Have the new Veterinary Medicines Regulations passed anyone else by?

RE: Have the new Veterinary Medicines Regulations passed anyone else by?

Clive Ansell — Thu, 30 May 2024 21:01:11 GMT

Refreshing that, with the exception of petdrugsonline, common sense prevails and a writen script with either a generic or a brand name would be accepted.

RE: Have the new Veterinary Medicines Regulations passed anyone else by?

Ben Walker — Thu, 30 May 2024 17:38:24 GMT

[quote userid="5083" url="~/f/non-clinical-questions/30957/have-the-new-veterinary-medicines-regulations-passed-anyone-else-by/244732#244732"]the online pharmacy rejected it and insisted I used a brand name.[/quote]

Update!

So, I contacted a selection of online pharmacies. Most accept active ingredient/generic prescriptions. Viovet and Vets4U stated they prefer it. The former because they can handle supply issues better, the latter because it oftens ends up cheaper for the client.

petdrugsonline were the only pharmacy that specifically stated they do not accept this form of prescription. They are a fairly big presence so perhaps they were the pharmacy involved?

Responses below.

petdrugsonline.co.uk (IVC) - No

"I can confirm, as a company policy, we do not accept active ingredients and do require the specific brand / manufactur's name as the product"

animeddirect.co.uk (CVS) - Yep

"You can use either the brand name or the generic. If you use the generic and there is more than one brand e.g. Meloxicam, then we can supply Loxicom/Metacam/Meloxidyl/Rheumocam etc. If you state the brand, we can only supply that named brand."

365vet.co.uk (VetPartners) - Yep

"When we receive a prescription with an active ingredient we shall usually dispense what the client orders as long as that product is the same active ingredient, any issues we will contact the veterinary surgery. Common example we receive is for Meloxicam being the active ingredient which then allows the client to order any of the brands Loxicom/Metacam/Meloxidyl"

vetuk.co.uk (VetPartners) - Yep

"I can confirm that we are happy to receive a prescription with the active ingredient stated. For example, if you submitted a prescription for Meloxicam, this would then enable the customer to choose between Metacam, Loxicom, Meloxidyl etc when they place their order. If a brand name such as Metacam is stated on the prescription, we would only be able to dispense the specified brand."

viovet.co.uk (Pinnacle Pet Group - mainly do insurance eg. Animal Friends) - Yep

"If the active ingredient is prescribed then the customer can choose any appropriate brand that equates to that ingredient and formulation. It is worth noting that the description needs to be precise, for example stating Meloxicam 1.5mg/ml oral suspension for dogs 180ml rather than just Meloxicam. So we can ensure the correct formulations are used. Prescribing the active ingredient as opposed to the brand is preferred from our dispensary perspective, this allows room for alternatives should there be stocking issues and so ensures a reliable supply for the customer."

thepharmpetco.co.uk (Pharmacy2U) - Not sure

"I can confirm that we dispense veterinary medicinal products in keeping with the VMD’s guidelines."

vets4u.uk (Unimed Global) - Yep

"If the Rx was written for a product generically (ie Meloxicam 1.5mg/ml oral solution) we could supply a generic product or any of the proprietary brands such as metacam, loxicom etc. However, if the prescription was prescribed by proprietary name, (ie Loxicom) then we can only supply the proprietary brand prescribed. This is obviously restrictive for the client as often the brand with the best trade terms of the practice and not necessarily the best financial outcome for the client are prescribed."

vetpharmacy.co.uk (Norchem Healthcare) - Yep

"Thank you for your enquiry. We are happy to dispense a prescription with the generic name. If it's a human medication and there is a generic medication available we would automatically supply the generic. If there's only one brand available for that ingredient/strength then we would automatically supply that brand, or if it's something like meloxicam where multiple brands are available we would find out if the patient has used it before and supply the same brand, or if not would generally offer the cheapest brand as the first option."

vetmedi.co.uk (Vet owned) - Yep

"If the prescription states the active ingredient with no brand name for the medicine we can dispense the appropriate brand you order. If the prescription states the brand name there can be no substitute for a different brand."

RE: Have the new Veterinary Medicines Regulations passed anyone else by?

Cinzia Gandini — Mon, 27 May 2024 09:28:00 GMT

[quote userid="2675" url="~/f/non-clinical-questions/30957/have-the-new-veterinary-medicines-regulations-passed-anyone-else-by/244778#244778"]the price is determined by an accountant[/quote]

I totally agree with you, it's just a thinking to see where the prices can be lowered considering the CMA has confirmed its decision to launch a market investigation into the veterinary sector

RE: Have the new Veterinary Medicines Regulations passed anyone else by?

Richard Carter — Mon, 27 May 2024 08:31:04 GMT

But the point is the vets have been taken out of the game through no (or very little) fault of their own. Our profession has been hijacked and in the now common scenario, the price is determined by an accountant at head office and the computer tells you the price. So we back to the vets on the front line getting the hate mail and aggro.

Most of vets in corporate practices would not be able to buy amoxicillin generic even if they wanted to

RE: Have the new Veterinary Medicines Regulations passed anyone else by?

Cinzia Gandini — Sun, 26 May 2024 21:39:11 GMT

[quote userid="5012" url="~/f/non-clinical-questions/30957/have-the-new-veterinary-medicines-regulations-passed-anyone-else-by/244776#244776"]How can this be justified or acceptable? [/quote]

It can't

prices can change depending where you buy the product, so I think a veterinary visit should always end with a prescription, included in the price of the visit, because this is what a visit is for, and what should be paid for. Unless the client expressively wants to purchase the medicine from the vet clinic

RE: Have the new Veterinary Medicines Regulations passed anyone else by?

Clive Ansell — Sun, 26 May 2024 18:57:56 GMT

[quote userid="24356" url="~/f/non-clinical-questions/30957/have-the-new-veterinary-medicines-regulations-passed-anyone-else-by/244774#244774"]There was a comment in the i this weekend about they can get metacam for £16.99 online , yet charged £100 by the vets. Thought it sounded like an exaggeration so checked for myself .[/quote]

One of my regular practices sells 10ml Metacam out for about £9, which includes a mark up, fixed dispensing fee, and VAT. They buy it in and make a small profit from it.

Other local practices sells the same for £34, almost a 4 fold difference. How can this be justified or acceptable?

RE: Have the new Veterinary Medicines Regulations passed anyone else by?

Elizabeth — Sun, 26 May 2024 16:47:51 GMT

RE: Have the new Veterinary Medicines Regulations passed anyone else by?

Elizabeth — Sun, 26 May 2024 16:46:27 GMT

There was a comment in the i this weekend about they can get metacam for £16.99 online , yet charged £100 by the vets. Thought it sounded like an exaggeration so checked for myself .

RE: Have the new Veterinary Medicines Regulations passed anyone else by?

Richard Carter — Sun, 26 May 2024 15:22:34 GMT

Letter sent to my MP

..would like to bring to your attention the gold plating of regulations in the veterinary industry regarding the availability and prescribing of medicines for use in animals.
…
In the U.K., products used in treating animals need to be licensed and regulated by the Veterinary Medicines Directorate (VMD). There were originally good intentions to restrict compounds and chemicals going into food producing animals which everyone in EU signed up to. This lead to the development of the Cascade in U.K. which prohibits a vet from using a product not authorised for species, condition or other if a registered product is available. All laudable. As a professional registered with the Royal College of Veterinary Surgeons (RCVS), I am permitted to go ‘off cascade’ to treat my patient if special circumstances exist. I may not substitute on grounds of costs.

The U.K. decided to gold plate this EU directive to include companion animals, by far the largest part of the profession. We have recently been informed the VMD intends to make going off Cascade a criminal offence. As a trained, experienced professional, this creep of bureaucracy is unintelligent and deliberately reducing the professional standing of vets.

At the very same time, the profession is being investigated by the CMA for overpricing and by the standards of costs across the world, with some justification. Having a bottle of registered animal painkiller going out at about £100 which would last about 6 weeks in a Labrador sized dog is infuriating, embarrassing and leads to confrontation and stress.

We have used products for decades with very clever and experienced people across the world and we know how the active ingredients work and what the side effects are. The U.K. cascade however forces me to buy and sell the U.K. veterinary version. I may not import, may not substitute a human product or go to a compounding pharmacy even if I know exactly the active ingredient I need. This has had the consequence of a monopoly and very inflated prices in a market protected by government regulations. I can’t even advise a client to go buy some paracetamol from the supermarket or artificial tears from the pharmacy, both over the counter medications. The only people winning in this scenario are the drug companies who pick up what treatment has become established, put on a pretty picture of dog or cat, give it a catchy name and laugh all the way to the bank.

And no one tries to fight for the pensioner who can’t afford £100 per month for painkillers for their elderly dog.

So with elections announced, ….

So please try look beyond the parties paid for by these drug companies and realise the vets out there are being beaten with every stick and most will be walking away from the profession if we can’t help little old ladies with arthritic pets with common sense advice.

Doubt much will come of this but if someone more eloquent can catch the attention of someone to champion, who knows? Perhaps we survive as a profession for another few decades

RE: Have the new Veterinary Medicines Regulations passed anyone else by?

Beats — Sat, 25 May 2024 17:04:20 GMT

Clive, there is nothing saying that you pick an active ingredient and then see if there is a VMP containing it.

The wording in your link is:

"Where there is no suitable veterinary medicine authorised in your territory for the specific condition in the animal being treated, to avoid unacceptable suffering, you are permitted to use your clinical judgement to treat animals under your care in accordance with the cascade."

Emphasis on the no suitable veterinary medicine ... for the specific condition.

I am assuming here the condition is degnerative joint disease.

If you believe you are following these rules, you would need to pick the VMPs licensed for this, specific condition e.g.:

"For the treatment of lameness and pain of degenerative joint disease/osteoarthrosis (non-infectious arthrosis) in the skeletally mature dog. " (Anarthron)

"For the treatment of pain associated with mild to moderate osteoarthritis in dogs" (Galliprant)

"For the reduction of acute and chronic mild soft tissue and musculoskeletal pain." (Tramvetol)

Nothing to do with active ingredients.

Tranexamic acid is off the table, I'm afraid as you have:

"Prevention and treatment of surgical ... haemorrhages" (Hemosilate)

Your diarrhoea treatment is presumably:

"An aid in the relief of the symptoms of mild diarrhoeas in dogs, cats, puppies and kittens over 12 weeks of age" (Johnson's Diarrhoea Tablets)

or "For treatment of diarrhoea of non-specific origins in dogs and cats." (Kaogel)

"As supportive therapy for acute diarrhoea." (Spasmium)

etc.

RE: Have the new Veterinary Medicines Regulations passed anyone else by?

Clive Ansell — Sat, 25 May 2024 16:03:51 GMT

[quote userid="9440" url="~/f/non-clinical-questions/30957/have-the-new-veterinary-medicines-regulations-passed-anyone-else-by/244717#244717"]Pardale only licensed for a five day course - not long term [/quote]

True enough.

But, if you wish to prescribe paracetamol for long term use, there is no licenced veterinary product for this, so therefore the next step down the cascade would still be pardale-v, because it licenced in the same species for a different use.

https://www.gov.uk/guidance/the-cascade-prescribing-unauthorised-medicines

RE: Have the new Veterinary Medicines Regulations passed anyone else by?

Rob Loxley — Sat, 25 May 2024 15:57:24 GMT

[quote userid="8991" url="~/f/non-clinical-questions/30957/have-the-new-veterinary-medicines-regulations-passed-anyone-else-by/244751#244751"]I don't know how much it costs to licence a medication[/quote]

A lot, to the VMD, who make the rules that encourage this behaviour?!

RE: Have the new Veterinary Medicines Regulations passed anyone else by?

Clive Ansell — Sat, 25 May 2024 15:56:54 GMT

There is some confusion on this thread regarding the word generic.

When the term "generic" is used, it usualy refers to unlicenced human generic drugs; for example Frusemide or Metoclopramide.

While the likes of Loxicom may be generic, they are still licenced veterinary products that we are able to prescribe. Loxicom is listed in the NOAH compendium of dats sheets, and has POM-V status

RE: Have the new Veterinary Medicines Regulations passed anyone else by?

Ben Walker — Sat, 25 May 2024 11:00:38 GMT

[quote userid="8991" url="~/f/non-clinical-questions/30957/have-the-new-veterinary-medicines-regulations-passed-anyone-else-by/244761#244761"]Once a drug is off patent you can use any form - veterinary, human, whatever. That would be true market forces allowed to come to the fore. That is the cascade only applies during patent years.[/quote]

Do you mean patent, or are you referring to products licensed under a full MA application?

RE: Have the new Veterinary Medicines Regulations passed anyone else by?

David Mills — Sat, 25 May 2024 10:55:11 GMT

[quote userid="25265" url="~/f/non-clinical-questions/30957/have-the-new-veterinary-medicines-regulations-passed-anyone-else-by/244757#244757"]I’m lost by your argument[/quote]

Once a drug is off patent you can use any form - veterinary, human, whatever. That would be true market forces allowed to come to the fore. That is the cascade only applies during patent years.

RE: Have the new Veterinary Medicines Regulations passed anyone else by?

Cinzia Gandini — Sat, 25 May 2024 10:28:08 GMT

[quote userid="8991" url="~/f/non-clinical-questions/30957/have-the-new-veterinary-medicines-regulations-passed-anyone-else-by/244756#244756"]Question - if all veterinary generics went off the market tomorrow would we be any worse off?[/quote]

Surely not the clients

RE: Have the new Veterinary Medicines Regulations passed anyone else by?

Ben Walker — Sat, 25 May 2024 09:34:53 GMT

I’m lost by your argument. You stated that we have too few manufacturers and now you want to drop it down to one for many drugs. Boehringer would have a field day if Metacam were the only form of meloxicam we could sell.

RE: Have the new Veterinary Medicines Regulations passed anyone else by?

David Mills — Sat, 25 May 2024 08:35:19 GMT

Question - if all veterinary generics went off the market tomorrow would we be any worse off?

RE: Have the new Veterinary Medicines Regulations passed anyone else by?

David Mills — Sat, 25 May 2024 08:21:47 GMT

[quote userid="4181" url="~/f/non-clinical-questions/30957/have-the-new-veterinary-medicines-regulations-passed-anyone-else-by/244748#244748"]monoclonal antibody drug[/quote]

Yes but they've been used in human medicine for years before veterinary (with some pretty wild side effects). Hehe vet version is an off shoot.

[quote userid="4181" url="~/f/non-clinical-questions/30957/have-the-new-veterinary-medicines-regulations-passed-anyone-else-by/244748#244748"]isoxazoline[/quote]

Yes probably the best example but then the preventative market in the UK for vet parasites is very big - with big returns.

Still in 16y of doing this, two drugs is a pretty poor return for paying ,at least 100x the price of human drugs on a daily basis 1000x per day.

RE: Have the new Veterinary Medicines Regulations passed anyone else by?

David Mills — Sat, 25 May 2024 08:17:11 GMT

I don't know how much it costs to licence a medication, or being it to market with associated launch and advertising/marketing but I suspect it is significant.

Because it has to be marketed as it is being sold as a brand to the profession, vets, owners. It is completely the other way round in human medicine. And that's because you can only get into the sphere of actually selling a generic if it is branded and promoted. Because of the cascade.

In theory it should be cheap to bring a generic into production but it is the selling of the medication which is the issue. If every drug off patent was sold as generic (brand name) and didn't need to be licensed for veterinary use then sure it would likely have some market forces applied. But that isn't, never has been, and likely never will be the case. So vets aren't pushing or entrenching the cascade. People at the VMD are, with the pithy excuse about safety and efficacy which don't stand up to any kind of scrutiny.

RE: Have the new Veterinary Medicines Regulations passed anyone else by?

Rob Loxley — Sat, 25 May 2024 08:12:39 GMT

[quote userid="8991" url="~/f/non-clinical-questions/30957/have-the-new-veterinary-medicines-regulations-passed-anyone-else-by/244740#244740"]Ask yourself this - what new drugs have come to the vet market in recent years that aren't cast offs or add ons to the human market? There is no real R and D in vet medicine.[/quote]

I'm not setting out to defend the pharma industry, but the monoclonal antibody drugs, the isoxazoline antiparasitics would spring to mind. Licensing system should encourage this, but licensing lactulose to sell for 100x with no added benefit I really seems to be an oxploitation of the system

RE: Have the new Veterinary Medicines Regulations passed anyone else by?

Ben Walker — Sat, 25 May 2024 07:36:02 GMT

Interesting, but I’m still struggling to follow the logic.

You already produce written prescriptions that don’t have a brand name. Great. Is this standard practice across the profession? Am I the only one who didn’t realise we could do this?

You agree it’s relatively simple to licence veterinary generics. Great.

You ask why more companies aren’t licensing generics. Again, most of the drugs we have on the vet market are generics. Why do you think the manufacturers give them brand names instead of generic names?

Finally, there is no set price for human generics. Competition alone pulls the price down. If the veterinary market has inflated prices and generics applications are cheap, what explanation can you provide for more manufacturers not coming in?

My answer to the final question is easy. Vets typically prescribe by brand, so generic products have to be branded and spend money on promotion.

RE: Have the new Veterinary Medicines Regulations passed anyone else by?

David Mills — Sat, 25 May 2024 07:19:43 GMT

[quote userid="25265" url="~/f/non-clinical-questions/30957/have-the-new-veterinary-medicines-regulations-passed-anyone-else-by/244743#244743"]Then why on earth are we contributing towards this skew by only prescribing by brand name?[/quote]

I'm not sure that we are? N=1 but I only use the active ingredient.

(Interesting tangent - try and prescribe levetiracetam for a client to fill at a human pharmacy and almost always they'll dispense keppra brand as it's still far more £££ than the generic unless you state on the px not keppra).

The economics are quite simple. There are only a very limited number of suppliers of meloxicam - maybe 5 or 6. So for the 1000s of dogs on it that's a big bit of market each. As seen they are already charging 100x what the cost of production is. The price point is probably manageable for most it's not as if there is a huge untapped market waiting. So they will charge close enough to each other. That is a monopoly, essentially a closed market with few suppliers so there is a regression to a mean price point to their advantage. As you say it is relatively straightforward for generics to get a licence so why hasn't someone done what you said?

It isn't because we're prescribing brand names. It's because all the brand names are pretty much the same in price because there aren't that many brands because of the licensing requirements to sell veterinary medicines. There are more suppliers of human meloxicam than there are veterinary and it's a rarely used drug in the former. That's because there is a set low price, not a price set by pharma. So there is competition. There is no cascade. That's the nub. Vets aren't responsible for the skew. It's built into the broken system.

RE: Have the new Veterinary Medicines Regulations passed anyone else by?

Ben Walker — Sat, 25 May 2024 06:22:29 GMT

[quote userid="4103" url="~/f/non-clinical-questions/30957/have-the-new-veterinary-medicines-regulations-passed-anyone-else-by/244739#244739"]So you can't make a prescription of an active ingredient if there's a veterinary medicine available with the same active ingredient?[/quote]

This contradicts the VMD’s response I quoted earlier.

This discussion is ending up a confused muddle.

The point is that we can prescribe VMPs using a common name. It’s not quite the same as just prescribing the active ingredient. For example, “Amoxicillin 400mg / Clavulanic acid 100mg Tablets for Dogs” ought to comply.

I don’t really understand how this discussion has ended up mostly about human pharmacists. Why is the client taking a VMP script to their local Lloyds pharmacy, and why wouldn’t the pharmacist take one look at it and say “sorry, we don’t keep this in stock”?

RE: Have the new Veterinary Medicines Regulations passed anyone else by?

Ben Walker — Sat, 25 May 2024 05:54:01 GMT

[quote userid="8991" url="~/f/non-clinical-questions/30957/have-the-new-veterinary-medicines-regulations-passed-anyone-else-by/244740#244740"]it doesn't work in a closed skewed monopolised market, never has.[/quote]

Then why on earth are we contributing towards this skew by only prescribing by brand name?

I’m not advocating for the cascade. But this is a change we can instigate right now.

You are misunderstanding or misrepresenting the market forces. The motivation for suppliers is that if most prescriptions used the generic name then they don’t have to stock every brand. The manufacturers can then only compete on price to be the favoured product.