Amazon is going into the pharmacy business?

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I heard from my friend working for Amazon that it's basically CVS of tech companies...
 
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Yup, how did you know? You're not a druggist, are you?
I'm not even human, I'm an AI algorithm designed to mimic human behavior on internet forums in the most widely acceptable way. I've simply observed that retail, and particularly the big pharmacy chains, are literally the worst.
 
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I heard from my friend working for Amazon that it's basically CVS of tech companies...
What I heard too... all about shareholder returns
 
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I would like to see them produce pharmacy automation and warehouses to deliver medications. I would be happy as I am a shareholder and would love to give them my opinion on how to run operations.
 
Amazon just celebrated their 20 year IPO anniversary as an "online book Company". Things have changed. They certainly have many barriers of market entry but Steve Bezos is not to be counted out and has the vision of another silicon Steve and I think we all know what his last name was. If Amazon pulls the trigger and goes at this full blast then it will not only cause ripples but a tsunami.
 
Well, the secret is going to be whether Amazon is going in as a wholesaler or as a DTC pharmacy seeing that they are incorporated in ND. Those of you in the know, there's specific laws relating to FD&C and CSA that require separate wholesaler and DTC organization. Amazon can't be both legally as CVS found out when merging with Caremark and when Merck merged with Medco.
 
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Well, the secret is going to be whether Amazon is going in as a wholesaler or as a DTC pharmacy seeing that they are incorporated in ND. Those of you in the know, there's specific laws relating to FD&C and CSA that require separate wholesaler and DTC organization. Amazon can't be both legally as CVS found out when merging with Caremark and when Merck merged with Medco.
Which part of Amazon is incorporated in ND?
 
I'm not even human, I'm an AI algorithm designed to mimic human behavior on internet forums in the most widely acceptable way. I've simply observed that retail, and particularly the big pharmacy chains, are literally the worst.
Don't get too frustrated with the pharmacy. It can be a mixed bag, but we do a lot to protect patients and the providers prescribing for them. Even if you are perfect and you have never made a mistake, I guarantee that a community pharmacist has caught and corrected an error made by your staff. I had an MA try to call in a trazodone written qHS as "every hour for sleep." You might not know about the lengths a community pharmacist went to in order to get your patient with a DVT the direct Xa inhibitor you prescribed without checking if it was covered. We would probably try to call you, but if you were unreachable you might not know about the pharmacist's recommendation that the patient interrupt statin therapy during the clarithromycin course you prescribed. Don't even worry about it. We've got your back. :)

One issue with mail order is that pharmacists are less accessible to patients. That creates problems when it comes to monitoring for side effects. Mail order also gets in the way of checking drug interactions on urgent care orders. Those urgent care orders are not going to be sent to the mail order pharmacy. If a patient uses mail order, I hope the ER is obtaining an accurate med history and checking for these interactions. :/
 
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Don't get too frustrated with the pharmacy. It can be a mixed bag, but we do a lot to protect patients and the providers prescribing for them. Even if you are perfect and you have never made a mistake, I guarantee that a community pharmacist has caught and corrected an error made by your staff. I had an MA try to call in a trazodone written qHS as "every hour for sleep." You might not know about the lengths a community pharmacist went to in order to get your patient with a DVT the direct Xa inhibitor you prescribed without checking if it was covered. We would probably try to call you, but if you were unreachable you might not know about the pharmacist's recommendation that the patient interrupt statin therapy during the clarithromycin course you prescribed. Don't even worry about it. We've got your back. :)

One issue with mail order is that pharmacists are less accessible to patients. That creates problems when it comes to monitoring for side effects. Mail order also gets in the way of checking drug interactions on urgent care orders. Those urgent care orders are not going to be sent to the mail order pharmacy. If a patient uses mail order, I hope the ER is obtaining an accurate med history and checking for these interactions. :/
I was referring to employment conditions.
 
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Amazon just celebrated their 20 year IPO anniversary as an "online book Company". Things have changed. They certainly have many barriers of market entry but Steve Bezos is not to be counted out and has the vision of another silicon Steve and I think we all know what his last name was. If Amazon pulls the trigger and goes at this full blast then it will not only cause ripples but a tsunami.
You mean Jeff Bezos?
 
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You could say I'm hedging my bets by buying and accumulating AMZN stock. So if they do end up dominating pharmacy, I'll be able to retire anyway. ;)
 
Competition is good for both, consumers and the employees. Now the question is will Amazon have any competitor lol?
 
Any job openings at their headquarters in Seattle?
 
I know everyone likes Amazon but Amazon is just a place for vendors to sell things. If something goes missing then it is the vendor's loss, not Amazon. Is Amazon going to refund Mr. Johnson's Lipitor if it goes missing? That is going to be a huge loss in a already low margin business.


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Patient's Dr sends their RX to AmazonRx™. Dr can look at the AmazonPrime™ copay instantly through Amazon.com. Prime includes low cost generics and let's you order your favorite manufacturer and preferred quantity. Shipped within 2 days of course. If a medication is out of stock it will show the estimated availability time. Additional insurance is available for brand names.
 
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Which part of Amazon is incorporated in ND?

The main holding company. That's partly how Amazon got around Sales Tax all those years. It's not hard to incorporate a subsidiary outside ND though for this. Relating to @Charcoales point though, there are both major legal and operating issues with vertical integration. Historically, that has never worked out (Merck and CVS arguably lost productivity by integrating). Wal-Mart whose expansion into pharmacy over the past 20 years buys at the rate that they could be their own wholesaler, still refuses to. Every time I go to Little Rock, the issue has always been around liability and Chinese Wall information problems that Wal-Mart didn't think they could overcome.

The Japanese website that was shown is ridiculous, the Japanese model for pharmaceutical distribution is extremely different than the US. It's very rare for pharmacists to dispense legend medications, it's usually the physicians who do that directly (and in blatant conflict of interest by US standards).

But like other tech companies, Amazon breaks the law until they become it. It's the Uber model, could work elsewhere, although I don't think that the DEA would be ok with that component of it. Oh, but for the federal indictment that's upcoming to Uber and is being worked on for Theranos...
 
The main question for pharmacists is how will this effect the job market? I think amazon's entry will spurt demand for a short amount of time until everything become online/automated. Then the job market will really be bad.
 
My buddy started working at Amazon when I was a P1. They were "starting" it then, and now I'm graduated- took NAPLEX today. It should be interesting, but Amazon is pretty cutthroat from what he tells me.
 
Wouldn't automation be a huge concern for the job market?

It's always been a concern, but now it seems like it's going to be the real deal if Amazon really takes over.
 
If amazon gets something liek this going and going well, then you can almost certainly spell the end of pharmacy as we know it. And hoenstly it's probably a lot better this way than as it currently is.
 
Wouldn't automation be a huge concern for the job market?

It's always been a concern, but now it seems like it's going to be the real deal if Amazon really takes over.
The manual aspects of pharmacy have been "automated" ever since the inception of the pharmacy technician. Whether a robot or a human is filling the prescriptions, the cognitive duties of a pharmacist are still legally the realm of a human being.

The real nightmare will be the metrics. Read any article on how Amazon treats its warehouse workers to get a feel for how it'll be.
If amazon gets something liek this going and going well, then you can almost certainly spell the end of pharmacy as we know it. And hoenstly it's probably a lot better this way than as it currently is.

I wouldn't go this far. The older patients who are on the most prescription medications are less likely to be comfortable using an online pharmacy. I don't see this making any more of a splash than other mail-order programs unless Amazon pulls off a miracle.
 
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If Amazon can figure out drone/self driving car delivery and implement it widely delivering drugs would make a lot of sense. Imagine the labor savings with only having 4 or 5 facilities servicing a metro area.
 
Am I the only one who thinks it would be horrible for Amazon to get into pharmacy?

I want the yellow ones, not the white ones.
My medication didn't come in. I want another one.
I don't want these. I want to return them.
I'm going to sue you.
Did my doctor send in my prescription yet?
I don't want any generics made in India.

Amazon pharmacy would be great for the millennial generation going into the future, but the point is, it's OLD PEOPLE who take medicine, and whether you are an old person now, or a millennial who is an old person 30 years from now, you are not going to want your drugs from a drone from Amazon in 2 to 3 days. You want to go to the store, pick it up, and go home.

Amazon has to deal with 50 state boards of pharmacies. Different rules and regulations in each state. They have to deal with insurances, low reimbursements, negative reimbursements, DIR fees. You are telling me they will ship your aspirin 81mg which NY medicaid pays $0.50 free to your door?

If there was no medicare, medicaid, insurance, and people paid for their own medication the same way we pay for our own electronics and other shi* we buy from Amazon, it makes sense for them.

But that's not how things are.

Amazon is a great company, I'll still buy their stock at today's highs of $960/share, but I don't want them in the pharmacy business. They have to do something revolutionary, otherwise, they are just another online pharmacy possibly selling second hand generics from India.
 
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Am I the only one who thinks it would be horrible for Amazon to get into pharmacy?

I want the yellow ones, not the white ones.
My medication didn't come in. I want another one.
I don't want these. I want to return them.
I'm going to sue you.
Did my doctor send in my prescription yet?
I don't want any generics made in India.

Amazon pharmacy would be great for the millennial generation going into the future, but the point is, it's OLD PEOPLE who take medicine, and whether you are an old person now, or a millennial who is an old person 30 years from now, you are not going to want your drugs from a drone from Amazon in 2 to 3 days. You want to go to the store, pick it up, and go home.

Amazon has to deal with 50 state boards of pharmacies. Different rules and regulations in each state. They have to deal with insurances, low reimbursements, negative reimbursements, DIR fees. You are telling me they will ship your aspirin 81mg which NY medicaid pays $0.50 free to your door?

If there was no medicare, medicaid, insurance, and people paid for their own medication the same way we pay for our own electronics and other shi* we buy from Amazon, it makes sense for them.

But that's not how things are.

Amazon is a great company, I'll still buy their stock at today's highs of $960/share, but I don't want them in the pharmacy business. They have to do something revolutionary, otherwise, they are just another online pharmacy possibly selling second hand generics from India.

All those complaints will resolved by Amazon. They don't care about tiny thin margin, they make their money in volumes, subscription based business model, and seller fees. They will continue to innovate unlike traditional retails. I do believe if they break into pharmacy business, retailers WILL be screwed. If you know Amazon, customers is #1 above anything else. Sure, old folks will utilize traditional pharmacies more but they are dying, millennials will embrace Amazon business model and they are getting older. It will be the death of CVS, Rite Aid, Walgreen, Walmart as we know it. They will revolutionize groceries store with Amazon Go and they will do the same with pharmacy if they choose to. I am NEVER unsatisfied after calling their customer service hot line. They will refund me gobs of money even if it is my fault. They often don't even ask me to return the merchandise. Just look at Jeff Bezos quote...

Jeff Bezos

1. "All businesses need to be young forever. If your customer base ages with you, you're Woolworth's."

2. "There are two kinds of companies: Those that work to try to charge more and those that work to charge less. We will be the second."

3. "Your margin is my opportunity."

4. "If you only do things where you know the answer in advance, your company goes away."

5. "We've had three big ideas at Amazon that we've stuck with for 18 years, and they're the reason we're successful: Put the customer first. Invent. And be patient."

6. "I very frequently get the question: 'What's going to change in the next 10 years?' And that is a very interesting question; it's a very common one. I almost never get the question: 'What's not going to change in the next 10 years?' And I submit to you that that second question is actually the more important of the two -- because you can build a business strategy around the things that are stable in time. ... n our retail business, we know that customers want low prices, and I know that's going to be true 10 years from now. They want fast delivery; they want vast selection. It's impossible to imagine a future 10 years from now where a customer comes up and says, 'Jeff I love Amazon; I just wish the prices were a little higher,' [or] 'I love Amazon; I just wish you'd deliver a little more slowly.' Impossible. And so the effort we put into those things, spinning those things up, we know the energy we put into it today will still be paying off dividends for our customers 10 years from now. When you have something that you know is true, even over the long term, you can afford to put a lot of energy into it."

7. "If you're not stubborn, you'll give up on experiments too soon. And if you're not flexible, you'll pound your head against the wall and you won't see a different solution to a problem you're trying to solve."

8. "Any business plan won't survive its first encounter with reality. The reality will always be different. It will never be the plan."

9. "In the old world, you devoted 30% of your time to building a great service and 70% of your time to shouting about it. In the new world, that inverts."

10. "We've done price elasticity studies, and the answer is always that we should raise prices. We don't do that, because we believe -- and we have to take this as an article of faith -- that by keeping our prices very, very low, we earn trust with customers over time, and that that actually does maximize free cash flow over the long term."

11. "The framework I found, which made the decision [to start Amazon in 1994] incredibly easy, was what I called a regret minimization framework. I wanted to project myself forward to age 80 and say, 'OK, I'm looking back on my life. I want to minimize the number of regrets I have.' And I knew that when I was 80, I was not going to regret having tried this. I was not going to regret trying to participate in this thing called the Internet that I thought was going to be a really big deal. I knew that if I failed, I wouldn't regret that. But I knew the one thing I might regret is not ever having tried. I knew that that would haunt me every day."

12. "We innovate by starting with the customer and working backwards. That becomes the touchstone for how we invent."

13. "When [competitors are] in the shower in the morning, they're thinking about how they're going to get ahead of one of their top competitors. Here in the shower, we're thinking about how we are going to invent something on behalf of a customer."

14. "A company shouldn't get addicted to being shiny, because shiny doesn't last."

15. "I think frugality drives innovation, just like other constraints do. One of the only ways to get out of a tight box is to invent your way out."

16. "If you double the number of experiments you do per year, you're going to double your inventiveness."

17. "If you never want to be criticized, for goodness' sake don't do anything new."

18. "If you're long-term oriented, customer interests and shareholder interests are aligned."

19. "Invention requires a long-term willingness to be misunderstood. You do something that you genuinely believe in, that you have conviction about, but for a long period of time, well-meaning people may criticize that effort. When you receive criticism from well-meaning people, it pays to ask, 'Are they right?' And if they are, you need to adapt what they're doing. If they're not right, if you really have conviction that they're not right, you need to have that long-term willingness to be misunderstood. It's a key part of invention."

20. "You want to look at what other companies are doing. It's very important not to be hermetically sealed. But you don't want to look at it as if, 'OK, we're going to copy that.' You want to look at it and say, 'That's very interesting. What can we be inspired to do as a result of that?' And then put your own unique twist on it."
 
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Pharmacy is not an impulse based industry. Amazon generally thrives on that market. They are also not used to being in an highly regulated industry. Also, while there is a lot of money in pharmacy/pharmaceuticals, the margins are thin. Losing money on a fill is not uncommon.


Since they will probably be using a mail order model, they will have to make enough to cover shipping. There are no guarantees PBMs will cover a mail order pharmacy which isn't their own. If they tie any promotion to Amazon Prime, they have to exclude all who receive government insurance.

There are all the issues surrounding licensing and getting insurance contracts. Pharmacies don't have a lot of leverage against the PBMs.
 
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Pharmacy is not an impulse based industry. Amazon generally thrives on that market. They are also not used to being in an highly regulated industry. Also, while there is a lot of money in pharmacy/pharmaceuticals, the margins are thin. Losing money on a fill is not uncommon.


Since they will probably be using a mail order model, they will have to make enough to cover shipping. There are no guarantees PBMs will cover a mail order pharmacy which isn't their own. If they tie any promotion to Amazon Prime, they have to exclude all who receive government insurance.

There are all the issues surrounding licensing and getting insurance contracts. Pharmacies don't have a lot of leverage against the PBMs.
They could go a Wal-Mart $4 generic model and bypass insurance and use a Walgreens/Valeant relationship and bypass PBMs.
 
They could go a Wal-Mart $4 generic model and bypass insurance and use a Walgreens/Valeant relationship and bypass PBMs.

They won't make enough money. You can't survive on $2 profit especially as a mail order. You need to make about $10 a script to just break even. Walmart uses that list as a loss leader. They are hoping you will come in and then buy something profitable while there.
 
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They won't make enough money. You can't survive on $2 profit especially as a mail order. You need to make about $10 a script to just break even. Walmart uses that list as a loss leader. They are hoping you will come in and then buy something profitable while there.
Amazon wants you to have amazon prime to access their $4 generics though
 
Amazon wants you to have amazon prime to access their $4 generics though

However, you'll have to exclude all those with government based insurance because of Stark Act. Think of the issues Wags had with their Prescription Savings Club. They can't sell it to anyone with government based insurance even if the drug isn't covered.

Walmart gets away with the $4 generics because it is their regular price.
 
What I heard too... all about shareholder returns

Hahaha, if Amazon does make a big, successful play at disrupting the retail pharmacy industry, it is the end for pharmacy as a profession.

I'm not usually one of the doom and gloom guys, but I'm going to start thinking about a career change the minute it looks like Amazon picks up steam

Well, the secret is going to be whether Amazon is going in as a wholesaler or as a DTC pharmacy seeing that they are incorporated in ND. Those of you in the know, there's specific laws relating to FD&C and CSA that require separate wholesaler and DTC organization. Amazon can't be both legally as CVS found out when merging with Caremark and when Merck merged with Medco.

Wait, doesn't north Dakota have laws forbidding corporately owned pharmacies?
 
Hahaha, if Amazon does make a big, successful play at disrupting the retail pharmacy industry, it is the end for pharmacy as a profession.

I'm not usually one of the doom and gloom guys, but I'm going to start thinking about a career change the minute it looks like Amazon picks up steam



Wait, doesn't north Dakota have laws forbidding corporately owned pharmacies?


No, they don't, what do you think Dakota Drug (practically the only wholesaler in the state) is? What they do have is a rule (which comes up every so often) that prevents ownership of a pharmacy without physical representation as the PIC unless under very specific circumstances. But what Amazon would do is build another subsidiary to get around the rule, and I know the North Dakota State Board won't have the resources to go after Amazon.

I'm not worried either way if Amazon comes into the business. Like the chains' and mail orders' total destruction of independents*, having that kind of a pharmacy will just change the business a bit. That said, I still wonder how Amazon is going to deal with the regulatory as even Wal-Mart had to bow to the DEA when it came to those issues (and they tried to go around the DEA).

CVS and Wal-mart's expansion in the pharmacy and grocery business really got rid of the mid-sized chains (Eckerd, Thrifty's, Phar-Mor, Brooks). It'll be interesting to see how the environment changes with Amazon in play.

*And the independent apocalypse never happened. Independents just learned to be smarter about competing or died.
 
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Patient's Dr sends their RX to AmazonRx. Dr can look at the AmazonPrime copay instantly through Amazon.com. Prime includes low cost generics and let's you order your favorite manufacturer and preferred quantity. Shipped within 2 days of course. If a medication is out of stock it will show the estimated availability time. Additional insurance is available for brand names.

So the doctor is going to spend 10 mins to exam you and then spend another 15 mins looking up your coverage, copayment and your favorite manufacturer?

Two day delivery is not something people want. They want to drive down the block and pick up their medications right away.

For Amazon to make it in this business, they need to be able to do something that is outside the box. Something that is simple and affordable. Amazon got into the low margin grocery business and you don't see supermarkets closing. So it is not just about delivery. It is also about freshness and cost. Certainly, the pharmacy business is much more complicated than the grocery business.


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So the doctor is going to spend 10 mins to exam you and then spend another 15 mins looking up your coverage, copayment and your favorite manufacturer?

Two day delivery is not something people want. They want to drive down the block and pick up their medications right away.

For Amazon to make it in this business, they need to be able to do something that is outside the box. Something that is simple and affordable. Amazon got into the low margin grocery business and you don't see supermarkets closing. So it is not just about delivery. It is also about freshness and cost. Certainly, the pharmacy business is much more complicated than the grocery business.


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They have 1 store Amazon Go as concept store in Seattle, it's employee only store, they haven't rolled it out yet.
 
No, they don't, what do you think Dakota Drug (practically the only wholesaler in the state) is? What they do have is a rule (which comes up every so often) that prevents ownership of a pharmacy without physical representation as the PIC unless under very specific circumstances. But what Amazon would do is build another subsidiary to get around the rule, and I know the North Dakota State Board won't have the resources to go after Amazon.
.

Dakota Drug is not "practically the only wholesaler in the state" - McKesson has a big presence in the state too. I'm not sure what a wholesaler has to do with the ownership laws.
 
This seems inevitable, amazon already doesn't care if it makes money or not. The question is how many verified scripts per hour will they require?
 
Two words: employee discount

I hope you know that Amazon's employee discount is only 10% of the first $1000 of your purchases per year (i.e., $100). They also pay the least among their tech peers, and have the worst match and benefits package. Don't get your hopes up.
 
Concerning employment, Amazon does not have a good reputation for how they treat their employes: Worse than Wal-Mart: Amazon’s sick brutality and secret history of ruthlessly intimidating workers I highly doubt they would treat any pharmacists they hired any better.

As for taking over retail....there is a reason why mail order has enjoyed a very limited success. 1) Baby boomers (the majority users of pharmacies) hate the impersonalness of mail-order. 2) people don't want to have to think ahead about ordering medicines, they want to show up at their local pharmacy get their maintenance med that they've been out of for the past 4 days NOW 3) when mail-order pharmacy makes a mistake, it's not a quick & easy fix like it would be at the local pharmacy.

My prediction, Amazon Pharmacy will take the majority of their customers away from existing mail-order pharmacies, and very few from retail pharmacies. Maybe this will change in 20 years when GenX becames the majority of pharmacy users....oh wait, that isn't going to happen in 20 years because the Baby Boomers will still be around. In fact, the Baby Boomers will probably outlive GenX, because GenX will age faster because they will never be able to retire because the Baby Boomers will raise the retirement age so they can keep living in the Medicare lifestyle they have become accustomed to. So until Baby Boomers are convinced that mail-order is the way to go, mail-order will not be getting a bigger slice of the pie.
 
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Yeah, in case anybody forgot, there were a few articles a couple years ago about how bad it was to work for Amazon. Supposedly working for Amazon is horrible. Of course there were the articles afterwards in which other employees expressed how great it was and how much they love their CEO.

https://www.nytimes.com/2015/08/16/...g-big-ideas-in-a-bruising-workplace.html?_r=0

Jeff Bezos' Amazon fights back against accusations of 'brutal' workplace conditions

How People Who Work For Amazon Really Feel

Amazon is the CVS of it's industry. Let's not confuse working for Amazon with working for Costco.
 
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Every major grocery and pharmacy chain has taken a hit to their stocks after this announcement. Might as well buy 'em at a discount.
 
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