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一位药剂师的创业之路

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2017年04月06日

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When Michael Rea started working as a pharmacist, he soon found all his customers asked the same question: why had their medicines become so expensive?

当现年35岁的迈克尔•雷亚(Michael Rea)开始担任药剂师时,他很快就发现,所有客户都在问同一个问题:为什么他们的药变得这么贵?

The plight of one particular woman on eight different drugs — a 65-year-old diabetic with high blood pressure — prompted him to find answers.

一名65岁的女性患有糖尿病和高血压,需要服用8种药物,她的困境促使他去寻找答案。

“She asked me which two medications she should skip,” says Mr Rea, who in 2008 was working for Walgreens, the US pharmacy chain, in Kansas City. “She was making a matter-of-fact, life-or-death decision and wanted to know which drugs were the least important.”

“她问我应该把哪两种药省掉,”雷亚说,“她正在做一件实事求是的、关乎生死的决定,她想知道哪些药物是最不重要的。”2008年,雷亚在堪萨斯城的美国连锁药店沃尔格林(Walgreens)工作。

Mr Rea, now 35, could not in good conscience advise a patient to stop taking a medicine that might keep her alive. So he spent six-and-a-half hours working out how to save the customer money, eventually suggesting alternative drugs that worked in the same way but were less expensive.

出于良心,雷亚无法建议患者停止服用一种可能保她活命的药物。所以他花了六个半小时算出如何让这位客户省钱,最后建议客户服用药效相同、但更便宜的替代性药物。

His suggestions, he says, saved her $250 a month.

他说,他的建议每月帮这位女士节省250美元。

Mr Rea got a kick out of helping the patient, and found himself offering a similar service to other customers.

帮助这位患者,让雷亚从中获得了极大乐趣,于是他也为其他客户提供类似的服务。

A month later, he set up his own company and website, Rx Savings Solutions, to help patients cut the amount they spend on medicines.

一个月后,他成立了自己的公司Rx Savings Solutions并设立网站,帮助患者减少他们的药品花销。

As well as suggesting cheaper alternatives, including generic versions, Mr Rea found customers could reduce outlay with simple tricks: two 5mg pills sometimes cost less than a 10mg one; tablets could be less expensive than capsules; and some pharmacies were cheaper than others.

除了推荐更便宜的替代药品(包括仿制药),雷亚发现客户可以通过简单的技巧减少支出:有时两枚5mg药片的价格之和低于一枚10mg药片;片剂可能比胶囊便宜;有些药房比另一些药房便宜。

Today the work that used to take Mr Rea several hours per patient is done in seconds by proprietary algorithms. The company’s desktop and mobile app is offered by US employers and insurers to more than 1m people.

通过专有算法,雷亚为每名患者花几个小时完成的工作,如今只花几秒就完成了。美国雇主和保险公司向逾100万人提供了该公司的桌面和手机应用。

Patients tend to contribute to the cost of drugs out of their own pocket in the US, and they save by using the app to find cheaper alternatives. But so do their employers and insurers through lower overall healthcare costs.

在美国,患者往往自掏腰包支付一部分药物费用,他们使用该应用寻找更便宜的替代品,达到了省钱目的。他们的雇主和保险公司也通过降低总体医疗费用来省钱。

For the first three years, Mr Rea ran the business while continuing to work as a pharmacist for Walgreens, although his interest in his day job was waning.

在最初3年里,雷亚一面继续担任沃尔格林的药剂师,一面经营这块业务,但他对药剂师工作的兴趣在减弱。

“What became difficult was that it was very transaction based — it was just how many prescriptions can you churn out,” he says.

“让事情变困难的是,这项业务非常依赖交易——完全与你可以开出多少处方有关,”他说。

Mr Rea quickly realised that for his start-up to make a significant impact it would have to sign up a large employer or health insurance plan that could offer its services to all its members.

雷亚很快意识到,若想让他的创业企业产生重大影响,就必须签一家大企业或一个医疗保险计划,好将服务提供给后者的所有成员。

During lunches and break times, Mr Rea would retreat to his car on a roof-top car park and hold conference calls with prospective customers. Eventually, in 2012, he signed Mutual of Omaha, an insurance company based in Nebraska. The contract gave him the confidence he needed to quit his job.

在午餐和休息时间,雷亚会回到他那辆停在屋顶停车场的车上,并与潜在客户举行电话会议。终于,他在2012年与内布拉斯加州保险公司Mutual of Omaha签订了合同。合同给了他辞掉药剂师工作的信心。

But the deal with Mutual of Omaha failed because it was linked to the insurer’s ill-fated attempt to expand into healthcare. It was a sign of how an entrepreneur’s plans can hinge on the actions of a larger company.

但是,与Mutual of Omaha之间的交易失败了,因为这家保险公司扩展进入医疗保险的努力未能成功。这表明,一位创业者计划的成败可能多么依赖于一家大公司的行动。

Mr Rea was left without an income for 16 months, during which he and his family had to survive on his wife’s attorney salary.

雷亚有16个月时间完全没有收入,在此期间,他和家人不得不依靠妻子的律师工资生活。

“That was a difficult time, when I made the jump,” he recalls. “I had a small kid, and we had hundreds of thousands of dollars in student loans.”

“我跨出这一步时,我们处于艰难时刻,”他回忆道,“我有一个小孩,我们有几十万美元的学生贷款。”

Mr Rea’s friends, many of them pharmacists, encouraged him to return to his old profession. “They were saying, ‘You’re insane, why would you leave this stable, well-paid job?’

雷亚的朋友们——其中很多是药剂师——鼓励他回到原来的职业。“他们说,‘你疯了,为什么要离开这个稳定、薪酬不错的工作?’”

“I did consider that for a while and at some point would have probably gone back to it,” he says, but he worried that he might have to sign a non-disclosure agreement that could make it harder to grow his company.

“我确实为此考虑了一段时间,在某一刻,我差一点儿就回去了,”他说。但他担心,他可能不得不签署一份保密协议,该协议可能使他更难发展他的公司。

But in 2013, Mr Rea raised $1.2m from wealthy investors in Kansas City and subsequently went on to secure a further $3.7m from another group of rich individuals. The company’s investors include Dan Henry, a veteran of fintech companies such as NetSpend and Euronet.

但在2013年,雷亚从堪萨斯城的富有投资者手中筹集了120万美元,随后又从另一群富人手中筹资370万美元。该公司的投资者包括丹•亨利(Dan Henry),他是NetSpend和Euronet等金融科技企业的资深人士。

Mr Rea was introduced to early investors by his mentor, Drew Komenda, who eventually left his job in sales at Johnson & Johnson, the healthcare group, to join Rx Savings’ board and become its chief revenue officer.

雷亚是被他的导师德鲁•柯曼达(Drew Komenda)介绍给早期投资者,柯曼达最终辞掉了在医疗集团强生(Johnson&Johnson)销售部的工作,加入Rx Savings董事会,成为公司的首席营收官。

Mr Komenda had been looking for a new challenge after J&J, and his next-door neighbour knew Mr Rea, whom he said had a good idea for a business but needed help with sales.

柯曼达在离开强生后一直在寻找新的挑战,而他的邻居认识雷亚。这位邻居跟柯曼达说,雷亚有个创业的好主意,但需要人帮他打理销售业务。

Today Rx Savings employs 35 people in its head office in Kansas City and Mr Rea says he is “always in fundraising mode” so the business can expand more quickly.

如今,Rx Savings在堪萨斯城的总部雇用了35名员工,而雷亚表示他“一直处于筹资模式”,以便公司能更快地扩张。

Clients of Rx Savings include Sprint, the large mobile phone network and Berkshire Hathaway Media, the US newspaper group controlled by billionaire Warren Buffett, as well as a string of public sector employers.

Rx Savings的客户包括大型移动网络运营商Sprint和亿万富翁沃伦•巴菲特(Warren Buffett)控股的美国报业集团伯克希尔哈撒韦传媒(Berkshire Hathaway Media),以及一些公共部门的雇主。

One customer, the State of Kansas, says it saved $7.5m last year thanks to changes suggested by Mr Rea’s company to its employees via the app.

其中一家客户——堪萨斯州政府——表示,由于雷亚的公司通过应用向其雇员提出的药品变更建议,去年州政府节省了750万美元。

Rx Savings tries to win business by offering to perform a retrospective analysis of a company’s health insurance claims, using its algorithms to work out how much money would have been saved if the client had been using its service all along.

Rx Savings尝试对一家公司的医疗保险索赔进行回顾性分析(即用算法计算出,如果客户一直使用其服务,本来可以节省多少钱),来赢得业务。

If a company signs up, they pay a nominal fixed fee each month for every member covered by the Rx Savings service.

如果一家公司与Rx Savings签约,他们会在每月为后者的服务所覆盖的每名成员支付一笔名义固定费用。

“When we do the opportunity assessments we find anywhere from 22 to 25 per cent of the money being spent on drugs could be saved,” says Mr Rea.

雷亚表示:“我们在进行机会评估时发现,可以节省22%至25%的购药资金。”

If that kind of saving were applied to the roughly $450bn spent on prescription medicines in the US each year, it would equate to a saving of more than $100bn, Mr Rea says.

雷亚表示,目前美国每年的处方药费用大约是4500亿美元,如果按这一节约比例计算,那么其中逾1000亿美元可以节约下来。

Others are not so sure. Dr Peter Bach, an expert in drug pricing at the Memorial Sloan Kettering Cancer Center in New York, says it would be difficult to find such a saving without “very large price concessions” from drugmakers. “I don’t know where you would find $100bn,” he says.

其他人对此不太确定。纽约的纪念斯隆凯特琳癌症中心(Memorial Sloan Kettering Cancer Center)的药物定价专家彼得•巴赫(Peter Bach)博士说,如果制药企业不做出“非常大的价格让步”,这么大幅度的节约就难以实现。“我不知道你会在哪里省出1000亿美元,”他说。

President Donald Trump, who has promised to repeal and replace President Barack Obama’s Affordable Care Act, recently admitted to having had no idea healthcare could be “so complicated”.

美国总统唐纳德•特朗普(Donald Trump)曾承诺废除并取代前总统巴拉克•奥巴马(Barack Obama)的《平价医疗法》(Affordable Care Act)。不久前,特朗普承认,他没想到医疗问题可能会“如此复杂”。

“The only thing that can unwind the complexity is revealing information to those paying the bill,” says Mr Rea.

“唯一可以化解复杂性的方法,是把信息披露给支付账单的人,”雷亚说。

Castlight Health, a San Francisco-based group, also promises to lower people’s healthcare costs, although it focuses on procedures like operations rather than the price of drugs.

总部位于旧金山的Castlight Health公司也承诺降低人们的医疗花销,不过其发力点是手术等环节,而不是药物价格。

The growth of Rx Savings has coincided with a big shift in US healthcare. The price of medicine has soared, and employers and insurers are asking individuals to shoulder a greater share of the cost.

Rx Savings业务的增长恰逢美国医疗行业的重大转变。药价飙升,雇主和保险公司要求个人承担更高比例的费用。

Almost 50 per cent of Americans are now insured in “high-deductible” plans, which means they must pay an excess of several thousand dollars out of their own pocket towards healthcare before their insurance picks up the tab.

如今,近50%的美国人参加了“高自付额”的医疗保险计划,这意味着,他们必须自己多支付数千美元看病,然后才会由保险公司替他们付账。

Mr Rea points out that some consumers have deductibles of as much as $5,000 — “a number most people will never get to”.

雷亚指出,有些消费者的免赔额高达5000美元——这是“绝大多数人永远不会达到的金额”。

“What they can do is put tools like us in place to help them manage it, to help them keep away from the $5,000,” he says.

“他们可以做的就是,使用我们这样的工具,帮他们管理这个问题,帮他们花不到5000美元,”他说。

But Mr Rea says the company needs to raise its profile.

但雷亚表示,他的公司需要提升形象。

“That’s our number one issue as a company: we do this work and the clients we have speak very highly of the results,” he says. “The problem is most of the nation doesn’t know we exist.”

“这是我们公司的第一大问题:我们做了这项工作,我们的客户们对结果给了很高评价,”他说,“问题是国内的大部分人不知道我们的存在。”

Now Mr Rea spends most of his time doing just that, on the road pitching to clients, and at healthcare conferences, where he tries to raise awareness of the business. A trio of executives based at the group’s Kansas City offices look after operations, finance and technology from day to day.

现在,雷亚的大部分时间都在做这件事——在向客户推介公司的路上、在医疗大会上——他在努力提高公司的知名度。公司堪萨斯城总部的三位高管负责日常的运营、财务和技术。

For now, Rx Savings has no direct competitors, says Mr Rea, and he has no plans to take the company public or to sell it, adding there is “far too much work to do”.

雷亚表示,现在Rx Savings没有直接竞争对手,他也不打算将公司上市或卖掉。他补充道,眼下还有“太多工作要做”。

“There are some real advantages to being private,” he says. “We can make decisions in a boardroom in 10 minutes to meet the needs of a client.”

“非上市公司具有一些真正的优势,”他说,“我们用10分钟就可以在董事会议室做出决定,以满足客户的需求。”

“What really makes the company tick is the feedback we get from members,” he says. “I just think that if you can keep the focus on that, then you don’t have to worry about meeting an investor’s expectations.”

他说:“真正让公司运转起来的,是我们从用户那里获得的反馈,”他说 ,“我认为,如果你能持续关注这一点,那么就不用担心会辜负投资者的期望。”
 


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