What approach is best when making a request you think may be rejected...UPDATE #55

[StephanieZ]

Either of the first two options would work fine. Be assured that the vet's office handles prescription requests routinely. Every practice is different (and states do vary in their rules and ethics about outside RXes), but most will be happy to give you a *written* prescription, at no charge. Many/most practices will NOT fax/call/speak to outside pharmacies due to the liabilities they incur by doing so (many online pharmacies are fraudulent, not licensed in the state, illegal to sell in the US, etc) and the incredible hassles and staff time involved. There are 1001 potential "pharmacies" and many ethical veterinarians are not comfortable dealing with these unknown entities. So, you can get your written prescription, and you can take it wherever you want, at your discretion, and with you taking responsibility for errors, etc, by the "pharmacy". Your vet might worry about it if they hear about it, because the vets are the ones that deal with the fall out of the incorrectly-filled RXes, etc, but they probably won't say that to you. They'll most likely smile and hand you the RX. 

 

I've never heard of clients getting fluid prescriptions filled at an outside pharmacy. In fact, I'm not even aware that it's possible. I'm sure it is, but I've just never heard of it (thousands of clients, owned a practice for over a decade, many patients on fluids). 

 

FWIW, the "best practices" are for a new IV line and new IV bag to be used with every single fluid administration. Some standards allow a bag to be reused for some number of days. Others are more strict. 5 days is pretty generous. Many veterinary hospitals will discard the bag after a one day, others after a few days, others after a single patient, no matter how much is used. 

 

Also, FTR, $15 out-the-door for a bag of lactated ringers (assuming that's what you're using) is a great price. Your vet isn't making any profit on that sale. That I can guarantee. 

 

Likewise, $5 for an IV line set and a handful of needles is selling it at a loss. No profit there, guaranteed. 

 

So, anyway, your vet/staff might be annoyed at the minor hassle of producing a written RX and then worrying that their patient might get the wrong fluids/needle size/whatever . . . but they're not going to be losing money if you take that business elsewhere. 

 

So, anyway, IMHO, your vet is doing you a solid in his pricing. Feel free to shop around. I think you'll find you might be able to save a few dollars max by shopping online -- just due to the bulk savings that massive distributors have and of course their much cheaper staffing costs, since they aren't handling the client education aspect of supporting home fluid administration. Just be sure you get what you were prescribed. 

 

Understand that there are dozens of choices when it comes to fluids, so be sure you get what the prescription called for. The wrong fluid choice can be very dangerous. 

 

Fluid prices have been very volatile in recent years, as have many drug/prescription prices due to the craziness that is the US pharmaceutical industry. Nothing the vet can do about that . . . Vet medicine is the poor step-child of human medicine . . . Totally subject to fallout from the insane market forces in the human field.

 

Good luck!

 

 

[Guest]

Either of the first two options would work fine. Be assured that the vet's office handles prescription requests routinely. Every practice is different (and states do vary in their rules and ethics about outside RXes), but most will be happy to give you a *written* prescription, at no charge. Many/most practices will NOT fax/call/speak to outside pharmacies due to the liabilities they incur by doing so (many online pharmacies are fraudulent, not licensed in the state, illegal to sell in the US, etc) and the incredible hassles and staff time involved. There are 1001 potential "pharmacies" and many ethical veterinarians are not comfortable dealing with these unknown entities. So, you can get your written prescription, and you can take it wherever you want, at your discretion, and with you taking responsibility for errors, etc, by the "pharmacy". Your vet might worry about it if they hear about it, because the vets are the ones that deal with the fall out of the incorrectly-filled RXes, etc, but they probably won't say that to you. They'll most likely smile and hand you the RX.

 

I've never heard of clients getting fluid prescriptions filled at an outside pharmacy. In fact, I'm not even aware that it's possible. I'm sure it is, but I've just never heard of it (thousands of clients, owned a practice for over a decade, many patients on fluids).

 

FWIW, the "best practices" are for a new IV line and new IV bag to be used with every single fluid administration. Some standards allow a bag to be reused for some number of days. Others are more strict. 5 days is pretty generous. Many veterinary hospitals will discard the bag after a one day, others after a few days, others after a single patient, no matter how much is used.

 

Also, FTR, $15 out-the-door for a bag of lactated ringers (assuming that's what you're using) is a great price. Your vet isn't making any profit on that sale. That I can guarantee.

 

Likewise, $5 for an IV line set and a handful of needles is selling it at a loss. No profit there, guaranteed.

 

So, anyway, your vet/staff might be annoyed at the minor hassle of producing a written RX and then worrying that their patient might get the wrong fluids/needle size/whatever . . . but they're not going to be losing money if you take that business elsewhere.

 

So, anyway, IMHO, your vet is doing you a solid in his pricing. Feel free to shop around. I think you'll find you might be able to save a few dollars max by shopping online -- just due to the bulk savings that massive distributors have and of course their much cheaper staffing costs, since they aren't handling the client education aspect of supporting home fluid administration. Just be sure you get what you were prescribed.

 

Understand that there are dozens of choices when it comes to fluids, so be sure you get what the prescription called for. The wrong fluid choice can be very dangerous.

 

Fluid prices have been very volatile in recent years, as have many drug/prescription prices due to the craziness that is the US pharmaceutical industry. Nothing the vet can do about that . . . Vet medicine is the poor step-child of human medicine . . . Totally subject to fallout from the insane market forces in the human field.

 

Good luck!

Yes, it's Lactated Ringer's solution. The fluid bag alone is $15; the IV line and set of needles is another $15. That is $30 for not quite a week's worth, and that is if I'm being stingy (150ccs), not generous (200ccs). He also has Buprenex, Denamarin, Famotedine, Mirtazapine, Cerenia and Proviable. And Pill Pockets to make 1/2 of these meds easier to administer. He has special food, too.

 

He goes in tomorrow for a blood test to see if any of his labs are improved. This is bound to be another $200 at the very least. They want to do a urinalysis, but I think I am going to refuse. She told me how that is collected (abdominally, ultasound-guided) and that sounds also expensive, not to mention horrible. If sedation would be needed, I would also not want to risk that with him. He has a heart murmer in addition to his other problems and I'm not putting him under for anything that isn't crucial.

 

I cannot believe it is considered best practice to throw away a half-full bag being used for the same animal. I can understand why you would throw away a sterile bag for a new animal, but to use part of the fluids for ONE animal and then throw it away? Why?! That sounds so wasteful, not to mention it would simply not be sustainable for daily administration. Actually, this whole program I'm on does not sounds sustainable and it's really breaking my heart.

[StephanieZ]

I do recommend talking things over with your vet. Every vet is accustomed to dealing with financial limitations to care. Even vets themselves have to face these choices! If your vet can't help you come up with a treatment plan that you feel good about and can afford, then it may be advisable to check out another vet. The vet should be able to come up with a "treatment plan" for some period of time that can help you see the estimated costs. Sometimes, diseases are very expensive to get diagnosed and stabilized, but much less so to maintain longer term. I hope that's the case in your situation. 

 

(((hugs)))

 

Yep, it sure does feel wasteful to throw out partially (or even barely) used bags of fluids, but there you have it. Medical standards -- I'm sure there's some rationale re: contamination/etc. My dh doesn't like it either, lol -- feels so wasteful. Add to that the fact that a small bag of fluids costs nearly exactly the same as a liter bag . . . Very annoying, and it makes it hard to be economical for your clients, too. 

 

FYI, often times, the urinalysis is bundled with the blood work (on send out labs) to cost almost nothing. We have some bundled labs that include u/a for no increased cost over bloods. This all depends on the lab your vet uses and what bundles they've negotiated, too. For some diseases, the u/a is even more important than bloods, so don't refuse w/o serious consideration and consultation with the doctor. Sometimes you can do at-home urine collection using some plastic granules "no-sorb" in place of litter in a clean litter pan. This isn't acceptable for every type of u/a, depends on what they're looking for . . . but if it's acceptable, you can DIY the collection and if it's combined with send-out labs, the cost may be nothing or very small. Your vet might dispense/sell no-sorb. Probably 7-10 bucks for a small container, but might be more. 

 

Be up front with your vet about the cost limitations. I suggest just telling them, "Hey, I love my cat. I really want her to be OK. I've spent $900 in the last 2 weeks, and I see a lot more care is going to be needed. I need a treatment plan, with cost estimates, so I can budget. Can you help me?"

 

 

[Laurie4b]

You could also preload the request with the data: I can get x bags of saline online for $--- but I would need a prescription. I can't afford the saline at $--- a bag. Would you please write me a prescription so I can afford this?

[ThursdayNext]

After reading all this, I feel you really need to switch vets. Call around and ask for prices. I know it's awkward. But it's saved our family a bunch of money. The cheaper vets are no less caring, but they understand when your pockets aren't so deep.

 

We switched to a vet that has old "wood" paneling and faded prints. It's so so much cheaper than the vet with the shiny new office. And they get that we're not here for premium care when we bring our old dog in for shots. When I bring my dog in for shots I don't want to come out with a $300 bill!

[Guest]

UPDATE: I take back what I said about the vet seeming to be mercenary. My approach in asking for the script was that I did not ask for the script and did not mention any knowledge that there may be cheaper options. I simply asked (someone suggested this) if there was any way, either by buying bulk or if there is an independant vendor where I can get the fluid and supplies at a discount. Basically, just asked for any assistance in making this part of my kitty's life as comfortable as I can while still being as affordable as it can be. The vet I have been wotking with is not the senior-most vet, apparantly, because she said she would have to ask the managing partner, but she did call back with an online supplier that they use and said it was no problem at all if they required a written script; to just have them fax the request and they would approve it. :) So that was very nice.

 

If you are sending healing thoughts or prayers for my Thor Bear, his kidney numbers have all improved, but now he is Anemic and has a low RBC count. :( Some days he seems pretty good and is even playful and goofy; other days he clearly does not feel too hot. He is not having a good day today so far. :( I am supposed to go on a trip this weekend, but I am full of worry about the cat and am not even excited about the trip.

[Annie G]

Glad you worked out the cost issue but sorry to hear your trip is going to be impacted by your worry.  Hope he rallies before you go. 

[Suzanne in ABQ]

I was wondering if you were able to resolve the cost problem.  Sounds like they were very reasonable.  I'm so glad.  I wish you and your kitty didn't have to go through all this.  How was your trip?  

[Twigs]

:grouphug:  :grouphug:  :grouphug:

[Miss Peregrine]

:grouphug: for Thor and your family.

[Guest]

I was wondering if you were able to resolve the cost problem. Sounds like they were very reasonable. I'm so glad. I wish you and your kitty didn't have to go through all this. How was your trip?

My trip was great. I am so lucky to have that group of ladies as friends.

Thor is hanging in there. Some days, he seems pretty perky, but others, he's not looking so good.

[Scarlett]

UPDATE: I take back what I said about the vet seeming to be mercenary. My approach in asking for the script was that I did not ask for the script and did not mention any knowledge that there may be cheaper options. I simply asked (someone suggested this) if there was any way, either by buying bulk or if there is an independant vendor where I can get the fluid and supplies at a discount. Basically, just asked for any assistance in making this part of my kitty's life as comfortable as I can while still being as affordable as it can be. The vet I have been wotking with is not the senior-most vet, apparantly, because she said she would have to ask the managing partner, but she did call back with an online supplier that they use and said it was no problem at all if they required a written script; to just have them fax the request and they would approve it. :) So that was very nice.

 

If you are sending healing thoughts or prayers for my Thor Bear, his kidney numbers have all improved, but now he is Anemic and has a low RBC count. :( Some days he seems pretty good and is even playful and goofy; other days he clearly does not feel too hot. He is not having a good day today so far. :( I am supposed to go on a trip this weekend, but I am full of worry about the cat and am not even excited about the trip.

It is very hard to see our pets decline. I am sorry.

[wintermom]

UPDATE: I take back what I said about the vet seeming to be mercenary. My approach in asking for the script was that I did not ask for the script and did not mention any knowledge that there may be cheaper options. I simply asked (someone suggested this) if there was any way, either by buying bulk or if there is an independant vendor where I can get the fluid and supplies at a discount. Basically, just asked for any assistance in making this part of my kitty's life as comfortable as I can while still being as affordable as it can be. The vet I have been wotking with is not the senior-most vet, apparantly, because she said she would have to ask the managing partner, but she did call back with an online supplier that they use and said it was no problem at all if they required a written script; to just have them fax the request and they would approve it. :) So that was very nice.

 

If you are sending healing thoughts or prayers for my Thor Bear, his kidney numbers have all improved, but now he is Anemic and has a low RBC count. :( Some days he seems pretty good and is even playful and goofy; other days he clearly does not feel too hot. He is not having a good day today so far. :( I am supposed to go on a trip this weekend, but I am full of worry about the cat and am not even excited about the trip.

 

I'm sorry your cat is going through this.

 

I'm really confused about your first paragraph, though. Are you saying that NOT asking directly for what you want is a recommended approach? You knew exactly what you wanted, but were intentionally vague? Was this approach to feel out whether the business was open to you having purchasing options, or wanted everything to go through them for their financial gain?

[Catwoman]

My trip was great. I am so lucky to have that group of ladies as friends.

Thor is hanging in there. Some days, he seems pretty perky, but others, he's not looking so good.

Still praying for Thor!

 

I'm glad you had a fun trip. :)

[momacacia]

Trust me, if the people working in a vet's office cared more about money than pets they would work in human medicine, it pays WAY better.

Note to self: will now discourage second born from vet school.

[Guest]

I'm sorry your cat is going through this.

 

I'm really confused about your first paragraph, though. Are you saying that NOT asking directly for what you want is a recommended approach? You knew exactly what you wanted, but were intentionally vague? Was this approach to feel out whether the business was open to you having purchasing options, or wanted everything to go through them for their financial gain?

I'm saying that coming at it from the perspective of "how can you help me" was better (at least, in this case) than the approach of "I have all the answers and just need you to perform the way I want." It is the cooperative stance, as opposed to the commanding stance. Each approach, I'm sure, has its place, but I was going with the aikido  stance in this case and I think it worked out.