DEAR DR. FOX: I have an 8-year-old teacup Yorkshire terrier who was diagnosed with encephalitis over four years ago.
He began walking in circles whenever he was awake. I took him to our family vet, who referred me to a neurologist. The neurologist performed a spinal tap and a CAT scan, which confirmed that my Yorkie had encephalitis. The prognosis for my dog's survival was one week. In spite of this, the neurologist prescribed cyclosporine and prednisone to be given twice daily. I took my dog home with little hope he would survive. He has been on these medications ever since. He stopped walking in circles one day after beginning the drug combination. His health and quality of life have been mainly quite good. He does what "well" dogs do: barks at the cat, plays, interacts with my other dogs, follows commands and does tricks. He has a sweet disposition.
I want to share this with your readers: Just as with humans, it is possible to shop around for reasonably priced prescription medications for companion animals. It is important to keep your dog on medications without going bankrupt. For example, prednisone is frequently given to humans, and it is inexpensive. I get a prescription for it from my family physician, and then I cut the tablet down to the correct dosage for my dog.
If I'd had to buy cyclosporine locally, the cost would have been $500 a month. I would have had to put my dog down years ago because I could not afford that. Instead, I get it for $30 a month from a mail-order place out of state that specializes in veterinary drugs. -- L.R., Montgomery Village, Maryland
DEAR L.R.: I am glad that this drug combination helped your dog overcome his inflammatory brain disease that may well have been an adverse reaction to a vaccination, which in the future would probably best be avoided.
Yes, the cost of pharmaceuticals has really gotten out of hand, and veterinarians are being wrongly blamed for this drug industry profiteering and monopolistic, cartellike business practices.
Readers will appreciate your diligence in finding less costly sources for the human medications, generally prescribed in the category of "off-label" by veterinarians when they are not specifically approved by the government for animal use.
A veterinarian friend of mine, Dr. Ron Gaskin of Shakopee, Minnesota, who has been investigating this issue, sent me the following statement, which I ask all readers to pass on to their congressional representatives:
"Pet owners of America might have noticed that the prices of medications for their pets are increasing. Many of these drug price increases are astonishing! Over the last three years, our veterinary clinic has seen an increased frequency of manufacturers backordering drugs. When -- and if -- the drug returns to the market, a huge price increase usually follows. This has happened to doxycycline, a powerful antibiotic used to treat tick-borne diseases found in Minnesota. The human generic doxycycline tablet price has increased at least 600 percent. Generic doxycycline tablets from some human drug wholesalers have gone up as much as 1,800 percent.
"Another example of stratospheric drug price increases is phenobarbital, a human anti-seizure medication used to control epileptic seizures in cats and dogs. Phenobarbital has been a frontline drug for extra-label use in my patients for over three decades. Phenobarbital tablets were on a manufacturer backorder for eight months. When the tablets finally came back into the market, we had a 600 percent price increase. Yet another example is the cost of fluoxetine, an anti-anxiety drug used for feline behavior problems, which increased 2,300 percent in one day. This is a drug that can save a cat with such issues from being surrendered to a shelter, abandoned or worse.
"If these human generic drug price increases continue at this rate, veterinarians will not be able to economically treat our nation's pets within five years! Some pets will go without treatment or have to be euthanized because their guardians cannot afford the necessary medications.
"Human doctors are seeing the same problem. Senior citizens are often unable to afford their digoxin tablets, a formerly cheap but very effective drug used to treat congestive heart failure. When a senior citizen cannot afford the digoxin and is forced to go without it, he will likely end up in urgent care struggling for his life! Only in the American health care system does it seem that it is less expensive to treat a senior with decompensated life-threatening congestive heart failure than it is to manage the disease with a previously affordable 6-cent tablet.
"Why is this happening in America today? We are seeing human generic drug manufacturers increasing their prices just because they can. The drug powder or active pharmaceutical ingredient (API) price has not gone up, nor has an API shortage been a problem. It comes down to one cause: human greed. There used to be six manufacturers of phenobarbital; now there are only two, and they set the price. Small, independent, competing generic drug manufacturers are being acquired and shut down or incorporated into larger drug manufacturing corporations, who then control the price of the generic drug.
"The American Veterinary Medical Association (AVMA) top brass, in a private conversation, stated that the human generic drug price increases are 'free enterprise-driven,' and they claim there is nothing that the AVMA can do about it. When the price of a human generic drug gets high enough, this could entice our veterinary generic drug manufacturers to apply for and get approval to manufacture economical generic veterinary drugs. Our veterinary generic drug manufacturers appear to be holding the line on their generic drug price increases; however, the writing is on the wall. For example, a bottle of veterinary generic levothyroxine, priced at $49 just three years ago, is now double the cost at $101. One of the gold-standard brands of levothyroxine is currently on a manufacturer's back order. I hope this is not a trend. It begs the question -- why can't human generic drug manufacturers hold down the cost of their generic drugs and charge fair prices?
"What is the federal government doing about this? Stringent Food and Drug Administration regulations and an aging drug manufacturing infrastructure have resulted in many small generic drug manufacturers being shut down or becoming more easily acquired by larger, predatory generic drug manufacturers. The Federal Trade Commission is allowing this monopolistic process to happen. Why is this happening? Money. There is a huge amount of money involved. A recent Senate oversight committee investigation has become silent about the exorbitant generic drug price increases. Pet owners should be aware it is not usually your veterinarian making the 'big money.' Our veterinary practice has started to write a lot more pet prescriptions to be filled at local pharmacies because the drugs are too expensive for us to inventory, or we just want to help the pet's owner find the most affordable option they can. Sadly, almost always our pet owners find out what the real, and unanticipated, costs of human generic drugs are -- for them and their pets."
I urge readers to send this statement to their Congressional representatives to address this serous issue affecting both human and animal patients in need of prescription medications.
(Send all mail to firstname.lastname@example.org or to Dr. Michael Fox in care of Universal Uclick, 1130 Walnut St., Kansas City, MO 64106. The volume of mail received prohibits personal replies, but questions and comments of general interest will be discussed in future columns.)