Re-examine your pharmacy

It’s OK to walk away from drug sales, but whether you do or not, revenue lost to outside sellers can be recaptured in other ways.

Re-examine your pharmacy
Whether a medication is for seizures, arthritis, allergies, inflammatory bowel disease, pain or recurrent infections, why would you continue prescribing drugs without doing frequent rechecks and laboratory testing?

When I began my career in veterinary medicine, our profession faced the challenge of low-cost vaccine and spay/neuter clinics. Then we saw flea preventives show up in stores. Then corporate medicine began testing the solo practitioner. This was followed by many of our over-the-counter products ending up on the internet. And now we have an even tougher challenge: the loss of pharmacy income to local drug stores promising cheap medications.

One issue we tackle when I present my marketing workshop at veterinary conferences is how to deal with this potential loss of 10 to 20 percent of our income. I’m comforted by many of the suggestions from attendees who are already thinking about the latest threat, and I want to share some with you. It’s up to you to decide which ideas, if any, to apply to your practice. If these suggestions stimulate you to come up with more ideas, I’d love to hear them.

First, I want you to consider something a number of attendees have shared with me. That is, do you really want to save your pharmacy? Think about it. While the pharmacy is a convenience for clients and a dependable source of income for the practice, it can be a real pain in the rear at times. Someone needs to spend time contacting distributors to find the best pricing and place the order. Then the order needs to be unpacked, inventoried and put on shelves. Filling prescriptions takes time and needs to be done accurately.

Then there’s the ever-present reality of employee theft. Would it be a better and more profitable use of your time to not have to deal with being a “pill pusher” and to devote more time to practicing medicine?

I’m not saying you should give up your pharmacy,  but consider the possibility. As several veterinarians have told me, they’d be happy to give up their pharmacy and then raise their prices to compensate for the loss. They’d rather be compensated for their skills.

At this point, I’ll assume you want to keep your pharmacy, or at least the income. Here are some of the many ideas I’ve gleaned during my marketing presentations.

1. Every Pet Gets at Least One Injection

This is something I learned from a mentor many years ago. Injections guarantee immediate dosing of the appropriate medication and is something doctors routinely do in human medicine. A client can’t usually price-shop injections when he is already in the office with a pet that needs help. If you’re not using injectable medicines regularly, rethink this important medical procedure and charge appropriately. And if you’re a holistic/functional medicine doctor like me, use injectable herbal medicines with or in place of traditional pharmaceuticals.

2. Use Supplements

Speaking of holistic medicine, every pet can benefit from supplements. Fatty acids, antioxidants, enzymes and probiotics, and joint support are just a few of the products that can benefit patients. Adding one or more supplements to a patient’s treatment will benefit the pet, possibly prevent side effects from prescribed medications and help the bottom line. To counter internet competition, consider private-label products or purchasing from manufacturers that sell only to doctors.

3. Prescribe Limited Quantities

Let me give an example. We know that a three-week minimum dose of antibiotics is needed to treat pyoderma, but nothing says we need to prescribe that three-week dose at the time of diagnosis. Whether you fill the prescription or script it to a pharmacy, prescribe a seven-day dose, recheck the pet to make sure the treatment is working — charge for the recheck — and then fill the rest or switch to another therapy after the recheck.

4. Do Rechecks

It took me a while to realize the importance of frequent rechecks, but I no longer rely on owners to diagnose improvements in their pets’ condition in order to relieve my responsibility as the doctor. Rechecks are needed to continue medications — see points 3 and 5 — and often uncover additional treatable diseases. Yes, some clients complain about the hassle and expense, but we tell them that without a recheck we won’t put their pet’s health at risk by continuing to prescribe medications that have possible side effects.

5. Insist on Regular Monitoring

You likely have many patients on medications for chronic conditions. Whether the medication is for seizures, arthritis, allergies, inflammatory bowel disease, pain or recurrent infections, why would you continue prescribing drugs without doing frequent rechecks and laboratory testing? Our human medicine counterparts don’t do it, and neither should we. Our society is too litigious and too quick to trash us on the internet for me to not insist on providing high-quality medicine.

Sure, some clients have limited funds and can’t afford multiple visits, but most pet owners can have something done to verify that the medications are not harming the animal and are still needed. Logical intervals — say, every three to six months — for a recheck of the pet and its blood and urine keep you out of trouble and uncover problems that need to be addressed. This also means that if your client gets heartworm medication from a source other than your practice, the client can get a six-month script that is renewed only after another exam and heartworm test.

Because I don’t trust drugs from unknown manufacturers, because my license is on the line every time I write a script and because well-known manufacturers of heartworm medication guarantee the efficacy of their products when purchased from a veterinarian, I find a six-month recheck/retest to be reasonable. “No testing, no refills” is a motto that supports the best medical practices.

6. Practice Better Medicine

Sure, we all think we provide the best medicine, but I know there is always room for improvement. For example, a pet with a suspected urinary tract infection must have a culture done. In my practice, I prescribe antibiotics only when a culture confirms the disorder is caused by an infectious organism, and the antibiotic chosen is based on sensitivity testing. Ditto for pets with pyoderma if antibiotics are needed or if I’m concerned about a methicillin-resistant organism, which I find about 20 percent of the time.

7. Meet Local Pharmacy Prices

I’m not a big fan of losing money or discounting, but if you follow the suggestions above to replace lost income, then lowering your drug prices might not ultimately affect your pocketbook.

8. Consider Recommending Pet Health Insurance and Third-Party Payment

Many of my clients have pet insurance or Care Credit, allowing them to embrace high-quality medicine and look out for their pets’ best interests. Not all insurance is the same, and some companies are easier to work with than others, but the goal is to help clients say “yes” to your treatment recommendations.

9. Perform a Fee Diagnosis

Let’s face it: Income lost in one area must be made up in other areas. Make sure your fees adequately compensate you for being a doctor. Raising fees in one area can allow you to lower your pharmacy fees and not lose income.

Ultimately, you need to decide how much of your pharmacy business, if any, you choose to keep. The suggestions above are some of the more popular ones I’ve gleaned from workshop attendees, so they’ve stood the test of time and helped doctors maintain or even increase their incomes despite the threats from unexpected sources of competition.

Dr. Shawn Messonnier is a speaker and the owner of Paws and Claws Animal Hospital in Plano, Texas. He can be reached at [email protected]. Protection Status