Vet News Online pet pharmacies: The good get Vet-VIPPS, the bad miss out and the ugly fight back

Yesterday’s telephone call from a major online pet pharmacy was totally unexpected. When I heard it was on the phone, I figured I’d get treated to a sales pitch. The last thing I expected was a contentious phone call over a request for “language clarification.”

It was the pet pharmacy’s in-house legal peeps, calling over last week’s USA Today column. Here’s the “objectionable” language:

“...[H]ere's something you may not know: Pet pharmacies are not regulated the same way human pharmacies are. If the FDA and the DEA have trouble keeping human pharmacies on the level, what do you think veterinary pharmacies get treated to?”

The “implication,” claimed the pharmacy’s pitbull (whose legal department status I had to extract), is that pet pharmacies are not licensed and not regulated.

“Hmmm...that’s a stretch,” I said. To be honest, I don’t believe anything I wrote could be misconstrued in that way except by those who work hard to identify “implications” and bully “clarifications” out of quivering columnists. “And why are you calling me and not my employer, anyway?”

After all, that’s the professional way to handle this kind of dispute. Contacting an inconsequential, “special to USA Today” columnist like me when they should be talking to my behemoth employer is a blatantly unethical, big-stick scare tactic.

I should know. This isn’t the first time I’ve been harassed by corporations looking for a quick, belly-up response.

That was my stressful end to a busy day.

But here’s the good news: As for all infuriating, corporate bully calls that come my way, there’s always a silver lining. Though I always have to suffer a prickly interaction I’d normally rather avoid, I do get to see some naked underbellies as I invoke the universal truism that a good offense is always the best defense. (Pushing buttons is always fun, right?)

In this case, here’s where I learned that this company (presumably like many others in its category) is nervous about its inability to receive a new certification for veterinary pharmacies called Vet-VIPPS. That’s when I did some digging.

Though I’d heard of Vet-VIPPS, I hadn’t fully explored it, thinking it just another one of the online pet pharmacy industry’s ineffectual tactics aimed at legitimizing itself in the eyes of consumers. However, it turns out that this kind of certification really does have some merit.

Pharmacies who apply have to prove they meet all the criteria for legitimate operation in accordance with the National Association of Boards of Pharmacy (the foremost consumer-protection organization in the pharmacy industry). And it’s a long list. From the NABP website:

“In 2009, the National Association of Boards of Pharmacy launched the Vet-VIPPS program to address a growing sector of Internet pharmacy; Vet-VIPPS will incorporate new criteria specific to veterinary pharmacies. The Vet-VIPPS program is an expansion of the Verified Internet Pharmacy Practice Sites program, which was established in 1999 after a coalition of state and federal regulatory associations, professional associations, and consumer advocacy groups provided their expertise to develop criteria for accredited Internet pharmacies to follow.

Pharmacies displaying the Vet-VIPPS seal have demonstrated to NABP compliance with Vet-VIPPS criteria including patient rights to privacy, authentication and security of prescription orders, adherence to a recognized quality assurance policy, and provision of meaningful consultation between clients and pharmacists.”

According to one industry insider, at least a half dozen companies (presumably the big players licensed in all 50 states) have forked over the $8,000 required for certification since January of 2009 when certification became available. Yet when I scoured the internet last night I could only find one company listed as Vet-VIPPS certified. And it’s been accredited since April.

VetRxDirect.com is the lucky recipient of this rarefied classification. The 75 or so others in this category (mostly mom-and-pop players, but this includes the big guys, too) have either not yet made the grade, not had the funds to apply or not cared enough to seek certification.

Despite the poor showing among pet pharmacies, Vet-VIPPS certification is likely the wave of the future if some states have their way. In response to consumer complaints and the exhortations of veterinary safety advocates, the states of Virginia and Indiana are currently considering excluding all but Vet-VIPPS certified pharmacies from playing in their backyard.

The writing’s on the wall: Those who do not receive Vet-VIPPS certification may not be eligible for a pharmacy license in states that require it. So if you live in Virginia, you may no longer be able to get the best deal on the internet. But then, do you want it if the pharmacy offering you the best deal online can’t promise not to buy dugs from overseas, won’t disclose the names of their distributors or lapses in its responsibility to require a prescription from your veterinarian?

For the record, online pharmacies that work through veterinarians (like VetCentric and VetStreet) don’t fall under the NABP’s Vet-VIPPS program. They don’t require this kind of certification due to the veterinarian’s direct involvement (the distribution chain is well established and the veterinarian’s direct involvement basically makes this an extension of their own hospital’s pharmacy). For better or for worse, you might say.

Nonetheless, it’s clear that the days of widespread counterfeiting, gray markets, distribution obfuscation and diverted products are numbered. Sure, there will always be rogue pharmacies on the human and animal side, but here’s where a little regulation goes a long way towards weeding out the vast majority of the bad apples.

Because selling drugs without a license is something every consumer and every regulator understands.

So regulate them to the tune of the human pharmacies on the federal level, I say. And if you can’t, then force them to comply with states’ requirements for higher standards through a system like Vet-VIPPS.

Will it mean you pay more for your vet drugs? Maybe in the short term. Maybe not at all. Either way, I promise you that haggles over written scripts and other uncomfortable veterinarian/client interactions on the subject of drugs and products will fall by the wayside when online veterinary pharmacies rise to a standard we can all comfortably live with.

***

Over on DailyVet, an impassioned reprisal of a post on the five lies pet shops tell.

September 15th, 2009

Add Comment46 Comments

Thank You Dr K

Hobson September 15th, 2009 10:50:10 AM

I just looked at two sites I frequent. One just said it was FDA approved and EPA registered. The other had a "Pharmacy Checker" seal which gave information about the pharmacy, including the fact that it was licensed by the NY Board of Pharmacy.

I'm thinking that maybe being licensed by the NY Board of Pharmacy is something positive. I'm not sure how their prices compare to the place I used to go, but that's the first place I mentioned. It saved me a lot of money, to be frank (I had a bulldog who was on a lot of medication, but my two current dogs are quite healthy, knock wood), and their customer service was always wonderful, but you've given me a lot to think about.

Susan September 15th, 2009 12:57:24 PM

You are learning, sadly, that even "insiders" feel the pressure of implied legal threats when they speak out about quality issues in the veterinary or "pet products" realm. You have violated the "See No Evil, Speak No Evil, Hear No Evil" rule. Keep violating it, it's the only way things will ever improve.

I am glad the encounter had an informational silver lining, for yourself and your readership here. I am all for even the most meagre steps toward quality improvement seeing as how it's all the wild wild west.

All the same, my concern is this: None of the criteria as outline above means much of anything. I wouldn't declare the days of counterfeiting numbered quite yet. The criteria seem to be . . . .

1. The supplier is able to fork over $8,000

2. The supplier has something written that "sounds good on paper" about patient privacy (anyone who works in an environment where privacy conditions exist knows that there is a big gulf between having something in writing that sounds reassuring vs. implementing reliable privacy protection measures)

3. Transactional soundness (authentication and security of orders, this can be achieved by purchasing vendor turnkey systems)

4. Adherence to recognized quality standard - that is meaningless without quantifiable, verifiable compliance inspections. Without those, this is just fluff. Without unnannounced sampling inspections, this is meaningless.

5. Provision of meaninful consultations between clients and pharmacists. Again, this sounds good, but how do you make sure they are doing it? Is it adequate to simply submit another nice sounding "fluff piece?" Without doing "secret shopper" type unnannounced quality checks, this is also meaningless.

Perhaps more detail on the quantifiable verifications being conducted would change my mind, but so far I don't see how this reassures the buyer of anything other than sophistication level of the seller, not quality or integrity of product. If there are not objective spot checks, a program like this runs the risk of turning into a "pay to play" type thing that only misleads consumers into a false sense of security.

Stefani September 15th, 2009 01:20:34 PM

Susan: Indeed, state license and FDA approval are good things. But this is what's required of them before they can sell you drugs––nothing more. It's like saying I have a license to practice. It doesn't mean I've been certified as a practitioner that has been audited and adheres to high standards. If the vet pharmacy business wasn't so shady to begin with they'd never have cause to need anything extra to prove they do a good job.

Dr. Patty Khuly September 15th, 2009 01:33:13 PM

Stefani: Great point. But if this process were so limited, why wouldn't all of them pass? So far I count one out of six. That alone speaks to the stringency of the criteria––or the sad state of veterinary pharmacy affairs.

Take a look at the criteria itself. Then look at the application process. There are inspections, btw, including follow up inspections whenever complaints are received by the NABP. It's not perfect but it definitely sets a reasonable bar.

Dr. Patty Khuly September 15th, 2009 01:41:39 PM

I honestly don't think it's such a huge stretch to read "Pet pharmacies are not regulated the same way human pharmacies are." and conclude "that pet pharmacies are not licensed and not regulated." I read through the USA Today article to see where you explain whether/how pet pharmacies ARE licensed or regulated but I must have missed it - I would like to know.

Anne September 15th, 2009 01:45:56 PM

Anne: Of course, I can see where the company was going with its argument. However, I'm not responsible for what someone might conclude. If they read "[not] the same way" to mean "not at all," I consider that a stretch. One is a qualified statement. The other is not.

In fact, "[not] the same way" more effectively implies that there is some regulation––though I'll concede that what that regulation might be remains unclear (and disparaged).

Moreover, explaining the details of pharmacy regulation would not have been appropriate here (much though it would have been fun to include). The column, after all, was not about a human/vet pharmacy comparison or veterinary pharmacy regulation. It was about a wide range of reasons why vet drugs are expensive.

The truth of the matter is that a clarification here does not speak to the point of the column and would not be to the pharmacy's advantage to hear me "clarify" things, anyway. It raises more questions than it answers and helps no one. Ultimately, this is not about truth. It's about bullying.

As to your Q on pharmacy regulation between human and animal pharmacies: They are both subject to the same legislation. However, animal pharmacies are not subject to equal enforcement of the laws' provisions. They are largely overlooked––that is, until expensive polo ponies die. This fact is not disputed by anyone.

Dr. Patty Khuly September 15th, 2009 02:39:34 PM

Thanks for the links, Dr. Khuly. I was able to review the criteria, but I could not access the application w/o logging in. I was able to access the "please read before applying" warning document and it in part reiterated the criteria.

I didn't see the part about inspections. Was I speed reading right over it? Or is it on the actual application form? All I saw was a reference to an "an" [read: one] on-site survey to be conducted after the application. Not spot inspection after certification. I know what kind of flurry goes on for an AAHA visit (from lurking on vet tech boards), and in some cases it is precisely to make sure the business presents itself as operating routinely at a level that is far above what it really does. Not all mind you: the place I know now coudl I'm sure, stand up to an unannounced inspection. But it can be gamed. This is possible because the inspections are announced, rather than unannounced.

Clearly a mountain of "process" documentation is required, but I wonder how accreditees (is that a word?) prove that they are "enforcing" these written policies.

Maybe better than nothing but . . .

Having first hand experience with having been misled by AAHA memberhips into believing it meant something it didn't I am going to say that without spot checks, it's possible that VIPPS accreditation could simultaneously raise the bar and yet ironically do more harm than good.

Perhaps one day the process will be mature enough that there is more quantifiable verification. Its a start.

Stefani September 15th, 2009 02:58:47 PM

Thanks, I am not trying to be argumentative, this is an important topic for me because my own vet likes to imply that the internet pet pharmacies are just not to be trusted, and I spend hundreds of dollars every month on prescription drugs and food for my dogs. I understand why it's expensive for a small vet hospital to stock all the meds they may need on a weekly basis in quantities they are likely to sell before they expire, but I've got four dogs on a number of meds that they will take every day for the rest of their lives, and the difference in price really adds up when you go through a bottle of Metacam every 3-4 weeks. I want to do the right thing for my pets and it's hard to get good information on keeping the costs under control.

Anne September 15th, 2009 03:16:30 PM

Anne: You are well within your rights to use an internet pharmacy for your pets' meds. In fact, I personally think you're within your rights to ask for generic meloxicam (if your dog hates the liquid, for example, and needs the oh-so-much-cheaper human stuff).

Anywhere you can legitimately save money is fine with me. And as long as these places are licensed, they are considered "legitimate." Do they have problems despite their legal status? Absolutely. Are they safe? Almost always. Do you have better options? Now, maybe you do. Personally, I would look into it. Your vet would be hard-pressed to deny you an Rx from a Vet-VIPPS certified pharmacy.

Dr. Patty Khuly September 15th, 2009 03:29:53 PM

Thanks for the information, I am going to ask about the meloxicam. And I will look for the Vet-VIPPS certification.

Anne September 15th, 2009 04:47:18 PM

patty, i swear i wrote my blog this afternoon, hours before reading yours! it was also about internet pharmacies (and kanye west): http://levittownvetblog.com/general/kanye-west-betty-white/

like you, i have no problem with clients turning to other LEGITIMATE sources for their pharmaceuticals, as long as it does not compromise patient care. the way i see it, i stock and dispense drugs at the hospital for the convenience of my clients. They don't need to take a prescription elsewhere and wait while it gets filled -the diagnosis and treatment are all provided in one convenient stop.

i DO have a problem with gray-market products and prescriptions being shipped without a doctor's approval. i don't think this will stop anytime soon. about a year ago, i decided that if i couldn't beat the internet pharmacies, i would join them. so i started my own and began matching prices with petmeds. it wasn't about making money or recapturing lost pharmacy fees -it was about making sure my patients got drugs that i trusted. and i can offer everything at a lower cost because i don't have to stock anything.

Dennis Leon, DVM September 15th, 2009 05:16:35 PM

Dr. Leon, That's using some real common & business sense!

As agreed with Stefani, it is all about the non-culpability involving animals, period. Regulations? Sure it will keep the honest, honest--but the others? Oh yes, just look for ways to go around it and maybe not even try that hard, because as you said above Dr. K. "they are largely overlooked".

FDA and DEA and state statutes govern the entire veterinary field, laws broken are just as serious whether a DVM or MD or DMD, but when it comes to being about animals, some how the standards fall apart. I get the part about the pet being a "toaster", but I still don't get the difference in violating the exact same laws, and never will.

Barbara A. Albright/NH September 15th, 2009 06:54:30 PM

Dr. Leon: email me. I'd like to hear more about your venture and your opinions on certification, etc.

Dr. Patty Khuly September 15th, 2009 07:34:50 PM

I have mixed feelings about this. I miss the days of walking into Haskell's Pharmacy and dealing with one single pharmacist, Mr. Haskell, who knew me, my family, my doctors and vets, and all my critters AND who did what little compounding could be done back then. But I know those days are long gone. Part of me wants federal regulation but that comes with its own detriments. Part of me likes this kind of private certification but hopes it doesn't become a "write a check/buy your certification" process and really, really hopes there are at least 2 of them competing to give us the best of the best.

I wonder if there's any chance at all that these types of certified pharmacies could carry the "vet only", not really Rx products and that silly "we'll try to weasel out of responsibility" from the manufacturers could stop.

Barbara, "when it comes to being about animals, some how the standards fall apart" I've been stuck in research mode because I can see we're being heard although the materials are somewhat scattered. Give me a couple of more days to pull it all together but, from what I'm seeing, our pets won't be considered "toasters" much longer. I think you'll like the information and links I plan to post by end of week. (Yeah, my blog's never going to be daily :)

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