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標題: 亞馬遜、波克夏、JP摩根共組公司進軍醫保業 [打印本頁]
作者: mikeon88    時間: 2018-1-30 20:51     標題: 亞馬遜、波克夏、JP摩根共組公司進軍醫保業

Amazon, Berkshire Hathaway and JPMorgan have agreed to create an independent company focused on technology solutions aimed at providing U.S. employees and their families simplified, high-quality, transparent healthcare at a reasonable cost.
• The initial formulation of the company will be led by Berkshire investment officer Todd Combs, JPMorgan Chase Managing Director Marvelle Sullivan and Amazon SVP Beth Galetti.
• Healthcare providers/insurers are down premarket on the news: (NYSE:UNH) (-2%); (NYSE:ANTM) (-2%); (NYSE:AET) (-3%); (NYSE:CNC) (-2%); (NYSE:MOH) (-2%); (NYSE:CVS) (-7%).
• ETFs: GRX, THW, BME, IXJ
作者: mikeon88    時間: 2018-1-30 20:53

救郎喔∼∼今晚我的淨值重創
作者: Curry    時間: 2018-1-30 20:54

Mike大的UNH中槍了...
作者: chousirbuy    時間: 2018-1-30 23:30

剛才開盤還很好奇為什麼我的美國醫院公司大漲 8%然後去查醫藥股全躺下
原來是這樣, 但是我還是搞不懂醫保公司會對這些公司有什麼影響?
作者: Raimu    時間: 2018-1-31 00:10

HCA 盤中一度大漲9%懶得去研究為什麼…
作者: mikeon88    時間: 2018-1-31 07:01

In a tweet, CNBC's Meg Tirrell reports that Express Scripts (ESRX -4.2%) "looks forward to hearing more" about the Amazon/Berkshire/JPMorgan healthcare venture aimed at simplified affordable healthcare.
• Express says it has reduced costs by $32B in the past year alone related to the management of chronic conditions like diabetes and heart disease, adding that it would like to hear how "we can work together to improve healthcare for everyone."
作者: mikeon88    時間: 2018-1-31 08:37


作者: mikeon88    時間: 2018-1-31 13:35

美國分析師都質疑這三巨頭可以讓藥價會降得下來？
我也是。
聲明中說這家新公司是非營利事業，
三巨頭願意永遠承擔虧損的風險？而且可能是巨額虧損！

藥廠、藥房、醫保之所以有高低不一利潤率是因為要承擔大小不同風險，
把利潤降低了，供給就減少，如此更非患者之福。
供需是經濟運作的基本道理，老巴應很懂才對。
作者: duwa    時間: 2018-2-1 11:53

新藥假如效果勝出價格無法下降，而且還會更高。
但是其他競爭藥(新藥)價格會被砍或是也有市場利基就維持價格的結果也無法使整體藥價下降。
生物相似藥(大分子)價格會被影響，但是生物新藥的開發沒有那麼快，所以這邊藥價也省不了多少。
學名藥(小分子)價格就慘了，這三巨頭就是要吃這一塊，所以可能競爭的醫保(例如UNH vs 波克夏)+可能競爭的信貸(例如現在藥房的信用卡業務 vs JPM)+可能競爭的物流(例如CVS vs AMZN)就會受到影響，但是三巨頭也沒辦法一跳下來就全吃，更何況三巨頭利益不一定一致，未來很不確定，說不定只是政策背書...
作者: mikeon88    時間: 2018-2-1 12:43

通路的利潤率是低的，ESRX 3Q7 營利率才6%不到，
藥價高也不是它造成的，
亞馬遜老是以此為藉口想進軍藥品通路業。

UNH 4Q17 營利率8%不到
AMZN 3Q17 營利率 1%不到
作者: duwa    時間: 2018-2-1 16:33

我猜AMZN不是真的想賺通路的辛苦錢，只是藉由策略聯盟切入市場拿到病患的用藥數據整合自己的線上行銷系統跟最近新併購的有機超市Whole foods，然後再炒股價。AMZN從來都不是賺錢來提升股價，都是炒未來提升股價，然後再拿自己炒高的股價去買別人辛苦經營的公司。
作者: mikeon88    時間: 2018-2-1 17:24

亞馬遜越賺越少，股價越吹越高，
美國投資人不曉得在想什麼？
去開藥品通路不怕初期會虧損嗎？

作者: mikeon88    時間: 2018-2-1 19:07

亞馬遜應回去好好整頓Whole Food，入主之後管理上出了大問題。
亞馬遜用管理雜貨Just-in-time的方式在管理食物類存貨，造成Whole Food 架上大缺貨

'Seeing someone cry at work is becoming normal': Employees say Whole Foods is using 'scorecards' to punish them

Whole Foods uses checklists called "scorecards" and tests called "walks" to ensure stores comply with a new inventory-management system.
Employees say the system has crushed morale and led to widespread food shortages.
"The stress has created such a tense working environment," a supervisor at a West Coast Whole Foods store said. "Seeing someone cry at work is becoming normal."
Many employees at both the corporate and the store levels don't understand how OTS works, employees said.

作者: chousirbuy    時間: 2018-2-1 22:17

我很直覺的就想到以後可以在亞馬遜上用很方便的方式和老巴簽保單，而且可以從JP銀行自動扣款然後保單組合自己決定，不用請人，不需要房地產
接著亞馬遜再用很利害的數學程式教人如何自己選保險組合, 順便取代經銷商去和藥廠談價錢
但又不知道會不會掛掉，所以先從自己員工開始


反正這塊這麼大, 不滿意現狀的民眾又那麼多, 那怕有一點點效果, 都是正面的
以後老巴股東會上, 桌上會放可樂和藥....



[ 本帖最後由 chousirbuy 於 2018-2-1 22:18 編輯 ]
作者: chousirbuy    時間: 2018-2-1 22:28

https://zh.wikipedia.org/wiki/2017%E5%B9%B4%E7%BE%8E%E5%9B%BD%E4%BF%9D%E5%81%A5%E6%B3%95%E6%A1%88]https://zh.wikipedia.org/wiki/2017%E5%B9%B4%E7%BE%8E%E5%9B%BD%E4%BF%9D%E5%81%A5%E6%B3%95%E6%A1%88]https://zh.wikipedia.org/wiki/2017%E5%B9%B4%E7%BE%8E%E5%9B%BD%E4%BF%9D%E5%81%A5%E6%B3%95%E6%A1%88

忘了之前在那篇文章看到, Amazon很大一部份員工都是中低收入戶
作者: david31408    時間: 2018-2-2 10:31

我也是這麼想的
以退為進
老巴才說沒跟到亞馬遜
哈哈 現在自己合組聯盟
到時候亞馬遜就賣藥了
線上幫老巴賣保險
大家跟摩根借錢
只是我覺得奇怪 怎麼不是富國銀行

QUOTE:
原帖由 chousirbuy 於 2018-2-1 22:17 發表
我很直覺的就想到以後可以在亞馬遜上用很方便的方式和老巴簽保單，而且可以從JP銀行自動扣款然後保單組合自己決定，不用請人，不需要房地產
接著亞馬遜再用很利害的數學程式教人如何自己選保險組合, 順便取代經 ...

作者: baggiotsai    時間: 2018-2-2 11:31

Amazon 第四季財報 (2017) 18.56億    (2016)7.49億
作者: mikeon88    時間: 2018-2-2 11:37

都是因減稅
作者: mikeon88    時間: 2018-2-13 09:33

The distribution segment generated about $195.9 billion in revenue in the last year. We have to point out that although the distribution segment is generating almost all of McKesson’s revenue, it has an operating margin of only 1.7% while the technology solutions segment has an operating margin of 12-13%.

MCK藥品配售營利率才1.7%，亞馬遜的利基不大。
作者: Raimu    時間: 2018-2-13 11:59

低毛利是優秀的護城河
作者: Curry    時間: 2018-2-13 12:38

Raimu桑，小弟也有同感，WMT就是一個例子！
作者: mikeon88    時間: 2018-2-13 17:39

作者: mikeon88    時間: 2018-2-13 21:16

利潤率高低跟周轉率有關，
為何MCK藥品批發商營利率2%不到可以賺錢，因周轉率高，
下游ESRX藥房營利率要高到6%，因藥房的藥品需等客戶上門買，周轉率較低。

所以亞馬遜和巴菲特以為美國藥價貴是因為通路沒效率，看來並不成立，
以MCK和ESRX的營利率這麼低來看是有很好效率的，
亞馬遜想進來是討不到便宜的。
作者: mikeon88    時間: 2018-2-15 15:12

We asked Jamie Dimon why JPMorgan is forming a new healthcare company with Amazon and Berkshire Hathaway — here's what he saidGrant Eizikowitz and Lydia Ramsey


FACEBOOKLINKEDINTWITTEREMAILEMBEDAMZN  Amazon.Com
1,451.05  36.54 (+2.60 %)



DisclaimerGet real-time AMZN charts here »

JPM  JPMorgan Chase
115.03  2.60 (+2.30 %)



DisclaimerGet real-time JPM charts here »



Jamie Dimon is fed up with the way America does healthcare.
In a conversation with Business Insider's Matt Turner, the JPMorgan CEO explained why he, along with Amazon and Berkshire Hathaway, are banding together to form an independent nonprofit venture to lower healthcare costs for their employees.
When it comes to how the US spends on healthcare, it often doesn't make a lot of sense.
"Look, America has an issue, OK? We spend 17% of our GDP in healthcare. You know we have the best of all worlds, some of the best healthcare in the world. And the worst of all worlds. We don't do very good preventive medicine. It costs too much," Dimon said.
The rising spending is something Berkshire Hathaway CEO Warren Buffett has called the "hungry tapeworm on the American economy."
And getting people to be more active consumers in the healthcare system with health plans that feature deductibles—the amount of money paid out of pocket before insurance kicks in — hasn't gone over as well as expected.
"Going into deductibles was important to get you to shop a little bit but hasn't really worked really well," Dimon said.
The three companies are self-insured employers, which means that when you're an employee going to a doctor's appointment, your employer is ultimately footing the bill for the MRI you receive, rather than a health insurer. The insurance companies are there in the middle to handle the logistics of getting the claim from one place to another.
"So I tell people, JP Morgan Chase already buys a $1.5 billion of medical, and we self-insure," Dimon said. "Think of this, we're already the insurance company, we're already making these decisions, and we simply want do a better job."
JPMorgan for example has lowered deductibles for employees who make less than $60,000 a year. The deductible can also be tied to lifestyles as well, bringing that deductible even lower.
"If you do your wellness stuff now, if you take care of yourself, if you don't smoke, we give you benefits and the deductible effectively goes to zero," he said. "So we've kind of really made it easier for folks to get proper medical care."
Dimon said he started chatting with Buffett and Berkshire Hathaway investment officer Todd Combs, who also sits on the board of JPMorgan, and Amazon CEO Jeff Bezos.
"We said, we know we can do more. We know we can do more just thinking through every single part of it," Dimon said. Whether that be giving employers more information on their phones, which could in turn help with their overall wellness. Keeping employees healthier for longer in turn could cut down on healthcare spending by preventing patients from getting sicker.
"There are ways that, when you face this, maybe we can change things to make it much better for everybody," Dimon said. "We want happier employees, better medical outcomes, and I do think at the end of the day that'll actually be cheaper."
Following is a full transcript of the conversation.
Matt Turner: JP Morgan announced an initiative with Amazon and Berkshire Hathaway. How did that come about, and what are you hoping to achieve there?
Jamie Dimon: Look, America has an issue, OK? We spend 17% of our GDP in healthcare. You know we have the best of all worlds — some of the best healthcare in the world. And the worst of all worlds. We don't do very good preventive medicine. It cost too much. Warren Buffett calls it the tapeworm of corporate America.
Going into deductibles was important to get you to shop a little bit but hasn't really worked really well. So I tell people, JP Morgan Chase already buys a billion and a half dollars of medical, and we're self-insured. Think of this: We're already the insurance company, we're already making these decisions, and we simply wanna do a better job.
And in conversation with Warren, and someone who works for him called Todd Combs, who's one of my board members, who's exceptional, and Jeff Bezos, we said we know we can do more. We know we can do more just thinking through every single part of it. Both the customer-facing part so you might be able to get look at more data on your phone and stuff like that, getting you do wellness.
I mean, 20% of our medical expense is at end of life, and a lot of people don't want to go through it — they go through it in a hospital. So maybe we need a legal change of that. A lot of people over-utilize certain medicines, but they also under-utilize it. And it's also silly they have no wellness. Like, if you take care of yourself, I think smoking and obesity — I forgot the number — account for 25% of all medical expenses. Well, that's us!
So, you know, there are ways that when you face this maybe we can change things to make it much better for everybody. We want happier employees, better medical outcomes, and I do think at the end of the day that'll actually be cheaper.


作者: mikeon88    時間: 2018-2-15 15:15

Business Insider 記者訪問JPM老闆談三巨頭合組公司，
內容蠻空洞的，
希望建立員工自我健康管理，降低吸菸及肥胖率，
......
我就放心了。
作者: Curry    時間: 2018-2-15 15:33

這樣就對了...
蒸的很放心
顆顆∼
作者: Curry    時間: 2018-2-19 07:27

Charlie Munger: Rising medical costs in the US are 'evil'Berkshire Hathaway’s (BRK-A, BRK-B) vice chairman, Charlie Munger, is “all for” his company and other corporate giants figuring out how to cut costs in the U.S. healthcare system.
Back in January, Amazon (AMZN), JPMorgan Chase (JPM), and Berkshire Hathaway announced a partnership where they’re working together to address rising health care costs in the U.S. for their employees.
“The existing system runs out of control on the cost side and it causes a lot of behavior, which is not only regrettable, it’s evil,” Munger, 94, said at the Daily Journal’s (DJCO) annual meeting.
He added that there’s a lot of “totally unnecessary” costs that have crept into the medical system. His comments on Tuesday echo what he’s said for years. At Berkshire Hathaway’s annual shareholder meeting in 2017, he said there’s “too much medicine” and “too much chemotherapy” for people who are “all but dead.”
The Amazon-JPMorgan-Berkshire Hathaway partnership will look at how the incentives have gone wrong and come up with a solution.
“Of course, that’s a very difficult thing to take on,” Munger said. “I don’t know how it will work out.”
Presently, the American medical system is like vultures treating the sick like a “carcass.”
“It’s not right to bleed so much money,” he said, adding that it’s “deeply wrong” what’s happened.
作者: Curry    時間: 2018-2-19 07:33

蒙格(老巴的貴人)說：這很困難，我們甚至不知道怎麼work on...

作者: mikeon88    時間: 2018-2-25 13:25

這個問題其實很容易解決，
老巴和亞馬遜把藥房通路股買下來，
直接降價，事情就解決了！
作者: Curry    時間: 2018-2-25 14:34

  1. 老巴和亞馬遜若直接把其中的一個藥房＋通路買下來，那不就跟當初買Whole Foods Market一樣
  2. 有種恐怖的不要、不要∼
作者: Sharon    時間: 2018-2-25 16:28

我倒不覺得Jamie Dimon說的東西很空洞,我認為他蠻有遠見的,他說的應該是預防醫學這一塊,不容易做到,可是長期來說會有最大的效果,總比快死了再花一大筆錢好多了,所以文中有提到這是 independent nonprofit venture,應該是這意思.
作者: mikeon88    時間: 2018-2-25 16:30

若說的是預防醫學，那我更放心了，
對MCK、CAH、CVS、ESRX更沒影響。
作者: Umberto    時間: 2018-2-25 18:33

剛才看了一則新聞，上海醫藥(601607)，於2月2日宣布以5.57億USD，100%收購CAH
最終以5.76億USD完成交易
節錄自下列網址的第一則消息。

http://www.sse.com.cn/assortment/stock/list/info/company/index.shtml?COMPANY_CODE=601607
作者: mikeon88    時間: 2018-2-25 18:37

那是CAH在中國的業務
作者: mikeon88    時間: 2018-3-8 17:55

ESRX 盤前大漲13%，
天啊∼要抱一輩子的股票，就這樣被買走了

Health insurer Cigna is close to buying Express Scripts: report
作者: powerhouse    時間: 2018-3-8 18:59

不知可否請 Mike 再複習一下若持股確定要被收購，該如何處理該股的買賣原則？感謝您。
作者: mikeon88    時間: 2018-3-8 19:09

Read 講稿
作者: mikeon88    時間: 2018-3-8 19:21

Health insurance company Cigna Corp. CI, +0.06% said Thursday it will purchase Express Scripts Holding Co. ESRX, +16.14% in a cash-and-stock deal worth $67 billion. The agreement includes Cigna's assumption of about $15 billion in Express Scripts's debt. The transaction consists of $48.75 in cash and 0.2434 shares of stock for each Express Scripts share. The deal represents a premium of 31% to Express Script's closing price of $73.42 on Wednesday. Shares of Express Scripts climbed 16% to $85 in premarket trade. Cigna shares were down 2% in scant premarket volume.
作者: Raimu    時間: 2018-3-8 20:01

CI好公司
這個收購不錯
作者: mikeon88    時間: 2018-3-8 20:04

ESRX我才買個不到一個月就賺了31%，可是仍然被賤賣了




作者: mikeon88    時間: 2018-3-8 20:13

藥房紛紛找保險公司合併，
這樣亞馬遜更進不來這個行業了，
要比銀彈，現在藥房CVS、ESRX有保險公司當靠山也不輸亞馬遜了。
作者: powerhouse    時間: 2018-3-8 20:24

講義 T 併 DTV 案例，買方 T 達貴價所以需要賣。

但以本案，目前買方 CI 價位剛好介於中間帶，如果確定併購，這樣是該賣還是不賣 ESRX？

除了存續公司股價高低作為主要考量還有甚麼需要留意的嗎？謝謝。
作者: mikeon88    時間: 2018-3-8 20:30

不曉得為何台灣學生不敢自己下決定，都在等老師的答案？
而且舉一反三的能力太差！

台灣產業為何只能做代工，培養不出創新人才，
都是因為填鴨式教育的結果，被是非選擇題考壞掉了。
作者: Raimu    時間: 2018-3-8 20:35

讓你現賺30%
還送你不算貴的CI股票
我以為答案很明顯 @@
作者: powerhouse    時間: 2018-3-8 20:46

了解，現在才看到預備收購價，謝謝。
作者: Curry    時間: 2018-3-8 21:42

  1. CI是美國醫保老五＋還有預期報酬+ESRX現賺30%(Top 5 Largest Health Insurance Payers in the United States)
  2. 希望過一陣子Anthem可以再把Cigna吃下來(Anthem與Cigna 480億美元的併購交易被美國法官否決，原因是違反反 ...)
作者: mikeon88    時間: 2018-3-8 22:42

奇怪？CI撿到便宜，股價格居然跌9%
作者: Curry    時間: 2018-3-9 10:09

小弟在猜應該是因為:
  1. 這次併購目前最大贏家為ESRX股東，因為ESRX股東現賺30%，而CI還要承接ESRX債務。
  2. Cigna(醫保老五)未跟Anthem(醫保老二)合併卻轉而併購ESRX(藥房老三)。而對手卻是CVS(藥房老大)將與AETNA(醫保老三)合併。
  3. https://seekingalpha.com/news/3337646-mizuho-weighs-cigna-express-scripts-tie
  4. Justice Department requests more information on CVS-Aetna merger
作者: mikeon88    時間: 2018-3-9 10:15

把公司買下來本就必須承接負債，即便只買 1 股的股東也承接了 1 股負債。
ESRX被賤賣了，股東是最大輸家。
作者: katechen0714    時間: 2018-3-9 18:16

所以手上沒有ESRX的人，可以考慮CI囉 ??????
作者: Raimu    時間: 2018-3-9 20:25

CI如果繼續跌下來 符合俗價應該還是可以買
未來這些保險+藥局的聯盟應該會形成幾家寡頭分庭抗禮
本來開藥局的難度相對低
現在卻還非得具備保險的渠道
感覺外部人越來越難進入了
作者: mikeon88    時間: 2018-4-17 02:00

• Amazon.com (AMZN +1%) has killed a plan to sell and distribute pharmaceuticals through its Amazon Business marketplace, according to CNBC.
• That's in part because Amazon's had trouble convincing hospitals to change their traditional purchasing process, according to the report.
• The retailing/tech giant will instead focus on selling less sensitive medical supplies to hospitals and smaller clinics, a business even Amazon has found more challenging than expected.
• Handling pharmaceutical products would have mean heavy changes to its logistics network as well considering temperature sensitivity, sources told CNBC.
• Pharma products needing a "cold chain" for transport were worth around $283 billion as of 2017, with heavy growth predicted ahead.
• Updated 1:18 p.m.: On a spike up: Walgreens Boots Alliance (WBA +4.4%); CVS (CVS +4.8%); AmeriSourceBergen (ABC +1.3%); Cardinal Health (CAH +4.3%); McKesson (MCK +3.9%).
作者: Curry    時間: 2018-4-17 08:22

不錯！這樣代表美國的醫藥盤商、藥房所構成的銷售體系會更加穩固（亞馬遜認證）！
作者: mikeon88    時間: 2018-4-17 10:03

Ted桑從美國來電，他是美國醫學博士生，
也買了一堆通藥房通路股，覺得亞馬遜進不來，
他說：亞馬遜喊得很大聲，可是他們醫院根本沒人在理它。
他說：醫療最好賺的是醫院，這也非亞馬遜進得來的。
我說：醫保也很好賺，他認同。
他打算把這些股票抱到5年後博士班畢業。
作者: Curry    時間: 2018-4-17 13:19



QUOTE:
原帖由 mikeon88 於 2018-2-13 21:16 發表
利潤率高低跟周轉率有關，
為何MCK藥品批發商營利率2%不到可以賺錢，因周轉率高，
下游ESRX藥房營利率要高到6%，因藥房的藥品需等客戶上門買，周轉率較低。

所以亞馬遜和巴菲特以為美國藥價貴是因為通路沒 ...

  1. 覺得Mike大這則留言很棒！從關鍵數字清楚判斷！
  2. 希望自己以後也能這樣判斷∼
作者: ted_17    時間: 2018-4-17 13:50

各位晚安：Mike說的沒錯，簡單的來說是這樣的。
若不嫌棄，我來為各位介紹一下美國的醫療保險。
簡單的來說，美國醫療保險分這幾種：HMO, PPO, EPO, POS 還有HDHP/HSA。
所有美國的保險分In-network跟Out-network。就是有沒有跟保險公司合作就對了。
這個合作範圍屬兩種，一種是藥房的合作範圍與醫院/診所的合作範圍。

這五種基本保險不好解釋，所以我來用病人的角度來舉例看看有沒有幫助理解:

小明在台北一家很棒的公司工作，住台北，老闆給U*H的PPO保險。台北的所有醫院/藥房都在合作範圍內。每個月保費100元(總保費的10%)。這個PPO保險抵扣額(Deductible)是2000元，copay是25元。抵扣額就是自掏腰包上限，copay很像健保的掛號費。

今年小明病了三個星期，扁桃腺發炎去看醫生。醫生說得化驗看看是什麼細菌/病毒，所以拿了檢體化驗。一個星期後複診，扁桃腺還沒消腫，醫生說得吃拜牌的抗生素兩個療程。

我們來算算小明的醫療帳單：看了兩次醫生，一次copay是25元。這個copay有點像是健保的掛號費。實驗室養小明的扁桃腺細菌，用了三個實驗，共600元。R*HBY牌的抗生素比較貴，一個療程200元。保險給付兩個實驗，一個抗生素療程。所以小明的帳單是：25+25+200(假設每個實驗200元)+200元(一個抗生素療程)，共450元。基本上EPO跟PPO很像，但是能看的醫院/能領藥的藥房較少。如果堅持去沒合作的藥房的話，藥會很快的貴起來。
如果小明保的是HMO/POS，這樣的算法只能應用在區域性的醫院診所。若小明離開台北市去台北縣看病的話，在HMO底下小明的帳單可能會是600+200+200+診所要價(copay跟所有的給付項目沒了，因為小明離開了居住地區，屬out network)。HMO與POS主要的合作對象為被保人居住區的醫院/診所/藥房。

我想不用多說也知道，如果患有慢性病需長期藥物者需要一個好的醫療保險才能降低長期的藥物成本。

如果小明保的是HDHP，帳單有可能是1000元以上，因為HDHP保費少但是抵扣額高。最便宜的是HDHP/HSA。HSA是Health Savings Account，存進去的錢是免稅的，但通常與HDHP綁在一起。

講到了Deductible，那我們來讓小明的生活悲慘一點好了。小明騎機車犁田，膝蓋不見了。醫生說把小明全部修好加起來PPO保險給付後還需要5000元，請問小明的醫療帳單多少錢?
答案是4600元，因為之前小明扁桃腺感染已經從自掏腰包付了400元。換去話說就是無給付自費金額上限。

這些只是門診項目，還沒有談到住院項目。而且小明的案例只牽扯到台北市/台北縣，在美國，州與州之間的保險法都不一樣，同一個公司提供的醫療保險在不同的州也會有所不同。再加上，美國四月報稅的時候，稅金抵扣額度跟醫療保險的保費跟一個人的收入也有關係。簡言之，美國的保險是非常的複雜，牽扯到州法，稅法，聯邦法，勞基法，光政府管理機構有五間(HIPAA, CMS, HHS, OCR, ONC)還有無數縣市政府與民間團體。別忘了，這些醫療保險公司、醫院、還有藥廠也有自己的遊說集團。
我想要說的話是這樣的：在美國看病是很貴的。一個人的保險決定能看什麼樣的醫生，能吃什麼樣的藥，接受治療的時間長短。美國的醫療幾乎是繞著保險轉。

所以，基於這樣的複雜情勢，我不認為Amazon有能力競爭。在美國成藥任何地方都買得到，就連鄰居的雜貨店都有。處方藥跟醫院是最好賺的。但是處方藥需要醫生處方，而病人看的醫生又由醫療保險決定。醫療保險公司與藥局醫院互相利用，利用彼此的資源把顧客/病人綁住。醫療保險公司、藥廠與醫院花了很多的時間確保高昂的入行成本、不論是法律上還是通路上。即便Amazon有辦法販賣處方藥，沒有保險的給付處方藥幾乎是不可負擔的。

我希望這豆腐塊能夠給大家一點在美國看病、使用保險的印象。
如果同學還有問題的話，在時差允許的範圍內我會盡我的能力所及回答。
感謝。
祝好。
Ted
作者: mikeon88    時間: 2018-4-17 13:53

謝謝ted桑指導，醫學專家，請多來教導我們。
作者: Raimu    時間: 2018-4-17 14:16

非常感謝Ted哥優文
小弟持股信心指數++
作者: Curry    時間: 2018-4-17 15:04

  1. 感謝Ted哥這麼棒滴分享
  2. 看完後，偶滴持股信心也是UP UP!
作者: chunhsieh    時間: 2018-4-17 16:36

謝謝Ted同學,今晚入倉ESRX.
作者: mikeon88    時間: 2018-4-17 16:57

白色巨塔難進攻 亞馬遜擱置販售與分銷藥品B2B事業鉅亨網編譯許家華2018/04/17 16:33[url=][/url][url=][/url]

0


亞馬遜的物流倉庫欠缺冷鏈系統 （圖：AFP)相關個股亞馬遜網路書店US-AMZNCVS健康連鎖藥店US-CVSWALGREEN BOOTS ALLIANCE INCUS-WBA

知情人士透露，亞馬遜（Amazon）(AMZN-US) 的 B2B 事業「Amazon Business」經過去年考慮後，已決定擱置販售和分銷藥品的計畫。


該公司反而透過 B2B 事業致力於銷售較不敏感的醫療供給品給醫院與小診所，但發現該事業比預期更具挑戰。


這個阻礙說明了進軍醫療供應產業和藥品產業的挑戰，即便如亞馬遜這樣的大公司也舉步維艱。在報導稱亞馬遜有意進軍此產業後，一些健康保健和醫療分銷公司的股價直直掉落，但在這些擔憂真的變成威脅之前還要花上一段時間。


亞馬遜變更計畫部份是因為，亞馬遜一直未能說服大醫院改變其傳統採購流程，這其中一般牽涉到數個中間人的問題，以及忠誠關係。


此外，知情人士也透露，亞馬遜尚須建立一套更複雜的物流網路，才能處理對溫度敏感的藥物產品。


儘管如此，亞馬遜尚未完全排除進軍藥品分銷產業，眾多報導推測，該公司將來某日會增加直接販售給消費者（B2C）處方藥業務。多位消息人士表示，一旦亞馬遜的規模更大，Amazon Business 也會考慮進軍製藥領域。


同時，公司不同的團隊繼續探索其他醫療保健項目，包括 Alexa 和秘密的「大挑戰 (Grand Challenge)」團隊，有時以「1492」代稱。


在這個消息傳出後，藥品和藥物分銷商店包含 Cardinal Health（CAH-US)（漲逾 3%）、 CVS (CVS-US) (漲逾 4%）、 McKesson （MCK-US) (漲逾 3.5%）和 Walgreens (WBA-US) (漲逾 3.7%) 等公司的股價大漲。


亞馬遜不再是威脅，CVS 股價大漲比預期更難的挑戰

亞馬遜多年來一直向醫療診所銷售血糖儀、手套和聽診器等醫療產品，在美國 50 州內取得 47 州和哥倫比亞特區的許可。但知情人士透露，亞馬遜一直難與大型醫院系統簽訂契約，儘管召集了包含大醫院高層在內的顧問委員會。這些醫院集團有長期配合的分銷契約，例如 Cardinal Health 和 McKesson。許多醫院也在集團採購組織中持有股份，而這個採購組織代表他們談判，使用其集體談判能力。


除此之外，亞馬遜也不販售視為高風險的產品，即「第三類」設備，例如亞馬遜不販售任何需要植入人體內並維持生命的東西，像是起搏器等。一些大醫院不願意改向亞馬遜採購，部分就因為亞馬遜缺乏這一類產品。


亞馬遜欠缺風險較高的第三類設備

據一位專家稱，醫療保健供應鏈根深蒂固，很難打破。 Leidos Health 戰略和業務發展主管 Tom Cassels 表示，「醫院和醫療保健系統已經與他們現有的採購和供應鏈合作夥伴綁在一起， 很難成功複製亞馬遜在醫療保健方面的購買體驗。」


目前， Amazon Business 在醫療保健的甜蜜點是在較小型事業上，例如牙醫診所、獨立門診手術中心和小型醫生手術，其獲得許可的醫療服務因其便利性和經濟性受到歡迎。


儘管如此，《CNBC》採訪的幾位醫生表示，他們堅持與大多數供應商的現有分銷商合作，只依靠亞馬遜一些產品或緊急情況。


缺乏冷鏈

另一個亞馬遜進軍此產業的大屏障是倉庫和物流設備問題，因為亞馬遜的倉庫和物流非用以儲存和運送對溫度敏感的藥物產品。許多生物製藥公司要求其產品必須儲存、運送在高度控制的供應鍊系統中，例如有些產品必須隔離放置在冷凍庫中。


亞馬遜目前的物流系統沒有這麼複雜，知情人士表示，一些販售對溫度敏感產品的賣家必須使用客製化交付過程。這樣的供應鍊稱為「冷鏈」，這對亞馬遜來說，建置成本高昂。


根據 Pharmaceutical Commerce 的數據，截至 2017 年，需要冷藏儲存和運輸的製藥產品價值約為 2830 億美元，到 2021 年該部分預計將增長 70％。


亞馬遜的一家保健產品銷售商表示，「你不能使用 FedEx 或 UPS 卡車運送這些產品，這會是（建築上的）大工程。」



作者: twang1019    時間: 2018-4-17 17:21

執照不同，受到聯邦或州監管單位規定不同。Amazon 已經申請到數州 家用醫療器材、Health、beauty product 執照 ，但目前沒有申請 Pharmacy 執照，因為這執照非常嚴格，要求很多。

Amazon 也許想先試一試監管較少的執照，成功後，才考慮進入 pharmacy 執照。
作者: mikeon88    時間: 2018-5-7 11:02

點：未來幾個月能選出合作醫保公司的 CEO
今年初，伯克希爾、亞馬遜和摩根大通等三大巨頭宣布，將合作成立一家醫保公司，為數萬名美國員工降低醫保費用，但此後沒有最新進展的消息爆出。
巴菲特在股東大會預計，未來幾個月應該能選出醫保公司的 CEO，重要領導崗位確認後將令項目儘快啟動。醫保一直是巴菲特關心並喜歡的領域，他今日再次稱，醫療保健成本在美國 GDP 計算中占比越來越大，但當前的費用架構非常沒有競爭力，醫保開支正成為「寄生蟲」（tapeworm）。
作者: mikeon88    時間: 2018-5-12 08:01

• "President Trump rightly recognizes drug companies charge way too much, and their prices need to come down," says Express Scripts (ESRX +3.7%) following today's speech.
• "CVS Health (CVS +4.3%) is already well positioned to implement many of the key proposals outlined by the Administration," says that company.
• Previously: Drug sector on the move after Trump speech (May 11)
作者: Curry    時間: 2018-5-12 08:05

  1. 川普認證！
  2. 漲幅都不錯！
作者: Curry    時間: 2018-6-7 21:21

Buffett, Dimon and Bezos found the person they want to fix health careWarren Buffett: CEO in-place for our health-care initiative  2 Mins Ago | 03:20

Berkshire Hathaway CEO Warren Buffett, J.P. Morgan CEO Jamie Dimon and Amazon CEO Jeff Bezos have chosen a CEO for their health-care venture and will likely reveal who that person is within two weeks, Buffett told CNBC on Thursday.
The trio announced in January they would partner to tackle rising health-care costs. Buffett said Thursday they've picked a leader and are "just tidying up a couple of things."
In an interview with CNBC's Becky Quick, Buffett and Dimon praised their incoming leader and acknowledged the daunting task ahead.
Health-care experts have expressed skepticism on whether the three, while business icons, could simplify the current system. Most agree there's plenty of costs to cut, but they doubt the companies can do it.


Getty Images (l) | CNBC (c-r)
Jeff Bezos, Warren Buffett and Jamie Dimon.

The interesting thing when interviewing job candidates, Buffett said, was they didn't run into one that "didn't think significant improvement was both possible and important."
"It isn't like there's anybody out there that's connected with the system that thinks we've already arrived at nirvana, and they know how difficult the job will be to make major changes," Buffett said. "They're all cheering for us to succeed.
"A number of them might not have wanted to be the one to help us succeed ... but nobody disagreed with the mission, the importance of it or the feasibility," Buffett said. "But it's also a very, very tough nut to crack, and it's going to take significant time. We've got the right person."
Buffett, Dimon and Bezos haven't outlined how exactly they plan to lower health-care costs. Dimon gave a bit more detail Thursday on where they could focus their efforts.
"This is a long-term thing," Dimon said. "We're not looking for immediate success, but there are a lot of ideas out there. There are a lot of things that can be done better. We know the fraud, the administrative costs, we know overuse and underuse of various drugs and specialized procedures. We know the end of life often costs far more than it should and is far more painful than it should be, and with big data, there's so many things to do."
Some employees have asked Dimon what the partnership means for them. His response: "We're just going to try to do it better."
"And you should expect we're going to do it the right way with the same kind of heart we've had before, which will improve your lives and improve your wellness, improve the outcomes, give you more choice, which I believe you if you do all those things, it will effectively be cheaper," he said. "And you'll have much healthier employees."
These three companies aren't the first to take on rising health-care costs. Many have tried unsuccessfully over the years on their own or through alliances. Even Walmart, the nation's largest private employer, hasn't been able to change the system.


[ 本帖最後由 Curry 於 2018-6-7 21:23 編輯 ]
作者: chenfd    時間: 2018-6-9 11:09

The Fear Is Gone As Amazon-BuffettHealth Care Venture Finds CEO
In just four months, Amazon (AMZN)has gone from being the biggest threat to health care industry profits to anunderdog.
Back in January, when Amazon, Berkshire Hathaway (BRKB)and JPMorgan Chase (JPM)unveiled their new partnership to tame medical costs, the news bulldozedhealth care stocks.
Barely four months later, the trio of companies havefound a CEO to lead their venture and plan an announcement within weeks, Berkshire CEO Warren Buffett told CNBC on Thursday.
Yet the emerging reality looks a lot less scary than theoriginal idea to health care investors, if Thursday's market action is anyindication.
For example, UnitedHealth (UNH),the nation's largest insurer slid more than 4% on that original Jan. 30announcement, while Walgreens Boots Alliance (WBA)tumbled about 5%.
But both stocks were higher on Thursday, with Walgreensgaining 0.7% and UnitedHealth edging up 0.1%, close to its all-time high hitthe day before the big Amazon-Berkshire-JPMorgan news.
CLOSE
Even though Amazon CEO Jeff Bezos, Buffet and JPMorganCEO Jamie Dimon admitted at the time, "Our group does not come to thisproblem with answers," and said they were in their early planning stages,investors panicked.
The only plausible explanation for such an overreactionwas that Amazon had reportedly been gearing up for months to take on the retaildrug industry, while challenging drug distributors and kicking themiddleman — pharmacy benefit managers — to the curb.
Yet four months later, Amazon's health care ambitionslook a whole lot less earth-shattering and unlikely to diminish health careindustry profitability for years to come.
In April, CNBC reported that Amazon had dropped plans to become a wholesale distributor ofprescription drugs due to the cost and complexity. Investorsseemed to interpret that retreat as decreasing the likelihood that Amazon willenter the retail prescription business.
Bezos is clearly comfortable in the underdog role andcan't be counted out. But a whole host of big industry players and technologycompanies have a huge head start. IBD's Computer Software-Medical group isranked No. 10 out of 197 industry groups at IBD Stock Checkup based on stock performance, led by TabulaRasa Healthcare (TRHC), Teladoc(TDOC)and Evolent Health (EVH).


https://www.investors.com/news/amazon-warren-buffett-berkshire-jpmorgan-health-care-ceo/
作者: mikeon88    時間: 2018-6-20 05:36

• Walgreens Boots Alliance (NASDAQ:WBA) is joining the Dow Jones Industrial Average, replacing General Electric (NYSE:GE), an original index member that's exiting.
• “General Electric was an original member of the DJIA in 1896 and a member continuously since 1907,” says S&P Dow Jones' David Blitzer. “Since then the U.S. economy has changed: Consumer, finance, health care and technology companies are more prominent today and the relative importance of industrial companies is less."
• Making the change makes DJIA more representative of consumer and healthcare sectors, he says, and correspondingly a better measure of the economy and stock market.
• GE's low price in a price-weighted index had it making up less than half a percentage point of impact.
• The move's effective prior to the open next Tuesday.


作者: Curry    時間: 2018-6-20 06:09

剛剛醒來看到這則新聞，心中真是感嘅，三十年河東三十年河西啊！
作者: mikeon88    時間: 2018-6-20 06:20

前一陣子市場傳聞波克夏在買GE，記者求證巴菲特，
老巴否認，直言衪沒興趣買GE
作者: mikeon88    時間: 2018-6-20 06:24

我美股賺4倍的UNH就是2012年底一聽到納入道瓊，
即跳進去買，當時股價也便宜
作者: Curry    時間: 2018-6-20 07:04

  1. 竟然沒跟到UNH∼
  2. 印象中小弟是2012年上Mike大的課
  3. 那時新手上路，經驗不足，重壓華固（雖然有賺但過程煎熬因為重壓），重壓台橡（驚覺操作錯誤趕緊減碼，之後長抱幾年，判斷台橡現在還這樣，距離大漲應該還有很長一段路，於是台橡小小賠出場）
  4. COL真的很感謝Mike大，當初買COL只知道他是航空界不錯的公司，但真的不知道會漲那麼多
  5. 那時剛上完課，操作上跌跌撞撞，直到COL經驗＋多種果樹，才讓小弟真的有賺到錢的港覺，再把講義＆公式想過後，操作上真的信心增加不少∼
  6. 現在還是時常把講義拿起來看，每次看都還是收穫滿滿
  7. 感謝Mike大∼∼∼
  8. 希望我的持股也有很多未來的UNH
作者: mikeon88    時間: 2018-6-20 07:28

Curry桑真不錯啊，鍥而不捨。
有些同學上完課之後買了一、二支股票讓他不滿意就離開巴菲特班，
殊不知這是正常現象，因為投資是社會科學，無法百分百正確，
買了股票之後被嚴重套牢機率高達27%，
所以要多種果樹。

作者: Joe    時間: 2018-6-20 09:05

美國工業巨頭通用電氣將被移出道瓊斯工業指數
新浪美股訊北京時間20日早間消息據法新社報導，美國工業巨頭通用電氣，將被移出道瓊斯工業指數。
通用電氣表示，關於道瓊斯指數的宣布不會改變公司轉身的努力。
藥店連鎖店Walgreens Boots Alliance將取而代之。該變化將在6月26日發生。



作者: Curry    時間: 2018-6-20 10:34

  1. 多種果樹後，心情真的坦然許多
  2. 多種果樹前，只要個股跌，心情就緊張，一直注意...
作者: ictim    時間: 2018-6-20 11:31

只買一兩支股的確會不滿意⋯要買很多支就會滿意了
作者: Curry    時間: 2018-6-25 22:28

  1. General Electric – GE is near a sale of its industrial engine unit to private equity firm Advent International, according to the Wall Street Journal. A sale worth $3 billion or more could be announced as soon as today, according to the paper, with Advent beating out Cummins for that business.
  2. https://www.cnbc.com/2018/06/25/early-movers-stocks-premarket-hog-nflx-ge-msft-amzn.html
作者: mikeon88    時間: 2018-6-28 20:28

Walgreens – the newest Dow component – reported adjusted quarterly profit of $1.53 per share, 5 cents a share above estimates. Revenue beat estimates, as well, and the drugstore operator also authorized a $10 billion share repurchase program and raised its quarterly dividend by 4 cents a share to 44 cents per share.
作者: mikeon88    時間: 2018-6-28 20:34

10b元買回庫藏股，今股價65.4元，可買回家152m股(=10b/65.4)
股數1,009m股，占15%

作者: powerhouse    時間: 2018-6-28 20:48

Amazon plans to acquire online pharmacy PillPack, the companies announced Thursday.
PillPack packages, organizes and delivers drugs. It sends consumers packages with the specific number of medications they're supposed to take at specific times. It boasts a "full-service" pharmacy, meaning its customer service team is available 24/7.

“PillPack’s visionary team has a combination of deep pharmacy experience and a focus on technology,” Jeff Wilke, Amazon CEO Worldwide Consumer, said in a statement. “PillPack is meaningfully improving its customers’ lives, and we want to help them continue making it easy for people to save time, simplify their lives, and feel healthier. We’re excited to see what we can do together on behalf of customers over time.”



WBA CVS 盤前跌近 8%

[ 本帖最後由 powerhouse 於 2018-6-28 20:49 編輯 ]
作者: mikeon88    時間: 2018-6-28 20:58

https://youtu.be/IE5ZxZINyZQ
作者: studentHank    時間: 2018-6-28 22:11

CVS.MCK.CAH.ESRX.PDCO.WBA全部應聲大跌
作者: mikeon88    時間: 2018-6-29 07:07

In a conference call with analysts on Thursday, Walgreens CEO Stefano Pessina seemed nonplussed about the damage coursing through his company's stock, saying he's "not particularly worried" about the one-day move.
"The pharmacy world is much more complex than just delivering certain pills or packages," said Pessina. "I strongly believe that the role of the physical pharmacy will continue to be very, very important in the future."

http://www.businessinsider.com/amazon-pharmacy-pillpack-acquisition-merger-showing-outsized-impact-2018-6

亞馬遜併購一家藥品包裝公司就讓藥房股價跌成這樣，投資人被嚇壞了
亞馬遜來了！

這種公司醫院和藥房要介入也很容易，有什麼好怕的？

作者: mikeon88    時間: 2018-6-29 08:09

亞馬遜1天宣布兩消息 8家公司市值掉5384億元
2018-06-29 07:54聯合報 記者季晶晶╱即時報導

亞馬遜公司周四（29日）發布兩項消息，令八家上市公司的市值因此蒸發175億美元（約台幣5384億元）。
這家電商巨擘已經成為影響華爾街的重要勢力，即使周四僅暗示將踏入新行業，都足以撼動投資人和相關個股股價。
亞馬遜說，將招募創業家負責經營在地送貨網絡，此舉可能衝擊聯邦快遞（FedEx）和優比速（UPS）的業務。兩家公司市值因此減少近30億美元。優比速損失較大，股價跌幅達2.3%。
幾小時後，亞馬遜又宣布收購線上藥房新創事業PillPack，撼動健康照護產業。根據財經網站CNBC報導，消息人士透露，亞馬遜支付10億美元左右買這家公司。此一交易使 Walgreens Boots Alliance、CVS Health和Rite Aid等藥妝店，以及Cardinal Health、AmerisourceBergen和McKesson在內的藥品經銷商損失145億美元。
另外，消息人士說，出價低於10億美元要收購PillPack未成的沃爾瑪（Walmart），周四市值損失30.4億美元。
作者: ted_17    時間: 2018-6-29 08:42

就抱著唄。沒什麼好怕的。美國人不能說換保險就換保險的。
保險不給付藥價再便宜也買不到。
作者: mikeon88    時間: 2018-6-29 08:47

藥品包裝公司看起來蠻費人工的，
把藥丸分拆重新包裝，填上每包藥的服用時間及注意事項，都無法自動化
而且一旦分裝錯誤會被告翻掉的，只為賺取一點服務費划得來嗎？
作者: billee    時間: 2018-6-29 09:22

我有一些疑惑想請教老師與學長
如果藥房股只是靠人力繁複和既有合約牽制，能算是護城河嗎？我從未投資過亞馬遜，亞馬遜崛起時我也已經離開外商資訊界非常非常多年。
但近年有同事去亞馬遜擔任新興市場開發，他被操的程度簡直不像人，(公司也亂得不像話XD)
但和他聊了一下，才發現貝佐斯真正過人之處
1.層級極為扁平，官僚主義問題不大，決策非常明確，貝佐斯居然可以直接釘到他
2.數字管理，策略與執行步驟非常清楚，而且落實到每一個Individual contributor身上，大家都不能打混
第二點在美國都不稀奇，但兩點都具備，卻是99.9%大型美國商業公司所沒辦法的
同樣的狀況，也發生在我在NVDA的同事身上
黃仁勳的Pilot in commit, 貝佐斯的6 pages, 領導人的堅強執行力+網路的連結，真的把既有官僚主義的大型組織打得抬不起頭，這幾年已經一再證明，被他們對上的公司幾乎都是全軍覆沒
當然，我也沒有NVDA,也絕無幫他們吹捧的意思，現在AMZN, NVDA股價的確也很高，我都不會去買。
不過我同事和前老闆都發了財 XD
只是當我仔細思考，我實在想不出傳統組織對上這種新物種，有多少存活的可能？
只是因為我工作經歷，深深感覺，當NVDA和AMZN這種超強執行力的公司，當他準備好進入一個產業時，就算不能勝，既有的競爭者恐怕也會被打得頭破血流。
因為根本反應不過來。效率與執行力差太多了，企業客戶與零售客戶扣除轉換成本後，省下的錢也太多太多了。
是否這也是巴菲特轉念，後悔沒買AMZN, 然後決定與他合作的原因?
老巴一樣盛讚貝佐斯的執行力。
不好意思，個人淺見。我昨天藥房股損失慘重，但這完全沒有影響我的判斷，因為我思考這問題很久了。
不好意思打擾了，這真的是我的困擾，希望能聽聽老師與同學的意見來解惑。

[ 本帖最後由 billee 於 2018-6-29 09:29 編輯 ]
作者: chousirbuy    時間: 2018-6-29 09:25

昨天晚上看到這個新聞, 想了三秒立刻就去掛WBA, CVS 才去睏
結果投資人比我想像中的還要理智, 掛太低沒買到
作者: mikeon88    時間: 2018-6-29 09:26

billee同學打字速度真快

之前討論過了，藥房的毛利很低，跟亞馬遜物流一樣低，
它進來能有何利基？

作者: chousirbuy    時間: 2018-6-29 09:30

我記得沒錯的話, 巴菲特的長期投資法則裡
沒有包含領導人的能力, 只有領導人的品格

所以我也不會買AMAZON...
作者: billee    時間: 2018-6-29 09:53

打字很快是因為無所事事......
謝謝老師的指導，因為多種果樹，買的又便宜，所以雖然藥房股一天大跌，整體來看也沒什麼
越來越有時間做投資以外的事，除了常常上討論區閒晃外，投資幾乎已經不用傷腦筋了
可能就是時間太多才會胡思亂想，我去運動了
作者: mikeon88    時間: 2018-6-29 09:54

藥品分裝在台灣是到藥房買藥時會幫客戶做的服務，它是藥房早有的服務，
若集中到一家公司出錯機率不會大增嗎？
作者: powerhouse    時間: 2018-6-29 10:13

AMZN 想進醫藥鍊的企圖是很明顯的，這只是牛刀小試，只是產業結構複雜加上這產業長年的上下游關係也不太可能這麼容易被打破，所以它只能從最單純的藥品分裝切入 (說藥品配送單純，有些需要特殊環境儲存的藥品，其配送的學問難度也非常之高，不是像一般商品塞到包裝袋裡面去配送就OK)。
對 AMZN 來說如意算盤當然是將來藥品也能像一般日用商品一樣用網購配送的方式運作，但誰生病不想立刻，立即，馬上，迅速拿到藥？更何況有些病痛是需要立刻服藥減緩的，沒有辦法等物流配送，因此小弟認為街頭藥局會是幾種商品通路裡面很難被電商取代的 (藥房的藥品利潤降低腐蝕獲利這是另一個藥品通路自己要面對的課題，與電商關係不大。)
AMZN 當然可能利用自己 WHOLE FOODS 的通路開藥房，但這種模式 WMT 這些通路也早就在運作，外來競爭本來就是企業要面對的課題，為何主詞一變成是 AMZN 市場就歇斯底里？

[ 本帖最後由 powerhouse 於 2018-6-29 10:24 編輯 ]
作者: mikeon88    時間: 2018-6-29 10:30

看了多篇powerhouse桑的貼文，精闢入理，是值得學習的榜樣
作者: powerhouse    時間: 2018-6-29 10:39

M 大過獎，小弟反而覺得應該要留意 AMZN 觸及的是尾端客戶，AMZN 可以取得病人的 RROFILES，用藥紀錄頻率等等資料，誰知道它們可以利用這些資料在未來做出甚麼顛覆？
AGAIN，傳統藥局也具備這些優勢，若最後被擊敗那只能說技不如人，怨不了誰，投資的股票虧了那我也只好認了。
作者: ted_17    時間: 2018-6-29 11:10

病人的資訊(Patient Health Information。PHI。任何跟病人有關的資訊)由美國HIPAA法案管理。法案明文規定，非經病人同意，受HIPAA管制的組織(包含醫院、復健師、藥局等Healthcare provider)不得以任何形式使用病人的資訊(即便是匿名的大數據)。
如果AMZN未經同意開始使用病人資訊來廣告或做市場調查，不只病人可透過美國州與聯邦法院訴訟求償，州政府與聯邦政府也會開啟民法與刑事調查。
依美國人的脾氣來看，病人屬於弱勢群體，容易被針對(舉例:利用病例與用藥歷史對有可能罹患乳癌的患者投放乳癌的廣告)，使用病人資訊來牟利是非常不道德的行為(是乘人之危)，所以藥房徵求病人同意使用用藥歷史來做分析/廣告的機率不大。Edit: font size
作者: mikeon88    時間: 2018-6-29 11:16

Ted桑真專業，謝謝指導
作者: billee    時間: 2018-6-29 13:26

從老師與學長的討論學習到很多! 相較之下，自己的見識實在太淺薄了想想有亞馬遜這樣殺人鯨+迅猛龍合成的公司，最後能存活下來的零售業應該也都是第五級變種怪獸才對。
謝謝老師與學長的指導!
作者: ted_17    時間: 2018-7-2 00:20

今早WSJ分析。Summery provided by smmry.com.
Amazon's PillPack Deal Gives It Access To Sensitive Health Data

Last week's acquisition of online pharmacy startup PillPack will give Amazon insight into people's prescriptions, putting the tech company into the highly regulated realm of health information with more restrictions than it is accustomed to on data-mining.

Amazon has mastered the use of personal data by analyzing people's purchasing decisions to predict whether they might buy toilet paper, watch a romantic comedy or ask its Alexa voice assistant for a recipe.

Amazon's purchase of PillPack gives it the ability to ship prescriptions to customers' homes in 49 states.

PillPack gives Amazon the chance to lure consumers away from the local pharmacy and win all the store purchases that can come with the trip.

While marketers can freely exchange data on consumers' nonprescription purchases, demographics and browsing activity, the federal government tightly controls the privacy of medical information through the Health Insurance Portability and Accountability Act, or HIPAA. Companies can't sell patient data to another party or market complementary products based on a person's health condition-like sending coupons for diapers to a woman with a prescription for prenatal vitamins.

He said Amazon likely would need to wall off PillPack from its larger operation, otherwise it might have to take steps to ensure the entire business meets federal privacy standards, which govern everything from who has access to data to how user passwords are encrypted.

Amazon already has insight into people's health by tracking consumers' browsing and shopping habits.

Source:https://www.wsj.com/articles/amazons-pillpack-deal-gives-it-access-to-sensitive-health-data-1530442800


Edit: font size.
作者: Curry    時間: 2018-7-2 10:12

  1. Amazon already has insight into people's health by tracking consumers' browsing and shopping habits.
  2. 亞馬遜這樣做沒有侵犯各資問題？
作者: mikeon88    時間: 2018-7-2 10:22

PillPack 是藥房還是只藥丸分裝公司？
醫生開了處方簽，到藥房買藥不就完成了，還要送到PillPack 分裝？
作者: goldenweek    時間: 2018-7-2 13:48


出處:2018/6/30 經濟日報 國際A9版

[ 本帖最後由 goldenweek 於 2018-7-2 14:10 編輯 ]
作者: duwa    時間: 2018-7-2 17:23

個人感覺PillPack是藥丸分裝公司，本身的物流能力不強，所以才要賣給大物流公司(AMZN跟WMT)，以加強它自己的網路效應，假如越多人用PillPack，PillPack才能對藥廠(提供藥物)及保險公司有談判能力，利潤才會有。不過這利潤應該也不高。
主要感覺AMZN買PillPack可能是要PillPack當大數據的database，數據在PillPack內部自己分析(不確定這樣是否違法，因為沒人會知道，只有內部人知道)，以及要網路上與顧客交流的平台，可能藉機推薦其他自己談判能力較多的等效藥物吧，說不定還會賣其他AMZN的網路產品，這樣它就有利潤了。
PillPack要勝出既有競爭者WBA, CVS就是要夠快，假如我把處方簽傳給你，你藥一個月才給我，病人不是就GG了。假如果24小時內馬上能拿到藥，物流建置成本一定會使AMZN一直賠錢[反正AMZN也不是靠EPS維持股價的]，但這邊有個重要的問題，不是全部的藥，病患都熟悉或能妥善儲存[而且病患直接去藥房拿藥還能直接取得藥師建議]，PillPack的藥看起來都放室溫，這都是最不敏感的藥，利潤也是最差，WBA, CVS的高利潤藥(例如低溫保存或針劑)整體的物流控管都要符合法規，否則病患一有問題，藥房廠就被告死了，這法規的護城河跟同業網路不是AMZN要進來，大家就一定會受到影響。有些藥廠的藥不給你AMZN賣，你也沒辦法利用PillPack給病患一次買足的需求滿足。總之，AMZN是打著降低藥價的大旗在到處找洞鑽。但是醫藥產業是ㄧ個生態不是幾家公司而已，AMZN要學會融入這個生態還早得很，這個生態系現存的公司都是生態鏈的一環，要取代都是要花時間的，不是網路公司想的那麼簡單。

QUOTE:
原帖由 mikeon88 於 2018-7-2 10:22 發表
PillPack 是藥房還是只藥丸分裝公司？
醫生開了處方簽，到藥房買藥不就完成了，還要送到PillPack 分裝？

作者: Raimu    時間: 2018-7-2 17:30

昨天看完Netflix上'黑錢:VRX'
感想是美國的藥價問題根源還是來自於藥廠
藥廠居然可以任意把600usd的藥抬價到20000usd以上
AMZN如果真心想要讓終端消費者能得到更合理的藥價 應該要買藥廠
而不是藥局
作者: mikeon88    時間: 2018-7-2 17:36

所以就知道高舉降低藥價大旗，只是幌子
作者: duwa    時間: 2018-7-2 18:32

沒錯 AMZN應該買JNJ, PFE, MRK跟TEVA後，然後說藥都不用錢，股價一定沖破外太空
作者: goldenweek    時間: 2018-7-3 08:02


出處：107／6／30工商時報A6國際投資版
作者: chenfd    時間: 2018-7-3 12:53

Happy Anniversary, Amazon-Whole Foods. Waht's Changed?
Amazon 買 Pillpack 進入藥品零售業, 是否會發生同狀況?
https://www.bloomberg.com/view/articles/2018-06-11/amazon-whole-foods-anniversary-walmart-kroger-lead-reaction
作者: genechen98    時間: 2018-7-9 12:41

HI 同學 桑：
這今年3月的收購案(CI收購ESRX)。為何至今ESRX依然存在美股掛牌？
收購後不是應該會如同T收購TWX，而TWX退現換股合併到T嗎？之後TWX已不存在。
難道這CI併購ESRX的消息後來告吹？
作者: norman1    時間: 2018-7-11 13:02

消費者的價格評估可能不會太遠。 由Brian Tanquilut領導的傑富瑞分析師仔細研究了亞馬遜非處方藥基礎護理藥物的定價與Walgreens和CVS提供的自有品牌產品的定價。 他們發現亞馬遜藥品的價格中位數比零售藥店提供的同類產品低20％至22％。此文章摘錄自以下新聞   http://news.morningstar.com/all/viewnews.aspx?article=/mw/tdjnmw2018070831_univ.xml
作者: ted_17    時間: 2018-7-14 08:00

美投資人在Reddit 上討論．
論點不錯．

https://old.reddit.com/r/stocks/comments/8yksqf/drug_prices_might_drop_because_of_amazon/
作者: Curry    時間: 2018-9-21 09:12

  1. 再次看了AMZN, MCK, CAH, WBA個別的Gross margin及EBIT margin差異，就更能確定AMZN的管理成本是相當高的！







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