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Dr. Coates is a veterinarian based in the other “Sunshine State” – that's Colorado to the rest of you – where she lives and plays with a varied range of animals. She shares her professional and personal experiences, Monday through Friday, here on petMD's blog, the Fully Vetted. Log in for your daily dose of her insight and wisdom.

The FDA Tackles Online Pharmacies ... This Time the Veterinary Ones

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April 15, 2010 / (20) comments

Since online pet pharmacies started taking your orders a couple of decades ago, they’ve been a thorn in the side of the veterinary profession. That’s when our clients started buying their drugs from Dr. Google — sometimes even without a prescription.

Fast forward to the present, and all our fears have been realized: Drug dispensing often happens without a veterinarian’s recommendation (at the shadier places, anyway), counterfeit products (read: fake, probably unhelpful, and potentially unsafe) are commonplace enough for me to have personally borne witness to their existence, and third party diversions (drugs and products from the “gray” markets) make a mockery of things like expiration dates and other FDA regulations.

To make matters worse, my profession’s complaints have until recently gone unheeded. Historically, that’s been because it’s hard to credibly criticize our competitors. After all, it stands to reason that veterinarians might complain about online pharmacies when these outlets out-compete us on prices, and our hospitals inevitably lose out on drug and product sales we’d formerly relied on.

It would be easy to discount my profession’s role in condemning some online pharmacy practices, sour grapes-style, were it not for a reality we all know to be the case: As much a boon to information technology as the Internet’s been, it’s undeniably awash with scumbags, charlatans, thieves, and snake oil salesmen. Surely you’ll have guessed that Internet pharmacies of all descriptions — human and veterinary, alike — are not exempt from these designations.

Indeed, human-oriented Internet pharmacies have long been regarded by the FDA as a major source of concern. The free flow of drugs may mean better prices for consumers, but they also mean more opportunities for scoundrels and bottom feeders. How else to explain the millions of Oxycontin, Viagra, and Vicodin doses that once traded hands — sight unseen, sans prescription — before the FDA and DEA cracked down?

And still it happens. Unlicensed shops, fake drugs, homemade compounds. They’re out there for those willing to take their risks, or are stupid enough not to know any better.

But most of us DO know better. Which means we now know enough to source our drugs from reputable outlets. For most of us that means the big names: Walgreens, Publix, Target, CVS. But you should also know that for those among us willing to seek out smaller outlets, there’s still a safe, reliable way. It’s called VIPPS (Verified Internet Pharmacy Practice Sites). This brand of certification, administrated by the National Association of Boards of Pharmacy, means the pharmacy has met a stringent set of guidelines that qualifies it as reliable and responsible.

Unfortunately, only a couple of online veterinary pharmacies have made the grade so far. Which is probably why the FDA is again up in arms about Internet pharmacies. Because now that VIPPS has been well-accepted by the human pharmacy industry and a critical mass of savvy consumers, the FDA’s turning its attention to the red-headed stepchild of the pharmacy world … ours.

 

In so doing, the FDA has issued a five-point bulletin describing the approach we should all take when buying anything as important as a drug online. Using the AWARE acronym, it's working hard to ensure you don't fall prey to the all-too-common scams even the biggest online pharmacy players are wont to perpetrate. Here's how it goes:

 

A – Ask Your Veterinarian
W – Watch for Red Flags (e.g., "No prescription needed!")
A – Always Check for Site Accreditation (i.e., VIPPS)
R – Report Problems and Suspicious Online Pharmacies (contact this FDA page)
E – Educate Yourself about Online Pharmacies (here's the FDA's basic veterinary page)

 

For a detailed explanation of these five points, head over to the FDA's new AWARE site. I'm sure they're appropriating the same information  from the human medical arena, but if it worked once, maybe it'll work again. Here's hoping the FDA will help the veterinary community get a little traction on this incredibly important safety issue.

 

 

Dr. Patty Khuly

 

 

Art of the day: "Cat and Red Haired Toy" by admiller.

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COMMENTS (20)
1
Cost of Drugs
by getyourleash on 04/15/2010 03:49am

I have never had to personally source my pet medications anywhere but my local human pharmacy and I consider myself lucky. Sometimes, I've had to make real financial sacrifices to afford these medications, so I do understand why these "black market" or "gray market" (whatever you want to call it) pharmacies exist. Places that sell the same drug for less, whether it be of equal quality or some adulterated version of a drug will always exist. Quality drugs are important to consumers, but they are sometimes cost prohibitive. (Don't get me wrong, I am not condoning black market sales.) The mark-up on drugs at my regular vet is so ridiculous that I often have to ask the vet to write me a prescription for my regular pharmacy. Reluctantly, they usually do, but even then there's still huge amounts of profit made by the drug company.
Money, gobs of it, is being made selling veterinary drugs and until prices are brought under control, there's always going to be sales of inferior drugs that go under the radar of the FDA. This is the same for human drugs.
My Boston Terrier Harpo is currently on a lifelong prescription of Flagyl for his Irritable Bowel Disease. Monthly, the cost is not too terrible. But for some, that extra 30.00 a month out of their pocket is more than their budget can sustain. When I had to purchase human cancer medications for my terrier, it just about broke the bank. She was a large dog and I had to make so financial adjustments so I could help her. I did, but at the time I was really broke. So, a huge part of this problem is the cost of drugs and their inflated pricing. If drugs were even close affordable for our pets, I doubt many would make the effort to seek out cheaper, less reliable sources for them.

2
by Equine DVM on 04/15/2010 07:36am

It amazes me when clients think they're being "smart shoppers" by purchasing drugs from me when my price is either comparable or cheaper vs. an on-line pharmacy but wish to purchase from an on-line pharmacy when their advertised price is much lower than mine.

Think about that for a moment. What would be my motivation for selectively gouging my clients? More to the point, why might the prices of those on-line products be so low?

3
Mutual support
by EAB on 04/15/2010 11:03am

In business, if you support a business, they will support you. For example, I go to the local Honda dealer for any service that I don't do myself. Now to be sure, there are places that might do it for 5-10% less, but I go to Honda anyway. Sure enough, a few weeks ago I was having a problem and I popped in and asked "JD", my usual mechanic. He said "Is it a stick shift" and I said "yes." He said "clutch material in the starter, just pull it and clean it up. Just like that, I saved probably 50 to 100 bucks. He wouldn't do that for just anyone, but he knows me, and has seen me. He knows my money has paid him.

And it has happened at the vet's office as well. I have told the story many times about my shelter pup, less than 24 hours in our custody, was having issues. No appointment open, but Doc treated her right in the waiting room, syringes in hand, and never charged me for an office call. Again, if I bought my scripts off of the net and gouged him for every penny I could, things wouldn't have come out like that.

If you like your vet, it's because they are a good and responsible professional. I say return the favor and be a good and responsible patron. In the long run, you won't lose money..I guarantee it.

4
sticky subject
by Anne in Socal on 04/15/2010 03:32pm

Equine DVM, I don't see this topic the same way you do. My vet is quite clear about why his prices are higher than online - he has a small practice and cannot order and stock meds in the huge quantities that he'd need to do in order to give me the kind of prices I can get online. I don't mind if it's a few weeks' worth of a medication, but when it comes to maintenance medications for large senior dogs, it adds up.

It's not that I think my vet is trying to "selectively gouge me", I just think he doesn't have the opportunity to buy in bulk and pass on the cost savings, and his business model, like many other vets, is to keep a well-stocked pharmacy and support the practice in part with that income.

For some meds, there's little difference in price, for others it's huge - one med is $1.50 per pill at the vet vs. $0.25 per pill online. One a day, that's $456/year. Another med (for a different dog) is $80/month at the vet, $50 online - another $360 right there. And there's more - I am saving over a thousand dollars a year easily, and I don't feel for one second that I'm compromising my pets' health.

I don't believe the only reason prices are lower online is that they're selling some kind of bootleg or fake meds. I believe it's the same reason big box stores sell breakfast cereal and soda and Televisions for less - volume and centralized distribution.

5
P.S.
by Anne in Socal on 04/15/2010 03:38pm

While I save a lot of money online, I still buy meds from my vet, just not all the maintenance meds. I get regular exams, blood work on the seniors, I buy prescription food as needed and I never complain about the bills. I have actually been wondering lately why there aren't pet pharmacies like we have for humans, at least in big cities.

6
by Equine DVM on 04/15/2010 07:07pm

>>It's not that I think my vet is trying to "selectively gouge me", I just think he doesn't have the opportunity to buy in bulk and pass on the cost savings, and his business model, like many other vets, is to keep a well-stocked pharmacy and support the practice in part with that income.>>

Read what I said a little more carefully.

For most pharmaceuticals my prices are indeed very competitive and frequently cheaper (try purchasing six 500-ct bottles of 100mg doxycycline tabs from CVS sometime). For certain pharmaceuticals, I can't do this and even break even. This is not fully explained by bulk cost savings. As a practice owner, I receive bulk price offers in the mail, so I know the "preferred price" paid by 50+ veterinarian, high-end performance horse practices who order enormous quantities. It's lower than my price, but sometimes it's still higher than the sale price on-line pharmacies advertise. Furthermore, manufacturers frequently refuse to sell directly to non-veterinarians, so at best on-line outlets are selling diverted product. Additionally, some manufacturers rather proudly do not offer bulk prices to ANYONE.

Pharmacies don't like to carry huge inventory any more than do veterinarians, so they aren't buying in the amounts one might surmise (true - I've talked to some and been told "we can order that then ship it to your client in two days"). Inventory is expensive. One reason my prices are competitive is my small, tightly controlled inventory, thanks to the magic of next day UPS/FedEx.

Like Dr. Khuly, I've seen pirated products. China in particular is producing excellent copies.

Be aware manufacturers will not honor any guarantees or cover costs of treating adverse drug reactions or treatment failures (Heartguard) when the client purchases the product from anyone other than a veterinarian or a licensed human pharmacy, if applicable.

>>I don't believe the only reason prices are lower online is that they're selling some kind of bootleg or fake meds.>>

I recommend you read: Dangerous Doses, by Katherine Eban. Not about the veterinary industry at all, but keep in mind regulating bodies care little about veterinary pharmaceuticals unless they're either controlled or used in human medicine.

I don't blame you for purchasing meds for chronic conditions in bulk. I've occasionally sold clients large bottles or even cases of certain products at considerable savings. If you haven't already discussed this with your veterinarian I suggest you do so. The dispensing and inventory costs are minimal when selling full bottles specially ordered vs. paying someone to count out a quantity of pills from inventory.

Like you, I'd welcome true "pet" pharmacies. Most of my income is derived from professional services, not dispensed pharmaceuticals. At the same time, there are very few reputable sources for pharmaceuticals other than little old me. I wish there were.

7
med costs
by Elizabeth and The Lab Crew on 04/15/2010 09:06pm

I fully support my Vet's clinic and buy "most" of my meds from the clinic. I would not normally go online to get meds. In the past I never considered what the markup of medications might be. I didn't really care, until the day my very young lab was diagnosed with Addison's and needed an expensive medication for the rest of his life. Without this medication my boy would die. The markup on this life saving medication was 150%. Now if that is a $10 medication that lasts a month who cares, but if that is $200 (cost in Canada ) that medication is now $500.. The same medication can be purchased online for $145 in the US.
That kind of markup forces people to go online. Now my Vet was able to get the practice to knock the normal markup down to 50% which still made the med $300. My Vet has given me her blessing to get the medication online.
I would rather buy the drug from my vet but I can't, not at double the cost I can buy it online.

So Dr. Khuly and Equine DVM what is a fair markup for drugs all things considered?

8
Kidding around
by ResQ Gal on 04/16/2010 12:57am

Sorry this is off topic, but the suspense is killing me! How are your baby boys and Tulip doing? Pictures???
---- We will now return to regular programing ------

9
Pricing and Inventory
by Equine DVM on 04/16/2010 09:25am

>>what is a fair markup for drugs all things considered?

Depends on the drug and type of practice, and it really has little to do with "fair". There are inventory calculators available on-line that illustrate the costs of maintaining inventory. Dr. Khuly, who completed her MBA (I dropped out of B-school, alas) can probably explain this more succinctly than can I, but I'll give it a whirl.

When I first set up my practice I began to keep track of the amount of each product I stocked in an effort to learn what I needed to have on hand at all times for immediate use and in what quantities. For example, I know approximately how many bottles of doxycycline I dispense on an annual basis and my practice's peak months of usage (when ticks are active). I try to flip my complete inventory every 8-12 weeks but don't always succeed.

Inventory is expensive, which is true for any type of business. That's why the CVS pharmacist stopped breathing for a moment the last time I tried to call in a doxycycline prescription for a client who insisted CVS would give her a better price than I would. On that day, CVS had only one and a half bottles of doxycycline on the shelf and my patient needed six. I think their quoted price was more than twice mine, too.

Okay, so why am I able to charge less than CVS for doxycycline? Why can Walmart beat my price for medicated mouthwash? Why are both CVS and I SOL when it comes to the price of Flovent?

My prices are calculated incorporating the following:

1. Cost of product. Can't sell it for less than the actual cost.

Flovent is an inhaled steroid. My supplier sells this to me for the same price CVS sells Flovent to consumers. No volume discount (I tried) and one inhaler = 10 days to treat a chronic condition. I call it in to the reputable human pharmacy of the client's choice. Flovent, unfortunately, is still on patent, and the price reflects this. It's not widely used in veterinary medicine, which is why my veterinary supplier's price is so high. I suspect the margin isn't that great for CVS. GlaxoSmithKline, OTOH, makes out like a bandit.

2. Amount of time product spends in my inventory. Markup is higher for something like doxycycline (regular inventory) and lower for a drug like Marquis (used to treat EPM, an uncommon neuro problem). Marquis is hellishly expensive. Look it up. I don't want my money tied up in inventory when I can order Marquis next day UPS/FedEx. OTOH, I dispense doxycycline weekly.

If a product has been with me for more than 30 days, the supplier has my money. That's called an opportunity cost, BTW.

It should not surprise you to learn I can match any on-line or catalog price for Marquis. Easily.

3. Dispensing cost. Mine is lower than Dr. Khuly's because my patients are huge. I usually dispense by the bottle, or even the case. If I don't have to count out pills, dispensing cost amounts to writing out the prescription label. That's cheap, other than my knowledge.

CVS charges much more than I do for doxycycline because they use a rigid formula to calculate dispensed drug costs (many veterinary practices also use a rigid formula, BTW, which I think has some obvious limitations). CVS doesn't offer a discount for anyone who requires half a case of doxycycline because humans are prescribed 100mg/day. My patients require fifty 100mg pills twice a day, frequently for a month. The CVS computer starts to smoke when the pharmacist tries to input one of my prescriptions.

Walmart pharmacy charges much less than I do for medicated mouthwash. Minty fresh and only $4 (CVS charges $15). Sold. Once I discovered this I began to call that stuff in all the time because mouthwash spills, freezes, and is a PITA to dispense and dilute from a huge container (Walmart and CVS order cases of premixed bottles). Why should I charge my clients more than the pharmacy when I'm really not making money, especially when the horse tips the bottle on Saturday evening? Much easier for the client to trot over to CVS for a refill.

Then there's triple antibiotic ophthalmic ointment. The price went way, way up last year, but I still stock and dispense this. I also call it in to CVS, because our prices are similar. If the client drops the tube into the water bucket on Saturday night, I'm calling it in.

One more wrinkle: Gastrogard, another hellishly expensive medication, is something I generally keep on hand. Clients frequently purchase one or two tubes. It's more expensive to purchase Gastrogard by the tube vs. by the full box vs. by the case. Again, some practices use a rigid, per-tube formula to calculate the price of Gastrogard. I think that's wrong-headed.

4. Client education. I try to go over major side effects as well as dosage and dosing frequency. Again, this works out to a lower cost *per bottle* for something like doxycycline for my clients vs. Dr. Khuly's or vs. CVS.

If someone insists upon a prescription and locates a reputable pharmacy, I will add a charge for client education (which the pharmacy will also add, even though my client won't fully benefit). As knowledgeable and helpful as human pharmacists are (they're among my favorite and most frequently-consulted human medical professions) they are the first to admit they understand humans, not horses. Though my client with the horse on gabapentin agreed he was too groggy to drive...

5. Cost of inventory maintenance (opening boxes, shelving/stocking, reading invoices, talking to suppliers, regularly counting inventory). This also includes rent/mortgage and utilities on the area used to store inventory. The less inventory one maintains, the lower the cost of maintaining inventory.

6. Cost of being allowed to prescribe drugs. DEA license along with some percentage of licenses to practice and CE.

7. Expired product cost. Because I'm not perfect. Your grocery store passes on the cost of expired products to you, too, BTW.

8. Product loss cost. This is very low for my practice, but occasionally, I get stiffed. Every business passes along the cost of "shrinkage" to consumers. I sometimes minimize my "shrinkage" costs by calling in prescriptions to pharmacies, especially when a new or untrustworthy client requires an expensive, special order medication. CVS is far more ruthless than I re: "bill me".

I think of all of the above when I look at the prices some of the on-line veterinary pharmacies offer. Some use "loss leaders" in an effort to gain customers' business. One catalog in particular dropped its price of one drug because equine veterinarians were regularly matching the price. Offering a loss leader means a low or non-existent margin because consumers are then more likely to purchase other items with much higher margins without price shopping (I did pay attention during my short tenure in B-school). I'm not certain this product is a loss leader, however, because it's the same catalog offering at least one product that is almost certainly counterfeit, because the manufacturer does not offer volume discounts to ANYONE. Adamantly. I called the company and asked (really) and the VP in charge of this product line told me it is commonly counterfeited.

In short, I'm happy to send clients to human pharmacies, but their prices are not always better than mine. Veterinary "pharmacies"... not so much. I've met some "pharmacy" owners in person at trade shows and, honestly, they're like sleazy real estate investors who were intent on flipping properties just before the market tanked. They are minimally regulated and I don't trust them with my clients' horses.

10
On the kids...
by Dr. Patty Khuly on 04/16/2010 02:44pm

ResQ Gal: Tuesday's post will tackle the babes. They're doing GREAT, though. Happy as can be. Stay tuned!

11
Pricing & Inventory
by Elizabeth and The Lab Crew on 04/16/2010 05:23pm

I guess "fair" wasn't the right word. I totally understand true cost of a product. We run a business as well. Generally the smaller items have a higher markup. Can you imagine if a car was marked up 150% after true cost..

It just seems like the markup on meds is whatever the market will bear at least in my area. As I said I have no problem with supporting my Vets clinic in every way I can. But 150% markup... and more.. that's not anything but greedy.

12
by Equine DVM on 04/16/2010 06:21pm

>>Can you imagine if a car was marked up 150% after true cost..

IIRC, most new car dealerships acquire their stock via a financing deal with the manufacturer. Different business structure entirely. Not 30-day net terms.

>>It just seems like the markup on meds is whatever the market will bear at least in my area.>>

Sure, to a certain extent.

>>But 150% markup... and more.. that's not anything but greedy.

As I don't know your veterinarian, his inventory management plan, or his overall business plan, I can only speculate. Most likely, he's using an inflexible dispensing plan based on a formula because it's easy and requires little creative thought. It's also highly likely his inventory is poorly controlled and actually costing him money despite his seemingly high markups.

Also, I don't know what kind of business you have, but the costs of selling pharmaceuticals should add significantly to the final price. That's why some veterinary business consultants recommend 150% across-the-board markups.

Finally, as I think we both can agree, veterinarians who dispense pharmaceuticals are truly running two types of high-overhead businesses, both of which can be a drain on available financial and personnel resources. One business is service-based, the other is inventory-based. It's difficult to make it all work together. At the moment there's an emphasis on the service-based component as the primary generator of income, but that wasn't always so. Hard to break old habits, though (which is not to say I think it's okay, as I hope was clear from my lengthy pricing explanation).

I'd rather be paid for using my mind rather than peddling drugs.

13
EQUINE DVM
by NOT just a dog on 04/17/2010 11:38pm

Re: "however, because it's the same catalog offering at least one product that is almost certainly counterfeit, because the manufacturer does not offer volume discounts to ANYONE."

You've piqued my curiosity in a major way here. PLEASE do share the name of this product!

14
by Equine DVM on 04/18/2010 08:13am

>>You've piqued my curiosity in a major way here. PLEASE do share the name of this product!>>

This product is used only in horses. I called the manufacturer because the catalog/on-line pharmacy's price was less than a dollar higher than the manufacturer's price and I know the manufacturer does not grant bulk discounts. The manufacturer also revealed that though the catalog/on-line pharmacy does have an account and purchases other items direct from the manufacturer, this product was not one of them. Then the VP told me it was probably counterfeit from China.

I will not reveal the name of the product or the manufacturer for obvious reasons. Suffice it to say it is a commonly used pharmaceutical and is generally sold for less than $100. Additionally, I think the product manager was a bit free with his information, even though I made it clear that I was only a curious random veterinarian with no special status. He sounded frustrated and thanked me for the information.

I'm sure this is not the only counterfeit or adulterated product being sold by on-line/catalog pharmacies because I've seen short-dated, expired, illegally compounded and questionably packaged products that weren't quite as convincing to me. Many clients, however, wouldn't know enough to question their purchases. As I mentioned earlier, anyone interested in this issue should read: Dangerous Doses, by Katherine Eban.

15
by horsegirlK on 04/18/2010 10:25pm

I have no problem buying something from my vet that I can't get at the pharmacy. I have no problem buying something from my vet if it's a one-shot deal (say, Clavamox after a dental). But the fact is that my vet charges $20 to put a label on every bottle, on top of the mark-up (usually 75%-100%). So, if I can get Flagyl for $4 at Walmart, I'm just not inclined to purchase the specially compounded cat treat version (that I would still need to shove down the cat's throat) for $50.

16
Compounded Meds
by Equine DVM on 04/19/2010 04:42am

>>I'm just not inclined to purchase the specially compounded cat treat version (that I would still need to shove down the cat's throat) for $50>>

If you can pill your cat, great! Whenever possible, I avoid compounded medications because those drugs are exempt from regulation and safety testing required for generic or brand name medications. Compounded medications are to be prescribed only when a generic or brand name product is either not available OR when an animal needs a special formulation (different drug strength, drug form, or flavor). In equine practice, this is almost never the case, with the one exception of pergolide. Many pharmacies argue long and hard that it's legal to produce flavored bute powder... it isn't, though it is profitable.

In many states, it is not legal to mark up compounded medications with the exception of a standard prescription fee that does not differ; if it's $20, it's $20 regardless of the cost of the compounded medication. Yes, you read that correctly. When a horse in my practice requires a compounded medication, I call it in. The client purchases it directly from the pharmacy. I'm out of the equation.

That said, if you are purchasing compounded meds directly from a compounding pharmacy, price is generally related to quality. This is because legally compounded medications are supposed to be created from the generic or brand name pharmaceutical. If you see a compounded medication being sold for less than the cost of the generic or brand name, it's almost certainly been created using bulk chemicals. Currently, almost all bulk chemicals are imported from China, India, Pakistan, etc. Not well regulated, and usually not legal, either.

17
by horsegirlK on 04/19/2010 06:12am

Well said, equine DVM. I didn't know there were so many regulations in place regarding compounded meds. Honestly, when my vet said "compounded," the first thing that came to mind was those polo ponies that died so needlessly after they were administered the compounded Biodyl (not available in the US). My next thought was, "Hey, Flagyl is on the Walmart list."

Now, if you could find a way to legally produce carrot flavored bute, Banamine, etc. you'd be a millionaire!

18
Compounded Meds
by Equine DVM on 04/19/2010 10:03am

>>I didn't know there were so many regulations in place regarding compounded meds.>>

Many veterinarians don't seem to know, either, and they should, because malpractice insurance does not cover patients' adverse reactions to compounded meds. Joe Bertone, DVM, DACVIM, has been speaking out on this issue for years, loudly. You can find some older articles on the DVM360 website in which Dr. Bertone discusses pirated and compounded medications. He's an equine veterinarian on the faculty of Western University in CA.

>>Honestly, when my vet said "compounded," the first thing that came to mind was those polo ponies that died so needlessly after they were administered the compounded Biodyl (not available in the US).>>

Sure, that's a valid concern.

>>My next thought was, "Hey, Flagyl is on the Walmart list."

Also valid. BTW, Walgreen offers a discount on certain pet prescriptions for AAA members.

>>if you could find a way to legally produce carrot flavored bute, Banamine, etc. you'd be a millionaire!>>

There is a legal way: go through the formal FDA approval process. It's expensive; any new flavor must go through safety testing similar to that done on the original unflavored formulation. That's why almost no one wants to spend the money to do this legally.

Legally available generic or brand-name flavored bute:

Apple bute paste (Luitpold, the Adequan company)
Apple bute powder (SuperiorBute - accept no substitutes!)
Citrus bute powder (Equizone, made by A&G; also sold under another name I don't recall at the moment)

No legally produced flavored oral Banamine on the market, but I have yet to meet many patients who refuse to swallow regular Banamine paste. The only exceptions are those horses that are impossible to orally dose with anything, regardless of taste. Similarly, if a horse won't eat plain, SuperiorBute or Equizone in its feed, flavor is irrelevant.

The two legally produced bute powders were approved in the last few years. Compounding pharmacies still whine it's legal to produce bute powder in peppermint, carrot, etc. flavors and certain veterinarians continue to sell these products because their markup (though markup is not legal in most states, as I mentioned in my earlier post) is higher than it would be if they were selling either of the legal bute powder products. So consumers are being stuck two ways: by the compounders, and by their veterinarians. Execrable behavior, but at the same time, consumers see "bute powder" as a commodity with little difference in quality. Demand the best for your horse!

I actually had a compounding pharmacy (one of the better ones) agree with me, rather self-righteously, that a competitor was producing illegally compounded apple banamine paste then start to argue that their own peppermint bute powder was legal. Then there was a silence on the other end of the phone as I heard the gears grinding...

19
Search Engine
by VapeChiep on 02/19/2011 08:48am

Sorry for the stupid question. What is the best search engine http://google.com or http://yahoo.com?

20
Markups
by markMD on 02/03/2012 01:39pm

I want to be clear, I’m not talking about black market counterfeit drugs, fly-by-night fraudulent stores, or short-term acute condition drugs, like antibiotics. I’m talking about the same drugs vets get from the pharma houses, accredited online pharmacies with licensed pharmacists, and lifetime chronic condition drugs.

The markups I’ve seen are at least 200%. Sometimes much more. Equine DVM first claims his/her prices are comparable or better than online pharmacies, then in a later post, that a 150% markup is standard. Well which is it?

Equine says “try purchasing six 500-ct bottles of 100mg doxycycline tabs from CVS sometime.” Well try purchasing Neurontin 600mg 180ct at the vet for nearly $800, or generic gabapentin for nearly half that. Online it’s $47 (for 360ct 300mg). And by the way, that is for one month.

Equine also says “… the costs of selling pharmaceuticals should add significantly to the final price.” Well, I feel then for your clients. In my case, for the generic, the markup was nearly 1000%.

Other cases I’ve seen include 250-400% mark ups for Proin, Lasix, oh, and those antibiotics I mentioned before.

I can’t recall the last time my physicians sent me home with anything but a sample. Why are veterinary clinics any different?

My vet once said about heartworm medication when I showed my omahavaccine.com printout: “I can’t get it for that.” Makes you wonder.

Don’t confuse illegitimate stores and product with a safe, legal, and cost effective alternative to in-clinic dispensing.

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About fully vetted

Patty Khuly, VMD, MBA

Photo of Dr Khuly

Dr. Khuly is a former petMD blogger and small animal veterinarian in Miami, Florida, where she practices medicine at Sunset Animal Clinic and serves on the board of the South Florida Veterinary Medical Association. She is a graduate of Wellesley College, the University of Pennsylvania School of Veterinary Medicine, and The Wharton School of Business.

As a significant sideline, she writes...a lot. She authors pet health columns for USA Today, The Miami Herald and Vetstreet. She also writes a popular monthly column for Veterinary Practice News and serves as regular contributor to Veterinary Economics, The Bark, and the Veterinary News Network.

Dr. Khuly lives in South Miami with her brood of hens, goats, dogs, cats...and humans.

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