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A veterinarian who regularly refers clients to pharmacies that honor GoodRx discounts for drugs has found the coupons being rejected, for reasons he can't ascertain. H-E-B Grocery, for example, notes that a prescription for amoxicillin is $13.54 but the "discount card will not work for pet prescriptions."
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It takes just moments for Dr. Guy Mathews to type the name of a drug into his GoodRx mobile app to help his clients find discounted prices on human medications he prescribes off-label for their pets.
It's a goodwill gesture that goes a long way toward making drugs more affordable for clients and helping his patients.
"We use it all the time to save our clients money," Mathews told the VIN News Service. "It takes me 30 seconds to pull it up."
But the tool isn't working as well as it used to, Mathews reports. For reasons that aren't clear, the discounts aren't being honored for veterinary patients at a number of mass-market retail pharmacies that accept and fill prescriptions for both humans and animals.
Historically, veterinary hospitals have sold pet medications to clients from their in-house practice pharmacies. That is becoming less common as online and brick-and-mortar retailers compete in the pet medications arena.
GoodRx Holdings, a company that went public Sept. 23, offers digital coupons on medications via a free price comparison app (there's also a premium paid subscription service). When consumers present the coupons, GoodRx receives a portion of the fee pharmacies pay pharmacy benefit managers, which are the companies hired by pharmacies to handle drug benefit programs from health plans.
The company says more than 70,000 U.S. pharmacies, including those at major chains such as Walmart and Walgreens, are contractually obligated to accept GoodRx coupons on medications for humans, even when prescribed for pets.
"We love our pets, but they can be expensive! It has been hard to compare prices on pet medications — until now," the company's website reads. "GoodRx brings together prices from major online pet medication retailers, local pharmacies and other sources to find you the lowest prices on all your pet medications."
But about a year and a half ago, Mathews noticed that the Walmart near his practice in Kyle, Texas, suddenly stopped accepting GoodRx coupons for prescriptions from veterinarians. At the time, Mathews said, he didn't think much about it because other pharmacies honored the coupons, which still allowed pet owners to price shop.
Now he's finding that other pharmacies, too, are rejecting GoodRx coupons for pet prescriptions.
Mathews made the discovery last month, when he prescribed terbutaline, a fast-acting bronchodilator, for a dog with end-stage pulmonary disease. Mathews logged on to GoodRx, which found terbutaline for "around $35.98, 75% off the average retail price of $149.33."
"For this prescription, you're looking at more than $1,200 a year without [the discount]," Mathews told VIN News. "A lot of owners can't afford that, so the ability to use GoodRx coupons has been important."
He was dismayed to find that, like Walmart, a nearby Walgreens also rejected the GoodRx pricing. "This discount card will not work for pet prescriptions," read a disclaimer on the GoodRx app.
Mathews thought he'd solved the problem when he found that the pharmacy at H-E-B, a grocery chain based in San Antonio, offered the drug for $35.98 with the GoodRx coupon, pet prescriptions included. But then his client reported that the pharmacist at the H-E-B in Kyle wouldn't take the coupon. So Mathews called the pharmacy.
"He tried to tell me I needed an NPI number for it to work," Mathews recalled, describing the discussion as pointed and unfriendly. "We had a pretty direct conversation about that."
National Provider Identifier (NPI) numbers are 10-digit unique identification codes for health care providers. It's not uncommon for pharmacists to ask doctors for NPI numbers as a means of verifying and tracking prescriptions, identifying providers and streamlining the electronic transmission of health information.
The thing is, most veterinarians don't have NPI numbers because they do not meet the definition of "health care provider" in federal code.
Is the missing NPI number the issue?
VIN News was unable to ascertain whether the absence of NPI numbers is at the root of the problem. Reached by email, an unnamed H-E-B representative denied that their pharmacists reject GoodRx coupons for pet prescriptions, saying, "To clarify, H-E-B does accept GoodRx coupons for vet prescriptions, and we will continue to communicate the processing practice with our pharmacies."
H-E-B did not respond to follow-up emails to address specific instances in which GoodRx coupons were declined or whether NPI numbers are required for them.
Thomas Goetz, chief of research for GoodRx, acknowledged that a prescriber's lack of an NPI number could hinder use of the discount. "This a simple fix, thankfully!" he wrote in an email to VIN News. He said the solution is for veterinarians to provide their U.S. Drug Enforcement Agency numbers in lieu of an NPI. DEA numbers are issued to doctors, including veterinarians, who prescribe drugs that are classified as controlled substances.
A blog post on the GoodRx website, directed to pharmacists, elaborates: "To process a coupon for a pet medication, please enter the vet's DEA number when prompted for an NPI number. You may need to contact the vet to get this information. Human prescriptions require an NPI number to identify the prescriber. However, veterinarians only have DEA numbers. While a DEA number is typically only needed for controlled medications, it is the only prescriber number that will work for pet prescriptions."
From veterinarians' perspective, this "fix" may be problematic. Not all veterinarians have DEA numbers, and those who do tend to guard them carefully lest they be used for unauthorized purposes, such as obtaining controlled substances for abuse.
Offering a workaround, the National Council for Prescription Drug Programs, an organization that develops industry standards and guidance within the U.S. health care system, stated in 2013 that rather than DEA or NPI numbers, veterinary license numbers should be used by pharmacies and third-party processors to identify prescribing veterinarians in their databases.
Mathews isn't convinced that veterinarians' lack of NPI numbers or reluctance to divulge DEA numbers explains the problem. "It doesn't make sense," he said. "We are never prompted for an NPI number. We don't even have to get involved in the GoodRx process. … The prescription doesn't even go through GoodRx — it goes through the pharmacy. We include the GoodRx information to the client as a convenience for them."
Goetz of GoodRx did not respond to several follow-up emails from VIN News seeking clarification. Officials with Walgreens and Walmart, and pharmacists at the H-E-B store in Kyle, Texas, did not respond to repeated inquiries.
Frustrated by the lack of transparency, Mathews nevertheless would like to continue to recommending GoodRx to pet owners. "This has been a great service for my clients for a long time," he said. "It's important to them, and I want to them to be able to use it."
VIN News Service commentaries are opinion pieces presenting insights, personal experiences and/or perspectives on topical issues by members of the veterinary community. To submit a commentary for consideration, email firstname.lastname@example.org.