Pharmacy and prescription issues

Opioid bottle

 

The changing veterinary pharmacy landscape presents both opportunities and challenges to veterinarians and veterinary practices. This page provides an overview of pharmacy issues that are relevant to veterinary medicine, including the rules and practices related to the sales, dispensing, and compounding of drugs, chemicals, medicines, and/or prescriptions.

​Writing prescriptions

When the decision has been made to treat an animal with a prescription drug, veterinarians are ethically bound to have a veterinarian-client-patient relationship (VCPR) in place in order to prescribe medication for the patient and to provide a prescription when requested. In addition, many states require that a prescription be provided upon client request, and the majority of states prohibit veterinarians from prescribing animal medications outside of a VCPR. Clearly written prescriptions help prevent misunderstandings and misinterpretations that can harm patient health. Our downloadable prescription-writing best practices poster helps train and remind your staff.

Additional resources:

Obtaining prescriptions from retail pharmacies and drug distributors

While many pet and livestock owners prefer to have their prescriptions filled online, the U.S. Food and Drug Administration (FDA) cautions that it has found companies that sell unsafe medications and/or conduct unlawful pharmacy practices (such as dispensing prescription medications without a prescription). The FDA also indicates there is a growth of rogue drug distributors. FDA urges healthcare professionals to verify that their distributors are licensed by their state.

These AVMA resources provide guidance and information to about requirements and best practices related to prescription writing:

Client requests for prescriptions (AVMA policy)
Prescriptions and pharmacies FAQ

Compounding

Compounded medications are vital resources for veterinarians when no other effective treatment options are available. It's important to understand the rules and regulations around compounding.

Controlled substances

The use and prescribing of controlled substances is subject to regulation by the Drug Enforcement Administration (DEA) and state controlled substance authorities.

AVMA resources:
Veterinary practitioners' guide to DEA recordkeeping requirements
Veterinary Medicine Mobility Act: FAQs for veterinarians

DEA and NPI numbers

Conflicts have occurred when some pharmacies inappropriately required DEA numbers for prescriptions that were not controlled substances. The DEA says it strongly opposes the use of a DEA registration number for any purpose other than for transactions of controlled substances. Use of DEA registration numbers as identification is not appropriate, according to the DEA.

National Provider Information (NPI) numbers, which were developed for use associated with human health care, are not for veterinary use. According to the federal government, businesses cannot insist on NPI numbers from veterinarians. Veterinarians who need to deactivate their NPI number can do so by submitting an NPI update form.

When asked for an NPI number, or for a DEA registration number for noncontrolled substance prescriptions, veterinarians instead can provide their state license number. If pharmacy staff are unwilling to process the prescription, email the AVMA at NPIatavma [dot] org (NPI[at]avma[dot]org) or, if the pharmacy in question is CVS, contact CVS Corporation at 1-800-SHOP-CVS (1-800-746-1821). You will need to provide the name of the pharmacy staff and pharmacy store information (name, store number, location). Although a pharmacy might find it convenient to use NPI and DEA numbers, ultimately, it's a veterinarian's state veterinary medical license that authorizes the prescribing of drugs for our patients.

E-prescribing

The electronic submission of prescriptions, or e-prescribing, is commonplace in human medicine and of increasing interest in veterinary care, as use of connected care technologies continues to grow.

Pharmacy complaints

AVMA members have reported problems with outside pharmacies, such as inappropriate substitution of medications, unauthorized alteration of prescriptions, and errors. Unlawful pharmacy practices and pharmacy errors should be reported to the state board of pharmacy.

In addition, the AVMA requests that members also inform us of the problem by completing and submitting our complaint form. This information is kept confidential and is used only for our advocacy efforts. The AVMA's form can also be sent to other organizations, namely the FDA's Center for Veterinary Medicine and individual state boards of veterinary medicine.

Educating clients

The following resources can help you educate pet owners about obtaining and safely using medications:

Your pet prescription choices (PDF client handout; member login required)
Online pharmacies
Your pet's medications
Prescriptions and pharmacies FAQ for pet owners
NSAID safety client handout (PDF, member login required)

Additionally, the Oregon Veterinary Medical Association has developed a helpful message for clients on pet prescriptions (PDF).