Position statement on cost considerations and the prescribing Cascade
BEVA believes that veterinary professionals must be empowered, not discouraged, to apply the prescribing Cascade in the best interests of animal welfare. Decisions should be based on clinical judgement, informed by pharmaceutical quality, and responsive to the needs of the individual patient, including considerations of access to care.
The Veterinary Medicines Regulations (VMR) provide the legal authority for veterinary surgeons to prescribe under the Cascade on a case-by-case basis. These regulations do not prohibit cost from being considered when selecting appropriate treatment in accordance with the Cascade’s risk-based framework.
Current VMD guidance advises that a human medicine should not be selected solely because it is cheaper. However, this is not the same in cases where the cost of a medicine represents a genuine barrier to care. These situations are clinically and ethically distinct. When an authorised veterinary product is not suitable because a client’s financial limitations would prevent access to treatment, the Cascade may lawfully and appropriately be applied to ensure the animal receives veterinary care.
Veterinary professionals are encouraged to maintain records justifying Cascade use, especially when decisions relate to cost being a barrier to care. However, such records are a tool of professional accountability, not a basis for retrospective criticism or coercion. The attending veterinary surgeon is legally and ethically responsible for the decision, and that decision must be respected. BEVA reminds all parties that attempts to influence, constrain or override a clinician’s decision under the Cascade may constitute an offence under the VMR.
BEVA recognises that assessing a client's financial capacity, particularly in equine practice, is complex and sensitive. To support practitioners, BEVA has produced example text for consent forms that allows clients to declare when financial constraints may limit treatment options. This places the responsibility for disclosing financial barriers with the owner, rather than requiring the veterinary professional to make assumptions or judgments about affordability.
As the professional body representing equine veterinary medicine in the United Kingdom, BEVA will continue to support lawful, patient-centred prescribing and the proper application of the Cascade. We call on regulators, suppliers and stakeholders to support veterinary clinical freedom and uphold the integrity of case-based decision-making. Where imported veterinary products may be needed, BEVA supports the use of pre-emptive Special Import Certificates (SIC) to ensure lawful access and availability, including the holding of stock in anticipation of individual clinical need in accordance with this position. Such applications must be based on a realistic assessment of clinical need, including the likely number of cases and dosage requirements.
Take home message
Veterinary clinical judgement—not price tags, pressure, or protocol—must guide cascade prescribing. When cost creates a barrier to care, the law supports responsible, patient-focused decisions. BEVA stands firmly behind vets who act lawfully to safeguard animal welfare.
Owner declaration (example)
I have been advised to treat my horse with the medicine described below. However, I have declined that option based on cost.
Medicine: XXXXXXX
I understand that this may prevent my horse from receiving necessary care.
I have therefore consented to the use of an alternative product under the prescribing Cascade, in the interests of my horse’s welfare and to ensure that treatment is not delayed or withheld.
See our Clinical Catch-Up recording 'The Cascade in practice' for additional information.
The audio is also available as BEVApod Focus episode on our podcast channel.