一位藥劑師的創業之路

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?

當現年35歲的邁克爾?雷亞(Michael Rea)開始擔任藥劑師時，他很快就發現，所有客戶都在問同一個問題：爲什麼他們的藥變得這麼貴？

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歲的女性患有糖尿病和高血壓，需要服用8種藥物，她的困境促使他去尋找答案。

“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.”

“她問我應該把哪兩種藥省掉，”雷亞說，“她正在做一件實事求是的、關乎生死的決定，她想知道哪些藥物是最不重要的。”2008年，雷亞在堪薩斯城的美國連鎖藥店沃爾格林(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.

出於良心，雷亞無法建議患者停止服用一種可能保她活命的藥物。所以他花了六個半小時算出如何讓這位客戶省錢，最後建議客戶服用藥效相同、但更便宜的替代性藥物。

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

他說，他的建議每月幫這位女士節省250美元。

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

幫助這位患者，讓雷亞從中獲得了極大樂趣，於是他也爲其他客戶提供類似的服務。

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

一個月後，他成立了自己的公司Rx Savings Solutions並設立網站，幫助患者減少他們的藥品花銷。

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.

除了推薦更便宜的替代藥品（包括仿製藥），雷亞發現客戶可以通過簡單的技巧減少支出：有時兩枚5mg藥片的價格之和低於一枚10mg藥片；片劑可能比膠囊便宜；有些藥房比另一些藥房便宜。

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.

通過專有算法，雷亞爲每名患者花幾個小時完成的工作，如今只花幾秒就完成了。美國僱主和保險公司向逾100萬人提供了該公司的桌面和手機應用。

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.

在美國，患者往往自掏腰包支付一部分藥物費用，他們使用該應用尋找更便宜的替代品，達到了省錢目的。他們的僱主和保險公司也通過降低總體醫療費用來省錢。

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年裏，雷亞一面繼續擔任沃爾格林的藥劑師，一面經營這塊業務，但他對藥劑師工作的興趣在減弱。

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

“讓事情變困難的是，這項業務非常依賴交易——完全與你可以開出多少處方有關，”他說。

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.

雷亞很快意識到，若想讓他的創業企業產生重大影響，就必須籤一家大企業或一個醫療保險計劃，好將服務提供給後者的所有成員。

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.

在午餐和休息時間，雷亞會回到他那輛停在屋頂停車場的車上，並與潛在客戶舉行電話會議。終於，他在2012年與內布拉斯加州保險公司Mutual of Omaha簽訂了合同。合同給了他辭掉藥劑師工作的信心。

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，與Mutual of Omaha之間的交易失敗了，因爲這家保險公司擴展進入醫療保險的努力未能成功。這表明，一位創業者計劃的成敗可能多麼依賴於一家大公司的行動。

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.

雷亞有16個月時間完全沒有收入，在此期間，他和家人不得不依靠妻子的律師工資生活。

“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.”

“我跨出這一步時，我們處於艱難時刻，”他回憶道，“我有一個小孩，我們有幾十萬美元的學生貸款。”

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?’

雷亞的朋友們——其中很多是藥劑師——鼓勵他回到原來的職業。“他們說，‘你瘋了，爲什麼要離開這個穩定、薪酬不錯的工作？’”

“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.

“我確實爲此考慮了一段時間，在某一刻，我差一點兒就回去了，”他說。但他擔心，他可能不得不簽署一份保密協議，該協議可能使他更難發展他的公司。

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，雷亞從堪薩斯城的富有投資者手中籌集了120萬美元，隨後又從另一羣富人手中籌資370萬美元。該公司的投資者包括丹?亨利(Dan Henry)，他是NetSpend和Euronet等金融科技企業的資深人士。

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.

雷亞是被他的導師德魯?柯曼達(Drew Komenda)介紹給早期投資者，柯曼達最終辭掉了在醫療集團強生(Johnson＆Johnson)銷售部的工作，加入Rx Savings董事會，成爲公司的首席營收官。

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.

柯曼達在離開強生後一直在尋找新的挑戰，而他的鄰居認識雷亞。這位鄰居跟柯曼達說，雷亞有個創業的好主意，但需要人幫他打理銷售業務。

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在堪薩斯城的總部僱用了35名員工，而雷亞表示他“一直處於籌資模式”，以便公司能更快地擴張。

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的客戶包括大型移動網絡運營商Sprint和億萬富翁沃倫?巴菲特(Warren Buffett)控股的美國報業集團伯克希爾哈撒韋傳媒(Berkshire Hathaway Media)，以及一些公共部門的僱主。

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.

其中一家客戶——堪薩斯州政府——表示，由於雷亞的公司通過應用向其僱員提出的藥品變更建議，去年州政府節省了750萬美元。

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嘗試對一家公司的醫療保險索賠進行回顧性分析（即用算法計算出，如果客戶一直使用其服務，本來可以節省多少錢），來贏得業務。

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

如果一家公司與Rx Savings簽約，他們會在每月爲後者的服務所覆蓋的每名成員支付一筆名義固定費用。

“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.

雷亞表示：“我們在進行機會評估時發現，可以節省22%至25%的購藥資金。”

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.

雷亞表示，目前美國每年的處方藥費用大約是4500億美元，如果按這一節約比例計算，那麼其中逾1000億美元可以節約下來。

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.

其他人對此不太確定。紐約的紀念斯隆凱特琳癌症中心(Memorial Sloan Kettering Cancer Center)的藥物定價專家彼得?巴赫(Peter Bach)博士說，如果製藥企業不做出“非常大的價格讓步”，這麼大幅度的節約就難以實現。“我不知道你會在哪裏省出1000億美元，”他說。

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”.

美國總統唐納德?特朗普(Donald Trump)曾承諾廢除並取代前總統巴拉克?奧巴馬(Barack Obama)的《平價醫療法》(Affordable Care Act)。不久前，特朗普承認，他沒想到醫療問題可能會“如此複雜”。

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

“唯一可以化解複雜性的方法，是把信息披露給支付賬單的人，”雷亞說。

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.

總部位於舊金山的Castlight Health公司也承諾降低人們的醫療花銷，不過其發力點是手術等環節，而不是藥物價格。

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業務的增長恰逢美國醫療行業的重大轉變。藥價飆升，僱主和保險公司要求個人承擔更高比例的費用。

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%的美國人蔘加了“高自付額”的醫療保險計劃，這意味着，他們必須自己多支付數千美元看病，然後纔會由保險公司替他們付賬。

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

雷亞指出，有些消費者的免賠額高達5000美元——這是“絕大多數人永遠不會達到的金額”。

“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.

“他們可以做的就是，使用我們這樣的工具，幫他們管理這個問題，幫他們花不到5000美元，”他說。

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

但雷亞表示，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.”

“這是我們公司的第一大問題：我們做了這項工作，我們的客戶們對結果給了很高評價，”他說，“問題是國內的大部分人不知道我們的存在。”

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.

現在，雷亞的大部分時間都在做這件事——在向客戶推介公司的路上、在醫療大會上——他在努力提高公司的知名度。公司堪薩斯城總部的三位高管負責日常的運營、財務和技術。

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”.

雷亞表示，現在Rx Savings沒有直接競爭對手，他也不打算將公司上市或賣掉。他補充道，眼下還有“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優勢，”他說，“我們用10分鐘就可以在董事會議室做出決定，以滿足客戶的需求。”

“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.”

他說：“真正讓公司運轉起來的，是我們從用戶那裏獲得的反饋，”他說 ，“我認爲，如果你能持續關注這一點，那麼就不用擔心會辜負投資者的期望。”