Graham Garrison is the managing editor of Veterinary Advantage, one of four journals published by the North American Veterinary Community.Read Articles Written by Graham Garrison
Stanley Truffini, DVM, of Georgetown Veterinary Hospital in Connecticut, has seen almost four decades’ worth of product introductions designed to combat an age-old pet conundrum: fleas and ticks.
First were the flea collars.
“You can sometimes forget about the fleas, but they always come back,” Dr. Truffini said. “I’ve seen this happen frequently. Over the summer, you’ll never see fleas on the dogs that are protected, but all of a sudden a cat or a dog that doesn’t have some sort of preventive will show up. You tend to think they aren’t out there, but they are.”
Then came the topicals.
“We originally started with the topicals because that was what was available,” he said. “They had their issues with application, applying it properly. We always recommended them to families with children but would advise that they didn’t hug or touch their pets in the area the topical was applied, and that was always a little bit of an issue.”
Then the oral preventives started appearing. Dr. Truffini’s team waited a year or so before bringing a new product into the hospital.
“They seem to work well,” he said. “We didn’t have too difficult a time convincing clients, especially with families. Families were key, with children hugging pets and hanging around them.”
Indeed, preventive products for years have been able to combat fleas and ticks and the diseases they carry. It’s the compliance component — convincing the clients of the benefits of the products and then follow through with appropriate use — that’s remained a challenge.
Compliance isn’t just an animal health challenge. Human medicine and pet medicine studies have shown that the adherence step of compliance — what clients actually do when they get home — is poor across the board, said practice management consultant Karyn Gavzer, MBA, CVPM.
As the former director of marketing for the American Veterinary Medical Association, Gavzer created public campaigns within the industry, such as “Pets Need Dentistry, Too” and training programs to help veterinarians and their teams market their services more effectively.
Poor compliance has many potential causes, Gavzer said.
“Clients may get confused,” she said. “They may forget to give the medicine to their pets. They may have trouble giving the medication because the pet fights it, such as ear squirt treatments and pilling cats. Or clients may run out of the medication and forget to order more.”
One interesting development Gavzer sees on the human medicine side is experimentation with “smart pills” that digitally log in when they are taken and with implantable dispensing devices that automatically deliver needed medications.
“In the meantime, they are little better off than we are with our veterinary patients,” she said. “For now, the two main tools to improve client compliance are more convenient products and medications, and human support.”
Gavzer has seen tremendous improvement in products that can be administered in the veterinary practice, like ear treatments, injectable antibiotics, heartworm preventives, and chewables for flea and tick.
“Products like these are usually the best choice to ensure our patients get what they need, and they are so much easier on clients. We do all the work for them,” she said.
Although determining compliance is more difficult today when clients purchase flea/tick products online and over the counter, as well as from veterinary practices, Gavzer said the hurdles to compliance remain the same:
Do clients know that their pets need the products and do they know how to give them?
“Did we recommend the products when they were in?” Gavzer said. “Did we let them know that they could get everything they needed for their pets before they left us and that we could give the first dose while they were there? Also, did we dispel the myth that our prices are higher? Did we let them know that our price would be about the same as they would pay online and they could take it home and be done?”
Do clients give the product regularly even if they have it?
“We can help them with this by offering to do it for them,” Gavzer said. “Is there an injection in lieu of a pill their pets could take? Or are there pills that could be given every three months instead of monthly? Can we offer to send text or e-mail reminders when their pets need their next dose?”
Product safety is always top of mind for clients and veterinarians. That’s why Dr. Truffini said his practice waits at least a year when a product is introduced in the market and reads up on the research before using it. Fortunately, there is a familiarity with chewables as preventives, having been on the market now for several years, as well as the similarity to heartworm preventives.
“Everybody is used to giving something oral to kill something, such as heartworm,” Dr. Truffini said. “Clients are already aware that these products are safe based on safety studies. They know about heartworm meds being safe, so that has paved the way for allowing these other oral products. We do explain the safety involved and studies done, and how little medication is needed. Knowing these products are safe when taken as directed, they are pretty much on board with it.”
Like Dr. Truffini, Shannon Jensen, DVM, of Perkins County Veterinary Hospital in Grant, Nebraska, waited to try chewable flea and tick products when they were introduced.
“I resisted selling chewable flea/tick products when they first came out due to the fact that they last so long in the body,” she said. “I had past experience with chewable heartworm prevention causing GI signs for the full four weeks of efficacy.”
Last summer was her practice’s first to really offer chewables, and Perkins County chose Bravecto (fluralaner).
“Clients love the convenience of once every three months, and so far we have not seen any adverse reactions,” she said. “The monthly preventives drive traffic in the clinic more so than Bravecto as far as frequency of visits [monthly vs. quarterly]. Availability of oral, however, brings clients to the veterinary clinic.”
One of the biggest selling points for the new chewables is in how quickly they act, Dr. Truffini said.
“We’re getting more complete killing of the tick before it can actually transmit anything,” he said. “That’s important.
“Most of our clientele is pretty well educated that you have to do something about ticks, especially because of Lyme disease,” he said. “We’re in the No. 1 place in the United States for them. This area of Connecticut has the highest rate of Lyme disease. People are wary. Usually one or two family members have had Lyme disease. So they are aware, and they see ticks on their dog and know what’s going on. They’re all pretty much on board.”
At the Right Price
Zack Mills, DVM, owner of Tiger Tails Animal Hospital in Duluth, Georgia, and a member of the Today’s Veterinary Business editorial advisory board, said the vast majority of his clients are switching from topical to oral/chewables medications.
“When it is easy to administer, clients are more apt to use the product,” Dr. Mills said.
Manufacturer rebates help create a high compliance rate among owners purchasing a year’s supply, Mills said.
“What gets people to purchase is the rebate,” he said. “The [manufacturer’s guarantees] help, but it’s really about price.”
Pricing products competitively is extremely important, he said.
“Today’s consumer is going to price shop if they are used to purchasing items online,” Dr. Mills said. “When you price products too high customers can easily check to see if you are overcharging, and if you are overcharging for these items, they will ask themselves, ‘What else are you overcharging for?’”
Compliance products are attractive and desirable to clients if they know about the products, Gavzer said. That’s where clear communication from the entire veterinary practice team comes in. Having the preventive conversation is important during wellness checkups and at appropriate times during other visits. Veterinary practices might be surprised by the client response.
“It’s been my experience that clients don’t always hear about these options because they can cost more,” Gavzer said. “Many in practice shy away from recommending them for that reason. I think we’ve misread clients. I think that most would say ‘yes’ if we offered them a better way to take care of their pets, even if it cost more.”
Dr. Truffini hasn’t seen a bump in sales as much as he has seen clients switching from topicals to chewables when his team initiates the discussion.
“It hasn’t been too hard to talk to people or convince that there are options with flea/tick products,” he said. “I would say maybe a third of clients are using orals.
“Every time we talk to people and they need to have refills, we mention the chewables. Clients are already used to giving once-a-month heartworm, so it becomes a pretty easy thing. They like that they aren’t parting fur. People weren’t always applying it properly. So with that issue, it’s a very convenient thing to hand them this tasty, once-a-month treat. We are getting good compliance.”
Chewable flea/tick products have made a noticeable impact in the market in a short period of time. According to industry reports, compounded growth in flea/tick products that have been veterinarian dispensed has been just under 5 percent since 2011. However, using 2014 as the baseline year shows a sharper uptick of close to 16 percent.
What accounts for the increase? In 2014, Boehringer Ingelheim’s NexGard (afoxolaner) and Merck Animal Health’s Bravecto were introduced to the market. The movement accelerated when Zoetis jumped into the space with Simparica (sarolaner) in early 2016.
Examining compliance through a two- or three-year window is important rather than looking at year over year. That’s because pet owners traditionally stretch their use of flea/tick products beyond a calendar year. One analysis showed that most owners who buy a six-pack of a monthly topical typically didn’t buy it again for 25 months. At some hospitals, subsequent purchases are 36 to 38 months out. So, when clients make the initial purchase at a yearly exam, they might tell the veterinary team when asked about flea/tick product refills that they still have some preventives at home.
Veterinary hospitals must have total buy-in when it comes to the products they carry.
“The most successful hospitals, no matter what product they are carrying, have a consistent recommendation from the entire veterinarian staff instead of a plethora of options,” said Pasquale Bondi, a regional manager with Merck Animal Health.
Chewables aren’t limited to flea and tick preventives. The formulation and palatability make antibiotics easy to administer as well. Here’s a sampling of what’s on the market:
- Zoetis’ Clavamox Chewable (amoxicillin and clavulanate potassium tablets) was launched in 2017 for the treatment of skin infections in dogs and cats, periodontal infections in dogs and urinary tract infections in cats.
- Virbac’s Rilexine (cephalexin) Chewable Tablets is a broad-spectrum canine medication used to treat bacterial infections of the skin, urinary tract, respiratory tract, bones and joints.
- Bayer’s Baytril Taste Tabs (enrofloxacin) are prescribed for the treatment of dermal, urinary and respiratory tract infections in cats and dogs.