I had a brief email discussion with my vet about the possibility of starting my pony on Invokana. Because it’s so expensive here in the US, a told her that it would be best to get it from a Canadian pharmacy where it’s cheaper. She sent me back a response and said that technically it’s illegal. She has to request special permission that takes up to 10 weeks to get approved. And that has to be done every time I need some. No automatic refills.

Has anybody else run into this?
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Dorothy Marsh, NY, USA. 2022

Hi Dorothy,

I have not had that experience.  I submitted an online request with pricepropharmacy.com (I chose the Invokana version coming from the UK).

They contacted my vet who gave them an RX. 

Their customer service is fabulous. They called me to let me know the status of the RX,  and have placed outbound calls to me for refills when they had reports of shipping times being longer.  It has been incredibly easy. 

Thanks Nancy
--
Nancy and Vinnie and Summer
Oakley, Ca
Joined Nov 2018
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie 
https://ecir.groups.io/g/CaseHistory/album?id=245855

Summer
https://ecir.groups.io/g/CaseHistory/files/Nancy%20and%20Vinnie/Summer 
https://ecir.groups.io/g/CaseHistory/album?id=249104

Sorry you're dealing with this, Dorothy.  Different states have different laws about allowing their residents to source prescription drugs in Canada. Florida, for example, allows its residents to get prescriptions from Canada. Many of us are getting our Invokana through Canadian pharmacies that in turn source the exact same drug, Invokana, manufactured by the same company, Janssen Pharmaceuticals, at a fraction of the price. Some of us start here:
https://www.pharmacychecker.com/

--
Cass, Sonoma Co., CA 2012
ECIR Group Moderator
Cayuse and Diamond Case History Folder                
Cayuse Photos                Diamond Photos

My vet sent me the government documentation about importing prescriptions from other countries. It looked  to me like it’s like this across the entire United States, not just individual states. I don’t think she wants to do it because of the legal issue. I told her that I would order it and fax the prescription myself, but she said that she would still be breaking the law because of her involvement and knowing it was coming from outside the US.
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Dorothy Marsh, NY, USA. 2022

My vet won’t prescribe for Canada either. It’s not legal, as she put it. My primary care doctor has no problem giving me a prescription for a medication that I need that I get filled in Canada for 1/10th the price, but my vet won’t do that for my horse. 

some vets obviously will, so maybe you can find one without losing your current vet for everything else. Good luck!
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EdieFr
Cape Ann, Massachusetts
Joined March 2021

It may not help but it's worth reminding your vet that writing a prescription is not illegal. The vet/M.D. has nothing to do with where you fill that prescription. The prescription won't specify where it is to be filled. You also don't have to tell the vet where you want it filled or why you want a prescription. You are entitled to a prescription rather than buying a drug from your vet.
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Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."

It is technically (i.e. by existing law) illegal but the FDA has been exercising "regulatory discretion) for decades when it comes to drugs from foreign pharmacies for personal use. See https://attorney.elderlawanswers.com/buying-prescription-drugs-from-canada-legal-or-illegal-1204 . In fact, this has been going on so long they would have a hard time trying to reverse the policy if it was challenged in court.
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Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."

Importing drugs is actually a federal law, not state.
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Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."

That’s what I got from the info she emailed me. She says it’s rarely prosecuted though. The bottom line is that she has every right to refuse my request.

I’m not going to look to anyone else to do it. The circumstances with my pony aren’t that dire. But there is no way I can afford the US price. 
--
Dorothy Marsh, NY, USA. 2022

I would disagree she has every right to refuse to write you a prescription. If you were to go to her and say, OK, I'll fill it here, what would she say?
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Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."

This reminds me of when Senator Sanders would take busloads of his constituents, who couldn’t afford their prescriptions locally, up to Canada to pick them up there.  He was quite public about what he was doing - I think that was his point - but, as far as I know, there were no repercussions and the bus riders were thrilled.  They left the US with their prescriptions in hard and came home with the drugs they needed, mostly insulin I believe.
--

Exactly right, Martha, and I remember it became a big issue in the Clinton administration - maybe before then but that's the earliest I remember. We are the only country in the world that doesn't regulate drug prices.
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Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."

She knows I’m not going to buy it here because we’ve already had that discussion about the medication being way too expensive. I don’t want to destroy our vet/client relationship and trust by telling her one thing and going behind her back and doing another.
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Dorothy Marsh, NY, USA. 2022

I understand, Dorothy, but for future reference with potentially another veterinarian all I am saying is you are entitled to the prescription and do not have to disclose/discuss what you are going to do with it. This veterinarian was already informed what you planned to do but the you don't have any obligation whatsoever to tell the veterinarian what you plan to do with the prescription.

BTW, it's not rarely prosecuted - it's never prosecuted.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001
The first step to wisdom is "I don't know."

Hi Dorothy,
Usually when we’re having this discussion about invokana, it’s because the horse has dangerously high insulin which cannot be controlled with diet alone and for which a metformin trial has proved unsuccessful.  You mentioned that thankfully your pony is not in dire enough straits to need invokana which prompted me to take a closer look at the pony’s situation.

I was apparently the one who sent you a welcome letter back in May and you mentioned that you could not get near them with a needle.  Desensitizing the little one to needles is something you should begin.  You really can’t get a good read on how close the pony is to being laminitic without testing the insulin level.  It’s fine to treat it as though it’s IR (most likely it’s pasture mate is as well) in terms of diet because there is nothing in our recommended diet which would be detrimental to the health of a non-IR horse.

We generally recommend saving metformin for dangerously elevated insulin and cases which diet adjustment doesn’t help because it’s usefulness may not be indefinite.  Whether your pony would benefit is something we don’t know because we don’t have an insulin level.  Invokana is for those with high insulin which can’t be relieved with metformin.  It’s a complicated drug to use, involving a lot of testing.  It’s great for those that need it.  More surprising to me than your vet not wanting you to purchase it from outside the country was that she didn’t question your need for it.  

Back to the needles. I have an IR/PPID mini which we rescued from a field by paying his deathly ill owner some cash.  We’re thinking he might have been in some sort of cart accident from his behavior.  It’s taken a long time but we are now comfortable drawing blood from him.  One tip I can offer about the little ones is to keep yourself as low to the ground as feasible when working with them so they don’t perceive you as towering over them.  I had a Trakehner mare who was very needle averse and I found that she didn’t mind the actual poke as much as the lead up to the big event.  I draped a scarf over her eyes and had someone else hold her and do the needle work.  There was no question that my anxiety about what was going to happen next contributed to her behavior.  I eventually found that she really liked having her teeth floated and once that was done, injections were no longer a problem.  I would suggest that you take this discussion on desensitization to the Horsekeeping Group to see what sort of tips you can pick up there.  You are not the first to encounter this issue so there will be others to share. 

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When I started my ponies on Prascend I mentioned to my vet that I knew I could ask for a prescription and shop/fill it anywhere to get the best price. Her immediate answer was that there was a $25 charge for writing the prescription. Of course, I just took the Prascend. Before she gave it to me she checked prices online. Awesome info in this thread. Thank you for keeping us informed.
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Rene` in WI 2021
https://ecir.groups.io/g/CaseHistory/files/Rene%20and%20Isaac%20-%20Joshua
Isaac  Photos https://ecir.groups.io/g/CaseHistory/album?id=270605
Joahua Photos https://ecir.groups.io/g/CaseHistory/album?id=277074