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In recent years, the supply of both human and animal medication online has become more prominent.
Online supply provides animal owners with consumer choice and an alternative to purchasing medication from their veterinary practice. For many owners, it is a personal decision weighing up their own circumstances.
How medication can be purchased will depend on the pharmaceutical product required. Some animal medicines are controlled drugs and can only legally be supplied by certain groups or organisations, such as veterinary practices.
The availability of prescription-only medication online has given animal owners choice. The issue for many owners is weighing up the advantages and disadvantages of the options available.
(Note: during the COVID-19 pandemic, some of the restrictions on how vets could and should prescribe and supply medication have been varied. Please speak to your vet if those current variations have had an impact or may be a factor in your query).
During lockdown, the normally strict ruling for a veterinary surgeon to have examined an animal before dispensing a prescription-only medicine has been relaxed temporarily, but the veterinary surgeon still retains responsibility for what he or she prescribes.
If they cannot be sufficiently confident of the diagnosis and appropriate treatment on the basis of a telephone, video or photographic consultation, or if they cannot be confident of the animal’s weight for dosing purposes, they should still refuse to prescribe.
If they do prescribe, while this may be very convenient for the owner, they should bear in mind the increased risk of a misdiagnosis of an animal which has not been physically examined.
The need for a prescribed drug
If a medication is only available on prescription, the vet must consider the health and welfare needs of the animal, and the owner’s circumstances. If you are worried or have any queries about medication which has been prescribed by your vet or your vet’s decision not to prescribe a certain medication, talk to your vet. Information available online and on public forum may be incorrect, irrelevant or may not directly apply to your animal’s condition, breed or species. While online information can be incredibly helpful, it cannot replace a constructive conversation with your vet to understand their recommendation, and where both owner and vet to have input.
What and how much is prescribed
Veterinary surgeons have legal and professional duties which must be complied with when prescribing or dispensing medication. Many of these obligations are explicitly set out in law and veterinary practices must ensure they follow the controls in place.
This can include a limit to the amount of medication prescribed and supplied, and how often the vet must examine the animal when there is a long-term need for medication and a repeat prescription is provided.
Some of the restrictions may seem over cautious or unnecessary. The veterinary professional issuing the prescription may need to follow very prescriptive regulations, or use their clinical professional judgement within tight guidance issued by the government or professional bodies.
A consultation may need to take place regarding each animal before certain medication or repeat prescriptions can be issued.
In all prescriptions, the vet must be satisfied that the medication is right for your animal and also your own circumstances.
How the medication is administered, any particular needs you may have and your experience as an animal owner may all be relevant factors. In these situations, the vet may need to refer to sensitive issues, and the conversation may feel difficult for all involved. Everyone involved must remember that the animal’s best interests are a key priority for everyone involved.
In our experience of mediating complaints in these situations, we advise:
- Keeping calm
- Asking questions to understand why the vet considers the recommendation approach to be the right one, and why as an animal owner you may be unhappy with that approach
- Remember any clinical decision or a query about the decision made, is not personal or a criticism.
Choosing whether to obtain medication from the practice or online?
Since 2008, vets can charge a fee for providing a prescription. This issue is monitored by the Office for Fair Trade, following a Competition Commission inquiry.
Veterinary practices are not allowed to charge more for services where an animal owner does purchase medication elsewhere, but they are permitted to charge for their time in prescribing the medication. This covers their time, skill and experience in considering which medication, the dosage and if needed, advice on how to administer the medication.
There are no set fees for prescriptions or services. Each practice must set their own fees.
The RCVS Code of Conduct states that practices must advise clients, by means of a large and prominently displayed sign, or signs, (in the waiting room or other appropriate area), with reference to the following:
Animal owners who are considering obtaining medicines from an online retailer may wish to visit Veterinary Medicines Directorate’s Accredited Internet Retailer Scheme (AIRS) for more information.
‘Prescriptions are available from this practice.
You may obtain relevant veterinary medicinal products from your veterinary surgeon OR ask for a prescription and obtain these medicines from another veterinary surgeon or a pharmacy.
Your veterinary surgeon may prescribe relevant veterinary medicinal products only following a clinical assessment of an animal under his or her care.
A prescription may not be appropriate if your animal is an in-patient or immediate treatment is necessary.
You will be informed, on request, of the price of any medicine that may be prescribed for your animal.
The general policy of this practice is to re-assess an animal requiring repeat prescriptions for/supplies of relevant veterinary medicinal products every XX months, but this may vary with individual circumstances. The standard charge for a re-examination is £XX.
Further information on the prices of medicines is available on request.’
Animal owners who are considering obtaining medicines from an online retailer may wish to visit Veterinary Medicines Directorate’s Accredited Internet Retailer Scheme (AIRS) for more information.
There may be a variation in the cost of medication. Each supplier (whether an online retailer or a veterinary practice) will set their own pricing based on:
- How much it costs them to purchase the product themselves. Generally, the larger the order the lower the unit cost per item. Large scale suppliers may be able to purchase medication at a substantially lower cost
In addition, veterinary practices will also need to consider:
- Overhead charges which in the case of a veterinary practice will include complying with all the legal requirements on the storage and oversight of controlled or prescription only medication. These also include the cost of running the practice, the administration and the premises
- The fees charged (consultation fee etc) covers the time and skill in examining the animal and reaching a diagnosis, but the decision-making regarding medication, dosage, and taking legal liability for this decision will be covered either by the medicines determination fee/dispensing fee (which may be included in the medicines cost, not necessarily itemised separately) or in a prescription fee, according to the owner’s purchasing decision
- Any advice, guidance or support in administering the medication if needed by the animal owner.
As with all consumer choice, there also comes a responsibility to weigh up the options and considers these in the context of your circumstances. Many practices will be happy to help by discussing those options with you. On each occasion, your experience may then influence your decision next time.
If a client opts for a prescription, rather than buying their medication from the veterinary practice, they can then buy their medication from a physical pharmacy or online. As well as the practice’s prescription fee, they also need to consider the following:
- Is the medicine genuine or a fake? Physical practices and pharmacies have a clear chain of custody from the manufacturer via a wholesaler. VMD-accredited online pharmacies should be reliable, but anyone can set up a website, sell a product then disappear before they can be challenged. A large proportion of human drugs obtained illegally online (i.e. foreign imports for which no prescription is requested) are fake, containing no drug at all, a different drug, or fillers such as plaster or even rat poison, and there is no reason to believe that the situation is different for veterinary drugs. If a website is selling prescription-only medicines without insisting on a prescription, or if the price seems too good to be true, it is wiser not to take the risk.
- Risk of delays in transit, resulting in not receiving the medicines in time. This is especially a problem during lockdown, when the post is taking several days longer than usual. Medicines may even go missing in transit, and in these circumstances you are unlikely to be able to obtain a refund as you cannot prove that you didn’t receive them.
- Maintenance of a cold chain, most commonly an issue for insulin. The ordinary post cannot maintain a proper cold chain, especially if there are delays in transit. Specialist couriers are expensive, and if the product arrives warm it may well be wholly or partially inactivated.
Animal owners can discuss the options with their vet which may help them to make an informed decision. Every animal owner, and each circumstance where medication is required, will be different and the factors influencing our decisions as consumers will be more or less important depending on those circumstances. Where owners and practices can discuss options, this can strengthen the relationship between client and practice.
A variation in price between one medication supplier and another is not in itself a consumer complaint. As consumers we have choice and can exercise that choice as we see fit, and much like in any purchase, we each buy from different businesses for different reasons.
Complaints can arise where clients feel they were not aware of the option of purchasing medication elsewhere, and with access to the practice premises restricted during the COVID-19 pandemic, the usual information available in waiting rooms may not be visible. Many practices are looking at ways to share this information but for many clients who have been with the practice prior to lockdown, this would have already been shared and available during previous visits. In the complaints mediated by the VCMS, we will explore why the discussion around the dispensing of medication has become difficult and look to resolve those tensions to allow the relationship to get back on track or to find an appropriate resolution for both parties.
As a veterinary client or a practice, a complaint has been raised and finding a resolution is proving difficult, remember you can contact the Veterinary Client Mediation Service and we will discuss with you the circumstances of the complaint and help you to decide if mediation with the VCMS would be helpful. The VCMS is funded by the Royal College of Veterinary Surgeons and is free at the point of use.
