TANYA'S

COMPREHENSIVE GUIDE TO

FELINE CHRONIC KIDNEY DISEASE

 

 

OBTAINING SUPPLIES CHEAPLY: USA

 

     

ON THIS PAGE:


Discount Cards


Fluids


Needles


Winged Infusion Sets


Fluid Administration Sets


Syringes


Prescription Food


Medications & Other Supplies


 

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TREATMENTS


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Fluid and Urinary Issues (Fluid Retention, Infections, Incontinence, Proteinuria)


Waste Product Regulation (Mouth Ulcers, GI Bleeding, Antioxidants, Adsorbents, Azodyl, Astro's CRF Oil)


Phosphorus, Calcium and Secondary Hyperparathyroidism (Calcitriol)


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FLUID THERAPY


Intravenous Fluids


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How to Give Subcutaneous Fluids with a Giving Set


How to Give Subcutaneous Fluids with a Syringe


Subcutaneous Fluids - Winning Your Vet's Support


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Home > Supplies > USA

 


Overview


  • In most cases, your vet will charge more for sub-q supplies and prescription foods than other sources. If you can save money on the basics, you will have money available to pay your vet for regular check ups.

  • The cheapest place for fluids is often a local pharmacy, but you have to know where to go and what exactly to ask for.

  • Alternatively, there are good, reliable and cost effective online suppliers, both for fluid supplies and food.


Discount Cards                                                                                                 Back to Page Index


 

Some members of Tanya's CKD Support Group have printed out the free Pet Medication Card and successfully used it to obtain discounts at some pharmacies. In February 2014, one person was able to obtain a case of 12 bags of fluid from her local Walgreens for US$16 using this card, which of course was free, whereas Walgreen's own discount card mentioned below is not free and does not give you such a large discount on the fluids.

 

One member of the support group has successfully used the Pet Drug Card to obtain discounts at Wal-Mart.

 

Your Pharmacy Card has also been used successfully.

 

Pet Med Saver Card and the RX Free Card also offer discounts, but I don't know anybody who has used them as yet.

 

I would try obtaining all these cards and then see which one gets you the biggest discount at your local pharmacy. Group members have not received any spam as a result of using the cards, though many choose to use an inaccurate e-mail address to be on the safe side. See below for tips on obtaining fluids from local pharmacies.

 

If you have an AAA Travel Card, I understand that you may be able to use this to obtain discounts at some pharmacies.

 


Fluids                                                                                                                   Back to Page Index


 

See Subcutaneous Fluids Tips for more information on the various types of fluid.

 

A prescription is required for fluids in every state. If your vet refuses to write a prescription, you may be able to insist that s/he does so, depending upon which state you live in - Scooter's Page has more information on this.

 

Even if you do not live in a state where the vet must give you a prescription if you ask for one, the American Veterinary Medical Association states "As a veterinarian, when you determine that a medication is needed for a patient, you can discuss with your client the benefits of having the drug dispensed directly from your clinic. If your client still wants the prescription filled elsewhere, you should comply with their wish and provide a written prescription."

 

2014 Fluid Shortages


In the US, there is currently (2014) a severe shortage of fluids. This problem first arose in late 2013 when one of the major manufacturers of fluids, Hospira, reduced its production capacity while trying to improve its facilities following a series of warning letters regarding quality control procedures from the Food and Drug Administration. Another major manufacturer, Baxter, also shut down for planned maintenance in December 2013. Since these closures coincided with the flu season, fluid supplies for both the human and veterinary markets have been low ever since. Saline solution is the most severely affected, but lactated ringers is also in short supply. As a result, the fluid manufacturers are only supplying companies with which they have had contracts since 2013, and this is unlikely to change before mid 2015.

 

The improvements made by Hospira to their plants cost millions of dollars, and as a result of this and the low availability of fluids generally, prices have increased dramatically.

 

If you are likely to need fluids, do not wait until you are about to run out before trying to source them. Since fluids are usually good for at least a year, if your cat seems stable I would try to obtain a case or two as soon as you can so as not to have the potential headache of trying and failing to find any at short notice later in the year.

 

American Society of Health-System Pharmacists has a list of current (June 2014) shortages.

The Food and Drug Administration also has some information.

 


Fluid Suppliers


You have three basic choices for obtaining your fluid: your vet, local pharmacies or online suppliers. Most vets charge more than the other sources, though it can be worth asking your vet if s/he will price match other suppliers; some of them will do so.

Local Pharmacies


The cheapest source for fluids is usually to find a local pharmacy in your area offering low prices. This has two advantages. Firstly, it saves on shipping costs, which are often expensive since fluids are heavy. Secondly, your vet may be more comfortable about you using a local pharmacy and therefore more inclined to give you the prescription you need.

 

Most pharmacies do not stock fluids but until 2014 chains such as Walgreen's, Costco, Target and CVS could all often obtain fluids for you quickly and cheaply, usually for under US$30 a case (a case usually refers to twelve bags of 1000 ml fluid). The Costco record is US$7 for a case (and that was in NYC). Using a discount card issued by the pharmacy chain itself or one of the discount cards discussed above can also result in worthwhile savings: the record for a purchase with a discount card (a locally issued card in this case) was US$5.99 for a case at a Target branch in Texas.

 

Unfortunately, in view of the current (2014) nationwide fluid shortage, obtaining fluids locally may not be so easy, and prices seem to be changing quickly. Ask the pharmacist to call their supplier or check the online system to make sure the supplier has your chosen fluids in stock before you place your order. Otherwise you could be disappointed a few days later when they call to tell you they can't fill your order after all. Also ask for the price before you order so you don't get any nasty shocks. It is usually far more cost effective to buy a case (12 bags of 1000ml fluid, though sometimes 14).

 

It can help if you have NDC (National Drug Code) numbers, which enable pharmacists to search their stock and supplier database quickly. NDCs consist of 11 numbers in total: the manufacturer code (five numbers), followed by the drug code (four numbers), followed by the size code (two numbers). If a number is missing, you usually just add an extra 0 at the beginning of the section with the missing number. These are the NDC codes for the most popular fluids:

  • Lactated Ringers Solution, DEHP Bags, Hospira: 0409-7953-09

  • Lactated Ringers Solution, DEHP-Free Bags, Hospira: 0409-7953-48

  • Lactated Ringers Solution, DEHP-Free Bags, Braun: 0264-7750-00

  • Lactated Ringers Solution, DEHP-Free Bags, Baxter: 0338-6307-04

  • Normosol-R, DEHP Bags, Hospira: 0409-7967-09

  • Normosol-R 7.4pH, DEHP Bags, Hospira: 0409-7670-09

  • 0.9% Sodium Chloride Solution, DEHP Bags, Hospira: 0409-7983-09

Walgreen's


Many members of Tanya's CKD Support Group use Walgreen's. I used to hear quite often from people who said they had not been successful buying fluids from Walgreen's, but in every case they did not follow the steps below. If you follow these steps exactly, you may still need to be persistent (very few Walgreen's employees seem to know what fluids are), and even if you are, Walgreens may not be able to obtain fluids for you because of the nationwide shortage of fluids. However, if you get lucky, you should receive your fluids quickly and at a very good price. Unfortunately, following a change of supplier in 2014, Walgreens no longer supplies DEHP-free fluids, so you will have to decide if this is a dealbreaker for you.

 

These prices are for members of Walgreens' Prescription Savings Club, which costs US$20 for your cat to join for a year (see point 6 below). Please also see above about online savings cards. In some cases, these may give you an even lower price for your fluids. I have heard of people obtaining a case of fluids for as little as US$16 with one of these cards, plus you save US$20 on the Prescription Savings Club card.

 

This is how to obtain your fluids from Walgreen's at a good price:

  1. Visit Walgreen's. You have to use this link - just going to the Walgreens website and searching will not work.

  1. Type lactated into the box (you will need to allow cookies), then click on the first item that will pop up over to the right (Lactated Rin Inj 1000ml). You will see prices for 2000, 12000, 14000 and 36000. The 12000 means 12 bags of 1000ml each, which as at June 2014 cost US$22.96 in total, or US$1.91 per bag. The 14000 option (14 bags of 1000ml) costs US$26.12, or US$1.86 per bag.

  1. If you want Normosol, type normosol into the box instead of lactated. The price as at September 2012 was US$43.61 for 12 bags of 1000ml each.

  1. Print the page displaying the prices and take it to your local Walgreen's, along with your cat's prescription. Try to speak to a pharmacist rather than a clerk if possible.

  1. The pharmacist will probably also need the NDC (National Drug Code) for your fluids, see above.

  1. Try to use a discount card - I would try one of those I discuss above in the first instance. Alternatively, apply for your cat to join the Walgreen's discount scheme, the Prescription Savings Club. This costs US$35 a year for family membership, which includes cats, or US$20 a year for an individual (i.e. your cat).

  1. Ask the pharmacist to order the fluids for you at or near the cheap price on the page you have printed.  Some Walgreens pharmacies will actually sell them for less, especially if you have a discount card. However, other people are being quoted around US$48 for a case, which is probably because of the current fluids shortage and the fact that Hospira greatly increased their prices. Take the printout with you and see if they will honour the lower price. However, even if they will not, being able to get the fluids at the higher price is probably worth it in light of the current shortages.

  1. Wait for the fluids to arrive (it should only take a day or so) and go and collect them.

It is particularly important to take the print-out with you to prove Walgreen's can obtain these supplies - many Walgreen's employees do not seem to be aware that it is possible. It is also essential to explain that you wish to order the fluids - most branches do not hold them in stock, but can order them quickly.

 

Online Pharmacies


If you don't live near a pharmacy which can order fluids for you cheaply, you will probably want to use an online pharmacy. A case of 12 bags of 1000ml sub-Q fluid costs around US$50, including shipping, but availability and pricing vary widely because of the 2014 nationwide fluid shortage. A prescription is required.

 

The US Food & Drug Administration discusses precautions you should take when using online pharmacies. I only link to sites which I or members of Tanya's CKD Support Group have used personally.

 

Lactated Ringers Solution (LRS)


American Livestock

Sells 1000ml bags of Lactated Ringers for US$2.15 per bag plus shippng (free for orders over US$150). There is no discount for a case. I am told their website is not the easiest to use, but they are very helpful on the phone.

 

Santa Cruz Biotechnology

sells 14 x 1000ml Lactated Ringers bags for US$36. Shipping costs US$29.50, or is free with orders over US$50. Some members of Tanya's CKD Support Group plan to use this company, but I have not had any feedback as yet (June 2014).

 

Moore Medical

Sells 1000ml bags of Lactated Ringers for US$3.79 a bag with promotional code E338ESA1 according to a member of my facebook group, but you can only see prices if you have an account, so I have been unable to verify this.

 

KV Vet Supply

Sells 1000ml bags of Lactated Ringers for US$5.99 each, or US$4.99 each if you buy six or more, with free shipping over US$50 (so basically, you can buy 13 bags for US$59.88 all in).

 

Valley Vet

Sells a case of 12 x 1000ml bags for US$53.88 with free shipping. I have used Valley Vet myself for other items and have always received fast and efficient service.

 

UPCO

Sells 1 x 1000ml bag for US$4.95, but 14 x 1000ml bags cost $55.50 (equivalent to US$47.40 for 12). Handling charge is US$4-5.50 but is free with orders over US$85. The price on the website reflects the price of buying one bag of fluids only; if you enter 14, you should find the price reduces automatically.

 

Petfood Direct

sells 1 x 1000ml bag for US$5.99, with free shipping for orders over $49 and up to 60lbs. Thus 12 bags cost a total of US$71.88.

 

Drs Foster & Smith

Sell Lactated Ringers for $6.99 per 1000ml bag, with free ground shipping US$49 and over, and no minimum order.

 

Thriving Pets

Sell 12 bags of fluid for US$90. If you enter the word "tanya" (without the ") in the promotional code box, you will receive a 10% discount on orders over US$55. Shipping is free for orders over US$75 (after the discount).

 

Normosol-R/PlasmaLyte


Normosol-R comes in two pH types, 6.6 (a very similar pH to lactated ringers solution) or 7.4. Your prescription should show which pH you need. PlasmaLyte is essentially the same as the Normosol-R with a pH of 7.4. You can read more about these fluid types here.

 

Vet America

Sells Normosol-R with a pH of 7.4. A case of 12 bags costs US$70.99, with ground shipping costing US$5.95. They may charge more for heavy items.

 

Thriving Pets

Sell 12 bags of Normosol-R for US$89.95. They sell both pH types (6.6 or 7.4), but the 7.4 pH costs an additional US$10. If you enter the word "tanya" (without the ") in the promotional code box, you will receive a 10% discount on orders over US$55. Shipping is free for orders over US$75 (after the discount).

 

Drs Foster & Smith

Sell Normosol-R for US$5.99 a bag if you buy four, with free shipping. They do not say which pH they sell.

 

Heartland Veterinary Supply

Sells 14 x 1000ml  of PlasmaLyte 7.4 pH for US$69, which works out at US$4.93 per bag. Shipping is US$7.95, or free for orders over US$75.

 

Valley Vet

sells PlasmaLyte at US$6.49 a bag or US$77.88 for twelve, with free shipping. I have used Valley Vet myself for other items and have always received fast and efficient service.

 


Needles                                                                                                                Back to Page Index


 

Most people use Terumo needles - you can read here why they are so popular. Unfortunately the favoured UTW (ultra thin wall) needles are being discontinued, so like fluids, they are increasingly hard to find. I would therefore recommend stocking up on them. Terumo needle codes may help you if you are trying to track down UTW needles.

 

A prescription is required for needles in CT, MA, NJ, NY and RI.

 

Med-Vet International

Sells a box of 100 needles for US$5.95. Shipping is US$10 for orders under US$100.

 

Quick Medical

Sells a box of 100 size 21 needles for US$6.17 plus shipping.

 

California Veterinary Supply

Sells a box of 100 needles in a variety of sizes for US$6.49 - US$7.49.

 

Thriving Pets

Sells Terumo needles for US$9.90 per 100, plus shipping. If you enter the word "tanya" (without the ") in the promotional code box, you will receive a 10% discount on orders over US$55. Shipping is free for orders over US$75 (after the discount).

 

Amazon

Sells a variety of Terumo needles at differing prices, which do not always need a prescription. Since Amazon is not a specialist seller, make sure you're purchasing the correct item.

 


Winged Infusion Sets (Butterfly Needles)                                                       Back to Page Index


 

These are used when giving sub-Qs with a syringe rather than a giving set (see How to Give Subcutaneous Fluids: Syringe Method).

 

Thriving Pets

Sells these for US$23.95 for 50 Terumos in size 19 or US$24.95 for sizes 21 or 23. If you enter the word "tanya" (without the ") in the promotional code box, you will receive a 10% discount on orders over US$55. Shipping is free for orders over US$75 (after the discount).

 


Fluid Administration Sets (Giving Sets)                                                      Back to Page Index


 

These are used to connect the bag of fluid to the needle. If you are careful not to contaminate them, you can re-use them 2-3 times. Click here to learn more about what features you need.

 

Med-Vet International

Sells these for US$1.10 each. Shipping is US$10 for orders under US$100.

 

KV Vet Supply

Sells giving sets for US$2.85.

 

Thriving Pets

Sells 72 inch long DEHP-free sets for US$2.20 each or US$24 for 12. If you enter the word "tanya" (without the ") in the promotional code box, you will receive a 10% discount on orders over US$55. Shipping is free for orders over US$75 (after the discount).

 


Syringes                                                                                                               Back to Page Index


 

Lambert Vet Supply

Sells Baxter syringes (without needles) in a number of different sizes.

 

Pet Supplies 4 Less

also sells Baxter syringes.

 

Please see the Persuading Your Cat to Eat page for information on obtaining smaller syringes for assist feeding purposes.

 


Prescription Diets                                                                                               Back to Page Index


 

Pet Food Direct

Sells Hi-Tor Neo, a low protein, low phosphorus food which does not require a prescription. Shipping can be expensive, but there are regular 20% off sales which can help offset the cost.

 

Amazon

Sells Hi-Tor Neo without prescription.

 

Southern Agriculture

Sells prescription diets from Purina, Royal Canin IVD, Waltham Royal Canin, Eukanuba and Hill's. They will also sell individual tins, which can be helpful if you want to try different foods (though sometimes your vet can get a variety of prescription foods for you to try too).

 

RX Petfood

Sells prescription diets from Purina, Royal Canin IVD, Waltham Royal Canin, Eukanuba and Hill's. They need a prescription or contact details for your vet. I do not know of anybody who has used them as yet.

 

Mr Chewy

Sells prescription diets and a variety of other brands.

 

Alternatively, you could ask about buying in bulk from your vet. One of our cats needed a prescription food which cost US$2 per 5.5 oz can. However, when we bought a case, the price fell to US$1.40 a can.

 


Medications and Other Supplies                                                                  Back to Page Index


 

Wal-Mart and Target both sell a number of generic medications, such as lactulose or benazepril, for US$4 for a month's supply.

 

Please also see the following pages:

  • Medicating Your Cat - for items to help make pilling less stressful for you both, such as Pill Pockets and gelcaps.

 

 

 

Back to Page Index

This page last updated: 25 June 2014

Links on this page last checked: 25 June 2014

   

Website last updated: 26 June 2014

 

See above for when this particular page was last updated

 

*****

 

TREATING YOUR CAT WITHOUT VETERINARY ADVICE CAN BE EXTREMELY DANGEROUS.

 

I have tried very hard to ensure that the information provided in this website is accurate, but I am NOT a vet, just an ordinary person who has lived through CKD with three cats. This website is for educational purposes only, and is not intended to be used to diagnose or treat any cat. Before trying any of the treatments described herein, you MUST consult a qualified veterinarian and obtain professional advice on the correct regimen for your cat and his or her particular requirements; and you should only use any treatments described here with the full knowledge and approval of your vet. No responsibility can be accepted.

 

If your cat appears to be in pain or distress, do not waste time on the internet, contact your vet immediately.

 

*****

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