Chew on This

By Vet-Advantage
February, 2018
How chewables and other compliance-friendly products are driving more traffic to veterinary practices

Stanley Truffini, DVM, Georgetown Veterinary Hospital, Conn., has seen almost four decades worth of new product introductions into the marketplace to combat an age-old pet conundrum – fleas and ticks.

First were the flea collars.

“You can sometimes forget about the fleas, but they always come back,” he says. “I’ve seen this happen frequently. Over the summer, you’ll never see fleas on the dogs that are protected, but all of a sudden a cat or a dog that doesn’t have some sort of preventative will show up. You tend to think they aren’t out there, but they are.”

Then came the arrival of topicals.

“We originally started with the topicals, because that was what was available,” says Dr. Truffini. “They had their issues with application, applying it properly. We always recommended them to families with children, but would advise that they didn’t hug or touch their pets in the area the topical was applied, and that was always a little bit of an issue.”

Recently, the orals started appearing. Truffini says his team waited a year or so before bringing a new product into their hospital. “They seem to work well,” he says. “We didn’t have too difficult a time convincing clients, especially with families. Families were key, with children hugging pets, and hanging around them.”

Indeed, preventive products for years have been able to combat fleas and ticks and the diseases they carry. It’s the compliance component – convincing the clients of the benefits of the products and then follow through with appropriate use – that’s remained a challenge.

Compliance isn’t just an animal health challenge. Human medicine and pet medicine studies have shown that the adherence step of compliance – what clients actually do when they get home – is poor across the board, says Karyn Gavzer, KG Marketing & Training, Inc.

Gavzer is a practice management consultant specializing in marketing, training and customized solutions for veterinary practices. She has worked with industry, associations, and veterinary practices for over 20 years. As the former director of marketing for the American Veterinary Medical Association (AVMA) she created public campaigns with industry, such as “Pets Need Dentistry, Too” and training programs to help veterinarians and their teams market their services more effectively.

There are many potential reasons for poor compliance, says Gavzer. “Clients may get confused,” she says. “They may forget to give the medicine to their pets. They may have trouble giving the medication because the pet fights it, such as ear squirt treatments and pilling cats. Or, clients may run out of the medication and forget to order more.”

One interesting development Gavzer sees on the human medicine side is experimenting with “smart pills” that digitally log in when they are taken and implant dispensing devices to automatically deliver needed medications. “In the meantime, they are little better off than we are with our veterinary patients,” she says. “For now, the two main tools to improve client compliance are more convenient products/medications, and human support.”

Gavzer says she has seen tremendous improvement in products that can be administered in the veterinary practice – like ear treatments, injectable antibiotics, heartworm preventives and chewables for flea and tick. “Products like these are usually the best choice to ensure our patients get what they need, and they are so much easier on clients – we do all the work for them!”

Although it’s a little more difficult to determine compliance today because clients can purchase flea/tick products online and over-the-counter, as well as get them from veterinary practices, Gavzer says the hurdles to compliance remain the same:

  • Do clients know that their pets need them and how to give them? “Did we recommend the products when they were in? Did we let them know that they could get everything they needed for their pets before they left from us and that we could give the first dose while they were there? Also, did we dispel the myth that our prices are higher? Did we let them know that our price would be about the same as they would pay online and they could take it home and be done?”
  • Do clients give the product monthly, weekly, etc., even if they have it? “We can help them with this by offering to do it for them,” Gavzer says. “Is there an injection in lieu of a pill their pets could take? Or are there pills that could be given every three months instead of monthly? Can we offer to send text or e-mail reminders when their pets need their next dose?”

Safety first
The safety of a product is always top of mind for clients, as well as veterinarians. That’s why Truffini says his practice will wait at least a year when a product is introduced in the market and read up on the research involved before using it. Fortunately, there is a familiarity in place with chewables as preventives, having been on the market now for several years, as well as their similarity to heartworm preventives.

“Everybody is used to giving something oral to kill something, such as heartworm,” he says. “Clients are already aware that these products are safe based on safety studies. They know about heartworm being safe, so that has paved the way for allowing these other oral products. We do explain the safety involved and studies done, and how little medication is needed. Knowing these products are safe when taken as directed, they are pretty much on board with it.”

Like Dr. Truffini, Shannon Jensen, DVM, at Perkins County Veterinary Hospital in southwest Nebraska, waited to try chewable flea & tick products when they were introduced into the marketplace. “I resisted selling chewable flea/tick products when they first came out, due to the fact that they last so long in the body. I had past experience with chewable heartworm prevention causing GI signs for the full four weeks of efficacy.”

This past summer was her veterinary practice’s first to really offer chewables, and they chose Bravecto. “Clients love the convenience of once every three months, and so far we have not seen any adverse reactions,” she says. “The monthly preventives drive traffic in the clinic more so than Bravecto as far as frequency of visits (monthly vs quarterly). Availability of oral, however, brings clients to the veterinary clinic so far.”

Truffini says one of the biggest selling points for the new chewables is in how quickly they act. “We’re getting more complete killing of the tick before it can actually transmit anything,” he says. “That’s important.”

“Most of our clientele is pretty well educated that you have to do something about ticks, especially because of Lyme disease,” he says. “We’re in the number one place in the United States for them. This area of Connecticut has the highest rate of Lyme disease. People are wary. Usually 1-2 family members have had Lyme disease. So they are aware, and they see ticks on their dog and know what’s going on. They’re all pretty much on board.” There are some that may try natural products, but 98 percent want some sort of topical or systemic product, Dr. Truffini says.

At the right price
Zack Mills, DVM, owner of Duluth, Ga.-based Tiger Tails Animal Hospital, says the vast majority of clients at his practice are switching from topical to oral/chewables. “When it is easy to administer, clients are more apt to use the product. I saw this myself with Frontline and Heartgard. I would always give Heartgard because it was given easily as a treat. I would delay on doing the Frontline many times, forgetting to do it later.”

Manufacturer rebates also help create a very high compliance rate of owners purchasing a year supply of both products, Mills says. “What gets people to purchase is the rebate. The [manufacturer’s guarantees] help, but it’s really about price.”

In today’s marketplace it is extremely important to be price competitive with products, Mills says. “Today’s consumer is going to price shop. If they are used to purchasing items online. If they can save $5-10 they will purchase online. When you price products too high customers can easily check to see if you are ‘overcharging,’ and if you are ‘overcharging’ for these items, they will ask themselves what else are you ‘overcharging’ for?”

Conversation starters
Compliance products – that are better for the patient and easier for the client – are attractive and desirable to clients, if they know about them, says Gavzer. That’s where clear communication from the entire veterinary practice team comes in. It’s important to have the preventive conversation during wellness checkups especially, but also at appropriate times for other client visits. Veterinary practices may be surprised by the response.

“It’s been my experience that clients don’t always hear about these options because they can cost more,” Gavzer says. “Many in practice shy away from recommending them for that reason. I think we’ve misread clients. I think that most would say yes if we offered them a better way to take care of their pets, even if it cost more.”

Truffini says he hasn’t seen a bump in sales as much as clients switching over from topicals to chewables when his practice discusses it with them.

“It hasn’t been too hard to talk to people or convince that there are options with flea/tick products. “I would say maybe a third of clients are using orals,” he says. “Every time we talk to people and they need to have refills, we mention the chewables. Clients are already used to giving once-a-month heartworm, so it becomes a pretty easy thing. They like that they aren’t parting fur. People weren’t always applying it properly. So with that issue, it’s a very convenient thing to hand them this tasty, once-a-month treat. We are getting good compliance.”  

Market impact
In just a short period of time, chewable flea/tick products have made a noticeable impact in the market. According to industry reports, compound growth for flea/tick products that have been veterinarian dispensed has been just under 5 percent since 2011. However, using 2014 as the baseline year shows a much sharper uptick of close to 16 percent.

What accounts for this increase? In 2014, NexGard and Bravecto were introduced to the market.

In addition to the increase of product dispensation, there has also been an increase in product compliance with both pet owners and veterinary hospitals. That movement accelerated when Zoetis jumped into the space with Simparica in early 2016.

It is important to examine compliance through a 2-3-year window rather than year over year. That’s because pet owners have traditionally stretched out their use of flea/tick products beyond a calendar year. Analysis shows that most owners who buy a six pack of a monthly topical, are typically not buying it again for another 25 months, on average. At some hospitals, subsequent purchases are 36-38 months out. So, when clients make the initial purchase at a yearly exam, they may tell the veterinary hospital when asked about flea/tick product refills that they still have some at home.

With the introduction of Merck Animal Health’s Bravecto Chew, dogs get 12 weeks of flea and tick protection with a single treatment. That’s nearly three times longer than monthly treatments.

“What we are finding with Bravecto is that pet owners at most of these hospitals are getting – at least – two doses of Bravecto every year,” says Pasquale Bondi, Regional Manager, Merck Animal Health. “That’s at least six months of protection in those pets every year, as opposed to historically two months, or at best three months.”

The extended coverage helps. So does the convenience of it being delivered in a chewable. “Just the convenience factor alone is paramount,” says Bondi. “Bravecto is the only flea/tick product that lasts for 12 weeks, eliminating the worry of monthly doses. And since the chews are basically a treat that provides important protection against fleas and ticks, it’s easy on the dogs too.”

NexGard, Bravecto and Simparica are all sold exclusively through veterinary hospitals, which helps drive clients back into the clinics. The manufacturers have created incentives for purchasing the products, including rebates in place for the pet owner. For example, in 2018 Merck will offer $30 off four doses of Bravecto. For Simparica, Zoetis is offering $15 off for 6 doses, and $35 off for 12 doses via the Simparica website.

For NexGard, clients can download a coupon to present when they see their veterinarian for a prescription and receive a free first dose. Merial, part of Boehringer Ingelheim, is also offering $50 back in savings when clients buy 12 doses of NexGard® and 12 doses of HEARTGARD® Plus together.

Still, even with those selling points, veterinary hospitals must have total buy-in when it comes to the products they carry to successfully move product.

“The most successful hospitals, no matter what product they are carrying, have a consistent recommendation from the entire veterinarian staff instead of a plethora of options,” says Bondi.

Topics: Cover Story


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