Introduction

Estimated sales of pet care products and services in the US was estimated at over $124 billion in 2022, with veterinary services making up roughly 38% of these sales.¹ On average, prescription sales are the second-largest share of veterinary clinic revenue after pet examination fees.^2,3 However, veterinary clinics are competing against increasing usage of online pharmacies, with 55% of equine veterinarians reporting internet pharmacies as a major cause of lost income.² Additionally, managing online prescriptions for clients is an example of nonvisit care, which adds substantial nonbillable workload to the medical team.⁴ Pet owners may not realize the impact that online pharmacies have on veterinary clinics. Therefore, understanding why clients choose to use an online pharmacy is an essential first step to mitigate online pharmacies’ impact on the viability of veterinary clinics.

E-commerce options are growing in part because of the COVID-19 pandemic, which led to stay-at-home orders and required consumers to seek online retailers.^5,6 Aligned with this, online pet pharmacies have shown large increases in revenue. Since 2020, Chewy, an online pet pharmacy, experienced continuing annual revenue increases and reported more than $11 billion dollars in revenue for 2024.⁷ Over the COVID-19 pandemic, veterinary clients reported lower levels of both convenience and perceived value at their veterinary clinics.⁸ Convenience and lower perceived price are both factors that drive consumers to use online pharmacies for their own prescriptions⁹; declining satisfaction in these areas within veterinary clinics could be influencing clients’ decisions about where to shop for their pets’ medications.

This study’s primary aim was to determine what factors drive client decision-making in selecting an online pharmacy rather than veterinary clinic pharmacies for their pets’ prescriptions. Secondary aims were to determine overall client satisfaction with their chosen pharmacy and the degree to which clients believe online pharmacies adversely affect veterinary clinics.

Methods

This study was deemed exempt by the University of Wisconsin-Madison Institutional Review Board. A survey was developed in partnership with the University of Wisconsin-Madison’s Survey Center to collect information on values driving client purchasing behaviors. The survey collected information on 7 client values: price of items, reputation of pharmacy, convenience, communication and trust, service quality, product quality, and shipping costs (Supplementary Material S1).

The list of customer values was distributed for expert review and pretesting by 1 or more veterinarians, a veterinary pharmacist, a layperson, and the Survey Center to obtain feedback on survey content, terminology, and clarity. The survey was refined to establish face validity of survey items.

Respondents were asked what type of pharmacy they used to fill their pets’ medications within the last year. The options were an online pharmacy (such as 1800PetMeds or Chewy), the teaching hospital (UW Veterinary Care [UWVC]) pharmacy, a primary care veterinary clinic (other than UWVC), or a local pharmacy (like Walgreens, CVS, or Walmart). Respondents could choose more than 1 pharmacy. Respondents who used only a local community pharmacy were not queried further and were not included in the analyses. The total number of survey items included in each pharmacy type were as follows: online pharmacy, 26 items; teaching hospital, 19 items; primary care veterinary clinic, 19 items. The same survey items were asked of respondents who used a primary care veterinary clinic and teaching hospital pharmacy. Additional targeted survey items were asked of those who used an online pharmacy. Four additional demographic questions were included: respondent’s age range, type of residence neighborhood (urban, suburban, rural), pet species, and whether their veterinarian recommended an online pharmacy.

Respondents reported their level of agreement with the following statement: “Thinking about your decision to use [pharmacy type] … how important is each of the following reasons in your decision to use [pharmacy type].” Possible responses ranged from “not at all” to “extremely” on a 5-point Likert-type scale. Open-ended prompts were included for respondents to provide additional reasons important in their decision-making. Respondents were also invited to select which of the previously listed 7 client values they liked the most and least about their chosen pharmacy type. Respondents were asked to rank the level of importance of traits consistent with each of the 7 client values (eg, on the same Likert-type scale). Finally, respondents rated their overall satisfaction on a 5-point Likert-type scale and likelihood to refer on a 10-point Likert scale for their selected pharmacy types.⁸

Respondents who reported using online pharmacies were further surveyed on which online pharmacy they used, what type of prescriptions they obtained from their online pharmacy, and whether and to what extent they felt that online pharmacies impacted their veterinary clinic (teaching hospital or primary care clinic). An additional open-ended prompt was provided for additional comments.

Data analysis

Responses to survey items about pharmacy preferences were analyzed among users of online pharmacies, teaching hospital pharmacies (UWVC), and primary care veterinary clinics. Each Likert-type response was encoded as an ordinal variable. For comparison, groups were classified as either “any online” or “no online,” and the “no online” group could consist of either teaching hospital and/or primary care veterinary clinic (Figure 1). For each item, the set of encoded responses from the online pharmacy was compared to the encoded responses from either the teaching hospital or primary care veterinary clinic via either a Wilcoxon rank sum test or a χ² test. Analysis of responses on the Likert scale requires nonparametric tests such as the Wilcoxon rank sum test. The χ² test was used to assess categorical and binary based responses. A multivariable logistic regression was used adjusting for age, veterinarian online recommendations, and household neighborhood type (urban, suburban, or rural) with the binary dependent variable of online usage versus veterinary clinic usage. Logistic regression models returned ORs and corresponding 95% CIs for assessing factors that were independently associated with the likelihood of online pharmacy usage. The Kendall rank correlation was used to assess the relationships between individual values and overall client loyalty score (CLS) and client satisfaction. The strength of correlation was defined as follows: negligible (0.0 to 0.05), weak (0.06 to 0.25), moderate (0.26 to 0.48), strong (0.49 to 0.7), and very strong (0.71 to 1.0).¹⁰ P values < .05 were considered significant. All statistical analyses were performed with available statistical computing software (SAS, version 9.4; SAS Institute Inc).

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Distribution of survey responses regarding respondents’ veterinary pharmacy usage within the last year. UWVC = UW Veterinary Care.

Citation: Journal of the American Veterinary Medical Association 262, 11; 10.2460/javma.24.05.0348

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Results

Surveys were received from 208 respondents. Respondents could select the use of more than 1 pharmacy type. Sixty-four respondents reported using an online pharmacy, 57 respondents used UWVC, 82 respondents used a primary care veterinary clinic, and 56 respondents reported using a community pharmacy (Figure 1). Analyses were conducted for the 158 respondents that completed at least 1 survey item for their chosen pharmacies.

Demographic information from the 158 respondents who partially or fully completed the survey are provided (Table 1).

Online pharmacy usage

Respondents between the ages of 31 and 45 were significantly more likely to use an online pharmacy compared to other choices (P = .028; Table 1). There was no difference in pharmacy preference for clients of other age groups or neighborhood type (urban, suburban, or rural).

For respondents that used an online pharmacy, there was a relatively even distribution of prescription types purchased: prescription diets (27 of 57 [27.6%]), medications (34 of 57 [34.7%]), and preventatives (37 of 57 [37.8%]), with respondents able to choose more than 1 option. For the specific online pharmacies used, Chewy was the most common (38 of 57 [56.7%]), followed by other (18 of 57 [31.6%]), 1800PetMeds (3 of 57 [5.3%]), Walmart (3 of 57 [5.3%]), and VetRxDirect (2 of 57 [3.5%]). Some respondents (12 of 57 [21.1%]) reported using an online pharmacy affiliated with their primary care clinic, with MyVetStoreOnline (5 of 12 [41.7%]) and VetsFirstChoice/Covetrus (3 of 12 [25%]) being the most reported. Again, respondents were able to select more than 1 option.

Online versus local veterinary pharmacy usage

Reported users of different pharmacy types were asked what they liked the most about their chosen pharmacy. Users of online and primary care veterinary clinic pharmacies both reported convenience as the value they liked the most, while teaching hospital users reported liking the communication and trust the most (Figure 2). Online users preferentially liked price (P < .001), whereas users of both types of veterinary clinic pharmacies preferentially liked communication and trust (P < .001).

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Price of items was the value reported to be liked most by respondents that used online pharmacies compared to respondents that used the teaching hospital (A; UWVC) and primary care veterinary clinics (B; local). In contrast, communication and trust were the values reported to be liked most by respondents that used their teaching hospital (A) or primary care clinic (B; P < .001 for all).

Citation: Journal of the American Veterinary Medical Association 262, 11; 10.2460/javma.24.05.0348

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When each user was asked what they liked the least about their chosen pharmacy, online pharmacy users least liked shipping costs and communication and trust (P < .001). Price was liked the least by users of the teaching hospital (P < .01) and primary care veterinary clinics (P < .001; Figure 2). Teaching hospital pharmacy users liked convenience the least (P < .01).

When ranking the level of importance of different values in their decision to use a specific pharmacy type, online pharmacy users ranked price as significantly more important, with respondents who marked price as more important approximately twice as likely to use an online pharmacy compared to a primary care clinic (OR, 1.93; CI, 1.38 to 2.80) or teaching hospital pharmacy (OR, 2.37; CI, 1.51 to 4.03; P < .001; Tables 2 and 3). Teaching hospital and primary care clinic pharmacy users reported “caring about my pets,” “explaining and reviewing prescriptions,” “recommended by your veterinarian,” and “getting pet supplies in one place” as significantly more important. Respondents that reported these values as more important were significantly less likely to use an online pharmacy. Regarding the teaching hospital comparison, lower odds of online pharmacy usage were observed among users who assigned more importance to “caring about pets” (OR, 0.52; CI, 0.30 to 0.83), “ explaining and reviewing prescriptions” (OR, 0.28; CI, 0.14 to 0.47), and “recommended by your veterinarian” (OR, 0.56; CI, 0.33 to 0.87). Similar patterns were observed for the primary care clinic comparison, with lower odds of online pharmacy usage observed among users who assigned more importance to “caring about pets” (OR, 0.31; CI, 0.18 to 0.49), “ explaining and reviewing prescriptions” (OR, 0.45; CI, 0.31 to 0.61), and “recommended by your veterinarian” (OR, 0.40; CI, 0.26 to 0.59). There was an additional significant observation regarding “getting pet supplies in one place” (OR, 0.65; CI, 0.46 to 0.91).

Table 2

Differences between level of importance of the following values by online pharmacy users and teaching hospital (UWVC) pharmacy users. Options ranged from “not at all” (1) to “extremely” (5).

Client values	Online median (IQR)	UWVC median (IQR)	P value*	OR† (95% CI)*
Price	4.0 (3.0–5.0)	3.0 (2.0–4.0)	< .001‡	2.37 (1.51–4.03)‡
Discounts	3.0 (2.0–4.0)	3.0 (1.0–4.0)	.720	1.07 (0.74–1.57)
Available	4.0 (4.0–5.0)	4.0 (4.0–5.0)	.138	1.53 (0.88–2.79)
One place	4.0 (3.0–4.0)	4.0 (3.0–5.0)	.258	0.78 (0.50–1.19)
Caring	4.0 (3.0–5.0)	5.0 (4.0–5.0)	.011‡	0.52 (0.30–0.83)‡
Explanations	3.0 (1.0–3.0)	4.0 (4.0–5.0)	< .001‡	0.28 (0.14–0.47)‡
Familiarity	3.0 (3.0–4.0)	4.0 (3.0–5.0)	.078	0.69 (0.44–1.03)
Reputation	4.0 (3.0–4.0)	4.0 (4.0–5.0)	.374	0.76 (0.41–1.36)
Recommended by veterinarian	3.0 (3.0–4.0)	4.0 (3.0–5.0)	.016‡	0.56 (0.33–0.87)‡

*Adjusted for age, veterinarian online recommendation, and neighborhood type.

†Represents likelihood of using an online pharmacy.

‡Value is statistically significant.

Table 3

Differences between the level of importance of the following values by online pharmacy users and primary care veterinary pharmacy users. Options ranged from “not at all” (1) to “extremely” (5).

	Online median (IQR)	Primary care median (IQR)	P value*	OR† (95% CI)*
Price	4.0 (3.0–5.0)	3.0 (2.0–4.0)	< .001‡	1.93 (1.38–2.80)‡
Discounts	3.0 (2.0–4.0)	3.0 (2.0–4.0)	.959	1.01 (0.76–1.33)
Available	4.0 (4.0–5.0)	4.0 (4.0–5.0)	.132	1.46 (0.92–2.46)
One place	4.0 (3.0–4.0)	4.0 (4.0–5.0)	.014‡	0.65 (0.46–0.91)‡
Caring	4.0 (3.0–5.0)	5.0 (4.0–5.0)	< .001‡	0.31 (0.18–0.49)‡
Explanations	3.0 (1.0–3.0)	4.0 (3.0–5.0)	< .001‡	0.45 (0.31–0.61)‡
Familiarity	3.0 (3.0–4.0)	4.0 (3.0–4.0)	.257	0.83 (0.61–1.14)
Reputation	4.0 (3.0–4.0)	4.0 (4.0–5.0)	.481	0.85 (0.53–1.34)
Recommended by veterinarian	3.0 (3.0–4.0)	4.0 (4.0–5.0)	< .001‡	0.40 (0.26–0.59)‡

*Adjusted for age, veterinarian online recommendation, and neighborhood type.

†Indicates likelihood of using an online pharmacy.

‡Value is statistically significant.

Overall client satisfaction measures between pharmacy selections

Clients were asked to report their overall level of satisfaction with their pharmacy choices, on a scale of 1 to 5. The median satisfaction score for both online users and local veterinary clinic was 4.0 (IQR_online, 4 to 5; IQR_primary, 4 to 4) and for teaching hospital pharmacy users was 4.5 (IQR, 4 to 5). Respondents were also asked about the likelihood of recommending their chosen pharmacy using the CLS on a 1-to-10 scale. The median CLS for online pharmacy users was 9 (IQR, 6 to 10), for teaching hospital was 10 (IQR, 9 to 10), and for local veterinary clinic was 8 (IQR, 6 to 10). Teaching hospital pharmacy users had a significantly higher likelihood to refer than online pharmacy users (P < .05), but there was no significant difference between online pharmacy and local veterinary clinic users (P = .32). Correlations between satisfaction, CLS, and client values are summarized (Table 4).

Table 4

For veterinary clientele, correlations between client values and reported satisfaction and client loyalty score (CLS) are reported by chosen pharmacy type (online pharmacy users [online]), teaching hospital (UWVC), and primary care veterinary clinic pharmacy (primary).

Client value	Online		UWVC		Primary
	Satisfaction	CLS	Satisfaction	CLS	Satisfaction	CLS
Price	0.25*	0.27*	0.11	0.09	0.05	0.10
Shipping	0.15	0.23*	–0.24	–0.11	—	—
Discounts	0.13	–0.03	0.12	0.22	–0.07	–0.02
Return policy	–0.08	–0.01	—	—	—	—
Availability	0.14	0.17	0.10	0.08	0.20*	0.08
Prescription	—	—	0.25	0.03	0.15	0.12
One place	0.12	0.18	0.27	0.12	0.18	0.11
Convenience	0.16	0.27*	—	—	—	—
Recommended by family	0.09	0.25*	—	—	—	—
Good reputation	0.13	0.24*	0.34*	0.34*	0.33*	0.26*
Website	0.22	0.39*	—	—	—	—
Caring	–0.02	0.10	0.35*	0.29	0.33*	0.33*
Familiarity	0.07	0.24*	0.07	0.13	0.16	0.12
Pharmacist explanation	–0.09	–0.05	0.27	0.21	0.35*	0.34*
Recommended by veterinarian	0.06	0.07	0.19	0.22	0.30*	0.25*
No shipping costs	—	—	—	—	–0.04	0.01
Support local	—	—	0.30*	0.21	0.29*	0.38*

*P < .05.

— = Questions about this category were not asked of both user groups.

Pet owners’ perceived impact of online pharmacies on local veterinary clinics

Respondents were asked to consider how online pharmacies impacted their veterinary clinic. Eleven of 54 respondents (20.4%) believed online pharmacies positively impacted their veterinary clinic, 5 of 54 (9.3%) believed there was no impact, and 38 of 54 (70.4%) believed that online pharmacies negatively impacted their veterinary clinic. Of those that reported a positive perceived impact, 6 of 12 (50%) reported using a veterinary-affiliated online pharmacy. A negative perception of online pharmacy impact did not affect online pharmacy usage (P = .66).

Discussion

Overall, this study found that 32.9% of veterinary teaching hospital clientele surveyed reported using an online pharmacy to fill their pets’ prescriptions, while 67% reported not using an online pharmacy. This aligns with market data showing that 58% to 65% of shoppers buy from physical locations when given the option.^11,12 Respondents between 31 and 45 years old were more likely to report using online pharmacies. There were no other differences in pharmacy selection based on age or neighborhood type. The prescription types purchased using an online pharmacy were evenly distributed among prescription medications, food, and preventatives.

To our knowledge, there are no published data evaluating how often clients use a veterinary-affiliated online pharmacy. Our study showed that affiliated online pharmacies were the second-most-used type of online pharmacy, consisting of approximately 20% of online users. This high prevalence could be because clients prefer to “1-stop shop,” and this blend provides them a complete set of services between brick-and-mortar and online options.¹

Over 50% of respondents across both the online pharmacy and primary care veterinary clinic users reported liking convenience the most from their chosen pharmacy. This aligns with previous market research showing consumers are protective of their time.^1,9 In contrast, teaching hospital pharmacy users reported liking communication and trust most highly, and users of primary care veterinary clinic pharmacies rated communication and trust higher than users of online pharmacies. This aligns with market research showing that trust is an important component in consumer selection of products designed specifically for pet health.¹

Clients that used online pharmacies reported liking price significantly more than those that used a veterinary clinic (primary care or teaching hospital) pharmacy, aligning with research showing price as a driving force for consumers purchasing their own prescription medications through online pharmacies.⁹ With many consumers concerned about the cost of pet supplies becoming unaffordable, clients might be increasingly reaching for areas of perceived cost savings.¹

When asked what values they liked the least, perhaps not surprisingly, users of online pharmacies were least happy about communication and trust and shipping costs. Primary care and teaching hospital pharmacy users were least happy with the price. Interestingly, teaching hospital users were also significantly less happy with convenience. This is not surprising, as teaching hospitals have inherent inefficiencies that could affect client wait times as well as shipping times. However, given the clear association between convenience and consumerism, this is an important target for teaching hospitals seeking to increase in-hospital pharmaceutical purchasing.¹

When ranking values based on importance, online pharmacy users again ranked price as significantly more important, whereas primary care and teaching hospital pharmacy users ranked personalized care (“caring about my pets,” “explaining and reviewing prescriptions”) and a recommendation by their veterinarian as more important. This coincides with prior research demonstrating the importance of personalized interactions on client satisfaction.⁸

Client satisfaction and CLSs were high across all pharmacy types used. There was no significant difference between online pharmacy users and veterinary clinic types in client satisfaction. However, teaching hospital users reported a higher CLS compared to online users. Given the high median likelihood to refer scores across all pharmacy types, this is likely of limited clinical significance. While online and veterinary clinic pharmacy users represented 2 distinctly different populations based on their values, each was comparably satisfied with their chosen pharmacy type. There were positive correlations found between client values and overall satisfaction and CLS for both the online pharmacy and veterinary clinic pharmacy users, further supporting the relationship between price and online pharmacy users and the importance of a personalized experience for the veterinary clinic pharmacy users.

Lastly, we found that most clients believed online pharmacies negatively impacted veterinary clinics. However, most respondents did not consider the impact to be substantial. Clients’ perceptions of the impact of online pharmacies on their veterinary clinic did not appear to influence their decision to use an online pharmacy. This suggests that while clients understand online pharmacies affect veterinary clinics, they might not grasp the scope of that impact or even recognize the potential harm online pharmacies could have on a veterinary clinic. This lost pharmaceutical revenue is more than reduced direct revenue; it is the additional uncompensated workload that comes with checking, approving, and troubleshooting outside prescriptions.⁴

Our study does have some potential limitations. The survey used a convenience sampling of UWVC clients and those that follow UWVC social media pages, thereby inducing geographic and possibly socioeconomic sampling biases. While this has the potential to limit generalizability, < 20% of respondents reported using the teaching hospital pharmacy compared to 47% using their primary care veterinary clinic. Because the population of UWVC respondents was smaller than the other groups, this limited the strength of findings for teaching hospital pharmacy users. For clients that used multiple pharmacies, the percentage they used of each pharmacy to fill medications was not evaluated. Understanding the extent to which each respondent chose each pharmacy type could have been useful to better understand client decision-making. While price was a major value for online pharmacy users, income information was not asked as a demographic question. This could have been an interesting comparison to assess the influence of income and the need for cost savings. Future studies should include a larger and more diverse population to enhance these findings’ generalizability. Client interviews and focus groups would also be valuable to better shed light on these 2 distinct client populations.

This study highlighted the primary values used by clients when they select a pharmacy for their pets’ prescriptions. Convenience was the primary determinant for users of online pharmacies and primary care veterinary clinic pharmacies, whereas communication and trust were the primary determinants for teaching hospital pharmacy users. This study highlighted 2 distinct populations of veterinary clients in terms of core values. Online pharmacy users valued perceived price, whereas both types of veterinary clinic pharmacy users valued a personalized experience. Despite these divergent values, all clients were similarly satisfied with their chosen pharmacies.

For veterinary clinics wanting to increase in-clinic pharmaceutical sales, these findings can help inform ways to encourage clients to purchase prescription products by leveraging what they value most. This could include implementing a practice-directed online pharmacy to pair in-house convenience alongside competitive and transparent pricing and a personalized experience to meet the needs of all clients.

Supplementary Materials

Supplementary materials are posted online at the journal website: avmajournals.avma.org.

Disclosures

The authors have nothing to disclose. No AI-assisted technologies were used in the generation of this manuscript.

Funding

This work was funded by Institutional Clinical and Translational Science Award UL1 TR002373.

ORCID

A. E. Nichelason https://orcid.org/0000-0003-4788-9217