As the economy continues to reject a rapid bounceback, I happen to know that more of you are looking for ways to curb your consumption of expensive veterinary drugs and products by sourcing them online or through big box pharmacies.
It’s also clear that the EPA spooked many of you after issuing an advisory for many flea and tick topicals (the primary reason my clients head to the web for savings). And the presence of counterfeit products online and in big box retailers has been postulated as one of the possible explanations for the surge in these products’ adverse effects on pets.
This is a big issue for veterinarians, as you can imagine. Though many vets might point to the evils of veterinarian-circumventing Internet sales as a driving force behind higher veterinary service prices and the cause of everything evil that afflicts the profession, the majority of us are far more concerned about the safety issues. After all, the web provides an easy means for unscrupulous merchants to offer counterfeit (read: potentially toxic and ineffective) products at seemingly incredible prices.
Q: So how can pet owners know for sure they’re getting the safe product their veterinarian recommends?
A: They can’t...not for sure, anyway.
Nonetheless, I can offer you some tips that can help you make the process as safe as possible:
#1 Beware companies you’ve never heard of before or that don’t come highly recommended from someone you trust. Stick to companies that have a reputation to protect.
#2 Ask your veterinarian for a recommendation. (Many vets are highly receptive to this and most have plenty of experience with online retailers/pharmacies.)
#3 You can always check the Better Business Bureau (BBB) for complaints lodged against any company you plan to do business with. (Sure, this might seem annoying and it might not help when you realize that all these companies have received some complaints but it’s a place to compare outlets, anyway.)
#4 Know that trademarked drugs tend to be your safest bet. After all, you can see what they look like and match them up against the manufacturer's pictures (usually available on their websites). The biggest risk here is for drugs that are dispensed by the pharmacy’s stash in separate vials (independent of manufacturer packaging). There’s always the risk that they might be expired.
#5 Big box human pharmacies tend to be more reliable for generic, non-animal drugs. They’re often more tightly regulated. For example, Walgreen’s online (or the brick-and-mortar variety) is more likely to get squeezed by the DEA and FDA than Pet Meds Express. Not to say that the latter is doing anything wrong. In fact, the reliability of human pharmacies in general probably compares very favorably to that of individual veterinarians as well.
#6 "Vet-only" flea and tick products, in particular, are least reliably purchased safely online. That’s because veterinarians are the flea and tick manufacturer’s intended distributors. So that means that whenever non-veterinarians carry Frontline or Advantage––whether they be online pet supply outlets or brick-and-mortar retailers––they’re doing so in the least-regulated of all scenarios. We call this the “gray market.” It’s these cases where I’ve seen counterfeit products––or those diverted from other countries––even from some of the most well-known suppliers.
#7 Beware any company willing to sell you drugs without a prescription. You should know better, anyway, right? If your veterinarian doesn’t have a record of a prescription or refill authorization that’s a sure bet you’ve reached out to a shady operator. Never a good sign.
#8 Make sure your pre-packaged veterinary drugs and products come with expiration dates and lot numbers. To check and see whether the company you’ve bought from is legit (and the product itself is safe), call the manufacturer and ask where this product originated and if it’s a vet-only flea and tick product, what veterinary hospital purchased it.
***
If everyone took these measures to heart to ensure the safety of their drugs, products and supplies, we’d go a long way towards putting some foul players out of business...and towards making all pets much safer.
Do any of you have any additional items you’d like to add to my list? I’m all ears...
Add Comment32 Comments
I couldn't afford Zack's meds if it was not for the big pharmacys. I use Sams Club for his heart medicine.
I use Dr. Foster and Smith for the Deramaxx. I would love to support my vet more by buying the meds thru him, but he doesn't carry the heart drug, and the Deramaxx is about 4 times more expensive, as it is - I am paying about $40 a month for it. I figure they are such a big name in pet products, and have been around for a long time, they have a good reputation.
Sam's is great about filling pet prescriptions, and has the lowest price on everything, you don't need to be a member to use the pharmacy.
Teri June 4th, 2009 01:48:07 PM
No WAY we'll purchase medicines and medications from the internet. It's either from our Vet or a legitimate established Pharmacy no compromise.
Evet June 4th, 2009 05:58:34 PM
Dr. khuly,
Rich Parsons has posted many times about a "cease and desist" letter you personally received from a certain manufacturer of flea & tick products. Could you please publish the letter on the thread below your blog on that manufacturer?
Josie G June 4th, 2009 05:58:35 PM
Josie G: Unfortunately, it was sent directly to my employer at The Miami Herald. It was read to me by telephone. I was never granted a copy by their legal department. Thanks for asking, though. It did ask for an apology and a retraction, if that helps any.
Dr. Patty Khuly June 4th, 2009 06:28:26 PM
Here is a link to the EPA's site about counterfeit flea and tick products: http://www.epa.gov/pesticides/health/pets.htm It has pictures of things to look for that indicate that the product is counterfeit, but these things are not always present. Also, the package has to be opened to look at the vial. Usually not going to happen at a big box retailer, and certainly not from an online source.
Here in Michigan, a big-box retailer - not a pet store, a home-improvement store! - was selling Frontline for less than we could purchase it for! Our Merial rep investigated, and the product they were selling was counterfeit. Our local store pulled it off the shelves, but others in the chain did not.
sassy June 4th, 2009 06:54:10 PM
Dr. Khuly,
So it was a "cease and desist" to the Miami Herald who publish the column, not to you personally? Or it was to you personally, but mailed to the Miami Herald and they opened it and the Miami Herald Legal Dept. wouldn't let you see it? If the Miami Herald did that, it was a Federal violation. By law, you are not allowed to open US Mail that is addressed to someone else. Your employer could be in trouble.
Josie G June 4th, 2009 06:58:15 PM
There are a few of us in Michigan on this blog so would like to know the name of the store selling the counterfeit products - although I won't buy them there, but would like to let them know I won't buy ANYTHING there if they continue to sell what they know is counterfeit.
dottie June 4th, 2009 08:20:44 PM
Dottie, I agree with you, I'll never go there again. It was Menard's.
sassy June 4th, 2009 09:05:21 PM
Well, I do wonder, (only because I sort of remember reading something on this..) doesn't the EPA consider it counterfeit even if it IS the real product, but it is say the Australian version?
which doesn't really make the product counterfit, just different formulation/packaging/regulations then those sold in this country.
for me with frontline, it's a mute issue anyhow. Frontline no longer works in my area.
I do order a huge % now from 2-3 favorite suppliers online and it saves quite a bit. The same with the $4.00 walmart/target prescriptions. I know my vet doesn't love it, but I am not paying the 300% markup.
LorriM June 4th, 2009 09:25:14 PM
The counterfeit product I identified was from a PetCo store––though it wasn't within the past 11 months. I hope that doesn't bring about another round of recriminations and legal letters.
And yes, Josie G., it was to The Miami Herald that the Hartz "cease and desist" letter was addressed. In most ways that was a blessing. At least I didn't have to hire my own lawyer. Unfortunately, it also meant that the apology and retraction was applied on my behalf. Not fair in some ways, but it wasn't my responsibility given the adressee.
Dr. Patty Khuly June 4th, 2009 09:33:53 PM
LorriM: Our markup is only 100%. In other words, we only mark up a $30 to $60. BUt when you consider the stocking and inventory-taking, it's not a big money-maker. For us, it's a convenience we offer our clients. WE DON'T MAKE MUCH ON IT AT ALL.
btw, which are your favorite suppliers? We'd love to know.
Dr. Patty Khuly June 4th, 2009 09:36:46 PM
When people ask about getting flea/tick and HW preventatives online, we try to match the price. Since some companies charge shipping, we figure that into the price we'll sell it to them for. We explain that we'd rather not make much than to risk the health of their pets with a possible counterfit product. Showing we care about that more than the $$, makes clients appreciate and trust us. In Ohio, vets are not legally required to give written prescriptions for anything (meds, food, etc.), and I know a couple who tell clients they won't write scripts for meds (HW preventative mostly) that the client wants to buy online. They say it's to prevent clients from buying counterfits, but the way they go about it doesn't make clients appreciate the reason.
KateH June 4th, 2009 10:27:59 PM
In our vet hospital we lowered all "flea, tick, etc" type products to match 800-PetMeds prices as a courtesy to our clients. We've also informed them about the possibilities of counterfeits. We still have clients who buy Rimadyl (no prescription necessary) from Australia at a too-good-to-be-true price.
I've done some deep and persistant internet searching (my previous career) and found connections between this retailer (whose stated main market is the US, and whose other incarnation is as an Austrailian furniture importer) and Chinese import/export companies. I believe this connection to be stronger than the Iraq/alQaeda connection. And I assume the worst from the Chinese exporter based on the past 5-year flow of dangerous human medicines produced there.
I can dig up the names and links later. Right now we are in the final stages of preperation for AAHA accreditation.
Rob O June 5th, 2009 07:13:58 AM
Rob O and Kate H: That's the right tack--lower the drugs and products to a competitive price--for safety reasons and to prove that you're not out to abuse their trust and their wallets. You simply want what you believe is best for your patients.
KateH: I'm not sure that's the case on your Ohio law. My understanding is that veterinarians cannot withhold a prescription--anywhere. Not only is it illegal to do so, it's absolutely unethical. Regardless of how we feel about where our clients get their drugs, it's wrong to force our clients to suffer our markups--that is, unless we're willing to match the price.
Rob O: Congrats on the AAHA thing!
Dr. Patty Khuly June 5th, 2009 07:54:01 AM
Dr. Khuly:
You might find this interesting. As of Oct 08 only 26 States required Veterinarians ( under state law or regulation ) to write prescriptions upon client request.
I realize the following is a personal website but I have checked out numerous State Veterinary Websites and the list appears to be correct.
http://members.verizon.net/~vze2r6qt/supplies/legal.htm
The AVMA's stand "Drugs may be dispensed or prescribed. Veterinarians should honor client requests to prescribe rather than dispense a drug (AVMA Principles of Veterinary Medical Ethics) The client has the option of filling a prescription at any pharmacy."
Elizabeth - From Nova Scotia June 5th, 2009 09:38:03 AM
Elizabeth: Thanks for this. One more thing to lobby for/against. How to change the world? One script at a time!
Too bad doing the right thing isn't always legislatable. :-(
Dr. Patty Khuly June 5th, 2009 09:57:56 AM
That web site is interesting. If you read some of the states, it seems that it is discretionary, even actually unknown....I wonder if it simply means that before a few years ago, people didn't ask for an Rx...
I wouldn't use a vet that refused me a rx regardless of what state I was in. I fully support vets making money practicing medicine, but not as food or drug distributors. Having choices means more people are likely to comply with long term medication regimes if they can get the drugs at reasonable prices.
And if FDA says that most flea and tick products are EPA regulated, that makes the vet a pesticide distributor as well....how incredibly convoluted and bureaucratic...makes my head hurt just thing of the ways people are taking advantage of by unethical practitioners. Both online and in person.
When people ask me why I don't trust my vet and doctor blindly, it is because of these conditions. It has little to do with my faith in them and more because if you don't educate and advocate, then sooner or later a mistake is going to be very costly.
LorriM June 5th, 2009 10:13:23 AM
Yes, I'd always assumed they had to give scripts, but a friend was going to a vet in another county for allergies his cat had, and she refused to give him a script to buy prescription food from Banfield, which sold it for less than her clinic did. She also was insisting on using a non-generic antibiotic and when he asked about getting a script to get it at Walgreen's, she denied him that, too. He switched vets. Yes, completely unethical, and professionally stupid, but yep, it's legal.
KateH June 5th, 2009 10:16:54 AM
Rob,
if you are referring to 800 petmeds as having chinese connections, I think I remember seeing something on the news a WHILE back about how they are related to 800 contacts, run by an indian man/group and were filling without RX... etc...
again limited brain capacity doesn't remember details....but it should be still floating around in cyberspace someplace...
LorriM June 5th, 2009 10:18:50 AM
Dr. Khuly,
You deserve whatever markup you get. I once owned a shop and I know how costly it is to carry inventory and then be responsible for all the overhead of stocking, selling & managing. We need our wonderful vets, like you, not to have to worry about all that crap and to be free and available to animals in need, not worrying about whether you'll be stuck with costly inventory after you've paid for it.
I think you have to correct Rich, Dr. Khuly. He's all over the internet using your name, saying that both you, personally, and the Miami Herald independently received threatening intimidating legal letters from that manufacturer. If that's not true, you look bad. Worse, if they were to decide to challenge you publicly, and ask you to produce the alleged letter in a court of law. Don't get dragged into the dirt by other people with an axe to grind. Be true to your wonderful self and stay above the fray. That's just one person's opinion, who respects who you are.
Josie G. June 5th, 2009 11:18:13 AM
Josie G. Thanks for this info. I will look into it. Truly, though, Hartz deserves whatever they get from Rich's vituperations. If it really does mean that the word gets out then I'm not going to make a fuss. However, I will email him and ask that he be accurate in his representation of the details--no need to get sued for no good reason. In my original post on this, I believe I was clear on who got the letter and why. That alone should keep things quiet for me--but who knows?
Dr. Patty Khuly June 5th, 2009 12:33:50 PM
LorriM - the EPA does not consider flea and tick products, or drugs, from other countries as counterfeits, if they are made or authorized by the original manufacturer, to make the drug in that country. However, it is illegal to important them into this country. I once looked into getting some of my prescriptions from Canada - my doctor even mentioned trying it. But my research showed that it is illegal, so, even if I could get away with it, I won't do it.
Counterfeits are made illegally, without permission from the original manufacturer, and may contain anything, from different types of pesticides (which may be dangerous) to inert ingredients (so they don't work like they should), or may be contaminated with other substances, which can cause adverse reactions. Scary!
Sassy June 5th, 2009 06:43:03 PM
Sassy,
actually #11 on this page refers to the report I remembered.... http://www.epa.gov/opp00001/factsheets/petproduct.htm#counterfeit
I don't remember who did the report however....some news ...and it was a while back <lol>
LorriM June 5th, 2009 08:59:05 PM
From the EPA website referenced above:
You should be careful when purchasing products such as these to look for the indicators described above. In addition to the counterfeited products described above, other illegal versions of these products may be available, including the following:
foreign labeled product with stickers containing some U.S. information
foreign-labeled products.
These illegal products pose potential risks related to units of measure that are unfamiliar to U.S. consumers, lack of child-resistant packaging, lack of precautionary statements, and the potential for the pesticide itself to be other than what is indicated on the carton.
Oh.
So Americans are too stupid to figure out mg per kg.
Got it.
I manage. Funny thing, working in the base-ten world of metrics, I screw up dosing math less often.
As for "lack of child-resistant packaging," that's pretty rich when speaking in reference to Frontline and those other nasty foil-and-plastic jobbies that are clearly designed to spill all over the human, necessitating another astronomically-priced dose for the dog, and as far as I can tell, doing nothing for the human in regards to ticks.
But in case the EPA was super worried, the stuff I get from Australia comes in the exact same infuriating adult-proof packaging, and has a helpful metrics-to-stupid-American chart for the dosing. And is like 1/3 the best domestic price.
H. Houlahan June 6th, 2009 12:36:54 AM
H. Houlahan: I agree on the packaging. I have to use scissors to get into my Atopica, too. And Frontline? Jeez! Even with scissors I've been known to make a mess. If the packaging gets any more complex I'm going to have to start taking out a surgical pack to get into my stuff.
Dr. Patty Khuly June 6th, 2009 05:46:03 AM
H Houlahan,
I hear you...<lol> worse yet, since the product I use now is the same as the dog products (and yes my vet knows I do this) I order the biggest dog package and get about 5 cat doses out of each vial...
OMG... call the cheese police....
now each product is NOT always the same and people "should" read or ask their vet about doing that..(some dog products contain different ingredients that could harm cats) .and no doubt someone will be along to once again chastise me on my practices. Because I care what they think..<lol>
LorriM June 6th, 2009 01:29:25 PM
I dunno.. when Bayer sells the IDENTICAL product and labels one in the UK (called "Advocate") for use against demodex, with references on its website to the clinical study demonstrating effectiveness; the other in the US (called "Advantage Plus") and NOT labelled for demodex (my vet assumes because Bayer didn't want to, or hasn't yet, gone through EPA approval,) you know that warning against Rx drugs "diverted from other countries" isn't always the whole story.
The issue isn't buying perfectly legitimate and identical products in the "gray market" because they are cheaper. The only issue should be helping people determine how to identify whether the packaging is legitimate or indicates a fraudulent product. After all, crooks can counterfeit a US package, too.
EmilyS June 7th, 2009 10:24:49 PM
Dr. K, Even asking for a script from a Texas vet puts your pet at the risk of retaliation from the vet because many (most, IMO) are so very offended by even the request. You may not use meds as a profit center but our vets here certainly do.
Elizabeth, thanks for the link!
PJBoosinger June 9th, 2009 05:05:09 AM
You won't find many posts from "Josie G." on Dr. Khuly's website, or from "Olivia" or "Annie" for that matter.
Why should "Josie G." care if Dr. Khuly personally received a 'cease and desist' letter from Hartz? How does she know that someone is "all over the Internet" saying that Dr. Khuly received a 'cease and desist' letter from Hartz, and how does that make Dr. Khuly "look bad" if it's not true? How would it be "worse" if Hartz decided to "challenge her publicly," asking her "to produce the alleged letter in a court of law" if Dr. Khuly never stated that she personally received it?
The 'cease and desist' letter that Hartz sent to the Miami Herald put Dr. Khuly in a very difficult situation.
Has Dr. Khuly personally received a "threatening intimidating legal letter" from Hartz? I don't know, but they did try to get her to "correct" a statement that she made on her website:
http://www.dolittler.com/2009/04/27/The-EPA%E2%80%99s-finger-wag-at-the-topical-pet-insecticide-industry-is-this-the-pet-food-recall-revisited-.html
Here is what Dr. Khuly posted:
As to Hartz convincing me their products were not listed, that was only true for the first list. I have taken my lumps on this one and have amended the post to reflect this.
The Hartz veterinarian is also adamant that I correct something on this post. She argues with this statement:
"Despite the fact that you and I know that anything that goes ON any animal with a porous membrane for protection (i.e., skin) will end up IN him, pet flea and tick manufacturers have long understood that when it comes to animals, life is easier if you're dealing with the EPA instead of the FDA."
Her take is that these products are not intended to go inside an animal and that they do not, unless they are inappropriately applied.
But I don't agree.
#1: Pets will be pets and they have ways of ingesting things that go ON them, no matter how careful we are in applying them. This possibility must always be taken into account when using any product.
#2: Most of these products are taken into an animal's body through absorption--even in only minute quantities. There are no studies to demonstrate the lifelong effects of chronic exposure to these products.
Sorry, Hartz, but the statement stands.
That may not be a "threatening intimidating legal letter," but anytime a company asks a writer, especially someone who also happens to be a doctor, to "correct" something that he/she wrote, I can see how that could be viewed as being intimidating.
James June 12th, 2009 01:14:30 PM
I have the utmost respect for my vet, but they are absolutely making money on prescriptions. They charge $20 EXTRA, on top of mark-up, for every prescription. So, I pay $40 for a $12 bottle of Clavamox. In my mind, that's excessive. I pay it willingly in an emergency. One of my cats had an allergic reaction after a day on the first of two $40 bottles that I had to purchase. Of course it wasn't returnable, so I was out the $80, PLUS the ridiculous amount for the new drug. For routine drugs (heartworm, flea products, wormers), I always turn to the internet. I have 3 cats, a dog, and 2 guinea pigs (all rescues); there isn't any other way to pay for all of their special care (cardiac ultrasounds, dentals, emergency stomach surgery) if I don't try to save somewhere. Sad, but trrue.
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