Dr. Angie Krause (00:00)
Welcome back to Tails of Truth where we tell the truth about veterinary medicine. I'm Dr. Angie, and this is my co-host and veterinary nurse extraordinaire Jojo. And today we are going to be talking about where you should get your pet's drugs. We're going to talk about pharmacies.

JoJo (00:16)
Yes.

Yeah, and I feel fiery about this one.

Dr. Angie Krause (00:21)
⁓ I feel... Yeah.

JoJo (00:22)
on so many levels. So I'm excited.

I'm like, I don't know where it's going to go because I can think of 10 things I want to talk about.

Dr. Angie Krause (00:28)
Well, can I just start off with, it's a little bit of a gripe of how much time every day I spend signing off on prescriptions from online pharmacies. And I want everyone to understand this is what happens. This is the flow. And then we'll get into all the things pharmacy, but I just have to start with this gripe. And I want to start with this gripe so that everyone understands what's happening on the backend for us. So.

JoJo (00:30)
Yes.

Okay, but

let's clarify. When you say online pharmacy, you don't mean your clinic's online pharmacy. You mean big box online pharmacies. Can we just name the big one?

Dr. Angie Krause (01:04)
I mean, sure, but there's actually like, most of it comes from Chewy, but it's not even about Chewy. Cause like then there'll be other ones. mean, sometimes people are like, can you call this into Canada? And I'm like, I can't, I can't call it into Canada. I don't have, yes, yes. But I mean, sometimes you can call things into Canada, but that's, that's like a whole different episode.

JoJo (01:21)
because Canada, you're cheaper.

Dr. Angie Krause (01:31)
But what happens is, there are other, like, you know, what is it like Valley vet or, you know, and it's not inherently a problem with them, but what happens is they fax us or email us or what, however they're communicating to us. Okay. So someone's, you know, for their dog, they want Rimadyl or they want, you know, X medication. And so then what happens is the reception staff has to then look

and see do we have that animal? Because sometimes we're like, that's not even our patient. I don't know who this is. So that happens. And then they have to look to see like, okay, is this animal up to date on an exam? How are things going? Can we even legally prescribe? Because we have to have.

JoJo (02:14)
Yeah, thank you

for using that legally prescribed because people get frustrated because we asked for an exam. But it's because Dr. Angie's license is on the line. If she's not examined your pet in the last year.

Dr. Angie Krause (02:17)
subscribe. Yeah.

Yeah.

Yeah, I can't do it. And it's not that I want to be difficult. I really don't want to be difficult. then, so then what happens is then that chart makes its way to my desk. So then I a little bit do the same thing. So I'm pulling up this animal and then let's say it's a medication. Maybe I've never seen this pet and it's a medication I didn't prescribe. Then I have to look through that pet's the majority of their medical history because I'm signing off on this drug.

JoJo (02:29)
She can't prescribe it.

Dr. Angie Krause (02:56)
that I need to make sure they've had it before, there's a good reason, then I'll recalculate the dose. Now, if I, I mean, if this is my patient that I've been seeing for years, I know I don't have to do that, but oftentimes in a multi-doctor practice, it's coming on your desk, you're not necessarily the last doctor that saw that patient, you're the doctor on for the day. So we really try to get those done the same day. And so then I'm reading this. I mean, sometimes it can take me like 15, 20 minutes. When then what's really frustrating, I'm like,

this is the wrong dose. This is the wrong medication. Or some days people will just call in random medications. So then I have to pick up the phone and say, Hey, Mrs. Smith, why are we do what what's happening? And so then that takes up my time and I'll probably sign of anywhere from like five to 10 of these per day, sometimes more. And that takes up so much time and the amount of revenue made on that.

is none.

JoJo (03:52)
No, that's

not true. It's negative $50 or negative $100, whatever it is.

Dr. Angie Krause (03:55)
Right? Because then you have to think about,

just paid to have that filled. And while human pharmacies, and that's how the medical system works, the human medical system, their margins are way better than ours. And so like the sustainability of using these pharmacies are just, it's not very good. And so there is a push for most clinics to use

our internal pharmacies. They are connected to our computer systems. They're connected to your pet's medical chart. And so we will have our own online pharmacies. So you can still get everything mailed to you. You can still get it compounded. It's just as convenient. It's just not maybe the name that you're used to, but it's way easier for us to use.

JoJo (04:47)
easier and we make a percentage. So a super, super small, let me make that clear, your vet is not getting rich on prescribing you medications. They're getting poorer. Even in our online pharmacies that are connected to our clinics, it still takes a lot of staff time.

Dr. Angie Krause (04:49)
Yes, it's very small.

Exactly.

Yes.

JoJo (05:08)
to do that. But when you then

go to a third party, like Chewy, because you're trying to save $2, ⁓ it is gutting the small practices that are left.

Dr. Angie Krause (05:15)
Yeah.

It really is. The ones that aren't corporatized, is that a word corporatized? Okay. Yeah, if your veterinary clinic's not corporate, like it's really putting them under and it's a big problem. It's a really big problem.

JoJo (05:23)
It is now.

And

you know me, if you've been here long enough, skepticism at its highest. That is the intention. The intention is to crunch and squash the small clinics that are left.

Dr. Angie Krause (05:45)
Do you think that's the active intention?

JoJo (05:47)
Yes, because they're offering money for these clinics. Yeah, we have private equity firms trying to buy it all out. Like it's just, I mean, maybe not intentionally like, hey, if we're going to do this, we can put them all out of business. But it does make you more approachable for purchase. If you're struggling.

Dr. Angie Krause (05:52)
You don't think it's just for their own?

Yeah.

That's true.

I didn't think about that, but I wouldn't. I wouldn't have thought about that angle. Yeah. You're like, I'll do that for you. Yeah. And so.

JoJo (06:14)
And that's just

one aspect of problematic pieces of big pharmacy.

Dr. Angie Krause (06:20)
And you know, I used to think like, you know what, it's our job as veterinarians and practice owners to compete with these pharmacies, but it's just getting to the point where there's no chance. Like some of these pharmacies are, I mean, some of the things you can buy on Chewy, they are selling it for less than we can buy it for at wholesale because they're...

JoJo (06:43)
That is true. I

remember the moment that happened. And I just was like, I had people saying, well, I can why are you selling it to me at that price when I can get it at Chewy? I'm like, because Chewy's selling it for a better price than I can get it for you.

Dr. Angie Krause (06:46)
Yeah.

Right. And it's like, how can you argue with that? And of course, everyone wants it as cheap as possible. And Chewy treats everyone really well. They send you flowers when your dog dies. like, they, I mean, it's, it's kind of really not about Chewy's integrity. It's just you understanding what happens when you fill that at Chewy and how it pretty soon small practices just aren't going to do it. ⁓

I think a couple local practices have said, we're not using online pharmacies anymore unless it's our own. And if you want to come pick up a written script, you can. But I thought, God, wouldn't that be, that's just as much work to write that script, don't you think? Yeah.

JoJo (07:37)
for sure. Writing scripts is a pain. So that's when

you're talking about somebody going to a Walgreens or a CVS or that type of stuff that you can get from a human pharmacy has its own set of problems that I think we should talk about. But I want to further on what you're talking about the local community vets that are if you want to keep that kind of feel and that if you enjoy going to a privately owned clinic.

Dr. Angie Krause (07:45)
Yeah.

JoJo (08:04)
please order from your clinic. I mean, at this point, some of them are begging to stay in business. Please do this because as Dr. Angie said, it's costing them staff time to do that prescription. There's no profit at all. They don't make any percentage of that chewy order. And the quality control aspect of it, I think that's another piece we should talk about.

Dr. Angie Krause (08:09)
Yeah.

No.

JoJo (08:31)
⁓ but yeah, please do. And I appreciated this one local clinic who just called it out. Like if you're ordering from Chewy and I've seen other clinics and I didn't finish my sentence there, but just so y'all know, like Dr. Angie talked about, sometimes we don't finish our sentences. I say right all the time, but I just watched Michelle Obama and she doesn't finish her sentences either. So I'm going to put that up there with the I'm okay. My brain's just going so fast. and now I've lost all my train of thought.

Dr. Angie Krause (08:51)
Yeah. You're totally right.

JoJo (08:58)
You

Dr. Angie Krause (08:58)
Okay, well you were recapping basically the harm of some of these big online pharmacies on small animal practices, but that where we were headed next, or where you were headed next, is that when your veterinarian, because sometimes we just don't carry a medication, or we need to script it in for you, or maybe I'll have a client that's up in the mountains, and so I'm like, okay, well let me call something into the Walgreens. When you have your veterinarian call something into the local, like,

JoJo (09:03)
Yeah.

Dr. Angie Krause (09:26)
just chain pharmacy, sometimes and Jojo and I have had this happen to us, they don't do the right medication. And so we implemented a policy in our practice. And we always told people when you get that medication, please text us a picture before you give it to your pet. Because do you want to tell the story?

JoJo (09:44)
Yeah, I was hoping we could tell the story because this is this is good as a pet parent to hear. ⁓ warning. ⁓ We had a cat in the practice. And you can help me remember what his person really wanted us to use Walmart. And so I called in a prescription to Walmart.

Dr. Angie Krause (09:46)
Let's tell the story.

JoJo (10:05)
They have a lot of times because they're also understaffed, these human pharmacies. So we often have to leave our prescriptions on a voicemail. ⁓ I left this prescription, I believe on a voicemail. I don't think I actually spoke to a pharmacist or maybe I did. I don't know, but we notated everything. If I left it on a voicemail, that's notated. If I talked to the pharmacist, that's notated. And left this prescription and it was for his, what did he have? It was it for his blood pressure? Yeah, he had high blood pressure.

Dr. Angie Krause (10:09)
Yeah.

Okay.

Mm-hmm.

JoJo (10:34)
And so it was his blood pressure medication. And what was it? Amlodipine? It was probably amlodipine. And then we saw this cat maybe like five weeks later and she showed us a prescription bottle and what Walmart had prescribed for her cat with her cat's name on the prescription bottle was her blood pressure medication. Is that correct? Yeah, in her dose. So for five weeks she had been giving

Dr. Angie Krause (10:37)
I am Lodopine. Yep. Yep, super easy.

It was in her dose. Yeah.

JoJo (11:01)
her cat and I think she had the opposite I don't know they had like opposite issues or something I don't remember it's been years but so for five or six weeks as cat habit taking his humans blood pressure medication which could have been devastating and we just horrifying and I don't even know how they got

Dr. Angie Krause (11:08)
Yeah, I didn't know the medication.

Yeah, no, was horrifying.

JoJo (11:24)
It was a completely different name of a drug, a drug that I hadn't heard of, so I clearly didn't call that in.

Dr. Angie Krause (11:30)
Yeah, we don't even use it in veterinary medicine. I don't even remember what the drug was. Yeah.

JoJo (11:32)
Yeah. Yeah.

And so that's a cautionary tale of I mean, ever since then, we've had to check every which was an added task of checking every prescription that is filled in a human pharmacy.

Dr. Angie Krause (11:42)
Right.

JoJo (11:46)
to make sure that it was prescribed correctly before you give it to your pet. And so the benefit of using your veterinary clinics online pharmacy is that they are veterinary focused and only have veterinary safe drugs. So they're actually checking against, okay, this is a cat that you're prescribing this off label. Even if it's off label for a dog, they will check in with us. I like, why are you prescribing this?

So it's just an extra layer of security to make sure your pet is getting the safe medication.

Dr. Angie Krause (12:10)
Yeah.

It's both annoying and reassuring. They're like, are you sure that's what you wanted to do? And I'm like, yes, but it makes me feel good because that's one thing that gives me anxiety at night is like, did I mess up a prescription? Did I miscalculate a dose? And when I use these online pharmacies that are just for veterinarians, I know that they're calculating behind me and it's really nice. So.

JoJo (12:18)
You

Yeah.

So.

Yeah, it's

really nice for you as a pet parent to know that because prescriptions is one of the most stressful things in veterinary medicine for me of just like, what if I called in something wrong? It's nice to have that extra security check, whereas the human pharmacy is like, oh, you want this? Okay. Or wait, I don't know who Mr. is. I So like, let me just fill out for his person.

Dr. Angie Krause (12:52)
Yeah.

⁓ like how did that, how did that go and missing in translation? But you just never know. You never know if the phone's cutting out. You never know what they've written down. You never know what was communicated. You never know who's new. And so I think it's, it's helpful. So, I mean, I think that's our, that's the whole spiel is like, if you want to support your veterinarian, buy from their pharmacy whenever possible. And when you can't buy from their online pharmacy. at least they're not.

JoJo (13:04)
What the heck?

Dr. Angie Krause (13:29)
losing a ton of money every time they fill a script because we want to make you happy. We really do like we want to please everyone. We want you to get your stuff. We want you to get it for the best price possible too. It's just right now it's coming at our expense.

JoJo (13:42)
Yes. And if you're using your your clinic's online pharmacy, that's pretty close to price matched with what Chewy's doing. Yeah. I mean, I don't know if Chewy ships for free. Maybe that's where the difference is. But and if you can do something on auto ship, you're saving there. A lot of times your your veterinary clinic can click a little button that gets you a discount on auto ship. So we're trying. We are trying.

Dr. Angie Krause (13:50)
really? that's good to know.

Yeah.

Yeah.

Help us help you.

JoJo (14:10)
Okay, Jerry McGuire.

Dr. Angie Krause (14:13)
Okay.

And if you want help with your pet, you can reach out to us at boulderholisticvet.com. You can book a consultation with me and I can go over your pet's medical history. We'll meet on zoom. It'll be recorded and I can help you make a plan. And we also, because you watched this whole episode, it's only 16 minutes.

You can have a free course on us. If you go to boulderholisticvet.com and go to, think is it learn with us. still never know, but, ⁓ learn more. We're learning. And then you can see our course selection. If you use the code truth tales spelled T A L E S or T A I L S, ⁓ you can get one of our courses for free. Okay. We'll see you next time.

JoJo (14:49)
I have to learn more, I think. Yeah.

Thank you.

Bye

bye.

Dr. Angie Krause (15:08)
Bye.