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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.

 

What veterinary medicine costs: Injectable drugs

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November 09, 2010 / (17) comments


On Dolittler (Fully Vetted's former incarnation), I used to offer you a series of posts designed to demystify the expenses associated with keeping your pet healthy -- particularly with respect to veterinary products and procedures. Since I really don't know why I stopped writing about this crucial topic, it's probably time to reprise it.

 

This time, it's all about injectable drugs and why they cost what they do. It's a subject I find especially fascinating since it's an area most consumers of veterinary services tend to ignore. Yet when it comes to identifying how a big bill got that way, the savvy invoice scanners among you (especially those whose pets are plus-sized) will often make a quick discovery: The danged injectable drugs nearly double the bill!

Now, it's not always so obvious as that. Nor are injectables disproportionately expensive to the same tune in every hospital. But vet medicine is clearly headed into this pricier-drug landscape, one in which drugs and products comprise more of your pet's expenses than the veterinary services themselves.

Yes, this truism was brought to you by a pharmaceutical company near you. Their goal? To create drugs and products that improve your pets' health so effectively you'll not want to let them go without. Their game? To price these products carefully so that they can: a) at the very least recoup their investment, and b) make the product as profitable as possible.

Makes sense. Trouble is, sometimes the drugs are priced so high that veterinarians feel they can't hardly charge for anything except the service connected to administering the drug. After all, there is no fee attached to coming up with the right diagnosis and there's only so much we can charge for an office call, regardless of how much time we spend with your pet. Drugs, especially those of the injectable variety, are often how we manage to make up the difference.

Why the injectables? Because the dispensable drugs (pills and such) are different. We can't rightly mark these up too much seeing as: 1) pets often need them on a chronic basis, 2) competition abounds, online and elsewhere, and 3) we're finally starting to get used to losing the the in-house pharmacy as a profit center.

But with the injectables we see things differently. We feel comfortable pricing them higher because we can file this procedure under "service," which indeed it is. How an injection is administered, I'm sure you'll agree, is an important aspect of care.

For example, when a veterinarian draws up a drug with one needle and then replaces it with a fresh, sharper needle to help minimize any discomfort, that's not only a kindness, but a valuable aspect of the service that distinguishes it from other practitioners' versions. Warming the drug, anatomic placement, drug storage, and clinical skill all play into this as well.

Still, does that justify the sometimes 1,000 percent markup I've seen on some invoices? Um … probably not. But it all depends on a hospital's overall pricing strategy. Because if the office visit is only $30, it matters less that the injectable drugs are priced at a 500 percent markup. (So you know, this is a common approach: low prices on the items clients price-shop for and high prices on those they'd never think to ask about.)

Then there's this to consider: Small animals and large animals get different-sized doses, of course. Some hospitals price injectable drugs strictly according to the size of the animal, so that a Rottweiler will incur about ten times more of an expense than a cat. Some hospitals will be more lenient on the Rottweiler and less so on the small cat or pocket-dog, charging more of a one-size-fits-all fee.

The last issue to consider is this one: Does your pet really need that injection? Hmmm … not always. Sometimes it is just an invoice padder, seeing as we know we can charge more for injectables. But then, if you suspect your veterinarian of padding the bill, you're probably not still going there, right?

 

Dr. Patty Khuly

 

 

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COMMENTS (17)
1
Cost of Immiticide
by Heather (getyourleash) on 11/09/2010 09:46am

I am about to have a large breed rescue undergo heartworm treatment with Immiticide. Not only am I terrified about the risks to this middle-aged dog, the cost is horrific. I will know more when I get him, but for now it appears Immiticide may the be treatment of choice.
Is there any other drug that is more expensive or is it that it typically requires hospitalization that bumps up the cost?

2
Email
by ckaybruce on 11/09/2010 09:51am

I am no longer receiving emails from petmd and I tried to sign up again and it says I am already receiving them. I would like to get them via email as sometimes I forget about it if I don't.

Luckily I haven't had to deal with expensive injectables yet. Hopefully I won't have to in the future either.

3
ckaybruce
by Dr. Patty Khuly on 11/09/2010 02:59pm

Hoping you will get your emails again. I will be sure to let the techies know.

4
Immiticide
by Dr. Patty Khuly on 11/09/2010 03:07pm

In case others don't know about Immiticide, this is a product used to treat canine heartworms in two or three injections. I favor the three injection protocol, myself, but I will freely admit that this is the single priciest injection I ever have to administer. One big mastiff mix once required so many bottles his injectable bill alone was probably over $500.

And yet the biggest deal is not the priciness of the drug itself, it's the stress of the actual procedure and the high likelihood of side-effects. Still, I find that easily more than 50% of my patients tolerate the injections with nothing more than manageable muscle soreness. The others suffer greater pain, requiring extra drugs (opiates) to keep them comfy (usually the smaller dogs) and only rarely have I seen a tough-to-manage fever case. Never in the several dozen cases I've treated have I seen anything worse.

Though we always hear about the scary cases...

I do sincerely wish you luck.

5
by itserich on 11/09/2010 03:51pm

At first I thought Immiticide was a typo for ivermectin.

I am treating a dog for mange. A quarter's worth of ivermectin apparently is worth $55 after the vet compounds it.

6
Interesting!
by Esmee on 11/09/2010 04:41pm

Dr. Khuly wrote:
"For example, when a veterinarian draws up a drug with one needle and then replaces it with a fresh, sharper needle to help minimize any discomfort, that's not only a kindness, but a valuable aspect of the service that distinguishes it from other practitioners' versions."

So some vets draw up the drug and then inject with the same needle? Interesting..i don't think my dogs have ever needed an injectible drug aside from vaccines but I'm curious if they do that.

7
Fresh needles
by Dr. Patty Khuly on 11/09/2010 05:07pm

It's a perfectly acceptable practice, Esmee. That's why one-dose vials are so common. Only one needle needed. Even in multi-dose vials, the one-needle to draw and "stick" I believe is the norm. But maybe someone else can offer us a more legal POV?

8
Thanks!
by ckaybruce on 11/09/2010 09:19pm

Thanks for letting the techs know about my email issue!

I don't even know how much injectable vaccinations cost because mine are all included in my plan. Are they expensive too?

9
Immiticide
by Heather (getyourleash) on 11/10/2010 03:46am

Thank You, Dr. Khuly, for your information on Immiticide and its use. I feel better knowing that while the cost is pretty ridiculous, it is effective treatment for heartworm and with any luck this male rescue should be none the worse for the wear when it is all over.

I hate the idea of putting this dog through anymore pain than he has already endured as a likely abuse case and a certain neglect case. (He is recovering currently from an embedded chain around his neck. Once he recovers, he is being transported from OH to DE.)He will then be evaluated by my vet and likely start Immitcide treatment. He is on Doxycycline as a precursor to the Immiticide and address his heartworm without undue risk before he is transported. It's my understanding that once he is injected with the Immiticide, he will require cage rest and pain management.
This is all fairly imminent, so your post was extremely timely and response especially valuable. Thanks again.

As an aside, I thought I was done with large breeds, but apparently that's not the case. LOL

10
Notifications
by TheOldBroad on 11/10/2010 07:12am

Dr. Khuly,

I'm having the same problem as ckaybruce and not getting emails (although today I got two).

I see that a comments notification has been added. Wonderful!

11
Immiticide
by Morticia on 11/10/2010 04:13pm

@Heather,

My dog Mort went through the treatment for heartworms. We used Immiticide, and yes it was expensive; but it did the trick. He was 13 at the time and a large breed and really showed no side effects from the treatment. I didn't crate him after or during treatment because he was pretty immobile anyway with arthritis.

Sadly, he died about 6 months after treatment, but the cause was unrelated.

Good luck to you and your rescue dog.

12
Annual Vaccinations
by kpmourey on 11/10/2010 04:26pm

My vet insists I vaccinate every year. I keep reading that the normal coverage for those diseases is 2 to 3 years. My dog is a house pet, never out of my yard, and only short time there and to groomers one every three weeks. What is the real truth?

13
vaccinations
by itserich on 11/10/2010 06:10pm

@ kpmourey

I think you are on the right track. Dr Khuly has written about this, perhaps on her old blog.

I don't want to give medical advice but even the vet training hospitals have changed in recent years. Do a little internet searching, "dog vaccine protocols," the AVMA perhaps.

Good luck.

14
annual vax
by Dr. Patty Khuly on 11/10/2010 06:52pm

Yeah, it's pretty much a thing of the past, the annual vaccination requirement. Though veterinarians can still choose to purchase and administer vaccines that are only *approved* for one year, the recommendations handed down by the academic community is for three years on *core* vaccines for both dogs and cats. For non-core vaccines, such as bordetella, feline leukemia and coronavirus, for example, the reccs will differ depending on your pet's degree of risk.

15
Core vaccines
by DrV on 11/11/2010 12:50am

Here I have to call attention to the apparently not so obvious difference between dogs and cats :-) And the difference between the academic communities that cater to them.

Dr Khuly writes in post 14 that the "recommendations handed down by the academic community is for three years on *core* vaccines for both dogs and cats." I am a cat vet, member of American Association of Feline Practitioners, and the only rabies vaccine this particular academic community approves for cats is the non-adjuvanted vaccine licensed for one year. A three-year cat rabies vaccine exists, and you could not pay me enough to administer it after I personally witnessed near-fatal anaphylactic shock following use of this vaccine. So yes, we choose to purchase the rabies vaccine *approved* for one year, and we give it every year (and are not about to give it as a three-year vaccine). Maybe some veterinarians use the one-year vaccine as a three-year and maybe this is what Dr Khuly meant, but this is very different from claiming that the "academic community" is calling for this.

16
I stand corrected...
by Dr. Patty Khuly on 11/11/2010 07:15am

...on what the AAFP recommends.

However, you could not pay *me* enough to recommend a rabies vaccine every year for an indoor cat –– or an outdoor kitty, for that matter.

But this is one area I've found that veterinarians feel very passionately about in widely divergent directions. Perhaps this evident fact is enough to inform kpmourey that even within the veterinary community there are passionate differences in how we interpret the research community's findings given the vaccines the pharma community has made available.

17
Clarification
by DrV on 11/11/2010 03:36pm

Dr Khuly -

My comment was meant with the utmost respect for your work and expertise. We obviously agree that on some matters there is no such thing as a single-minded academic community out there.

I may not push hard enough for yearly rabies vaccination either if the cat lives on the 16th floor of an urban condo with no possibility of a bat getting in the home. As long as I make clear to the owner that the Merial Purevax rabies vaccine is licensed for only one year. Yes, we know that a technicality in the test protocol resulted in it being licensed for one year only. Yes, we suspect it's good for longer than that - if the cat is developing the desired immunity at all, which we can't really measure. The 3-year vaccine covers our asses legally, but that's the one I stay the hell away from. Why so different in cats? They're just more "reactive" animals, and adjuvants are presumed guilty until proven otherwise. The temperature of the vaccine seems to matter as much, so I make sure to warm it to at least room temperature before injecting. Does giving the vaccine yearly make up for the harm we try to avoid by leaving out the adjuvant? Maybe. I was a philosophy prof before I became a veterinarian. It doesn't make it any easier :-)

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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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