Kristi Fender is a freelance writer and editor in Shawnee, Kansas, with a long history of covering animal health and veterinary medicine. She is the former news channel director of dvm360.com and editor-in-chief of dvm360 magazine.Read Articles Written by Kristi Fender
Advances in veterinary medicine and pharmacology are giving practitioners access to more options than ever in the treatment of companion animals. A newer technology that’s changing the product landscape is the long-acting injectable. Drugs like ProHeart, Cytopoint, Adequan and others offer several advantages over oral take-home medications. Chief among the advantages? Client compliance.
“To me, that’s the greatest benefit of using injectable medications,” said Joy Fuhrman, DVM, MBA, CPA, a partner with Harmony Veterinary Clinic in Prescott, Arizona. “For example, clients forget to give monthly heartworm preventive — I sometimes forget in my own dogs. So using a six- or 12-month injectable is very effective for compliance. The same is true for a kitty with a UTI when you give Convenia as opposed to oral antibiotics.”
Injectable medications carry another advantage in that they keep revenue in the practice as opposed to sending the client home with a prescription to be filled online or at a retail pharmacy.
“There’s a lot more pressure these days from online pharmacies and consumers alike to script out medications,” Dr. Fuhrman said. “So, it does keep revenue in the practice. That being said, it’s not always the most cost-efficient option for the client.”
Cost vs. Convenience
Dr. Fuhrman likes to offer her clients oral and injectable options and explain the convenience of having an injection given in-clinic versus the cost savings of an oral drug.
“In my experience, most clients will almost always opt for a more convenient option,” she said.
Of course, the decision sometimes comes down to what the pet will tolerate.
“It’s not so difficult with a heartworm chewable, but if you have a cat that hates taking medication, is difficult to pill or is otherwise fractious, then injectables can be your only option,” Dr. Fuhrman said. “I take all those factors into consideration when making a recommendation.”
Besides convenience and patient tolerance, many clients like the comfort level that comes with leaving the treatment in the veterinarian’s hands and not having to worry about it. With a pill, Dr. Fuhrman said, clients often have to wonder: “Is the medication getting in? Is it not getting in? Are they going to spit half of it out? Are they going to vomit?”
“An injectable ensures that the patient is getting the appropriate dose of the medication,” she said.
However, if a client is particularly price-sensitive, an oral medication might be the best way to go, and that’s fine.
“It’s important to be clear that both would be equally effective,” Dr. Fuhrman said. “They’re not jeopardizing the patient’s health by choosing one option over the other. We need to make sure they feel comfortable if they choose the less costly option.”
Communicating All Options
Client discussions all come down to transparency, Dr. Fuhrman said. When faced with a situation where an injectable and an oral are options, she suggests saying something like this: “We have two options: We can give an injection today, which does cost a little bit more, but you won’t have to worry about administering the medication on time twice a day every day for a week or be concerned about your pet spitting it out or not getting the dose it needs.”
Clients can make the decision, Dr. Fuhrman said, “if you’re frank and upfront about laying out the options and the associated costs.”
What’s important in multidoctor practices is to establish a protocol for injectable products so that a client seen by one doctor will get the same treatment with another, Dr. Fuhrman said. And when products are administered recurringly, such as with Cytopoint, will a technician or doctor give the injection and will a recheck exam be conducted during the visit?
“Those are all factors to consider from a medical protocol standpoint and a pricing standpoint,” Dr. Fuhrman said.
Wendy Hauser, DVM, of Peak Veterinary Consulting in Parker, Colorado, agreed that a standardized approach to injectable products is important.
“It’s incumbent on hospital leadership and the doctor team to agree on what products are going to be offered, how they’re offered and maybe even when they’re offered,” she said.
Once the doctors are in agreement, the next step is to educate veterinary technicians and other staff members.
“The team needs to understand the why behind it; they have to understand what type of a client this would work for,” Dr. Hauser said. “Everybody should be on board.”
Asking the Right Questions
One way the veterinary team can identify whether a client is a good candidate for an injectable like ProHeart, for example, is to ask a question like this: “So tell me, Ms. Client, what day do you give Buddy’s heartworm prevention?” Dr. Hauser said.
“If you get a blank stare, they’re not giving it,” she said. “The technician could also say, ‘It looks like you picked up 12 doses of heartworm prevention last year, so you should be ready for a refill.’ If they respond with, ‘No, I have six months left,’ the technician can say, ‘Wow, it sounds like life is busy for you! I’ll ask Dr. Hauser to tell you about another option that might make things easier and ensure Buddy is getting the protection he needs.”
Dr. Hauser also noted that having clients come in for regular injections of products like Cytopoint or Adequan gives the practitioner another touch point with the client and a chance to check the patient’s progress.
“Cytopoint is a monoclonal antibody that blocks the itch reflex,” she said. “But if there’s a secondary infection, it’s not going to address that. We want to do what’s right for our patients, so we need to have a recheck exam when we give that next shot.”
If an in-person follow-up isn’t practical, the opportunity might be perfect for telemedicine, Dr. Hauser said.
Injectable medications represent a major step forward for veterinary practices that want to offer convenience and drive compliance (or as Dr. Hauser prefers to say, “adherence.”) By providing in-clinic treatment and getting pets to return for subsequent injections, injectables improve pet health, client satisfaction and practice revenue.
HOW TO PRICE INJECTABLE DRUGS
A client bringing her pet to a veterinary clinic for an injection of Cytopoint or Convenia is not going to shop the internet for the best price, Dr. Joy Fuhrman said. That means markups on injectables tend to be significantly higher than on prescription medications. And that’s how it should be if you’re smart about it.
“You have your or your technician’s time to administer the injection, the knowledge it takes to know how and where to administer the injection, and of course, the medical supplies you use in addition to the drug itself,” she said. “All those things need to be accounted for in the cost.”
Some clinics create package deals in which a client pays a fixed price for six injections of, for example, Cytopoint.
“If they’re administered once a month or every six weeks or whatever works best for the pet, clients might pay a bulk price that is equal to if not slightly lower than the individual cost,” Dr. Fuhrman said. “There’s also the option of spreading those out as a monthly charge to your clients to make it more cash-flow-friendly. That’s a great way to also gain client compliance because if they’re being charged for it, they are going to come in every month for the injection.”
Dr. Fuhrman noted that the fee for any injection given in the clinic needs to capture all auxiliary charges.
“You calculate what would be a reasonable injection fee and apply that to any and all injections that you administer in your practice,” she said.
Most practice management systems allow injection fees to be incorporated into the product price.
ADHERENCE VS. COMPLIANCE
Dr. Wendy Hauser wants the veterinary profession to replace the word “compliance” with “adherence.”
“In human medicine, the preferred term is ‘adherence’ because it conveys partnership,” she said. “It means you and I are deciding to work together. You’re consciously deciding to partner with me and adhere to the recommendation I’m making in the best interest of your pet.”
The word “compliance,” on the other hand, can come across as paternalistic.
“It means, ‘You will do what I say. You will give these pills if you want your pet to get better.’ Rather than, ‘We’ve got some options. The best choice is to give these pills twice a day. How is that going to work for you?’” she said.
Because adherence is a willful decision to go with a doctor’s advice, it’s even more crucial in veterinary medicine than human health care, Dr. Hauser said.
“We’ve got the intermediate layer” of obtaining buy-in from the pet owner, she said. “So, the idea of partnership is even more important.”