescriptions that the state pays for, but the NHS is getting a bit off topic as they don’t do dogs.

It's illegal I was quoting the legislation.

Which act? 

https://www.gov.uk/guidance/legal-controls-on-veterinary-medicines

There would also be likely offences under the Veterinary Surgeons Act. 

Interesting, thanks, so administering medicines to animals is more protected than administering them to yourself. I didn’t know that! I guess it makes sense in that dodgy stuff could get into the food chain that way if it is a farm animal.

Always annoying to read threads regards meds. So much BS.

Clomipramine is / should be as cheap as chips. But that isn't the point.

In the UK almost everyone has absolutely no idea what healthcare costs. Which is on the one hand brilliant and on the other tragic.  

Apart from when pet owners go o the vets!  2 weeks back- emergency trip to out of hours vet as dog bitten in the park.

We'd cleaned the wound at home;  consult, admin, surgical cost, sedation, pain relief, cleaning, suring, surgical kit, gloves, antibiotics, pain relief, reversal; £600. Kind of amazing for me as in the 1990's I stiched up a lot of humans- at no cost to them and at a very modest salary to me.  If you worked it out on a fee for service basis then the NHS pays most doctors a fraction of what it would cost to see a similar professional and I am not moaning about that either.

I AM NOT COMPLAINING! This is what health care costs. The cost of dispensing a tablet is a multiple of the cost of the chemical. Involving professional fees, registration, premises, time, indemnity, staff, storage, audit and others.

"Big Pharma" has nothing at all to do with legacy drugs like clomipramine.

Without "Big Pharma" (which for sure has lots of faults) lots and lots of us would die from infectious diseases in childhood, as our very recent ancestors did in the pre antibiotic / vaccine era that lasted for 100,000 years of human history.

But perhaps some of you could make your own homeopathic shipwreck- calming apparently. https://www.maryenglish.com/homeopathy/

http://system-sat.de/lignum_naufragium_helvetiae.htm

Answering the question- get it from an online vet pharmacy.

Or maybe it’s the morality of how vets can charge so much of a mark up on some medications? 

Given the proliferation of online pharmacies, vets can put whatever markup they want in things - consumers can compare costs and buy via bricks and mortar or online pharmacies if the cost differential is sufficient to make it worthwhile.

It would have been the case twenty odd years ago that an unscrupulous vet* could gouge customers with a big mark up, but those days are pretty much gone, and in any case big mark ups used to cross subsidise professional services.

(* consider “to get something vetted” and “to get something doctored”)

I’m not sure vets are that less unscrupulous than before in their mark ups.

You go to the vet and pay x for a consultation fee. The fee for any medication shouldn’t cross subsidise other professional services. Take Amoxicillin/clavulanic acid. £15/20 in the vets for a small animal. 20p to buy. 

It’s not really a case of being unscrupulous - the cross subsidy thing (which has been declining for years) is really a hang up from a period when vets did not value their own advice or expertise, or perceive that clients did - so they tended to Bill more for tangible stuff like tablets as the client “got something” and less for consult fees/advice. 

I used to spend lots of time answering clients questions, investigating problems etc for free back in my GP days - would not happen anything like as much now, especially as we’ve been forced into remote consulting in the last few months.
 

20p to buy a (human) generic tablet maybe, but NOT 20p for the Veterinary licensed version which a Vet is legally obliged to buy/ supply. 

vets are highly trained professionals who have had 6 years @ £9250 tuition fees probably more in the region of 6 years at £12000 ( no paid work in the very short holidays they get, lots of travel and expense) and then like other health professionals extremely high expenses just to work. They all had to be in the top tiny percent of students to get a place  ( these days probably 10-12 A** GCSEs 4 A* levels)   
 

have you ever been to a solicitors?

my mum recently delivered a letter to a solicitors office  they charged the estate ( her friend had died) £120 just to receive it)

professional services cost money  there are lots of hidden expenses  

most small animal vets do not make much money all things considered  

race horse vets are a different matter  but we aren’t talking about race horses

To put this all in a context that is understandable and translatable to humans

the price of an NHS prescription is £9.15  

the total cost of issuing an NHs prescription for a cheap drug is in the region of £30-45  and the NHS is one of the most efficient health services in the world

https://www.itv.com/news/meridian/update/2017-01-09/pay-for-your-painkiller...

I sometimes get a prescription from the vet and buy from pet drugs online. Same meds but cheaper

I just reread your post. It isn't a hint - it's the way things are. There should be in the waiting room or somewhere similar the following notice.

Prescriptions are available from this practice.
You may obtain relevant veterinary medicinal products from your veterinary surgeon OR ask for a prescription and obtain these medicines from another veterinary surgeon or a pharmacy.
Your veterinary surgeon may prescribe relevant veterinary medicinal products only following a clinical assessment of an animal under his or her care.
A prescription may not be appropriate if your animal is an in-patient or immediate treatment is necessary.
You will be informed, on request, of the price of any medicine that may be prescribed for your animal.
The general policy of this practice is to re-assess an animal requiring repeat prescriptions for/supplies of relevant veterinary medicinal products every XX months, but this may vary with individual circumstances. The standard charge for a re-examination is £XX.
Further information on the prices of medicines is available on request."

https://www.rcvs.org.uk/setting-standards/advice-and-guidance/code-of-profe...

Prescription-only medicines  (human or veterinary) must not be imported without a license. Buying drugs from abroad off the internet without a prescription counts as importing.