Welcome to the third in the series of Mark Five: Policy Off Leash, which are short video casts about policies affecting virtual care and veterinary medicine in the United States.
We looked earlier at the basic rules right now that govern the states in terms of what is in the laws affecting veterinarians in the VCPR with telemedicine. Today we dive into an important but a more dry subject, it’s going to feel like this is federal politics 101 – apologies – but it is important and I think it can be explained in a way that makes sense to you.
This concerns the Food and Drug Administration, the FDA. The FDA is a federal agency that governs both human medicine and drugs and animal medicine and drugs; it basically approves or disapproves the introduction and use of drugs and sets the rules for using drugs both in the human and animal sphere.
The FDA doesn’t get as much discussion in veterinary medicine because, as I talked about last week, veterinary medicine is very much regulated at the state level by state practice acts and state veterinary medical boards. But if you’re living in the US and you’re practicing veterinary medicine, there are FDA rules that affect you. One that definitely affects you (and is controversial because it causes people some confusion about whether they can use telemedicine at all) is a rule governing prescription of off-label drugs.
The FDA rule says that you can only prescribe off-label drugs for an animal if a traditional VCPR – a physical examination before you consider yourself the veterinarian for that animal – has taken place. Many people assume that means you cannot use telemedicine unless you’ve got a traditional VCPR in place.
Well, yes, it is true the rule governs a whole country, but it is limited to extra-label drug prescriptions. Those are important to veterinary practices but it’s certainly not all that a veterinary clinic does all day long, or even all that a veterinarian, a vet tech or nurse does all day long. It regulates that one part of a practice. You must decide how important that is and be aware of that in your practice.
You may wonder why they even passed that rule. The FDA is mainly focused on national issues, particularly food animals. This makes sense – cattle raised in Texas are not just slaughtered, turned into meat and eaten in just the state of Texas. That beef goes all over the country and in some cases, all over the world. So, what happens to an animal, say a sheep, a lamb, a pig, etc. in any state has an impact across that state’s borders. The FDA takes very seriously the issue of antimicrobial resistance. Even though it’s a much bigger issue for food animals, the FDA takes this very seriously for pets as well.
At the time when the FDA applied this rule to companion animal veterinarians, there was really no discussion about traditional versus non-traditional VCPR. The VCPR has pretty much always looked the same. But what happened with COVID was that the FDA waived the requirement of a traditional VCPR for prescribing extra-label drugs for veterinary medicine. The reason for this of course was the concern about social distancing, the safety and welfare of pet owners as well as veterinary staff and teams. This is currently still in effect as of the middle of October. This is significant because the FDA would not have taken that step if it believed it was going to lead to harm to pets across the country.
At the same time, we now have at the national level a laboratory where we can see if the FDA has received any evidence or complaints of negligent harm or death for a pet due to the prescribing of an extra-label drug where there was not a traditional VCPR but instead a telemedicine VCPR. This really adds to the information we’ve learned from the 17 states during COVID, and also from the province of Ontario for the last three years, and now the FDA nationally as to how it has worked when we’ve allowed a telemedicine VCPR to be created. That opens a door for dialogue between states and their VMAs and whomever else with the FDA about whether that rule might end up looking a little different from situation to situation. All of this is to say that as long as a veterinarian is in compliance with her state’s VCPR rules, she can prescribe extra-label prescription drugs.
Thanks for watching and remember to go to the VVCA.org website if you want to be part of the general conversation with other colleagues about these and other issues concerning virtual care. There, you can find a 3,600-member strong organization engaging on all topics that concern telemedicine and virtual care for veterinary practices. Not just limited to the policies discussed in this series, but how to use it best, how to implement it, how to train your staff, what are the proper roles for all the staff members and how pet owners have reacted to it.
We’ll see you next week!