Charging for a script

[StartingoverVet]

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Someone on a dog owner's site is complaining that their vet said they would charge them an additional $3 to write a prescription to be filled outside of the clinic. This is a regular client of theirs. Assuming the client has seen the vet properly what do you all think about this?

1) Is this legal?
2) If it is legal, is this ethical?
3) If it is legal and ethical, is it smart?

I will tell you upfront, the vet has lost this person as a client, and the client is calling up all of their local friends to complain and hopefully get them to leave as well. I guess you know my answer to third question.


DISCUSS!

 

[Felixor90]

Not sure about legal, but it's neither ethical nor smart.

 

[OneGrainOfSand]

Gotta pay back those vet school student loans somehow yeah 😛

It isn't illegal but it is in poor taste if they are that blatant about charging for a script. Agreed they probably lost a customer or a few.

 

[SummerTheLynx]

Someone on a dog owner's site is complaining that their vet said they would charge them an additional $3 to write a prescription to be filled outside of the clinic. This is a regular client of theirs. Assuming the client has seen the vet properly what do you all think about this?

1) Is this legal?
2) If it is legal, is this ethical?
3) If it is legal and ethical, is it smart?

I will tell you upfront, the vet has lost this person as a client, and the client is calling up all of their local friends to complain and hopefully get them to leave as well. I guess you know my answer to third question.


DISCUSS!

I am pretty sure it's legal in both New York and in virginia, but not sure about other states. Ethically speaking I can see how people might claim that it's okay. Two components there, first is that by buying the medications elsewhere, it's affecting the anticipated revenue associated with a client. Second is that most vet places that I have worked at/shadowed in my life have quick order systems and don't need to take the time to write out medications that they fill in house. Thus the 1-2 minutes extra it takes can be seen as vets being charged for their time at the cost of $1.50 per minute. For me personally, I don't think it's that ethical to do this, but then again I am used to working at vet offices where people just quite frankly don't have the money most of the time to pay for the essentials. Smart, heck no. If I was a client, I would be outraged by this....

 

[battie]

Don't know about the legality of the situation. Ethically or smart though I can see both sides of the fence because the vet I work for does one of two things when clients want to buy outside the clinic. 1) Try to price match. If she can price match it, she'll do it. 2) Try to price match, but can't, so she'll write the script, but tell the o she cannot guarantee the efficacy of the product if it doesn't walk out our door. But she won't do either until you come talk to her personally. If you refuse to come in to talk to her, she just won't do anything.

For the client, I know they just want to order it elsewhere for the convenience. I order my prescriptions through Safeway for the gas points. But with how many of our patients are emergencies that get sent home with an antibiotic and anti-inflammatory, losing that revenue would truly suck. Even though it's only 20 bucks, 20 bucks adds up quickly when you see 10 emergencies a day, 6 days a week. That's almost five grand a month on average. That kind of money can enable a clinic to keep going.

Did she go about it the right way? Probably not. She should have it as a running policy that clients know about upfront and say it is for the time/supplies/effort/whatever of sending the prescription to the desired pharmacy. Would it be a good idea for vets all over do? No, simply because we already have a negative stigma that we're in it for the money and not the animals.

 

[DVMDream]

If you go to a pharmacy as a human patient and pay for your rx, you are paying an upcharge at the pharmacy (or your insurance is). That upcharge includes the pharmacist's expertise to be sure that your doctor is prescribing the right med, dose, etc. After all, the pharmacy and pharmacist has to make money. Human pharmacies do NOT have veterinary knowledge.

Now as a vet, you sell the drugs in your pharmacy at an upcharge... to include your expertise in knowing what drug, dose, etc to give that dog/cat for that disease condition.

People so often think... you are just giving me an antibiotic.. anyone can grab an antibiotic off the shelf why such a large cost? Well, sure, anyone can grab an antibiotic off the shelf and give some to their pet. But the vet knows what abx has the distribution to get to that skin infection, what bacteria are most likely to be present on that skin infection, what abxs will kill that bacteria as well as what dose is needed and is safe for that species (time dependent vs. concentration dependent abx). So when you buy your rx at the vet clinic, you have paid, in part, for that expertise. And the vet should be rightfully compensated for that.

Now, when the owner asks the vet to write an rx, the vet is no longer being paid for the expertise in knowing what drug to give, the dose, etc. So now you come up to should the vet charge for their knowledge? Which if every person in the world were smart and recognized what they are actually paying for the answer would be yes. However, people are irrational and don't recognize that they are actually paying for a service when that vet uses their knowledge to write an rx for their pet (that knowledge that cost them... oh $200K).

So this is one of those gray areas... can a vet charge for that? Yes. Should they? Well, up to them. I personally wouldn't but only because people are irrational.

However this does bring up another point... if vets are going to be writing more and more rxs, which seems to be happening... are prices going to go up elsewhere to cover the cost of them prescribing meds? Maybe. You could see increased exam costs, which would suck because not every patient coming in needs an rx.

Just my thoughts... which aren't worth much at all.

 

[StartingoverVet]

If you go to a pharmacy as a human patient and pay for your rx, you are paying an upcharge at the pharmacy (or your insurance is). That upcharge includes the pharmacist's expertise to be sure that your doctor is prescribing the right med, dose, etc. After all, the pharmacy and pharmacist has to make money. Human pharmacies do NOT have veterinary knowledge.

Now as a vet, you sell the drugs in your pharmacy at an upcharge... to include your expertise in knowing what drug, dose, etc to give that dog/cat for that disease condition.

People so often think... you are just giving me an antibiotic.. anyone can grab an antibiotic off the shelf why such a large cost? Well, sure, anyone can grab an antibiotic off the shelf and give some to their pet. But the vet knows what abx has the distribution to get to that skin infection, what bacteria are most likely to be present on that skin infection, what abxs will kill that bacteria as well as what dose is needed and is safe for that species (time dependent vs. concentration dependent abx). So when you buy your rx at the vet clinic, you have paid, in part, for that expertise. And the vet should be rightfully compensated for that.

Now, when the owner asks the vet to write an rx, the vet is no longer being paid for the expertise in knowing what drug to give, the dose, etc. So now you come up to should the vet charge for their knowledge? Which if every person in the world were smart and recognized what they are actually paying for the answer would be yes. However, people are irrational and don't recognize that they are actually paying for a service when that vet uses their knowledge to write an rx for their pet (that knowledge that cost them... oh $200K).

So this is one of those gray areas... can a vet charge for that? Yes. Should they? Well, up to them. I personally wouldn't but only because people are irrational.

However this does bring up another point... if vets are going to be writing more and more rxs, which seems to be happening... are prices going to go up elsewhere to cover the cost of them prescribing meds? Maybe. You could see increased exam costs, which would suck because not every patient coming in needs an rx.

Just my thoughts... which aren't worth much at all.

Strongly disagree with the bolded part.

The rest I agree with.

But I think that it is fair for a client to expect the cost of a visit to include writing a prescription. I certainly expect that to be included in the costs I pay.

If you want to be the one to start parsing out that cost, expect a lot of negative feedback.
If everyone in the industry joined in the a la carte pricing method, it wouldn't be a problem, but you are really screwing yourself to be the leader here.

Personally, I would just increase the cost of a visit by a few dollars if this were to become the norm, because you don't make $20 on a $20 prescription. Far from it.

 

[DVMDream]

Strongly disagree with the bolded part.

The rest I agree with.

But I think that it is fair for a client to expect the cost of a visit to include writing a prescription. I certainly expect that to be included in the costs I pay.

If you want to be the one to start parsing out that cost, expect a lot of negative feedback.
If everyone in the industry joined in the a la carte pricing method, it wouldn't be a problem, but you are really screwing yourself to be the leader here.

Personally, I would just increase the cost of a visit by a few dollars if this were to become the norm, because you don't make $20 on a $20 prescription. Far from it.

Yeah, I agree, it is fair to expect the cost of writing an rx to be part of the visit, but then you get into is that fair to those patients that don't need an rx (which is really getting into nitty gritty details about what should an "exam fee" be covering). Think vaccine appointment which are very common appointments. People bitch as it is with cost of an exam for "just getting a vaccine". So some of the cost of getting the rx at the vet, is the vet's knowledge.. the rest is the drug, stocking it appropriately, etc.

Yeah, I know that you don't make $20 on a $20 prescription.... hardly that... you might be lucky if even $.50 of that comes directly back to you as the vet.

 

[dyachei]

Yeah, I agree, it is fair to expect the cost of writing an rx to be part of the visit, but then you get into is that fair to those patients that don't need an rx (which is really getting into nitty gritty details about what should an "exam fee" be covering). Think vaccine appointment which are very common appointments. People bitch as it is with cost of an exam for "just getting a vaccine". So some of the cost of getting the rx at the vet, is the vet's knowledge.. the rest is the drug, stocking it appropriately, etc.

Yeah, I know that you don't make $20 on a $20 prescription.... hardly that... you might be lucky if even $.50 of that comes directly back to you as the vet.

Well...not entirely. Usually the mark up on drugs is between 100-300%. The cost includes the overhead, the pill vial, the actual drug, vet's expertise, the tech's time to fill, etc. On a more expensive drug, you typically make more. On $20, I probably make more than 0.50

 

[StartingoverVet]

I was more disagreeing with batsenecal's "the $20 add up " comment. That is the revenue, not the profit to the clinic.

 

[deleted480308]

No ethical issues here, charge what you want for a service and the customer can either pay or leave. Then you can watch how it changes your client base over time, for better or worse

 

[StartingoverVet]

No ethical issues here, charge what you want for a service and the customer can either pay or leave. Then you can watch how it changes your client base over time, for better or worse

I disagree on the no ethical issues.
If someone comes in to an appointment, and then you have an unusual policy that forces them to pay additional or find a new vet, there is an ethical issue there.
Not saying this is unethical, but what if you started charging for use of the stethoscope or the pen. If I found that out in the appointment I would be (rightly) vexed, and would wonder about your ethics in treating patients.

 

[DVMDream]

I disagree on the no ethical issues.
If someone comes in to an appointment, and then you have an unusual policy that forces them to pay additional or find a new vet, there is an ethical issue there.
Not saying this is unethical, but what if you started charging for use of the stethoscope or the pen. If I found that out in the appointment I would be (rightly) vexed, and would wonder about your ethics in treating patients.

See, to me though... an exam should include things that ALL patients will be getting... so a thorough history, listen to concerns, a full physical exam, listen to heart/lungs, address any issues, explain findings on exam (even just a normal exam the vet should be explaining.. as they are going along.. heart sounds great I don't hear any murmurs, no skin problems, I don't feel any lumps anywhere, abdominal organs all feel normal in shape and size, etc). This way the client is recognizing what you are actually doing while examining their pet. Any problems on exam should be explained to the client as well as any recommendations as to what should or should not be done. Obviously the exam will also need to cover the exam room, tech time, electricity, etc, in part.. but including prescribing costs in that, well I can see where a person would expect it to be included but it seems more appropriate to me to include that cost in the medication itself and not in the exam because medications are not something that every patient needs.

Again though, that is just me. I still wouldn't charge a client to write an rx because I know I will be creating drama and issues where I shouldn't be. Much easier to just increase exam prices by a few dollars and make everyone pay for that knowledge whether I actually need to use it or not.

 

[bunnity]

Looks like the Fairness to Pet Owners Act was introduced earlier this year; I can't find anything indicating that it passed.

Our local grocery store chain has free cephalexin and amoxicillin and occasionally other antibiotics as well. If it is an appropriate antibiotic for my patient and the owner asks I do not hesitate to write them a script... sometimes I bring it up if I know they have money concerns. I would rather they spend their money on the diagnostics and recheck exams that I want them to do than throw down everything on the antibiotics. And clients are pretty good about understanding that there are situations where the antibiotic I want to use is animal-only (baytril, clavamox) and not available as part of the program. I also have owners who request scripts for ongoing meds because of their (schedule, disability, location) and I am okay with that too. I think it helps build trust with owners if you are willing to try to save them money.

I also think there is a big advantage to scripting out controlled drugs because it stops people from visiting multiple vets for the same prescription... it is harder to cheat if you're going through a pharmacy. We script out benzos and phenobarb and it's nice to not worry about it as much.

 

[LetItSnow]

Not all pharmacies are completely void of veterinary knowledge, and I think we're at the beginning of traditional pharmacies increasing their knowledge somewhat. UMN's pharm school, for instance, offers a third-year elective called Veterinary Pharmacotherapy, and we frequently have Pharm students on rotation in the VMC. No, it's not "sufficient," and I'm not suggesting it is. But I think it's the start of traditional pharmacies becoming more conversant (and theoretically more competent) with veterinary pharmaceuticals. Obviously the big downside that the vet community is afraid of is the loss of pharm as a revenue center. And, historically (and still today), there's the issue of potential harm to the animal from some pharm filling a script incorrectly/inappropriately when they assume they can treat the animal like a human. The first issue ... might be a lost cause. The second issue ... has the potential to change over time.

I would be awfully cautious about the wording if you're going to tell a client that you can't "guarantee the efficacy" of a drug from a separate pharm. That implies you are guaranteeing the efficacy of the one you dispense. When that animal doesn't get better, what do you tell your client? I mean, I get what that vet is <trying> to say, but I think they might be setting themselves up for conflict if your wording is not very carefully chosen.

I disagree on the no ethical issues.
If someone comes in to an appointment, and then you have an unusual policy that forces them to pay additional or find a new vet, there is an ethical issue there.

That might be bad business (it's probably never a good idea to surprise your customer with line-items they didn't expect), but I don't understand why you think it's unethical? I don't think one veterinarian's set of services has to have the same line items as another. Why would it?

Personally, I think that vets should <be allowed> to upcharge for scripting something out if they want. And at the same time, I don't think it's probably a good business practice just because it would make customers feel like they're being nickel and dimed. I'd probably calculate out the cost of doing it and bury it in the prescription filling cost for meds I *do* dispense. Usually calling in a script is quick 'n easy and takes a couple minutes at most. But there are times it takes significant time - I sat on a phone for 20 minutes last week trying to call in a script. And then it cost me another 5 when they called back to say "Oh, uh, yeah, we don't stock that." In a clinic, that 25 minutes of employee time costs real money, and a practice should be allowed to be compensated for that somehow.

 

[that redhead]

You're providing a service; it is not unethical to charge for services performed. Look at it this way: Many places charge $50 for a physical exam. (The clinic I was at charged $60, but it was in an affluent metro suburb, so I'll be fair and say $50). If you divide that by 60 minutes in an hour, it works out to $0.83 per minute. If it takes me five minutes to call in the script (optimistic in my opinion, but we'll try to estimate on the low side), that's $4.16 for my time. So really, you're getting a deal at $3.

I know I'm making the situation black and white when reality is somewhere in between, but I'm always frustrated by the entitled attitude that some clients have. Veterinary practices make money by prescribing drugs in-house, but they won't keep clients if they refuse to script out to Walmart or other cheaper options. So we script out. But that means we only get the cost of the physical exam, maybe a small procedure like a fecal or a blood draw. If we're scripting out for a longer term drug, we lose even that small profit. So we're essentially giving our knowledge away for free.

I'm not advocating the nickel and dime approach; as a pet owner, I'm cost-conscious too. But veterinarians have to make a living, and the 25 minutes it took LIS to call in a script could be two lunch breaks for some poor vet who came in early and is staying late. To have someone kvetch about $3 for me take the time out of my busy day to call in a script is insulting, frankly.

 

[NStarz]

You're providing a service; it is not unethical to charge for services performed. Look at it this way: Many places charge $50 for a physical exam. (The clinic I was at charged $60, but it was in an affluent metro suburb, so I'll be fair and say $50). If you divide that by 60 minutes in an hour, it works out to $0.83 per minute. If it takes me five minutes to call in the script (optimistic in my opinion, but we'll try to estimate on the low side), that's $4.16 for my time. So really, you're getting a deal at $3.

I know I'm making the situation black and white when reality is somewhere in between, but I'm always frustrated by the entitled attitude that some clients have. Veterinary practices make money by prescribing drugs in-house, but they won't keep clients if they refuse to script out to Walmart or other cheaper options. So we script out. But that means we only get the cost of the physical exam, maybe a small procedure like a fecal or a blood draw. If we're scripting out for a longer term drug, we lose even that small profit. So we're essentially giving our knowledge away for free.

I'm not advocating the nickel and dime approach; as a pet owner, I'm cost-conscious too. But veterinarians have to make a living, and the 25 minutes it took LIS to call in a script could be two lunch breaks for some poor vet who came in early and is staying late. To have someone kvetch about $3 for me take the time out of my busy day to call in a script is insulting, frankly.

Also, all of the cost-cutting by pet owners has to be made up SOMEWHERE. Vets lost spay/neuter income, pharmacy income, flea/tick/HW prev income. I don't think it's sustainable.

 

[StartingoverVet]

Not all pharmacies are completely void of veterinary knowledge, and I think we're at the beginning of traditional pharmacies increasing their knowledge somewhat. UMN's pharm school, for instance, offers a third-year elective called Veterinary Pharmacotherapy, and we frequently have Pharm students on rotation in the VMC. No, it's not "sufficient," and I'm not suggesting it is. But I think it's the start of traditional pharmacies becoming more conversant (and theoretically more competent) with veterinary pharmaceuticals. Obviously the big downside that the vet community is afraid of is the loss of pharm as a revenue center. And, historically (and still today), there's the issue of potential harm to the animal from some pharm filling a script incorrectly/inappropriately when they assume they can treat the animal like a human. The first issue ... might be a lost cause. The second issue ... has the potential to change over time.

I would be awfully cautious about the wording if you're going to tell a client that you can't "guarantee the efficacy" of a drug from a separate pharm. That implies you are guaranteeing the efficacy of the one you dispense. When that animal doesn't get better, what do you tell your client? I mean, I get what that vet is <trying> to say, but I think they might be setting themselves up for conflict if your wording is not very carefully chosen.



That might be bad business (it's probably never a good idea to surprise your customer with line-items they didn't expect), but I don't understand why you think it's unethical? I don't think one veterinarian's set of services has to have the same line items as another. Why would it?

Personally, I think that vets should <be allowed> to upcharge for scripting something out if they want. And at the same time, I don't think it's probably a good business practice just because it would make customers feel like they're being nickel and dimed. I'd probably calculate out the cost of doing it and bury it in the prescription filling cost for meds I *do* dispense. Usually calling in a script is quick 'n easy and takes a couple minutes at most. But there are times it takes significant time - I sat on a phone for 20 minutes last week trying to call in a script. And then it cost me another 5 when they called back to say "Oh, uh, yeah, we don't stock that." In a clinic, that 25 minutes of employee time costs real money, and a practice should be allowed to be compensated for that somehow.

You're providing a service; it is not unethical to charge for services performed. Look at it this way: Many places charge $50 for a physical exam. (The clinic I was at charged $60, but it was in an affluent metro suburb, so I'll be fair and say $50). If you divide that by 60 minutes in an hour, it works out to $0.83 per minute. If it takes me five minutes to call in the script (optimistic in my opinion, but we'll try to estimate on the low side), that's $4.16 for my time. So really, you're getting a deal at $3.

I know I'm making the situation black and white when reality is somewhere in between, but I'm always frustrated by the entitled attitude that some clients have. Veterinary practices make money by prescribing drugs in-house, but they won't keep clients if they refuse to script out to Walmart or other cheaper options. So we script out. But that means we only get the cost of the physical exam, maybe a small procedure like a fecal or a blood draw. If we're scripting out for a longer term drug, we lose even that small profit. So we're essentially giving our knowledge away for free.

I'm not advocating the nickel and dime approach; as a pet owner, I'm cost-conscious too. But veterinarians have to make a living, and the 25 minutes it took LIS to call in a script could be two lunch breaks for some poor vet who came in early and is staying late. To have someone kvetch about $3 for me take the time out of my busy day to call in a script is insulting, frankly.

Eh, now you are talking about different issues.
Calling in scripts is different than giving a script at an appointment.
One takes a few seconds (writing on a pad), the other can take a considerable amount of time depending on the pharmacy.

I think most clients would be more understanding of a charge for calling than for not being willing to write on your little pad while in the office.

Again, these nuances matter.

And it seems also a different story not to be willing to write a maintenance med script without an appointment. I think giving 6 months supply on a script and requiring an officer visit for refills is reasonable and would be acceptable.


And I am sorry, but charging a service to write a few words on a prescription does not seem reasonable. It is not entitlement. You seem to want to parse out the choosing the right drug from the rest of the office exam, and that does not seem to be a reasonable course of action. And that is where it is an ethics issue. You are now withholding the ability for your client to treat their pet unless you agree to use your profit center, after they have already paid you for your expertise. Shall you charge now to tell them your diagnosis, because they might go elsewhere, or charge them for knowing what types of tests are required because they might go elsewhere? No, just because filling drugs has been a profit center doesn't mean a vet has the right to hold that information hostage.

Yes, vets need to make money, but they need to adapt their business model, and charging for their knowledge is already part of their exam. If that is not sufficient, charge more for the exam.

Not wanting to spend 20 minutes on the phone with the pharmacy is a completely different issue.

 

[that redhead]

I think most clients would be more understanding of a charge for calling than for not being willing to write on your little pad while in the office.

Honestly, I've only ever seen scripts called in by the vet office, never written out like the human doctors do/did.

And it seems also a different story not to be willing to write a maintenance med script without an appointment. I think giving 6 months supply on a script and requiring an officer visit for refills is reasonable and would be acceptable.

I agree. However, someone isn't going to want to pay a $50 exam fee for you to ask, "So, how's Fluffy doing? Good? Okay, here's your script." I imagine even more of a fuss about that from someone who doesn't want to pay $3 for a script.

And that is where it is an ethics issue. You are now withholding the ability for your client to treat their pet unless you agree to use your profit center, after they have already paid you for your expertise.

I am not at all withholding the ability of them to treat their pet, I'm just asking them to compensate me for my time in filling out a script. Even using a little white pad, I need to talk to the pharmacy to make sure they have that drug, that concentration, that quantity available. If I already know they have that drug because it's so common, the worst that happens is someone pays me $3 when it would have cost them maybe $20 for a script from the hospital. They're saving money overall by getting it from the human pharmacy. Is it so unethical to ask that I get a little bit of their money when I did all of the work?

 

[StartingoverVet]

I am not at all withholding the ability of them to treat their pet, I'm just asking them to compensate me for my time in filling out a script. Even using a little white pad, I need to talk to the pharmacy to make sure they have that drug, that concentration, that quantity available. If I already know they have that drug because it's so common, the worst that happens is someone pays me $3 when it would have cost them maybe $20 for a script from the hospital. They're saving money overall by getting it from the human pharmacy. Is it so unethical to ask that I get a little bit of their money when I did all of the work?

You are seriously overestimating what is involved here.
You write the script, patient takes it to pharmacy. If, and only if there is a problem do you get involved.
This happens all the time with on-line pet scripts.

If they can't fill it, they come back and you get the business.

I think you are over-complicating it.

And they are compensating you for your time already.

 

[LetItSnow]

Eh, now you are talking about different issues.
Calling in scripts is different than giving a script at an appointment.
One takes a few seconds (writing on a pad), the other can take a considerable amount of time depending on the pharmacy.

I think most clients would be more understanding of a charge for calling than for not being willing to write on your little pad while in the office.

Again, these nuances matter.

And it seems also a different story not to be willing to write a maintenance med script without an appointment. I think giving 6 months supply on a script and requiring an officer visit for refills is reasonable and would be acceptable.


And I am sorry, but charging a service to write a few words on a prescription does not seem reasonable. It is not entitlement. You seem to want to parse out the choosing the right drug from the rest of the office exam, and that does not seem to be a reasonable course of action. And that is where it is an ethics issue. You are now withholding the ability for your client to treat their pet unless you agree to use your profit center, after they have already paid you for your expertise. Shall you charge now to tell them your diagnosis, because they might go elsewhere, or charge them for knowing what types of tests are required because they might go elsewhere? No, just because filling drugs has been a profit center doesn't mean a vet has the right to hold that information hostage.

Yes, vets need to make money, but they need to adapt their business model, and charging for their knowledge is already part of their exam. If that is not sufficient, charge more for the exam.

Not wanting to spend 20 minutes on the phone with the pharmacy is a completely different issue.

You do realize that the "writing a few words on a prescription" can very easily result in a phone call from the pharmacy that takes time to deal with, right?

You're portraying it as "writing a script is trivial" and that's not a safe assumption.

And sure, I don't have any problem with a vet charging for a diagnosis separate if they wanted to try that business model. That's precisely what auto repair places do ...."Sure, we can read the computer code in your car - for a fee." And then they charge me for the repair. And, they charge me for every little tool they use and fluid they dispose and ....

I think it is VERY reasonable to want to "parse out" choosing the right treatment from the rest of the exam.

I dunno, Maybe I just don't understand what you're saying... but yes, I think it is reasonable to charge for an exam fee aimed at arriving at a diagnosis, and then additional fees as necessary for treatment; whether that's a script-dispensing fee, a drug fee, whatever. It should cover the costs the vet has plus include a reasonable profit.

I don't agree with what I think you are saying, which seems to be that the exam fee should be all-encompassing and include tx fees. But I dunno if that's really what you mean.

 

[DVMDream]

Eh, now you are talking about different issues.
Calling in scripts is different than giving a script at an appointment.
One takes a few seconds (writing on a pad), the other can take a considerable amount of time depending on the pharmacy.

I think most clients would be more understanding of a charge for calling than for not being willing to write on your little pad while in the office.

Again, these nuances matter.

And it seems also a different story not to be willing to write a maintenance med script without an appointment. I think giving 6 months supply on a script and requiring an officer visit for refills is reasonable and would be acceptable.

Which drug are you talking about? I don't know any vet that will allow a client to get 6 months worth of medicine up front. It just doesn't happen. They might write a script that allows you a certain number of refills before you have to call to get another refill, but a BIG part and BIG issue of vet med is follow-up with clients especially when it comes to things like bloodwork and stuff. I can guarantee that if you write a 6 month script for say thyroid medication, that client will call you when they run out and go... "oh, I don't have the money for bloodwork this time, can't you just refill it?" It happens ALL the time. So, you refill it for a month and again..."Oh I am out and I need a refill." So then you have to refill it because the dog needs to be on the med to do the BW... you eventually go from checking that thyroid BW once every 6 months to once every 9-12 months. This above does not work. You can't write an rx for 6 months of time for most medications.

And I am sorry, but charging a service to write a few words on a prescription does not seem reasonable. It is not entitlement. You seem to want to parse out the choosing the right drug from the rest of the office exam, and that does not seem to be a reasonable course of action. And that is where it is an ethics issue. You are now withholding the ability for your client to treat their pet unless you agree to use your profit center, after they have already paid you for your expertise. Shall you charge now to tell them your diagnosis, because they might go elsewhere, or charge them for knowing what types of tests are required because they might go elsewhere? No, just because filling drugs has been a profit center doesn't mean a vet has the right to hold that information hostage.

Yes, vets need to make money, but they need to adapt their business model, and charging for their knowledge is already part of their exam. If that is not sufficient, charge more for the exam.

Not wanting to spend 20 minutes on the phone with the pharmacy is a completely different issue.

Actually, you do charge them to tell your diagnosis.... technically. When the client pays for BW, they are paying for you to read that BW and for your knowledge of those values and to give a diagnosis based upon that. Same thing for xrays. Same thing for surgery (your surgery expertise is not charged in exam fees it is in the charge for the surgery). We "parse out" our knowledge ALL the time... why should it be different for our knowledge on drugs? Simply because clients don't want to see that charge? Clients don't see the vast majority of charges because we don't line item everything. I don't go stethoscope use: $3.50, palpating internal organs: $4, checking teeth: $3, looking at eyes: $4, rectal: $5, putting what I feel/see into context: $10, etc, etc. Clients don't understand what exactly an exam entails. Your dog with diarrhea I have used more knowledge on than the client will ever be aware... (chronic vs. acute, small bowel vs. large bowel, life threatening or no).

I get what you are saying, that it isn't reasonable for the vet to charge separately for the rx BUT not because they don't deserve to be compensated for that knowledge but because people (including how you have stated it above) are irrational. They don't realize what they are paying for. They don't realize that the pharmacy down the road sees "levothyroxine 0.8mg q 12h" and freaks out that you are "overdosing" poor Fluffy so you spend 20 minutes with the pharmacist telling them that yes Fluffy really does need that much thyroid medication.

So what I predict happening is that instead of the clients who need meds getting charged for pharmacy knowledge, vets will start tacking it on to the exam for EVERY client and now you are paying for a service that you may or may not really need.

 

[that redhead]

You are seriously overestimating what is involved here.
You write the script, patient takes it to pharmacy. If, and only if there is a problem do you get involved.
This happens all the time with on-line pet scripts.

In my experience, it is never that simple. Again, we've always called in the prescription for the reasons stated - need to verify concentration, need to assure the pharmacist that we aren't overdosing, etc. Sure, you can just send the slip of paper over with the client...but when the client comes back or the pharmacist wants to verify something (and I'm elbow deep in a spay, or euthanizing a dog, or simply in my next appointment)...I will kick myself for not having called. And then my points above all come into play.

I can see it being frustrating if I were to charge the same fee for the script as I would for the drug itself...but in this case it's THREE DOLLARS. For the amount that people are looking to other sources for their pets' medications, I think it's completely fair to ask.

 

[StartingoverVet]

And sure, I don't have any problem with a vet charging for a diagnosis separate if they wanted to try that business model. That's precisely what auto repair places do ...."Sure, we can read the computer code in your car - for a fee." And then they charge me for the repair. And, they charge me for every little tool they use and fluid they dispose and ....

This already is the model we are using. We have an office visit to read the computer code. Then you charge to do a treatment. And then you charge for the needle you use, or the isoflourane. etc. I have no problem with that.

I am saying, that ethically, it is like charging an office fee to see fluffy and then saying I won't tell you what is wrong unless you pay me more.
I see that as a problem.

I see in your analogy this as the mechanic saying, I won't tell you what part you need unless you buy it from me.
That is a problem.

If there are costs associated with that, they are minor. Sure there are occasional complications. I have worked in a pharmacy and seen pet drug meds, and few required a call to the vets.

But being able to purchase a drug for your pet to meet the diagnosis provided as part of an office exam seems obvious. I don't see ANY reason why this writing of a script which legal allows me to treat my dog should be held hostage. You really are extorting a fee out of the client at that point. This is not a time issue. It is an unwillingness to accept that the client has the right to be given the right to purchase the drugs as they choose. The time issue is a straw man argument IMO.

 

[DVMDream]

I don't see ANY reason why this writing of a script which legal allows me to treat my dog should be held hostage. You really are extorting a fee out of the client at that point. This is not a time issue. It is an unwillingness to accept that the client has the right to be given the right to purchase the drugs as they choose. The time issue is a straw man argument IMO.

$3 for a written rx on a script pad:

1. That script pad is NOT free to the vet. There is part of the charge.
2. That vet has knowledge of the medications, what dose is needed, etc. Another part of the charge
3. The time it takes to write a script (it does take time, sometimes a few minutes sometimes 30 seconds).
4. The time it takes to verify a place has the drug and dose. I worked as a tech for 7 years, we called pharmacies beforehand for many drugs to be sure they had them. I have easily spent 40 minutes before locating a drug, at the proper dose, for a decent price for the client. And no, that 40 minute example isn't a happened one time, I would say I did that at least once a week. This is another part of the charge.

Seriously... $3 is such a ridiculous amount of money to get upset over and when you REALLY think about what all goes into get that written rx into your hand so that you can skip down to Walgreens.. it is not unreasonable. Alternatively, I can just increase my exam fee from $50 to $53... which actually brings me in more money... so meh. I would rather if I were a client keep the cheaper exam fee and pay the $3 for the time I do need that rx, then to have to pay an increased exam fee every time I see the vet because of some irrational people.

 

[StartingoverVet]

You guys are missing the point, so I give up.
You could assign a charge for every single minute of every appointment.
Cost of stethoscope.
Time to listen.
Cost of clock.
Time to measure respiration.

My point is that when you pay an office exam fee, that those items necessary to give your client a diagnosis are included. And writing a part of that treatment plan on a piece of paper is part of that. If you think otherwise, then fine. But charging for what seems to be naturally included in that office visit seems absurd, gives a bad impression to the industry IMO, and I would never do it.

 

[DVMDream]

Thought of more you have to do still when writing out that rx:

-Still need to inform the client of any possible adverse effects of the drug.
-Need to talk about the importance of completing the medication
-Good to discuss with them how the med is being prescribed as we have had many issues with human pharmacies telling clients to do something different, so be adamant to the client that the med is given as you prescribed it. This meant usually writing it down a second time for the client.

 

[dyachei]

Eh, now you are talking about different issues.
Calling in scripts is different than giving a script at an appointment.
One takes a few seconds (writing on a pad), the other can take a considerable amount of time depending on the pharmacy.

I think most clients would be more understanding of a charge for calling than for not being willing to write on your little pad while in the office.

Again, these nuances matter.

And it seems also a different story not to be willing to write a maintenance med script without an appointment. I think giving 6 months supply on a script and requiring an officer visit for refills is reasonable and would be acceptable.


And I am sorry, but charging a service to write a few words on a prescription does not seem reasonable. It is not entitlement. You seem to want to parse out the choosing the right drug from the rest of the office exam, and that does not seem to be a reasonable course of action. And that is where it is an ethics issue. You are now withholding the ability for your client to treat their pet unless you agree to use your profit center, after they have already paid you for your expertise. Shall you charge now to tell them your diagnosis, because they might go elsewhere, or charge them for knowing what types of tests are required because they might go elsewhere? No, just because filling drugs has been a profit center doesn't mean a vet has the right to hold that information hostage.

Yes, vets need to make money, but they need to adapt their business model, and charging for their knowledge is already part of their exam. If that is not sufficient, charge more for the exam.

Not wanting to spend 20 minutes on the phone with the pharmacy is a completely different issue.

I bolded the part above because I have clients that bitch that I won't allow them to refill their hw prevention without a yearly test. Patients on chronic meds can sometimes be worse about following up appropriately.

You also aren't holding them hostage. You can give them the diagnosis and they can hound other vets for free scripts or cheaper antibiotics...

 

[DVMDream]

My point is that when you pay an office exam fee, that those items necessary to give your client a diagnosis are included. .

No. It isn't. I don't include the cost of BW and xrays in an exam fee. Often those are needed to give a diagnosis. If a skinny cat, with high HR, dehydrated, etc comes into the clinic I can't tell if that cat is hyperthyoid, renal failure, etc. I NEED to do BW to give a diagnosis and I do charge that client for the BW.

Same thing with skin issues...I charge for a skin scrape, trichogram, fungal culture, impression smear, etc. Then I can inform the client of what I see and give a diagnosis.

Same with diarrhea... I charge for a fecal float and a fecal smear. If client doesn't have money for tests I might do a trial with dewormer and metronidazole, but I am still charging in part for that "diagnosis" by prescribing those meds and saying, "it could be intestinal parasites lets' try this and if there is no improvement come back in x amount of days."

 

[dyachei]

to answer your question, I wouldn't charge it not because it is unethical, but because the client perception would be negative and I like to foster trust with my VCPRs

 

[DVMDream]

To me what vet clients want is free treatment. Which is essentially what they are getting when they aren't charged for the written rx. They get a diagnosis and they get "free" treatment. "Free" can be argued here but the vet is now making $0 for treating your pet.

Again, I wouldn't charge a fee for the written rx, but I don't see how it is unethical to charge that fee. I just wouldn't personally do it.

 

[LetItSnow]

You guys are missing the point, so I give up.
You could assign a charge for every single minute of every appointment.
Cost of stethoscope.
Time to listen.
Cost of clock.
Time to measure respiration.

My point is that when you pay an office exam fee, that those items necessary to give your client a diagnosis are included. And writing a part of that treatment plan on a piece of paper is part of that. If you think otherwise, then fine. But charging for what seems to be naturally included in that office visit seems absurd, gives a bad impression to the industry IMO, and I would never do it.

Perhaps it's not so much that all of us are missing the point as it is that your point isn't (to us) reasonable.

I don't agree with your assertion that just because I diagnose a problem in an animal I have an obligation (based on charging them for a diagnosis) to give them any tools to treat their animal. I mean, if that's your argument, why aren't you arguing that I should provide ALL means of treatment as part of my diagnostic fee? Whether it costs me relatively little (writing a script) or a lot (performing a multi-hour procedure) is irrelevant; if it costs me money to do it I should be able to pass that cost onto the client. Whether that's as a line-item fee or as a cost built-in to some other line item (like the exam fee) really should be up the veterinarian ... it's their business model to implement.

It's certainly not unethical to expect to be compensated for any service I provide a client. The fact that YOU think it's a trivial service isn't really relevant (other than as a marketing type of decision - i.e. is charging for this service worth risking alienating my client).

So no. I don't see any ethical issue whatsoever. I'm under no obligation to provide you the means to treat your animal just because I diagnose it. You should be expected to pay the costs of treatment as well as diagnosis.

 

[NStarz]

I've actually been reading up on this a bit on VIN. Seems the consensus is that it does nothing more than to p*** clients off, while vets (understandably) think they should be able to charge for a written script. The solution was to increase exam fees by the dollar amount.

 

[LetItSnow]

I've actually been reading up on this a bit on VIN. Seems the consensus is that it does nothing more than to p*** clients off, while vets (understandably) think they should be able to charge for a written script. The solution was to increase exam fees by the dollar amount.

I think pretty much all of us have agreed that actually putting a line-item for "script writing" would piss people off and we wouldn't do it.

What I take issue with is calling it "unethical" to do so. I do not believe it is "unethical," and none of the arguments supporting that position seem compelling to me. They all seem to rest on some sort of "they paid your exam fee, therefore you have an obligation to provide them the means to treat their animal" argument, which doesn't (to me) make sense. You paid my exam fee, which bought you an exam and access to my expert knowledge. Nothing more. Further diagnostics and any treatment (including prescriptions) would reasonable incur further cost to the client because it costs me more to give it. Whether it's a trivial cost or a large cost really doesn't matter; it's a cost and therefore I can reasonably expect to recoup it. It doesn't matter that SOV points out that it doesn't cost much. It costs me <something> and therefore it's ethical for me to charge for it.

I agree with what SOV said earlier in the thread; that the most likely real-life outcome is that practices will simply increase their exam fee incrementally to cover what they think is an appropriate cost, because reasonable or not, people don't expect to pay for a script just to go somewhere and pay (again, in their perception) for the drug itself. So as a matter of practicality, practices will undoubtedly spread that cost out to all clients.

 

[NStarz]

I think pretty much all of us have agreed that actually putting a line-item for "script writing" would piss people off and we wouldn't do it.

What I take issue with is calling it "unethical" to do so. I do not believe it is "unethical," and none of the arguments supporting that position seem compelling to me. They all seem to rest on some sort of "they paid your exam fee, therefore you have an obligation to provide them the means to treat their animal" argument, which doesn't (to me) make sense. You paid my exam fee, which bought you an exam and access to my expert knowledge. Nothing more. Further diagnostics and any treatment (including prescriptions) would reasonable incur further cost to the client because it costs me more to give it. Whether it's a trivial cost or a large cost really doesn't matter; it's a cost and therefore I can reasonably expect to recoup it. It doesn't matter that SOV points out that it doesn't cost much. It costs me <something> and therefore it's ethical for me to charge for it.

I agree with what SOV said earlier in the thread; that the most likely real-life outcome is that practices will simply increase their exam fee incrementally to cover what they think is an appropriate cost, because reasonable or not, people don't expect to pay for a script just to go somewhere and pay (again, in their perception) for the drug itself. So as a matter of practicality, practices will undoubtedly spread that cost out to all clients.

It also becomes a legal issue (again, thanks VIN). You are not legally allowed to charge for some written scripts and not others. So you can't, theoretically, wait for an owner to decide to buy the drug from elsewhere before charging them a script writing fee. You either have to charge all of your clients or none of them. You would also see a problem with rechecks when the owner is not due to bring the pet in. Do you charge for a script?

I think it's definitely ethical. A good business practice? Meh...

 

[Lissarae06]

I wish scripting out meds was as simple as taking 30 second to write it down. I swear if Walgreens calls me to ask my DEA number for doxycycline one more time....

 

[1doggeek]

The Fairness to Pet Owners Act deals with script writing... http://avmacan.avma.org/avma/issues/alert/?alertid=63099296 (yeah, it's AVMA, but it'll give you a link to the bill at least lol)
This would prohibit the option to charge script writing fees, and basically require vets to always write scripts.

 

[DVMDream]

The Fairness to Pet Owners Act deals with script writing... http://avmacan.avma.org/avma/issues/alert/?alertid=63099296 (yeah, it's AVMA, but it'll give you a link to the bill at least lol)
This would prohibit the option to charge script writing fees, and basically require vets to always write scripts.

I don't think it will pass. There is a lot of work going into making sure it doesn't pass. It is also called the "WalMart Bill" if I remember correctly. The bad part about the Act isn't that it makes vets write prescriptions it is that we can't have the client to sign a liability waiver for having the meds filled elsewhere. Basically it makes vets responsible for how the pharmacy fills the medication and considering the nightmare mistakes and "corrections" I have seen human pharmacies make with pet meds, it is a bad idea. I don't care if a pet owner wants a written rx, I will gladly give them one, but I am not responsible if the human pharmacy decides that all insulin syringes are the same and misinforms my client about that and my client overdoses their dog on insulin because the pharmacist is an idiot.

 

[pp9]

Opinions: Refusing to approve any rx requests that come from 1-800-Petmeds or similar services. What do you guys think? It's very situation-dependent, I know.

 

[dyachei]

Opinions: Refusing to approve any rx requests that come from 1-800-Petmeds or similar services. What do you guys think? It's very situation-dependent, I know.

I don't refuse. But I inform them why I don't like to. And I will price match them. But it's well within your rights to refuse to fill from them.

I mean, they legally cannot get half the drugs they have. Which means that they are coercing or at least give benefit to veterinarians who won't stand by their agreements.

 

[jmo1012]

$3 is a bargain, apparently my uncle's vet charges $25. to each his own.

 

[pp9]

$3 is a bargain, apparently my uncle's vet charges $25. to each his own.

😵 I mean it makes sense....let's assume the average prescription is $25 at that clinic. That vet isn't losing that sale, technically speaking, if she/he charges that much to let a sale walk out the door.

 

[SummerTheLynx]

😵 I mean it makes sense....let's assume the average prescription is $25 at that clinic. That vet isn't losing that sale, technically speaking, if she/he charges that much to let a sale walk out the door.

But there are no meds being sold... People are confusing revenue and profit. Just bc it sells for 25 dollars does not mean whatsoever that the hospital just made $25. So no, that type or practice is outrageous in my opinion... On $25 worth of medications, the practice I work for makes between 5 and 15 dollars depending on what the drug is (usually there is a flat fee for giving out a medication, and then there is a cost per pill as well). So to charge $25 to script out is just sort of astronomical IMO...

 

[Lissarae06]

I don't think it will pass. There is a lot of work going into making sure it doesn't pass. It is also called the "WalMart Bill" if I remember correctly. The bad part about the Act isn't that it makes vets write prescriptions it is that we can't have the client to sign a liability waiver for having the meds filled elsewhere. Basically it makes vets responsible for how the pharmacy fills the medication and considering the nightmare mistakes and "corrections" I have seen human pharmacies make with pet meds, it is a bad idea. I don't care if a pet owner wants a written rx, I will gladly give them one, but I am not responsible if the human pharmacy decides that all insulin syringes are the same and misinforms my client about that and my client overdoses their dog on insulin because the pharmacist is an idiot.

A friend just told me about this happenening to one if her clients the other day. The pharmacist told her she should be using U-40 syringes because they were cheaper than the U-100 syringes she was instructed to use. Luckily the client was a very knowledgeable tech or it could have gotten bad.

 

[cowgirla]

A friend just told me about this happenening to one if her clients the other day. The pharmacist told her she should be using U-40 syringes because they were cheaper than the U-100 syringes she was instructed to use. Luckily the client was a very knowledgeable tech or it could have gotten bad.

had a pharmacist dispense -R insulin instead of -N insulin. needless to say, it didnt work very well and a previously well controlled diabetic was no longer controlled. Spent 40 minutes on the phone with various people at the pharmacy, because our script clearly had the right thing on it (yes, always photocopy your scripts!)

 

[DVMDream]

Opinions: Refusing to approve any rx requests that come from 1-800-Petmeds or similar services. What do you guys think? It's very situation-dependent, I know.

When I worked as a tech, we explained to clients why we do not approve of them getting medications from 1-800-Petmeds. They aren't regulated and there is no knowing where some of their medications actually come from.

Just remember no two online pharmacies are the same and you can find ones that are reputable.

So, we gave the client options:

1. Get the medication filled with us
2. Get a written rx that they could get filled anywhere (we did not charge for written rx's).
3. We had an online pharmacy that we recommended that would often price match. We could call in their rx to that pharmacy
4. If they really still wanted 1-800-Petmeds then we gave them a written rx and told them they would have to mail it to the company or fax it in. We would not call in prescriptions to 1-800-Petmeds for clients. When rx refill requests were faxed from 1-800-Petmeds, we would inform they clients that they have to come pick up a written rx and send that in themselves.

 

[DVMDream]

A friend just told me about this happenening to one if her clients the other day. The pharmacist told her she should be using U-40 syringes because they were cheaper than the U-100 syringes she was instructed to use. Luckily the client was a very knowledgeable tech or it could have gotten bad.

Thankfully, she knew what she was doing, that could have been a nightmare.

 

[DVMDream]

had a pharmacist dispense -R insulin instead of -N insulin. needless to say, it didnt work very well and a previously well controlled diabetic was no longer controlled. Spent 40 minutes on the phone with various people at the pharmacy, because our script clearly had the right thing on it (yes, always photocopy your scripts!)

That just really sucks. But now I have made a mental note to copy all of my rx's, could probably scan them right into a patient chart if there is a computer system being used.