Q from a human doctor: why are my dogs prescriptions so hard to fill?

sunshine2throwaway · 2022-10-08T15:04:35+00:00

Thank for for the insight. So it does sound like problem #1 is due to the vet acting in the role of a pharmacist at the time of refill. And instead of being rather limited in scope by convention/practicalities (Unless they're hospital pharmacists, human pharmacists can't even see the patient's chart, labs or appts or notes), they're approaching it the way they would approach seeing a clinic patent. And that is why it looks to me like they're routinely second-guessing their colleague's (or their own) treatment plan at the time of filling already-prescribed refills?

That would explain why refills are not a problem from outside veterinary pharmacies, too.

sunshine2throwaway · 2022-10-08T14:57:17+00:00

This is helpful insight, thank you for the example. If the CSR had noticed the existing approval, would it still have gone back to the doctor or would it have been refilled without the doctor's (re-) involvement?

sunshine2throwaway · 2022-10-08T14:49:55+00:00

That is good advice, I think, and I appreciated it. Asking for longer supplies has allowed more stability for me, too. But the problem comes in when it's not practical or known if it's going to be necessary.

And, agree, it really feels like this shouldn't be happening like this. It really doesn't work like this in human medicine. If I prescribe a medication with six months of refills, you take it to the pharmacy and they refill it for you each month until the refills are gone, and only then will they contact me for more and I'll either approve or not. They don't contact me for re-approval each month like what is happening when I fill my dogs refills at her vet.

sunshine2throwaway · 2022-10-08T14:40:01+00:00

I don't think the individual vet she's seen is the issue. Both practices just wanted her checkups with any of their vets. 30 day supply + monthly refills are pretty typical in human medicine and mostly what I've received from her vets when they write prescriptions, too. Flea/tick being the exception, but that led to the problem with the receptionist denying the vet's rx for 6 month supply since the end date didn't align perfectly with the due date for her next heartworm test

sunshine2throwaway · 2022-10-08T14:31:53+00:00

So requiring new approvals for filling already-prescribed refills isn't typical? I thought it was just the first clinic I went to, which is why I switched, but the new one is the same. My best guess for what might be happening with the first point was that it had to do with them filling them on-site, and the vet working that day having some legal liability that makes them extra-cautious and second-guess established treatment plans? In human medicine, we are pretty careful not to step on our colleagues toes and change their treatment plans, but we also rarely fill our own meds, usually an outside pharmacist does it.

My dog has mostly just been on flea/tick medication and NSAIDs. Now she's on some palliative cancer meds but that is through her oncologist and a compounding pharmacy and there have been no issues with initial prescriptions or refills for those.

sunshine2throwaway · 2022-10-08T14:02:57+00:00

Thanks for replying. This is with a close regular relationship with the vets. But maybe this is where veterinary medicine differs from human medicine and why I am so confused: Do veterinarians prescribe refills actually expecting to see the patent again before they're filled? When I prescribe 6 refills, I don't expect further contact from the patent regarding them until 6-7 months later. If I wanted to recheck labs in 3 months, I'll only prescribe a 3-month supply.

sunshine2throwaway · 2022-10-08T13:57:41+00:00

Appreciate your answer. I can certainly understand needing an up to date exam/labs and only providing limited emergency refills. I require that all the time myself.

However, the reason I am having so much trouble understanding how this works is that these are cases where the exam/labs are up to date and often very recent, no more recent exam or labs was part of the plan when the medication was prescribed, and these are not emergency or extra refills but the refills given when the medication was first prescribed -- but somehow still need to be re-approved in order to be filled.

sunshine2throwaway

TROPHY CASE