6 Sept 2024
In submission to Competition and Markets Authority, one sector body wants restrictions in the prescribing rules on clinicians considering clients’ financial circumstances to be “lifted forthwith”.
Allister Webb
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Image: andreysp03 / Adobe Stock
The rules governing how vets decide which drugs to prescribe to their patients should be reviewed and potentially reformed, business regulators have been told.
One sector organisation called for restrictions within the prescribing cascade that prevent clinicians from considering clients’ financial circumstances to be “lifted forthwith” in its submission to the Competition and Markets Authority (CMA).
A prominent welfare group has also voiced concerns, though other veterinary bodies warned of potential knock-on effects for research and development if substantial changes are sought.
The topic has been highlighted in responses to the CMA’s statement of issues, published in July, that it expects to examine in its ongoing review of companion animal services.
The authority said it wanted to understand how regulations on the sale and prescription of medicines were leading to prices being “higher than they otherwise would be”, together with the “rules and purpose of the prescribing cascade”.
Most veterinary associations and companies were broadly supportive of the scheme in their responses to the authority.
But the submission from BEVA, which stages its annual congress in Liverpool this week (11-14 September), argued that its implementation and application had had “quite the opposite” effect from the original intention of maintaining drug access – particularly in equine practice.
It claimed the system’s impact was “very anticompetitive” and removing the bar on vets considering clients’ finances offered a “very simple solution” to the authority’s concerns.
The paper continued: “This restriction on financial considerations should be lifted forthwith. This would allow a veterinary surgeon to present options to a client, exactly as the CMA is seeking.”
The association also alleged many clinicians were “fearful” of using the cascade to its fullest because of the threat of potential criminal sanction.
In its joint response, the BVA, BSAVA, SPVS and VMG argued that the focus on contextualised care meant clinicians would already be discussing a range of treatment options and their costs with clients.
They added: “It is not for a vet to judge a client’s financial means per se, and affordability is not, and cannot legally be, a justification for moving down the steps of the cascade.”
But while they said they understood the level of investment needed to develop new drugs, Dogs Trust officials argued there had been cases where a newly licensed product had effectively replaced an effective generic treatment.
They said: “This has resulted in the obligation under cascade to use a much more expensive version of the same active ingredient.”
Elsewhere, the Federation of Independent Veterinary Practices acknowledged that scrutinising the cascade was “in scope” as part of the review, though it went on to warn of potential consequences for pharmaceutical research and development if the system were to be “radically overhauled”.
VetPartners also agreed that the CMA process provided “an opportunity to review” the cascade but argued that greater public awareness of its restrictions on vets was also needed, suggesting there may be a role for the RCVS in that area.
The cascade is overseen by the Veterinary Medicines Directorate (VMD), which introduced revisions to its rules earlier this year.
A spokesperson said it could not comment on the CMA process directly until the final report, expected late next year, and its recommendations are made available.
But while she said vets should not use a medicine under the cascade “simply because it is cheaper than an authorised veterinary medicine”, she also insisted the rules do not prevent clinicians from discussing treatment options with an owner or keeper.
