26/09/2026
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Mostly, yes. But it also shows how delicately veterinary medicine has to balance regulation, evidence, cost, and what's genuinely best for the individual horse.
Take insulin dysregulation; a common underlying cause of laminitis. For most horses, the foundation of treatment is management: an appropriate low-sugar diet, weight loss where needed, and regular exercise where the horse is comfortable enough. Some horses, however, continue to have dangerously high insulin despite owners doing everything right. For those horses, medication can make a real difference. Until recently, no medicine was licensed for this in horses. In carefully selected cases, equine vets have therefore used a human diabetes medicine from a drug class called SGLT2 inhibitors. We could only prescribe it because of the Veterinary Medicines Cascade.
Veterinary medicine doesn't have a licensed drug for every disease, in every species, in every situation. The Cascade lets vets prescribe outside a medicine's veterinary licence, including human medicines in some circumstances, but only in a set order and only where it's clinically justified. It's an essential safety net. Without it, many treatments we rely on every day simply wouldn't be available to our patients.
WHAT'S CHANGED
Great Britain now has its first SGLT2 inhibitor licensed specifically for horses: velagliflozin. It isn't the same drug as the human medicine previously used, but both belong to the same class and act on the same pathway in the kidney.
This is where the rules shift. Once a veterinary medicine is authorised for the species and condition we're treating, the Cascade works differently, and vets can't just prescribe a human medicine because it's cheaper.
Under the Veterinary Medicines Directorate's guidance, new cases should now receive the authorised veterinary medicine. For horses already stable on a Cascade medicine, vets should consider moving them onto the authorised product (though the guidance accepts that there may be individual cases where there's a clinical justification for continuing existing treatment).
So this isn't a commercial choice vets are making. It's the legal framework we're required to work within.
WHY THE COST HAS CHANGED
One UK online pharmacy currently lists a bottle of velagliflozin at around Β£251. For an average 500 kg horse, that works out at around Β£14.80 per day, or roughly Β£440βΒ£450 per month. That is several times more per day than the tablets many horses were previously on.
These aren't identical treatments. They are different drugs with different formulations and doses, and one has been studied and licensed specifically in horses. But it's easy to see why many owners will notice a real change in the cost of managing their horse.
SO, IS A LICENSED EQUINE MEDICINE A GOOD THING?
A medicine developed and authorised for horses gives us horse-specific information on dose, efficacy, safety, side effects and monitoring. That's a significant step forward, and velagliflozin has been studied in horses and has a licensed dose rate.
The other side of the conversation matters just as much, though. Horses with significant insulin dysregulation rarely need medication for only a week or two. Some need it for many months, and some for the long term, depending on how they respond and how well management alone can control their insulin. So affordability matters. The most scientifically advanced medicine in the world doesn't help a horse whose owner can't keep giving it.
That's why we think veterinary medicine has to hold two ideas at once. We should welcome companies that invest in developing and licensing veterinary medicines. And we should keep talking openly about affordability and access to treatment.
Those positions don't contradict each other. Licensed veterinary medicines bring real advantages. So does the Cascade. Human medicines have filled important gaps in veterinary care. But there are legal reasons why vets can't simply prescribe whichever version is currently cheapest.
It's also why good management remains so important. Every improvement in diet, weight and exercise helps protect your horse, whether or not medication is part of the plan.
WHY WE'RE TELLING YOU THIS
Owners may be worried that they can no longer use a medicine that is already working for their horse, and that switching will cost more. And no, this isn't vets suddenly deciding to charge more for medication. Our prescribing decisions sit within veterinary medicines legislation, and we can't ignore them, because doing so carries real legal and professional consequences.
Perhaps the bigger conversation is this. We want more medicines researched for horses, and we want pharmaceutical companies to see equine medicine as worth the investment. We want better evidence, safer medicines, and the ability to prescribe responsibly.
But medicines also need to stay realistically affordable for the owners who may give them every single day.
Good veterinary medicine isn't just about having a drug that works. It's about finding a way for evidence, regulation, welfare and affordability to work together.
We'd genuinely like to hear your thoughts in the comments.
