Additional information on pharmacy requests for prescriptions

After reading the news article in the December 1, 2009, issue of JAVMA¹ regarding pharmacy requests for prescriptions, I thought I should add my perspective to this issue. As a pharmacist in charge of a Veterinary-Verified Internet Pharmacy Practice Sites (Vet-VIPPS)–accredited pet pharmacy, I believe my advice could be valuable to veterinarians. Please let me divide my perspective into three areas for clarity.

The veterinarian-client-patient (VCP) relationship²—Remember, you, the veterinarian, are responsible and liable for the medical care of your patients, even if a prescription is provided for a client to obtain medicines or supplies elsewhere. This has always been the case in human medicine. Therefore, veterinarians have the right and responsibility to uphold the VCP relationship by requiring adequate tests (eg, heartworm test, serum biochemical tests, thyroid test, and tests of drug concentration) and timely examinations appropriate for each patient's medical condition prior to writing a prescription.

The prescription—Regardless of how a prescription is provided, it should be entered into the patient's medical record concisely and permanently.² Here is my advice: written prescriptions that are likely to be filled by an Internet pharmacy should be on a form that cannot be easily altered. Unscrupulous pet owners may alter the amounts of medicine or number of refills and may mail or fax copies to multiple pharmacies. Unethical pharmacies may accept these altered documents without authenticating them, even though it is illegal for pharmacies to accept faxed prescriptions from anyone other than the original prescriber. Also, most states generally require documentation that a prescription provided by telephone is authentic and that the person providing the prescription represents the prescriber. In my opinion, faxed prescriptions from the veterinarian are the most secure, most tamperproof, and, in all likelihood, easiest to file in the patient's medical record.

The pharmacy—Your clients do have legal and ethical rights that vary from state to state regarding prescriptions and where they are filled. However, veterinarians still have the right to recommend a pharmacy that they know and trust, including their own clinic pharmacy or a local human pharmacy. The Vet-VIPPS certification program³ for veterinary Internet pharmacies, run by the National Association of Boards of Pharmacy, has been in existence since early 2009.⁴ Many states are beginning to adopt the Vet-VIPPS certification as a prerequisite for state licensure and relicensure of online veterinary pharmacies. You may want to lobby your state to adopt this requirement. My advice to veterinarians is to verify that an Internet pharmacy is licensed in your state as well as its home state. I also advise reading the AVMA policy on Internet pharmacies.⁵ A Vet-VIPPS certification ensures that a veterinary pharmacy is properly licensed in all states where it conducts business.

In summary, considering requests for prescription drugs to be filled at the pharmacy of a client's choice is a complex issue and requires a lot of thought on the veterinarian's part.

Shawn Roe, PharmD

VetRxDirect Veterinary Pharmacy, Coralville, Iowa.

Comments on prevalence of bovine tuberculosis in Minnesota

I would like to clarify a point made in the recent JAVMA News article “USDA accepting comments on tuberculosis, brucellosis plan”¹ regarding the prevalence of bovine tuberculosis among white-tailed deer in Minnesota.

The article stated that “[t]uberculosis is endemic among white-tailed deer in Michigan and Minnesota….” An infection is said to be endemic in an animal population when that infection is maintained in the population without external inputs. Since 2005, the Minnesota Department of Natural Resources has done statewide sampling of more than 11,700 deer. Of the deer sampled, only 27 have tested positive for tuberculosis. All of the test-positive animals were harvested in a small geographic area in northwestern Minnesota. Furthermore, there is no evidence of efficient deer-to-deer transmission in the area, as all but one of the infected deer were born before or in 2005, when the infection was first found in cattle, and the remaining infected deer was born in 2006.

Minnesota is dedicated to eradicating tuberculosis from the state, and that goal will be met, with help from the state's producers, stakeholders, and industry groups. Indeed, the fact that tuberculosis is not endemic in deer in the state is one of the reasons why Minnesota is looking forward to complete eradication of tuberculosis in the near future.

Bill Hartmann, DVM, MS

Minnesota State Veterinarian, Saint Paul, Minn.