(As you may well have noticed, my posting has become far less frequent than my typical. For that I heartily apologize--it seems that blogging does not work well on Royal Caribbean Cruise Line (just letting you know should you ever try it). I have been unable to upload my posts due to poor connection (the connection times out before I'm able to upload) and my trusty Mac is not supported.
Next week you'll be seeing posts in the double-digits but this week it's slim pickings until I can find another person with a PC and enough patience to survive the long upload.
Sorry!
For that reason, I've decided to re-schedule some of the most popular posts of the past until I can get back to my home base on dry land. Here's the first:)
Have you ever heard this term before? As in, not black, not white…but gray. Somewhere between the legal and the illicit market lies this amorphous zone of unease we call the “gray market.”
Vets have become all-too familiar with this term since online pharmacies began taking “vet-only” product sales out of our hands. These are the “gray” products—the supposedly “vet-only” items that have somehow managed to end up in the hands of these online retailers.
Merial, Novartis and Pfizer won’t sell their Heartgard, Frontline and Revolution directly to the likes of 1-800-PetMeds. They don’t want to be seen by vets as the bad guys who help others take the retail business out of veterinary hands. So where are online pharmacies getting these products if the manufacturers claim they aren’t selling them to non-vets?
The gray market for these products exists when some vets sell their surplus products back to online pharmacies or when third-party companies in other countries (less regulated than we are here) do the same. It’s technically not illegal, since the vet-only pharmaceuticals don’t have the same regulations as human meds and products.
The Merials and Pfizers of this world decry the gray market that allows these products to get re-routed to a third party retailer like PetMeds. And to show us how much they dislike this practice they stand up for their vets by refusing to stand by their products when sold through third parties.
But think about it: Isn’t it convenient for Pfizer to sell Revolution in a wider marketplace while shirking any legal responsibility for its safety or efficacy once it hits the gray market? It’s more profitable. It keeps vets happy. And so it’s brilliant!
Just because I’m critical of the whole industry doesn’t mean I wouldn’t buy from companies like this. In fact, I’ve ordered from PetMeds and I respect the science behind Pfizer’s products. What I object to is the marketing strategy shell-game that goes on behind the products that keep our pets healthy. The hypocrisy is not just odious on principle, its opacity hurts everyone but the big guys who know how to play the Goldilocks game—that is, they’ve got their moves down just right.
I started thinking about all this after I mentioned in my VetCentric post’s comments that it’s illegal for a vet to refuse scripts for products. And, so you know, that’s true for all states. There’s a Federal law that prohibits any medical provider from not offering a choice. Here’s a pharmacist’s explanation (as it appeared on the Veterinary Information Network):
There is trade law that applies (Robinson-Patman Act). No state specific law is required.
Under a menu driven business model (which is the traditional manner of veterinary practice) clients have the legal right to get their prescriptions filled at the source of their choice. If you interfere with that right you have committed a Robinson-Patman (Federal trade law) violation.
For guidance contact the Federal Trade Commission and talk to someone in the antitrust division who is knowledgeable about Robinson-Patman. Be prepared for a long conversation. Last time I talked with FTC it was a 5-hour long-distance phone call (on their dime). Unfortunately they sometimes don't get it right, either. I had to point out errors to the "expert" I was talking to - and she later called back to say that I was right.
I expect that PetMed is fully aware of the implications of Robinson-Patman. For a while they seemed to be gathering data about veterinarians' refusal to issue prescriptions. They can also afford to spend the dollars on the lawyers in private practice who will become experts in this area of law before they remove your skin.
-Doug Kemp, Pharm.D.
During the course of my research, I also read about a significant percentage of vets (including a well-respected vet in my area) who explain that they won’t write scripts for vet-only products if the retailers and manufacturers won’t stand by them. They claim (although there’s no precedent for this) that this scenario makes them liable for any issues a client might have with these pharmaceuticals. So they won’t write scripts. Period.
Under these conditions I can understand a vet who says ‘no’ to vet-only drugs—but antibiotics? Thyroid meds? Vitamins?? There’s no excuse for denying a non vet-only script according to Federal law. That seems pretty clear.
But now that I’ve heard the argument against gray market scripts I’ve got to wonder: Am I liable for my indiscriminate scripting of vet-only meds? Do I need to inform my clients before scripting? Should I include a caveat on all these scripts? What’s my legal position here? Does the Federal law protect us if we script out gray market vet-only meds? Are we breaking the law if we don’t?
I wouldn’t be so concerned for my own scripting except I’ve heard confirmed reports of PetMeds and others sourcing their products from overseas. I’ve heard tell of expiration date counterfeiting and expired product sales. It’s enough to make any legally nervous vet a nervous wreck. What if I’m hurting my patients with these drugs? What if some of the “flea and tick resistance” I’m seeing is because my clients are using expired or counterfeit drugs? How would I know?
I know that sounds alarmist but this is a relatively new concept for me. I don’t know what the answer is but I do know that vets are between a rock and a hard place on this one, convenient though that may seem to the yellow-eyed among us.
I do know, however, that VetCentric (the subject of the post that spawned this revelation) sells only on behalf of vets. This gives them the ability to buy vet-only drugs with impunity. But the PetMeds thing? I’m looking into it. I’ll let you know when I have more answers. In the meantime, I’ll rely on you to fork ‘em over if you’ve got ‘em.
Add Comment28 Comments
It was explained to me long ago that pet stores and internet shops like 1-800-Pet-Meds buy atleast some of their product (i.e- Frontline) from places like Germany. I'm going to have to pick the brain of the person that told me this as there is a way to tell the difference and how that is done is by looking at the serial number on the box.
This person is a tech for my vet, I just cannot remember what he told me exactly. What I do know is that my vet's staff are often questioned about whether these said products are any good beyond their expiration date. This leads to questions such as "Where did you buy the product from?" which some pet owners apparently have a problem with as they'll reply with "What difference does that make?"
What these clients fail to realise is that where they purchased their product from does make a difference and it isn't just about what is in their wallet.
Merial refuses to stand by these grey market products and who can blame them. I wouldn't want the responsibilty for another company that makes product under different standards than ours either. It's a lawsuit waiting to happen. Note that I'm not defending the FDA here in the states, but atleast if Merial screws up a batch, there is something that can be done about it. What is a person going to do with bad product that came from Germany? Not much other than complain because Germany's laws and regulations regarding medication, prescriptions and such are different than what we have here in the states.
Through the eyes of a vet, I'm not really sure how to handle such issues other than stick to your sources that you know are valid and don't dip into the grey market pot. If a client is that adament about using said product, make them aware that it's a buyer beware situation and why.
One would think that with all the mess that surrounded the pet food recall which is still isn't over as more reports are trickling in that people would get the idea that buying product from overseas or that is manfactured overseas doesn't always mean you get what you wanted for a fair price. Sometimes it can actually prove to be fatal and yet companies like 1-800-Pet-Meds don't care. This of course doesn't come to any surprise to me as they don't care about their customers or pets despite what Betty White is paid to say about them.
The same can be said about big box stores like Walmart. I think they should add "Made in China" to their labels as just about everything they carry comes from there. Price things cheap enough and people will come. Good for business, but it sucks for the rest of us as we have to listen to the never-ending whining that comes from people buying cheap crap from them that wasn't meant to stand the test of time. A piece of furniture that is put together with a screw driver is not the same as 100 year heirloom piece that was hand carved. This would seem obvious, but apparently people need this reality check occasionally.
Stacy September 15th, 2007 01:03:00 PM
What a sticky wicket! We're supposed to believe that meds straight from vets is safer than other sources..... just like the tainted food that was handed out at so many vets' offices.... IMHO it's all a bunch of marketing aimed to scare the bejesus out of us so our dollars will stay in the vet's pockets.
AGADORE'S MOMMA September 15th, 2007 04:40:00 PM
Personally, I have no problems using medications manufacturered outside the US for myself or my pets. Having done a lot of in-depth reading about the antics of the FDA (and knowing that we can all list example after example of FDA screw-ups), I'm comfortable using any medication manufactured in a country with, let's say, a "progressive" standard of living. I used to laugh when politicians would argue against importing drugs from Canada, because those drugs might not be "safe". I'm quite sure that Canadians demand that their medications be just as safe and controlled as Americans do. The same with Great Britain, Germany, Australia, etc. I've even used medications imported from India and Mexico when I was unable to afford the American version of the drug (my personal medication expenses total hundreds of dollars each month, and I don't have insurance), and the meds have worked fine. However, I do feel there's a bit of risk involved with those unless they're from an established source, and while I can choose to take that risk myself, I wouldn't choose it for my pets.
As for expiration dates, aren't they also a bit of a ruse by the pharmaceutical industry? There are a few large charities which collect expired medications and then "recycle" them for use by the poor in third world countries. I doubt this practice would be permitted, let alone supported, if it was actually dangerous. I think expiration dates are just something we all expect to see, not necessarily something carved in stone.
In summary, I think it's very kind of you to allow your patients to have access to less-expensive medications via the Internet, and if those companies sold dangerous or ineffective medications, they wouldn't stay in business. I have a beef against 1-800-Pet-Meds because they recently threatened to sue me over a domain name I've owned since 2003, but I have no problem with the concept (or with their competitors, heh).
Leigh-Ann September 16th, 2007 04:36:00 AM
I think I'm almost more uncomfortable with the stories I've heard about PetMed's tactics of getting prescriptions than I am with the stories of expired meds, foreign meds, improper storage, etc. They seem to be bent on getting around the patient-doctor-client relationship, like refilling prescriptions after they're expired, or replacing the prescribed med with a version they call "generic" but is really a different medication altogether. They turn the vets into the money-grubbing bad guys. Why go to an expensive yearly physical when you could just get a yearly refill through PetMeds? Why didn't your vet offer you the cheap generic version but the nice PetMeds lady did? I am hesitant to support a company whose commercials paint a trip to the vet as so darn inconvenient and expensive, and doesn't your dog just *hate* going to the vet, too? Er, there's a reason your vet wants to see your pet when he prescribes a drug, right?
People see the price of a medication and assume that the med is all they're paying for... But I personally don't view my dog's $50 a bottle Clomicalm to be the same as the PetMeds $34.99 a bottle Clomicalm, because when I purchase from my vet I'm supporting her office and her expertise, and paying for the time she puts in when I call with questions about how to use it.
I dunno. I don't understand why vets are being labeled as money-grubbing and PetMeds is viewed by so many as altruistic because they offer cheap prescription drugs. Of course PetMeds is also making money off of these drugs... And you are paying an unseen price somewhere.
I'm all for offering prescription drugs in the most affordable way possible, but I'd definitely opt for a company with a better track record than PetMeds. Why deal with a company that has been known to harass clinics to fax a prescription for a dog who hasn't been seen there in over a year? VetCentric sounds like they try to work with rather than against vets, which I think turns out better for patients.
It seems a little like the debate over low-cost vaccination clinics... they sure reduce vets down to the base level of vaccine-pusher, but you get a lot more pets vaccinated. Many of these Petco-vaccinated pets never see a vet for a physical because "they got their shots". Is the public health benefit worth the risk to the individual animal?
Megan September 16th, 2007 08:25:00 AM
I wonder how the set of people who'd happily buy overseas drugs of poorly-charted provenance overlaps with the set of people who were outraged by the recent pet food fiasco.
About expired drugs being sold in third world countries-- it's widely viewed as a problem. Expiration dates exist for a good reason (that being that many drugs, especially those that cost quite a lot to make, are unstable and break down; they break down even faster when transported and stored in less than ideal conditions. Handwringing over the plight of the poor doesn't change the cranky nature of hydroxymethylchickenwire, the key ingredient in most expensive drugs.) Having access to counterfeit and expired drugs is worse than having no access at all: after all, it's better to sit home and suffer than to walk miles to buy a dead drug for a day's pay, walk miles home (depleting energy with every step) and then suffer.
Back to enjoying this morning's "progressive standard of living", (let us say).
Thing One September 16th, 2007 09:48:00 AM
Great discussion.
Isn't it interesting that the vet industry works hard to ensure that animals get safe drugs while human docs take a far more hands-off approach? (Think of all the Oxycontin people can buy online!) Sometimes having a [financial] vested interest in a product means there's more safety, more service and more good medicine as a result. Doesn't it make you wonder about the human medical system?
Dr. Patty Khuly September 16th, 2007 10:06:00 AM
Thank you for this article! My current equine vet (a large, well-known practice in Wellington, FL) has a strict policy of not writing prescriptions. They charge almost double the internet retail price for drugs like Adequan, so my horse has been getting half the dose she needs because that's all I thought I could afford. I plan on bringing this law to their attention tomorrow.
As far as buying from vets, I feel like I support my vets (equine and feline) quite well. My cats are always UTD on shots and teeth, and my horse is a disaster area and needs the vet out at least once a month (if it's not IA injections, it's teeth or stitches or clogged tear ducts or acupuncture). If it's a one-time drug--antibiotics, eye drops, etc., I have no problem buying from them. If it's a lifetime thing (like Adequan), I'm looking for the best price.
Sarah September 16th, 2007 09:00:00 PM
Quick question for you--does a regular petstore fit into the "gray area" as well? I recently walked into a Petco (similar but smaller version of a big box pet store) and at the checkout line, they sold someone some Frontline. The customer simply told the cashier the sizes of her 4 dogs and the cahsier reached under the glassed-in counter and pulled them out. I thought Frontline was supposed to only be sold by a veterinarian.
Karen September 16th, 2007 09:15:00 PM
aren: Same thing. The pharmaceutical companies won't sell directly to pet retaliers. PetCo and the like get these products from third parties.
Dr. Patty Khuly September 17th, 2007 08:20:00 AM
This is all so interesting.....I've found PetMeds does NOT have the lowest prices. I use a site called EntirelyPets, but it's more or less the same thing- Just better prices. That being said, I've only used it twice. Once for syringes (for allergy shots) and once for FrontlinePlus. It was more or less an experiment. My Vet sells the FrontlinePlus for $10 more than Petmeds, et al. So I'm not really in a situation where it behooves me to buy from these sites. I don't think my Vet's mark-up is a big deal and once you factor in shipping, it's like $3 more. So, I'd rather buy from my Vet and give the money to him. JMHO. One thing that did tick me off, is when my dog started her allergy shots, my vet would not write me a scrip for syringes and charged me $1 PER NEEDLE from his office. He said he "wanted to be able to keep track of the needles", like I'm shooting up or something? I eventually found a site that did not need a script and ordered them, so that did make me a little mad. I guess I would order from those sites again, as long as I respect the law/practices of the country of origin (like Canada, the EU, etc.). If it's coming form China, I'm out.
Amy in Somerville September 17th, 2007 09:09:00 AM
Amy: Wow! That's $2 a day for a diabetic. $700 a year! Multiply that by twelve diabetics in your average practice at any one time and that's an extra $10,000 a year in revenues--just on needles! Add in the allergy shots and maybe you're up to $12,000. At most, needles cost 10 cents! That's a profit of $10,800! Why not charge a more reasonable fee for a spay and *earn* your income? Because the other vet down the road has priced his spays at $180. $180 for open-abdominal surgery! Is this crazy or what? If all the prices we charged were reasonable then perhaps those of us who charge a mandatory $1 a needle could stop making us all look like money-grubbing schmucks. Or maybe it's human nature to get the most out of any situation.
Dr. Patty Khuly September 17th, 2007 10:50:00 AM
I've never used the online sites, so I can't comment on that. One of my cats has several meds that we get from the local CVS, in addition to meds directly from his vet. They're not inexpensive, but as many people pointed out here, the food situation was scary enough. No way am I going to get important medications if I don't know where they're coming from.
Debby September 17th, 2007 03:18:00 PM
Grey-market goods from overseas are often made in the USA, or at least made in the same factory as the product sold in the USA. Especially for drugs, which are easy to transport, it's usually more economical to have a single plant make all that's needed, and have it made to meet the highest standards the manufacturer is going to encounter.
Check it out - the label will say where the drug is manufactured. Brand name products should be safe even if imported. There is some risk where generic drugs are concerned, since there are often many manufacturers located around the world.
Jim D September 25th, 2007 04:14:00 PM
I am looking over these posts and can't help but feel that a few are from either a.) vets, or b.) a spouse/friend of a vet. I look at my vet as an expert in helping me with my dog's heath. That's all. When it comes to meds, I get them where I wish. There is no discussion on this.
Trever Barker January 4th, 2008 02:23:00 PM
This topic makes my head hurt. Also, I'm still upset Patty is on a cruise and we're not. I have nothing useful to add besides that. :-(
(ok one thing. I like my vet so I buy my drugs from him/them. I don't think they're gouging me, but if they are so be it.)
Have fun playing shuffleboard you *&*&&%*&. Make sure the sturgeon doesn't accidently fall off the boat. ;-)
Larry March 13th, 2008 09:26:00 PM
I'd never set foot in a vets office that wouldn't write scripts. I seriously doubt that a lawsuit would ever find a vet guilty of any kind of malpractice because a pet suffered due to their owner acquiring meds outside of the approved system.
Sherri March 14th, 2008 06:42:00 AM
with the counterfiting scam that was uncovered several years ago
http://www.epa.gov/pesticides/factsheets/petproduc...
http://vetmedicine.about.com/b/2004/03/11/counterf...
I am very reluctant to purchase these products anywhere other than where the manufacturer will stand behind them.
I have been pretty fortunate in the care of my pets so far. One was diabetic, and I purchased her insulin and needles from the local drug store.. other than that, there has been some antibiotics, and other random one time medications, and for those I am willing to pay my vet's prices - mostly because I love him, and he recently opened up his own shop and I want to support him to ensure he stays in business.
Now if someone came down with a long term expensive medication and my vet wasn't willing to match online prices, I might have to reconsider that..
Connie March 17th, 2008 03:13:00 PM
Trever, given the nature of the blog it wouldn't surprise me if many posters here are, or know vets, or just have a lot of respect for the profession in general. But vets are hardly raking it in general and retailers do typically mark up product and accompany it with a guarantee.
emily March 17th, 2008 03:25:00 PM
A few thoughts from a vet: Megan: Bravo and well said. I would have to say that most "good" or "great" veterinarians aren't wasting the public's time by trying to make them pay more than what's fair for drugs we dispense, instead we are providing expertise and valued service, and providing medications immediately needed in many cases; which often ARE generics. There simply aren't generics commonly available for some drugs, some of which happen to be quite expensive, such as the antibiotic "Baytril" (enrofloxacin). Would you expect to go to your local grocery store and get groceries for cost? How is your veterinarian supposed to pay their staff, run their clinic, and cover cost of equipment and purchases, without charging appropriate fees, just like any other business? Also we have established a relationship with you and your pet, usually have done a full physical exam and diagnostic assessment, and recommended treatment that we feel is in your pet's interest based on our knowlege and experience. I don't think we are out of line by prescribing meds from our own pharmacies that we stock. That said, I personally will not hesitate to write a written prescription for someone that wants medications through other pharmacies (although I first warn them about potential dangers of using internet pharmacies); and furthermore I do not hesitate to call in prescriptions to Walmart or Walgreens drugstores as well as others, when requested by my clients. Some drugs, however are "for veterinary use only" and there are no human equivalents. On another note, why does there seem to be this feeling that "we vets" are just out to make a buck? I think the general public has NO IDEA how much the average associate veterinarian makes yearly, compared to their educational debt. Hey if I wanted to get rich, I would have been a human doctor or a lawyer, or some other such profession more likely to be financially rewarding. FYI the average graduate's debt load after veterinary school is now over $100,000; whereas average starting salary is only in the $60,000 range. A human doctor is going to make over twice that much easily. And we both went to the same amount of schooling to get there. The educational debt to income ratio for veterinarians is becoming so alarming that many choose not to pursue this career for that reason alone. The nation actually faces a current shortage of food animal/production animal veterinarians! So next time I hear someone complain that vets are just trying to make a buck, I'm going to pretend I didn't even hear you and be glad that you're not my client. I do this because I love animals, not because I want to get ahead in life (LOL, I've never really been ahead. My personal student debt is a 30 year loan which won't be paid off until I'm about 56).
Dr. Sarah January 20th, 2009 01:09:45 PM
Man vets are just trying to make a buck.
Jim May 5th, 2009 05:44:34 PM
Blah Blah, Yea and I sell roofs because I love keeping people dry. Stop complaining about your student debt lady.
Jim May 5th, 2009 05:50:53 PM
Ok, just a simple question. Why cant Merial take Petmeds to court if they are selling a "knock Off" of their product? I would assume that there could be many laws being broken here. Mail fraud, copyright (?), Im sure there is a FTC law also being broken? It kinda reminds me of the music/recording industry taking Napster to court to make them stop the music sharing that was going on. Any takers to answer this question?
Ed May 20th, 2009 08:39:03 PM
I tried PetMeds once and when they called my vet for the script, my vet inturn called me and offered me the same price as Petmeds. He said they go after young Vets fresh out of school with huge student loans to pay off and offer them alot of money in exchange for using their license to dispense these drugs. He told me they often use expired or nearly expired meds. He now will match any price for any medications I may need. That's a win/win for me! Perhaps some of you could ask your vets the same.
Val June 25th, 2009 01:50:35 AM
دردشة
منتديات
يوتيوب
ertwrt June 26th, 2009 08:50:27 PM
Hundreds of links of london jewellery in stock,Free Gift Wrapping,Complete links london jewellery collection,including necklaces,braceles,earrings.links london store links of london,links london Bracelet links of london Charms Cheap Links London,Fast Deliv ery!linksoflondon silver range for 2009 including links of london necklaces,Links Of London Earrings,Charms,and Bracelets links of london ,links of london Bracelet Earrings,links of london Bracelet Necklaces. The love for beauty is a nature of all human beings; the love for links jewelry is a habit of the public since various smashing links of London necklaces Tiffany Jewellery.
links london September 3rd, 2009 04:16:03 AM
The donkey means one Ugg Sale thing and the driver another ugg bailey button.The benevolent see benevolence and the wise ugg classic cardy see ugg classic tallwisdom.No man is his craft's master the first ugg classic mini day.two dogs fight for a bone coquette, and. A piece of jade unless cut forms no article of vertu.http://www.ladiesugg.com/
ugg boot September 12th, 2009 04:08:02 AM
tiffany jewelry
tiffany cuff links
TIFFANY October 26th, 2009 03:56:08 AM
bamboo knitting needles
bamboo walking canes
Motorized bamboo back scratcher
Edmund October 26th, 2009 08:55:03 AM
Add Commment