Which veterinary drugs are more expensive because of the Cascade?

RE: Which veterinary drugs are more expensive because of the Cascade?

Michael Woodhouse — Thu, 30 May 2024 23:41:24 GMT

[quote userid="2100" url="~/f/non-clinical-questions/30962/which-veterinary-drugs-are-more-expensive-because-of-the-cascade/244727#244727"]I think in each case, the question is what has licensing brought to the party. Presumably in this case, a dosage suitable for cats (it would be a problem, I presume, to break a 5mg human tablet to 1.25mg. I am not sure what trials amodip had to go through for use in cats, or what additional support or resources the vet licensed drug comes with. [/quote]

It's really not a fair comparison with the different tablet sizes. The licenced product is meaty flavoured so much easier to give. There is support materials available for vets and owners. If you ring CEVA you can have access to one of their vets to discuss cases, use, problems, off licence use. Try that with a box of human pills that you try and split into 4 or 8 pieces accurately. I don't know if you saw what I said about the vet licenced lactulose, but handing out a 50ml bottle is so much easier than splitting a human big pack, and everyone forgets the time, hassle, mess, waste, consumables created by decanting from a big bottle.

[quote userid="2100" url="~/f/non-clinical-questions/30962/which-veterinary-drugs-are-more-expensive-because-of-the-cascade/244727#244727"]Per tablet, veterinary is 272% more. [/quote]

Remember, human meds don't have VAT on them and vet meds do, so you need to take that into account (ie on Superdrug the price is exVAT but should have VAT added if sold for animal use).

[quote userid="24356" url="~/f/non-clinical-questions/30962/which-veterinary-drugs-are-more-expensive-because-of-the-cascade/244729#244729"]Also, remember that we don’t get drugs for the price the online pharmacies sell at. [/quote]

It would be lovely if we all just paid exactly the same for medicines. That way we could decide what margin we needed to charge for each of our business models, but unless the online sellers wanted to lose money, we would at least have a chance of competing (when they have postage to contend with and we don't). Imagine a world without buying groups, rebates, offers, cross-linked discounts etc.

RE: Which veterinary drugs are more expensive because of the Cascade?

Beats — Sat, 25 May 2024 14:11:02 GMT

[quote userid="2100" url="~/f/non-clinical-questions/30962/which-veterinary-drugs-are-more-expensive-because-of-the-cascade/244727#244727"]So what was the legal pivotal moment?[/quote]

I'd have to dig throuhg my archives, but the pivotal moment was a series of moments, which became a gradual shift in culture.

on an initial trawl, I can confirm that as recently as 2000 distinguished UK vets were happy to publish books with comments such as this:

"“Modern drugs such as non-steroidal anti-inflammatories ... are wonderful. They provide a good range of treatment options with a high safety index. Are they really vital in all cases? Would an older pain killer costing a penny or two for a tablet be that much worse than the modern effective but expensive drugs?”

I believe the first pivotal moment was the inclusion of the words "pets" in article 10 of EU Directive 2001/82/EC (accessible at: https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:32001L0082)

The next pivotal moment was the thorough implementation by the UK of this directive, through the VMD.

The next pivotal moment was the decision to remove the derogation from such VMD guidance that cost could no longer be considered a reason, in the interests of animal welfare, for a vet to prescribe outwith this strait-jacket. (c. 2005 IIRC, but I'd need to check my archives) - what I refer to as the Steve-Dean-era.

The next pivotal moment was vets euthanasing animals as they would no longer prescribe generic phenobarbitone etc.

Then their has been gradual creep of this as an accepted norm, aided on by diktats from the RCVS and others.

Then the big brother montioring of what human medicines vets are procuring through their regular wholesalers.

Then corporate consolidators who feel a need to follow rules, and procurement departments that could understand no other way, and it is no longer the individual vet making the prescribing decisions in some instances. Perhaps aided by a lack of trust from individual vets in their Big Brother employer and even more rigid compliance.

Throughout all of this, I do not recall an occasion when anyone ever prosecuted a vet for prescribing a cheaper drug (human med rather than licensed vet med) to a dog or cat (where there is no public health issue as we are not eating them) let alone where the reason was altruistic and the interests of the animal.

Throughout all of this, there have always been glaring examples of non-compliance, but those become accepted as normal. There has never been a logical way in which complete compliance can be achieved, and there has never been a rationale for why this would even be desirable. These issues have been discussed at length in this forum before, and the archives will be littered with them.

I believe culture and fear within the veterinary community has been more pivotal than anything else.

The example I used to give for contrast was how many vets check the clinical waste handling and transportation certificate for a pet owner before allowing them to remove the body of a recently euthanased pet from the veterinary premises (or in plain English, when you put a cat to sleep do you let the owner take it away with them). An example of a logical consequence of a not disimiliar contemporary EU diktat that was never taken seriously.

What has become ingrained is that you can make any choice with freedom of prescription, including human medicines, in non-food producing animals so long as this is an individual clinical decision in each instance, and not a general rule, and you are not stating that the cost of the treatment is a factor in your decision making. I don't see anything in the recent press releases or legislation that changes that. Where things differ a lot is in individual vets interpretations of what it all means. Nowhere in the original directives do I recall ever seeing the phrase "active ingredient" however this became a big thing whereby it was fine if the active ingredient was different, but not fine if it was the same - this was a cultural norm that developed organically within the veterinary community as far as I am aware.

It used to all be blamed on the EU made me do it. I think as years pass, there has been more of a realisation of we are doing this to ourselves.

RE: Which veterinary drugs are more expensive because of the Cascade?

Beats — Sat, 25 May 2024 10:23:03 GMT

don't forget water and salt solution.

I am supplied that vet-licensed oxygen has not made an appearance yet.

RE: Which veterinary drugs are more expensive because of the Cascade?

Richard Carter — Sat, 25 May 2024 09:55:37 GMT

So actually more a question of what drugs have become veterinary from the human field and have since been repurposed / licensed by vmd with veterinary data sheet? This remembering we cannot buy drugs on bulk from a human drug wholesaler

All epilepsy drugs- potassium bromide; phenobarb; pexion

All heart drugs except pimobendan- it was a bespoke vet drug- frusemide; spironolactone, acei (all), digoxin

blood pressure- amlodipine

Hormonals: all up to current implant drugs, thyroid meds; estriol, propalin ; cortisone in all the formulations oral, injectable, topical

nsaids- all

antibiotics- all

insulin

Almost all premed: acp, atropine, methadone; buprenorphine

anaesthetics- all. Propofol; halothane; iso/ sevo

Stupid things like disinfectants; artificial tears; other non pom drugs with veterinary licence

RE: Which veterinary drugs are more expensive because of the Cascade?

David Mills — Sat, 25 May 2024 08:32:47 GMT

[quote userid="2100" url="~/f/non-clinical-questions/30962/which-veterinary-drugs-are-more-expensive-because-of-the-cascade/244727#244727"]So what was the legal pivotal moment? If cascade alone was not the cause, then it must have been something on the other side of the equation that triggered companies to start licensing these drugs that had been comfortably in use for years or decades. [/quote]

I think it slightly predated my graduation but I seem too remember that you could ignore the cascade for a reasonable reason including cost. It was then that guidance under the pharma poodle Steve Dean came out and said cost was not reasonable.

However it is AFAIK not in the legislation about cost. It is in the VMD guidance as a "must not" but it has not been tested in court. AFAIK the VMD have never taken anyone to court for this - indeed they won't confirm or deny this. Therefore there is a legal case to be made against it along the lines of the AWA.

It's amusing that the CMA has chosen vet prescription fees as something to look at. The elephant in the room isn't the £20 script fee. It's the price of meds, the online pharmacies that sell lower than we can buy, and the cascade policed by govt that allows this system to continue.

RE: Which veterinary drugs are more expensive because of the Cascade?

Robert FalconerTaylor — Sat, 25 May 2024 08:15:14 GMT

potassium bromide

RE: Which veterinary drugs are more expensive because of the Cascade?

Robert FalconerTaylor — Sat, 25 May 2024 08:13:26 GMT

+...

selegiline (==>Selgian ~X10 the cost overnight)

chlomipramine (==> Clomicalm ~X10 the cost overnight)

RE: Which veterinary drugs are more expensive because of the Cascade?

Cinzia Gandini — Fri, 24 May 2024 22:49:43 GMT

Hystorical ones...

Amoxycillin

Acepromazine

prednisone

prednisolone

Betamethasone

Griseofulvin

Ketamine

Metronidazole

Heparin

Insulin

Ivermectin

Lidocaine

Metoclopramide

Thipental

....

RE: Which veterinary drugs are more expensive because of the Cascade?

David Mills — Fri, 24 May 2024 22:19:18 GMT

[quote userid="24356" url="~/f/non-clinical-questions/30962/which-veterinary-drugs-are-more-expensive-because-of-the-cascade/244728#244728"]Activated charcoal would be an interesting one[/quote]

O checked this today. It's classed on the TEVA data sheet as a supplement/dietary so isn't actually licensed.

RE: Which veterinary drugs are more expensive because of the Cascade?

Elizabeth — Fri, 24 May 2024 16:34:00 GMT

Also, remember that we don’t get drugs for the price the online pharmacies sell at.

RE: Which veterinary drugs are more expensive because of the Cascade?

Elizabeth — Fri, 24 May 2024 16:32:59 GMT

Activated charcoal would be an interesting one

RE: Which veterinary drugs are more expensive because of the Cascade?

Arlo Guthrie — Fri, 24 May 2024 16:22:02 GMT

[quote userid="12930" url="~/f/non-clinical-questions/30962/which-veterinary-drugs-are-more-expensive-because-of-the-cascade/244720#244720"]I'll try to come bck to this later with egs, but for historical context, 1995 is not the key date.[/quote]

So what was the legal pivotal moment? If cascade alone was not the cause, then it must have been something on the other side of the equation that triggered companies to start licensing these drugs that had been comfortably in use for years or decades.

[quote userid="8991" url="~/f/non-clinical-questions/30962/which-veterinary-drugs-are-more-expensive-because-of-the-cascade/244725#244725"]Ones that spring to mind from smallies - there are probably others.[/quote]

Fantastic, just what I was after, thanks.

Starting with Amlodipine. Found it on sale for 9.95 (e-surgery), 9.00 (Superdrug) 13.99 (Simply Meds) for 28 days 5mg.

Amodip (Ceva) costs 84 for 100 1.25 mg tablets (pet drugs online), .92p per tablet from VetUK 1.07 per tab from Evans pharmcacy.

So, average price in humans = 10.98 per box, or 39 pence per tab for a 5mg tab = 8p per mg

Cost in animals is 1.06 per tab, for a 1.25mg tablet = .85p per mg

Per tablet, veterinary is 272% more.

Per milligram, it's more than 10x

My maths is shocking, but I think that's right!

I think in each case, the question is what has licensing brought to the party. Presumably in this case, a dosage suitable for cats (it would be a problem, I presume, to break a 5mg human tablet to 1.25mg. I am not sure what trials amodip had to go through for use in cats, or what additional support or resources the vet licensed drug comes with.

RE: Which veterinary drugs are more expensive because of the Cascade?

David Mills — Fri, 24 May 2024 14:15:18 GMT

Ones that spring to mind from smallies - there are probably others.

Amlodopine

Ampicillin (?)

Apomorphine

Atropine

Diazepam

Erythromycin

Fentanyl

Fluoxetine

Frusemide (tabs)

Hydrocortisone

Lactulose

Methadone

Metronidazole (tabs)

Metoclopramide (liquid, tabs, injection)

Midazolam

Mirtazapine

Liquid paraffin

Spironolactone

Tramadol

Trimeth-suplhonamides (oral liquid)

RE: Which veterinary drugs are more expensive because of the Cascade?

Beats — Fri, 24 May 2024 12:48:18 GMT

I'll try to come bck to this later with egs, but for historical context, 1995 is not the key date.

It was when Steve Dean at the VMD started to advise that cost of medicine was not a consideration for vets c. 2005 IIRC that the problem began.

I will happily assist with figures and the daftness of this all when I get time.