q1 how important to your practice is how veterinarians use ...how veterinarians use compounding...

HowVeterinariansUseCompoundingPharmacy

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Q1Howimportanttoyourpracticeishavingaccesstocompounded

medicationswhenyoubelievetheyarenecessary?

Answered:1,030 Skipped:0

91.17%939

8.25%85

0.19%2

0.29%3

0.10%1

1,030

4.90

VeryImportant Important NeitherImportantnorUnimportant

SomewhatUnimportant NotatallImportant

Importanceofaccessto...

0 500 1000

1

3

2

85

939

VeryImportant

Important NeitherImportantnorUnimportant

SomewhatUnimportant

NotatallImportant

Total AverageRating

Importanceofaccesstocompoundedmedications


2/89

98.44% 1,011

0.78% 8

0.78% 8

Q2Somesaythatveterinariansoftendonotrealizetheyareusingacompounded

medication.Whenyouadminister,dispense,orderorprescribeamedication,

doyouknowwhenyouareusingacompoundedmedication?


Total 1,027

# Feelfreetosaymoreaboutyouranswer. Date

1 Anyonewhoissmartenoughtograduatefromaveterinarycollegeiscertainlysmartenoughtoknowwhenacompoundedmedicationisbeingused!

5/23/20139:54AM

2 TOSAYYOUDONOTKNOWISREDICULOUS 5/22/20133:13PM

Yes

No

Notsure

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

AnswerChoices Responses

Yes

No

Notsure


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3 Aretheykidding??????Dotheythinkveterinariansareignorantofthemedicationswedispensefromourpharmacyanddonotrealizewhatismanufacturedandwhatiscompounded?Theymustbepartofaspecialinterestlobby!

5/20/20138:09PM

4 Iworkwithwildlifeandordercompoundedmedicationsmoreoftenthanretailmanufacturedones. 5/20/20136:14PM

5 generalizedaspecializedrequestorreplacementforoutofstock 5/20/20139:14AM

6 Iorderthemspecifically. 5/20/20136:49AM

7 OfcourseIknowthatIamusingorprescribedacompoundedmedication!IneedtodispenseorprescribecompoundedmedicationsbecauseformulationsthatIneedarenotcommerciallyavailable.

5/19/20131:18PM

8 Ispecificallyordercompoundedmedicationsforspecific purposes.IamVERYawareofwhenIamusingacompoundedmedication.

5/19/201310:23AM

9 Ofcourseaveterinarianisawareofthemedicationbeingcompounded.Whenthemedicationisorderedfromamedicalsupplieritisobvioustheoriginofthemedication.ifthereisafor-instancewhereaveterinarianisunsureoftheoriginofmedication-orifi tiscompounded.thatprofessionalshouldnotuseit!

5/18/20137:18PM

10 Wehavespecific flavorscompoundedforourfelinepatients. 5/18/20135:29PM

11 TheVeterinarianareveryknowledgableonthemedicationsandtheformstheycomein.Itisoftenrequestedtospecialordercompoundsforspecific patients/treatments.

5/18/201311:13AM

12 Therearespecific combinationsthatareveryeffectiveandhavebeenperfectedviaexperience.Theyarenotavailableinanywayonthemarket.

5/18/201310:37AM

13 Inmyexperienceveterinarianshavebeenmoreawarethanmyphysic iansregardingcompoundedmedications. 5/18/20139:10AM

14 Iorderallmedications. 5/18/20135:21AM

15 Veterinariansaren'tignorant,ofcourseweknowwhenamedicationiscompounded.However,doesthegeneralpublic ,l ikelymanydonot-nofaultoftheirs,theysimplylackthetrainingtomakethedetermination.

5/17/201310:26PM

16 SinceIusuallyorderitcompounded,naturallyIwouldknowifi twas! 5/17/20139:44PM

17 Youmustbekidding.Ican'tpossiblythinkthatanyoneinmyprofessiondoesn'tknowiftheyareusingacompoundeddrug. 5/17/20133:45PM

18 Weusecompoundedmedicationsspecificallyfortheirformulationsandflavorssothatadministrationiseasierforownersandpets. 5/17/20132:58PM

19 OfcourseIknowifamedicationIamusingiscompoundedornot.WhenIadminister,dispense,orderorprescribeanymedicationorproduct,Iknowexactlywhatitis,whereitcamefromandwhomakesit,compoundedornot.Thisistheonlywaywe(i.e.,veterinarians)practice.Whoevercameupwiththethoughtthatwe(i.e.,veterinarians)wouldnotknowthatamedicationweareusingiscompoundedisextremelymis-informed,hassomepoliticalagenda,orisjustflat-outignorant.Whointheworldthinksthat?Yougottabekiddingme.

5/17/20132:03PM

20 Mostcommonusages:bromideforseizuredisorders;l iquidmedicationsfordifficult-to-dosecats;cyclosporinopthalmicprepsforkeratoconjunctivitissiccafordogs

5/17/20131:42PM

21 Wealwaysknowexactlywhatisacompoundedmedication,thereisnoquestioninouroffice 5/17/20139:33AM

22 Compoundedmedicationsneedtobeorderedspecifically,sothisstatementisabsurd. 5/17/20139:25AM

23 Certainconcentrationsarenotappropriateforexoticsorl ightweightanimals&mustbecompounded. 5/17/20138:53AM


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24 Whenweordercompoundedmedsweorderthemspecificallybecausetheownercannotgetthemintothepatientinpil l formorthemedicationisnotcommerciallyavailableoronbackorder.

5/17/20137:59AM

25 Yes,Iorderaspecific compoundedmedicationandformulationforaspecific patientanddiseaseprocess.Itistheonlymethodtogetthemedicationinsomepatientstocontroltheirdisease.

5/17/20137:29AM

26 MostofthecompoundedmedicationsIuseinvolvetheadditionofflavoringsorachangeintheconsistency.Forinstance,drugsthatwouldnormallybedispensedinpil l formareputinaflavoredl iquidtobegivenorally,oreveninatransdermalpreparation.Therearealotofanimalsthatsimplycannotbemedicatedusingpil lsorcapsules.

5/17/20137:23AM

27 Ithinkveterinariansknowwhentheyareorderingmedicationsastoiftheyarecompoundedornot. 5/16/201311:33PM

28 WheneverIorderamedicationthatiscompoundedthefirsttimeIspeakdirectlytothecompoundingPharmacist.Il iketobesurewhatisbeingcompoundedandthatitiswhatmypatientneeds.

5/16/20139:58PM

29 OfcourseIknowitiscompoundedbecauseIspeciallyorderitforspecific animals.Ialsotelltheowners. 5/16/20139:04PM

30 AlthoughImaynotknoweverytimeIusecompoundedmeds. 5/16/20138:32PM

31 compoundedmedicationasisdispensingacommercialmedicationeveninabottleotherthanwhatthatmedicationcamein,is"offlabel"useofthismedication.Manytimes---mostofthetimeveterinariansbuyacommercialproductinalargevolumeandthendispensepartofthisouttoanindividualpatient.Thatis,asIunderstandit,"offlabel."Iuseandordercompoundedmedicationsforthefollowingreasons:Nocommercialproductiscurrentlyavailable(thisiscomplicatedwiththeeverincreasingfrequencyofbackorders/commercialproductisunavailable,dosage/concentrationofthecommercialproductisnotappropriateforthepatient,patientcan'torwon'ttakethecommercialproductduetotaste,formofthemedication,ect.Idon'tandwil lnothaveamedicationcompoundedifthereisaviablecommercialproductavailableonthemarketthatthepatientwil laccept.Inmypractice,itisandneverwil lbeacostcuttingissuei.e.justtosavemoneyofthecostofthemedication.Ifullyrespectthemanufacturersofthecommercialmedicationsandrealizethecosttheyincurredtogettheproductapprovedandinthemarket.However,therearecircumstanceswithindividualpatientswherethereisnowaythatpatientisgoingtobeadequatelytreatedwiththecommercialproductforthereasonsIdescribedabove.Ifyouthinkthisisacopoutthenyoutrytreatinga1000poundhorsewithapasteproducttwiceadayversusapowderedcompoundedproduct.Somehorse'sjustdon'tl ikeandwil lviolentlyobjecttohavingapasteadministeredorally,yetdon'tobjecttoapowderedformofthemedicationmixedinwithfeed.Thatisbutoneexampleofwhycompoundingisbenefic ialtothehorse,theownerofthehorseandtheveterinarian.

5/16/20136:54PM

32 Ugh! 5/16/20134:44PM

33 Occasionallyadrugthathasbeenbackorderedisorderedfromacompounderbythestaffandthedoctorisnotnotifiedofthechangeinmanufacturerbythestaffpriortoadministration

5/16/20134:25PM

34 Ialwaysamfullyaware 5/16/20134:22PM

35 "Compoundedmedication",tome,representsageneric formofadrugoraspecific formulation(differentdosage,alternateform--powder,l iquid,capsule,etc.)thatisnotalreadycommerciallypreparedand/oravailable.

5/16/20134:20PM

36 Ispecificallycallacompounderforspecific needsthatcantbemetbyregularpharmaceuticals 5/16/20133:26PM

37 Iamfullyawareofthepedigreeofanydrugandit'soriginwhenIstockitororderitmyself.Itisonlytheoriginofmedicationsfromonlinepharmaciesthatarebeyondmycontrolorabil i tytoverify

5/16/20133:12PM

38 AtleastITHINKIknowwhenIamusingacompoundedmedication.PerhapsIdon'tknow.ButIrealizemostbrandnamesareNOTcompoundedandanythingformulated(especiallyl iquid,transdermal,etc)isl ikelycompounded.

5/16/20132:48PM

39 Wetendtousecompoundedmedicationsonlywhenthesizeormethodofdeliverydoesn'tsuittheowner,astheygenerallyaremoreexpensivethisisnotourfirstchoiceforthec lient

5/16/20132:32PM


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40 HowintheworldcouldIprescribeacompoundedmedandnotrealizeitiscompounded?That'spreposterous! 5/16/20131:55PM

41 Weordercompoundedmedicationsfromcompoundingpharmacists,sowearealwayswell-awareofwhentheyarecompoounded. 5/16/20131:36PM

42 Iwouldsaythatitisplausiblesomestaffareoccasionallyunawarethatcertainmedicationsarecompounded,howeverveterinariansare(orshouldbe)alwaysaware.

5/16/201312:48PM

43 after9yearsofcollege,IwouldhopetoknowwhatIprescribed.(Aretheygoingtotellmethatabeurocrat700milesawayknowsandIdon't)???????.Ithinkthatoffendsme...........canIsue?

5/16/201312:35PM

44 Yes,marketdemanddictateswhethereffectivemedsaremanufacturedbylargepharmaco.Thatimpactsmyabil i tytotreatmypatients.Thankfully,compoundpharmaciesoffermeoptionsthatc learlyhaveaverypositiveonmyabil i tytocareformypatients.Further,givenmylevelofeducationandtraining,Ifinditinsultingforthegovernmenttotakea"parental"roleinthismatter.TheFDAwouldbemoreeffectiveifi tregulatedaccessofpharmaceuticalstothelaypersonwhoc learlydoesnotunderstandtheramificationsofmedstheycurrentlyhaveaccessto.

5/16/201312:24PM

45 Allmedicationsinmypracticeareprescribedanddispensedthroughtheveterinarianwithfullknowledgeoftheirsourceinc ludingcompoundedmedications.

5/16/201312:17PM

46 Ispecificallyseekoutcompoundedmedicationsforcertainpurposes.MostofthetimeIusedrugsthatarenotcompounded,duetoeasyaccesstomanycommonmedications,butfromtimetotime,thereisnotasuitablemedicationorformofthemedication,forasmalleranimal,andcompoundeddrugsbecomenecessary.Ireallydon'tseehowaveterinarianwouldnotknowthattheyareusingacompoundedmedication.

5/16/201312:16PM

47 ObviouslyIknowit'scompounded. 5/16/201312:02PM

48 Wehavemedicationscompoundedfrequentlyduetothefactthatdifferentsizepetsrequirespecific dosageamountsthatarenotreadilyavailable.Withoutthecompoundedmedicationsthesepatientswouldnotbeabletobemedicated.

5/16/201312:01PM

49 Ofcoursewedo.Wehavetoorderitfromaspecializedcompoundingpharmacy. 5/16/201311:45AM

50 Ihaveanexotics/avianpracticeaswellandcompoundalotofmedications. 5/16/201311:30AM

51 Astherearenotmanymedicationsapprovedforuseincats,manyofourmedicationsarecompoundedinadifferentstrengthordifferentformforeaseofadministration.Manycatsaredifficulttoadministeratabletto.Thingsl ikesmallertablets,fi lmcoatingortransdermalformsmaketreatingcatsmuchbetterfortheownerandmorehumaneforthecat.

5/16/201311:29AM

52 Alltheveterinarianinourpracticeareveryawareofthemedicationsprescribed. 5/16/201311:27AM

53 Weknowwhatweareprescribing.ThatstatementisanINSULTtoallhardworkingprofessionalveterinarians. 5/16/201311:14AM

54 IspecificallyhavetocallacompoundingpharmacytogetacompoundeddrugsoI'mnotsurewhodoesn'tknowwhentheyareusingacompoundeddrug.Thatdoesn'tmakesense.

5/16/201311:08AM

55 Ourmanagementstaff,technic ians,andveterinarianscommunicateaboutwhichmedsarecompounded. 5/16/201311:04AM

56 Whenmedicationsareonbackorderweknowthemedicationiscompounded.Thelabel,bottleandstrengtharealsoanimportantindicator.

5/16/201311:00AM

57 Ifitisorderedlegally,itisc learlylabeled...thisopinioniscompletelywrong... 5/16/201310:44AM

58 Compoundedmedicationsareacriticalpartofourpracticewhentreatingonlycats. 5/16/201310:26AM

59 Weuse2differentcompoundingpharmaciesforoursuppliesandthemedicationsarec learlylabelledwiththecompoundedpharmaciesname.You'dhavetobeanidiotnottonoticeit(mostveterinariansarenotidiots).

5/16/201310:25AM


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60 Icannotimaginebeingstupidenoughtonotknow. 5/16/201310:20AM

61 Compoundedmedications,becausetheyarespecific totheimmediateuse,causelessstresstotheanimals. 5/16/201310:19AM

62 Iworkinseveralpractices.Compoundedmedicationsarealwaysc learlymarkedassuch. 5/16/201310:12AM

63 WeneedtobeabletogettheEXACTdosageintheformthatthepatientanimalwil ltakereadily. 5/16/20139:46AM

64 Ofcourseweknowwhenweareusingacompoundedmedication! 5/16/20139:46AM

65 Unfetteredaccesstocompoundedmedicationsenablesourveterinarianstoprovidetheverybestmedic inetoourpatientsbasedontheirindividualneeds.Animalsarenotpeople,andtheywon'tfollowdirectionsl ikeapersonwould.Theywil lnotconsumethemedicallynecessarydrugsthatweprescribeunlesstheyarehighlypalatable.Forc ingveterinarianstoonlyusethosemedicationsavailablefromlargepharmaceuticalmonopoliesintherelativelyfewdosagesandconsumableformsthattheymanufacturedamagesourpatientsabil i tytorecoverquickly.

5/16/20139:31AM

66 Iamflabbergastedbythestatementthatveterinariansdonotrealizetheyareusingcompoundedmedication.Ispecificallyorderincompoundedmedicationswhenneededandamfullyawareofmyuseofcompoundedmedications.

5/16/20139:29AM

67 Wehavetoorderitspecifically.Idon'tknowhowanybodywouldnotbeawaretheyareusingcompoundedmeds! 5/16/20139:22AM

68 WhenIneedacompoundedmedication,Ispecificallyseekoutapharmacythatisaccreditedtodosuchwork.Mostoften,Iamusingacompoundedmedicationbecausenocommerciallyacceptablealternativeexistsforthesituationfac ingmyparticularpatientandc lient.

5/16/20139:19AM

69 Honestly,youwouldhavetobeprettydensenottoknow. 5/16/20139:15AM

70 Iamusuallytheonehavingtocompoundmedicationbecauseapatientcan'torwon'ttakeit,ortheownercan'tgiveitduetotheformat.Alsohumandrugsthatwecommonlyuseareoftennotinsmallenoughdosagesizes,sothisisanecessity.

5/16/20139:00AM

71 BigpharmapullsdrugsbecausetheyworktoowellorthemedsaretoocosteffectiveienotenoughprofitsforPfizer.Thiscommonnonsensemuststop.Andsincenoonewil ldoanythingaboutthemonopolythatbigpharmahasonmedic ine,compoundedmedsareoneoftheonlychecksandbalanceswehaveonthisdisgustingandprofitdrivenindustry.

5/16/20138:59AM

72 Ineedcompoundedmedicationformyverysmallpatients-betheyChihuahua'sorsmallcats 5/16/20138:54AM

73 Ipersonallyrequestcompoundingorcompoundedmedicationsforallmypatients,soIalwaysknow! 5/16/20138:52AM

74 OfcourseIdoasdoALLVeterinarians.Whatpeoplethinkwearethatstupid? 5/16/20138:49AM

75 Ithinkitisimportanttouseapprovedproductsforthevastmajorityofmyneeds,anddoso.Ithinkitisi l legalforcompounderstomanufacturecopies(whethertheybethesameformorasimilarform)ofapproveddrugsandsellthemforlowerpricesthantheapproveddrugs.ThesecopieshavenoguaranteestoevenworkandIhaveexperiencedthemnotworkingandknowmanyothershaveaswell.

5/16/20138:45AM

76 Itisobviousthatyouareusingacompoundedmedic ine.Labelsarecompletelydifferentthenmanufacturedproductsandyouknowyouordereditthatway

5/16/20138:43AM

77 Compoundedmedicationsarerequestedforverysmallspecies(birds,pocketpets)orwhenmedicationdeliveryneedstobealtered(catsthatcan'tbepil led).

5/16/20138:37AM

78 Inourpractice,compoundedmedicationsareusedasalastresortandrequireresearchandorderingthroughreputablecompoundingpharmacies.Theseprescriptionsarenottypicallyorderedthroughadrugmanufacturer.Intherarecasethattheyareitisc learlydescribedwhenorderingandlabeluponreceiptthatitisacompoundeddrug.Itwouldbeextremelydifficulttoconfusethisissue.

5/16/20138:32AM


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79 Compoundedmedicationsareorderedandlabeleddifferentlyfrommanufacturedmedications.Theyareorderedspecificallybecausethereisnotanotheroptioneitherfromadrugavailabil i tyissueoranpatientadministrationissue.(someanimalssimplycannotnotbepil ledeitheronashorttermorlongtermbasis.

5/16/20138:22AM

80 Compoundedmedicationsarealwaysc learlylabeledandhavetobespecificallyordered.Theyappeardifferentfrommassproducedmedicationsinalmosteveryway

5/16/20138:15AM

81 OfcourseIknow.IfIorderitfromacompoundingpharmacy,itiscompounded! 5/16/20138:10AM

82 IknowtheyarecompoundedbecauseIamspecificallyorderingthemfromacompoundingpharmacy. 5/16/20138:10AM

83 IamthoroughlyawareofwhichmedicationsarelabeledforthespeciesItreat,andwhichmedicationsIhavetogo"offlabel".Withthisinmind,IamalsoawareofwhichmedicationsareofflabelandaremadeindosesizesthatarenotapplicabletothespeciesItreat.

5/16/20137:56AM

84 Wecompoundmedsformanyreasonsinc ludingalteringpalatabil i tyandtailoringdosesmorespecificallyforapatient'sneeds. 5/16/20137:36AM

85 anymedicationthatisalteredfromitsoriginalformiscompounding,evencuttingpil ls. 5/16/20137:22AM

86 Ifwechoosetouseacompoundedmedicationwedosobecausethereisnotavailabil i tyofthenon-compoundedmedication,orweneeditinadifferentform.

5/16/20137:21AM

87 Ihavenoideahowaveterinariancouldnotknowthisinformation. 5/16/20137:17AM

88 Forsmallanimalpracticeitisprettyobviouswhenweusecompoundedmeds. 5/16/20137:16AM

89 Howcouldyounotknow?Seriously.... 5/16/20137:14AM

90 Idon'tknowhowIwouldnotknowitiscompoundedwhenIordereditspecificallyfromacompoundingpharmacy. 5/16/20137:12AM

91 "Donotrealize..."?thatmakesabsolutelynosense!HowcanInotrealizethatsomethingIspecialorderedfromacompoundingpharmacyisnotacompoundedmedication?

5/16/20137:07AM

92 Asdoctorsofveterinarymedic ine,wearefullyawarewhenweselectacompoundedmedicationforourpatients.Weinformourc lientsofthepotentialriskswitheverymedicationthatisprescribed;weperformthatdutywithcompoundedmedicationsjustaswedomedicationsfromothersources.Inthepracticeofmedic ine,weweighmultiplefactorsineveryprescribingdecisionwemake.

5/16/20137:04AM

93 Iwouldn'tbeusingthemiftherewasn'tashortageofavailableproprietarymedicationinappropriatedosestrengthsformypatients. 5/16/20136:53AM

94 onlyacompleteidiotwouldnotbeawareifhe/shewereusingacompoundedproduct. 5/16/20136:52AM

95 Thatc laimiswildlyinaccurate.Wehavetoorderacompoundedmedicationsfromacompoundingpharmacy.Ofcourse,weknowit'scompounded.

5/16/20136:42AM

96 IonlyusecompoundeddrugswhenIhavenothingcomparablealreadyavailableorinaformthepets-especiallycats-wil l take.SoIamalwayswellawareofthenatureofthemedicationIamusingorprescribingtomypatients.

5/16/20136:42AM

97 inexoticsitisoftendifficulttohavemedicationthatistherightdosageorstrengthfortheanimalthatrequiresimmediatetreatment-whenwritingaperscriptiontobefi l ledbyacompoundingpharmacyandhaveitsenttothepetitcantakeupto5days-bythattimethethepethasfinished1/2ofthetreatmentcourse....

5/15/201310:30PM

98 Wealwaystry.tousethenoncompoundedmedicationsfirstandasbestaspossible. 5/15/201310:18PM

99 Compoundinghelpswithtinypatientsforwhomtherearenomanufacturedequivalents. 5/15/20139:50PM

100 OfcourseIknow,IhaveorderedthedrugfromareputablecompoundingpharmacysuchasWedgewood 5/15/20136:55PM


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101 Especiallyusefulforcatsandsmalldogs.Iknowit'scompoundedbecauseIordereditthatway! 5/15/20133:40PM

102 wemustordercompoundedmedsspeciallyforaspecific patient,usuallywhena"brandname"medisnotavailabletofitthepatient'sneeds--therefore,itwouldbeverydifficultNOTtoknowthatthemedwascompounded

5/15/20133:21PM

103 OfcourseIknowwhenIprescribeanymedication,andwhereitcomesfrom,andhowitisused. 5/15/20132:42PM

104 compoundedmedsareonlyavailablefromacompoundingpharmacy 5/15/20132:28PM

105 Wecallandorderthemedicationfromacompoundingpharmacy,soifwedidn'trealizewewereusingcompoundedmedsweshouldn'tbepractic ingmedic ine!

5/15/20132:08PM

106 Absolutely,weusethembecausewehavenootheroptionsforourpets. 5/15/20131:53PM

107 WhenIuseacompoundingpharmacy,IassumeIamgettingacompoundedmedication. 5/15/201312:05PM

108 Werespectcompounders'labeling,andnoteitwhenadministering. 5/15/201311:53AM

109 Thisisamazingtome.Idobelievethatveterinariansknowwhenwepurchaseadrugfromasuppliervs.acompounder 5/15/201310:02AM

110 Whosaysthis?? 5/15/20139:56AM

111 Weordercompoundedmedicationseitherduetocommercialinavailabil i tyand/ortohavethecorrectdoseforthepatient. 5/15/20139:44AM

112 Weshouldalwaysknowwethercompoundedornotasweareorderingthesemedicationsfromthepharmacy,andnotchangingthemoncereceived.

5/15/20139:30AM

113 Weordercompoundedmedicationsfromacompoundingpharmacy.Othermedicationsareorderedfromadistributer-thedifferenceisveryc lear.

5/15/20138:36AM

114 IbuythemedicationsthatIknowarecompoundedbecausethatistheonlywayIcangetthemforcertainanimalsandconditions 5/15/20138:26AM

115 Ourc linic wil lprescribetoapatientmedicationthatisnotavailableforpurchasefromourdistributor.Wehavehadseveralmedicationsthathavebeenonbackorderandnotcommerciallyavailable.

5/15/20138:18AM

116 Wearemedicalprofessionalsthattakeanactiveroleinwhereweorderourmedications.Weknowthedifferencebetweenacompoundingpharmacyandamedicaldistributor.

5/15/20138:11AM

117 Itiscompletelyobviouswhenusingcompundedmedication!!!! 5/15/20138:03AM

118 Idonotseeanywaythataveterinariancouldnotknowthattheywereusingacompoundedproduct 5/15/20137:59AM

119 Ourc lientsareadvisedandtheoptionpresentedtothemforuseofacompoundeddrugwhenappropriateandrequiredforthebestmedicaloutcome.

5/15/20137:51AM

120 wecompoundmedicationsforeaseofadministrationanddoseingsincesomeofthesmallersizescomerciallyavaiablecannotbeaccuratlydosedoradministered

5/15/20137:45AM

121 Itisimportantforaveterinariantofindtheeasiestformofmedicationanownercanadministersafelytoananimal. 5/15/20137:41AM

122 Whenyouhavetocallacompoundingpharmacytoorder-youknowitiscompounded. 5/15/20137:17AM

123 Thisisridiculous!Youwouldhavetobeblindandstupidtonotknow. 5/15/20136:47AM

124 Thatstatementisidiotic ! 5/15/20136:15AM


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125 Eachmedicationonourpharmacyshelveswithinourveterinaryhospitalisstoredinitsoriginalcontainer,whetheritcomesfromapharmacy,veterinarydistributor,orcompoundingpharmacy.Theyareallc learlylabeledandeasytoread,thereforeitisnotdifficulttoquicklyfindoutifsomethinghasbeencompounded.Furthermore,ourentirehospitalanddatabaseiselectronic,inc ludingprescriptions.Eachmedicationisnamedwithdetail,andislabeledas"compounded"ifso.Lastly,wehavespecific trainedpharmacystaffthatcanansweranydoctor'sortech'squestionsaboutanymedication,aswellasaPharmacyManager.

5/15/20135:48AM

126 HowcanyounoteknowyouareusingacompoundedRx...ithastobeordered 5/15/20135:46AM

127 Iamalwaysawareofmedicationbeingcompounded,whetheritisanindividualorderforaparticularpatientoraninpatientproductwestockinthehospital.

5/15/20135:26AM

128 ThereisNOreasonwhyacompetentveterinarianwouldbe"unaware"thatheorsheisusingacompoundedmedication.Typicallytheveterinarianistheindividualwhoisrequestingthecompounding,andweworkc loselywiththoseperformingthecompoundingtomakesurethatthecorrectdose,etc.isbeingprescribed,whetherthecompoundingisbeingperformedbystaffinthehospital,orbyanoutsidepharmacy.

5/15/20135:19AM

129 WithoutcompoundedproductsbeingFREELYavailableasneededwithoutarbitraryrestric tionsapplied,Iwouldhaverealizedtheabsoluteabsenceofsomemedicationsduetoproprietaryproductionshutdownsofcriticalmedicationsinrecentyears.Compoundersareacriticalgapfi l lerwhenourregularmedicationsgoonshortorlongtermhiatusduetoproductiondisruptions.

5/14/20139:37PM

130 ItisveryobviousbecauseIamusuallyorderingit. 5/14/20139:19PM

131 Therearespecific reasonsastowhyIreachforacompoundedmedicationversusandcommerciallyavailabledrug,inc ludingtasteandformulationforeasieradministrationtoadifficultanimalandalsotohaveadifferentconcentrationthatallowsformoreaccuratedosingfortheanimalinsteadofsplittingtabletsorgivinganextremelyminuteamountthatIcannotwithconfidencesaytheanimalreceivedthemedication.

5/14/20139:11PM

132 Onewouldhopeaftergoingthroughasmanyyearsofschoolasveterinariansdotheywouldknowwhatmedicationstheyareusingandforwhatpurpose.Theattendingveterinarianisthemostknowledgablepartywhenitcomestodiagnosinganddispensingmedicationinwhateverformforthepatient.

5/14/20139:09PM

133 Whoarethese"SOME"?Iknowit'sacompoundedmedicationbecauseIspecificallytailoredadose&requestedaspecificcarrier/formofthemedandthenordereditfromtheCOMPOUNDINGpharmacy.

5/14/20138:52PM

134 IalwaysknowwhenthemedicationthatIuseordispensehasbeencompounded. 5/14/20138:48PM

135 intentionallyusecompoundedmedicationsbecausemypatientsaresmall(cats)andmanyofthedrugsIneedformypatientsarenotmanufacturedinthedosageformsthatIneedformypatients

5/14/20138:18PM

136 Ineedthesemedicationsandrelyonrespectedpharmaciestocompoundittogetthedesiredstrengthandmethodtobeabletoadministerittoananimal.

5/14/20138:17PM

137 Ifeell ikethisisanobviousanswer,andthequestionorratherwhatsomesayisinsulting. 5/14/20138:16PM

138 Idonotusecompoundedmedsifthereisapremadeproductavailable. 5/14/20137:57PM

139 Duh!Ihavetoorderitfromacompoundingpharmacy...! 5/14/20137:56PM

140 Iwouldthinkitextremelyunusualforaveterinariannottoknowwhentheywereusingacompoundedmedications.InfactIreallycannotimagineitatall.

5/14/20137:47PM

141 Thatisabsolutelyridiculoustosuggestthatwewouldnotknowthataproductwewereusingwascompounded. 5/14/20137:44PM

142 OfcourseIknow. 5/14/20137:38PM


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143 Ithinkitisobviouswhenweusecompoundeddrugs. 5/14/20137:37PM

144 Weusecompoundedmedicationsonlywhennoncompoundedmedicationsarenotavailableornotindoseorflavorswhichallowustotreatourvariedpatients.

5/14/20137:30PM

145 theavailabil i tyoftheseproductsisessentialtothehealth&wellbeingofourpatients.c l ientsalsoappreciatetheaffordabil ityfactor 5/14/20137:26PM

146 TothinkIdon'tunderstandwhatmedicationsIamprescribingispreposterousandaninsulttoveterinariansasawhole. 5/14/20137:11PM

147 Thisisaridiculousquestion-Ispecifyexplic itlyontheprescriptionthatIneedacompoundedsizeormethodofadministration.Ionlycompoundwhenmanufacturedmedswil lnotwork.

5/14/20137:00PM

148 Wespecialorderalmostallcompoundedmedicationsforeachindividualcase. 5/14/20136:21PM

149 Intheveterinaryfieldwehavepatientsthatrangefromlessthanapoundto2000poundsandmanytimestogetthemthemedic inethattheyneed,inaformthattheycantake,orwil ltake,orthattheirparentscanadministerrequiresthinkingoutsidethebox.

5/14/20136:20PM

150 Howcouldyounotknow? 5/14/20136:08PM

151 Wespecificallyordercompoundedmedicationsfromacompoundingpharmacy,usingawrittenprescription. 5/14/20135:48PM

152 Wehavemanyanimalsthatwil lonlytakecompoundedmedication,eitherbecauseofflavororownersareunabletopil l ananimal. 5/14/20134:50PM

153 Usuallyyesalthoughtheremaybeproductsthatarecompoundedthatiamnotawareof.Thecomppundedproductsthatidousearevertimportanttomypractice

5/14/20134:40PM

154 Usuallystandardpharmaceuticalcompaniesonlymakeacertainsizeanditisahumansize-withanimalstheyoftenneedasmallermgdoseandcompoundingpharmaciescancreatethatdoseforus.

5/14/20134:26PM

155 WhenIorder/dispenseacompoundedmedicationfromacompondingcompanyIknowthatithasbeencompounded! 5/14/20133:56PM

156 IdefinitelyknowsinceIorderthemfromcompoundingpharmacies!HowcouldInot? 5/14/20133:47PM

157 Thereisabsolutelynodoubtwhenaproducthasbeencompoundedratherthanpurchasedasacommerciallyavailableproduct. 5/14/20133:46PM

158 Normally,wearetheonesspecificallyorderingacompoundedmedication.Itiseasilydeterminedwhichmedicationsarecompounded.

5/14/20133:40PM

159 iknowitiscompoundedwheniorderitfromacompounder 5/14/20133:37PM

160 HowcouldaprescriberNOTknowit'scompounded??WhenIorderspecializedformulationsfromacompoundingpharmacy,Iknowthatitisnotanmedicationcarrying"FDA"approval.

5/14/20133:30PM

161 absoloutely,compoundedmedicationarespecialorderinourpractice 5/14/20133:22PM

162 SometimesImayuseacompoundedmedicationwithoutrealizingit. 5/14/20133:17PM

163 Iusuallyonlygotocompoundedmedicationforaneaseofuseissue-l ikeforsmallerdosagesordifferentformsiel iquidortransdermaltoallowc lientstoadministermedicationmorereliably.

5/14/20133:17PM

164 I'mnotsurehowyoucouldsaywedidn'tknow?Wespeaktoacompoundingpharmacytoorderthemedication. 5/14/20132:59PM

165 Wespecificallyhavemedscompoundedfortheeaseofadministrationtopetswhenotherroutesofadministrationarenotpossible. 5/14/20132:48PM

166 Allmedicationsarecompoundedsomewhere~!!!!!!! 5/14/20132:48PM

167 it'susuallymyideatoorderthecompoundeddrug 5/14/20132:27PM


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168 Weordercompoundedmedicationsforapatientbasedontheneedtocombinemedicationsforeaseinadministration,tochangethetypeofdeliverythatcanbeused(l iquidvstablet/capsule),toadjustdosesforsmallpatients,andtoprovidespecialflavoringortransdermalapplications.Eachisaspecialorder.Ofcourseweknowwhenweareusingthem.

5/14/20132:22PM

169 Verysil lytothinkwewouldnotknowthat. 5/14/20132:20PM

170 Ican'timagineanyonenotknowing.Idon'tbelievethatc laimwasmadeinearnest. 5/14/20132:19PM

171 Manytimestheveterinarianasksforspecific drugstobecompoundedtomakeaspecific medication. 5/14/20132:13PM

172 HowcouldyouNOTrealizeit! 5/14/20131:54PM

173 AcompoundingpharmacisttoldmethatT3waslevothyroxin.I'venoticedthatmanycompoundeddrugsarecountedoutofapurchasedbottlebyanemployeewhoknowslittletonothingpharmaceuticals.

5/14/20131:52PM

174 Theonlytimec lientsareevergivenacompoundedmedicationiswhenoneisscriptedbyme.Therehasneverbeenatimewhencompoundedmedicationshavebeenswitchedforregular.Iwouldnotthinkthatisevenpossible.

5/14/20131:47PM

175 Mostmedicationsneedtobereducedinstrengthforsmallanimals.Iusethistypeofmedicationonadailybasis. 5/14/20131:46PM

176 Manymedicationsmustbecompoundedduetodosingrequirementsand/orpalatabil i tyissues.Thisisofparticularconcernforourfelinepatients.

5/14/20131:41PM

177 Itismyjobandresponsibil i tytoknowaboutthemedicationsIuseforanimals. 5/14/20131:38PM

178 Somemedicationcanbeverydifficultorimpossibleforownerstoadminister,especiallyincats.Thesemedsneedtobecompoundedforexactdosageandneedtobeflavoredsotheownerwil lactuallygetthemedic ineintothepet.

5/14/20131:37PM

179 Theveterinarianordersit,obviouslyweknowitsgettingcompounded. 5/14/20131:30PM

180 Oftentimesthehumanformulationsareeithertolargeastrengthortosmallastrengthforourpatientsandwehavetohavetheproperdosecompoundedtomakeitareasonableamounttoadministertopets.

5/14/20131:27PM

181 Itisobvioustoaprofessional. 5/14/20131:25PM

182 ItismyjobasadoctortoknowwhatIprescribeformypatients. 5/14/20131:16PM

183 Wehavespecific medicationscompoundedbecausetheyarenototherwiseavailableindosessmallenoughtotreatsmallanimals 5/14/20131:07PM

184 Icallmycompoundedpharmacisttoaskforacompoundedproduct 5/14/20131:07PM

185 Iwenttoschoolfor8yearstogetaDVMdegreeandthenspentayearinuniversityinternship.TheconceptthatIwouldn'tknowwhatIwasprescribingisextremelyinsulting.Ihadanumberoffederalloanstopayformyeducation...sodoestheFederalgovernmentthinkmyeducationissoinferiorthattheywastedmoneyonit?

5/14/201312:59PM

186 IorderfromWedgewoodandknowanythingfromthereiscompounded 5/14/201312:56PM

187 Wetreatfish,birds,repti les,mammalsofallsizes,andcompoundingmakestreatmentoptionsmoreuserfriendly.Thedifferentflavorsalsomakeiteasiertotreatanimalsthatwecannotrestrainandtheyhavetotaketreatmentsvoluntary.

5/14/201312:50PM

188 Withoutquestion.Ihaveahardtimetakingseriouslysomeonewhomakessuchastatementasiscontainedinthisquestion. 5/14/201312:48PM

189 Weonlygowithcompoundedmedic ineswheneitherthecommerciallyproduceddrugisnolongeravailableorthestrengthofthedrugneedstobemadeinmuchsmallerdosesorifthec lientisunabletoeitherpil l orfeedinfood,manytimesweusetransdermaldeliverytosolvetheproblem.

5/14/201312:47PM

190 Howwouldyounotknowitwascompounded? 5/14/201312:45PM


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191 IalwaysknowwhenIamusingacompoundedmedication.Compoundedmedicationsareusuallyrequestedforeaseofc lientusetoincreasecompliance.

5/14/201312:43PM

192 Weprescribeacompoundedmedicationonlythroughacompoundingpharamacy. 5/14/201312:43PM

193 Ithinkthatisfairlyobvioustoanyeducatedveterinarian. 5/14/201312:41PM

194 Mostofthetimeatleast.Therearesti l l onesthatyoudonotrealizeunti llaterafteryouhavebeenpurchasingitforabit. 5/14/201312:38PM

195 IalwaysknowifIhaveorderedacompoundedmedicationandIknowifIamusingageneric orbrandmedicationaswell. 5/14/201312:37PM

196 Thereareseveraldrugsthatwespecialorderascompoundedtoachieveaspecific dosingrangeortoprovidetreatmentthatisnolongeravailablecommercially.

5/14/201312:37PM

197 IbelievethatIamaware. 5/14/201312:36PM

198 IamalwaysawareofwhereofthesourceofeachmedicationthatIadminister,prescribe,ordispense.Idonotseehowanythingelsewouldbethecase.

5/14/201312:34PM

199 WhenIgotoacompoundingpharmacy,IprettymuchknowI'mgettingacompoundeddrug! 5/14/201312:34PM

200 That'sthemostridiculousthingI'veeverheard! 5/14/201312:33PM

201 Iknowthatwhenadrugischangedinanywayitisconsideredcompounded. 5/14/201312:32PM

202 Weabsolutelyknow!We'reorderingfromacompoundingcompanyspecificallyduetol imitedmarketavailabil i tyandormedicationstrength.

5/14/201312:31PM

203 Ofcourseweknowwhenweareadministeringacompoundedmedication.Itisoftentoobtainadosethatisnotavailableforourpatients(asmosthumanscomeinaone-size-fitsalldosingrangeandthatiswhatpharmaceuticalcorporationsgeartowards).

5/14/201312:29PM

204 Weordercertainmedicationsfromacompoundingpharmacy,whereeverymedicationiscompounded. 5/14/201312:28PM

205 Iintendspecificallyusecompoundingmedicationtoensureproperandfulldeliveranceofmedicationtomypatient,intheirownpreferenceofformgiven.

5/14/201312:27PM

206 Allofourcompoundedmedicationsusedarespecialorder,andassuchwealwaysknowthattheyarecompounded. 5/14/201312:27PM

207 SinceIhavetocalli tintoacompoundingpharmacy,andtailorthedosage(andoftenflavor)tothepet,Iknowthatitisbeingmixeduptomyspecifications

5/14/201312:26PM

208 Veterinarymedicationrequirestreatingdifferentspeciesatverydifferentpatientsizes.InordertodosemypatientseffectivelyIneedtheabil i tytousecompoundedmedications(i.e.differentconcentrationswithdifferentflavorsandroutesofadministration,etc.).

5/14/201312:23PM

209 Weorderanddispensethemedicationsoweknowwhereitcomesfromandwhomakesit. 5/14/201312:22PM

210 Compoundedmedicationisusefulandeffectiveinourpractice. 5/14/201312:22PM

211 Yes,absolutelyalways.Sincetheycomefromadifferentsourceandneedtobeorderedseparately,I'dsayitwouldbeprettyhardtoNOTknowthemedicationiscompounded.UsingmedsatatypicalprivatepracticeisNOTlikeaphysic iansendinganordertothepharmacyofalargehospitalorevenoffsiteandhavingitfi l ledwithnoknowledgeofcompoundingornot.

5/14/201312:21PM

212 Weusecompoundedmedicationswhenthereisnoviablealternativemedicationavailablecommercially.Manyofthemedicaitonsusedinveterinarymedic inesarenotusedinthesamewayinhumanmedic ineandthereforearehardtoobtainwithoutcompounding.

5/14/201312:21PM

213 TheonlytimeIuseacompoundedmedicationisifthenormalversionistoodifficulttogive(unflavored,tabletvs.l iquid,etc). 5/14/201312:20PM


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214 Wespecificallyordercompoundedmedicationsbecausemanufacturersdonotmakethedruginthestrengththatweneed.Wealsoordercompoundedmedicationswhenwecannotgetthedrugsweneedduetomanufacturer'sbackordersorbecausethey'vestoppedmakingadrug(whichhasbeenamajorproblemforthelastfewyears!)

5/14/201312:18PM

215 Aftergraduatingfromveterinarycollege,youwouldhavetobeanidiotnottoknowthedifference. 5/14/201312:14PM

216 IpersonallyordermycompoundedmedicationsthroughareputablecompoundingpharmacyforeachpatientwhenIdonothavetheminstock,sothereforeIalwaysknowthemedicationisacompoundedone.IfIcarryitinstock,Ihavetoorderfromthesamepharmacy,soagain,Ialwaysknowwhichmedicationiscompoundedandwhichisnot.

5/14/201312:10PM

217 OfcourseIknowit'scompounded--Ispecificallyorder&prescribeitthatway! 5/14/201312:10PM

218 Weonlyrequestcompoundedmedicationifi tisnotavailablecommerciallyoronmanufacturebackorder 5/14/201312:07PM

219 manyvetsinourpracticedonotrealizewhenourpharmacyiscompoundingamedicationandbelievetheyareprescribingitasFDAapproved.thisisanimportantissuethatihavetoemphasizeroutinelywithmypeers.

5/14/201312:07PM

220 thisisridiculous.Iordertheproduct,concentration,andevenflavor.ALWAYSknowit'scompounded 5/14/201312:06PM

221 ThatisoneofthemoststupidstatementsIhaveheard.Whoorderscompoundedmedicationsfromacompoundingpharmacyanddoesnotknowitiscompounded?Really....Whoarethosepeople?

5/14/201312:05PM

222 Wealwaysknowwhenweareusingcompoundedmedication. 5/14/201312:05PM

223 Compoundingpharmacieshavetheirownlabelonbottlessoit'sprettyobviousit'sacompoundedmedication. 5/14/201312:04PM

224 Wecannotactinthecapacityofapharmacysowhenwedispenseamedicationthatiscompoundedwehavetoprovideaprescriptionforit.Wedothisoften!

5/14/201312:04PM

225 Someofthel iquidmedicationswekeepashospitalstocktodispenseinsmalleramountsaremoreobviousthansomeofthepil lswedispenseinbottles.

5/14/201312:03PM

226 GenerallywhenIuseacompoundedmedication,it'sonethatI'veorderedfromacompoundingpharmacy,eithertoreplaceanotherdrugthatisnotcommerciallyavailable,ortoprovideamorepalatableformofaneededdrug.

5/14/201312:03PM

227 Itisveryc learfromthelableifamedicaitonismanufacturedorcompounded,asaveterinarianIamveryc learlyawaretheorigenoftheproductsIusedaily

5/14/201312:01PM

228 Ispecificallyorderthem. 5/14/201312:00PM

229 HowwouldINOTknowIwasusingacompoundeddrug?Ihavetocalli tinorrequestthecompoundedmedicationspecificallyformypatient.Wearedoctors..Whichtypicallyimplieswearen'tstupid!

5/14/201311:59AM

230 SometimeswhenIbuyitfromavetpharmacy,Idon'tknowifi t'scompoundedbuttrustthem! 5/14/201311:58AM

231 Absolutely!! 5/14/201311:57AM

232 Ifyournotsure,youshouldgetyoul icensechecked. 5/14/201311:54AM

233 IalwaysknowIamusingacompoundedmedication. 5/14/201311:52AM

234 Compoundedmedsareorderedfrompharmacies,nottheusualdistributors.Theyarealwayslabeledwithapharmacylabel,identifyingthesource,strength,andformulation,amongotherdetails.

5/14/201311:51AM

235 Yadayada 5/14/201311:23AM


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Q3Howimportanttoyourpatients'healthandmedicaloutcomesisyourabilitytomaintainofficestockofcompounded

medications?Answered:1,026 Skipped:4

79.82%819

15.89%163

2.92%30

0.49%5

0.88%9

1,026

4.73

# Pleasefeelfreetosaymoreaboutyourresponse. Date

1 Thereareoftensizesofdrugsthataren'tcommerciallyavailablethatareneededtotreatsmallerpets,andcompoundingismuchmoreaccuratefordosingthanhavingtheownertryto1/4or1/8atablet.

5/23/20139:54AM

2 TOOMANYDRUGSHORTAGES 5/22/20133:13PM

3 newtohaveimmediateaccesstosomedrugsversesthedaysittakestogetthemorderedfromaremotesource 5/22/201310:16AM

4 Ihaveanimalsthataretoosmallforthecommonmedicationsandthereforewehavetocarryl iquidsowecanadministertheproperdosage.Otheranimalsareextremelydifficulttomedicateandwehavetohavedifferentwaystobeabletogetthemedicationinthepet--transdermal,l iquid,flavored.

5/22/201310:11AM

5 sometimesthereisaneedtostarttreatmentimmediately,beforethereistimeforacompoundturnaround 5/22/20139:47AM

6 Il ive/workinaveryruralarea.Itcanbethedifferencein5-7daystostartamedicationforoneofmypatients.Ineverkeepverylargeamounts,justenoughtogetpatientsstarted.

5/20/201310:02PM

Importanceofofficestock...

0 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5

VeryImportant

Important NeitherImportantnorUnimportant

SomewhatUnimportant

NotAtAllImportant

Total AverageRating

Importanceofofficestocktopatienthealth


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7 ThereareDAILYinstanceswhereIwouldnotbeabletotreatmypatientswithoutcompoundedmedications.Eitherbecauseofsize,species,orbecausethepharmaceuticalcompaniesfinditnolongerprofitabletoMAKEsuchmedications.

5/20/20138:09PM

8 Therearesomemedications(forexampleMetronidazoleinsizessmallerthan250mg)thatwegetcompoundedandareimportanttohaveonhandbecausewetreatalotofsmalldogsthatneedquickaccesstothesemedications.

5/20/20137:35PM

9 Critical,themajorityofwhatwedo. 5/20/20136:14PM

10 Manypatientsaretoosmallforthestockstrengthofcertainmedications.Itisalsoimportanttohaveavarietyofformulas(i.e.suspensions,flavoredmedications)forpatientsthatcanbedifficulttomedicate.

5/20/20132:15PM

11 Itisessentialtoourpracticetobeabletodispensecompoundedmedications.Manyofourfelinepatientscannotbemedicatedwithpil ls,andwaiting2ormoredaysforcompoundedmedicationsisnotacceptable,andwouldbebelowthestandardofcare.

5/20/201312:57PM

12 Certainmedicationsareunavailableforanimalsatlocalpharmaciesandsomepetsneedthesemedicationsupondischargefromthehospital.

5/20/201311:22AM

13 medicationsareneededimmediately,especiallyforexoticsandhorses 5/20/20139:14AM

14 Minnesotaalreadydoesn'tallow"office"stockofcompoundedmedicaitons.Thisalreadymakesitdifficulttogetanimalstreatedpromptly.Itiscrucialthatcompoundedformsareavailableforpickycats,pickydogs,exoticsforsmallsizesandmedsnotavailablebecauseofconstantgovernmentinterferencewithmanufacturingandavailabil i tyespeciallywithinthepast2years

5/20/20137:17AM

15 OftenIneedtodispensemedicationandfeelitwouldnotbeinthepatient'sbestinteresttohavetowaitseveraldaystohavetheappropriatemedicationformulatedandshipped.

5/20/20136:49AM

16 Iuseofficestockofcompoundedmedicationseverydayinmypractice! 5/19/20131:18PM

17 Wegenerallyusecompoundedmedicationswhenthereisnotaviablealternative. 5/19/201311:37AM

18 Wearecurrentlynotallowedtostockanycompoundedmedsatourcorporatepractice.Thisaffectspatientcareandthepractice'sbottomline.

5/19/201311:14AM

19 Duetolargeweightrangeinveterinarymedic inecompoundedmedicationsareamust.Especiallywithcatsandsmalldogs.Manymedicationscannotbedosedappropriatelyintheiroriginalform.

5/19/201310:47AM

20 IworkinashelterenvironmentinColorado.Recentlegislationwil lnotallowustokeepanoffficestocknowandwemustorderperpatientwhichisdifficultwhentheanimalmaynotevensti l l betherebythetimewegetitorderedanditarrives.

5/19/201310:23AM

21 Wehavepatientswhoaredifficultorimpossibletoadministertabletsto.Compondedmedicationsgivemeanalternativetotabletswithl iquid,flavoredpreparationsandcompoundingintotastetreatsortransdermals

5/19/20137:22AM

22 Itismoreimportantforthec lientotbeabletoobtainthecompoundedmedicationsperiod.Idoalotofscriptintopharmaciestoreducetheoverheadofmypractice.Aslongasthemedicationsareavailableeveryoneishappy.

5/18/20137:18PM

23 Manyc lientsareunabletogivepil lstotheircatsandrequirel iquidthatisflavoredsothecatwil ltakeit. 5/18/20135:29PM

24 Therehavebeencasesinwhichadayortwodelayinobtainingmedicationthatisinapetusablesizewouldbequitedetrimentaltothehealthofthepet.

5/18/20133:49PM

25 Whenwehavemedicationsinstockthatgivesustheabil i tytoadministertothepatientimmediately.Whenwehavetoplaceanorderittakesafewdaysforustoreceivethem,maybeevenlongeriftheweekendinterferswithshipping.

5/18/201311:13AM

26 Compoundproductsinsmalleramountsforpetitepatients(egdewormers,antibiotics)areneededquicklyandatsafeadministrativedoses.

5/18/201310:37AM


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27 Certainmedicationsaresimplynotavailableinappropriatedoseswithoutdangerousadditivesthatcankil l pets.Thesepatientscannotalwayswaitformailorder.

5/18/20139:10AM

28 NootheroptionsareavailableorIcannotaffordtopurchaseinlargevolumeduetothesizeofmyc linic . 5/18/20135:21AM

29 Whymustourpatientswaittoreceiveeffectivetreatment?WithofficestockofcompoundedmedicationsIcanoftenresolvesymptomsandcurediseasebeforeaspecialordercanbereceivedanddispensedtothec lient-wouldn'tyouwantthatforyourself,whynotourpatients,too.

5/17/201310:26PM

30 IfitissomethingthatIwil l usetotreatahospitalizedpatientorthatIwantapatientonimmediately,naturallyIwil l wanttobeabletohaveacompoundedmedicationonpremises.Ifi tissomethingthattheownercanhaveathometotreattheirpet,Iamfinewiththemhavingitsentdirectly.

5/17/20139:44PM

31 Withoutcompoundingwewouldbeunabletoprescribemanynecessarymedicationsthatarenotavailableindosagesappropriateforverysmallpatientssuchassmalldogsandcats.

5/17/20137:41PM

32 Oftentimes,itistheonlyformofamedicationthatistolerated,orthepetownercanapplyasinthecaseoftransdermals. 5/17/20135:13PM

33 Manypatientsneedspecific sizesthatcanonlybecompoundedorspecific flavorsetcinordertoadministermedications.Insomecases,iftheownerscouldnotusetrans-dermalgelsorflavoredmedicationstheywouldelecttoeuthanizetheirpetsbecausetheycannotgivethemtheappropriatecriticalmedications.

5/17/20132:58PM

34 Manymedicationsarenolongeravailableincommercialforms.Somemedicationsarenotusedinhumanmedic ineanylongersoarenotmanufactured-wehavetogetthemcompounded.Also,nottoolongago,diazepamwasbackorderdforalmost2yearsIthink.Thismedicationisl i fe-savingforpatientshavingseizures...so,wehaditcompoundedforin-hospitaluse.

5/17/20132:03PM

35 differentstrengthsareahugethingwithuswhenwecan'tgetthemfromregulardistributors 5/17/201310:46AM

36 Oftenpetsneedthesemedsthatday,Notin2-3days,responsecanbecritical.Itisdifficulttomanagehospitalizedpatientswithoutmedsavailable

5/17/201310:29AM

37 Itreatexotic petsandcompoundingismandatoryforattainingtheirdrugdosages. 5/17/20137:38AM

38 Weoftenneedtostartamedicationimmediatelywhenadiagnosisismade. 5/17/20137:29AM

39 Themostcommonin--stockcompoundedmedicationweuseisacompoundedearmedication.Weuseitacoupleoftimesaweek,atleast.Wealsousecompoundedbuprenorphineineverycatsurgicalprocedureandasananalgesiaforcats.Wecannotgetthisimportantmedicationinaformthatisn'tcompounded.Ifwedidn'thaveit,wewouldnotbeabletoprovidepainreliefforcats.

5/17/20137:23AM

40 Weoftenneedliquidsorflavoredmedicationforeaseofadministration. 5/17/20136:44AM

41 Manyanimalsneedimmediatetreatmentandcannotwaitformedstobeordered.However,duetotheirsizeortemperament,theyoftenrequirecompoundedmeds.

5/17/20136:30AM

42 Exotics,felines,etcoftenrequirespecialformulations,dosages,administrationmethodstoeffectivelytreatthem.Thesearen'thumansthatcanswallowapil l .Thedifficultyinadministeringmedicationstocertainanimalsandthetinydosesrequiredforsomemakecompoundingcriticaltopractice.Ibelieveitshouldbeuptothedoctortodecidethebestoptionsfortheirpatient.

5/16/201311:33PM

43 IhaveahousecallpracticesoIdonotcarryanycompoundedstockmedication.Ihaveallcompoundedmedicationseitherpickedupbytheownerfromthelocalpharmacyorhaveitdelivereddirectlytothec lient.

5/16/20139:58PM

44 Weareanavian,exotic (repti le,pocketpets,etc)practiceandmanyofourmedsneedtobecompoundedinpartduetooursmallpatientweight.

5/16/20138:32PM


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45 Asa"primaryhealthcareveterinarian"Ineedtohaveal imitedsupplyofmedicationsinstocktostartapatientonthemedicationsthatareappropriateforthemedicalconditionsbeingtreated.Idon't"stockpile"medicationsofanymedications.Inthisageofquickdeliveryandcommunicationl,Ihavenoneedto"stockpile"medications.Asasolopractitionerandowneroftheveterinaryc linic ,keepinginventoryataminimumisvital.Irealizetherearepricebreaksfororderingin"bulk"butthissavingrarelyifeverpaysoffforhavingtopayal ittlebitlessforamuchlargeramountofinventoryandthenhavethatinventorysetontheshelf.Thepracticehastopayforthemedicationsorderedupfront,ifi tsitsontheinventoryshelfverylongthatismoneythatisn'tearningthepracticemoneyandthe"discount"ofbuyinginbulkquicklygoesoutthewindowandturnsintheoppositedirectioninthattheinventoryisnowcostingthepracticemoney.

5/16/20136:54PM

46 Manyanimalswouldnotreceivethetreatmenttheyneedifi twerenotforcompoundedmedications. 5/16/20136:14PM

47 TherehavebeenseveraldrugsthatweuseregularlythatarenolongeravailablebecauseCompanyAboughtCompanyB,andCompanyAdecidedthatDrugXwasn'tprofitableenoughtocontinueproduction.Wealsousecompoundeddrugswhenbackordersituationsarise,orwhenweneedtodoseverysmallpatientssuchastoybreeddogsorexotic petsandcommerciallyavailablepreparationscannoteasilybetitratedforthesmallerpets

5/16/20135:41PM

48 If1/2kgyorkieneeds7.5mgFlagyl,trytodividethe250mgtablet!!!! 5/16/20135:29PM

49 Somepatientsneedtobestartedonmedicationimmediately,andcannotwaitunti lthedrugcanbecompoundedforthem.Havingthesemedicationsonhandallowsustotreatthepatientimmediatelywhennecessary.

5/16/20134:44PM

50 Trulyessential-oftenamatterofl i feanddeath,nottomentionownerconvenience 5/16/20134:28PM

51 Clientshardlyeverfi l l outprescriptionsandwhentheydoitishardlyeveronatimelymanner.Mostconditionsseeninveterinarymedic ineareemergencyanddelayoftreatmentcanmeanfatalityorworseoutcome

5/16/20134:25PM

52 Manymedicationsarenotinasizeorformulationneededforourtiniestpatientsandcompoundedmedicationsareabsolutelynecessaryandl ife-saving

5/16/20134:22PM

53 Theoption(andavailabil i ty)tousecompoundedmedicationstotailormypatient'smedicalmanagementforthebestpossibleoutcomeisextremelyimportant.Drugprotocolsshouldbetailoredtoapatient'sneedsnotadjustedtowhatiscommerciallyavailableandmanufacturedbylargedrugcompanies.

5/16/20134:20PM

54 Itisanessentialpartofmytreatmenttopatients 5/16/20133:26PM

55 becauseoftheverywiderangeofbodyweightanddosingrequirementsbetweenspeciesifthereisnotanappropriatesizeavailable,somepatientsmayhavetowait3-7daysbeforetheirmedicationarrives,andinmanycasesthisdelaycouldbefatal

5/16/20133:12PM

56 Obviouselyallofourpatients'healthandmedicaloutcomesareveryimportant,however,Idonotl iketocarrymedicationsthatcanoutdateeasily.Also,itismoreconvenienttoorderonan"asneeded"basis.Itiseasierforinventoryaswell.

5/16/20133:01PM

57 Havingofficestockcompoundedmedicationsforin-houseuseforhospitalizedandsurgerypatientsandleave-ineartreatmentsallowsustokeepoverheadlow(essentialforc lientsinthiseconomicc limate)yetprovidequalitymedic ine.

5/16/20132:48PM

58 thingsl ikecompoundedmetronidazoleintoal iquidareamustforcatsandtowaitanddispenseinafewdayswhentheindividualmedicationisreceivedisoftentolate,orconverselyownersmaynevergivethemedication

5/16/20132:32PM

59 Somemedicationswehavecompoundedinformsthatareunavailableandsomebecausetheyareunavailablebyotheravenuesinanyform,soitisofparamountimportance.

5/16/20131:36PM


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60 Theproblemsti l l existsthatinmanyifnotmostcases,weareforcedtousecertainformsofcompoundedmedicationstoprovidethesafestdosingorformulationforsmallordebil itatedpatients.Theresimplyaren'tenoughapprovedorappropriatechoicestosupplysuchawiderangeofsizesandbreeddifferenceswiththeoptimalcarewithoutcompoundedmeds.Ifwehadtoindividuallyprescribecompoundedmedstoeachcase,wewouldoftenneedtocompromisecarewhilewaitingforshipmentofmanyoftheseimportantformulations.ESPECIALLYimportantisthiscasewhendoctorsseeexotic patients(asIdo)wherethereareoftenNOchoicesofapprovedmedicationsavailableandtheirconditioncandetiorateinamatterof12to24hourswithoutappropriatecompoundedmedicationsavailableinc linic .

5/16/20131:29PM

61 Weusecompoundedmedicationsmostoftenbecauseitmakeseitherdosingorapplicationeasierfortheowner.It'snotterriblycommonforusandwewouldsurvivewithoutit.ThoughIhaveconfidencethatthemedicationswedogetcompoundedwouldnotberestric ted.

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62 Ijustthrowmudonthewalltoseewhatsticks.Don'treallycareifthepatientgetswell.#$@!%)(*??? 5/16/201312:35PM

63 Somemedicationsarenotcommerciallyavailableinsmallenoughconcentrationsorinaformthatiseasyforac lienttoadministertotheirpet.Example:amedicationmaybeonlyintabletform,butanownercan'tpil l theircatandneedsal iquid.

5/16/201312:32PM

64 Sourcesofneededmedicationsareoftencompromisedbyavailabil i ty.Compoundingsourcesareofprimeimportanceforthecontinuedappropriatecareofmypatients.

5/16/201312:17PM

65 Ihaveatleast2patientsthatwil lonlytaketheirmedicationifi tisgivenasaflavoredtablet(whichmustbecompounded).Foroneoftheseanimals,thisisal i feordeathsituation,fortheother,thelackofthedrugwouldgreatlyimpactherqualityofl i fe.Becauseclientsoftenarenotabletoinformus2weeksormoreaheadoftimewhentheyrunoutofamedication,itisimperativethatIbeabletokeepcertaincompoundedmedicationsonhandallthetime.

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66 Theyaredogsandcats.Theyoftenwon'ttakeitinhumanpil l form.WENEEDTHISOPTION. 5/16/201311:53AM

67 Somemedicationsforinhospitalusearenotavailablethroughothervenues. 5/16/201311:45AM

68 Iusealotofcompoundedmetronidazoleinmyc linic foruseinbirds,repti les,andsmalldogs,cats,andothersmallmammals. 5/16/201311:30AM

69 Manysickcatscannotwaitseveraldaysforcompoundedmedicationstoarriveatthehospital.Theyneedimmediatetreatmenttoassureabetteroutcome.

5/16/201311:29AM

70 Itallowsustostarttreatmentrightaway.Somedrugsarealsousedinemergencysituationsanditiscriticaltohavethemonhandatthepractice.

5/16/201311:27AM

71 Wehavemanypatients,especiallycats,whoseownersareunabletogivethemcertainmedicationsinanoralform.Acompoundedtransdermalmedicationgreatlyimprovescompliance.

5/16/201311:08AM

72 Therearetoomanydrugsthatgoonbackorderwithnootheralternatives,nottomentionmostdrugsweusearehumandrugssosmallanimalsthatcouldbenefitfromthosedrugswouldgetleftoutwithoutcompounding.

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73 Wedesperatelyneedthesmallercompoundsforpatientsthatcannotreceivetheoverthecounterstrengthsorthepil lsandneedliquidsortransdermals.

5/16/201311:00AM

74 Wehavetohaveaccesstoinjectableapomorphineandbuprinorphinetomaintainourstandardofcare. 5/16/201310:43AM

75 Somepatients/casesneedthemedic ineASAPandcouldsufferfromthedelayittakestogetthemedic inecompounded.Manyclientsrunoutofamedic ineANDTHENcometotheoffice.Havingtothencompounditmeansthepatientmissesadoseortwo.

5/16/201310:30AM

76 Whenweareworkingwithcats,lessthan10%ofthemedicationsweuseareapprovedforuseincats.Theonlywaythatwecantreatthesepatientsistomaintainastockofcompoundedmedicationstotreatthecatwhentheyaresick-notwaiting48-96hoursforamedicationtoarrive.Catsaregreatathidingdiseaseandbythetimetheyareseentheyareusuallyquitesickandneedtherapyimmediately

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77 Clientsdonotwanttowait2-5daystorec ieveamedicationwehavedeterminedtheyneedtoday.Patientsshouldnotbeforcedtoneedlesslysufferwhilewaitingforamedicationtobepreparedandshipped.

5/16/201310:25AM

78 Theavailabil i tyandthecostofpetcarewouldbechangedramatically.Weneedtobeabletouseourmedicaljudgement. 5/16/201310:20AM

79 Havingofficestockincreasesownercomplianceandinturnthewellbeingoftheanimals. 5/16/201310:19AM

80 Veterinarypatients'medicationsaredosedbyweightandeaseofadministrationmustalsobeconsidered.Becauseofthehugevarianceinpatientsize,itisnecessarytohaveoptionsforgivingappropriatedoses.Palatabil i tyisalsoamajorconcern.

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81 WeneedtohavetheEXACTdosageandmedic ineinstocksothatwemaydispenseimmediately. 5/16/20139:46AM

82 Itreatmanysmallmammals,birdsandrepti les.Icouldnotmedicatethemwithoutaccesstocompoundedmedications. 5/16/20139:37AM

83 Lifeordeathformanypatientsattheendstagesoftheirl i fe,especiallywhentheyareunwill ingtoconsumeformsofdrugsthatarenothighlypalatable.

5/16/20139:31AM

84 Withoutanofficestockofcompoundedmedications,patients'healthwouldsufferandbeatriskduetounavailabil i tyofimmediateaccessofnecessarymedications.Forcertainsituations,anydelayorchangeintreatmentthatwouldbecausedbynothavingmedicationonhandcouldevenbel ifethreatening.

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85 Althoughthecompoundingpharmacyweusecangetmedicationstoac lientwithinadayortwo,certainconditionswarrantstartingthemonmedicationimmediately.Ifapethasbloodydiarrheatheownerwil lnotwanttowaitafewdays!

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86 Irarelystockcompoundedmedications.Iuti l izecompoundingforveryspecific situationsandhavingcompoundedmedicationonmyshelveswouldbeunlikelytobeanymorebenefic ialtomethancommerciallyavailableproducts.Thebenefitwithcompoundingisfoundinmyabil i tytoworkwiththepharmacytofitthespecific needsofmypatients.

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87 unabletogetanyformofdoxycyclinewithoutcompounding.ThenewrulesmakeitVERYdifficulttotreatmyheartwormpatientseffectively.

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88 Idon'tneedthemallthetime,butwhenIneedthem,weREALLYneedthemtobeavailable. 5/16/20139:00AM

89 Usually,weordercompoundingforaspecific patientbutourmost-usedcompoundeddrugismetronidazoletinytabs.Itwouldbeveryhardtopracticegoodmedic inewithoutbeingabletoprescribetheseonthespotforcatsandsmalldogs,asthereisnocommerciallyavailablealternativeandtheseareurgent-needcases.

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90 Usemanycompoundeddrugs 5/16/20138:49AM

91 IfIamgoingtohavesomethingcompounded,IwantittobeforjusttheanimalorgroupofanimalsIamtreating.ThereareveryfewdrugsthataretrulyunavailableandIwouldneedtohaveonhandintheoffice.NearlyallhaveapprovedhumanformsofthedrugthateitherIcanuseorshouldbeusedbythecompoundertomakewhatIorder.

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92 Manyproductsareeitherunavailableortooexpensiveinthecommercialmarket.Treatingsmallindividualsorunapprovedspeciesisimpossiblewithoutcompounding

5/16/20138:43AM

93 duetolawsthatdoprotectsafety,westric tlyusealocalcompoundingpharmacy.thelossinproductionisworththesafety/efficacyoftheproducts.compoundedmedicationshelpmeincreasec lientcompliance,anddoseoursmallerpatients.

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94 Orderresponsetimeisusuallyshortenoughtoaccomodatepatientneeds. 5/16/20138:37AM

95 Thisisespeciallyimportantnowthatsomanyprescriptionmedicationsareonindefinitebackorder.Consistenttreatmentwiththecorrectionmedicationisessentialtoameaningfuloutcome.

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96 Orderingcompoundedmedicationsiscriticaltoprovidingtreatmenttoourpatients.Withtheendlessdrugrecalls,longtermbackordersandunreasonablepriceincreases,wecouldsimplycouldnottreatmanyofourpatientsforthediseasestheyhaveifi twerenotforcompoundeddrug.Wewouldfarpreferdrugsbemoreavailablefromthedrugmanufacturers.Mostcompoundedmedicationscostmore,haveashortershelfl i feandarefarmoreinconvenienttoorderanddispense.Weusethembecausewehavetoinprovidingahighlevelofcareandcomforttoourpatients.

5/16/20138:22AM

97 Antibioticsandpainmedicationsforsmalleranimalsandexoticsare,manytimes,notavailableinthecorrectdosages.Itisimperativethatwebeabletoprovidepainmanagementanddiseasemanagementtothesepatientsinthesamewaywedoforourlargerpatients.

5/16/20138:19AM

98 Iwouldaskthecommitteelookingintothislegislationtospendanhouratashelterandtrytogive6randomcatsacommerciallypreparedpil l ,eitherdirectlyorhiddeninfood.Itwil l quicklybecomec learthatthisisalmostimpossibleformostcats,andmanydogs.Equallytrytakingahumansizedpil l andbreakitinto1/6thssothesizeisappropriate,ortrygivingacata"cherryflavored"children'sversionofadrug.Allwil l beveryunsuccessful.Withoutproperlyprepared,readilyavailablecompoundeddrugs,manycatsanddogswouldsufferthroughil lnesswithfewalternatives.

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99 Therearemedicationsthatcanonlybeobtainedviacompoundingthatarecriticaltosuccessfultreatment.Andthosemedicationsareoftenneededimmediately.

5/16/20138:10AM

100 IordercompoundedmedicationswhenIamunabletopurchasethecommercialpreparationduetoavailabil i ty. 5/16/20138:10AM

101 Thereare5-7compoundedmedicationsIcanthinkofinstantlythatareessentialtoappropriatepracticeofmedic ineinmyc linic .Throughtheyearsastheseregulationshavebeengettingmoreandmorestric t,Ihavetriedtofindalternatives.Thereissimplynotenougheconomicdrivefordrugcompaniestomakethesemedicationsspecificallyforveterinaryuse.Mypatientswil lNOTsufferbecauseoflackofeconomicdriveifthereisanythingatallIcandoaboutit.

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102 Oftentimesweorderthecompoundedmedicationonaspecific needbasis-notmuchinhousestock. 5/16/20137:51AM

103 Itisveryimportantforustobeabletomaintaincompoundedmedicationstoensurewehavecorrectdosesforpatients-especiallysmalleranimalsthataredifficulttodosewithtypicalpil l strengths.Also,catsoftenrequirecompoundedmedicationsforbetterpalatabil i ty.

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104 Especiallynowthatoureconomyhasforcedsmallerpharmaceuticalcompaniestoc losetheirdoorsandthathasseverelyl imitedouraccesstoalotofthedrugsweuseeveryday.

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105 Manypeoplecannotseemtoplanaheadfarenoughtoaskforthemedicationtobecompoundedforthemsowekeepasmallbackuptobereadywhentheycall

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106 Namebranddrugsupplyisoftenaffectedforavarietyofreasons.Backlogsoccurtoelevatetheprice,fromaninabil ityofacompanytoacquirerawmaterialsandwhenaplantisshutdownbyauthoritiesforviolationstonameonlyafew.

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107 Mostarenotstockedandspecialorderedasneededbutthereareaselectfewmedic iationsthatneedtobeinthehospitaltouseimmediatelywhenneeded.

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108 couldnotdosemostdogswithoutsomeformofcompounding 5/16/20137:22AM

109 Crucialactually. 5/16/20137:21AM

110 Therearenumerousconditionsinhorsesthatareveryseriousandtimesensitiveandrequiremedicationthatwecanonlygetcompoundedinauseableform.Takingthisawaywouldcauseirreparableharmtothosepatients.

5/16/20137:17AM

111 Weneedtobeabletotreatpetsthedaytheyareexamined-thisiswhywealsostockourownpharmacy.ThisisespeciallyimportantwhenmedicationssuchasDoxycyclinegoonbackorder.Additionally,compoundedmedicationscanbeflavored,whichcanhelpthepetownermedicatethepetinasafermanner.

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112 Twothings,One,somemedicationsareonlyavailableascompoundeddrugsdependingonshutdownsandbackorders,andtwosomedosagesthatarecriticaltovetsarenotmadecommercially.

5/16/20137:14AM

113 Weusuallyorderthemedicationsasneededbecausethepracticeownerdoesn'tl iketokeepabigstockofthingsincasethey'reshortdated.

5/16/20137:13AM

114 Withrecentproblemswithmanufacturersitisoftentheonlywaytoobtainthemostefficaciousmedications. 5/16/20137:13AM

115 Weusecompoundedmedicationswhenthereisnothingelseonthemarkettotreatoutpatients'problems.Takingawaytheabil i tyororderthesemedicationstakesawayourabil i tytotreatourpatients'diseases.

5/16/20137:07AM

116 Asaveterinarian,itiscriticallyimportantthatcompoundedmedicationsareavailableandin-stockinoffice&onourambulatoryvehic lesinordertobeginimmediatetreatment.In-stockaccesstocompoundedmedicationisavitalcomponentinmitigatingthediseaseprocess;withouttheabil i tytohavecompoundedmedicationsin-stock,ourpatientswouldsufferunnecessarypainandpotentiallydisablingorfataloutcomesiftherewasadelayintheavailabil i tyofcompoundedmedic ine.Tostateitc learly-Ourabil itytopracticeveterinarymedic ineinthebestinterestoftheanimalandc lientisfundamentallycompromisedwhenwearelimitedinourabil i tytokeepcompoundedmedicationsin-stock.

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117 WithouttheuseofcompoundedmedicationsIwouldnotbeabletoprescribemedicationsthathavebeentakenoffthemarketinhumanmedic inebutisverybenefic ialtoourpets.OftentimesIcangetcompoundedmedicationsatalowerpricethanIcanbuythemforandresale.Inveterinarymedic inethisisveryimportantbecauseitallowsmyc lientstotreattheirpetsatanaffordablecost.

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118 Especiallysomemedicationssuchaspotassiumphosphatewhichcanmeanlifeordeathforsomediabetic ketoacidosispatients. 5/16/20136:53AM

119 withmoreandmoreproductsnolongercommerciallyavailable,thecompoundpharmacistisourlastandbesthopefortreatingourpatients.ifoneofthesedouchebagsenatorshadalovedonewhoselifedependedonmedicationthatwasonlyavailableviacompoundingthey(thesenate)wouldstopthiswitchhunt!!!IDIOTS!!!!

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120 Whencommercialdrugsareonbackorder(whichisextremelyfrequent)compoundedversionsareouronlyoption. 5/16/20136:42AM

121 Easyofmedicationacceptanceisagreatpartofthereasonforusingcompoundedmedications.Catsdonotdowelltakingnonliquifiedmedicationsaswealsoseerisksofcapsulesandpil lsbecominglodgedintheesophaguscausingnecrosisofthesevitaltissues.Horsesalsobenefitfromcompoundedmedicationsprimarilyforacceptanceandcomplianceofadministeringthemedications.

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122 Idoalotofexotic petsandcatswhicharedifficulti fnotimpossibletogiveoralmedicationssocompoundedmedsarerequiredsincetherearenomanufacturedtransdermalsandfewliquids

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123 Idon'tfeelallcompoundedmedicationsneedtobeinstock.However,Idofeeltherearesomepreparationsthatarehighlybenefic ialtohaveimmediateaccess.

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124 Manyofthecompoundedmedicationsweusearetomakethempalatabletorhethepetorgivetheownertheabil i tytoactuallymedicatethepet

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125 Especiallyforcats,forwhomnoncompoundedmedicationsareoftennotwellaccepted. 5/15/20136:53PM

126 It'smuchmoreconvenienttomaintaininventoryofcompoundedmeds,butusuallyoktoprescribethemindividually. 5/15/20136:41PM

127 IfwedonotcarrytheRx,theownermaynottakethetimetopickitupatanotherlocation,riskingthepatientshealth.IftheRxwouldbemailedtotheowner,thepatientshealthmaybeatriskduetoadelayinstartingaRx.

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128 Formostcompoundedmedication,Itrytoprescribeitfor1patient.Insomec ircumstancesIneedtohavecompoundedmedicationontheshelftouseimmediately.Thepatientdoesnothavetimetowait5-7daysforaprescriptiontoarrivebymail.AlsomanymedicationshavebecomebackorderedandunavailablefromtheregularmanufacturersandIneedcompundingpharmaciestofi l linthegapunti ltheregularmedicationbecomesavailableagain.

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129 Theabil i tytobeginimmediatetreatmentisoftenvitaltopatientoutcomeespeciallybecausec lientstendtodelaypresentationunti lthepatientisserioustocritical.

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130 Manymedicationsarenotmadeatstrengthssuitableforsmalleranimals-thehumanequivalentistoobig.Also,formanyc lients,compoundedmedicationsaretheonlywaytheycanaffordtomedicatetheiranimalswithcertainmedications.

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131 Whencatsneedmeds,Iwanttobeabletosendaneasilyadministered,ietransdermalcompounded,Rxhomethatday.Givingavomitingcatapil l isuseless.Theycan'twait2-3daysforamedtobecompoundedandsenttothemtobetreated.Theyusuallyhavealreadybeensickfor2-3daysbeforeanexam.

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132 wedonotusuallymaintainstockofcompoundedmedsunlessthereisamanufacturer'sbackorder-otherwise,ourcompoundedmedsaremadeupforspecific c lientsandtheirpetsandthereforearenotkeptasstockonourshelves

5/15/20133:21PM

133 Compoundingcantakeseveraldaystobemadeandshippedandinsomeinstancesthepatientneedscertainmedicationsasap. 5/15/20133:07PM

134 Itrynottostockcompoundedmedsandonlyuseprescriptionsforspecific animalsasIhavebeenleadtobelievethatistheLEGALwaytodo.ITwouldbeaverybigenhancementstomyc lientstobeabletogetthemedicationatthesametimeastheirappointment.

5/15/20132:42PM

135 TherearedosagestrengthsIuseregularlyforacuteconditions(can'twaitforshipment)thatarenotavailablecomercially 5/15/20132:28PM

136 Wetypicallydonotstockcompoundedpreparations.Weprefertohavethepharmacycompoundforeachpatientindividually. 5/15/20132:13PM

137 Weneedoptionsinveterinarymedic ine.Notallanimalswil ltoleratepil lsorcapsules.Andsomemedicationsarenotavailableinthelowerdoseswemayneed.

5/15/20132:08PM

138 Itisextremelyimportantespeciallywithalltherecallsandshortsuppliesofmedications,ifi tweren'tforcompoundingpharmaciesourpatientscouldn'tgetthemedicationtheyrequireforhealingthereforewouldsufferwithouttreatment.WealsoseeexoticsandthisisourONLYoptionusuallyduetosmalldosingandpalatabli l i ty.WecouldNOTtreatourexoticsifwedidnothavethisanoptionthereforenoonewouldbringthemintobcthereisnothingwecando!Thisseemsridiculoustomethatouranimalsmayhavetosufferbcoftheseproposedlaws.

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139 Somemedicationsaresometimesnotavailableduetomanufacturerordistributorbackorders,butaresti l l criticaltoourpatientsneeds

5/15/201312:37PM

140 Particularlywithophthalmic,neonatalandseptic patientsIstandagoodchanceoflosingtheeyeorthepatientwhilewewaitfordrugstoarrive.Iwisheverycongressmanhadtolooksomeoneintheeyeandsay"wecouldhavesavedyoureyeorfoalbutwecouldn'tgetthemedic inefastenough"!

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141 Weareveterinarianswith100%mobileequinepractice,andstockedproductsonthetruckhavebeenthestandardinourtypeofpracticeforoversixtyyears.

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142 Compoundedstrengthsandformulationsareessentialineverydaypractice.Someofourpatientsaretoosmalltotakeafullstrengthadultformofadrugandbreakingthepil l orcapsuleisnotpossibleandcanresultinanimalsbeingunderdosedoroverdosed.Catsoftencannotbemedicatedorallyandthatcanresultinthembeinguntreatedorownersgettinginjured.Transdermalpreparationsareessentialintheseanimals.

5/15/201311:39AM

143 Wehavesomepatientsthatsimplycannottakeamedicationanyotherway.Beingableto'hide'amedicationinsideaspeciallyflavoredtabletorl iquidisinvaluable.

5/15/201311:24AM

144 Iusehomedeliverypharmaciesratherthanmaintainingapharmaceuticalinventory. 5/15/201311:23AM

145 Someownersareunabletoadministerpil lstotheirpetsandneedmedicationformulatedintoatastyl iquid,chew,ortransdermal.Somepetsaretoosmallandrequirecompoundedmedications.Thesepetswouldnotreceivethemedicationtheyneedwithoutacompoundingpharmacy.

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146 Catsareverydifficulttomedicate.Compoundeddrugscanbemadetotastebetterorbesmallerinsize.Withoutthemmanycatscouldnotbemedicatedathome.

5/15/201310:22AM

147 IwasundertheimpressionthatIamnotlegallyallowedtomaintainofficestockandsoprescribeforeachpatientindividually,butitwouldbeniceforthec lienttonothavetowaitifIamabletodothis.Insomeinstancesitisveryinconvenientandaltersspeedofrecoveryortreatmentsuccess.

5/15/201310:02AM

148 Oftenmedicationsinstockstrengthsaretoostrongforoursmallerpatients. 5/15/20139:56AM

149 Weoftenneedmetronidazoleinl iquidformforsmallpatientswithdiarrhea.Otherwise,smallpatientssometimeshavetowaitwhenproductisshippedtothemorifcompoundingpharmacyisc losedoverweekend.

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150 Theimportanceisfargreaterthanimagined,especiallywhenthedrugisnotavailablethroughdistributors.Oftenprescribingacompoundedmedicationisnottimelyenoughforsomemedications,anddelayisl i fethreateningastheownerwaitsforthemedtobecompoundedandthenshipped(sometimesseveraldays)Ifi tisonourshelfwecanprescribeitinatimelymanner,,,

5/15/20139:44AM

151 Abil itytocontrolpainanddiseaseinanimalsisoftenchallengingaswecanbewithoutlabelusemedicationsforongoingcareorgettingtoproperdosingintervalfortinypatients.

5/15/20139:30AM

152 Exotic animalsandsmallpets(<15lbs)oftenrequiredosesofmedicationsthatarewellbelowstandardmgstrengths.Additionally,someanimals(exoticsandsomecats)areimpossibletomedicatewithpil lsandrequirel iquidmedicationsforsuccessfultreatment.

5/15/20138:36AM

153 Acertainamountofveterinarydrugscanonlybeobtainedthrucompoundingandthesedrugsareimportantforourpatients'health...withoutcompoundeddrugswewouldbel imitedinthewaywetreatourc lients'petstothedetrimenttoourc lientsandtheiranimalcompanions.

5/15/20138:26AM

154 It'smoreimportanttometobeabletoorderacompoundedmedicationasneededthanitistokeepitinstockinhospital 5/15/20138:20AM

155 Havingmedicationavailabletoprescribeanddespensequicklyisimportant.Havingthismedicationalsosimplifiesthedespensingofthemedicationwhenwehaveit.Themorerestric tions,paperworkandrequirementsfororderingcompoundedmedicationsonlydelaystreatmentofthepatients!

5/15/20138:18AM

156 ManymedicationsthatareFDAapprovedforhumanuseareusedextra-labelbytheveterinaryprofession.Manyofthesemedicationsareverydifficulttoadministertosomespeciesbasedonsizeoftheanimalorthedifficultyinadministeringduetotaste.Thecompoundedmedicationshavebeenal ifesaverfortheveterinaryprofessional.

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157 Manydrugsneedtobeformulatedforourdifferentpatientsizesinasmallanimalpractice.Standardpil l sizesoftencannotbedosedsmallenoughforminature/pocketpatients.

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158 Someofourpatientsaredowntotheirlastresortinmanagingthespecific conditionforwhichthecompoundeddrugisprescribed. 5/15/20137:51AM

159 Weareanemergencyhospital.Weseepatientsofallshapesandsizes24-7.Ifapatientcomesinforanemergencyat11pmonaFridaynightandneedsacertainmedicationinacompoundedform,itmightbe3or4daysbeforethey'reabletogetthatmedicationfromacompoundingpharmacy.Byhavingsomeinstock,wecangivethemasmallsupplytogetstartedunti lafullprescriptioncanbecompoundedbyanoutsidecompoundingpharmacy.

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160 withoutthisoptionwewouldbeunabletotreatmanypetsthattheownersareunabletogiveapil l ortabletto.Alotofcomerciallyavailablemedicationscanbedifficulttoquarterandaccuratlyaddministerandalotofthemarebittermakingadministrationmoredifficult

5/15/20137:45AM

161 Somanyinstancesapatientneedsamedicationnowasapposedtowaitingforaspecialordertocome. 5/15/20137:41AM

162 Monthsofamedicationsbackordercanhaveseriousconsequencestoapatient'shealth. 5/15/20137:17AM


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163 IfIdon'thavethemedicationsonhand,itcanpotentiallytake1-3daystogetthemedications.Indealingwithexotics,oftentheydon'thavethatmuchtime.Ifyoudon'ttreatimmediately,theywil ldie.

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164 Therehavebeensomanydrugrecallsandshortagesinthepastfewyears,thatwithoutbeingabletoobtaincompoundedmedicationswewouldhavebeenseverelyhamperedinourabil i tytopracticeveterinarymedic ine.

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165 Criticalinmanycases.OftenacompoundedformistheONLYwaytogetapatienttotakeal ife-savingmedication. 5/15/20136:21AM

166 Itisvitaltobeabletoproperlydoseourpatients.Thedosagesofmanymedicationsaretoohighortoolowforveterinarypatients.Compoundingisessential.Ifthepharmaciescan'tdothrirjob,we'l l havetogobacktodoingitourselves.

5/15/20136:15AM

167 ThenumberofscenariosinwhichIusecompoundedmedicationisendless!Catsaresomeofthemostdifficulttomedicateforowners.Havingmedicationcompoundedintoaflavoredl iquidispriceless!

5/15/20136:14AM

168 WithregardtoRxingcompoundedmedications,Idon'tkeeptheminstock.Rather,IdispensethemedicationorsupplementandprovideawrittenRxforthec lientstotaketothelocalcompoundingpharmacy,

5/15/20136:11AM

169 Wemaintainanextensiveexoticsspecialtyarea,andmanyofthemtypicallyneedsomesortofcompoundedmedication(antibiotics,anti-inflammatories,etc).Eachdifferentspeciesmetabolizeseachdrugdifferently,sohavingthefreedomtocalculateeachdosageappropriatelyanddispensetherightamounteachtime,helpsusserveboththepatientandthec lient.

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170 CRITIVALTherearemanypetsthatwouldnotbetreatedifwecouldnotprovidemedicationinaformthattheownercouldbesuccessfulatadministering.

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171 Whentreatingexotic speciesandveryoldorfractiouscats,itisessential. 5/15/20135:29AM

172 Ifthemedicationdoesn'tgetintothepatientasprescribedduetodifficultyofadministration,thereisnochanceofsuccess. 5/15/20135:26AM

173 Weseepatientsonadailybasiswhowouldbeunabletobemedicated(mainlycats)withouttheuseofcompoundedmedications. 5/15/20135:19AM

174 Withsuddendrugshortages,itcouldmeanlifeordeath,successorfailurewhentreatingdisease,protectinghumanandanimalhealth.

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175 Usediagnostic compoundsinstock(ACTHgel) 5/14/201310:03PM

176 Thereisrarelyadrugstrengthavailablethatcanbeusedforexotics.Weneedtohavecompoundeddrugsonhand.Wecan'twaittoorderwhileanimalisindistress.

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177 Weareafelinespecti l i typracticeandorpatientsoftenwouldnotgetbetterifwecannotstarttheircompoundedmedsasap. 5/14/20139:57PM

178 Manyofmypatientsaregeriatric horseswhoseownerscannotaffordtheproprietarydrugs,buthavingsafeandeffectivecompoundedoptionsallowthemtocarefortheirretiredanimalswithintheirbudgets.Also,thegeriatric animaloftenbecomeshardertomanagewithoutcreativeflavorsandformsofmedicationbecauseoftheirreducedappetiteandfinickybehaviors.

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179 SometimessuppliersareonbackorderandtheonlyaccessIhaveiscompounded. 5/14/20139:19PM

180 Manytimesofficestockofcertainmedicationsmeanstheanimalcanstarttreatmentwhennecessary,nothavetowaitunti lshipmentsarrive,whichcouldbeseveraldaysdepending.

5/14/20139:09PM

181 Itcantake1ormoredaystoreceivecompoundedmedicationforaspecific patient,sohavingthemedonhandtodispenseisbetterforthepatientifi t'sverynecessarytogetthemedicationstartedASAP--iemetronidazolebeingacommonone

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182 ManyofthemedsthatIusearenotavailablefromanon-compoundingpharmacy. 5/14/20138:48PM

183 havingtowaitdaysfororhavingtoovernightanessentialcompoundedmedicationcouldriskapatientssuccessfultreatmentandwilldefinitelyaddtothecostoftreatmentforthatptient

5/14/20138:18PM


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184 Ver,Veryimportant.Weneedtohavethisreadiltavailableforourpatients. 5/14/20138:17PM

185 Therearemanydifferentbodysizesofanimalsandmanufacturesdonotalwaysprovedapil l orsizetofitwhatIneed,soIhavetogetitmade.

5/14/20138:16PM

186 weneedapomorphinetogetpetstovomit 5/14/20138:05PM

187 HavingSustainedreleasebuprenorphineforpainreliefiscriticaltohaveonhand!Youcan'thavepeoplegopickitup!Especiallyafterthecompoundingpharmacyhasc losed!

5/14/20137:56PM

188 Some,l ikeapomorphineareusedinemergencysituationsandthereisnottimetogetadosecompoundedspecificallyforthatpatient.

5/14/20137:47PM

189 Mostoftenwhenweneedacompoundeddrugweshouldnotwait2or3daystostartit.Weshouldbeabletostockitandkeepgoodrecordsincaseofproblems.

5/14/20137:37PM

190 Mostmedicationsthatrequirecompoundingareneededonshortnotice.Ihavebecomeaccustomedtoprescribinganinitialamounttotesttheabil i tyofafamilytoadministerandusethemedicationandcanthenscriptoutalargeramountforthepatienttoreceivetotheirhome.

5/14/20137:11PM

191 TherearemedicationsthatIcannotgetinanappropriatesizeormethodofadministrationexceptbycompounding. 5/14/20137:00PM

192 Therearemanymedicationsthatdon'tcomeinanappropriatesize(ieMetronidazoleforsmallcats)thatIl iketokeepinstock. 5/14/20136:38PM

193 ManypetswouldotherwisenottakemedicationifwecouldnotgetacompoundedVersion 5/14/20136:21PM

194 Asabove...manypetsalsostressveryeasilywhichcanbedetrimentaltotheirhealth,,sohavingtheproperdoseofmedicationinapalatableformortransdermalformistheonlywaytheycangetthetreatmenttheyneed.

5/14/20136:20PM

195 Someofthemedicationsweusearejustnotavailableinsizesorstrengthsthatweneedforour.smallpatients 5/14/20136:09PM

196 IscriptoutalmostallmymedicationsbecauseIammobileanddon'thaveroomtocarrystock. 5/14/20136:08PM

197 Ifwedonothavethemedicationneededinstock,treatmentisdelayedunti lthec lientoruscanreceivethemedication. 5/14/20135:51PM

198 Manyofmypatientsareminorspecies(egbirds),andhavingaccesstocompoundedmedicationsisvitalfortheirhealth,asthedrugsarenotreadilyavailableotherwise.

5/14/20135:49PM

199 Inthepastyearseveralmedicationshavebeendiscontinuedorbecomeunavailable.thesehavebeenmedicationsthatareessentialtoourpracticesuchasopthalmicmedications,andcertainantibiotics,orinjectableanti-inflammatorymedications.

5/14/20135:48PM

200 Foralotofpetsinourpracticeweneedtokeepmedicationonhandforthesize&dosageofourpatients 5/14/20135:00PM

201 Frequently,havingcompoundedmedicationsonhandcanmeanthedifferencebetweenapatientl ivinganddying.Iseeonlycatsandveryoftendosagestrengthsorformsavailablearenotappropriateformypatients.Painmedicationsarealsooftennotavailableinappropriatestrengthsordosages,particularlyforanesthesiause.Withoutcompoundedmedication,Iwouldnotbeabletopracticetoashighofastandardorassafely.

5/14/20134:55PM

202 ManymedicationsarenotavailableinthesizesorformulationsneededtotreatthemanyspeciesandsizesofanimalsIseeeveryday.Compoundedmedic inesarearealblessingtomypatientsandreallyimprovepatientcareandoutcomes.

5/14/20134:27PM

203 Again,oftenweneedasmallerdosagesizeandhaveitmadeinaformthatistolerablefortheanimalssuchasaorall iquidinanappetizingflavor

5/14/20134:26PM

204 Forverysmallpatients,weoftencannotgettheappropriatesizemedicationthroughtraditionalpharmacies.Itisalsoverybenefic ialtohavetheoptionofflavoredmedicationavailabletoensureownercompliance.

5/14/20134:17PM


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205 Compoundsallowourveterinarianstostartpatientsonamedicationappropriateforthemimmediately.Withsomuchvarianceinneededdosages,compoundedmedicationmakesiteasytoprescribemedicationtomultiplepatientsregardlessofweight.

5/14/20134:04PM

206 Clientcomplianceisdefinitelyincreasedandthereforeimprovedpatientcare. 5/14/20134:02PM

207 Manymedicationsarenotavailable(orthepricehasskyrocketedtowhereitwouldbeimpossibletodispense)throughcommercialmarketsiedoxycyclineforonemajorexample.

5/14/20133:56PM

208 Beingabletoadministermedicationsinaformthatpetswil ltoleratetakingisvitaltothesuccessofourtreatmentplans.Thisisespeciallyimportantwhenyouaretalkingaboutamedicationthepetwil lneedtotakefortherestoftheirl i fe.

5/14/20133:49PM

209 Illpatientsneedtobetreatedpromptly.Adelayofseveraldayscouldprovefatal,especiallyinexotic species. 5/14/20133:46PM

210 IhaveMANYpatientsthatrelyoncompoundedmedicationstosimplymaintaintheirl i fe! 5/14/20133:41PM

211 somemedicationsareonlyobtainedthroughcompounders 5/14/20133:37PM

212 ThisisWAYbeyondjustconvenience.Weusecompoundedformulasforacutesituationsthatcannotwaiteven24hoursformedicationtobereceived.

5/14/20133:30PM

213 Especiallywhenthepharmaceutic companiespulloutneededdrugsforunknownreasons. 5/14/20133:27PM

214 Therearesomedrugsthatareverydifficulttoadministerorallytocatsandbeingabletohavethemcompoundedtoeitherl iquidorgelpensmakethemmucheasierforc lientstouse.

5/14/20133:21PM

215 Therearedefinitelyl i feanddeathsituationswherestartingthemedicationthesamedayiscriticaltohavingapositiveoutcome.Waitingtogetstartedonmedicationbecauseitmustbemailedisoftenunacceptable.

5/14/20133:17PM

216 Weseecats,dogsandexotics.Weneedtobeabletostockcompoundedmedicationsinavarietyofstrengthstoaccommodatesmallexoticsl ikehamstersaswellaslargedogs.

5/14/20133:17PM

217 Becausethepharmacyweusehassuchrapidresponseandweareasmallc l inic ,IdonotroutinelystockcompoundedproductsalthoughIdothinkitisimportantthatIhavethatoption

5/14/20133:04PM

218 ThereareinstanceswhereweneedtodispenseamedicationNOW.Theanimalcannotwaitthe1or2daysrequiredforthepharmacisttocompoundthemedicationthatwemaintain.Themedicationsweuseroutinelyarenotalwaysavailableinadosagereadilyuseableforapetthesizeofacat.

5/14/20132:59PM

219 Occasionallyback-ordersofvitalmedicationsoccurandwhenthereiseithernosubstitute,orthesubstituteisprohibitivelyexpensive,compoundedmedicationscanmakeal ifeordeathdifferencewithpeople'spets.

5/14/20132:59PM

220 needtostarttreatmentasap 5/14/20132:50PM

221 Someanimalsareverydifficulti fnotimpossibletomedicateandusingcompoundedmedicationscangreatlyaffecttheabil i tytoadministerthesemedications.Computedmedicationsgiveustheabil i tytousealternativewhenthetraditionalrouteisimpossible.Compoundingisessentialinveterinarymedic ine.

5/14/20132:42PM

222 Hospitalizedpatientsoftenrequiremedicationsinformsotherthanwhatareprovidedfromthedistributorswhichmeansoftentimesusingcompoundedmedications.Vomitingpatientsrequireinjectablemedication,felinepatientswhoaredifficultpatientstoorallymedicatebenefitfrommedicaltherapyviatransdermalapplicationofmedications.

5/14/20132:37PM

223 veterinarypatientsarenotalwayseasytomedicateandtheycomeinawiderangeofsizesandspecies.Itiscriticaltohavecompoundeddrugsavailableforthesedifferentneeds.

5/14/20132:27PM


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224 Importantduringtimesofsignificantbackorderorunavailabil i tyofadrugweneed...l ikerecentlywhenPrednisolonecouldn'tbefoundforcats.Wehadsomecompoundedinasmallamountsowecouldsend10-15pil lshomewithapatientatatimewhenneeded.

5/14/20132:22PM

225 Manycommerciallyavailablemedicationscomeindosagesthataretoolargeforthesmallerveterinarypatientsandinformsthatcannotbesplit.Havingcompoundedmedicationsmakesitpossibletomedicatethesesmallpatients.

5/14/20132:18PM

226 Currently,thereisalmostalwaysadrugwhichbecomesunavailableduetomanufacturerback-order,butisvitaltoourpatients.Orinthecaseofcats,althoughcantakeahuman-equivalentdrug,youcannotmakethedosesmallenoughtoappropriatelytreatsuchasmallbody.Inthatcase,compoundingisagainvitaltotreatingourpatients.

5/14/20132:09PM

227 Ownersappreciatehavingthemedicationonhandtotreatasickpetimmediately.Wecangivethefirstdoseintheofficetostartcareimmediately.

5/14/20131:46PM

228 Asafelineonlypracticecompoundedmedicationsareveryimportanttomypatients.Theeasiertreatmentisathomethebettercompliancewhichmaymeanthedifferenceofl ivingorbeingputtosleep.

5/14/20131:43PM

229 Itisindispensable.Particularlyforsmalldogs,catsandexotic patients.WithoutcompoundingIcouldnot,inanymeasureoftheword,effectivelytreatmypatients.

5/14/20131:41PM

230 Ican'ttreatverysmallanimalsquicklywithoutastockofcompoundedmedications,forexample50mgmetronidazoletablets.Isimplycannotwithholdtreatmentfordayswaitingonacompoundingpharmacisttobeavailabletomakeanimportantdrugforapet.

5/14/20131:39PM

231 Withouttheabil i tytoprescribecompoundedmedications,therearemanyanimals(catsinparticular)whowouldnotbesuccessfullytreatedbecauseavailablemedicationsareunsuitableforonereasonoranother.

5/14/20131:38PM

232 Somecompanionanimalswouldbeleftwithoutpropermedications/dosingfortheirsizeandneeds. 5/14/20131:36PM

233 oftenIwil l usethecompoundedmedic ineoninhospitalpatients. 5/14/20131:35PM

234 If 5/14/20131:27PM

235 VeryImportantforeaseofmedicating 5/14/20131:27PM

236 Duetothesignificantaboutofback-ordersthattakeplace,wesometimesdonothaveachoicetousesomethingotherthancompoundedmedications

5/14/20131:26PM

237 Toomanyofournecessarydrugsgoonbackorder,orareatthewrongstrength. 5/14/20131:25PM

238 Compoundeddrugsareimperativetomypractice 5/14/20131:22PM

239 Ittakestoolongtoorderdrugsindividuallyfori l l pets,especiallyiftheycomeinonaFriday.Nothavingthedrugsalreadyavailableandmeanthedifferencebetweenlifeanddeath.

5/14/20131:13PM

240 Certainmedicationsareonlyavailabletousasacompoundedmedications.Additionally,certainpetscannottakemedsintheir"traditional"formi.e.,pil lssuspensions,etc.Ifweareunabletoobtaincompoundedmedicationswewouldnotbeabletosuccessfullytreattheseanimals.Alos,manymedicationsarenotmanufacturedindosesthatcanbeusedforsmallanimals

5/14/20131:11PM

241 Therearetimeswhenwecannotgetmedicationsneededforpatientsinthestrengthsthatweneededorintheformsthatareuser-friendlyforourpatients.Compoundingallowsussomeversati l i tyinpatientcompliance.

5/14/20131:10PM

242 Iusecompoundedmedicationsinalargeanimalshelter.TheprimarymedicationwehavecompoundedatthistimeisdoxycyclinewhichistheONLYmedicationthatcurrentlytreatsthemycoplasmarespiratoryinfectionweareencounteringinourcats.Withoutthecompoundedliquiddoxycyclinewewouldbeeuthanizingthesecatsinsteadoftreatingandplac ingthemforadoption.

5/14/20131:07PM


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243 TowaitforcompoundingwhenIneedaproductimmediatelyisridiculous. 5/14/20131:07PM

244 Ipracticeexclusivelyoncatsandsmallexotic mammals.Drugformatsthatarelabeledforthesespeciesareprettyl imited,andinaddition,humanorcaninemedicationsusedoff-labelinthesespeciesoftenareunpalatableorunacceptabletothesespeciesandmustbedividedintosuchtinydosesthatdosingwithnon-compoundedmedicationsisimpracticalandpotentiallyunsafe.

5/14/201312:59PM

245 Mostofthetime,wecanordercompoundedmedsforourpatients,butsometimeshavingtheminhospitalmeansthedifferencebetweenlifeanddeath.

5/14/201312:58PM

246 Idispensealotoftransdermalmedicationsetctocatswhoareotherwisenoteasytomedicate.Thishassavedmanyl ives 5/14/201312:56PM

247 Manymedicationshavebeenbackorderedwhicharevitaltoanimalwellnessandareverymuchneeded,withoutthecompoundedmedicationwewouldnotbeabletotreatsomecaseswhichcouldbedevestatingtousasac linic aswellasourc lients.

5/14/201312:54PM

248 Itallowsustogetsmallerdosesofsomemedicationsthataresometimesneededforsomeofourexotic patients.Italsoallowsustousemedicationsthatarenotavailableotherwise.

5/14/201312:53PM

249 Therearetimes,especiallywiththeunavailabil i tyofcertainmedicationsthatweneedtotreatahospitalizedpatientnow. 5/14/201312:53PM

250 Foranumberofmypatients,it'sthedifferencebetweencomplianceandasuccessfuloutcomeversusnon-complianceandanunsuccessfuloutcome.

5/14/201312:48PM

251 IworkinanER&referralpractice.Exotic patients,criticalpatientsandpatientswithuncommondiseasesoftenrequirecompoundedmedicationsduetotherelativelylackingveterinaryformularyavailable.Havingcompoundedmedicationsregularlyavailableimprovespatientoutcome,ismoreconvenientforownersandoftensavesl ivesforlessmoney.IwouldsaythatcompoundedmedsareaNECESSITYforpropercare.Injectableapomorphineisaperfectexampleofacompoundedmedthatsavesl ivesand$1000sforowners.

5/14/201312:48PM

252 Weseemanypocketpetsandferrets,repti les.Havingasuspensioninthefrigereadytodispensecanmeanlifeordeathtothesesmallcritters.Ifwehavetowaittohavethedrugmadeupandthenshippedtousmanyofthemwoulddieastheownersaren'talwaysabletodeterminetheyarereallysickinatimelyfashion.

5/14/201312:47PM

253 Weareveryactiveincontinuingeducationandtryveryhardtomakethemostcurrenttreatmentmodalitiesavailabletoourpatients.Frequentlynewertreatmentprotocolsuti l izemedicationsthatarenotreadilyavailable,especiallyinanimalfriendlyformulations,throughothermeans.

5/14/201312:46PM

254 Many"human"medicationsweuseforcatsandsmalldogsarenotavailableinaformthatcanbereducedtoasmallenoughdosagethatwecandispense.Inaddition,manycatswil lnoteasilytakeoralmedicationinatabletform,sohavingtheabil i tytohavemedicationscompoundedincreasespetownersabil i tytogivemedicationandinthelongrun,savespetl ivesthroughcompliance.

5/14/201312:46PM

255 Somedrugsneedtobekeptonhandforimmediateuse,suchasanalgesics,anti-nauseadrugs,appetitestimulants,etc.--thatcan'twaitadayortwoorthreetobereceivedfromanoutsidesource.

5/14/201312:45PM

256 Manypetownershavedifficultygivingmedicationsincertainformsandwecompoundtomakesureourpatientsaregettingthecorrectdose.Withoutcompoundingourc lientcompliancewoulddecreaseandputourpatient'shealthatrisk.

5/14/201312:43PM

257 Manyofthecompoundedmedicationsweuseareneededatthatverymoment.Thepatientcannotwait1-2daystostartthemedication.

5/14/201312:43PM

258 Therearemanyoccasionswherethequalityofcaretoourpatientswouldbedramaticallycompromisedifwedonothavetheabil i tytohavein-stockcompoundedmedicationsimmediatelyavailableforourpatients.Nottomentionthefinancialimpactitwouldhaveonourpractice&thepetownerifwehadtoordereachtimeapatientneededamedicationratherthantakingfromourofficestock.

5/14/201312:41PM

259 Someownersareunabletomedicatetheirpetwithouttheuniqueflavorsorshapesofthecompoundedmedications. 5/14/201312:39PM


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260 Withmedicationsconstantlygoingoutofproductionandonbackordertheveterinaryfieldneedsasolutionforwhenthatoccurs. 5/14/201312:38PM

261 Theabil i tytostockandusecompoundedmedicationisvitaltothedailypracticeofveterinarymedic ine.Therearemanyinstanceswhenanamebrandorgeneric medicationisonback-orderornotavailablebecausetheproductisnotmadeanymore.Intheseinstancesitisabsolutelycriticaltohavethecompoundedmedication.Alsotherearetimeswhenavailablemedicationsarenotavailableinadosageorformthatworksforourverysmallpatientssoweasveterinariansusecompoundedmedications.

5/14/201312:37PM

262 Compoundedmedicationisoftenputintoaformthatwil linsurethattheanimalactuallygetsthemedicationinthecorrectdosage.Thisobviouslygreatlyimpactsthesuccessofoutcome.

5/14/201312:34PM

263 Especiallywiththeincrediblenumberofdrugshortages,ifwehavetorelyonFDAapprovalforcompounding,it'l l throwusbacktothedarkagesofveterinarymedic ine.Wereallymusthaveaccesstothesedrugsevenwhennotcommerciallyavailable.Faceit,i fwereallyscrewup,wewil lbel iable.Althoughouractionsmightnotbestric tlyregulated,wewil lcertainlybecontrolledbymarketandlegalforces.Idonotthinkthemajorityofveterinariansabuseormis-usecompoundeddrugs.Wearetrainedinpharmacologyandweuseourexpertiseeverydaytodecidedwhatanimalswil lbenefitfromwhatdrugs.

5/14/201312:34PM

264 Somemedicationsneedstobestartedimmediatelyforthewellbeingofthepatientandarenotcommerciallyavailable. 5/14/201312:33PM

265 Cats&dogsofdifferingsizesoftenneedmedic inesinformulationsordosesthatarenotmetbyeitherAnimalHealthdivisionsorthehumanhealthdivisionsofpharmaceuticalcompanies.Plus,thispastyearhasseenmanyextremelyimportantdrugsbecomeunavailable.Ifveterinarianscouldnotobtainthesedrugsfromcompoundingpharmacies,manyofourpatientswoulddie.Ihopenevertohavetoexplaintomyc lientsthattheirpethashadtodiefromaoutrageous&stupidregulation

5/14/201312:32PM

266 Ikeepal imitedstockofdrugsbuttheabil i tytokeepdrugsandcompoundthemispriceless. 5/14/201312:32PM

267 Whenthereareshortagesordiscontinuatrionsofmedication,itcanmakeahugedifferenceinqualityofl i feforourpatientswhetherornotwecangetthosemedscompounded.

5/14/201312:28PM

268 Medicatingsomepetswouldbevirtuallyimpossiblewithoutcompoundedmedications.Iftheywerenotavailable,thesepetswouldnotreceivethetreatmenttheyneedtol ivehealthyqualityl ives.

5/14/201312:27PM

269 wecallinwhatweneed,sinceIammoreworriedaboutpreparedcompoundsgoingoutofdatebeforebeingusedformostthings 5/14/201312:26PM

270 Veterinarymedicationrequirestreatingdifferentspeciesandverydifferentpatientsizes.InordertodosemypatientseffectivelyIneedtheabil i tytousecompoundedmedications(i.e.differentconcentrationswithdifferentflavorsandroutesofadministration,etc.).

5/14/201312:23PM

271 Whenweneedamedicationforapatient,weneedittoday,notinaweek. 5/14/201312:22PM

272 Compoundedmedicationthatisnotontheshelfandavailableforanemergencysituationisuseless. 5/14/201312:22PM

273 DuetothenatureofsomebreedscompoundedmedicationsistheonlywayIcantreatsomepatients.Theirsuccessoftreatmentisduetothefactthatcompoundedmedicationswereavailable.

5/14/201312:22PM

274 Patientspecific prescribingdelaystreatment.Themedicationswekeeponhandtendtobe1)ophthalmicpreparations,2)medicationsreformulatedfordosingsmallerpatients[ie-l iquidmetronidazoleasthecommerciallyavailablepil lscan'tbecutintosmallenoughpiecesforsmallpatients)or3)hormonalpreps(DES;topicalmethamazole).Forsomeoftheseconditions,especiallyhormonalandophthalmic,the2-3daydelayinstartingtreatmentcansignificantlyimpacttreatmentsuccess&outcome.Theabil i tytostock&immediatelydispensethesemedicationsnotonlyisinthebestinterestofourpatientsbutalsoincreasesc lientconfidenceinourpractice&product.Afterall,howwouldyoufeelifyouoryourchildweresickandyouweretoldbyyourphysic ian,"Ihavetheperfectmedicationbut,sorry,you'regoingtohavetowait3-4daystostarttreatmentbecauseI'mnotallowedtostockthisinmypractice."I'mguessingyou'dbeprettyupset.

5/14/201312:21PM


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275 Compoundedmedicationsverycommonlymeanthedifferencebetweensuccessandfailureinourmedicalcases.Withoutthem,wewouldstruggletomanagecertaindiseasessuccessfullysuchasdryeyeorfungalkeratitis.

5/14/201312:21PM

276 ThemostcommoncauseIusecompoundedmedsisforcats,whocanbeverydifficulttoorallymedicate. 5/14/201312:20PM

277 Weneedtomaintainthestockofdrugsinourpracticebecausethehealthofourpatientsdependsonit.Withthenumbersofbackordereddrugstoday,wecan'tjustorderfromournormaldistributers.

5/14/201312:18PM

278 Anythingwecandototreatormaintainthehealthofourc lient'spetsisveryimportant. 5/14/201312:14PM

279 COMMERCIALLYPRODUCEDMEDICATIONSGOONBACKORDERORARENOTAVAILABLEDUETOMANUFACTURERSDELAYWENEEDTOBEABLETOPROVIDETHESEMEDICATIONSTOTREATDISEASEESPECIALLYIFTHEONLYMEDICATIONSAVAILABLEARECOMPOUNDED

5/14/201312:14PM

280 Iuselocalcompoundingpharmaciesformypatient'sspecialmedicationneedsandhavethemselldirectlytothec lient. 5/14/201312:14PM

281 Iworkatauniversityandhavenosayinwhatdrugstheycarry 5/14/201312:12PM

282 Therearemanymedicationsthatarenotavailableforhumans,thatareimportanttothehealthandmedicaloutcomeofcompanionanimals.Weneedtohaveeffic ientaccesstothesedrugsorwearel imitingourqualityofveterinarymedic ine.

5/14/201312:10PM

283 Weabsolutelyrelyoncompoundedmedicationsmore&more,becauseofthefrequentunavailabil i tyfrommanufacturersoftheprescriptiondrugsourpatientsrequire.

5/14/201312:10PM

284 wecanalmostalwaysfindanappropriatewaytomedicateapatientwithoutusingcompoundedmeds. 5/14/201312:07PM

285 Exotic animalshidesymptoms.Theypresentoftenveryi l l andneedimmediatetreatmentandhospitalization.Wecannotwaitforthesemedstobemadeandsent...especiallyonweekends.Compoundedmedsforemergencyusageisessential

5/14/201312:06PM

286 Oftenpatientsneedtreatmentimmediately.Waitingunti lthenextdayorlongerforacompoundingpharmacytopreparethemedicationcanbethedifferenceinlongerhospitalstays,longertreatmenttimes,additionaladjunctivetherapies,etc.whichincreasescoststoc lient.Inthemostseverecasesitcouldleadtopoorpatientoutcome.

5/14/201312:06PM

287 Wedon'tnow. 5/14/201312:06PM

288 Allcompoundingpharmaciesarec losedonweekend.Animalsgetsickeverydayandthesedrugsneedtodosedcorrectly 5/14/201312:06PM

289 Oftentimesmedicationisgivenopportunisticallysoifi t'snotinthehospitalatthattime,theanimalmaynotreceivethemedication 5/14/201312:04PM

290 Oftentimes,thereareurgentoremergentsituationswherehavingthemedication(eitherinl iquidformoradifferentconcentration)onhandtodispensetotheownertostartimmediatelyisimportant.Waitingforthemedicationtobeshippedtotheowner,orforadaytimepracticetoopen&compoundthemedication,couldmakethesituationordiseaseworse.

5/14/201312:03PM

291 manylifesavingandcriticalmedicationsarenotmanufacturedforanimals,andasaveterinarianIrelydailyoftheuseofcompoundedmedications

5/14/201312:01PM

292 Therearemanytimeswhendrugsareonbackorderfromoursuppliers(happeningmoreandmore!)andwehaveapetwalkinthatdesperatelyneedsamedlikemetronidazole,whichwasonbackorderfortabs,butthecompoundershaditinl iquid,andbecausewehadastock,couldtreattheanimal.Otherwiseweareupacreek.

5/14/201312:00PM

293 Idon'tusecompoundedmedsinoffice.Theyhavetobeprescribedtoaspecific patient. 5/14/201311:59AM

294 Themaincompoundeddrugsthatweusearebecausetheoriginaldrugisnolongeravailable 5/14/201311:59AM


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295 Outsidepharmacieshavenoveterinarytraining.WhenIdoscriptoutdrugs,thescriptsareoftenmis-fi l ledandinappropriatesubstitutionsaremade....Substitutionsthatwouldbefineforahuman(egnaproxenformeloxicam)butaredevastingandpotentiallydeadlyforadog.

5/14/201311:57AM

296 Somecasesshouldnotwaitthe5-10daysittakesforustoorderamedication,thepharmacytocompounditandforthec lienttofinallyreceiveit.

5/14/201311:54AM

297 Ourpracticeworkswithalargevarietyofwildlifespecies.Theseanimalsdon'tgenerallyacceptdog/catpreparationsofcommonmedications.Compoundingallowsustoorderaformulationthatwil lallowhands-offadministrationtotheanimalandflavoringoptionstoincreasecompliance.

5/14/201311:53AM

298 Especiallywhentreatingcats/smallpatients;speciallypreparedotic medicationsusedforcomplicatedearinfections. 5/14/201311:51AM

299 InVirginia,wearenotallowedtokeepofficestockofcompoundedmedications;Iwishwecould. 5/14/201311:51AM

300 Yadayada 5/14/201311:23AM


32/89

8.37% 86

33.17% 341

4.96% 51

Q4Howfrequentlydoanyveterinariansinyourpracticeprescribeorusecompoundedmedications?


Oncedaily

Severaltimesdaily

Onceperweek

Severaltimesperweek

Oncepermonth

Severaltimespermonth

Onceperyear

Severaltimesperyear

Never

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Oncedaily

Severaltimesdaily

Onceperweek


33/89

32.20% 331

2.63% 27

16.73% 172

0.19% 2

1.75% 18

0.00% 0

Total 1,028

Severaltimesperweek

Oncepermonth

Severaltimespermonth

Onceperyear

Severaltimesperyear

Never


34/89

6.82% 68

50.95% 508

28.08% 280

7.32% 73

6.82% 68

Q5Howfrequentlydoyoudispensecompoundedmedicationstoananimal

ownerfromyourofficestock?Answered:997 Skipped:33

Total 997

Always

Frequently

Occasionally

Rarely

Never

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Always

Frequently

Occasionally

Rarely

Never


35/89

1.50% 15

16.85% 168

20.16% 201

24.07% 240

37.41% 373

Q6Howfrequentlydoyoucompoundmedicationsinyourpracticeinsteadof

obtainingthemfromapharmacy?Answered:997 Skipped:33

Total 997

Always

Frequently

Occasionally

Rarely

Never

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Always

Frequently

Occasionally

Rarely

Never


36/89

7.11% 71

54.01% 539

27.66% 276

5.81% 58

5.41% 54

Q7Howfrequentlydoyouordercompoundedmedicationsforofficestockthatyoulateradministertoapatient?

Answered:998 Skipped:32

Total 998

Always

Frequently

Occasionally

Rarely

Never

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Always

Frequently

Occasionally

Rarely

Never


37/89

12.68% 126

59.05% 587

23.14% 230

3.92% 39

1.21% 12

Q8Howfrequentlydoanyveterinariansinyourofficeprescribecompoundedmedicationsforaspecificpatientby

name?Answered:994 Skipped:36

Total 994

Always

Frequently

Occasionally

Rarely

Never

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Always

Frequently

Occasionally

Rarely

Never


38/89

40.42% 403

18.56% 185

41.02% 409

Q9Doesthestateinwhichyoupracticerequirepatient-specificprescriptionsfor

compoundedmedications?Answered:997 Skipped:33

Total 997


1 Thereareonlyacouplecompoundedmedicationsweuseregularlythroughthec linic ,butweusethemonanalmostdailybasis.Wehaveothermedicationscompoundedforspecific patientswhoneedacertainsize,ortheyneedtobeaflavoredl iquidorchewtogetthepettotakethem.

5/23/20139:59AM

2 IdowhatIhavetodototreatthepatient. 5/22/201310:12AM

3 Justrecentlyweweretoldthatwhenprescribingcompoundeddrugthattheyneedtobeorderedspecificallyforthatpatient.Myunderstandingisthatwecangivepatientscompoundeddrugsinhospital,butcannotbedispensedunlessorderedspecificallyforthatpatient.

5/22/20139:15AM

Yes

No

Notsure

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Yes

No

Notsure


39/89

4 Colorado 5/20/20139:00PM

5 Wepreviouslydispensedanumberofcompoundedmedicationsforourpatients,howeverduetostateregulationswehaveventuredawayfromthiswhichhasmadethingschallengingforouremergencypractice.

5/20/20132:18PM

6 Onlyforcontrolledsubstances.Forthemajorityofthemedicationswehavecompounded,theyarejustmedicationsthatareonbackorderfromthecommercialmarket.

5/20/201311:52AM

7 Weareabletocompoundmedsforexotic species 5/20/20137:21AM

8 Anditisasignificantchallenge. 5/19/201310:25AM

9 WefollowAVMA'smostrecentlypublishedguidelinesforcoumpoundedmedications. 5/19/20137:24AM

10 Justrecentlytheyhavestartedrequiringpatient-specific prescriptions. 5/18/201311:16AM

11 Yesforcontrolledsubstancesandhormones.athelminticscanbeorderedforinhouse. 5/18/201310:40AM

12 Thismaychangesoon 5/18/20139:11AM

13 IpracticeinKSandMO.KSdoesnotrequireit.MOdoes. 5/17/20139:59PM

14 Weareallowedtousecompoundedproductsthatourpracticepurchasesfromacompoundingpharmacyin-house,butarenotallowedtore-sellcompoundedproductsthatwepurchasefromacompoundingpharmacyto-go-home.Wecandispenseproductswecompoundin-houseto-go-home(causeTHATmakessense!)

5/17/20137:21PM

15 havingpatientspecific medicationregulationdelaysthebeginningoftreatmentforourpatients,thedayortwofordeliverydelaystreatment

5/17/20139:36AM

16 Ibelieveso. 5/17/20137:25AM

17 Don'tcarryofficestocksincehaveahousecallpractice. 5/16/201310:01PM

18 Recentlythestatechanged,byemergencyorder,topatient-specific prescriptions,butlaterrescindedtheemergencyorder.Iamnotsureatthispointwhattherulesare,butITHINKwecansti l l orderinofficestock....

5/16/20139:17PM

19 ThatisfinewithmethatthestateIpracticeinrequiresapatient-specfic prescriptionforcompoundedmediations.LikeIsaidbefore,Idon't"stockpile"anymedicationbeitcommercialorcompounded----inventorycostsapracticetoomuch.SoI'vegotapatientthatneedsamedicationthatIdon'tstock----IcallotherlocalveterinarianstoseeiftheyhaveadoseortwoofthemedicationneededuntilIcangetsomein.Theydothesame.

5/16/20137:28PM

20 Justrecently 5/16/20136:47PM

21 Ibelievethisistruebutwehavetoorderitaheadoftimetoendureitisavailableinourbusyemergencypracticewheremessareneededduringthemiddleofthenightorontheweekend

5/16/20134:31PM

22 Itwouldbesomuchmoreconvenienttobeabletostockmedicationswithoutaspecific prescriptionsothatmedic inewouldbeimmediatelyavailableforuse

5/16/20134:24PM

23 notforeverymedication,althoughrecentchangeshavemadeitmuchmoredifficulttohaveon-handsmalldosecompoundeddrugavailableinthec linic

5/16/20133:16PM

24 nowanditisabigproblem 5/16/20132:33PM

25 Thisisarecentchangeinlegislationforus.Upunti lrecently,wecouldordercompoundedmedicationsforofficestockthatcouldbedispensedasneeded.WeONLYstockedcompoundedmedicationsthatwecouldnotobtaininacommercialform.

5/16/201312:42PM


40/89

26 No,Idon'tthinkafederally-run,federally-controlledpharmacyisinmyormypatients'bestinterest. 5/16/201312:39PM

27 Absurd!! 5/16/201312:25PM

28 Mostofthetimeweusepharmaceuticalcompanymedications.BUT,wesometimeshavenochoicetousecompoundedbecauseofdosingissuesorpalatabil i tyorthedifficultyinadministeringmedstoapatient.

5/16/201311:55AM

29 Thisisleftatthediscretionoftheprescribingveterinarian. 5/16/201311:32AM

30 Thec linic Iworkatcallsinindividualprescriptionsbuthassomeonhandtogetapatientstartedunti lthecompoundedmedicationarrives.

5/16/201311:28AM

31 Weencounterthisissuewithcertainoutofstatepharmacies. 5/16/201311:18AM

32 OhiojustswitchedtothiswhichisveryfrustratingbecauseIdon'thaveanythingonhandtogivemypatientswhoneedsomethingliketacrolimuseyedropsororalbuprenorphine.

5/16/201311:16AM

33 WehavetousesomeofthePatientSpecific prescriptionsforofficestockattimes 5/16/201311:01AM

34 Ithinkso,butI'mnotcompletelysure. 5/16/201310:57AM

35 Notonlydoesthiscauseusdistresswhentryingtoorderinhospitalsuppliesofmedicationforapatientwearemakingupsothatwecanhaveitonhand,wearenolongerabletotakeadvantageofaRefreshprogramthatwouldreplaceunusedexpiredmedicationsthatwehaveonhand.

5/16/201310:27AM

36 Wehavejustturnedintoa"re-distribution"ofcompoundedmedicationsstate.Itisextremelyinconvientashavingtoindividuallyrxeachdrug:1)costismoreforthepatient2)patienthastowaitdaysandsometimesaweekormoretoreceivethemedication,asapposedtoitbeingonthecounteralready.IfthedrugwasavailabletometobuynotcompoundedIwouldbuyitthatway,butwithallthedrugshortages,ithasreallyputveterinariansinabindtotreatpatientsappropriately.

5/16/20139:28AM

37 InCAweareallowedtohavecompoundedmedicationinhospitalstocktouseinhospitalorwecansendhomenomorethan72hours'worthforapatient.

5/16/20139:25AM

38 Patientspecific prescriptionsarehowwealwaysuti l izecompoundedmedications.Idonotknowifthisisastaterequirement. 5/16/20139:21AM

39 Thisisverydifficulforimmediateneedmeds.Ittakestimetocompoundanddiarrheaorpainmanagementcan'twaitthedaysneeded.Havingcompoundedcommonlyusedmedsonhandisnecessary.

5/16/20139:17AM

40 Exceptformetronidazoletinytabsandmethimazoletransdermalpens,allourcompoundingispatient-specific 5/16/20138:54AM

41 Mostveterinariansdonotrealizethatanytimetheymixtwodrugsinonesyringetheyarecompounding.Werecognizethathere.Also,manyveterinariansdonothavemuchofanideaaboutthelackofconsistencywithinandbetweenbatchesofcompoundedproducts(especiallythosestartingfrombulkingredients)becausethetherapeutic windowmaybequitelargeforthatdrugtobeginwith.Ialsowonderiftheuseofcompoundedantibioticshashadasignificantimpactoncreationofresistantpopulationsoforganismsduetothisvariabil i tyinpotencyandstabil i tyinherentincompoundedmedications?

5/16/20138:45AM

42 Patientspecific prescriptionsisgoodintheory,itisnotpossibleforeverydrug.Therearecertaindrugsforpainmanagementthatitisnotanoptiontonothavethemonhandwhenthepatientneedsit.Thisplacesaburdenontheveterinarian-theymustchoosebetweentheiroathinprovidingpatientcare,providingahighlevelofcare,andthelaw.Ourc linic orderspatientspecificcompoundeddrugsonalmostadailybasisasthedrugmanufacturerissuescontinuetoincrease.Itcostsourc linic asignificantamountoftimeandmoneytotrack,priceandorderthesedrugsinatimelyandappropriatemanner.Manytimeswewil lcallmultiplecompoundingpharmaciesinanattempttofindthemostaffordableoptionforthec lient.

5/16/20138:28AM

43 WewriteprescriptionsformedicaitonssuchasTacrolimus,methimazole,etc.Wedousemetronidazolethathasbeencompoundedintoal iquidsuspensionthatwedispensefromouroffice.

5/16/20138:25AM


41/89

44 Thisisveryfrustrating.Wehavepatientsthatoftenneedtostartspecific drugsimmediately.Sometimesitiscriticaltotreatingtheiri l lness.Whenthisisdiscoveredonaweekendorintheevening,andnoinjectablealternativeexists,thepatientmustsufferunti lapharmacyopensbecausewecannolongerdispensecompoundeddrugsfroma"hospital"stock.Inveterinarypatients,especiallycats,havingcompoundeddrugsimmediatelyavailablecansaveananimal'sl i fe

5/16/20138:19AM

45 Iamdistressedthatkeepinghospitalstockofcompoundedmedicationsandthendispensingthemoutunderapatient'snamedoesnotqualifyas"patient-specific prescribing".Weareintheprocessofcomplyingwithourstate'spracticelawandwil lbeswitchingtohavingthec lientworkdirectlythroughthecompoundingpharmacy,butIdonotseehowthismakesanyimprovementtothissituation.IfIuseatrusted,authorizedcompoundingpharmacy,whycan'tIkeeptheirmedicationsonmyshelvesfordispensing?Thisdoesnotmakesensetome,thoughIdounderstanditisourstate'spracticelaw.

5/16/20138:04AM

46 Weonlycompoundwhenwecannotobtainthemedicationsweneedbecausetheyarenotavailablethroughtheregularpharmaceuticalcompanies.

5/16/20137:49AM

47 butweareallowedtodispenseafewdaystoananimaloutofourstock 5/16/20137:45AM

48 Thisisarestric tionthathurtstopetsmorethanthepractice.Wecannothavecompoundedmedicationsonhandandwefrequentlyneedthem.Asaresultofthispatientshavetowaitdaysbeforestartingonamuchneededcompoundedmediation.

5/16/20137:31AM

49 InTexas 5/16/20137:18AM

50 Thepatient-specific requirementisapointless'safeguard'.Myc linic cathasapparentlybeenonaplethoraofmedications... 5/16/20137:17AM

51 Patient-specific requirementshasdeeplydamagedourdutytokeepnecessarymedicationsin-stockandavailableformedicaltreatment.Thedelayinacquiringcompoundedmedicationbyorderingsolelyonapatient-specific basisistherootcauseofdelayinthetreatmentofi l lness,injuryandchronicconditions.Delaysduetopatient-specific requirementsaredirectlyresponsibleforunnecessarysufferingandourcompromisedabil i tytohaltormanagethediseaseprocess.Clientshavestrongandreasonableexpectationthatourveterinaryfac il i tystockthedrugsrequiredtobegintreatedofanimalimmediately.Anyandalllegislationkeepingcompoundedmedicationsfrombeingavailableonourshelvesalongsideourothermedicationsareshamefulbarrierstowardthehumanetreatmentofanimals.Limitationsonourabil i tytostockcompoundedmedicationsdirectlyharmsourabil i tytopracticeveterinarymedic ine.

5/16/20137:17AM

52 Theownersdoggetsalotofmedic ines...ifyouknowwhatImean. 5/16/20137:16AM

53 ThislegislationjustpassedinAlabamaunfortunately 5/16/20137:13AM

54 Ifindthistoberidiculous!Doctorsshouldbeabletodispensemedicationsthesamewaywhethertheycomefromadistributororacompoundingpharmacy.Ifsomethingisonbackorder&wecangetitcompoundedit'sridiculousthatwecanonlyorderonebottleatatimeorasweneedit.Especiallywithdoxycyclinesincewe'reinanextremelyLymeendemicarea.

5/16/20136:55AM

55 Wetendtohavethemcompoundedforspecific patientsbutIamnotsureifi tisrequired. 5/16/20136:54AM

56 Orderingmedicationsforaspecific patientratherthankeepingcertainmedicationsinstockisnotalwaysfeasibleasitisoftennotinapatientsbestinteresttowaitseveraldaystobeginmedications.

5/16/20136:52AM

57 Notsure 5/16/20136:44AM

58 seeaboveresponse 5/15/201310:35PM

59 Iwouldhopeitdoes. 5/15/201310:21PM

60 California 5/15/20136:54PM

61 rarelydispensingfromstockwehave,notorderinganymoreforofficestock 5/15/20136:49PM


42/89

62 Wedouseinstock,compoundedmedstoanimalsthatinhospitalized. 5/15/20135:29PM

63 AlthoughIonlyrecentlyfoundoutthatthisisthecase.Wedidn'tknowthiswasalawandwereoccasionallydispensingcompoundedmedications,butwestoppeddoingthisoncewefoundout.

5/15/20135:18PM

64 IfallowedIwoulddispensecompoundedmedicationsfromthepracticeoccasionally,wedidupunti lrecentlywhenthelawchanged

5/15/20133:16PM

65 Recentlywehavehadtostartprescribingpatient-specific medications. 5/15/20133:10PM

66 wecompoundentirelyoutofstate 5/15/20131:21PM

67 wisconsin 5/15/201312:50PM

68 Weusedtokeepessentialmedicationsinstock,nowwecannot. 5/15/201311:57AM

69 Compoundingpharmaciescallourofficeafterweorder,tochecktheorder,patientnameandDVMname 5/15/201311:55AM

70 IbelievethestateofTexasdoes,butamnotpositive. 5/15/201311:26AM

71 Thisjusttookeffectinourstate. 5/15/201311:09AM

72 Virginia'sBoardofPharmacyjustmetwithourAttorneyGeneral'sOfficeandBoardofVetMedthispastMonday.TheconclusionisthatVamustenforcefederallawstatingthatcompoundeddrugscannotberedistributedbyveterinariansforsale.Thisprecludesproperpatientcareinsomec ircumstanceswherepatientsrequiretimelymedicationdispensingforl i fethreateningdiagnosedconditionsandcannotwaitthe2-4daysitoftentakestoorderformanoutofStatepharmacyandwaitfordeliverybyUPSormail...MDsfacethesameissueie;ophthalmologitsneedtoprescribeavastincompoundedforimmediateophthalmicuseorpatientscanbecomeblind.TheFederallawsimplydoesnotaccountfortheralityofproperpatientcare...

5/15/201310:56AM

73 MScurrentlyallows"officeuse"compounds. 5/15/201310:10AM

74 Iwouldlovetobeabletomaintainofficestockofcommonlyprescribedsizesthatarenotavailablecommercially.Ialsodorepti leandsmallrodentmedic ineandsometimeshavetocompoundinofficetogetthemstarted.Iwouldratheracompounderdothis.

5/15/201310:04AM

75 Thepolicyrecentlychanged-nothappyaboutthenewregulations. 5/15/20139:42AM

76 Wehavehadtoordersomeofficestockformedicationsthatwekeeptoprescribetopatientfortrialthatisnotavailablefromdistributorandthenfollow-upwithpatientspecific medicationprescriptionifpatientshowssignsofimprovement.Wehavealsoorderedsomedoxycyclinethatiscurrentlynotavailablefromourdistributordotoitbeingbackordered.

5/15/20138:48AM

77 Iamnotsureonthisquestion,althoughwedocarrycertaincompoundeddrugsfordispensingatourVeterinaryHospital.... 5/15/20138:31AM

78 I'minGeorgia 5/15/20138:21AM

79 ThisisanewrequirementinourstateandhasmadetreatingourpatientsVERYdifficult.Manypatientsneedsmedicationsquicklytotreatseriousi l lnesses/issues.Waiting3daysfortheprescribedmedicationtobemadeandshippedistoolongforananimalwhoissufferingtowait.

5/15/20137:54AM

80 It'sarequirmentthatcompoundedmedicationsproducedinstateareforaspecific patient,butthatisaveryrecentchange.Marylandjustmadethatarequirementwithinthelastfewweeks.We'resti l l abletogethospital-usecompoundedmedicationsfromoutofstate.

5/15/20137:53AM

81 Asofrecentlyyes.Beforewewereabletoorderas'officeuse'sothatwecanhavemedicationsinstockwhenweneedthemtodispensetoc lients/patientswhenneeded.

5/15/20137:47AM


43/89

82 ourhospitalusescompoundedmedicationswhentheFDAapprovedmedicationisonback-orderandnolongeravailableorwhenamedicationdoseneedstobespeciallymadetofitthepatient'sneeds

5/15/20137:28AM

83 Thismakesitverydifficulttokeepneededmedicationsonhand.Seepreviouscommentaboutexotics 5/15/20137:16AM

84 Unsure,butwealwayscallinscriptwithinstructionsonhowtouse/givetothepatient. 5/15/20136:35AM

85 recentlyaddedlaw 5/15/20136:16AM

86 Thishaspresentedfrustrationandproblemsattimes 5/15/20135:48AM

87 Iusein-housesuppliestodispenseacuteusemedicationsuchasanalgesicsandantibiotics.Ialwayshaveindividualprescriptionspreparedforchronicusemedications.

5/15/20135:28AM

88 RhodeIsland...Idon'tthinkso,butI'mnotentirelysureexactlywhatthismeans.Wetypicallyspecifywhichpatientacompoundedmedicationisfor,butwehavealsoreceivedsamplesofcompoundedmedicationsthatwehavekeptinthec linic (withinexpirationlimitsofcourse)touseinappropriatecases.

5/15/20135:24AM

89 Wecandispensecompoundedmedicationfromstockforshorttermuse,ortostartapatientonamedicationwhichwewil lhavespecificallycompoundedfortheminthenearfuture(chronicmedications).

5/14/201310:07PM

90 WeareabletostartthemedsfromtheinofficestockandthensendaRxtoanoutsidepharmacytocompletethecourseofthemeds 5/14/201310:00PM

91 recentattentiontoandasIunderstandit,enforcementofstateregulationsnowrequireapatientspecific prescriptionforallcompoundedmedications.thistremendouslyincreasesthecostofthesemedicationstothec lientandwil ll ikelyresultinc lientsdecliningtreatmentduetothecost

5/14/20138:23PM

92 Supposedly.Absolutelyabsurd. 5/14/20137:48PM

93 iorderthecompoundeditemsonl ine,havethemdeliveredtoourveterinaryhospitalsotheyareavailabletoourpatientsrightaway 5/14/20137:30PM

94 Ibelieveitdependsonthescheduleofthemedication.ForscheduleIIwemustalwaysspecifyaspecific patientfortheprescription,sothescriptisforthatpatientonly.

5/14/20137:05PM

95 Wecanorderforc linic useanddispenseal imitedamounttoaspecific patient. 5/14/20136:53PM

96 LAisrunbyRWNJ'sthatwanttokeepthe$$inthehandsofbiginsurancecompanies,andl imitdrugavailabiltytopatients.Also,theywanttocutoutanycompetiton!!

5/14/20136:08PM

97 Ihavealwaysassumedso 5/14/20135:27PM

98 Unsure 5/14/20134:41PM

99 Currentlytheuseofcompoundedmedicationsmakeabigdifferenceinthetreatmentofmanydifferentcommondiseasesseeneachday.Veterinariansaretrainedinhowandwhytousecompoundedmedic inesandwhichcompaniesarereputable.Limitingtheavailabil i tyofcompoundedmedic ineswouldbeverydeleterioustopatientcare.

5/14/20134:31PM

100 Notwhenorderedtotheoffice.Patientspecific whendispensed. 5/14/20134:04PM

101 Andit'sarealpainintherear-inskiforthec lientandpatient.Ofparticularconcernispainmedicationforcats.Humanbuprenexisinshortsupplyandextremelyexpensive.Weusethesteri lehumanforinjectibleuse,butasadispensedmedicationfororaluse,it'scost-prohibitiveformostpetowners.Theglassampulesareapain/dangerousfordosingaswell.Weandourc lientsfarpreferthe.5mg/mlcompoundedbuprenexfororalhomeuse,butwith"patientspecific"requirements,we'renotsupposedtostockitinthehospital.Whenacatneedsanemergencysurgerytoremoveapieceofswallowedyarnisthecatsupposedtowaitfourdaysforthepainmedicationtoarrivebymailorder?Ridiculous!

5/14/20134:00PM


44/89

102 Dispensefromourownpharmacy-donotgiveoutprescriptionsforcompoundedmeds. 5/14/20134:00PM

103 Somecompoundingpharmaciesarerequiringthis,somearenot 5/14/20133:55PM

104 IbelievetheanswerisyeshereinPA 5/14/20133:01PM

105 JustrecentlyLouisianahasbecomeastatethatallcompoundedmedicationsaretobeorderedpatientspecific whichmakesitdifficulttoobtainanddispensestockcompoundedmedicationsforunexpectedhospitalizedpatients.Takingtimetoorderacompoundeddrugforasickpatientistimewasted

5/14/20132:39PM

106 TheonlytimewewouldorderastockofacompoundedmedicationwouldbeiftherewerenootheroptionavailabletousaswhenPrednisolonewasonindefinitebackorderandweordereda100countbottleofcompoundedPrednisolonetoholdusoverforawhile.

5/14/20132:26PM

107 Il iveinCalifornia,butI'mnotsurewhatthelawrequires.Weonlyprescribeonapatient-by-patientbasis. 5/14/20132:22PM

108 Isuspectthatitisrequired 5/14/20132:17PM

109 Havingcompoundedmedicationinstockpriortotreatingasickanimalbenefitstheanimalbecausewecanbegintherapyimmediately.

5/14/20131:58PM

110 Iamnotpositivebutisuspectitissupposedtobepatientspecific .Iwouldl ikeittowherecompoundedmedscanbepurchasedinbulkanddispensedtomultiplepatients.25mgmetronidazoleorflavoreditraconazoleareperfectexamplesofmedsyoul iketohavehandyratherthanorderforspecific patients.

5/14/20131:57PM

111 Ibreakthelaweverydayinordertoprovideahigherstandardofcareformypatients. 5/14/20131:40PM

112 Texas 5/14/20131:31PM

113 Nootherwaytopractice. 5/14/20131:27PM

114 Ioverseenonhumanprimatebreeding.Manytimes,wecannotobtaintheproperdrugorstrengthneededunlesswehaveitformulated.Anditseemsthatinrecentyears,backordersonroutinedrugsfrommanufacturershasforcedustousecompoundingagenciesmoreandmore.

5/14/20131:21PM

115 Thisisratherdifficultattimessinceittakes2-5businessdaystoreceivemedication.IfweorderinadvanceofsurgeriesthatMAYneedacompoundedmedandthenwecan't/don'tuseit,weareoutthemoney.Itcostssmallbusinessesquiteabitinwastedmedsanddelaysnecessarytreatment.

5/14/201312:55PM

116 OneofthecompoundingpharmaciesIuserequirespatient-specific prescriptionsanyway. 5/14/201312:51PM

117 Ithinktheyrequirepatient-specific prescriptions.IfIhaveapatientthatisgoingtobeonadrugformorethanashortcourseoftreatment,I'l l usuallyhaveaspecific prescription.

5/14/201312:48PM

118 Recentchange,whichcomplicatesthingsforus,especiallyforbuprenorphine.Theregularmedicationhasbecomesoexpensive,butweuseanddispensetheoralcompoundedbuprenorphineeveryday.

5/14/201312:48PM

119 Wenowarerequiredtohavethemedicationcompoundedonanasneededbasisinwhichourpatientsthenhavetowait24-72hourstoreceivetheirmedication.Whenc lientsforgettocallforrefi l lsorifapetneedsamedicationonanemergencybasisitisnolongerreadilyavailabletothem.

5/14/201312:46PM

120 Sometimesthismakesitverydifficulltbecausethepatientneedsthemedicationimmediatelyandwehavetowaitforittobecompoundedbecausewecannotkeepthesemedicationsinstockwithoutorderingforac linic petandthenkeepinginstock.

5/14/201312:42PM

121 Thismakesorderingyourc linic stockofmedicationsverydifficult.Ifyouareorderingtofi l l yourstockandnotforaspecific patientyouaresti l l requiredtouseapetname.

5/14/201312:40PM


45/89

122 Someofthemedicationswecompound(e.g.metronidazole)isnotcommerciallyavailableinaform/sizethatissafeforuseincats.Withoutcompounding,we'deithernotbeabletousethedruginthisspeciesinspiteofits'historyofsafetyandefficacy,orwe'dbesplittingtabletsinthebackroomandprovidingverypoordosing.

5/14/201312:38PM

123 Allcompounded(andnoncompounded)medicationsrequireawrittenprescriptionbyourveterinarians. 5/14/201312:34PM

124 Icangetofficestockcompoundsforuseinmyc linic withoutapatientnamebutanythingIsendhomewiththec lienthastobecompoundedforthatc lient'spet.

5/14/201312:31PM

125 Manymedicationshavebeengoingonbackorderoverthelastfewyears.Compoundingmedicationshasallowedustosti l l beabletogivemypatientsthesemedicationswhileonbackorder.

5/14/201312:27PM

126 PrettymuchtheonlytimeI'l l orderapatientspecific formulationiswheneither1)itssomethingrarethatwedon'tstockor2)I'mhavingitshippeddirectlytothepatient.I'dmuchprefertohavec linic stockofthemedicationsweusecommonly.

5/14/201312:22PM

127 LABEL 5/14/201312:15PM

128 Weareazoosoweownouranimals-therearenoc lients.However,wedispensemedicationtoourownanimalsjustl ikeinaregularhosptial,withavalidprescription,writtenbytheoverseeingveterinarian,giventothekeeperforaspecific animal.

5/14/201312:12PM

129 wehaveofficecompoundedmedsforemergencyuse.Beyondthat,compoundedmedsarecalledinforspecific patients 5/14/201312:08PM

130 Thefactthatitmaybecomeil legalformetokeepasmallstockofcompoundedmedsforpatientsyetitislegalformetomakemyowncompoundedmedicationsinhouseisridiculous.Muchmorel ikelyforerrorstooccurthatway.Medsshouldbecompoundedbyal icensedcompoundingpharmacistandthenonlythebriefstorageandprescribingouttopatientsshouldbelefttous.

5/14/201312:08PM

131 Thisisahassle,wepreferhavingitinstock 5/14/201312:07PM

132 Anotherdumblawthatmakesnosenseandbenefitsnoone. 5/14/201312:06PM

133 TapazoleBaytri l c isaprideMetacamFlagylReglan 5/14/201311:59AM

134 MN-notsure 5/14/201311:59AM

135 Justrecently 5/14/201311:58AM

136 Thismakesitdifficulttomaintainhospitaluseproducts 5/14/201311:52AM

137 Yadayada 5/14/201311:23AM


46/89

25.33% 251

12.82% 127

61.86% 613

Q10Moststatescurrentlypermitveterinarianstodispensemedicationstopetowners;manydonotdifferentiatetherulesfordispensingFDA-approveddrugsandcompoundeddrugs.Doesyourstate

permitdispensingcompoundedmedicationstopetownersforafee?


Total 991


1 IdowhatIhavetodototreatthepatient. 5/22/201310:12AM

Yes

No

Notsure

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Yes

No

Notsure


47/89

2 IfIamprovidingamedicationthattheycan'tget,itrequiresmetoknowhowtodiagnoseaconditionandhowtotreatit,whatmedicationisneeded,howorwheretogetit/howtodoseit/howtolableitandtimetocalli tin-IbelieveIshouldbeabletochargeadispensingfee.

5/20/201310:02PM

3 Exceptifusingexactsamefeeforregularscriptsorthemedswemixinhospitalbecausethereisnootheroptions.....andthesearechargednormalrxfeesnotaseperatecompoundingfee

5/20/20137:21AM

4 Wedonotchargeafee. 5/20/20136:31AM

5 IwouldassumenotasthisquestionmakesitsoundlikeIamdispensingfromofficestockwhichwearenolongerpermittedtohave. 5/19/201310:25AM

6 Wemayordercompoundedmedicationsforapatientandhavethec lientreimburseusforthecostofthemedicationplusaprofessionalfeeforhandlingtheorderingandproperstorageofthemedication.

5/19/20137:24AM

7 Notsureofthisquestion.Ifyoumeandoesourc linic chargeformedicationwecompoundyes.Thereisnotahigherfeeforthisconvenience.

5/18/201310:40AM

8 Thismaychangesoon 5/18/20139:11AM

9 Ithinkso? 5/17/20139:59PM

10 AsfarasIknow,wecandispensecompoundedmedicationstopetowners. 5/17/20139:45PM

11 InthestateofOhiowearepermittedtousecompoundedmedicationsbutasfarasIknowthereisnoassociatedfee. 5/17/20132:59PM

12 Idon'tdispensedirectlytotheowner.Iuseacompoundingpharmacy. 5/16/201310:01PM

13 IassumethatthestatepermitsitbutIamnot100%sure.IftheydonotIamunaware. 5/16/20139:32PM

14 Notsure 5/16/20139:09PM

15 Ibelievemystateallowsaminimalmarkupofthecompoundedmedicationthatisnomorethan33%overthecostofmyc linicobtainingthecompoundedproduct.Inpracticetermsthisisn'taverylargemarkuponmedicationsbutthatis,asiunderstandinmystate,the"letterofthelaw".Sobeit.Iassumethis33%markupl imitinc ludestheshippingfeeaswelltogetthecompoundedproducttomyc linic---soImarkupthecompoundedmedicationat133%ofmycosttohavethatcompoundedproductarriveatmyclinic .example:costofthecompoundedmedicationandtheshippingcosttomyc linic totals$100.00,thec lientcostorischarged$133.00.That'snotalotofprofittomyc linic .SohowdoIattempttostayinbusinessandstayprofitable?Iama"service"basedveterinarian.Ichargemoreforservices:exams,physicals,lameness,repro,ultrasound,radiographs,sheathc leanings,dentals,healthcertificates,labworkandinterpretationoftheresults,ect.thatmostdoinmyarea.WhydoIstructuremypracticebasedonthis?Thedaysofdispensingmedicationsforanydegreeofsignificantprofitinveterinarymedic inearelonggone.Furthermore,Idon'twanttomakemymoneyasa"drugdealer"Iwanttomakemymoneyformyprofessionalexpertiseinevaluatingapatientandusingmyknowledgeandskil lstodetermineandconcludewithadiagnosisandtreatmentplan.Myc lientspayapremiumformyexpertiseandgetthemedicationsatminimaltonoprofittomypractice."Paymeformyknowledgeandnotforthepaste,pil ls,l iquid,ect."Itallevensoutintheend.Lowcostexamanddiagnosticspricesbutveryhighmarkuponmedicationsvs.highercostexamanddiagnosticsbutlowmarkuponmedications.Intheendit'sthesame.Ifyouwanttoknowsomeinsighttothisthough---Peopleappric iatethe"services"farmorethananymedicationsyoudispense.That'swhypeoplel ikethispracticeconcept.Theyknowthey'repayingforprofessionalservicesandnotbeingbentovertotakeitintheshortsformedications.Peopleknowwhatdrugscostsarethesedays---theyjustgoonlineandlook.Idon'tgetmanycallsaboutmymedicationscostsevenafterpeoplehavelookedonlineandcompared.Irarelyevergetanybadfeedbackaboutmyprofessionalservicesfeeseither----theyknowtheygottheirmoney'sworthbecausetheyneededaprofessionaltodiagnosetheproblemandtheyonlycalledmebecausetheirfriends,therepsychic,theirtrainer,theirfarrierandeventheirchiropracter/accupuncturistcouldn'thelptheirhorse

5/16/20137:28PM

16 I'mnotsureIunderstandthequestion-doyoumeanafeetothestate?allmedicationsprescribedordispensedwouldhaveacosttotheownerandthedispensingpharmacy

5/16/20133:16PM


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17 Wedochargeafeeforcompundinginhospital.Asfarasthepharmacies,Iamunsure. 5/16/20133:03PM

18 anddon'tcare?Generally,Iletthepharmacybil l thec lient.Istayoutofthatloop. 5/16/201312:39PM

19 GoshIhopeso...Ihonestlydon'tknow. 5/16/201311:55AM

20 Not100%surebutthinkso. 5/16/201311:34AM

21 Petownersusuallyhavetopayfortheirmedications.Iknowofnolawstatingwemustdispensemedic ineforfree. 5/16/201311:18AM

22 Iwil lhavetocheckintothisasIhadnotideathatanystatesdifferentiatedbetweenmedicationsbasedontheirorigin 5/16/20138:54AM

23 Thisisnotc larifiedinmystatelaw.Itneedstobe. 5/16/20138:45AM

24 Iamunsureofthequestions,therefore,Ioptedfor"Notsure". 5/16/20138:21AM

25 Seelastanswer.Wecannotdispensecompoundeddrugs.Thiswasalossinrevenueforus,butjustasmallone.Moreimportantlythepatientssufferneedlessly

5/16/20138:19AM

26 AsIsaidabove,wehavebeendispensingcompoundedmedicationsnotknowingthiswasnotincompliancewithourstate'spracticelaw(theabovespecific permissionwasaddedinFebruary2013),andweareintheprocessoffullcompliance.Thatsaid,IremainfrustratedthatitmakesanydifferencetotheFDAsincethisisnotaproblemforthenation'shealth.Itseemstometherearemuchmoreimportantproblemstobetryingtosolve.

5/16/20138:04AM

27 Reallydoesn'tapplyasIpracticeinashelterenvironmentandtechnicallyalltheanimalsareownerbytheshelterandallareundermycareforthedurationoftreatmentwithfulldiscretiononmypartastowhatmedicationbestsuitsthepatientsneeds.

5/16/20137:16AM

28 Wedoit,Iassumeitislegaltodoso. 5/16/20137:16AM

29 Recentchangeinlawinthisstate(VA) 5/16/20136:51AM

30 exotic practicerequiresalargenumberofcompoundedmedicationstoproperlytreatthepatientsappropriately. 5/15/201310:35PM

31 Iwouldthinkitdoes. 5/15/201310:21PM

32 Ihavebeenleadtobelievethatiswhatisrequired. 5/15/20132:45PM

33 wisconsin 5/15/201312:50PM

34 Seeabovecomment 5/15/201310:56AM

35 Compoundedproductscannotberesold,thatis,theycannotberelabeled,repackagedanddispensed.Dispensedcompoundedmedicationsmustbeintheoriginalprescriptioncontainerfromthecompoundingpharmacyandlabeledforanindividualpatient.

5/15/201310:10AM

36 Ourstateallowsit,butnotforanadditionalfee-notsurewhatthatmeans 5/15/20139:11AM

37 OftenIwil l ordercompoundedmedicationsfromapharmacy.Thepharmacysendsthemtomyofficeandtheownerpicksupthemedicationsattheofficeforthesamepricethatthepharmacybil ledmeinc ludingshippingcostsifapplicable.

5/15/20137:16AM

38 Tothebestofmyknowledgewearepermittedtodispensesmallamountsforacuteuse,suchaspost-oppainmedication. 5/15/20135:28AM

39 notabsolutelysure,butIdon'tthinksowithoutacompoundingl icense 5/15/20132:28AM

40 exceptforthefirstdose 5/14/201310:00PM

41 Notsure 5/14/20139:20PM

42 Againthisisoutrageous 5/14/20137:48PM


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43 I'mwonderingifthisquestionreferstomixingmultiplemedicationstogetherintheofficetomakeacombinationthatisnotFDAapproved.Wevirtuallyneverdothisinourpractice.

5/14/20137:05PM

44 Wefrequentlyencountersituationswheredrugsgoonbackorderorarecostprohibitive.Thislegislation,ifpassed,wouldcausemypatientstogowithoutmedicationsthatarenecessaryandneeded!Doxycyclineisagoodexample.Weusethisdrugeveryday.Itiscurrentlycostprohibitive.

5/14/20136:29PM

45 California,weareonlyallowedtogive3daystreatment,thenmustdirectc lienttoobtainontheirown.Wealmostneverknowiftheremainingprescriptionisgiventothepet.

5/14/20135:53PM

46 Unsure 5/14/20134:41PM

47 Mostofthetimeourcompoundedmedicationsaredispenseddirectlytotheownerbythepharmacy.Theexceptionswouldbeearmedicationsandinjectablemedications.

5/14/20133:08PM

48 IbelievetheanswerisnohereinPA 5/14/20133:01PM

49 Yes,butitdoesnotpermitveterinarianstodothecompounding.So,forinstance,ifapatientneedsacompoundedmedication,l iketransdermalmethimazole,andthec lientdoesnotwanttodealdirectlywiththecompoundingpharmacy,wecanorderithereandselli theretothec lient;itcomeslabeledforthatpatient.

5/14/20132:26PM

50 I'mneversureifthecompoundingpharmacyusedormixedthemedicationproperly. 5/14/20131:56PM

51 Wedispensecompoundedmedications,butIamnotsureifthereisanadditionalfee. 5/14/20131:30PM

52 Aslongastherearenoethicalproductsavailable. 5/14/20131:06PM

53 Regardlessofwhetheriti tpermissibletochargeafeefordispensingcompoundedmedicationstopetowner,Idonotchargeanyadditionalfees.Petownersarechargedthecostofthemedicationandareasonablemark-up.

5/14/201312:51PM

54 Recentchange,whichcomplicatesthingsforus,especiallyforbuprenorphine.Theregularmedicationhasbecomesoexpensive,butweuseanddispensetheoralcompoundedbuprenorphineeveryday.

5/14/201312:48PM

55 Wearesupposedtochargethesamethingthatthecompoundingpharmacychargesusforaccompoundedmedicationbutofcoursewecanchargewhateverwewantfornon-compoundedmedicationsthatwestock.Thisdoesnotseemtobetherightwaytodothis-it'sourbusinessandourabil i tytochargewhatthemarketwil lbearandthatitshouldbethesameforallmedications.

5/14/201312:42PM

56 Nocompoundedmedicationiseverdispensed/prescribedforfreebyourpractice. 5/14/201312:34PM

57 Mystatespecificallysaysthatunlessacompoundwasmadeforaspecific patientthatitcanonlybeusedinmyoffice.Icanorderacompoundforaspecific patientandthendispensethatcompoundtothatc lientbutnottoanyotherc lient.

5/14/201312:31PM

58 Again,notaspecific concernforourorganization(zoo)soIhaven'tlookingintostatelawonthisissue.Iwouldthinkthatitwouldbecomeveryconfusingiftherulesweredifferent.

5/14/201312:12PM

59 emergencyusage 5/14/201312:08PM

60 Butmycompanydoesnotallowthis,weareonlyallowedtodispenseenoughunti ltheirprescriptionisfi l led. 5/14/201312:07PM

61 Yadayada 5/14/201311:23AM


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Q11TheSenatelegislativeproposalcontainselementsthatmayormaynotaffecthowyoupracticemedicineandtheavailabilityofcompoundedpreparations.

Foreachoftheseproposals,pleaseindicatetheimpactitwouldhaveonhowyouprescribeand/orpatientoutcomesifit

werethelaw.Answered:951 Skipped:79

Limitactivepharmaceutic...

Requireyoutodocumenton...


51/89

Restrictyourabilityto...

Openthepossibility...

Allowfederalofficialsto...


52/89

78.08%741

18.44%175

3.06%29

0.11%1

0.32%3

949

64.21%610

28.00%266

7.05%67

0.32%3

0.42%4

950

80.04%758

16.16%153

3.59%34

0.00%0

0.21%2

947

ALargeNegativeImpact SomeNegativeImpact

NeitherPositiveNorNegativeImpact SomePositiveImpact

ALargePositiveImpact

Allowfederalofficialsto...

Allowonlypatient-spec...

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

ALargeNegativeImpact

SomeNegativeImpact

NeitherPositiveNorNegativeImpact

SomePositiveImpact

ALargePositiveImpact

Total

Limitactivepharmaceuticalingredientsthatcanbecompoundedtoanumberthatcouldbemuchlowerthanthe250+incommonusenow,forexampleadozenortwo.

Requireyoutodocumentoneveryprescriptionwhythecompoundedmedicationwil lmakeasignificantdifferencetoyourpatientcomparedwithamanufactureddrug.

Restric tyourabil i tytoordercompoundsforofficeuse.


53/89

758 153 34 0 2 947

81.22%770

16.03%152

1.79%17

0.53%5

0.42%4

948

90.60%858

7.71%73

1.06%10

0.21%2

0.42%4

947

73.21%694

20.25%192

5.38%51

0.74%7

0.42%4

948

62.63%595

25.47%242

10.63%101

0.53%5

0.74%7

950

# Pleasefeelfreetosaymoreaboutyourresponses. Date

1 Withthelargevarietyofspecieswetreat,wecannotberestric tedtocompoundingonlycertaindrugs.Weneedtohavealloptionsavailable!Forexample,withanantibiotic ,weneedtousewhatantibiotic wil lbesttreatthebacteria,andifthepatientissensitivetothatantibiotic andcannottolerateit,weneedtohavetheabil i tytouseotheroptions.Also,withsomespeciesl ikerabbits,therearealotofantibioticswecannotuse,ortheywil lbefatal.Sowearealreadyl imitedonourchoicesfromthebeginning.

5/23/201310:07AM

2 Animalsarenotalwayseasytomedicate-flavoredl iquids,transdermals,chewiestremendouslyhelpmyc lientstohelptheirpets.Compoundingalsohelpsmepracticemedic inewhenmanycompanieshave"maufacturebackorders".Byhavingsomestocksuppliesofmedicationsthatarenotavailable(ie:DES)Icantreatpatientsasneededwithoutaweekwait.

5/20/201310:10PM

3 Iwouldl iketoseethierveterinarymedicaldegreeortheirpharmacydegreebeforeIgivethemtheauthoritytodecidehowtotreatpatientsanddecidewhogetwhatandhowdoesn't.Wearemovingfartherandfarthertowardssocializedmedic ine!!!!!

5/20/20139:02PM

4 Compoundingforthehospitalbyawellregulatedcompoundingpharmaciesallowsustodispenseneededmedsthatmaynotcosttheowneralotofmoney.Toooftencommondrugsthatwehaveregularpharmaciesdispenseareremovedfrmthemarketmakingthetreatmentofcertaindiseasescostprohibitiveforowners

5/20/20138:58PM

5 Restric tingcompoundedmedicationsl ikethiswouldbedevastatingtomostpractioners.Andhavingpeoplewhoarenotindailyprivatepracticeisevenworse;theycannothaveanyideahowthesedecisionaffectthedaytodayofveterinariansandtheirpatients.

5/20/20131:00PM

6 Manydrugsarebecominglessandlessavailable(backorderandthel ike),ortheyarenotavailablecommerciallyinanappropriatesizeorformforaspecific patient.Ifcompoundingpharmacieswereunabletoprovidethemedicationsthattheydo,manypatientswouldbeunabletogetthemedicationstheyneed,whichsometimescouldresultinal i fethreateningsituation.

5/20/201311:58AM

7 Asashelterveterinarian,compoundedmedicationsarecrucialtocombacttickbornediseases,contagiousupperrespiratoryil lnesses,etc.

5/20/201310:24AM

8 Nothavingmedicationsreadilyavailablejustaboutmakespracticeimpossible.....ticksoffpetowners.....steelsrx'stolocalpharmacieseventhoughpeopledon'tnecessarilywanttogoelsewheretopickupsomethingelse.

5/20/20137:23AM

9 Idonotunderstandwhyitshouldbeaproblemforaveterinarypracticetostockanddispensecompoundedmedicationssuchasmetronidazoletablets.Thedrugisnotavailablecommerciallyinappropriatedosagesforoursmallanimalpatients.Conditionsforwhichthisdrugisprescribedoftencausedebil itatingdiarrheaandrequireimmediatetherapy.Thesepatientswouldsufferunnecessarilyifforcedtowaitforanindividualprescriptiontobepreparedandshipped.Whyisitaproblemformetohaveitavailableforimmediateuse?Iwishsomeonecouldexplainthistome.

5/19/20137:53PM

10 ItwouldtakealargeamountoftimetocompoundmedicationsinmyofficeforeachpatientthatIuseinhousecompoundedmedicationsin.ThiswouldultimatelyreducethenumbersofcasesIcanseeduringtheday,reducingmyincome.

5/19/20131:46PM

Openthepossibil i tyforafederaloffic ialtodefinewhatmakesa“significantdifference”forapatientbetweenamanufactureddrugandacompoundedmedication.

Allowfederaloffic ialstorestric toreliminatecompoundinganyvariationofamanufactureddruginc ludingchangingthedoseordosageform.

Allowfederaloffic ialstodecidewhethercompoundsfordogs,catsandhorsesmustbemadefrommanufactureddrugsinsteadofbulkactivepharmaceuticalingredients.

Allowonlypatient-specific prescriptionsforcompoundedmedications.


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11 Mystatelegislationisalreadyhavingasignificanteffectonseveralofthese. 5/19/201310:27AM

12 TherearealreadyguidelinesinplaceaspublishedbyAVMAtodealwithcompoundedmedicationsandIbelievetheyareprettyexhaustive.Insteadofmakingthewholeprocessmorecomplicatedwhydoesthegovernmentjustholdcompoundingpharmaciesandveterinariansaccountableforwhatisalreadyinplace.And,asacompoundingpharmacy,whydoyounotupholdthelawinsteadoftryingtoincreaseyourrevenuebyfi l l ingmedicationandadvertisingmedicationthatyouknowarebeingrequestedinanil legalmanner.Thesepracticesare,inpart,whathasledtothissituation

5/19/20137:28AM

13 Compoundinghasawidedefinition.forexampleifImixthemanufactureddrugwithpedialyteinsteadofwaterthatiscompounding.Idon'tfeelIhavetodocumentareasonwhy,justthatIuseanalternativediluent.

5/18/201310:43AM

14 TherearemanyreasonstousecompoundedmedicationsthatIdonotfeela'federaloffic ial 'isalwayscompetenttomakeappropriatedecisionsregarding.Thepracticeofmedic ineshouldbeleftinthehandsofveterinarians.ManyofthedrugswecanusethatareFDAregulatedaresti l l offlabelandwehaveabetterunderstandingofourpatientsneedsandrisks.Unti lthereareveterinaryspecific pharmacistsavailableincommonpharmaciestonotepatientsafetyatacosteffectivepricethiswil lmakemanytreatmentoptionscostprohibitiveforc lients.Thedelayformailorderisalsodangerousformanyconditions.Whowil lbepayingfortheoversightofthislaw?

5/18/20139:15AM

15 Doctorsshouldbegiventheauthoritytodeterminethebestcarefortheirpatients,notlawyersandlawmakerswithnomedicaltraining.

5/17/201310:32PM

16 Ifourpatientswereallthesamespeciesandsamesize,thiswouldbelessofanissuebutgiventhatourpatientsweighfromouncestotons,weneedtohavetheabil i tytouseourtraininganddiscretiontoprescribeaccordingtothepatient'sneeds.

5/17/20139:50PM

17 Caughtmeatanegativetime.MoreBigBrother. 5/17/20133:49PM

18 Manyofthemedicationsusedareformulatedforhumansandwithoutcompoundingitcanbeincrediblydifficult,i fnotimpossible,toproperlydosethesemedications.Thesearequalityofl i feandqualityofcareissuesandtheseanimalsandtheirownersdeservethebestpossiblemedicalcare.Limitingcompoundingwouldcreateahugenegativeimpactontheveterinarymedicalcommunitiesabil i tytoprovidethebestcarepossibleandcouldleadtounnecessaryeuthanasia.

5/17/20133:03PM

19 Iftherewasn'tsuchaproblemwithmanufacturedproductbackorderstherewouldn'tbesuchaneedforcompoundedmedications.Theimpactofnothavinganalternativetoturntowouldhaveahugenegativeimpactonthepatientshealth.

5/17/20131:59PM

20 thegov'tisTOOinvolvedwithcompoundingmedsforpets.....thereaseonweturntocompundingpharmaciesisbecausethegov'tkeepsremovingitemswehaveusedforyearsandthenwhenthearebackonthemarket,theitemsare3-10timesmoreexpensivethantheywereoriginallyandhavebeenforyears.Weturntocompoundingpharmaciesalsotomakeitmoreaffordableforourc lientstotreattheirpets---otherwisetheycan'tandthentheyeuthanizetheirpet......

5/17/201310:52AM

21 Weareveterinaryprofessionalsandwantthemosteffectivedrugforthebestpriceforourpatients.AnddoingalotmorepaperworktogettxforthemisNOTneeded

5/17/20138:56AM

22 Somanyanimalswouldloseaccesstol i fe-savingtreatmentsbecauseoftheserestric tions. 5/17/20136:34AM

23 AgainIfeelitisthedoctorsresponsibil i tytodeterminewhatisthebesttreatmentoptionforapatientbasedoneachindividualcase.Duetothevarietyofspecies,optionsareveryl imitedtoveterinariansandduetothecostsofdevelopingandmarketingalternativedrugs,varyingdosages,drugforms,andespeciallyapprovalbyspecies,unlikethehumanfield,wemustbeabletodevelopeffectivetreatmentsforourpatients.Morel imitationswil ljustpreventusfromeffectivelytreating,andforcemoreveterinarianstocompoundil legallytobeabletotreat.

5/16/201311:38PM

24 Manytimespatientsneedmedications"rightnow"ifIcannotstocksomeofthesemedicationsitcouldputananimalsl i featrisk. 5/16/20139:36PM

25 Whentreatingi l l patients(especiallyavianpatients)thedelaytoobtaincompoundedpatient-specific medscouldbefatal. 5/16/20138:36PM


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26 Intheruralareawherewepractice,itcantakeaweekorlongertoreceivecompoundedmedications.Ifwemustorderacompoundeddrugforthespecific patientratherthanpre-purchasingastrengthweexpecttouseincertaindiseaseprocesses,thedelaycouldbedetrimentaltothehealthofthepatient.

5/16/20135:55PM

27 Somemedicationsarenottheappropriatesizeforsomeofthesmalleranimalsandthereforecompoundingissaferandmoreaccurate.Also,withallthedrugshortagesourpatientswil lsufferifwecan'tgetthemedicationweneed.

5/16/20135:36PM

28 Compoundedmedicationsarelessexpensivethanmanufacturedmedications,andIunderstandtheneedofthepharmaceuticalcompaniestoprofitfromtheirresearch/developmentinvestments.Ialsoamwaryaboutthequalitycontrolandconsistencyofcompoundedmedicationsbasedonstudiesdone,forexample,oftri lostane.Ifeelcompoundingisessentialformanycatsthatcannototherwisebemedicated.Ican'tl ivewithoutleave-ineartreatments!

5/16/20132:53PM

29 Thegovernmentshouldstayoutofourprofession.Wealoneweretaughtpharmacology,notthem.Thegovernmentistheworstorganizationforcompetencyandhonesty.

5/16/20132:04PM

30 Thesearealldecisionsthatshouldbemadeforthespecific patientbytheattendingveterinarian. 5/16/20131:39PM

31 Ithinkthereshouldbemoreofafocusonensuringthestockofcompoundedmedicationsisformulatedcorrectlyandfromappropriateactiveingredientssothewhenhospitalsdoneedthemforstockbottles,wecanrestassuredthemedicationsaresafeandeffective.Thefactremainsthoughthatwedo,asawholeprofession,continuetohaveaccesstoin-housecompoundedformulationsformedical,humaneandfinancialreasons.

5/16/20131:37PM

32 Ithinkitwouldbedifficultforfederaloffic ialstounderstandhowtodefinenewlawswithouthavingtodealwithtreatingpetsonadailybasis.Theycouldnotpossiblyknowwhathurdlesveterinariansmaycomeupagainstforindividualpatientneeds.

5/16/201312:46PM

33 IwishIhadsomethingsarcastic tosaythatwouldmakelightofthissituation.Mrobamahaslotsofothercountrieshecouldl iveintoru(i)n.

5/16/201312:42PM

34 Havingpolitic iansdictatehowIusecompoundedmedicationsinmypatientsisaoutrageous.Thisisasridiculousashavingsomeonelikeme(whosetrainingisinsc ienceandveterinarymedic ine)headingtheCIA.Ifeelcertainthatmostpolitic ianshavelittleunderstandingofwhyweneedcompoundedmedications.Ialsofeelcertainthatmostpolitic iansdonotrealizetheimpactthislegislationwouldhaveontheaveragepetowner.Forsomeofmypatients,theinabil itytochangetheformofadrug(fromaregular5mgtabletintoa5mgchicken-flavoredtablet)wouldhavecostthemtheirl ives.Ichallengethelegislatorstoadministerapil l toanunhappycateverydayfortherestofit'sl i fe.Thepolitic iansneedtofocusonthingsthattheyactuallyhaveknowledgeof,andnotpunishtheaveragepetowner.Ittakesaveterinarianordevotedpetownertounderstandtheuniquechallengesweface.Successfullytreatingmanyconditionsinanimalsrequirestheabil i tytogetthedrugintotheanimal,theabil i tyforthepetownertoaccessthedruginatimelymanner,andtheabil i tytoaffordthemedication.Alltheproposalsl istedabovewil lgreatlyimpairtreatmentofanimals,andleadtounnecessarydeathandsufferingoftheanimalsweareheretoprotectandcarefor.-KristyBaranik

5/16/201312:28PM

35 Irefertomyoriginalstatement 5/16/201312:26PM

36 1.Compoundedmedicationsimproveownercompliance.2.Manyanimalsaretreated,thatwouldsufferifcompoundingwererestric ted.

5/16/201311:52AM

37 Justsubstitutebigpharmaforfederaloffic ialthenthissurveymightgetc losertotheTruth! 5/16/201311:48AM

38 Somecompoundeddrugsarecommonlyusedl ikeDES.ItusedtobeavailableasahumandrugbutnowisonlyaVeterinarydrug.Therefore,humanpharmaciesnolongercarrythismedic ine.

5/16/201310:35AM

39 Tothinkthatsomeonenotdirectlyinvolvedinthedecision-makingprocessofapatient'scarecanmakereasonabledecisionsregardingthatpatient'scareisaskingforsignificantproblems.

5/16/201310:20AM

40 Myhospitalworksonavianandexotic species.Sotherearenodrugsavailableotherthancompoundeddrugs.Soitwoulddestroymypracticeandmakealotofanimalsnotgetthepropercaretheyneed.

5/16/201310:20AM


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41 Ifthefederaloffic ialsinc ludedveterinariansandtheirinputwastakenseriously,Idon'tseehowtheywouldallowsomethingl ikethistohappen.

5/16/201310:04AM

42 Alloftheseinitiativesseemtobeforthebenefitofthepharmaceuticalcompanyandarec learlynotdesignedtosupportthehealthneedsofourcriticalcarepatients.

5/16/20139:38AM

43 Thiswouldbeanightmare.I'mnotsurewhytheywanttodothisbutitsoundsl iketheonly"good"itwil l doiscostmoney,taketimeandmakeitmoredifficulttoappropriatelytreatourpatients!

5/16/20139:27AM

44 Veterinariansneedtobeabletomakethedecisionsforindividualpatients,notnonmedicalpersons.Notevenphysic ians. 5/16/20139:19AM

45 Iwantsaidlegislatorstotrytogiveanirate,sickcatwithallc lawsandteethsomeMetronidazole.ThatoughttoshowthemWHYweneedalternateformatsformedications,especiallywhenmultiplemedicationshavetobegiven.

5/16/20139:04AM

46 MyGod,thelastthingweneedissomenumbnutfederaloffic ialdecidingwhata"significantdifference"means.WelcomeBigBrothertotheNannyState

5/16/20138:52AM

47 Availabil i tyofmanufactureddrugshasbeensporadicrecentlywithmanybackorders.Compoundingallowsustodealwithinterruptionsinavailabil i tyandrestric tsdrugcompaniesfrommonopolytactics.

5/16/20138:48AM

48 Youmisspeakinusingtheterm"significantdifference"sincetheproposedlegislationusestheterm"c linicaldifference"andthatiswhatveterinariansshouldbestrivingforanyway.Your5thpointisfalse-compoundingpharmacieswil lbeabletocompoundvariationsofmanufactureddrugs.Asaprofession,weneedtotakemoreresponsibil i tyforouractionsrelatedtorecommendationanduseofcompoundeddrugs.Theproposedlegislationisabigstepintherightdirection.

5/16/20138:45AM

49 Itisobscenetothinkfederaloffic ialscouldtietheveterinarianshandsinwhattheydetermineshouldbeavailableorindicatedforpatients.Thereisasimpleanswer-iftheywantto"Fix"theincreaseduseofcompoundingpharmacies-thefocusshouldbeontheongoingdramatic increaseinbackorders,drugsnolongerbeingmanufactured(criticalandnoncritical),nonsubstantiatedpriceincreasesthatrenderthemanufactureddrugunusable.Noc linic wantstousemorecompoundeddrugs.Ittakesfromourbusinessbottomlineineveryway.ItistheONLYwaytoprovidethetreatmentourpatientsneed!!

5/16/20138:38AM

50 Idon'tknowwhattheimpactofthel imitationofwhatmedicationscanbecompoundedsinceIdon'tknowwhatmightbeonthel ist.Itmayhavenoaffectonme,orcouldbesignificant.Thesameistrueforsomeoftheotherrestric tions-theymayhavenoimpactonhowIpracticeormayhaveagreatimpactdependingonwhatthoserestric tionsaretobe.

5/16/20138:28AM

51 Compoundedmedicationsarevitaltothecareofcompanionanimals.Typingtheprescribingofthesemedicationsupwithredtapeoreliminatingtheiravailabli l i tywil llowerthestandardofcareforcompanionanimals.Thesepetswil lexperiencelongerandmorepainfulrecoveryfromsurgeryandi l lnessandanoveraldecreaseinqualityofl i fe.

5/16/20138:26AM

52 Unlessthedrugcompaniesaregoingtodrasticallyexpandthevarietyofmanufactureddrugsinc ludingdosageformsandsizes,compoundingwil lcontinuetobeessentialfortheeffectivepracticeofveterinarymedic ine.

5/16/20138:13AM

53 Therestric tionswil ldramaticallyl imitavailabil i tyandvarietyofdrugsinotherformsandconcentrationsthatwil limpactanimalhealthnegativelyinalargeway.Animalswil ldiesimplybecausetheirownersarenotabletomedicatethemwithamanufacturedoraldrugandhavenoalternativeformsthatcanbecompoundedandadministered.Otheranimalswil ldiebecauseasitisdrugsareexpensivetocompoundinmanycasesandsuchregulationwil lmakeitcostinhibitiveforownerstocontinuetherapiesthatkeeptheirpetsalive.Verysad.

5/16/20138:01AM

54 Itisveryimportantthatweveterinariansretainourabil i tytotreatnumerousspeciesofwidelyvaryingsizestothebestofourabil i ties.Thismeansmaintainingtheabil i tytoadministerandprescribecompoundedmedications.

5/16/20137:53AM

55 TooMUCHGOVERNMENT!!! 5/16/20137:50AM


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56 alreadythedocumentationthatwearedoingistakingasignificantamountoftimetodoonadailybasis-thereareonlysomanyhoursinmydayandthepatientscomefirst!

5/16/20137:47AM

57 Theselawsareessentiallymakingmakinglawmakersbreakthelawbyhavingthempracticemedic inewithoutal icense. 5/16/20137:40AM

58 Iamalreadyrequiredtousepatientspecific Rxs 5/16/20137:19AM

59 Thislegislationisjustmakingourjobsharderandaddinglotsofunnecessarypaperwork.Theyneedtojustletuspracticemedic ineandstopputtingl imitationsonhowwepractice.Itisbadenoughtheyaretyinghumandoctor'shands.

5/16/20137:17AM

60 WhatinGod'snamewouldhaveusthinkthatfederaloffic ialscanbetrustedtomakeagooddecisionfromoutpatients'pointofview?

5/16/20137:09AM

61 WhydoIgetthefeelingthateitherbigcorporatedrugmoneyand/orObamacareisbehindallthisnonsense!!justanotherefforttoputmomandpopoutofbusiness.Tellthesementalmorons(senators)whohavebeenboughtandpaidforinreturnforpoliticalfavors,thatidon'thearmypatientscomplaining.WhatIseeismypatientsgettingbetteroristhatnotimportanttothesecretins(senators).Afterfluroshingfor2000yearsnowIknowwhytheRomanEmpirecollapsedandfailed:theytoohadasenate!!

5/16/20137:04AM

62 Ittakessomuchtimetohaveamedicationcompoundedtospecific patientsthatitmayimpactsurvivalofthosepatientsneedingitimmediately.

5/16/20136:57AM

63 seeabove 5/16/20136:57AM

64 Weseealotofexotic animalsforwhichtheproperdosagedoesnotexistwithoutcompounding.Inaddition,maycatownersareunabletogivepil lstotheircatsinwhichcasecompoundingadrugtol iquidformiscrucial.

5/16/20136:55AM

65 Clinicallyitismuchbettertohavesomeofthesemedicationsonhandforpatientsthatneedthemnowandnothavetowaitforthemtobemadeandsenttothec lient.

5/16/20136:42AM

66 compoundedmedicationisneededtoadequatelytreatmanyexotic species.PleasedoNOTlimittheirusage 5/15/201310:38PM

67 Idon'tfeelthatthepeoplemakingthesedecisionshaveagoodworkingknowledgeofveterinarymedic ineandhowitdiffersfromhumanmedic ine.Ahumandoctorprescribesamedicationandthepatientpicksitupfromthepharmacy.Withanimalpreparations,pharmaciesarenotthatwidespreadandthusoftentimesthepreparationsmustbeshippedandthelagtimefromdiagnosistotheonsetoftreatmentcanbedevastating.

5/15/20137:34PM

68 Patientsoftenrequireimmediatetreatmentandcannotwait1-2daysformedication.Howobviousisthis? 5/15/20135:43PM

69 Aslongasthebulkpharmaceuticalsingredientsaresafeorinspected,ItrustthecertifiedcompoundingpharmacisttomakethedrugsIaskfor.Theyhavebeenagreatboontofelinepracticeandhealth.Itwouldbeverydifficulttopracticemedic ineotherwise.Catsarenotsmalldogs,whobythewayalsobenefitfromcompoundedmedications.Regulatetheingredientsnotthedistributors.

5/15/20133:46PM

70 Therewasalreadyalargenegimpactwhenourstatestoppedallowingcompoundsforofficeuse 5/15/20133:19PM

71 Backorderedmedicationsandpatientdosingaccordingtotheirweightarethebiggestreasonswecompound.Sickorinjuredpatientscannotalwayswaitunti lthereprescriptionisfi l ledatacompoundingpharmacy.Itispreferredtostartthemonmedicationinourhospitalandthenhaveitcompoundedtothespecific patient.

5/15/20133:19PM

72 Allofthesewouldnegativelyimpactourabil i tytotreatourpatients.Iunderstandtheconcernswithcompoundingpharmaciesbutweshouldleaveitinthehandsofthecompoundingpharmacytouptheirstandardstopreventissuesl ikecontaminationandletveternariansmaketheirowninformeddecisions.

5/15/20131:57PM

73 Thisisabsurd!Ourveterinariansarefarmorequalifiedtoprescribeandadministermedicationsthana"federaloffic ial"whohasnoideaofindividualpatientneeds.Thereisnoproblemwiththecurrentsystem,sothereisnotrueneedtocreateadditionallegislationtol imittheavailabil i tyofmedicationsandcompoundsthatareoftendifficulttoobtainthroughpharmaceuticalcompanies.

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74 Tohavefederaloffic ialsl imitcompoundingwhenthereisalsomanufacturingisahugenegative.TheMOnowistoremoveamanufacturedproductfromthemarket,thenputitbackonatahugelyinflatedprice.Thelegislatureworkswiththemanufacturertokeeptheproductfrombeingcompoundedifthereissomeonemanufacturingit.Thisisinterferencewithfreetradeandcommerce,butthelegislaturedoesitbecausetheyarebeingbribedwithcampaigncontributions.

5/15/201311:39AM

75 Ibelievepatient-specific prescriptionsallowgreateraccountabil i tyfortrackingprescriptionmedications,ensuringthatexpiredmedicationsarenotdispensed,andl imitingtheamountofpharmaceuticalwastefromapractice.

5/15/201311:26AM

76 Whilethereshouldbesomeexceptions(perhapsamaximumofa48-72hoursupplyofmedsdispensedfromofficecompoundswhenthevetneedstogetapatientstartedonamedbeforeitcanarrivefromthecompoundingpharmacy),Ibelievethatcompoundedprescriptionsshouldbefi l ledforanindividualpatientaccordingtospecific patientneeds.

5/15/201310:15AM

77 Iamonlyallowedtodopatientspecific prescriptionsandcannotmaintainofficestock,thereforitisadrawonthosetwoquestions.Iwouldlovetobeabletodobothofthosethingsthough.

5/15/201310:07AM

78 Wearealreadystrugglingwithshortagesofpharmaceuticaldrugs.Forexample,manymedicationsarenotavailableduetomanufacturingproblems.Nowthereisgoingtoberestric tionsoncompoundedmedications?!?MyhandsaregoingtobetiedandIwil lnolongerbeabletopracticemedic inewithoutsupplies.

5/15/20139:57AM

79 Theverylastthingthisgovernmentneedstodoistobecomelarger,moreintrusive,andtofurtherinhibitthepracticeveterinarymedineandfurtherrestric tsmallbusiness.Idonotseeanyproblemwiththewaythingsarenow,sowhyintroducemorecumbersomeandcostlyregulations?

5/15/20139:56AM

80 Ourprimaryreasonforuseofcompoundeddrugswouldbethatitiscommerciallynotavailablefromdistributor/manufacturerduetobackordersituationsandnoproductthathasbeenmanufacturedforpurchase.

5/15/20138:54AM

81 Ifyoul iveinanareawithoutanimmediatelyavailable,24hourlocalcompoundingpharmacy,patinet-specific prescriptionsrequireusingamail-orderpharmacytodispensecompoundedmedications.Bydoingso,patientsmaybedelayedinreceivingtheirprescriptionsby1-7days.Forsomemedications,thisisnotcritical.Butforantibioticsorl i fe-savingmedications,thisdelaycouldmeanthedifferencebetweentreatmentsuccessandfailure,andcertainlythedelaywouldcontributetoreducedqualityofl i feforthepatient.Bybeingallowedtodispensecompoundedmedicationsfromhospitalstock,thisdelayiseliminatedandpatientscanbetreatedeffic ientlyandeffectively.

5/15/20138:41AM

82 SomearetheseresponsesaredifficulttogaugeunlessIknowhowthefinalbil l wil l beputtogether..Allinall,anychangeinthewayweusecompoundeddrugscouldbeproblematic toourc lientsandtheirpets

5/15/20138:36AM

83 Thisiscrazy.Anyoneoftheseproposalsbeingimplementedwouldhaveaterribleimpactonthepetsthatwecarefor.Weneedcompoundedmedicationsinorderto1)havesuchmedicationson-handforemergencycases,2)helptocureinfectionand/orreducepainimmediately,and3)allowourc lientstoobtainthesemedicationsoutsideofourhospitalatareasonablecost.

5/15/20138:00AM

84 Theseproposalswouldchangemuchmorethanjusthowac lient/patientgettheirrequiredmedications.Manyoftheseproposalswil laddasignificantamountoftimeneededtoprescribemedicationstothosewhoneedit.Theserequirementsareaskingforfartoomuchtime,morethananybusyVeterinarypracticecanspare.Ifeelthatthepatientswil lbetheoneswhosufferthemostasmostVeterinarianswil ltrytofindnewwaysofdealingwithi l lnessesthatwil lbypasstheserestric tions.

5/15/20138:00AM

85 Itwil l ultimatelydrivecostsofpracticeup. 5/15/20137:44AM

86 Youcan'tgeneralizeveterinarymedic ineacrosstheboard.Eachpatientisuniqueandtheirneedsarespecific tothem.Veterinariansneedthefreedomtodoseeachpatientasseenfitforthatcase.

5/15/20137:27AM

87 Theimpactofrestric tionswouldbeprofound....andwhatisthemotivatingfactor?Istheresomethingbrokethatweareunawareof? 5/15/20135:49AM

88 Itiscriticalthatwebeallowedcompoundedanalgesicsforanesthetic use. 5/15/20135:30AM


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89 Anytimegovernmentandnon-medicalindividualsattempttoregulatemedic ine,itisNEVERapositiveoutcome.Ifailtoseethebenefitofrestric tionswhichwouldmakeitMOREdifficultformetoofferhelpfulmedicationstomypatients.

5/15/20135:26AM

90 Ithinkthemedicaldecisionsforjudic ioususeofcompoundedmedicationsarebestlefttoveterinarianswithoutregulationfromagovernmentagency.Asapractitioner,Iunderstandthel imitationscompoundeddrugshavecomparedtonon-compoundeddrugs/formulations.Becauseofthis,Ichoosetousecompoundedmedicationsforc lientsoccasionally,whenthereisnootherchoice.Non-veterinariansinthegovernmentthatareproposingthislegislationmaynotrealizethatvirtuallyallzoospecieswil lbeleftwithoutanytreatmentforvariousdiseases,becausethereisnolabelledproducttouse,thisallowinglargescalediseaseandsuffering.Animalshelterswil lbeunabletoeffectivelyorhavefundstotreatthesufferingandsuckanimalsintheircare,leadingtomanymoreeuthanasiasthanisnecessaryThisisahugestepbackwards.

5/15/20135:16AM

91 Humanscomeinsmall,medium,andlarge.Theyallhavethesamephysiologyandcanusethesamedrugsinjustafewstrengths.Butinvetmedthatisnotatalltrue.Youcan'tdosedownahumandrugforacanary.Andyoucan'tfeedanelephant750tabletsthreetimesaday.WeneedtobeabletocompounddrugstomeetaHUGEvarietyofpatients.

5/14/201310:05PM

92 Manyofthesefederaloffic ialsdecisionsandregulationsarel ikelytoresultinamarkeddecreaseinavailablemedicationsforanimalsinthatmanyofthecompoundedmedicationsareformerhumanmedicationswhichwerelegalforaveterinariantoprescribeoradministerwhentheywerebeingmade,buttheyarenolongerproducedonthehumanside.

5/14/20139:47PM

93 Asaneducatedperson,IfeelthatIshouldn'thavetoexplainwhyacompoundedmedicationwouldworkbetter.Whatawasteofmytime.

5/14/20139:24PM

94 Ireallydon'tbelievethefederaloffic ialsshouldhavesomuchsayinveterinarypracticeastheydon'thavethesamedegreeofeducationastheveterinarian,whoshouldbetheonemakingdecisionsforthepatients.

5/14/20139:16PM

95 Thepharmacythatcompoundedthecorticosteroidthatcausedfungalmeningitisc learlyhadotherissueswithsteri l i ty&procedures.That'swheretheregulationneedstobe.Alocalpharmacyheremadea1000xerroroncompoundedHWpreventative(ieMGvsMCG),sotraining&qualificationsarecritical.Makingmedsunavailabletocompoun[forprimarilysmallpets]isabsolutelyunacceptabletomylevelofpatientcare.

5/14/20138:56PM

96 "afederaloffic ial"-areyoukiddingme.I'vebeeninpracticeforover25years,howisthefederalgovernmentgoingtofindsomeonewill ingtoworkforthemwhoknowsanywherenearwhatIknowaboutcatdiseasesandwhatmedicationstheyneed...andalsoknowaboutbirds,andhorses,anddogs,and........arethey(deletetheexpletive)kiddingme!

5/14/20138:28PM

97 Aretheseoffic ialsgonnastarttell ingmehowtopracticeveterinarymedic inenext!Aretheyalsogoingtobethereorpublic allyexplaintoourc lientswhytheyfeeltheneedtomakemedicaldecisionsforus?Dotheydothisinthehumanfield,orareourmdsjustbetterequippedtounderstandwhentheyareactuallyusingcompoundedmeds?

5/14/20138:19PM

98 Withtheconstantshortagesandunreasonablewildlyincreasedpricesofmanycommondrugs;sometimescompoundingistheonlywaytoaccessthosedrugs.

5/14/20138:09PM

99 There'snothingthatwouldbemoredamagingtoourpatientshealthandourabil i tytocareforthem. 5/14/20137:50PM

100 Otherthanbigpharma,who/whatisdrivingthiscrazyrestric tions?Drugsareoftennotmanufacturedintherightsizesortherightmethodofadministrationtoallowustotreatanimalsofawiderangeofsizesandtypes.Howmanymedsarecommerciallymadeintuna-flavoredl iquid?

5/14/20137:09PM

101 Thefederalgovernmentdoesnothavetheknowledgeofthedrugs(unlesstheyhavebeenapractic ingveterinarianinthefield)northenegativeimpactonowner/parentstressofnotbeingabletotreattheirpetandl iterallythatmanypetswil lnotgettheproperdoseorwil lendureterriblestressordiewithouttheoptionofcompoundedmedications.Yesthereneedstobequalitycontrolregulationsandrepercussionsforthosethatdonotabidebyregulationsthatmaketheirproductsafe....iethemeningitisoutbreak...horribleandsadandshouldhaveneverhappened...buttoharmcountlessanimalsbecauseofacompanycuttingcornersandnotcaringaboutanythingbuttheirproductshouldnotoutweighthegoodthatcompoundingdoes

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102 I'dsayabout80%ofmycatpatientsneedcompoundedmedicationsbecauseeithertheavailablesizesaretoohighadoseorbecauseofthedifficultyinadministeringthemedication.Halfmyprescriptionswouldsay"Becauseownercan'tadministertablets"orsomesuchandtheotherhalfwouldsay"Becauseyoucan'tcutapil l into12piecestoaccuratelyadministerthedoserequired!

5/14/20136:13PM

103 Iworkinemergencymedic ineandtheprescriptionsIuseneedtobestartedbeforethelocalcompoundingpharmacywouldbeabletosupplyittotheownerdirectly.

5/14/20136:11PM

104 Talkaboutgovernmentalcontrols-thislegislationwil lbeanightmarefortheVets,andtheanimals,asitl imitswhatcanbedosedandyouwouldhavetobeexplainingwhyforeverydrugyouprescribed,onadailybasis!!

5/14/20136:10PM

105 Keepingcompoundedmedicationsallowustostarttreatment(s)immediatelyratherthenwaitingforthedrugtobefi l ledthendispensed

5/14/20135:56PM

106 Manyofourpatients,especiallycats,requiremedicationsindosagesthatarenotreadilyobtainableandmaybeinaccurate,orinformsthatthecatsWILLNOTtake,thusputtingthepatientcareinjeopardy.

5/14/20135:52PM

107 Ifwecan'tdoseproperlyortheownercan'tgetthemedic ineinitwil l haveamajornegativeimpactonmypatients 5/14/20135:30PM

108 Compoundingisadailynecessityinfelinemedic ine.Withoutcompoundedmedicationmanyofmypatientswouldl iveshorterl iveswithmoresuffering.

5/14/20134:59PM

109 Federaloffic ialsdon'thaveadoctor-patientrelationshipwithourpets.Theydonotknowourc lientsandtheirphysicalcapabil ities-iftheyhavedisabil ities,etcthatpreventthemfromgivingorstrugglingtogivetheirpetamedication.Ifweweretoberestric tedinusingcompoundingmedications,thiswouldadverselyaffectbusinessandl imithowwecanbenefitourpatientsandspeeduptheirrecovery.

5/14/20134:35PM

110 Pleaseallowlicensedveterinarianstotreattheirpatients.Donotallowagovernmentoffic ialtodecidewhatisbestforallwithoutanyrelationshiptothepatientsbeingtreated.Weseethepatientsandareresponsibleforthepatientoutcomes.Theseregulationswillhaveagreatnegativeimpactonveterinarymedic ineformanypatients.

5/14/20134:34PM

111 Asweareveterinaryprofessionalsandareeducatedandtrainedinourfieldofexpertise,andthe"federaloffic ials"arenot,the"federaloffic ials"donotneedtodic tatehowwepractice!

5/14/20134:08PM

112 Aslongasthecompoundingpharmacistsaren'tinventing"new"drugstoc ircumventtheFDAapprovalprocess,thereshouldbenoproblemhere.Ifveterinarianscan'tstockcompounded(read"incrediblylessexpensive")versionsofalreadyapprovedhumandrugssuchasbuprenex,pricesforpetownerswil lberidiculouslyhigh.Youreallycan'taskacatownertopay$75forfivedaysoforalpaincontrolafterhavingtheircatspayedorwaitfourdaysforthe$30medicationtoarrive.Unlessthereisarealhealth/safetyissuewiththesecompoundeddrugs...pleaseleaveitalone.

5/14/20134:07PM

113 Makingitmoredifficultforveterinarianstoprescribeadequatemedicationsfortheirpatientsisahugedisservicetothecommunity. 5/14/20132:42PM

114 Iwasinschoolfor8yearstomakethesedecisions. 5/14/20132:22PM

115 Dependswherethebulkmaterialisfrom;andwhatthequalityis. 5/14/20132:07PM

116 keepoutofmybusinessunlessyouaretrainedandl icensedthesameandareapartnerinthebusinessinsteadofaparasitethatdoesnotknowwhatishappeningintherealworld

5/14/20132:07PM

117 Adingmoreburocracytocompoundeddrugswil lhurtverterinarymedic ineandmyabil i tytocareformypatients. 5/14/20132:01PM

118 Thislegislationisnotonlyunnecessary,itaddsasevereburdentoveterinarypractitioners.Mostofusaresmallbusinesses,orsolopractitionersandarealreadystrugglingunderunduefederalgovernmentalbureaucracy.Donotaddmoreunnecessaryburdenstoourprofession.

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119 Restric tionsoncompoundedmedicationswil leffectivelyeliminatemefromtreating70-80%ofmypatients.Iseealargenumberofoldercanines,felinesandexotic animalsinmypractice.Manyofthemcanonlytakecompoundedmedicationsfortheiri l lnesses.Ifthislegislationisenactedintheformthatithasbeenpresentedtome,itwil l severelycurtailmyabil i tytoefffectivelyhelpmypatientsandwil lessentiallybeassigningadeathsentencetomanyofthem.Istronglyopposethesemeasuresfromallstandpoints.Quitefrankly,compoundedmedicationshaveallowedmetohelpmanymorepatientsthanIwouldbeabletoifIwasl imitedtoformulated,proprietarymedications.

5/14/20131:46PM

120 patientspecific rxswouldbeinconvenientbutnoatlargenegimpact.nothavingaccesstomedic inescompoundedappropriatelyforourvarietyofpatientswouldhaveahugenegativeimpact.Mostpharmaceuticalcompanieswil lnotseethevalueinprovidingformsanddosesthatweneed.Theirprofitisdirectedtowardthehumanrxneedswhicharen'tnec.thesame.IfinditunsultingthatIhavetojustifyacompoundingchoice.Thesearenotschedulei idrugs.

5/14/20131:40PM

121 Astheveterinarianthatistreatingthepatient,wefeelitisbestforustobeabletomakethedecisiononwhatmedicationthepetneedstobeprescribed,notapersonsoremotelyremovedfromthesituation.

5/14/20131:34PM

122 Dogsandcatsarenotpeople.Theycomeissomanydifferentshapes&sizes,it'simpossibletodoourjobwithouttheuseofcompoundedmedications.

5/14/20131:30PM

123 Governmentshouldnotinterfere. 5/14/20131:28PM

124 Feell ikethelargedrugcompaniesarefuelingthisfire!Compoundedmedicationsareveryimportanttomypractice,theimpactwouldbeforallofuswithhigherpricesonourpet'smedicationandprobablyoursaswell.

5/14/20131:28PM

125 Ithinkbetweenprofessionalpharmacistsandprofessionalveterinarians,wecanfigureitoutwithouttheregulatoryinputfrombureaucrats.

5/14/20131:24PM

126 PleaseaskallmembersofCongressandtheirfamiliesaswellasrepresentativesoftheFDAandtheirfamilieshoweasytheyhavefoundittomedicatetheircats,ferrets,rats,guineapigsandrabbitswithpil ls.Dotheycareatallaboutourc lientswhoownthesespeciesanddependonusforpracticalsolutionstomedicationproblemsfortheirpets.Iestimatethatabout80%ofourpractice'spatientpopulationwouldexperiencesignificantmorbidityandpossiblymortalitywithoutaccesstocompoundedmedications.

5/14/20131:08PM

127 Withdrugshortagesanddifferencesindosingfromhumans(ifaveterinarydrugisnotavailable)nothavingaccesstocompoundedmedicationswouldbeharmfultopatientsandpractice.Also,beingabletoofferdeliveryoptionstoensuremedicating(especiallyincats)hasbeenal ifesaverinmanyinstances.Theprescriptiondrugrulesarehardenoughonpractic ingveterinarians,manyregulationstakingupunnecessarytimeandresources(whichultimatelyhasanegativeimpactonpatientcareandfinances)

5/14/20131:00PM

128 Itisalwaysdangerousforsomeone(afederaloffic ial)tomakeorchangelawswhentheydonotworkinthefieldbeingaffected.Inthesameway,itisdangerousforinsurancecompaniestorefusetopayforatestorprocedurethatadoctorconsidersnecessary.Itisaveryfinel inebetweendoingtheirjobandpractic ingmedic inewithoutal icense.

5/14/201312:56PM

129 Iftheytakethisawayfromus,thentheyneedtoforcebigpharmatocomeupwiththerightsize,type,andformofmedicationsweneed.WeKNOWwho'sbehindthis--Pfizer,Merck,Elancotryingtoforceustousetheirmedications.

5/14/201312:53PM

130 Wedon'tknowaheadoftimewhatsmallcrittersmaycomethroughourdoorandrequiremeds,beingpatientspecific wil lreallycrampwhatourdoctorscando.

5/14/201312:53PM

131 Thisisanexampleofanover-reaching,burdensomefederalgovernment. 5/14/201312:51PM

132 Veterinariansspendthetimeinschoolandpractic ingtobeabletoproperlyhelptheirpatients;federaloffic ialsdonothavetheschoolingtoknowwhatmedicationsareappropriate.Weareheretohelpanimals,notharmthembutdenyingthemneededmedicationormakingthemwaitforitcanjeopardizetheirhealth.

5/14/201312:49PM

133 Willourgovgetoutofourl ivesIthoughtweare/wereafreeNation.IhatepeoplemuchlessIntell igentthanmetell ingmetheWrongthingtodo.

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134 TheFDAneedstodifferentiatefoodanimalsfromcompanionanimals.Companionanimalsmayneedawiderangeofcompoundeddrugsfortreatment.Treatmentwithdrugsthataredifficulttodoseornotreadilyacceptabletothepatientmayresultinadverseoutcomesduetoimproperdosingorinabil i tytoadministerthecorrectdose.Compoundingeliminatesmanyoftheseobstaclestopatienttreatment.

5/14/201312:47PM

135 Eachpatientisdifferent.Size,metabolism,andactivitywhichallaregoingtoaffectyourdosingneededandvariesbytheingredients/medications.Ifyoul imitthisyouwil lbetakingawayalloptionsforveterinarymedications.Humanmedhasfirstaccesstomedicationsandwegettheleftoverssowecameupwiththesolutionofmakingourownandhavefollowedalltherulesthathavebeencreatedovertheyears.Addontheproblemofcompetingwiththeonlinepetpharmaciesitmeanscompoundingisoneofthelastwaysthevetshavetokeeptheirc l inic compete-ablewiththeonlinebignames.

5/14/201312:44PM

136 Alloftheabovewouldhaveanegativeimpactonhoworwhatweprescibeforourpatients.Ifapatientissmallandthemedicationthatisneededforthehealthofthepetisnotcapableofbeingdoseddowntothecorrectdose,thepetmaygettoomuchortool ittleandneitherofthoseareanoption.Youhavesomepetsthatarenoteasytoadministermedicationto.Ifapetishardtomedicate,thec lientwon'tmedicateandthatcompromisesthepetshealth.Ithinkweshouldhavetheoptiontocompondthemedicationforthehealthbenefitofthepatient.

5/14/201312:40PM

137 Itishardenoughpractic ingveterinarymedic ineasitis.Whydoesthegovernmentwanttomakeitevenharder? 5/14/201312:38PM

138 Weoftenusecompoundingpharmaciesbecausewecan'tgetthemedicationasamanufactureddrug-orinthequanitythatweneed!Fromthesecomments,itimpliesthattheyaretakingthediagnosingandprescribingoutofthehandsofthetrainedveterinarianwithasolidvet-c lient-patientrelationship-NOTagoodidea.Willthefederaloffic ialsmakedecisionsonexotic animalsaswell?Willallthisregulationdriveupcostsofalreadyexpensivemedication?

5/14/201312:36PM

139 IfIwerenotabletocompoundcertainmedicationsIwouldhavepatientsthatwentuntreatedbecausenootheralternativewasavailable

5/14/201312:35PM

140 duetothesizeandsensitivityofourpatients,compoundingisanecessity.A4poundsickcatdoesn'ttakethesamedoseasalargeranimal,andmostmedicationscan'tbecuteffectively(Ihavetriedtogeta16thofatablettoproperlydoseacatbefore).Andformanyanimals,catsespecially,beingabletotailorthedoseandaddingflavoriscriticalfortheownertobeabletomedicatethepet.Ihavehadownersthatcouldn'tpil l theirhyperthyroidcat,butthecatwouldbegforthetriple-fishflavoredcompoundedmedication.Ourpracticeisnotone-size-fits-all,andourmedicationsshouldn'tbeeither.

5/14/201312:34PM

141 Again,withoutcompounding,someofourpatientswouldbevirtuallyimpossibletotreatwithneededmedications. 5/14/201312:31PM

142 Theuseofcompoundedmedicationisbeneficaltothetreatmentofmanypatients.Limitingaccesstotheseprepartionswil lhindersuccessfulrecoveryandpossiblypreventrecoverycompletely.

5/14/201312:29PM

143 Thisdoesmorethangivethepowertoafederaloffic ial.Itgivesthepowertothelobbyistsforthebigdrugmanufacturers. 5/14/201312:28PM

144 Manyofourpatientsrequiredosagesthatareunobtainablewithoutcompounding. 5/14/201312:28PM

145 Forwhateverreason,somanydrugsononindefinatemanufacturersbackorder.Compoundeddrugsc losethatgap.Thegovernmentneedstostepawayfromthisindustry.

5/14/201312:28PM

146 Iassumethatthe6thpointmentionedherewouldhaveasignificantfinancialeffectonthecostofcompoundedmedications. 5/14/201312:25PM

147 Everysingleoneoftheseproposalswouldmakelifemoredifficultforvets,theirpatientsandc lients.Whomeverwrotethisc learlydoesn'tunderstandhowthemajorityofveterinarypracticesruntheiroperationortheirpharmacydispensing.

5/14/201312:24PM

148 Unlesstheindividuals"ontheHil l"areroutinelymedicatingdogs,cats,birds,etc.,theyreallyneedtoreexaminetheirmotivesforintroducinglegislationthatmakesadifficultprofessionMOREDIFFICULTtotreatit'spatients.

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149 Untilthegovernmentaloffic ialswhowanttoregulatethisgotoveterinaryschool&obtaintheirDVMdegrees,theyhavenobusinesstell ingmehowtopracticemedic ine,andwhatisbestformypatients.Yetanotherformofgovernmentburocracyatitsworst!

5/14/201312:17PM

150 Idonotbelievethefederalgovernmentshouldberegulatingmyabil i tytoprescribemedicationsformyveterinarypatients.Instead,theyshouldbeallowingusmoreFDAapprovedmedicationstoimproveourscopeofpractice,insteadofl imitingitfurther.

5/14/201312:16PM

151 Regulatethequalityofproduction/certificationbutdonotpenalizethemill ionsofanimalsthatdependoncompoundedmedicationfortheircare.Ifpharmaceuticalcompanieswouldaddressourneedsthenwewouldn'tneedcompounding..unti lthathappensweneedthealternativesfothesegmentofveterinarypracticethatlargedrugcompaniesrefusetoserve

5/14/201312:12PM

152 Thechangesproposedwouldsignificantlynegativelyimpactourprofession.Itwouldlowerthestandardofcareandincreasescostofcarel ikelytoasignificantdegree.

5/14/201312:10PM

153 Veterinarianstreatanimalspeciesthatrangefromlessthanapoundtothousandsofpounds.Inaddition,eachspeciesmetabolizesmedicationsdifferentlyfromeachotheranddifferentlyfromhumans.Theinabil itytocompounddrugsintousableformsfordifferentspeciesanddifferentpatientswouldhaveanincredibleimpactonourabil i tytoproperlytreatourpatients.Thepatientsandc lientswil lultimatelysufferthegreatest,aseasilytreatablediseasesmaybecomefatal,duetheinabil itytoobtainaproperdrugconcentrationorformofdrugthatthepatientwil laccept.

5/14/201312:10PM

154 Asstatedearlier,therearedrugbackordersALLthetimenowinourfield.Withoutaccesstoinhousestock,WECANNOTTREATANIMALS!!!Acatthatcannottakeoralmedsneedtransdermalmethimazole.Acatinpainneedsl iquidgabapentin,becausethecapsulesaretoostrong.Aspecific dogthathasvomitinganddiarrheaCAN'Twait3daysforthepatientspecific metronidazoletobeshipped.WHYOHwhywouldyouwanttoinitiatetheserules?Weneedaccesstomedic ines,manytimesthatthepharmacieseitherdon'thaveinsmallenoughsizes,orthattheydon'thavetimetocompoundforus.Pleaseleaveustheabil i tytoorderandusethesemeds-wedon'twantClassIVdrugs-butitemslikemetronidazole,andgabapentin,andamlodipine,arebasics.

5/14/201312:09PM

155 Itwouldgreatlyaffectmypracticeifwewereputundersuchrestric tionsforcompundedmedications.Howcanfederaloffic ialsdictatetheuseandregulastionofcompoundeddrugsiftheydonothaveaDVMbehindtheirname.Notallmedicationsworkforeverycaseandwestrivetofindthosemedicationsthtadoworktohelpourpaitents,thatinc ludesgettingmedicationsfromcompoundingpharmacies.

5/14/201312:06PM

156 Ibelievethereareafewmedsthatneedcompoundingforofficeuse...MetronidazoleforcatsandsmalldogsandmethimazoletoaliquidformationforcatsandSRbuprenexarethethreethatcometomind.Icontinuetogetdifferentinterpretationsofthelaw,soIchoosenottocarryfortheofficeasIwon'tl ieandsaytheyarefor1patientwhichmostcompoundingpharmaciesask.Whateverhappens,Ihopeitatleastc larifiestherules!!

5/14/201312:05PM

157 somecatsrefuseoralmeds!itscompoundedtopicalhyperthyroidmedsordeath.IfZoetiswantstocomeoutwithatopicalmethimazole,great,butunti lthenrestric tingmyaccessisgoingtokil l mypatients.

5/14/201311:59AM

158 Thetypicalturnaroundtimeforacompoundedpreparationtobereceivedinthec linic is2-4days.Thisistoolongformanypatientstowait,giventheirc l inicalconditions.Patientcarewil ll ikelysufferduetolackoffollowupbypetowners(ie,returningtopickupmedsorhavemedsapplied).

5/14/201311:54AM

159 Ineedtobeabletoprescribethemedic inethatIfeelisbestformypatients,intheformthatbestsuitsmypatientsandtheirowners. 5/14/201311:54AM

160 Somemedicationsareonlyavailableasbulkactiveingredients 5/14/201311:52AM

161 Yadayada 5/14/201311:24AM


64/89

Q12Today,compoundingpharmaciesareregulatedbytheindividualstates,with

FDAoversightfocusedonhowchemicalsarestoredandused.IftheFDAweretohavesignificantlygreaterauthorityovercompoundingpharmacies,whatdoyouthinkwouldbetheimpact?Indicatethedegreetowhichyouagreeordisagree

witheachofthesestatements.Answered:940 Skipped:90

Theselectionand...

Thecostofcompounded...


65/89

Therewouldbeapositive...

Patientcompliance...

Theadministrati...


66/89

52.66%495

29.68%279

13.72%129

2.23%21

1.70%16

940

58.72%552

28.40%267

8.62%81

1.81%17

2.45%23

940

51.28%481

28.78%270

15.88%149

3.09%29

0.96%9

938

51.34%480

25.45%238

21.18%198

1.50%14

0.53%5

935

54.15%509

27.45%258

12.66%119

4.04%38

1.70%16

940

41.59%388

25.72%240

20.69%193

9.32%87

2.68%25

933

# Pleasefeelfreetosaymoreaboutyourresponses. Date

1 Anytimethegovernmentisinvolved,itmeansmoreproblems,redtape&cost.Obviously,thereneedstobeoversightonchemicalstorage&usage,butthegovernmentshouldn'tbeabletodic tatewhat,how&whythechemicalsareusedASLONGAStheyarebeingprescribedbyal icensedveterinarian.

5/23/201310:25AM

2 Iwil lfollowtherulesandregulationswhetherIagreeordisagree,butthemoreregulationsoutthere,theharderitistogetthebestpatientcare,affordablemedic ineandownercompliance.

5/22/20133:54PM

DisagreeStrongly Disagree NeitherAgreeNorDisagree Agree

AgreeStrongly

IwouldnotchangehowI...

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

DisagreeStrongly Disagree NeitherAgreeNorDisagree Agree AgreeStrongly Total

Theselectionandavailabil i tyofcompoundedpreparationswouldincrease.

Thecostofcompoundedmedicationswoulddecrease.

Therewouldbeapositiveimpactonanimalsinmypractice.

Patientcompliancewouldincrease.

Theadministrativeburdenonmeandmystaffwouldnotchange.

IwouldnotchangehowIprescribecompoundedmedications.


67/89

3 WhileIunderstandandagreethatmaybemoreoversightiswarranted,Ifeell ikethiswouldscarecompoundingpharmaciesintonotmakingasmanydrugs,ormakeitfinanciallydifficultforthem.SoI'mnotsurehowIfeelwithoutknowingexactlywhat"significantlygreaterauthority"means.

5/20/20131:02PM

4 Compoundeddrugsneedtobecarefullymade,thereisnoquestion,butasforthecontentofthesedrugsandtheiruse,pleasemakeitaseasyaninexpensiveaspossibleforme.Thiswil lsavel ives.

5/20/201310:26AM

5 Idon'thaveagoodfeelforwhattheFDAmightwanttoregulateinregardtocompoundingpharmaciessoIcannotsaywhattypeofimpactitmighthave.

5/19/201310:29AM

6 ThecostsforoversightwouldneedtobeveryminimalorIfearpric ingmedicationsforpetsoutofthemarket.Wearestrugglingasaprofessioninthiseconomytogainc lientcompliance.Costandconveniencearekeytotreatmentsformanypets.

5/18/20139:18AM

7 Becausepharmaceuticalcompanieschoosetomanufacturedrugsbasedonprofit,someveterinarydrugsarediscontinuedorbecomecostprohibitiveforc lientstopurchase.Thisnotonlyrestric tsthequalityofmedic ineIcanprovidebutalsorestric tsthecareanownercanprovidefortheirbelovedpet.

5/18/20135:26AM

8 Iwil lalwaysstrivetoprovidethebestcarepossibleformypatients,unfortunatelyourgovernmentthinkstheycandothatbetterfromtheirdesksthanthoseofusinteractingdirectlywithourc lientsandpatients.

5/17/201310:32PM

9 I'mnotc learonthis.AslongasFDAisensuringqualitywithoutimplementingrestric tions,Iamforthis. 5/17/201310:03PM

10 AlthoughIdon'tmindhavingqualitycontroltomakesurethatharmfulingredientsarenotusedandthatpropercompoundingtechniquesareuti l ized,Ithinkthiswouldbemoreofaheadachethanabenefit.

5/17/20139:53PM

11 IwouldnotchangethewayIprescribecompoundedmedications,unlessthemedicationswerenolongeravailableincompoundedform.

5/17/20137:27AM

12 I'mreallynotsurewhataffectthischangewouldhave. 5/17/20136:36AM

13 Youknowtherewouldbemorehassles. 5/16/20139:09PM

14 Additionalregulationsandbureaucratic redtapewil lincreasecostofmedications,increasepaperworkandthusmyoverheadcostsnegativelyaffectingmyc lientsbyincreasingcostsforthepetowner.Thiswil ldecreaseownercompliancebycausingmorepetownerstodeclinetreatment.IhaveaselectfewreputablepharmaciesthatIrelyonformycompoundingneeds.Thesepharmacieswillalsobenegativelyimpactedbymoreredtapeandmaynotbeavailabletocompounddrugsinthefutureiftheydecidethehassleandexpenseisnolongerworthcontinuingtoprovidecompoundingservices.

5/16/20136:02PM

15 TheFDAdoesnothavetheknowledgebaseordatatoaccesstheseneeds,andIfeartheywouldimposeregulationsthatwouldbeoverlyprohibitiveandaddadditionaladministrationtotheprocess

5/16/20133:31PM

16 howandwhatIwoldprescibewouldbedeterminedbythisfutureunknownlegislation,soIcannotpredicthowitwouldchangemyprescibingunti lIknowthedetailsofthelegislationproposed

5/16/20133:20PM

17 Woulddependonwhattheauthorityentails. 5/16/20133:10PM

18 Addingthese"extrasteps"ismoretimeandcostsmore. 5/16/20133:06PM

19 Iwouldprobablyusefewercompoundedmedicationsifmypaperworkburdenexceededthecostandcompliancebenefitstomyclients.

5/16/20132:54PM

20 Onlyal icensedveterinarianshouldhavethefinalwordinhowtotreathis/herpatients.Telltheineptgovernmenttostickwithwhattheyarebestatielying,cheatingandstealing!

5/16/20132:09PM


68/89

21 Assaidbefore,Iseealotofexotic patients(repti les,rabbits,hamsters,guineapigs,birds,etc)aswellasplentyofsmalldogsandcatsthatareforcedtotakecompoundedproductstobeinasafeandeffectivedoserange.Orwon'ttakepil lsandmusthavel iquidsortransdermalsavailablebecauseunlikepeople,theydon'talwaysknowwhat'sbestforthem.TheFDAdoesn'tseemtounderstandallofthesenuancesfully.

5/16/20131:40PM

22 Thiswouldbeahugeburdenontheindustrycausingpricestoincreaseduetotheaddedadministrativeburdenandconstraints.Thecostwil lbepassedontoconsumerswhoalreadycomplainaboutthecostofveterinarymedic ine.

5/16/201312:48PM

23 At4:00(quittingtimeatthegovernmentoffice)mycasewouldhavetowaitpatientlyforwhoknowswhat.Pleasetellthegovernmentformeto"getal i fe-andleavemealone!

5/16/201312:46PM

24 ThatdependontheFedsabil i tytoregulatetheindustryeffectivelywithoutimpedingitsabil i tytoprovidetheneededavailabil i tyofmedications.

5/16/201312:30PM

25 IdonotknowhowmoreFDAoversightwouldaffectmybusiness,IcanonlyassumeitwouldbenegativebutIhavenoinformationonwhichtobasethisdecision

5/16/201312:08PM

26 Havenoopinionhere. 5/16/201311:55AM

27 thiswouldputanundueburdenonalreadyoverburdensmallbusinesses,whichmostveterinarypracticesare...Itwil l ,asaresult,increasethecosttothepetowner....botharenegativesinabigway

5/16/201310:47AM

28 Compoundingpharmaciescansti l l makemistakesregardlessofwhethertheUSGovernmentoverseesthings.Ithinkthatlessgovernmentinouraffairsisalwaysbetter.Isti l l havetodomyjobtoprotectthewelfareoftheanimalandthereforethepublic .

5/16/20139:07AM

29 ThemoreinvolvedtheFDAis,theworseitisforallofus 5/16/20138:53AM

30 Youmissthepointofthiswholesituation.ThebasicreasonfortheoriginalFederalFoodDrugandCosmetic Actwastotryandensurethatwhatwasinacontainerofmedicationwasactuallywhatitc laimedtobe.Compoundingpharmaciesandespeciallycompoundingmanufacturershaveskirtedaroundthisforyearsanditistimethatcomestoahalt.

5/16/20138:51AM

31 Again,Compoundingisthattheproblem-itwoulddecreasedramaticallyifthetheissueswiththedrugcompanieswouldbedealtwith.IhavenoideahowtheFDAwouldactuallyimpactcompoundeddrugsinourpractice-Icanonlyassumemorelegislation,moreredtape,morecosts.Wearegoingtodothebestwecantocomplywithlawssurroundingcompoundedmedications-ultimatelywewil lchoosewhatweneedtodototakecareofourpatientsinanethical,humaneandresponsiblemanner.

5/16/20138:42AM

32 IpersonallyamnoteducatedonhowFDAauthorityvsstateauthoritywouldchangethings.Howeveringeneral,Idonotfindfederalcontroltotypicallybenefitanyone.

5/16/20138:14AM

33 TOOMUCHGOVERNMENT!!!! 5/16/20137:51AM

34 Financialimpactonc lientswouldbeenormous.Effectivemedicationswouldbehugelyl imited. 5/16/20137:43AM

35 Ifthegovernmentisconcernedwithmakingmoreaffordabledrugsavailableforthepopulationtheyshouldbetargetinglargecorporationdrugmanufacturers,notpharmaciesorprivatepractitioners.Itishardenoughtohaveprescriptionsfi l ledforpatientswithexistinglaws,wedon'tneedittobeharder.

5/16/20137:00AM

36 ifIcannotusecompoundedmedication-Iwouldnotbeadequatelyabletotreatmypatients 5/15/201310:39PM

37 Federalintervention/regulationwil lpossiblyincreasethecomplianceofsmallercompaniesforsafety,butthecostwil lprobablyincreaseandthenumberofcompoundingcompanieswil ldecrease.

5/15/201310:29PM

38 Ithasbeenmyexperiencewhenthefederalgovernmenttakesoverforourstategovernmentsitequalsmoreexpenseandmoreheadacheforusasveterinarians.

5/15/20137:36PM


69/89

39 Themorefederalgovernmentinvolvement,theworsetheoutcome. 5/15/20137:18PM

40 IftheFDAallowedcompoundedmedstobedispensedfromthec linic andthatoverridesthecurrentstatelawtherewouldbeapositiveimpactonanimalsandpatientcompliancewouldincrease

5/15/20133:22PM

41 Lastthinganyoneneedsistohavesomegovernmentbureaucrattell ingmeASADOCTOR,howIshouldusemedicationformypatients.Manyofmypatientsareverysmallandmostmanufacturedmedicationsareinformsthataretoolarge.SoIneedtohavealotofmedicationscompoundedtoaformthatisreasonabletoadminister.

5/15/20132:54PM

42 Biggergovernmentandmoreregulationisnotnecessarilythesolution.Biggergovernmentandbiggerbureaucracyallowsformorecorruptionandineffic iency.

5/15/20132:16PM

43 Again,additionallegislationisnotneeded. 5/15/201312:45PM

44 Iequatenationaloversightwithbetterconformityinproductavailabil i ty,quantity,andprice,whichIbelieveitbenefic ialtopatientsandtheirprescribersoverall.

5/15/201311:29AM

45 Ithinkanytimethegovernmentgetsinvolvedfurther,costsgoupandconveniencegoesdown.IthinktheFDAneedstoconcentrateonwhattheyshouldhavebeendoingbetter.Inpreviousinjurioussituations,thecompoundingpharmaciesinvolvedhaddecidedtostartmanufacturingonalargescaleandtheFDAdidnotdetect/addressit,i fIunderstandcorrectly.Ithinktheyneedtoaccomplishthejobtheyaresupposedtobedoingbeforetheytakeonotherjobs.Therearebadcompounders/situations,justastherearebadmanufacturers/situationsanddoctorsthatmakepoordecisionsbasedonlyonmoneyissues.

5/15/201310:11AM

46 IfIunderstandthesestatementscorrectly,anyadditionaloversight/authority/regulationsonlycomplicatestheprescriptionprocessofusingcompoundedmedications.

5/15/20139:01AM

47 AgaintoughtogaugeunlessIknowfinalbil l byFDA..... 5/15/20138:40AM

48 Iwil lcomplywithanynewfederalregulations.IwouldstronglyhopetheCenterforVeterinaryMedic inewouldbeguidingtheprocess.

5/15/20135:31AM

49 Thesearekindofano-brainer... 5/15/20135:27AM

50 Again,leavethemedicaldecisionsandjudic ioususeofcompoundedmedicationstothediscretionoftrained,ethicalveterinaryprofessionals.

5/15/20135:18AM

51 Italldependswhattheyowiththeirauthority 5/14/201310:07PM

52 Don'tfixwhatisnotbroken!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! 5/14/20139:48PM

53 Ireallydon'tknowhowthiswouldaffectme. 5/14/20139:42PM

54 Whetherit'sthepeanutbutterplantfi l ledw/mold&SalmonellainNMorthepharmacyinNewEnglandthatcontaminatedthecorticosteroids,thoseareareasthatneedtoberegulatedforsafety,steri l i ty,productstorage&handling,etc.

5/14/20138:58PM

55 Whatweneedtolearnaboutrecenttragiceventswithcompoundedmedicationsisthatweneedtoregulatetheconditionsunderwhichcompoundedmedicationsareprepared.Regulatingwhichdrugs,orwhichspecies,orhowmuchcompoundedmedicationcanbedispensedwon'tchangethesafetyissue.Thisisc learlyaqualitycontrolissue.

5/14/20138:31PM

56 Wetookanoath.Politic ianscouldn'tcarelessaboutthat. 5/14/20137:52PM


70/89

57 Icannotpredicthowindividualsinthegovernmentwil lvoteorchangethings...unfortunatelythereisnotusuallyassimplebil l orchangethatdoesnothaveanegativeimpactsomewhere.Idonotthinkpricesshouldincreasealthoughthereisalwaysinflation...butthereisalargevarianceinprices...buteaseandcorrectdosageout-weighsthatformany.However,assomeonewhosejobistodonoharmandtohelp...Idonotwantsomeonewhomayhaveothemotivesoral imitedunderstandingofpharmaceuticalstobethejudgeofwhatisbestformypatients.Idothinkthatthereshouldbequalitycontrolmeasuresthatarestric tlyfollowedsothatnothinghappensagainl ikethedeathsthatoccurredwiththemeningitisoutbreak..oranyi l lnessforthatmatter.Wecannotcontrolanindividualsreactiontoaspecific medication,compoundedornot,butwemustnotatethat...andinhistoryhowmanytimeshasamain-streampharmaceuticalcompanyhadmajorrecalls?Allthetime!

5/14/20136:39PM

58 TheFDAneedstostayOUTofthecompoundingpharmaciesunlesstheyarenotmeetingInspectionstandards. 5/14/20136:11PM

59 ThereasonwehavetousecompoundingpharmaciesISbecausetheFDAdecidedcertaindrugsweren'tbenefic ialtohumansanymore-penic il l inampic il l intabletstonameafew.Justl ikewhenTorbutrolusedtobereasonablypricedunti lthegovernmentcausedthepricetoincreasedramatically.

5/14/20134:43PM

60 Havingmoregovernmentregulationswouldinnowayimprovethequalityofcareandwouldsignificantlyincreasethecosts. 5/14/20134:37PM

61 Nodoubtaboutit,thiswouldhaveaverynegativeimpactforallconcerned. 5/14/20134:12PM

62 IdonotthinktheFDAshouldhaveANYgreaterauthorityovercompoundingpharmacies. 5/14/20134:09PM

63 Idon'tknowifbysayingtheFDAwouldhaveoversightthatitwouldbebetterorworse.Iwouldthinkthatiftherearestandardsthataremaintainedacrossthecountrythatthosestandardsmightbemorefair,butthestandardsshouldbesc iencebased,writtenbypharmacists,notbylegislatorsornon-pharmacistlobbyists.

5/14/20133:12PM

64 Iunderstandtheneedforcompoundingpharmaciestobeheldaccountableforqualityandsafety.HavingworkedfortheUSDAIseriouslydoubttheabil i tyoftheFDAtoregulatethisindustryinasafeandeffectiveway.I'mnotsurehowtheiroversightwouldaffectsomethingsbutIamsuretherewouldbesignificantlymorepaperworkandsignificantlymoredelayinobtainingcompoundedmedications.

5/14/20133:04PM

65 Neverseenanythingthefedsgotintothatdidn'tcosttwiceasmuchand10timesthepaperwork.WhynotjusttiethistoObamacare. 5/14/20132:52PM

66 governmentinvolved=lessgoodhappeningforanyone 5/14/20132:08PM

67 Morecostwouldbeassociatedwithcompoundeddrugsandmypatientswil lsuffer. 5/14/20132:02PM

68 I'mokaywithFDAoversight,aslongastherearepractic ingveterinariansandcompoundingpharmacistsrepresentedintheoversight 5/14/20131:53PM

69 Furtherregulationofcompoundingpharmacies,inmyview,isnotnecessary.Theyalreadyadheretospecific regulationsandhavingfurtheroversightisredundantandonlywil limpedeoutabil i tytoeffectivelytreatourpatientsusingsafeandeffectivecompoundedmedications.

5/14/20131:48PM

70 Moreregulatoryburdenwouldonlyincreasecostsanderrors. 5/14/20131:30PM

71 costisaBIGissue,thiswouldincreaseourcost,andthenincreasethecostforeveryone 5/14/20131:29PM

72 Federalregulationveryrarelyimprovesonserviceandcertainlydoesn'tbringdowncost.FDAapprovalwouldobviouslydecreaseavailabil i tyortheywouldn'tberegulating!

5/14/20131:26PM

73 IdonotknowhowFDAoversightwouldeffectmeandmypatients. 5/14/20131:15PM


71/89

74 IftheFederalGovernmentisconcernedenoughaboutitsbudgettoallowthe"sequester"tobecomeeffective,whyaretheysobusyfiguringoutmorewaystoextendtheregulatoryauthorityoftheFDA,whichnotonlywouldbeaburdentoveterinarypractices,butsurelywouldbesubsidizedbythetaxpayeraswell?AlsoalotofwhatIhearfromCongressishowtheyaresosupportiveofbusinesslargeandsmall.Thisproposedlegislationwil lplaceaheavyfinancialandlogistic burdenonveterinarypracticeswhichareoftenmarginallyprofitablesmallbusinessesemploying3-20people.SoisCongressreallybusiness-friendlybutjusttoBigPharmaandtherestisjustl ip-serviceandgrandstanding?IamaveterinarianinasmallfelinepracticeandIvote.Ialsotalktoothervoters--alot.

5/14/20131:13PM

75 Notsurehowitwouldimpactthings,butIamconcerned.Don'twanttoassumetheworstwithoutknowing... 5/14/20131:03PM

76 ItseemsthatwhentheFDAisinvolved,iftheydon'tthinkit'simportant,ittakesforever(ifatall)togetanythingapprovedordone.It'sonemorehugehurdleofgovernmentalbureaucracyforveterinarianstojumpthroughandgettangledupin.

5/14/20131:02PM

77 Theonlyoptionlefttouswouldbetotrytocutdosesofcommerciallyprepareddrugsandmixthemuphereatourhospitalwhichwouldbeverytimeconsumingandexpensive.

5/14/201312:57PM

78 Moregovernmentisnevertheanswer. 5/14/201312:51PM

79 AlltheabovequestionsdependonwhattheimpactFDAwouldhaveoverthemedicationsthecompoundingpharmacieswouldhaveaccessto.

5/14/201312:44PM

80 Theimpactremainstobeseenonhowcompliantpatientsareandhowtheveterinarianscouldorcouldn'tprescribe.Thereisaspeculationinmanyofthesequestionssooveralldifficulttoanswer.

5/14/201312:39PM

81 Theabil itytomakepreparationsthatarepalatableisveryimportant.Tobeabletogetthemedicationintotheanimalisfirstandforemost.IhaveNOstaff,i tisjustme.Tokeepupwiththerecordkeepingwouldbeanightmare.

5/14/201312:39PM

82 Theproblemwithbureaucratic oversightisthat99%ofthoseinvolvedareuneducatedinwhatisbeingregulated.Ihaveahardenoughtimewithpharmaciesfi l l ingincompoundedmedsformypatientsbecausetheydon'tknowwhatit'sfororwhatwearetreatingandquestionmyRX.

5/14/201312:37PM

83 FDAregulationwouldmakelifeverydifficult.ImaynotchangehowIprescribebecauseifi tsmyonlyoptionbutIamcertaincostswouldincreasewhichwouldthenbepassedontothepetowner.

5/14/201312:25PM

84 Mypatientswil lbetheoneswhosuffer,ifIamforcedtodiscontinueusingcertaincompoundeddrugsforthembecauseIamover-burdenedbyunnecessaryextraregulations.

5/14/201312:20PM

85 Itisobviousthatfederaloversightintocompoundingpharmacieswouldincreaseadministrativeburdenforeveryone,increasepricesformedication,decreasec lientcomplianceduetoincreasedmedicationcost,andultimatelyreduceourabil i tytopracticequalitymedic ine.

5/14/201312:19PM

86 IhighlydisagreewiththeFDAhavinggreaterauthorityovercompoundingpharmacies. 5/14/201312:14PM

87 Takingawayorhugelyreducingtheavailabil i tyofcompoundedproductswil lruintreatingcats,andsendusbacktothedarkagesinfelinemedic ine.Pleasedon'tcrippleus.

5/14/201312:12PM

88 manypetownerscan'tpil l theirpets.Compoundedmedicationsareamatterofl i feanddeath. 5/14/201312:12PM

89 I'msurethatthewholeprocesswouldbemorecumbersome. 5/14/201311:55AM

90 Yadayada 5/14/201311:24AM


72/89

57.37% 537

42.63% 399

Q13Beforeyoulearnedaboutthissurveyofveterinarypractices,wereyouawarethataSenateCommitteehadreleasedalegislativeproposalregardingregulating

compoundingpharmacy?Answered:936 Skipped:94

Total 936

# Other(pleasespecify) Date

1 Ihadanideabutnotsureexactlywhatwasproposed 5/17/20137:20AM

2 IheardthismighthappenattheFVMAconference. 5/16/201310:06PM

3 Ihadheardaboutitbutnottotallyawarewhatitwasabout 5/16/20139:40PM

4 wasnotawareofthedetails 5/16/20137:07AM

5 Iwil lbeattendingaCEmeetingregardingtheproposal. 5/16/20136:59AM

6 Onlybecausemycompoundingpahrmacymademeawareanditbecameaburdentomyc lientsandmyselftochangehowmedswereordered.

5/15/20133:49PM

Iwasaware.

Iwasnotaware.

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Iwasaware.

Iwasnotaware.


73/89

7 Artic lesinAVMA 5/15/20138:42AM

8 byinternet 5/14/20135:58PM

9 justfoundout 5/14/20131:34PM

10 Ihadheardsometimeagobutdidn'tknowthetimeframetoenactit. 5/14/201312:59PM

11 Iknewitwasanissuebeforecongress,butnotitsstatus 5/14/201312:00PM

12 Yadayada 5/14/201311:24AM


74/89

74.52% 699

0.32% 3

10.66% 100

2.35% 22

0.00% 0

7.46% 70

4.69% 44

Q14Whichofthesemostaccuratelydescribesthenatureofyourpractice?


Primarilycompanion-an...

Primarlyfood-chain...

Mixedlarge-and...

Catsonly

Dogsonly

Equineonly

Board-certifiedmedical...

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Primarilycompanion-animal

Primarlyfood-chainanimals

Mixedlarge-andsmall-animal

Catsonly

Dogsonly

Equineonly

Board-certifiedmedicalspecialty


75/89

Total 938


76/89

Q15Howmanyveterinariansworkfullorpart-timeinyourpractice?


1

2

3

4

5

6

7

8

9

10

Morethan10

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%



77/89

30.02% 281

21.05% 197

17.09% 160

10.36% 97

5.98% 56

3.85% 36

2.99% 28

1.71% 16

1.39% 13

0.96% 9

4.59% 43

Total 936

1

2

3

4

5

6

7

8

9

10

Morethan10


78/89

7.49% 70

36.19% 338

35.87% 335

11.03% 103

9.42% 88

Q16Withhowmanycompoundingpharmaciesdoesyourpracticedo

business?Answered:934 Skipped:96

Total 934

1

2

3

4

Morethan4

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


1

2

3

4

Morethan4


79/89

73.42% 685

6.43% 60

1.82% 17

5.25% 49

13.08% 122

Q17Whatisyourprimaryroleinyourpractice?


Total 933

# Other(pleasespecify) Date

1 Pharmaceuticalpurchasingagent 5/23/201310:26AM

Veterinarian

VeterinaryTechnician

OfficeStaff

PurchasingAgent

PracticeManager

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Veterinarian

VeterinaryTechnic ian

OfficeStaff

PurchasingAgent

PracticeManager


80/89

2 VetAssistantalso 5/22/20139:21AM

3 owner 5/20/201311:22AM

4 Surgeon 5/20/201310:27AM

5 CVTprimary,inventorymanagersecondary 5/20/20137:26AM

6 PracticeownerandMedicalDirector 5/19/20137:30AM

7 AndPurchacingAgent 5/18/201311:21AM

8 andowner 5/18/201310:45AM

9 andRVT/ECC 5/18/20138:45AM

10 Owneralso 5/18/20136:33AM

11 owner-soleproprietor 5/18/20135:27AM

12 SeniorVeterinaryTechnic ian,Mgmt 5/17/201310:55AM

13 PracticeManager/Owner 5/16/20136:19PM

14 purchasingmanager&officemanager 5/16/20136:04PM

15 CVTandManagement 5/16/20133:07PM

16 Owner 5/16/20132:54PM

17 InventoryManager 5/16/20132:21PM

18 Iamalsoal icensedveterinarytechnic ian 5/16/201312:50PM

19 IalsohaveaHouseCallPractice-IamtheonlyVet/owner/purchaser 5/16/201311:31AM

20 CVTalso 5/16/201311:04AM

21 Owner 5/16/201310:58AM

22 owner 5/16/201310:45AM

23 owner 5/16/20139:11AM

24 Owner 5/16/20139:10AM

25 Idoeverythingasfarasapprovingorders. 5/16/20139:08AM

26 Owner 5/16/20138:25AM

27 VeterinarianandMedicalDirector 5/16/20138:07AM

28 owner 5/16/20138:06AM

29 Owner/Partner 5/16/20137:59AM

30 LVTsupervisor 5/16/20137:34AM

31 owner,purchaser,officemanager 5/16/20137:01AM


81/89

32 Internist 5/16/20136:59AM

33 PurchasingAgent 5/16/20136:56AM

34 Owner/administrator/manager 5/16/20136:52AM

35 CEO/CFO 5/16/20136:51AM

36 owner 5/15/20137:01PM

37 andpurchasingagent 5/15/20136:41PM

38 Owner 5/15/20133:49PM

39 VeterinarianandOwner 5/15/201311:29AM

40 Owner/Director 5/15/201310:59AM

41 HospitalAdministrator 5/15/201310:39AM

42 Pharmacistataveterinaryteachinghospital 5/15/201310:17AM

43 Owner-veterinarian 5/15/201310:11AM

44 owner 5/15/20139:33AM

45 alsoaCertifiedVeterinaryTechnic ian 5/15/20139:26AM

46 owner 5/15/20138:59AM

47 AssociateVeterinarianandpreviousownerofHospital 5/15/20138:42AM

48 OfficeManager 5/15/20138:19AM

49 Pharmacymanager 5/15/20138:01AM

50 Pharmacy&Inventorymanager 5/15/20137:30AM

51 Owner 5/15/20136:18AM

52 owner 5/15/20135:51AM

53 Practiceowner 5/15/20135:28AM

54 Owner 5/14/20139:25PM

55 practiceowner 5/14/20139:17PM

56 owner 5/14/20138:32PM

57 owner 5/14/20138:00PM

58 Owner,aswell 5/14/20137:11PM

59 owner 5/14/20136:06PM

60 Iamalsotheowner 5/14/20135:53PM

61 Owner 5/14/20134:13PM


82/89

62 owner 5/14/20133:33PM

63 Owner 5/14/20133:22PM

64 Andpracticeowner 5/14/20133:10PM

65 Owner 5/14/20133:07PM

66 Inventory 5/14/20132:58PM

67 Veterinarian,PracticeManager,andowner 5/14/20132:29PM

68 owner 5/14/20131:46PM

69 InventoryControl 5/14/20131:44PM

70 Owner 5/14/20131:09PM

71 Owner 5/14/201312:50PM

72 PharmacySupervisor 5/14/201312:42PM

73 Zoo-exotic practice 5/14/201312:41PM

74 mostlyretired,workonedayamonth,butworkedfulltimefor16yearsbeforethen 5/14/201312:36PM

75 owner 5/14/201312:33PM

76 practiceowner 5/14/201312:30PM

77 Andanythingelsetherewastochoose,ie,purchasingagent,officestaff,etc.,etc. 5/14/201312:24PM

78 workforapublic aquarium,university,andexotic animalsanctuaryaswellas3privatepractices 5/14/201312:14PM

79 owner 5/14/201312:13PM

80 PharmacyManager 5/14/201312:10PM

81 InventoryManager 5/14/201312:04PM

82 Owner 5/14/201311:59AM

83 Yadayada 5/14/201311:24AM


83/89

Q18InwhatstateorU.S.territoryisyourmainpracticelocated?


Alabama

Alaska

AmericanSamoa

Arizona

Arkansas

California

Colorado

Connecticut

Delaware

DistrictofColumbia(DC)

Florida

Georgia

Guam


84/89

Hawaii

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

Maine

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri

Montana


85/89

Nebraska

Nevada

NewHampshire

NewJersey

NewMexico

NewYork

NorthCarolina

NorthDakota

NorthernMarianas...

Ohio

Oklahoma

Oregon

Pennsylvania

PuertoRico

RhodeIsland


86/89

1.83% 17

0.32% 3

0.00% 0

SouthCarolina

SouthDakota

Tennessee

Texas

Utah

Vermont

Virginia

VirginIslands

Washington

WestVirginia

Wisconsin

Wyoming

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%


Alabama

Alaska

AmericanSamoa


87/89

0.97% 9

0.54% 5

6.23% 58

2.26% 21

1.93% 18

0.21% 2

0.32% 3

7.20% 67

3.44% 32

0.00% 0

0.32% 3

0.43% 4

3.33% 31

1.61% 15

0.86% 8

1.07% 10

1.18% 11

1.83% 17

0.86% 8

3.44% 32

3.01% 28

4.19% 39

3.54% 33

0.75% 7

0.32% 3

Arizona

Arkansas

California

Colorado

Connecticut

Delaware

Distric tofColumbia(DC)

Florida

Georgia

Guam

Hawaii

Idaho

Il l inois

Indiana

Iowa

Kansas

Kentucky

Louisiana

Maine

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri


88/89

0.43% 4

0.54% 5

0.21% 2

0.75% 7

3.22% 30

0.32% 3

7.30% 68

0.11% 1

0.00% 0

0.00% 0

3.01% 28

1.29% 12

1.72% 16

5.59% 52

0.00% 0

0.43% 4

1.72% 16

0.11% 1

2.04% 19

5.48% 51

0.32% 3

0.86% 8

5.59% 52

0.00% 0

3.11% 29

Montana

Nebraska

Nevada

NewHampshire

NewJersey

NewMexico

NewYork

NorthCarolina

NorthDakota

NorthernMarianasIslands

Ohio

Oklahoma

Oregon

Pennsylvania

PuertoRico

RhodeIsland

SouthCarolina

SouthDakota

Tennessee

Texas

Utah

Vermont

Virginia

VirginIslands

Washington


89/89

0.21% 2

3.33% 31

0.32% 3

Total 931

WestVirginia

Wisconsin

Wyoming

q1 how important to your practice is how veterinarians use ...how veterinarians use compounding...

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