The Anatomy of Change

A look at how veterinarians evaluate whether to bring a new product or medicine into their practice.

When Whit Cothern, DVM, owned and operated a veterinary clinic, he would get updates on new product introductions into the market from his distributor rep about every other week. It wasn’t always a revolutionary product. One week it might be something as basic as a new deodorizer or cleaner.

But every once in a while, he’d hear about a blockbuster product or medicine. It would be something big enough to warrant an internal discussion within the veterinary clinic team on whether to add the product, change protocols, and shift the way things were done.

“Changing from Cleaner A to Cleaner B is not a big deal,” said Dr. Cothern. “That’s not customer facing, and that’s not a medical decision. But shifting from Drug A to Drug B would be more involved.”

Now as executive director of veterinary professional services for Boehringer Ingelheim Animal Health, Dr. Cothern is on the industry side of those discussions with the company’s recent FDA approval and subsequent launch of three landmark products:

• NexGard COMBO, which the company says is the first and only feline broad-spectrum protection against fleas, ticks, heartworm disease, roundworms, hookworms and tapeworms.
• NexGard PLUS (afoxolaner, moxidectin and pyrantel chewable tablets), a beef-flavored soft chew that protects dogs from internal and external parasites including fleas, ticks, heartworm disease, roundworms and hookworms.
• SENVELGO® (velagliflozin oral solution), the first liquid once-daily, orally administered prescription medication to improve glycemic control in cats with diabetes mellitus.

“As you can imagine, we’ve been pretty busy,” Dr. Cothern said. “Has anyone ever launched three major products like this, not just in a year, but over the course of about six months? ‘Our cup runneth over,’ but it’s a great problem to have.”

For distributor reps, Boehringer Ingelheim’s new product launches will inevitably lead to conversations with their veterinary clinics. Dr. Cothern shared some of his insights into what those veterinarians might be thinking during the product presentations, what goes into a practitioner’s evaluation process, and ultimately some of the compliance-related pain points veterinarians are hoping these all-in-one products like NexGard COMBO and NexGard PLUS could address.

As a practitioner, what did you look for when evaluating whether to switch products or add a new one to what you offered clients?

Dr. Cothern: Sometimes in our industry, I believe solutions get created to problems that don’t exist.

We need something that will be as good, or better, than what we’re already using. Will it be advantageous for the pet owner? Is it going to be easier for the doctors, staff and the pet owners to use?

There’s a list of things that we would look at to evaluate a product. First, do we need it? Do we have the patient base that will use this product? Other factors include:

• Safety. If a product is FDA approved, especially in the parasiticide world, then it’s reasonable to assume the product is safe.
• Cost. In my practice, we would typically put that lower down the list, because the cost is the cost. If it’s a good value, then cost becomes less of an issue. But that won’t be the case for every practice.
• Convenience. Is it easy for my team and my pet owners to use?
• Company support. Whether it’s a distributor or manufacturer – who has my back when I need them? Case in point with Boehringer, we have a great return policy for the clinic and a very consumer-friendly product guarantee for the pet owner. As a practice owner, I knew that if we did proper heartworm testing, and the pet owner purchased a sufficient amount of heartworm product, the heartworm guarantee was in place from the first dose.

Where do NexGard PLUS and NexGard COMBO fit on the spectrum of new product introductions?

Dr. Cothern: The key differentiator for NexGard COMBO for cats over the competitor products would be its efficacy against tapeworms. Historically, veterinarians have used an injectable or pill to treat tapeworms in cats. And you know how much fun it is to give pills to cats. So having a topical product that provides the full spectrum of prevention against heartworms, intestinal parasites, fleas, ticks – and then adding in your tapeworm coverage – that really sets it apart. If I were in practice and evaluating NexGard COMBO, those are the things that would come to mind.

On the canine side, Boehringer Ingelheim has always done a great job creating highly palatable products, whether it was the original HEARTGARD, which dogs still love, or NexGard. Now this all-in-one product NexGard PLUS comes out in a softer chew that we know dogs love and pet owners love to give. It’s like a treat.

Those are the things that I would notice as a practice owner as advantages. While NexGard PLUS is very similar in indications to the existing all-in-one product that’s on the market, the difference is a beef flavored chewable format versus a liver flavored tablet.

What is market research saying about the popularity of an all-in-one parasiticide?

Dr. Cothern: First some definitions. We have what we call ECTO parasiticides for external parasites, and we have ENDO parasiticides for internal parasites. The all-in-ones we’re labeling ENDECTOs, and we’re seeing the market shifting more toward them.

At some point over the next several years ENDECTOs will be what pet owners are going to prefer the most, and what veterinarians are going to want to prescribe. It’s what will be driving the parasiticide market for the next few years.

How should veterinary practices approach their portfolio of parasiticide products that they offer to clients?

Dr. Cothern: When I owned a practice, inventory consolidation was one of the things that I would try to drive home while speaking to other veterinarians. You need to reduce your inventory. When you offer clients too many different options, you get this paralysis by analysis.

Some veterinary clinics think that if they have more options on the shelf, (five different heartworm preventions, six different flea and tick preventions, etc.), it will satisfy more of their clients. But it’s just the opposite. The evidence is that clinics with products all over the board require the team to have to learn all about those different products. That’s hard on the team, and the pet owners, who are looking at a shelf with six different products and not knowing which one to pick. If your front desk person can’t answer the questions about the product, the client is either not going to buy it, or they’re going to just buy whatever is cheapest.

I’m a big believer in consolidating inventory. If I were in practice still, I would want a primary and a fallback preventive in my canine, and then a primary in my feline – then I’m done. I don’t need anything else. I don’t need two or three parasiticide options on my shelf.

Anytime you align under one umbrella brand, you can turn yourself into a top customer for a distributor or manufacturer, and that has benefits. You typically get better pricing and more incentives for purchasing, versus when you buy a little from here and there and everywhere else.

Are pet owners more compliant with preventives now than in the past?

Dr. Cothern: We know that the consumer is shifting, but are we getting more doses in dogs? We’re not sure yet. Industry data still shows most dogs that come to a veterinarian for wellness exams leave with no heartworm prevention.

I have some ideas personally on things I’d want to see done to change the way veterinary clinics address this and speak to it.

First, these are prescription products – veterinarians have to prescribe them. Let’s say you take your dog to the veterinarian because of an ear infection. The veterinarian would say, “Your dog has an ear infection, so I am going to prescribe antibiotics.” As a pet owner, you’re going to go with that.

But what’s happened in veterinary medicine with parasiticides is that the veterinarian will say, “You should think about preventives for heartworms because your dog could get them and die. I recommend you think about it. Let Billy at the front desk know if you want to know more.”

As a profession, we are missing out on an opportunity to say, “Heartworm infection is endemic in the area that you live, and fleas and ticks are everywhere and getting worse. I’m prescribing your dog 12 months of NexGard PLUS so you don’t have to worry about it. Just give it once a month. Your dog is going to think it’s a treat and love it. I’m prescribing it for you, and you can pick it up at the front desk.”

If I do nothing else before I keel over in this profession, it would be to get rid of the word ‘recommend.’ Veterinarians don’t recommend; they prescribe.

Back to the antibiotics example, imagine if you went to your veterinarian because your dog had an infection, but rather than prescribing an antibiotic, he or she tells you to look on the shelf and choose one on your own. You’d be confused. But that’s what we do with our heartworm prevention. The parasiticides are prescription products sitting behind the counter. All too often, we cede that responsibility to someone else.

You can probably tell I’m passionate about this. It’s something that I hope in industry we can help with messaging to veterinarians so they are leveraging their expertise. These are prescription products, and the veterinarian has full control. When that client is in the clinic with their pet, the veterinarian has the opportunity to prescribe parasiticide prevention to that pet owner at that time. And if a pet owner leaves with a 12-month supply of the prescription product from the veterinarian, guess what they don’t do? They don’t go home and shop online.

They have what they need. Yes, it gets expensive, but they’re going to pay for it somewhere else. Or they’re not going to get it at all, and that’s the worst-case scenario.

Image credit: istockphoto.com/Martinns