Written Prescriptions sent straight to online Pharmacies

RE: Written Prescriptions sent straight to online Pharmacies

Rob Loxley — Fri, 28 Mar 2025 08:39:32 GMT

Given that to write a POM-V prescription no longer (in most cases) requires a physical exam, I'm surprised we haven't seen a deluge of online vets (maybe part of the online pharmacy?) issuing the script after a 2 minute video call with the client?

RE: Written Prescriptions sent straight to online Pharmacies

Clive Ansell — Thu, 27 Mar 2025 07:15:48 GMT

[quote userid="12930" url="~/f/non-clinical-questions/31158/written-prescriptions-sent-straight-to-online-pharmacies/246936#246936"]Who is the victim in this crime?[/quote]

Perhaps the animal patient that is not coming in for checks and monitoring as often as it should, because owners are able to illegally obtain prescription meds?

Potential for welfare concerns if patients are not being presented for follow up checks, which is within our remit.

[quote userid="12930" url="~/f/non-clinical-questions/31158/written-prescriptions-sent-straight-to-online-pharmacies/246936#246936"]I love the idea that in N.I. it could be conceived that the otherwise preoccupied police might prosecute a poorly-off dog owner under the fraud act 2006 for sneakily getting heart meds, or painkillers or whatever for their dog, which the vet told them to keep getting for the rest of the dog's life.[/quote]

They would be prefectly safe where I live in the West Midlands. Police no longer seem to have any control over serious crimes such as burglary, car crime and drug dealers. That said, they will pursue a motorist doing 24mph in one of the new 20mph zones.

[quote userid="12930" url="~/f/non-clinical-questions/31158/written-prescriptions-sent-straight-to-online-pharmacies/246936#246936"]The poor middle class vet not getting their pound of flesh on a token prescription fee?[/quote]

I'm a locum paid by the day, so no financial effect whatsoever

RE: Written Prescriptions sent straight to online Pharmacies

Beats — Wed, 26 Mar 2025 23:22:43 GMT

I love the idea that in N.I. it could be conceived that the otherwise preoccupied police might prosecute a poorly-off dog owner under the fraud act 2006 for sneakily getting heart meds, or painkillers or whatever for their dog, which the vet told them to keep getting for the rest of the dog's life. Who is the victim in this crime? The poor middle class vet not getting their pound of flesh on a token prescription fee?

RE: Written Prescriptions sent straight to online Pharmacies

Clive Ansell — Wed, 26 Mar 2025 16:55:41 GMT

[quote userid="8991" url="~/f/non-clinical-questions/31158/written-prescriptions-sent-straight-to-online-pharmacies/246927#246927"]I just don't see why people are increasing their regulatory burden any more than necessary - arsing around wit sending the px to a pharmacy - no thanks. [/quote]

I want to spend as little time and effort with it as possible, while at the same time taking reasonable steps to avoid or prevent prescription fraud. After all, they are a legal document we put our signature too.

We seem to have had a run of them recently being picked up by online pharmacies. Clients are sacked in most cases

RE: Written Prescriptions sent straight to online Pharmacies

David Mills — Wed, 26 Mar 2025 13:11:08 GMT

[quote userid="25265" url="~/f/non-clinical-questions/31158/written-prescriptions-sent-straight-to-online-pharmacies/246928#246928"]- a prescription created electronically by the issuer, signed with an advanced electronic signature, and sent directly to the dispenser (possibly through an intermediary service).[/quote]

This is the convenience angle for most no-addicts - who can be arsed waiting for a physical prescription anymore? Contact the surgery, they electronically process, ask what pharmacy you normally use, by the time you get to the pharmacy an hour later meds are ready and checked and collectable. One of the very few areas of the NHS that works well for the consumer.

[quote userid="25265" url="~/f/non-clinical-questions/31158/written-prescriptions-sent-straight-to-online-pharmacies/246928#246928"]The end result is that it’s very difficult to use a prescription twice.[/quote]

It isn't with written prescriptions.

Many, many, many examples of the blank green slips (or whatever they are now) being obtainable / printable / reproducible - don't underestimate the innovation of addiction. My partner's mother is a GP who does a lot of work with addicts and she's seen it all. One particular good anecdote is meth addcits drinking the meth in front of the pharmacist, going outside, vomiting into a cup and selling it on to someone else in order to buy crack.

The electronic system was in part (or mainly) introduced to prevent abuse of controlled drugs - with the knock on effect that it made it a better system for regular consumers.

But yes it relies on a centralised system which doesn't currently exist in our profession - either this is because the pharmacies don't really care as long as they're selling drugs, or the need for such a system (repeat use same px, altering pxx) doesn't exist as the problem is so minor. Again without knowing the latter I cannot for the life of me - with all the oodles of red tape otherwise we have to deal with - why practices would put another obstacle in the way of an owner's legal right (obtaining a written px). In a way it is no wonder the CMA have this pretty prominently in their various updates.

RE: Written Prescriptions sent straight to online Pharmacies

Ben Walker — Wed, 26 Mar 2025 12:36:03 GMT

[quote userid="8991" url="~/f/non-clinical-questions/31158/written-prescriptions-sent-straight-to-online-pharmacies/246927#246927"]Human GPs do send directly to specific pharmacies but that is largely for convenience and to prevent the meth heads reusing the same script.[/quote]

This is only partly true. The HMRs dictate that prescription medications can only be supplied against:

- a prescription with a wet ink signature; or

- a prescription created electronically by the issuer, signed with an advanced electronic signature, and sent directly to the dispenser (possibly through an intermediary service).

Most GPs will use the Electronic Prescription Service. The EPS means most prescriptions are made electronically and sent to the NHS’s core IT infrastructure (NHS Spine). If you have a nominated pharmacy (online or brick and mortar) then Spine sends it through to them. If you don’t then your GP will either give you a token for your chosen pharmacy to pull the prescription from Spine, or will print and sign a paper prescription (FP10).

The end result is that it’s very difficult to use a prescription twice.

RE: Written Prescriptions sent straight to online Pharmacies

David Mills — Wed, 26 Mar 2025 10:51:04 GMT

[quote userid="5012" url="~/f/non-clinical-questions/31158/written-prescriptions-sent-straight-to-online-pharmacies/246920#246920"]Not trying to police it, and we are not a law enforcement body, but don't you think we should take reasonable steps to try and prevent or lessen prescription fraud?[/quote]

I just don't see why people are increasing their regulatory burden any more than necessary - arsing around wit sending the px to a pharmacy - no thanks.

Surely if this is a problem - repeated use of same scripts - and it becomes apparent - you don't want that client.

Changing scripts should be picked up by the pharmacy anyway - any doubt, contact the vet who has signed it.

Perhaps the pharmacies should create an online portal so repeated use of the same script can't happen?

As I say anything more than filling out and giving to the client and your obligation ends. Funny how people recoil at checking microchips, typing XL bullies etc, and getting involved in all that stuff hiding behind "we're not the police" and when it is something that may have a (small) financial impact we're coming up with ways to regulate something we don't even know is a significant problem and also incovenience the client.

Human GPs do send directly to specific pharmacies but that is largely for convenience and to prevent the meth heads reusing the same script.

RE: Written Prescriptions sent straight to online Pharmacies

Ben Walker — Wed, 26 Mar 2025 08:30:02 GMT

[quote userid="3169" url="~/f/non-clinical-questions/31158/written-prescriptions-sent-straight-to-online-pharmacies/246924#246924"]I still really can't see a particularly fair way of pricing other than %MU plus a modest dispensing fee.[/quote]

Playing devil’s advocate here, but the incentives from this pricing structure are weird. You lose money if you can source a cheaper version of a drug.

There’s the act of prescribing, which requires clinical expertise, and is performed whether a client buys from you or online. Why don’t we charge for this? PMSs should make it easy to separate prescribing from supply and it ought to be a button click to print a label or a written prescription.

Charging for supply ought to be a combination of (net net) product cost and a proportion of the overheads for running a pharmacy (including labour and profit). Must practices use a %MU based on list price, which means the actual markup is variable. A fixed fee on top of net net cost or one based on the size of the packaging would make just as much sense.

RE: Written Prescriptions sent straight to online Pharmacies

Rob Loxley — Wed, 26 Mar 2025 07:43:21 GMT

[quote userid="3169" url="~/f/non-clinical-questions/31158/written-prescriptions-sent-straight-to-online-pharmacies/246924#246924"]I want my prescription fee in 2 months when you need the next one[/quote]

If I was the pet owner (or the CMA) I might be asking why I couldn't have a prescription for 6 months worth? And I do get that income needs to come from somewhere so ultimately it ends up added on the service fees.

RE: Written Prescriptions sent straight to online Pharmacies

Michael Woodhouse — Tue, 25 Mar 2025 21:50:55 GMT

[quote userid="8991" url="~/f/non-clinical-questions/31158/written-prescriptions-sent-straight-to-online-pharmacies/246917#246917"]

Serious question - why are people trying to police fraud?

Your legal obligations start and end with the issuing of the px.

What happens after that is none of your business really.

[/quote]

Personally, I loathe writing prescriptions and will usually try and meet the owner in the middle with a price match plus the prescription fee. I've always charged a fair rate (as in my hourly rate for the genuine time taken to produce the script). I really wish I could simply say - if you don't like my price structure, find somewhere that suits you. Therefore, I require 5 working days notice, and will only send to the nominated online pharmacy. I feel it's my element of allowable resistance whilst remaining in the RCVS rules.

I don't want them re-using scripts. I want my prescription fee in 2 months when you need the next one, as I have bills to pay and need an income, that I have just lost on the sale of product explain to the client that the product always seems cheaper online as when they buy from us the cost includes the prescription element. I still really can't see a particularly fair way of pricing other than %MU plus a modest dispensing fee. Unless I make the %MU much smaller and charge a full prescription fee as the dispensing fee, the eye or ear drops, pred, Pardale will get a lot more expensive.....

RE: Written Prescriptions sent straight to online Pharmacies

Clive Ansell — Tue, 25 Mar 2025 20:13:27 GMT

Guidance from the college not particularly helpful.

Reporting prescription misuse

4.79 It is illegal for any person to submit a written prescription to a retailer on more than one occasion where the prescription is not repeatable. In England, Wales, and Scotland, this is a specific offence under the VMRs and in Northern Ireland it would fall under the Fraud Act 2006.

4.80 Suspected prescription misuse (which could include an alteration to an existing prescription or prescription fraud) can be reported to the VMD via its dedicated prescriptions misuse page. Making such a report will, in most cases, require a veterinary surgeon to release confidential information about their client to the VMD. The RCVS considers that reporting cases of prescription misuse is in the public interest and in most cases a report to the VMD will be a justified breach of client confidentiality. In addition, it is considered that such a report would be within the scope of the GDPR as this allows personal data to be processed where it is necessary for the purposes of a legitimate interest, and in most cases, it seems unlikely that this would be overridden by the interests or fundamental rights and freedoms of the relevant individual. However, this should be considered in each case. For advice on client confidentiality on a case-by-case basis please contact the RCVS Professional Conduct Department on 020 7202 0789.

RE: Written Prescriptions sent straight to online Pharmacies

Clive Ansell — Tue, 25 Mar 2025 18:13:03 GMT

[quote userid="8991" url="~/f/non-clinical-questions/31158/written-prescriptions-sent-straight-to-online-pharmacies/246917#246917"]

Serious question - why are people trying to police fraud?

Your legal obligations start and end with the issuing of the px.

What happens after that is none of your business really.

[/quote]

Not trying to police it, and we are not a law enforcement body, but don't you think we should take reasonable steps to try and prevent or lessen prescription fraud?

RE: Written Prescriptions sent straight to online Pharmacies

Anthony Dennison — Tue, 25 Mar 2025 13:17:02 GMT

[quote userid="8991" url="~/f/non-clinical-questions/31158/written-prescriptions-sent-straight-to-online-pharmacies/246917#246917"]

Serious question - why are people trying to police fraud?

Your legal obligations start and end with the issuing of the px.

[/quote]

Not really policing fraud - we've had a few get flagged up to us from different pharmacies. The only action we take is sack the client and we move on.

RE: Written Prescriptions sent straight to online Pharmacies

David Mills — Tue, 25 Mar 2025 11:57:24 GMT

Serious question - why are people trying to police fraud?

Your legal obligations start and end with the issuing of the px.

What happens after that is none of your business really.

RE: Written Prescriptions sent straight to online Pharmacies

giles broadhead — Tue, 25 Mar 2025 06:51:48 GMT

Client orders meds, receives confirmation email, forward this email to us, we email px direct to pharmacy. Works well.

like others we started after a few forgeries detected (presumably more that we were unaware of). Am amazed that PMS providers haven’t got a system add on yet to automate this…..

RE: Written Prescriptions sent straight to online Pharmacies

Claire Godfrey — Mon, 24 Mar 2025 19:12:41 GMT

Thank you,

This is one of the reasons.we want to send to the pharmacies ourselves. Just tying to work out all the logistics.

RE: Written Prescriptions sent straight to online Pharmacies

Steven Odell — Mon, 24 Mar 2025 18:11:35 GMT

After a couple of fraudulent cases and one client using one script at multiple pharmacies, it is now our policy to email them direct to the pharmacy, once the owner has an order number, in order to match up client, pet and drugs. No complaints so far after two months - the only ones likely to complain are those who've been found out....

RE: Written Prescriptions sent straight to online Pharmacies

Clive Ansell — Sun, 23 Mar 2025 20:25:03 GMT

I think the whole system needs an overhaul.

I have come across cases of prescription fraud recently, where online pharmacies have alerted us to altered scripts. One case involved a cat prescribed Thyronorm over 2 years ago, and has not been seen since. The client has been using the same script by altering the date.

There is nothing, or very little, at present to prevent a client obtaining a written prescription and using it with multiple pharmacies or editing it.

Maybe the way forward is either electronic copies directly to the online pharmacy, or only the original signed document is valid.

Completing them correctly in the first place would help too. Instead of just writing "60" write "60 (Sixty tablets)" and strengthen that with "1 (One) tablet twice daily for 30 (Thirty) days."

RE: Written Prescriptions sent straight to online Pharmacies

Francisco Gomez — Sun, 23 Mar 2025 14:19:14 GMT

Just so you know, in Spain you cannot sell drugs in your practice. All prescriptions go straight to an online system.

The owner gets the code in their phone and the pharmacy knows as well as its integrated. Any phrmacy.

Also regulations make mandatory that at least 1 pharmacy is open always in each town. There's a 24/7 requirement.

RE: Written Prescriptions sent straight to online Pharmacies

KMurphy — Sun, 23 Mar 2025 13:00:29 GMT

The client will get an order number from the pharmacy that you can use as a reference when you send the prescription.