Recently there have been a flurry of articles in the media highlighting the escalating cost of veterinary care, and the barrier this can create in treatment of our pets. Last month there were two such pieces in the press; Would you pay £20,000 to save your pet’s life? in the Daily Mail, and an article by Rachel Johnson in The Spectator, which painted a very unflattering image of vets as mercenaries, holding pet owners ‘over a barrel’.
In a previous blog post I tried to address some of the misconceptions the general public has about the real cost of medical care for pets. Much to my surprise, the post went viral, with over 140,000 views in just a few days.
I was flooded with messages from pet owners, which I was very glad to see were overwhelmingly positive. The majority of those commenting and messaging me recognised the dedication and hard work of those within the veterinary industry, and were cognizant of the financial responsibility that accompanies pet ownership.
On the whole, those who responded to the article were accepting of the reasons veterinary care costs what it does. However, one topic cropped up again, and again. The cost of medications.
One day a couple of weeks ago, I was going through the list of prescriptions at a practice I work at regularly as a locum. A client had requested a 180ml bottle of Metacam, a liquid anti-inflammatory pain killer, for his elderly arthritic Labrador, which had been on the medication for several years. The cost of the medication to the client was over £100. Out of interest, I looked up the cost from an online pharmacy. Animed sell the same size bottle for £19.99: that’s an over 400% difference in price. I cringed.
And that’s not a unique example, by any means. A 3.5 gram tube of Optimmune, an eye drop licensed to treat dry eye in dogs, can be purchased for £30.16 online, but as far as I can recall is sold for at least £70 in every practice I have worked in as a locum (please note I do work in London and the South East so prices may be a little cheaper elsewhere). Advocate, a spot-on used for parasite prevention starts at just over £3 per pipette online; you’d have to add a good tenner on to buy the same pipette from most veterinary practices.
For some medication (generally speaking, the cheaper ones), there is little difference in price between veterinary practices and online, where medication can be purchased using a prescription obtained from a vet. But for the overwhelming majority of more costly medications, the difference in price is eye-watering. So much so, that even with a staff discount, many members of veterinary staff who I know purchase their own pets’ pills online, not from the practice they work at.
In simple terms, the reasons for this disparity are twofold:
- Many veterinary practices do not have the purchasing power to even BUY medication from a wholesaler at the prices online pharmacies SELL it for. So they could never compete on price with the online pharmacies, even if they sold at cost price. Individual small veterinary practices inevitably do not sell anywhere near the same volume of medication as the online pharmacies. So infrequently used medications that are kept in stock often go out of date, and have to be disposed of.
- Traditionally, large mark-ups on medication have been used to cover the very high costs of running a veterinary practice.
So there are legitimate reasons for marking up medication prices – the cash paid doesn’t just line the pockets of practice owners.
But the issue is that the business model pre-dates the arrival of the online pharmacies, which have now been on the scene for years, and look to be a very much permanent fixture. Providing veterinary pharmaceuticals used to be the unique domain of veterinary practices, but that is no longer the case. However, practices are still reliant on money made from selling medications to subsidise other fees; prices for neutering procedures for example are artificially low. Most practices don’t make much, or any profit from spaying cats, and castrating Cockapoos; they charge low fees for these procedures to get the clients and their pets registered with them, and not with the competitor practice (of which there are often many).
What is clear, is that we are not currying favour with the public on this issue. The topic has been the subject of features on Watchdog and Rip Off Britain in recent years, and on these occasions, spokespersons for the profession have leapt to our defence to explain the above reasons for the price difference. The issue is then swept under the carpet for a bit longer.
Prescribing medication appropriately and safely, at the correct dosage is a service provided by a vet that requires knowledge. It is more convenient to get medication immediately and not go through the rigmarole of scanning prescriptions etc. A mark up to account for this is reasonable. But the medication itself is a product like any other. Let’s use apples as as an example. Most people know roughly how much apples should cost, and where they can go to buy them. Say Sainsbury’s were selling a bag of six Granny Smiths for £5, nobody would buy apples from them. £5 is absurdly expensive for a bag of apples – shoppers would feel ripped off. They would head to Tesco, or Asda, or even a corner shop where they are nearer to £1.
Returning to the Metacam example, the practice won’t have been able to purchase the Metacam for £19.99. So it isn’t comparing apples to apples. But it would have paid in most instances under £40 from the wholesaler. The problem is that, unlike with apples, most pet owners would have no idea what Metacam should cost, and many, though a shrinking number, haven’t even heard of the online veterinary pharmacies. So many will just pay over £100 for the bottle, unaware that there is an alternative; that they could pay for a written prescription from the vet (usually £15-20 approx) and save a tidy sum buying the medication elsewhere.
There are medications that veterinary practices will always need to stock that need to be used urgently, for example pain killers, and antibiotics. Waiting 2 days for delivery of ear drops for a dog with a painful ear infection is not at all desirable. But I personally am finding myself cringing more and more often when prescribing medications at substantial mark ups when it could conveniently be purchased by the client elsewhere for a much lower price. When I know that in their shoes, I would be doing just that.
Veterinary practices are required to display a poster stating they can provide written prescriptions, and most vets will happily write prescriptions when requested to do so. Generally speaking I proactively offer written prescriptions, particularly if the pet owner expresses concerns about cost, but don’t always remember to do so, particularly when in a rush. It can feel very uncomfortable breaking the news to a client who has been purchasing medication for their pet’s chronic health condition from a practice for many years, that they could have been saving hundreds of pounds. Likewise, pet owners whose companion is just starting long term meds can react with confusion when I tell them they can make big savings buying online.
There are also some, particularly the elderly who may not be internet-savvy, for whom ordering online is not a viable option. Fine, veterinary practices cannot to match online prices for them, but it does not sit well with me that they have no option but to pay the large mark-up, which may render the medication unaffordable to them.
I should say that there are many clients who are able to and more than happy to pay a premium for the convenience of getting medication immediately from their vets, even when provided with a cheaper alternative. But the situation is confusing and laborious to explain. It certainly does not invite trust.
The profession is suffering from an image crisis, and I can’t help but concur with pet owners who feel that drug mark-ups are excessive; viewed from an outsider perspective, it’s all just a bit murky, when we should be aiming for transparency, and it encourages ‘vet-bashing’. The veterinary industry should not feel apologetic for charging appropriately for its services. But in my opinion, charging £100 for a product, a painkiller, that can be purchased elsewhere for £20 does has a welfare impact; it creates a barrier to appropriate treatment that needn’t be there.
The reality is that if practices start selling medications with lower margins, other prices, such as consultation fees, would have to increase an equivalent amount to cover the losses, so veterinary treatment won’t be cheaper overall as a result. And some have concerns that increasing consultation fees could discourage people seeking veterinary attention if their animal falls sick – far from ideal either.
The whole industry would have to coordinate this change; it can’t be done by individual practices. But perhaps we need to adapt, to move with the times and change the status quo when it comes to these fees.
Source of featured image: Pixabay
Vet Reality Check 