Vet clinic upcharged on Pergolide

[grayarabians]

After several farm calls - over months - and testing to include x-rays, ultrasounds, bloodwork, venogram and TRH Stim tests - my horse was diagnosed with Cushings.

I suspected Cushings but previous baseline ACTH tests were in normal range.
After bad abscessing and rotation in LF and LH suspensory branch tears - I found out about and asked for the Stim test.
Bingo - unfortunately positive.
Actually the clinic should have twigged that my horse was probably PPID and suggested the Stim test.
It was a year from h*ll.
I asked for compounded Pergolide upon diagnosis.
Vet wanted to Rx Prascend but called in Rx to Wedgewood for compounded.
I called WW to give payment info and was told the capsules had already been shipped - and paid for.
I thought that odd.
I had expected - as with two previous PPID horses - vet calls in Rx.
I call in to pay and set up ship date.
I asked WW for invoice amount.
They wouldn’t tell me
I knew it would be around $100.
I called clinic.
Tech told me the invoice was $245.50.
I said you’ve got to be kidding.
I asked for the original WW invoice.
Nope - with much run-around ridiculous
sputtering from the tech about a handling fee.
I managed to get the original from WW.
$96.50.
Clinic changed $96.50 plus a $127 "handling"fee. (Shipping $22.00).
I emailed the vet - saying must be a mistake - please ask clinic to credit me back the $127.
Was told no - since meds already dispensed. How’s that for logic?
After all my horse and I had been through - thousands spent on diagnostics and treatment - they charged me $223.50 for a $96.50 prescription.
I was so pi$$ed and still am.
This is so uncool.
I’m tempted to call Visa and dispute the upcharge.
What would others do?
TIA… (Susan - formerly Grayarabs)

[skydy]

@grayarabians

What would others do?

I’d wait until you are not as angry, and have time to think about the logistics of finding another vet. Then, discuss with the Vet your reasons for being upset about the bill, calmly, and in person.

[Willesdon]

… and also consider what the vet brings to the equation, why vets are getting harder and harder to find…

[trubandloki]

@skydy

@grayarabians

What would others do?

I’d wait until you are not as angry, and have time to think about the logistics of finding another vet. Then, discuss with the Vet your reasons for being upset about the bill, calmly, and in person.

This! Totally this.

I might be in the minority here, but to me it is fine that the vet charges some handling fee. Do I think that is a little extreme for a handling fee? Sure.

[No1]

Honestly, the vet may be charging that much to discourage clients from seeking compounded alternatives to FDA drugs that are readily available. In any case, they should charge some amount over the cost from the compounding pharmacy, to cover their labor, storage, etc.

Either way, if you dispute the charges, you are the one in the wrong. If you don’t like the cost, make alternative arrangements next time.

[clanter]

I would and did change veterinary practices if service is/was unsatisfactory , (we live in an area of many equine vets but if there were none available I would get rid of the horses)

Over the years we have left the practices of two equine vets whose service was unacceptable

[wsmoak]

I would pay the bill without blinking. You didn’t ask for a quote in advance, you assumed. Then the vet and staff had to do extra work because you insisted on a particular drug. The one they wanted to prescribe would have been easier for them.

Then switch vets if you are not happy with this one.

I am sorry you’ve been through so much with your horse and I hope his condition improves.

[luvmyhackney]

You would have cheaper just the buy the name brand which the vet knows works.

I’d pay the vet and then use what the vet suggested.

[MsM]

I might take the angle of swallowing the charges on this one. Then asking since this will be a long term need, if you can order it directly from the pharmacy in the future and the pharmacy will verify the prescription with the vet.
If not, you will have to explore your options.

[clanter]

@grayarabians

I suspected Cushings but previous baseline ACTH tests were in normal range.
After bad abscessing and rotation in LF and LH suspensory branch tears - I found out about and asked for the Stim test.
Bingo - unfortunately positive.
Actually the clinic should have twigged that my horse was probably PPID and suggested the Stim test.
It was a year from h*ll.

the drug is not my concern but the Year it took to figure out what was wrong

[Janet]

@clanter

the drug is not my concern but the Year it took to figure out what was wrong

I’m with Clanter on this part.

[Janet]

@grayarabians

I asked for compounded Pergolide upon diagnosis.

WHY did you ask for compounded Pergolide instead of Prascend?

The handling fee seems a bit high to me, but since you didn’t ask about it when you insisted on the “compounded”, I think you need to bite the bullet and pay it. Then figure out what you want to do going forward:

• continue to pay for the compounded version
• switch to Prascend
• switch vets.

[Ghazzu]

I’d probably eat this one and then ask for a written prescription.
In many states, it is required that the DVM provide such if requested.
A one-off medication is one thing, but this is a long-term situation.

I would use Prascend, personally, but it’s your horse.

[vxf111]

I don’t have any problem with a vet charging reasonable rates to make a profit. I do have an issue with hidden fees that the office doesn’t want to be up front about.

That being said, having tried both you’re better off just using the Prascend. In my experience the better results are worth the cost.

[Cat.J95]

OP I think you were blindsided by getting a compound drug. I suggest having conversations with your vet about availability in the future.

[grayarabians]

Quick / partial reply for tonight:
Prascend comes in 1 mg tablets.
From experience (two previous PPID horses) I knew to be careful to avoid the Pergolide “veil”. (Side effects- the worst being one horse that stopped drinking).
So as many owners of PPID horses do - I wanted to slowly taper up the dose - increasing every four days by .25 mgs.
If side effects occurred - I could decrease - wait - then increase again.
(Not splitting Prascend tablets in quarters).
As it turns out - my horse needs 2 mg/day - so I’ve been tapering up since April diagnosis. He probably should be on 3 mg during the seasonal rise - which is now.
So I asked for compounded Pergolide in .25 mg capsules from Wedgewood.
Vet reluctantly agreed - saying he had strong feelings against compounded drugs.
The TRH Stim test I asked for and he performed?
The IV “drug” is Protirelin - compounded - at Wedgewood.
Imagine my surprise when I read that on Cornell’s website.

[stargzng386]

There’s a local vet to me who literally makes a killing off of upcharging meds. Any med off their truck is at least double and they push hard for you to buy from them. They claim meds from other companies are unsafe and not stored properly. My horse had ulcers and they wanted to charge me $67 per tube of gastrogard. That literally would have cost me an additional 2k to treat his ulcers since it took 2 months.

If you asked for a written prescription that they’re legally required to provide in my state they charge a $15 office fee. I sucked it up and paid the office fee but when I moved slightly further out I just switched vets. They also made me feel like shit everytime I had to pay the office fee and didn’t buy meds from them. I needed Equioxx and just wanted it from chewy - free shipping, autoship etc. and I had to fight them on the phone everytime I needed a refill approval. Also, I need to be able to trust and have my vet prescribe something and hand it to me off the truck in an emergency without making me broke. I do happily pay my current vets normal up charge of maybe 10-15% on average. I even buy meds from her that I could get slightly cheaper with a prescription because I know that’s partly how she’s making her income.

Honestly I’d pay the bill and find a new vet. They’re not going to change.

[clanter]

Any med off their truck is at least double and they push hard for you to buy from them. They claim meds from other companies are unsafe and not stored properly.

while those meds riding around in their truck for the last year subjected to excessive heat and not rotating the inventory are just fine

[stargzng386]

Exactly! Versus the med shipped from the pharmacy warehouse to my house directly brought inside and stored correctly by myself. It was just a money grab

[Ghazzu]

@stargzng386

It was just a money grab

Yes and no.
Any business has a bottom line on how much income is required to stay in business, and usually a higher number on what they’d like to bring in.
If it doesn’t come from column A (in this case, Rx prices), it will need to come from column B or C (perhaps farm call charges, or lab charges, or radiography charges, etc.)

I always find myself chuckling about this sort of thing, because when I was in f/t practice, I was the Queen of undercharging.

One of the reasons I like teaching–they send me a paycheck, and I don’t need to feel guilty about handing someone a bill.
Still, I never went to vet school to pimp for the pharmaceutical industry either.

I’m not saying I don’t find the particulars in this instance to be a bit much, but most people in practice aren’t aging hippies like yours truly, haven’t taken a vow of poverty, and everything from student loan payments to truck fuel to the sophistication and cost of equipment clients expect the DVM to have available is expensive these days.