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Friday, September 16, 2016

Is Charging For Prescriptions Legal Or Ethical?

Connie recently emailed me a great question....
As a veterinarian do you feel justified in charging a fee for writing a prescription?
I was a long-time client of a veterinarian who had one of my cats on a common medication that is very inexpensive at the pharmacy. I had been purchasing the medication from the vet who was charging substantially more for the medication. The condition my cat had was chronic, and I had spent quite a lot of money over time. The cat would continue to need this medication for the rest of his life, and I finally decided that it was nonsensical for me to be paying so much extra by purchasing this medication from the vet, so I asked for a written prescription which I planned to take to my pharmacy and save myself a little money. My vet did provide me with a written prescription, but charged a fee to do so. This actually hurt my feelings. It was as though he was saying, "I don't care about your many years of loyalty to my practice and the many animals I have treated for you, all I care about is your money. If you're not going to pay my high prices for medication, I will punish you by getting my share of the profit this way instead." I never went back to that vet.
I imagine that it's legal for a veterinarian to charge a fee for writing a prescription, but I find it unethical when the obvious reason for the fee is to recover lost revenue. I would really appreciate your thoughts about this type of situation.
Issuing a prescription isn't quite as simple as pulling out the pad and a pen.  Sometimes the size of medications in the human and veterinary fields can vary, so the doctor will have to look up what may be available somewhere else.  Sometimes we have to tweak the dose if we're changing medication.  We also need to take time to record the prescription in the patient's medical notes so that we can track it appropriately and any other doctors that see the records after that can know exactly what medications the pet is taking.  In some locations we have to do extra recording for controlled substances.  All of this takes time, and in any business time is money.  If we're taking even 5-10 minutes to do all of the above it can take away from other patients or services.  When we fill prescriptions in the clinic the costs of the time to do all of this is included in the prices, as well as the costs of labels, prescription bottles, and the medication itself.
In the US if a client asks for a written prescription the doctor legally must given them that prescription.  It is absolutely illegal for a doctor to refuse to authorize a prescription at another facility or pharmacy if they have fulfilled a legal client-patient-doctor relationship and would allow the prescription to be completed in their own clinic.  So if a vet (or any doctor) refuses to authorize a prescription just because you won't buy it from them they are breaking the law.  You are always legally entitled to a written prescription.
It is perfectly legal for a veterinarian to charge to write a prescription, and my first paragraph is generally the justification that is used for making these charges.  The question then changes from "can they charge" to "should they charge?"
I don't think it's unethical for a vet to charge for a written prescription.  However, I think that it's more trouble that it's worth, and pushes away more clients than an average practice would want (as in Connie's case).  Several years ago my practice owners decided to charge for prescriptions.  That lasted for a year or two but frequently caused problems with owners complaining and was a big hassle to explain why we were doing it.  They finally decided to take away that charge and we write prescriptions for free.  Personally I was very pleased with this decision, even though I understand the justification for the charge and won't condemn a vet who does so.
In my opinion you are losing more in goodwill and client loyalty by charging for written prescriptions than you lose in revenue or time.  I believe that if you happily and readily authorize prescriptions for patients those clients will be more likely to trust you in your decisions and agree to treatment plans in the future.  I would rather keep great clients than turn them away over a $5 prescription fee.
The veterinary profession has been facing big challenges in the last couple of decades as more people want prescriptions from online pharmacies.  Historically our clinics have been the only ones able to provide many veterinary-only medications which aren't stocked in human pharmacies.  Online options and even some regular pharmacies can be cheaper than the vet because of lower overhead and bulk ordering, all of which makes it hard for a veterinarian to compete.  But that's a problem with certain models of veterinary business and not with the medications themselves.  For too long veterinarians as a profession have relied far too heavily on income from vaccines and medications.  With vaccine durations lengthening and medications being available from other sources, many vets have seen reductions in revenue.  This topic has been heavily discussed in the profession for as long as I've been practicing, and I doubt we'll stop talking about it any time soon.
I believe that the answer to these challenges is to more closely model certain aspects of human medicine.  Human physicians don't stock medications for dispensing and concentrate pretty much on doing exams, making diagnoses, and authorizing treatment.  The real value in a doctor is in their knowledge and experience, not what they sell.  This is true of veterinarians and something that many of my colleagues need to realize.  We need to get away from retail and medication sales and focus on what we know and can do as doctors.

Doing so will result in somewhat increased costs of office visits and procedures as the lost revenue from pharmacy sales has to be made up in order for a vet to stay in business.  But having this kind of business model more appropriately represents where our true value lies, and clients will be able to find medications elsewhere, often for lower prices than a vet clinic can charge.

First and foremost we are doctors and surgeons, and need to position ourselves as such.

Connie, I hope that answers your question!