WATERLOO - The TV commercial for 1-800-PetMeds makes it sound easy: "Your pet's exact medications delivered to your door at the guaranteed lowest prices!"

But local veterinarians say when it comes to online pharmacies, specifically PetMeds, there's no guarantee pet owners are getting either of those things. Many Cedar Valley veterinarians don't trust the company, and some refuse to work with PetMeds at all.

Gary Koesten, director of pharmacy services at Florida-based PetMeds, says there are two reasons vets may refuse to fill a prescription through his company. It can be a legitimate medical reason, he says, but in many cases it is "purely economical on the part of the vet.

"I like to say that vets are the last of the medical prescribers that still derive a good portion of income from the sale of product," said Koesten. "It's a historical issue. Vets, for their entire practice, are used to going to farms and treating animals, and 'Hey, while I'm here, here's what needs to be corrected and here's the medication for it.'"

Koesten says PetMeds is just trying to offer clients an alternate distribution channel while saving them money.

Dr. Jim Taylor, of Taylor Veterinary Hospital in Cedar Falls, says it isn't about making money. The difference in price of the medications he sells from that of PetMeds usually amounts to a few dollars, he says. In fact, sometimes Taylor's prices are lower than PetMeds', he says.

Taylor says his job is to advocate for the safety of the pet. Every aspect of PetMeds' practice - from how they obtain medication to what actually is in the box - raises his suspicions.

"First off, any veterinary product sold to Osco or Walgreens, I would write a prescription for it, because when I call up, I can ask the pharmacist where they get their medications, how they are transported, how they are stored, and he will tell me," said Taylor. "I ask (PetMeds) where they get their medications and they say 'That's not required by law and we don't have to tell you,' and they hang up on me. It's a thing called trust."

There are a handful of veterinarians in the Cedar Valley who will work with PetMeds. Dr. Chuck Klima, of Klima Small Animal Clinic, says he receives less than a dozen PetMeds requests a year. Klima will approve PetMeds prescriptions, but only after explaining to clients his reservations with online pharmacies.

There are some medications, though, that Klima will not approve through online pharmacies, such as heart and thyroid medications. Also, he will not approve heart worm preventives if a dog has not had an annual heart worm check.

Doing so could be disastrous, says Dr. Brad Kneeland, of Pawsitive Pet Care. If a dog is prescribed a heart worm preventive - the No.1-selling prescription drug through PetMeds - and is already infected with heart worms it can result in irreversible cardiac disease or death.

Like Taylor, Kneeland is uncomfortable with PetMeds' practices and won't prescribe heart worm or any other kind of medication through the company. The delivery channel for PetMeds is murky, he says. Kneeland buys medications for his practice directly from drug companies like Novartis.

"… Drug (company) executives sell through vets, to vets - period. If you ask them, do you give drugs to PetMeds, they'll answer emphatically, 'No,'" he said. "My drugs are coming from drug reps. If (PetMeds) is not getting them through the makers, then where are they getting them?"

Koesten of PetMeds declined to be specific about where the company's drugs come from.

"There are legitimate alternate sources … we have all different suppliers for all different products. I don't want to go into any specifics other than the customer needs to be one hundred percent assured that the drugs are the same as at the vet's office," said Koesten. "We're a licensed pharmacy. Why would we do anything to put us or our clients in jeopardy?"

The Iowa Veterinary Medical Association does not take an official stand on online pharmacies, says Tom Johnson, IVMA executive director. However, the association does recommend checking with the Iowa State Board of Pharmacy Examiners to see if the pharmacy in question is licensed in the state.

Koesten says PetMeds is licensed in "just about every state that requires a license to practice." According to the Iowa State Board of Pharmacy Examiners, for an out-of-state pharmacy to legally dispense drugs in Iowa, it must be registered as a non-resident pharmacy. PetMeds is not a licensed pharmacy in Iowa, says Charity Harman, a clerk specialist with the IBPE.

Cedar Valley veterinarians aren't the only ones battling PetMeds and other online pet pharmacies. The company, was founded in 1996, has had multiple complaints filed against it. According to DVM Newsmagazine, a veterinarian trade publication, PetMeds has been disciplined several times for its drug-dispensing practices by the Florida Board of Pharmacy, and has faced similar charges from pharmacy boards in Alabama, Missouri, New Mexico, Pennsylvania, Ohio and Louisiana.

Six class-action lawsuits against the company were dismissed in February, but in April a lawsuit originally filed against PetMeds in 2002 by the Texas State Board of Pharmacy and the Texas{M3 State Board of Veterinary Medical Examiners resumed. The lawsuit "seeks injunctive and monetary relief relating to allegations the company sold prescription drugs illegally to Texas consumers. It also alleges at least two criminal acts - federal and misdemeanor crimes involving the unlawful drugs sales," according to DVM Newsmagazine.

"I am not aware of a current lawsuit against us … as a licensed pharmacist, as director of pharmacy services, there is nothing in our practice I need to be embarrassed about," said Koesten. "Unfortunately there are Internet pharmacies out there that are putting a bad taste in the minds of everybody … there may be a perception this one may be lumped in with that, but actions speak louder than words."

But those actions, says Taylor, are questionable.

" … They have a 10-year experience of violating laws," said Taylor. " … From my standpoint, I have to take the moral high ground. I've got to stand up for the dog. I live in your town - you've got to be able to trust me."

Contact Kelsey Holm at (319) 291-1464 or kelsey.holm@wcfcourier.com.