The Board intermittently receives queries from the practice inquiring about the obligation under the Board Rules or Ethical Principles to provide a prescription to a client. Often the veterinarian has questions concerning the source of the medication—from experience sometimes coming from abroad with product information in a foreign language without quality control assurances. At times the veterinarian is inundated with fax requests from online pharmacies that a prescription be issued for an existing client, requiring a review of records and prescription history for a patient and sometimes requesting a prescription for a medication new to the patient. The Board Rules and the Principles of Veterinary Medical Ethics as published by the AVMA address these issues, as has the Board on several occasions through the years.
Rule 705 G (Louisiana Administrative Code, 46:LXXXV) provides clear guidance to the practice. It recognizes that while a client is not obligated to purchase a prescription medication from the attending veterinarian with whom a VCPR has been established and a determination has been made that the patient will be treated with such medication, the obligation to provide the prescription is dependent on several factors:
- The veterinarian has determined the patient’s life is not endangered by a delay in the administration of the medication;
- The prescribed substance must be medically safe for in-home administration by the client;
- The prescription is not for a controlled substance or involves any medication which, in the veterinarian’s medical judgment, is inappropriate for the patient’s medical care;
- The prescription must be requested directly by the client with whom the VCPR has been formed for the obligation to apply.
Further, the Board has adopted the AVMA’s Principles of Ethics (on issues where there is no conflict with the Board Rules). Under Principle 6.3 of the AVMA’s principles, it is stated: “A veterinarian shall honor a client’s request for a prescription or veterinary feed directive in lieu of dispensing but may charge a fee for this service”.
In interpreting these provisions in the past, the Board has summarily concluded that a veterinarian’s motive in refusing to honor a request for a prescription must involve one of these exceptions and cannot be because a third party will receive the revenues from dispensing.
Applying these principles, practitioners have been advised by the Board that a request from a dispensing pharmacy or other entity for a prescription is not a “direct request” by a client. The veterinarian can choose to honor a request by an such an entity pharmacy but is also entitled to charge a “reasonable fee” to the client for this service. A veterinarian is not obligated to send a prescription to a dispensing entity/ pharmacy but can choose to provide the client with a written prescription. A bona fide concern that a medication is known to be manufactured without quality control assurances is a permissible reason not to honor a request for a prescription, in which case the veterinarian should voice his concerns to the client and provide a written prescription when otherwise appropriate for the client to have filled at the place of his choice.