Filling your pet’s prescription at a pharmacy: a complete guide

Your right to a written prescription

A veterinarian has to examine your pet, within an established veterinarian-client-patient relationship, before prescribing. Once a medicine is prescribed, the American Veterinary Medical Association’s policy is that vets should honor a client’s request for a written prescription, and many states require it in law or board rules. A federal requirement has been proposed in Congress several times but has not passed, so the details depend on your state; some clinics charge a small fee for writing the prescription.

Ask for the prescription at the visit, or ask the clinic to send it electronically to the pharmacy you choose. For a medicine your pet will take for months or years, this one request is where most of the savings come from.

What an ordinary pharmacy can fill

Vets use many human medicines extralabel under federal law, and a licensed pharmacy fills a vet’s prescription for a human drug just as it would a doctor’s, labeled for the animal and owner. Common examples include antibiotics such as amoxicillin-clavulanate, doxycycline and metronidazole; gabapentin for pain and calming; trazodone and fluoxetine for anxiety and behavior; prednisone and prednisolone; levothyroxine; insulin; methimazole for cats; heart medicines such as enalapril, benazepril, amlodipine and furosemide; and stomach medicines such as famotidine and ondansetron.

Some medicines are made only for animals and are sold through veterinary distributors, so an ordinary pharmacy cannot order them. These include Apoquel, carprofen, Cerenia, pimobendan, most flea and tick products, and heartworm preventives. Your vet can dispense them, and so can pharmacies with veterinary product accounts, including online pet pharmacies, on your vet’s prescription. Some treatments, such as Cytopoint injections, are given only in the clinic.

When a compounded medicine is the answer

Compounding pharmacies prepare strengths and forms that are not manufactured: a capsule small enough for a cat, a flavored liquid a dog will accept, a gel rubbed onto a cat’s ear for a cat that cannot be pilled. Compounding for an individual animal on a vet’s prescription is legal, and the FDA’s guidance for animal compounding sets limits on copying approved drugs. Compounded products are not FDA-approved and quality varies, so ask the pharmacy about its accreditation and testing. Some routes, such as gels absorbed through the skin, absorb less predictably, which is why vets check blood levels for drugs like methimazole.

Safety rules that differ for pets

The pharmacist’s check is the most valuable part of filling a pet prescription, because the risks come from products and species differences rather than from the pharmacy. Tell the pharmacist the species and weight, and keep pet medicines apart from your own.

• Xylitol: a sweetener in many human liquid medicines and chewables that is poisonous to dogs. Ask the pharmacist to check any liquid, or ask for tablets or a xylitol-free compounded version.
• Human painkillers: acetaminophen is poisonous to cats, and ibuprofen, naproxen and other human NSAIDs are dangerous to dogs and cats at doses people take. Never give one without your vet’s direction.
• Flea products: dog spot-on products containing permethrin are poisonous to cats, including cats that groom a recently treated dog.
• Insulin: veterinary insulins are U-40 and most human insulins are U-100, and each needs matching syringes; the wrong syringe gives the wrong dose.
• Doses: some drugs need much higher doses per kilogram in dogs than in people, and others much lower in cats. Never adjust a dose without the vet, and do not crush extended-release tablets.

Controlled medicines for pets

Some pet medicines are controlled substances: tramadol, phenobarbital and benzodiazepines such as alprazolam everywhere, and gabapentin in the states that schedule it. A controlled prescription carries limits on refills, cannot always be transferred between pharmacies, and in many states is reported to the prescription monitoring program under the owner’s name. Plan refills ahead of weekends and holidays, choose the pharmacy before the first fill, and check your state guide for local rules.

Buying pet medicines online

Legitimate online pet pharmacies require a valid prescription from your vet and contact the clinic to verify it. Be wary of any site that sells prescription pet medicines without one, offers prices far below everyone else, or ships from outside the country. The National Association of Boards of Pharmacy accredits online pharmacies, and your state board of pharmacy can confirm a pharmacy’s license. Counterfeit flea, tick and heartworm products have been sold online, so buying from a verified pharmacy matters for pets as much as for people.

How to pay less for your pet’s medicines

Pet medicines are paid for in cash at the pharmacy, because pet insurance, where it covers medicines, reimburses the owner afterward. That makes comparing prices worthwhile, especially for medicines your pet will take long term.

• Ask your vet for a written prescription, and ask whether a human generic would work as well as a veterinary brand.
• Compare pharmacies, including independent pharmacies and pharmacies that stock veterinary products; prices for the same generic vary widely.
• For long-term medicines, ask whether a larger supply is appropriate, which usually lowers the cost per dose.
• For veterinary brands, ask the clinic about manufacturer rebates on products such as heartworm and flea preventives.
• Use compounding when it solves a real problem, such as dosing or acceptance, rather than as a way to save money on a manufactured product.

Working with your vet

Your vet remains in charge of your pet’s treatment, and a good pharmacy works with them. Expect the pharmacist to call the vet if a dose looks unusual for the species or weight; that call protects your pet. Some medicines are better dispensed at the clinic, for example when treatment must start immediately, when a product is given by injection, or when the vet is adjusting doses from week to week. Keep a list of your pet’s medicines and doses and share it with every vet and pharmacy you use.