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Walmart is one of many commercial pharmacies now filling prescriptions from veterinarians and aiming for a slice of the animal-health market. The company supports the Fairness to Pet Owners Act, which would require veterinarians to write prescriptions for drugs to be filled outside of their practices. Critics counter that veterinarians already offer prescriptions when asked and say such a mandate would be burdensome and onerous.
Legislation that compels veterinarians to automatically provide prescriptions to clients was revived last month after two earlier attempts failed to pass Congress.
The Fairness to Pet Owners Act — HR 3174 and S 1200 — would require practitioners to give written prescriptions for pets that may be filled elsewhere, even if the clients don't ask.
Both bills have been referred to committees.
Unlike previous attempts, the latest Fairness to Pet Owners Act “may have legs,” warned Dr. Ashley Morgan, assistant director of the American Veterinary Medical Association Governmental Relations Division in Washington.
“Despite the significant opposition to this bill, some in Congress have expressed interest in moving the bill,” Morgan wrote on the AVMA’s blog. “Should HR 3174 pass out of committee, it would be very difficult to keep it from moving forward and potentially getting floor time.”
She added: “We do not believe that this bill will improve patient care. Writing unnecessary prescriptions is a regulatory burden that wastes time and resources that veterinarians and their staff could be using to care for animal patients. If a client wants a prescription, all they have to do is ask.”
Bill proponents maintain that many pet owners are unaware that they can shop around despite heavy advertising by Walmart, Costco and the like, which is educating consumers about the growing landscape of pet pharmacy choices.
Major retail pharmacies are in aggressive pursuit of the pet medications market, a business that the American Pet Products Association valued at approximately $7.6 billion in 2013. Historically, veterinarians have prescribed and sold pet prescriptions through the in-house pharmacies in their practices. Bill opponents point out that most retail pharmacists aren’t trained in veterinary pharmacology, which has led to mistakes and unauthorized prescription changes.
AVMA officials say practitioners are ethically obligated to script out when asked, and regulations in many states require it. On the association’s blog, Morgan argued that veterinarians aren’t refusing to script out to clients and pointed to a report from the U.S. Federal Trade Commission, which was prompted to study the market after the first Fairness to Pet Owner’s Act bill appeared in 2011.
The agency released its report in May.
“When the Federal Trade Commission issued its report late this spring that examined the accessibility of veterinary drugs in the pet products industry, at no point did the agency find evidence that would suggest that veterinarians are not providing their clients with written prescriptions upon request,” Morgan wrote. “Essentially, this legislation, then, would be creating a solution to a problem that does not exist.”
Morgan's statement does not reflect all the FTC had to say on the matter. The FTC acknowledged in its 121-page staff report that veterinarians are willing to write prescriptions. The problem, the report said, is that even when pet owners are aware that they can request a prescription, some won't ask for it because they're afraid or uncomfortable.
After interviewing stakeholders, FTC staff determined that "affirmatively asking for a prescription can be intimidating to consumers and that this intimidation factor can be amplified when veterinarians require waivers of liability, make disparaging statements about non-veterinary retailers (e.g., suggesting that the product may be counterfeit) or require extra fees for prescriptions.
"... Pet owners do not want to feel that they have somehow degraded or compromised their relationship with their veterinarian, even when they know the veterinarian has a clear economic interest in selling pet medications," the report said.
When asked why the AVMA blog post did not reflect those statements, Morgan responded that the article "served merely as a top-level summary of the FTC's report for our members ..."
By email, she added: "We believe that the FTC’s report offered many suggestions on how the pet medications industry could improve but lacked much evidence or data to support how this would help pet owners or prove that a problem actually exists. We do not believe that a federal mandate is necessary to solve a problem that may or may not exist when market forces without government intervention could, in the long run, drive further competition."
While the FTC acknowledged that the market is more competitive than in the past, the report identified needed improvements. FTC staff was critical of the longstanding and established policy by many large veterinary drug manufacturers to sell medications exclusively through veterinary practices.
"Veterinarians traditionally have been the principal source of pet medications for consumers, and many appear to believe that they are best suited to dispense these products safely to consumers," the report stated. "In addition, veterinary practices typically derive a significant portion of their income from the sale of pet medications, and many veterinarians have expressed concern about the financial impact to their practices of losing these sales. For these reasons, many veterinarians favor a distribution model in which they are the exclusive seller for most pet medications and oppose any changes that would make pet medications more readily available through other distribution channels."
On the other hand, the report continued: "Some retailers believe they could more effectively compete with veterinarians if portable prescriptions were more widely available to consumers and if it were easier for them to obtain supplies of pet medications. Manufacturers and veterinarians have expressed concerns, however, about the ability of retail pharmacists to dispense pet medications safely."
Retail pharmacists unaccustomed to dispensing drugs to pets sometimes misunderstand veterinary prescriptions, apparently out of ignorance of veterinary pharmacology. Veterinarians report that such changes often involve altering prescribed dosages or substituting one medication for another.
The Fairness to Pet Owners Act is supported by a group called Advocacy for Pets and Affordable Wellness, which claims to be a national coalition of pet owners and advocates, though it is unclear who is behind the group. The website lists 45 retailers that fill pet prescriptions, including those with active lobbyists such as Walmart.
Records from the Center for Responsive Politics, a research group that tracks money in U.S. politics, show that Walmart, Target, Walgreens and CVS Pharmacy collectively gave more than $15,000 to Rep. Jason Chaffetz during the 2013-2014 political action committee cycle. Chaffetz, a Republican from Utah, is the lead sponsor for HR 3174.
The same goes for the lead sponsor of S 1200, Sen. Richard Blumenthal, a Democrat from Connecticut who’s received thousands of dollars in campaign contributions from Walmart despite having a shaky track record with the mega-retailer. As Connecticut's attorney general in 2006, Blumenthal successfully pressured Walmart to carry the emergency contraceptive Plan B by threatening to exclude the pharmacy chain from the state's insurance program if it wasn't dispensed.
“… I believe medical decisions should be made between a patient and a physician, not a pharmacy,” he said.
Many veterinarians feel the same regarding pet prescriptions.
“This is ridiculous! If clients request a prescription, we write one for them,” Dr. Patricia Hidalgo of Amory, Mississippi, wrote in response to the AVMA blog post. “We have had recent experiences with pharmacists changing prescriptions we have given to clients for their pets, without calling to check with us first. They have questioned our dosages and our choice of medication. In one instance, it resulted in the patient's death.
“Pharmacists are not trained in veterinary pharmacology and seem to have little respect for a veterinarian’s education and multi-species training,” she continued.
Some in the veterinary profession don't have a quarrel with the legislation. On the Veterinary Information Network, an online community for the profession and VIN News Service parent, practitioners debated whether writing prescriptions for every patient truly would be problematic.
Nearly all said yes.
Dr. Michael Alt, a practitioner in Burke, Virginia, offered a proposition to colleagues who may doubt that generating prescriptions for patients would be onerous. "Take a month, and write out a prescription for every medication for every patient that comes through your door," he said on VIN. "And I mean every one ... even if they say they want (the medication) from you. Then get back to us with how things went. I'd be curious to know how you feel about the law after doing that."
The need to defeat the bill goes beyond inconvenience; it's a matter of independence, added Dr. Ron Gaskin in Shakopee, Minnesota.
"If we do not stand united for our profession, corporate special interests will direct our vet practices," he warned on VIN. "They have an agenda and a goal. Get active politically or try to practice with the consequences! Please let the AVMA and YOUR LEGISLATORS know how important this topic is to your practice health, your patient's health and how also important veterinary drug compounding is to our non-human patients."
AVMA officials want veterinarians to share such thoughts with congressional leaders by contacting them directly or signing an action alert crafted by the organization.