Veterinary Value

Sounds like dad's had some fun over the past few days. Seems getting prescription drugs online is a a battle of pedantics.

Placing an order with an online pharmacy couldn't be easier. After choosing one of the many online it was simple to complete the order and make payment.

After receiving the order confirmation simply replying with the scanned copies of the two prescriptions, one for Epiphen and one for Previcox, the order part was complete.

Now this is where common sense leaves the room. The prescription for 90 x 60mg  tablets of Epiphen for a months supply means that each time I take the 1.5 tablet dose I'm prescribed, a small 60mg tablet must be broken in two. This isn't an accurate science as it often means the tablet crumbles into 3 or more parts.

So why not order 60 x 60mg and 60 x 30mg - the half size tablets? This equates to exactly the dosage on the prescription, but is more accurate and convenient.

Well it turns out that my current vet wont allow the tablets to be supplied in this way. The online pharmacy calls up my vet and asks if they can supply pills of the correct size and the vet says no!

I suspect that if dad were to ask the vet they would then say I need 3 separate prescriptions to do this. So the vet would charge more and profit more each month.

Dad nor I can see the sense in having to continue breaking pills - where it is not a recommended practice as the dosage can not be precisely controlled. But it would appear that for nothing other than protecting their profits, my current vet insist we must stick to the prescription tablet size and quantity exactly, despite them having supplied half size tablets when they themselves have had them in stock.

Well that appears to be the last straw. Dad got on the phone a called a few more veterinary surgeries and was advised by his boss to call one local to where he works. After a very helpful conversation with the veterinary nurse it turns out that they are willing to assist and can provide a 3 month prescription - either as monthly repeats or as a single 3 month quantity - for £12!!! Yes, that's right, a saving of £6 per month.

Of course this means that I must come under their care and be seen by one of their surgeons, but the savings in prescription charges more than compensates for this. Other parts of the conversation relating to consultancy charges and prices for blood tests suggest even more savings.

So in February we're going to go pay this new veterinary surgery a visit. The extra good news for me is that I get to go to work with dad whenever I need to go see the doctor. It does mean dad would have to drive 35 miles each way if he wasn't going in to work, but as he's in work most every day, it seems like a reasonable trade off.

In all it pays to shop around. You can never ask too many questions and it pays to do some research online so you can get as much information as possible.

Prescription Drugs

Dad's been speaking to the doctor today and trying to find a more cost effective way of continuing my treatment. Not being insured turns out to be rather costly after all, but it's all about accepting certain risks. In my case it hasn't really paid off.

Insurance quotes for me ranged from £28-£33 per month, which is rather a lot of cash. I guess until mum and dad got really attached to me, they thought that a little too much to take on. Hopefully in hind sight they now see it as a small price to pay for a lovable monster like me.

Now with my current condition over the past few months the vet bills have grown more than mum and dad can afford - dad's been looking at some other options. It's not about the doctor, as I know dad's really pleased with them, the service is great, it's just about the money.

The two drugs that I'm taking (Epiphen and Previcox) work out at £69.35 per month when supplied by the vet.  This is made up of:

Description	Quantity	Price	Per Tablet
Epiphen (60mg)	90	£23.12	£0.256
Previcox (227mg)	30	£46.23	£1.541
	Total	£69.35

Now if dad goes online to many of the online pet pharmacies - and you too can just simply Google for almost any of them you'd see prices like this:

Description	Quantity	Price	Per Tablet
Epiphen (60mg)	90	£10.80	£0.12
Previcox (227mg)	30	£24.80	£0.826
	Total	£35.60

Can you believe that? Half the price that my friendly and so very helpful vet is charging! And I do mean friendly and helpful, as they are.  But the huge difference in price really has to be considered - especially with no insurance.

But things are not that straight forward. Since October 2008 veterinary practices can now charge for prescribing these drugs - which in itself isn't unfair, there has to be a cover for the administration of writing and recording prescriptions, or the vet would lose out. But the law now allows vets to charge anywhere up to £60 per prescription. Not that many do or would charge that much - but the law allows for it.

Thankfully my vet has set it's prescription charge at £7.20 per prescription. But that charge increases as I need two prescription drugs, so works out at £9.99. However, they will not provide a 3 month prescription, meaning this will require monthly prescriptions at £9.99 each month. Quite a money spinner as my medication is for a lifelong ailment, my vet is guaranteed £120 per year, for as long as I live.

Taking the vets prescription charges into account
there is still a huge saving of £23.76 per month (£285.12 per year)!

I'll still need to visit the doctor regularly for tests and checkups, so they'll still make money on my visits, but it still seems like there's £120 per year that they are making without any real effort.  I guess they have to protect themselves from people taking advantages of free prescriptions and not taking any of the vets services, but as we're paying for every consultation and test, it seems a better way would be to either offer repeat prescriptions or free prescriptions only where a contract of care between surgery and owner exists.

If a prescription were only issued at the time of consultation and valid only until the next, surely it would be fairer? As I must visit the vet every three months it doesn't sound unreasonable to have a three month prescription - instead I must get a prescription each month.

Dad did phone around other local vets and whilst very, very helpful the feedback was that the prices my vet are charging are typical of the industry. In fact the information regarding the change since October 2008 came from speaking to other practices.

Some very frank responses to the questions regarding drug costs expressed that veterinary surgeries often have high prescription charges simply to ward off bargain hunters, like myself, and attempt to keep the drug revenue within the practice. But if Internet sellers can supply and make money at the prices they charge I find it hard to believe that veterinaries aren't obtaining drugs at better prices and making huge mark ups.

There certainly seems like a large element of self preservation where practices are attempting to hold their market share simply by making the legislation work in their favour. No drugs without prescription, means cheap drugs only if you buy an expensive prescription. I feel certain that in some cases the cost of prescription means cheap drugs are not a viable alternative. In my case it seems there is an option - but how many could benefit by a fairer prescription process?

So far that's the best deal we've got. It's a good saving, but still an awful lot of money year on year. I'll update as we learn more.

UPDATE: Sad to say I missed the deadline in 2008 where the government were petitioned in regard to prescription charges. The governments response can be found here [http://www.number10.gov.uk/Page16942]

The Government is committed to delivering free and fair markets, with greater competition, for businesses, consumers and employees.

That is why the Government introduced the Supply of Veterinary Medicinal Products Order in 2005 to create a market for veterinary medicines away from veterinary surgeries. The Order was introduced following a Competition Commission report which found that the veterinary profession tended to understate the true cost of their professional services and offset this in their medicines pricing. This practice can allow two detrimental effects:

· Veterinary surgeons can hide excess profits in drug prices; and

· Inadequate pressure on manufacturers to maintain competitive drug prices.

The Competition Commission felt strongly that a three-year moratorium on prescription charges was essential to allow animal owners to become used to the availability of free prescriptions and encourage them to shop around. The availability of prescriptions was seen as the key element in opening up the prescription-only veterinary medicines market, increasing competitive pressure and driving prices down. High prescription charges had been a barrier to customers doing this in the past, but the three-year prohibition would kick-start the market.

The independent Office of Fair Trading (OFT) will be monitoring developments after the prohibition on charging for providing prescriptions comes to an end in October 2008 and will consider when and whether any further regulatory action may be needed to ensure effective competition in the supply of veterinary medicines.

Exercise Overdose

Dad went out to meet some people in his car on Saturday and that meant he wasn't going to be back until very late. This means no "walkies" for me!

But as luck would have it just before dad went out all the lights went out. There was a power cut. So with dad gone and mum not able to do anything, mum and Blaine took me out for a walkies! Yay, now if only I could figure out how to turn the electric off.

On Sunday dad wasn't at all shaky or holding his head muttering about an over hang or something, as expected. So we went to "Doggy Disney" and went for a proper walk. Not just a short route around the woods but all over. It was great! I got to chase those pesky squirrels for ages.

The good thing about this was that later that day and the following day my legs were much, much better than they have been in the past. These new tablets mum forces me to take are working wonders. It's fun watching mum think I've swallowed the tablet, when I haven't. Still I take it eventualy, but where would there be any fun if I took it first time?

Today dad took me out in the car to get his MOT done and we waked back through some green areas from the garage - about half an hours walk. It was great to be in places where I'd not been before - all the new smells to investigate.

Then in the afternoon we walked back to fetch the car. All this walking is great. Now I just need to find time for a decent nap.

Test Results

Well the Doctor phoned mum today and talked with her about my blood test results.  Looks like the 90mg of Epiphen is staying in my blood stream at a theraputic level for the 12 hours between tablets.

Good news as this means the dosage stays the same.

The Previcox seems to be doing a great job.  I'm a lot more mobile and even after a trip to "Doggy Disney" on Saturday, I was still mobile in hte evening and on Sunday.  Previously I've hobbled around a little uncomfortable for a day or two afterwards - but this time I was ready for going out again on Sunday!

I did notice that Monday I had a very runny number two - yeauch!  As this seems to be a possible side effect of the Previcox dad's going to keep an eye on it and make sure that it's nothing regular.

Blood Test Day

Well today dad took me back to the vets so the Doctor could take some blood. They need to figure out if the daily dose at 90mg of Epiphen is remaining in my bloodstream sufficiently to keep the seizures at bay.

The Doctor trusted me without a muzzle and got dad to hold me whilst he stuck the needle in to take the blood, and I didn't struggle or even make a sound. After all it's not as bad as having my temperature taken!!!

So far it's been 29 days since my last seizure, which is a very good thing.

Dad asked the Doctor about my legs which give me some discomfort after running about a bit. So he took a look see and felt around my hips and knees and it looks like my discomfort may be more related to my knees than my hips.

The Doctor signed me up for a treatment of Previcox (firocoxib) at 227mg per day (5mg per kg of weight, I'm 40kgs right now). The Doctor said to keep an eye out for side effects such as vomiting or diarrhoea.

After shopping around it looks as if Previcox is available far more cheaply online (I got dad to do this bit) than it is at the vets. It also seems it can have some quite severe side affects as with some other NAIDS (Non-steroidal anti-inflammatory drugs), so we're going to have to ask some questions on the next visit.

Without insurance the Epiphen and Previcox work out at £57 per month! So any saving to be made here is very useful.

UPDATE: Attached is the clinical trial report for Previcox (firocoxib, Merial) [Click here for PDF]