Month / January 2018

by Frank Maduri

Amazon Targeting Expansion Into Healthcare

Amazon announced a partnership with Berkshire Hathaway and JP Morgan to provide better healthcare for the employees of the three respective American corporate giants. The details of the exact parameters of the newly formed joint venture are unclear. It appears that the partnership will not be to form a healthcare company to compete with major health insurers.

However, the announcement certainly shook up the industry: from Wall Street to Main Street, everyone was talking about this news on Tuesday. The prospect of these three companies getting involved in the evaluation of costs is a daunting set of circumstances for the healthcare industry.

In addition, Amazon is rumored to be targeting expansion into the pharmaceutical area. The online retail giant filed for pharmaceutical licenses in a handful of states back before the holidays, but it is unclear whether they were related to the medical devices which they already sell on their site.

The strategy and route for Amazon into this space is through this partnership with Berkshire Hathaway and JP Morgan. The stakes for certain retailers or interested parties in the pharmaceutical industry could be very significant. The other side of the situation is the protection of patient records should Amazon start peddling prescription drug delivery services.

The potential for misdirected prescription abuse is also at stake here should Amazon enter the prescription drug space. This is all transpiring amid the backdrop of a prescription painkiller abuse epidemic in America.

Those are just some of the ethical issues presented in this situation. The business implications are also significant with the “Big Pharma” companies falling somewhere in between the distributors and the retail drug chains. The sentiment within the pharmaceutical manufacturers is that the potential entry of Amazon into the industry would be a welcome turn of events because it would provide greater competition.

The translation there is that the pharma companies have been at odds with the PBMs (Pharmacy Benefit Managers) for years. The PBMs handle mail order prescriptions and they negotiate prices for the large insurance companies and for large corporations that have a bigger “say” in the benefits for their employees.

The insertion of Amazon into the equation is problematic for the PBMs such as Express Scripts, CVS Caremark, and United Health/Optum. They will have diminished leverage in negotiating pricing and other terms with the pharmaceutical companies because Amazon will essentially disrupt the way that game has been played. This is why the pharmaceutical companies have no problem with Amazon entering the space, the online retail behemoth is going to look to undercut the other players in the mix.

The potential entry of Amazon into prescription drugs will also hinder the prescription drug distributors, particularly the top three: McKesson, Amerisource Bergen, and Cardinal Health. Amazon is going to push back on them on price and that is going to squeeze their margins. The massive consumer base that Amazon will bring to the table and could command with greater potential for consumers to join Amazon Prime membership just for the prescription drug services will put these distributors in a tough position.

The entry of Amazon would shift the distribution paradigm as well. Their presence would shape the cost structures for that component of the industry. The benefits would definitely be reaped by the consumer because it will have a domino effect on the prescription drug pricing across the board.

The final area is the retail prescription drug channel, which if Amazon does indeed enter this part of the industry it could have a profound impact on the entire industry. The biggest players that would be at risk in that scenario are: CVS, Walgreens, and Rite Aid.

Those three companies have existed for decades by servicing customers through predominately brick and mortar operations where the customer or patient will pick up their prescription products. These companies have delivery services available in some markets as well.

However, Amazon would turn that part of the industry on its head, so to speak, and reinvent the way that patients would get their prescriptions. The concept of ordering a prescription online, or through a voice- controlled device such as the Amazon Echo, one would think would be a compelling option for consumers.

There is a definite argument for the convenience that Amazon would provide to someone who was feeling too ill to drive to the pharmacy to get a prescription. It is appealing to people with busy lives as well, who need maintenance meds for a given medical condition to eliminate having to run over to the pharmacy from their routine thereby saving that time.

The retail pharmacy chains mentioned earlier would certainly have to adapt in the advent of Amazon potentially entering that sector. The strategy to combat Amazon would be two-pronged, in my opinion, in order to create resistance to Amazon grabbing too much market share.

First, the retail pharmacy chains can tout that they can fill prescriptions in one hour or less. The order of a prescription through Amazon will take more time to fill, so if you are sick (and the fact remains that being sick is when most people see a doctor and need prescriptions filled) the traditional retail route is still the most effective method.

Next, is an adaptation of the retail pharmacy operation into a true omnichannel approach. This approach is key to the survival of essentially every traditional retailer with a brick and mortar presence moving forward. The CVS, Walgreens, and Rite Aid chains and others in a regional presence have to consider developing delivery in most every market they serve. They also have to develop some type of website portal that can handle prescription orders for delivery to the consumer. This would allow for a truly omnichannel approach.

The patient prescription history and personal data are already in their database so these chains can tout the security and trust they have established with the patient over a period of time. This could become their pathway to remaining relevant with Amazon actively competing in the channel.

The patient confidentiality issues which were raised earlier in this piece still have significance as Amazon weighs whether to enter the pharmaceutical space or not. The potential for prescriptions to fall into the wrong hands is an aspect of this situation that should be careful considered by the government with respect to Amazon.

Conversely, that argument can be made for the major retailers and PBMs that are currently active in the retail pharmacy channel currently. The way the systems function today certainly provides some openings for the potential for prescription drugs to be misused or used by someone other than the patient it was intended to help. The mail order supply could easily get into the possession of someone who has the propensity to abuse prescription pain medications, anti-depressants, or some other type of pharmaceutical product.

The “Big Pharma” companies seem at this point, from their public statements, to be largely unconcerned with Amazon entering the market. I can understand how some people might be confused by this position. However, when you consider how the industry functions, and through my professional experience in different roles within the pharmaceutical industry, I can attest that the “Big Pharma” guys only care about making money. Amazon will allow them to do that especially with the PBMs.

The PBMs must be concerned about retaining profitability should Amazon enter that area of the industry. The joint venture announced on Tuesday with Amazon, Berkshire Hathaway, and JP Morgan has the healthcare industry shaken up already.

In full disclosure, some reports have also speculated whether Amazon is announcing this partnership to “save face” because of reports that they make their employees who work there for a certain length of time and then leave the company pay back the amount that Amazon paid for the healthcare coverage for that particular employee.

This new partnership could integrate new technology into the sector with rumors that the three companies in the venture will have an employee web portal that will provide healthcare planning information to help reduce the cost of tests and other services for those on their payrolls. The other rumor is that they are going to launch a smartphone app that streamlines healthcare choices and explains the protocols for different procedures very simply.

It is clear though that Amazon wants to get into the healthcare and potentially the pharmaceutical space and that has put everyone from the major health insurers, to PBMs, to those involved in the pharmaceutical retail drugstore segments on notice that changes are coming whether they are ready for them or not.

by Frank Maduri

Follow Up: Toys R Us to Close 180 Stores

In a follow -up to a prior article on Toys R Us entering Chapter 11 bankruptcy protection back in the Fall of 2017, the company announced on Wednesday that they will be closing 180 stores by April.

The beleaguered toy retailer has been consistently losing market share and foot traffic due to stiff competition from Amazon, Wal-Mart, and Target. The Chapter 11 filing was due to a heavy debt load of $5 billion and the need to reorganize the company to emerge a more streamlined organization.

However, while most experts and industry analysts understood the Chapter 11 filing, and my prior article covered the necessity of the timing of the decision, consumer perception was that the chain was “going under”.

The chain had to file when they did for bankruptcy protection because they had to be able to pay the suppliers to get the shelves stocked for the Christmas and holiday season (where the chain makes 90% of their annual sales).

The plan backfired because they failed to market the promotional items properly during the holiday season, and the toy seller neglected to properly provide a concise and simple explanation of the Chapter 11 decision.

Therefore, in survey results from customers the top reason why the company struggled at the holidays was because the public perception was that the chain was going to close their doors, so any gifts for the holidays were perceived to be not returnable merchandise. This perception caused shoppers to avoid the purchase decision at Toys R Us and to purchase those gifts elsewhere.
The company made a statement Wednesday regarding the store closures and cited “operational missteps” during the holiday season as the reason behind the closings. The company now has to move fast to salvage the future of the entire chain.

The competition from Target, who has placed many of their store locations near current Toys R Us locations as well as expanded their toy product offerings, has definitely cut into the revenue capture for Toys R Us. This competition is heightened by aggressive marketing campaigns from Amazon and Wal-Mart that are convenient places for customers to get a wider range of products as well.

The main issue with Toys R Us, in the survey results from consumers, is that they are not easy to shop either in-store or on-line. The company has recognized that both of these areas are a major source of the downward spiral they find themselves within at this point.

The ability to succeed in retail today in an increasingly competitive marketplace is to be an easy place for the consumer to make a purchase. The products must be easy to find and priced to move, and the omnichannel approach: in-store, over the phone, store pickup for large items, and a robust on-line presence are all essential to survival.

Toys R Us is apparently struggling in all of these areas, and they have to hope that this decision today will be approved by the bankruptcy court. They have to hope that they can restore confidence in both the toy suppliers and the consumers. The company has to improve operationally and become aggressive in promoting in-store and on-line product offerings which create a sense of urgency for the customer.

The unfortunate reality of the announcement today is that most likely the chain will announce more store closings in the future. The strategy is to focus on their best performing stores or their best potential locations, which is the path that other retailers have taken at this point in their life cycle.

A personal note, here amidst all of this is my own memories of going to Toys R Us as a child, and getting so excited about a new toy or game that just was released. It was a place you could go and be happy because they sold toys and that nostalgia for a different time makes this article really bittersweet.

The resources I consulted mentioned a rift between the company and toy suppliers because Toys R Us was still giving out executive bonuses before they paid the suppliers, and they were behind on payments. The argument can be made for both sides of that situation: the company does not want to lose quality executives to competitors over a compensation gap, but you also have to pay your bills.

The consolidation of stores, especially the elimination of underperforming stores, is a logical first step. The unfortunate consequence is the lost jobs involved, which in their statement the company did not address the actual number of eliminated jobs. The company needs capital to run a more streamlined operation, so executive bonus pay probably should be suspended until they emerge from Chapter 11 protection.

In the end, as one who has covered the retail space and bankrupt companies in the past, this is a familiar pattern which usually results in the end of the chain in question. The biggest issue here with the potential demise of Toys R Us is that some industry experts maintain that the toy business cannot survive without the presence of Toys R Us. The validity of that analysis may be tested in the near future.

by Frank Maduri

Unsubsidized: The Uncertain Future of Monmouth Park

My memories of growing up and living on the New Jersey coast have always included summer days at Monmouth Park watching thoroughbred horse racing. The race track has been a gathering place for families and groups of friends to get together for a day outside in the sunny, seemingly endless weekends.

The news from this past week regarding the new Oceanport town council and their concern for the future of Monmouth Park is very troubling to long time Shore area residents like myself. New Jersey has no subsidy from the state for horse racing, and rising operational costs are a looming threat to the future of world class thoroughbred racing in the Garden State.

Monmouth Park opened almost 150 years ago and is an iconic place to visit and spend a day at the races. The park entered an agreement with Resorts Casino at one point to attempt to merge the operation of the track with on-site casino game gambling. This measure has been blocked and has faced a number of hurdles in New Jersey.

The local news reports that without a subsidy of some type either from gambling revenues from introduction of slot machines and games at the track or from sports betting, the prognosis is not good for the future of Monmouth Park.

The sports betting has been argued all the way up to the Supreme Court and is awaiting a final verdict. A decision by the court in the affirmative would permit gambling on all sporting events from all the major professional sports and major college sports games to be legal in New Jersey. This would benefit a facility such as Monmouth Park in a substantial manner.

In one estimate, if sports betting was legalized, it estimated Monmouth Park to have a total gambling revenue per season of $50 million, of which the facility would get a 50% share because they would have to split the betting revenues with another party, should the measure be approved.

That cut of revenue at $25 million would be a very beneficial subsidy to the operational costs of running the facility. The town of Oceanport has a great deal at stake because Monmouth Park accounts for 20% of their municipal tax base. In the event that the state does not provide a subsidy and the race track fails, that is a huge tax revenue shortfall.

It should be noted that the surrounding states in the region: Pennsylvania, New York, Delaware, and Maryland all have a subsidy from their respective state to help with the operation of horse racing.

The horse racing industry has changed, I remember back in my younger days, Monmouth Park had a horse racing card every day during the summer through Labor Day weekend. The “meet” schedule for the year then changed to three to four days a week as the approach shifted to having fewer racing cards but with bigger purses, or better- quality races.

Then, the industry shifted again, and over the past few years, the racing “meet” schedule for the season has racing cards two days a week from the opening weekend in May through July 4th weekend before it goes to three days of racing per week. Then, it adds Thursdays in August to the meet schedule.

The reduction in the number of days of operation for full racing cards was needed throughout the horse racing industry, but is an absolute necessity in New Jersey without a state provided subsidy.

New Jersey is home to a numerous horse farms and equestrian training centers, yet it could be without a horse racing operation. That would translate to lost jobs, lost revenue, and the end of many different traditions for families who spend time at the track together.

I find it all very sad on a personal level, Monmouth Park, as I mentioned earlier in this piece, is a place where I spent time with my family and with family members who visited in the summer from outside the area. It was where I spent time with my friends on a day off from a summer job in my high school and college years. It was where I went on a sunny Sunday when my wife and I were dating, to spend a day outside doing something fun.

It is sad to think that Monmouth Park may not be there for future generations, the future is uncertain, and the path forward is unclear. The new racing schedule was released recently with the 50th edition of the famed Haskell Invitational race which is broadcast nationally on NBC coming our way on July 30th this year.

It is my sincere hope that the state officials, the Supreme Court, and local officials can all work together with the partners involved to find a long term solution to Monmouth Park to keep the doors open for years to come.