Pharmacy challenges: Present and future

Pharmacy revenues have been decreasing over the past few years. Challenges from both conventional retail stores and internet pharmacies are taking market share away from veterinarians. Although I’m all for consumers saving money, the reality is that pharmacy income has helped financially support our practices. Losing a significant source of income is not sustainable, and we must either compete with other pharmacies or find ways to practice better medicine and otherwise make up for lost income. These insightful tips will help you face the pharmacy challenges in your practice.

Better medicine equals better profit.

Pets have many problems, most of which the owner doesn’t even notice (and some are not noticed by us until lab testing is done). If owners will allow us to find and treat problems, any lost pharmacy income is easily replaced by caring for and seeing our patients more frequently. Why simply guess when presented with a possible skin, bladder, or ear infection? Work up the case, practice better medicine, serve our patients and clients with outstanding service and care, and watch your business soar!

Injectable medications improve compliance and profitability.

Giving most—if not all—pets a starter injection to help treat the condition can ensure they will begin healing prior to leaving your office. In addition, this method is also accepted by owners and is a service that can’t be shopped (yet). As a holistic veterinarian, I’m not a fan of longer-acting shots, but they can be useful to replace oral medications and certainly can’t be purchased at the local pharmacy (and hopefully won’t be available over the counter anywhere).

Nutritional supplements help the patient and the practice.

As a holistic doctor, I mainly use supplements for my patients rather than reaching for conventional medication. Every pet can benefit from supplements, and all doctors are qualified to use the most basic supplements, such as fatty acids, antioxidants, enzymes and probiotics, and joint supplements. Adding 1 or more supplements to your patient’s treatment plan will benefit the pet, possibly prevent adverse effects from your prescribed medications, and help the bottom line. To prevent clients from buying on the internet, consider private labeling or purchasing from manufacturers who sell only to doctors. If you’re unfamiliar with the science of supplements, I’ll offer a self-serving plug by recommending my latest book, Nutritional Supplements for the Veterinary Practice: A Pocket Guide.

Only prescribe enough medications on the first visit to ensure efficacy.

This idea is helpful for several reasons. First, there is no reason to prescribe a 3- to 4-week dosage of a medication that may not work. Second, prescribing a 5- to 7-day dose plus the all-important recheck/progress exam ensures efficacy and allows you to change the medication if your initial choice is ineffective. Thirdly, keeping in touch by seeing the patient again is good medicine. Finally, more visits equate to more bonding time with the client along with much-needed income to compensate you for your time and expertise.

Rechecks/progress exams are a must for a refill.

As a doctor, you’re more qualified than the owner to determine the progress of the pet and whether continued treatment with the original prescription is in the pet’s best interest. Rechecks are needed to continue medications and often uncover additional diseases to be treated. If you use a longer-acting injection at the initial visit, then it is important to realize you won’t have the automatic progress exam. To compensate for the lack of income, charge correctly on the first visit.

Regular lab testing is also a must for a refill.

Patients on chronic medications require constant evaluations. This is true in human medicine and needs to become the norm in veterinary medicine. Check your patients frequently. Most of the pets seen in my holistic practice have not had regular monitoring despite multiple refills of strong and potentially toxic medications. Don’t make this mistake. For example, iatrogenic Cushing is a real disease. Oftentimes, my evaluation reveals new diseases that should have been and would have been detected earlier if only the initial prescribing doctor did his job correctly. “No testing, no refills,” and “No rechecks, no refills,” is good medicine and good business.

If you can’t beat them, maybe you can meet them.

If you really want to keep the sale and avoid losing money, meet local pharmacy costs whenever possible. I’m not a big fan of losing money or discounting, but if you follow the suggestions above to replace lost income, then lowering drug costs to a smaller profit may not ultimately affect your pocketbook.

Make payment easy and less expensive with pet insurance, wellness plans, and third-party payment companies.

Many of my clients have pet insurance and Care Credit, which allows them to do the things listed above so we can practice high-quality medicine and be mindful of the pet’s best interests. Not all insurance is the same, and some companies are easier to work with than others, but the goal of insurance is to allow clients to say yes to your treatment. Care Credit allows clients to budget realistically for higher-priced treatment plans. Many practices, mine included, find monthly payments for wellness plans highly appreciated and accepted by pet owners. Not only do these plans, which allow for easily budgeted pet expenses and savings to the owner, result in more frequent health care visits, but these visits further bond clients and pets to your practice. Regular visits also render more opportunities to find problems that require treatment.

Evaluate your fees regularly.

Perform a fee diagnosis. Let’s face it: If you lose income in 1 area of the practice, it must be made up in other areas. Make sure your fees adequately compensate you for being a doctor. Raising fees in 1 area can allow you to lower your pharmacy fees and not lose income. There is more net profit in services performed than products sold. Make money for your knowledge and skill rather than for drugs anyone can sell.

Autoship commonly used medications.

Online (and retail) pharmacies do this, so if you want to increase client convenience, autoshipping is a must. It helps the client by saving travel time to pick up medications and ensures proper treatment of the pet. Autoshipping also provides a guaranteed and steady flow of funds to the practice, so everyone wins!

Shipping medications/supplements equal owner convenience.

For clients who don’t have the time because of busy schedules or travel distances to your practice, mailing medications/supplements ensure compliance, client bonding, and saves potentially lost income. Yes, this can be a pain and requires a dedicated employee, depending upon the number and frequency of shipped products, but it may be worth it to your practice.

Although these recommendations can help you battle lost pharmacy revenue and practice better medicine, at the end of the day, you’ll need to decide how much of your pharmacy business—if any—you choose to keep. The suggestions listed here have stood the test of time and helped doctors maintain or even increase their incomes despite the threat from yet another unexpected source of competition.

Shawn P. Messonnier, DVM, owns Paws & Claws Holistic Animal Hospital in Plano, Texas, and serves on the dvm360® Editorial Advisory Board. He has written multiple books on marketing as well as holistic veterinary medicine.