Quality Assurance Beyond the Product: Catching Fraud in Veterinary Compounding Pharmacies

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In veterinary medicine, trust is crucial to patient care. This is true for hospital’s relationships with its patients and clients, but trust is also necessary between a clinic and its pharmacy partners. While we all want to trust that counterfeit and fraudulent veterinary medication orders are not commonplace, they can happen. Being able to trust that your compounding pharmacy is working to prevent those fraudulent orders is critical to successful partnerships.

Epicur’s sister division, Stokes Pharmacy has caught and prevented a few different cases of fraudulent medication orders. Two of those orders were made under Dr. Micki Armour. We sat down with Dr. Micki Armour, VMD, DACVO, owner of Armour Veterinary Ophthalmology, to talk about those cases and how they have influenced what she looks for in a compounding pharmacy partner.

Thanks for sharing your side of these fraud cases, Dr. Armour! Let’s back up a little, how did Epicur Pharma and Stokes Pharmacy become your source for compounded drugs?

I started partnering with Stokes Pharmacy after I met Sam Newton at one of our conferences. She was so personable and relatable and put me at ease with how knowledgeable she was when discussing Epicur’s products.

When I started to determine who to use for compounding medications, I looked at the things that are most important:

I want to know that my clients and I will be the happiest with the products used. It became clear to me that those things are important to Sam and the Stokes team. I value that I can trust their commitment to product quality.

In cases when the drug is available as a manufactured product, my clients will receive Epicur’s products through Stokes Pharmacy. This proves their team’s commitment to going the extra mile when filling a prescription in order to give every patient the best product.

Even though 503B manufacturing is gaining traction in veterinary medicine, traditional compounding pharmacies, or 503As, are more widely known. What led you to partner with a 503B manufacturer?

Being in veterinary medicine, you have to stay on top of changes and regulations for your own licensing. The rules also vary in different states, so staying up to date for your own state or, in my case, the District of Columbia, is important to know what can and cannot be on the shelf.

In the hospital where I practice, we actually have a board-certified pharmacist on staff, which is really helpful and a little different than many other veterinary hospitals. With over 80 doctors at my hospital, we serve a large volume of patients.

Along with it being important to how we practice, it’s also nice to be able to understand the role of pharmacy within the veterinary field. Sam and the Stokes/Epicur team have made it their mission to keep veterinarians up to date on 503B outsourcing. There are a lot of compounding pharmacies out there, but not all of them have certain approval specifically for ophthalmic medications. As a veterinary ophthalmologist, knowing who you can go to for those specific formulations and in what state is important.

What has made Stokes Pharmacy different from other veterinary compounding pharmacies you’ve worked with?

The accessibility to the pharmacist. If I need to ask a question about any sort of compounding medication, they are immediately there to help. I recently had a client who was having difficulty medicating their cat with an eyedropper. I called Stokes to see if it was possible for them to compound the medication into an ointment preparation. They were able to give me an answer right away when I called so I could quickly get back to the client with a solution. They clearly explain why or why not medicine can be formulated a certain way.

Want to dive deeper into patient safety? Check out how to increase patient safety by stocking 503B drugs.

Let’s jump into the fraudulent medication cases. Can you tell us more details about those?

Both times fraudulent orders were made, it was Stokes that caught the odd activity and alerted me. In the more recent case of fraudulent activity, it was Sam who called me directly. Nothing about the order made sense and none of the details added up. I didn’t recognize the name of who the order was for and when we looked up the residence on Google Maps it didn’t even exist.

Rather than just putting through an extra bottle of medication blindly and making an extra dollar for the day, Stokes took the time to call me. The fact that the steps in their process caught this fraudulent order and they addressed it speaks volumes about their quality control and their professionalism.

Was the second fraudulent order just as odd?

The other time Stokes caught a fraudulent order had been a misunderstanding with a professional acquaintance who just wanted to learn more about a certain type of medication. When the order was placed Stokes had noticed something strange about the way that the medication had been called in, indicating the order wasn’t from a veterinarian. The order also hadn’t been called in from our normal business office.

After noticing this, they contacted me to let me know what they had found and what was odd about the order. They shared who the medication was for, and because I recognized the name, I was able to sort out the situation.

I was shocked and surprised, but so delighted that Stokes had uncovered these unexpected fraudulent orders. It made me feel more secure about the feedback loop between us and furthered my trust with them as a compounding pharmacy.

I am thankful for the professionalism and keen eye for medical excellence at Stokes/Epicur. In both situations, Stokes took the care and diligence to discover the discrepancies, alert me to the abnormal behavior and provide me the option of input rather than just blindly filling. This excellence in patient care and also in the feedback loop to the clinician is so critical for trust and accountability, and is one of the reasons that I keep coming back to Stokes and recommending you to my peers. Thank you for all that you do!
Micki Armour
How could have either of these fraudulent cases impacted you professionally if they had gotten through?

With the switch to online ordering systems, like Stokes and Epicur’s iFill, I think there are fewer opportunities for irregularities or fraud. It’s a secure connection between our offices with specific usernames and passwords for every user who logs in. It reduces the changes of a medication getting called in from anyone because the online system has a full lineup of who the medication was put in by and specific veterinary practice they are associated with.

Stokes/Epicur has put some parameters in that have helped regulate the direction that medication ordering needs to go in for the best quality control.

Thanks, Dr. Armour! We appreciate your insights into catching fraudulent veterinary medications!

Interested in hearing more from Dr. Armour? Check out our recent interview with her from the ACVO/Epicur National Service Animal Eye Exam Event back in May!

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