Veterinary prescriptions made easy

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Content sponsored by FDB (First Databank)

When it comes to prescription medications, veterinarians are in a unique position. Unlike most of our human health care counterparts, veterinarians are both prescribers and dispensers . Over the past few decades, veterinarians’ dual role has changed dramatically as the options for pet owners to fill pet prescriptions have increased. In the past, veterinarians were at times the only source of medications for our patients. For some expensive or less frequently used medications that were primarily human pharmaceuticals, veterinarians could write a prescription to be filled at a local pharmacy.

The available options increased substantially as the internet took off. In 1996, one of the first online pet pharmacies entered the fray. Soon thereafter, big-box retail stores also started to offer veterinary medications. In many ways, filling prescriptions has become the Wild West with the $36 billion veterinary industry¹ fulfilling medications in the veterinary hospital, local drug stores, compound pharmacies, online, and in a plethora of other ways.

It used to be easy for veterinarians to just hand the medication to the client and be the source for refills, but now it is becoming more and more common for pet owners to request a prescription, and now an electronic prescription, to be filled elsewhere, potentially for less. Writing prescriptions and responding to requests from online pharmacies for permission to fill prescriptions takes a huge amount of time, with no income being generated by veterinary practices. Equally confounding is the financial pressure competitive forces are putting on in-house veterinary pharmacies, pushing margins down. Are there simple solutions to help streamline this process while allowing veterinarians to stay in control of both the patient and client experience?

Background

The COVID-19 pandemic was a huge disruptor of the norm for the veterinary profession. In addition to a surge in pet ownership, an increasing demand for pharmacy options from pet owners led to changes in almost every aspect of the small business delivery model. With more pets came a greater need for providers and processes to deliver a great client experience. The number of veterinary telehealth and mobile veterinary practices increased. And, we saw a significant shiftfrom a brick-and-mortar pharmacy to an online pharmacy model, as well as fielding more requests for prescription fills and refills from online pharmacies outside the control of the veterinarian. The new virtual model requires electronic prescribing to function optimally and support their patients and pet parents.

Consider the following:

• The US pet industry generated $136.8 billion in sales in 2022.¹
• Veterinary care is worth $35.9 billion.¹
• Seven of 10 individuals consider their pets part of the family.²
• Thirty-three percent of millennials own at least 1 pet, making them the largest age group of pet owners.²
• Seventy-eight percent of pet owners acquired pets during the COVID-19 pandemic.³
• By 2023, online sales are expected to make up 25% of the total pet supply market.⁴
• Forty-five percent of pet owners spend the same amount of money or more on the health care needs of their pets as they spend on themselves.⁵
• Some of the greatest challenges to pet owners in 2023 include the high cost of pet medications.⁵
• In 2022, pet owners want their veterinarians to prioritize online options for purchasing medications.⁵

With millennials being the largest population of pet owners, who are also looking for online and convenient options, and with the growing amount of time needed to handle both online and client requests for out-of-hospital prescription fulfillment, what options are there to increase practice efficiencies and thus time savings?

A pain in the acronym—rules and regulations drive everything

Veterinary hospitals and veterinarians are overseen by many regulatory agencies. These include local, state, and federal rules that govern the practice of veterinary medicine, the veterinary client-patient relationship, and the prescribing and dispensing of medications. Because veterinarians can both prescribe and dispense,, the state boards of pharmacy, and in some cases, state-controlled substance regulations—in combination with federal agencies like the FDA and DEA—are all part of the alphabet soup that set the guidelines under which veterinarians operate.

In human health care, because most doctors and other mid-level providerscan only prescribe, regulatory agencies have worked diligently to create oversight around prescribing medications. Here are some oversights that are currently only specific to human health care:

National Provider Identifier

There are some human health care and pharmacy issues that are trickling into the veterinary realm. For instance, it has become more and more common for pharmacists to ask veterinarians for their National Provider Identifier (NPI) number. What is an NPI number?

An NPI is a unique 10-digit identification number for HIPAA-covered health care providers, created to help send health information electronically more quickly and effectively, including those that participate in Medicare services. Covered health care providers, all health plans, and health care clearinghouses must use NPIs in their administrative and financial transactions.Neither HIPAA nor Medicare apply to veterinarians which something that is why veterinarians do not require an NPI to prescribe—yet.

Electronic prescribing for controlled substances

Electronic prescribing for controlled substances (EPCS) is the process of electronically transmitting prescriptions for controlled substances to the pharmacy. Prescribers are encouraged to write and transmit prescriptions for controlled substances electronically to increase safety and security, identify potential misuse and abuse, and to reduce risk of fraud or other diversion. Pharmacists are then permitted to receive, dispense, and archive the electronic prescriptions sent to them by the prescriber.

National Council for Prescription Drug Programs

The National Council for Prescription Drug Programs (NCPDP) is an American nonprofit standards development organization representing most sectors of the US pharmacy services industry. It was founded in 1977 as the extension of a Drug Ad Hoc Committee that made recommendations for the US National Drug Code.

The NCPDP standards include several syntaxes used in the exchange of pharmacy information, such as the SCRIPT Standard, which is used to transmit electronic prescriptions from a physician or prescriber to the pharmacy. Specific messages included in the standard are: new, change, renewal, cancellation, and fill status.

With this level of oversight in human health care, and with the requirements for electronic medical records being the expectation for human health care, can veterinary medicine be far behind?

Practice information management systems and prescriptions

Practice information management systems (PIMS), your practice software, have several associated toolsthat go underutilized. Many PIMS can print out a written prescription for you (excluding prescriptions for controlled drugs). However, can your PIMS electronically transmit a prescription to a pharmacy?

The truth is that ePrescribing is state of the art for human health care, but most PIMS don’t meet the required NCPDP guidelines for transmission. When it comes to EPCS, this is a mandate that already exists in some states for veterinary medicine, but not all. Of the states with mandates, many also offer veterinary exemptions since the technology has not been available to them.

To be able to use ePrescribing, the PIMS will have to be updated to meet NCPDP and EPCS guidelines. The best reasons to do so are convenience, safety, and to make it easier to communicate with human pharmacies in the same language that the MDs use. In other words, we need to bring veterinary ePrescribing up to the speed of human ePrescribing.

What is the benefit of ePrescribing?

EPrescribing technology provides numerous benefits to veterinarians, their clients, and their patients. One of the most significant advantages is the faster and easier processing of prescriptions and renewals.An electronic system can—and should—track all prescription information, including renewal and refill, for all pets to keep furry friends safe. When a complete list of a pet’s drugs is not readily available in one system, the pet is at a higher risk of a drug interaction or an avoidable adverse drug event (ADE). With ePrescribing, veterinarians can access and manage their patients’ prescriptions directly from their PIMS or a standalone ePrescribing application, reducing prescription delays and paperwork.

In addition to improving efficiency, ePrescribing also enhances accuracy. The NCPDP SCRIPT standard makes it easier to process and complete prescriptions, minimizing the risk of errors that can occur with manual prescribing methods. Moreover, ePrescribing expands access to retail pharmacies, making it more convenient for pet owners to obtain the medications their pets need.

Perhaps one of the most valuable benefits of ePrescribing for veterinarians is the additional time it makes availableto focus on treating pet patients, satisfying clients, and expanding their practice. By reducing administrative tasks associated with prescription processing, like extra phone calls to pharmacies, ePrescribing can free up valuable time for veterinarians to concentrate on growing their practice and expanding services.

Why adopt ePrescribing?

One significant advantage of ePrescribing is that it uses the same common format as MDs, making it easier for veterinary professionals to communicate and collaborate with pharmacies. Another key benefit is that it automates a previously manual task, reducing the risk of errors and freeing up time for the staff to focus on their core responsibilities.

“Adding ePrescribing options to veterinarian practices is really all about flexibility, patient safety, and customer satisfaction,” said Lathe Bigler, general manager of FDB Vela. “DVMs now can meet the expectations of pet parents to pick up prescription in house or from a retail pharmacy, and spend more time with their patients, too.”

EPrescribing also offers greater oversight of the prescription process through the PIMS, making prescription monitoring and maintenance more convenient for both the practice and the client. By using ePrescribing, veterinary practices can bring their operations in closer compliance with state and federal board of pharmacy rules and regulations.

High tech to keep high touch

EPrescribing may seem like just another way that the veterinary pharmacy is being usurped and extricated from the control of the veterinarian. But it’s actually quite the opposite. With the way things are progressing right now and with the continued efforts federally to give pet owners the freedom to choose where they buy prescription medications (e.g., Fairness to Pet Owners Act), the need to simplify the pharmaceutical prescribing process and give pet parents prescription fulfillment options is staring the profession in the eyes.

The current time inefficiencies that we have with our in-house pharmacies and the growing demands from outside pressures (e.g., online pharmacies) will force the profession to seek new options to maintain the pharmacy as a profit center—and more importantly, to keep the relationship and trust of our clients. EPrescribing is a high-tech tool that hopefully will be a high-touch option for client relationship retention.

References

1. Pet industry market size, trends & ownership statistics. American Pet Products Association. Accessed May 5, 2022. https://www.americanpetproducts.org/press_industrytrends.asp
2. Lifetime of care study. Synchrony. Accessed May 5, 2022. http://petlifetimeofcare.com/#page=1
3. Tilford A. Survey: 78% of pet owners acquired pets during pandemic. Forbes. Updated December 8, 2022. Accessed May 5, 2022. https://www.forbes.com/advisor/pet-insurance/survey-78-pet-owners-acquired-pets-during-pandemic/
4. Digital pet care sales reach $27 billion, reports Packaged Facts. News release. Packaged Facts. September 22, 2020. Accessed May 5, 2022. https://www.prnewswire.com/news-releases/digital-pet-care-sales-reach-27-billion-reports-packaged-facts-301136021.html
5. Sprinkle D. Pet market outlook 2023. Presented at: Global Pet Expo 2023; March 22-24, 2023; Orlando, FL.