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Thread: Cost Savings for Owners of Cushingoid Dogs

  1. #1
    Join Date
    Apr 2009
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    139

    Default Cost Savings for Owners of Cushingoid Dogs

    Attached you will find a summary of some cost savings tips that we hope will be useful. Included are:

    Listing of online pharmacies that offer competitive pricing for Vetoryl and other prescription medications;
    Information about compounded versions of trilostane (the active ingredient in Vetoryl);
    A method for lessening the cost of ACTH stimulation testing used to monitor treatment progress;
    Information regarding a new trilostane monitoring protocol that involves less expensive testing of only pre-pill baseline cortisol levels.

    We know that the costs of caring for a Cushing's dog can be challenging, and hope that these tips may help lessen the expense for our members!

    Cost Savings_k9Cushings_Rev Final.pdf
    Attached Files Attached Files
    Last edited by lulusmom; 08-27-2018 at 01:33 PM. Reason: Replace revised pdf

  2. #2
    Join Date
    Apr 2009
    Posts
    139

    Default Re: Cost Savings for Owners of Cushingoid Dogs

    COST SAVINGS FOR PET OWNERS OF CUSHINGOID DOGS

    VETORYL (Trilostane)

    Vetoryl is expensive and most often a vet will charge more than outside pharmacies. There are many trusted online pharmacies used by thousands of pet owners who are very price competitive for name brand Vetoryl. Below are links to the three most competitive online pharmacies that are often shared with members in support groups. This list can change over time so pet owners should do their own research.

     Allivet - http://www.allivet.com/search.aspx?SearchTerm=Vetoryl

     California Pet Pharmacy - https://www.californiapetpharmacy.co...Search=Vetoryl

     Valley Vet Supply - https://www.valleyvet.com/ct_detail....20C-EFEA-490B-

    Pet owners will need a prescription from their veterinarian and we have found that most vets are willing to accommodate their clients. Please note the vast majority of states require that a veterinarian honor a request from a client and per the AVMA, refusal to comply with a pet owner’s request can “constitute unprofessional conduct, leading to discipline against a veterinarian. Unprofessional conduct generally refers to a departure from or failure to conform to the standards of acceptable and prevailing practice of a veterinary medicine.” We recommend pet owners check the AVMA State Summary Report (link below) which has most state requirements before requesting a script from a vet. We believe it is always best to be armed with
    knowledge and never be afraid to use that knowledge in advocating for our dogs.

    https://www.avma.org/Advocacy/StateA...on-orders.aspx

    The high cost of Vetoryl in the U.S. can make it very difficult to treat a cushingoid dog. Fortunately, for pet owners who otherwise could not afford treatment (and for dogs for whom appropriately-sized doses of Vetoryl are not available), there is a more cost effective alternative called compounded trilostane. Compounded versions of trilostane, while now in widespread use, are not the equivalent of generics, and do not carry the same U.K./U.S. certifications as does Vetoryl. Instead of being produced large-scale by pharmaceutical manufacturing companies, compounded versions of trilostane are prepared on an individual custom basis by specialty pharmacies. For these reasons, compounded trilostane should only be purchased from trusted compounding pharmacies, many of whom do ship nationwide. For more information regarding the use of compounded medications in the U.S., here is a set of FAQs compiled by the American Veterinary Medical Association (AVMA).

    https://www.avma.org/KB/Resources/FA...et-Owners.aspx

    Some vets are hesitant and some even refuse to write a prescription for compounded trilostane. This may be due to considerations discussed in the AVMA publication. Additionally, it may be based on a limited study funded by Dechra, the manufacturer of Vetoryl.

    https://www.ncbi.nlm.nih.gov/pubmed/22611212

    This study involved compounded trilostane in various doses purchased from eight (8) unnamed compounding pharmacies. “Findings in this study indicate that trilostane content of compounded capsules may vary from the prescribed strength, and dissolution characteristics may not match those of the licensed product.” However, if you feel that compounded trilostane gives you the best (or only) opportunity to successfully treat your dog, we encourage you to discuss the available options with your vet so that pros-and-cons can be balanced based on your specific needs. There are thousands of advanced compounding pharmacies in the U.S. and without the names of the pharmacies involved in this study, it is highly recommended that pet owners do their own due diligence or consider using a trusted pharmacy that is routinely recommended by support group members.

    The FDA prohibits pharmacies from compounding doses of trilostane (active ingredient in Vetoryl) in available Vetoryl doses. For instance, if a vet has prescribed 30 mg of Vetoryl, a compounding pharmacy can make a 28 mg or 32 mg dose but not 30 mg. It should be noted that some compounding pharmacies offer trilostane in tablet form which are usually less expensive than capsules. Additional cost savings can be found by purchasing more than a 30 day supply. However, because a dog may need to have their dose adjusted in the first few months of treatment, it may be more cost effective to purchase no more than a 30 day supply. Once a dog has stabilized on an effective dose, additional savings can be had by purchasing a 60 or 90 day supply.

    Links to information for two compounding pharmacies which are currently being recommended to us by pet owners are provided below. The cost for compounded trilostane is markedly cheaper so this can make the difference in a pet owner’s ability to treat their dog. However, we always recommend that pet owners perform their own research, contact pharmacies with any questions, and obtain quotes for the dosage needed before asking for a script from their respective vets. It is always preferable to be completely prepared and armed with knowledge when presenting this or any other request to a vet for consideration.

    • CareFirst Specialty Pharnacy - https://drive.google.com/file/d/1Xwq...jqj1KDcp_Xbt9U

    • Roadrunner Pharmacy - https://www.roadrunnerpharmacy.com

    Additionally, to aid your search for trusted pharmacies in the U.S., here are two links. In order to search for internet pharmacies that have been vetted by the National Association of Boards of Pharmacy:

    https://nabp.pharmacy/programs/dotpharmacy/

    To see whether a compounding pharmacy has received specialty accreditation:

    https://www.achc.org/compounding-pharmacy.html

    ACTH STIMULATION TESTS FOR MONITORING VETORYL (TRILOSTANE) AND
    LYSODREN (MITOTANE)


    If a vet uses Cortrosyn as the stimulating agent for the ACTH stimulation test and their canine patient weighs less than 55 lb (25 kg), the 250 mg vial can be divided into 5 mg/kg doses and stored in the freezer for future use. Cortrosyn is very expensive and is the reason why the ACTH stimulation test is so expensive. By splitting the vials, hundred and even thousands of dollars can be saved over the life of a dog. As an example, a dog weighing 55 pounds (25 kg) would require a 125 mg injection so one vial would be split in half, making it possible to get two ACTH stimulation tests out of one vial. A 10 lb dog (4.5 kg) would require a 25 mg injection, making it possible to get 10 ACTH stimulation tests out of one vial. The split vials are good for up to six months in the freezer so chances are a pet owner may be lucky and never use 10 vials but their vet could pass on the savings to other clients. It is definitely worth discussing this with your vet. Most general practice vets are mindful of the high expense associated with testing and are compassionate enough to help reduce expenses for their clients by learning how to split and store this stimulating agent. We have provided a link below which we encourage pet owners to read and print out for discussions with their vet. This link is to Dr. Mark Peterson’s Insights into Veterinary Endocrinology website that was created to help general practice vets and pet owners get the answers they need. Dr. Peterson is a world renowned and highly published endocrinologist and internal medicine specialist.

    https://endocrinevet.blogspot.com//2...rosyn-for.html

    PRE-VETORYL CORTISOL MONITORING (DOES NOT APPLY TO DOGS BEING TREATED WITH LYSODREN/MITOTANE)

    On April 4, 2018 the manufacturer of Vetoryl, Dechra Veterinary Products, issued a press release announcing an alternative method of monitoring dogs that are being treated for Cushing’s syndrome. This alternative method called Pre-Vetoryl Cortisol Monitoring was developed by Professor Ian Ramsey at the University of Glasgow. “Pre-Vetoryl Cortisol monitoring is a superior alternative to traditional ACTH stimulation in that it predicts clinical signs better, gives more consistent results, is less expensive and easier to perform. Trilostane is the active ingredient in Vetoryl so this monitoring method would also apply to those dogs being treated with compounded Trilostane”. Veterinarians in the UK and some countries in the EU adopted this new monitoring method well before this press release. As of this writing, veterinarians in the U.S. have not been informed by Dechra of this new monitoring method due to the need for FDA approval, and some questions have emerged as to whether this protocol would benefit from additional alteration. However, if used successfully, this monitoring method can save pet owners thousands of dollars over the life of their pets and as only one blood draw is required, a dog is going to be much happier with a short office visit and only one poke.

    Especially if testing costs present a barrier to treatment, it is very much worth the time and effort for pet owners to have discussions with their vets about this monitoring method. Vets, themselves, can research this method by visiting the link below. This link is to the Dechra (UK) site which has complete information, including three videos presented by Professor Ramsey. It is equally important that a pet owner take the time to familiarize themselves with the role they play in providing appropriate information to their vet in order to facilitate safe and effective treatment.

    https://www.dechra.co.uk/therapy-are...tisolSuperPage

    We hope this information is helpful in alleviating some of the burdensome expenses of treatment. We realize how difficult it is, especially for our members new to the disease, to understand all of the nuances of Cushing’s and its treatments so our staff members will be happy to answer any questions you may have.

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