January 2021 POV Amazon Is Entering the Pharmacy Marketplace: What it could mean 20 for you 20 On November 17, 2020, Amazon announced 2 new pharmacy offerings for customers to purchase medications: Amazon Pharmacy: a new store on Amazon that allows customers to purchase medications and manage insurance prescriptions. Learn more here Prime Rx: Amazon Prime members can save money at both the Amazon Pharmacy as well as at over 50,000 other participating pharmacies nationwide. Learn more here This has been in the making for a while… 1999 2018 2020 Buys 46% of Acquires Pill Pack Launches Drugstore.com Amazon Pharmacy Later sells its shares for For $753M in June 2018 New service is announced $5M in 2010 November 17, 2020 Let’s take a look at the Amazon Pharmacy process As with all Amazon services, the goal is to make it easy and convenient for the customer. If you have insurance, all you do is enter your name, birth date, and the last 4 digits of your Social Security number. After searching for a few seconds, Amazon pulls up your insurance information and prescription history. You then select your medication, purchase it, and track it. You can have your physician call in the prescription to Amazon, or Amazon will reach out to the doctor for you. Note: As of December 2020, Amazon does not allow manufacturer copay cards. Search Compare & Checkout Track The Amazon Prime savings card • The Amazon Prime prescription savings benefit is not insurance. It is included with Amazon Prime membership at no additional cost • The benefit provides savings on the price you pay for prescription medications if you are not using insurance. It can be used at over 50,000 participating retail pharmacies in the U.S. and Puerto Rico, including Amazon Pharmacy • This card can be used at brick-and-mortar and mail-order pharmacies • The savings benefit is administered by Inside Rx, a subsidiary of Evernorth (previously Express Scripts) • The card offers discounts of up to 80% on generic prescription medications and 40% on brand-name prescription medications • Benefit restrictions on select brand-name products exist for government-insured patients • The copay card is not a direct competitor to manufacturer copay cards. Customers cannot combine the Amazon savings benefit with their insurance Currently offers greatest benefit to cash-paying or HDHP patients on generic medications The Amazon Pharmacy promise We know that Amazon is all about service, and service does not end with functional benefits. Its promise is grounded in universal insights and what you’d expect from Amazon – including protection of your privacy. You can always expect: What’s in it for the HCP? Amazon knows that the HCP is a key stakeholder to drive change in the healthcare space. The For Prescribers page explains how simple it can be for HCPs. “Easy” and “fast” consistently used in messaging Messaging encourages HCP-driven process via e-prescribing And Amazon Gives Patients Options: Individual Bottles or Pill Packets What’s Not Included: Products Breast pumps REMS medications Compounded medications Schedule II-controlled medications Diabetic testing and administration Specialty medications supplies (e.g. test strips, glucose meters, Suspensions (e.g. liquid amoxicillin or and pen needles) fluconazole) Medical devices (e.g. braces, insulin Vaccines pumps, and nebulizers) Vitamins and over-the-counter Pet prescriptions (OTC) items https://pharmacy.amazon.com/help?ref_=ap_lp_main What’s Not Included: Service Dedicated assistance with post-prior authorization processes, such as medical exceptions and appeals Compatibility with drug manufacturer-provided copay cards and/or savings benefits The Market Reaction: When Amazon Pharmacy’s launch was announced, shares of major retail pharmacies and GoodRx plummeted 8.6% 9.6% 16.2% 22.5% The Motley Fool. Why CVS, Walgreens, Rite Aid, and Other Pharmacy Stocks Plunged Today CNBC. Shares of GoodRx plunge after Amazon announces push into pharmacy. What experts are saying about Amazon Pharmacy: “Amazon’s foray into the market will enhance the “The retailer is a known entity that many people trend of transparency and mail-delivery services. already use. It may be able to make price shopping It’s more about the convenience, affordability, and for prescriptions more pleasant, and it might be the infrastructure.” competitive on the pricing of generic drugs.” – Joseph Sanginiti, CEO of FamilyWize – Craig Garthwaite, Health Economist, Director of Healthcare, Northwestern University’s Kellogg School of Management “Amazon’s prescription business could be appealing to the uninsured or people who have plans that make them pay a high deductible first before their “For now, I think they are just going to be replacing coverage starts.” existing market share. But they may decide at – John Boylan, Senior Analyst, Edward Jones some point to be more disruptive once they have Research Department gotten settled into this new space.” – Stacie Dusetzina, Health Policy Professor, Vanderbilt University School of Medicine And this supports Amazon’s investment in whole health Pharmacy Nutrition Wellness Tracking Access The potential impact? Predicting adoption of novel services with the DOI model The Diffusion of Innovation (DOI) model describes how novel services and products get adopted in populations through: • The kinetics of the diffusion and through different segments (from early to late adopters) • The decision-making process to adopt • The factors that facilitate adoption Knowledge Persuasion Decision Implementation Confirmation Observability Trial-ability Compatibility Cost Relative Complexity Advantage Let’s look at the Kindle Analog Kindle demonstrates the importance of a quick initial diffusion through early adopters as well as a strong secondary diffusion afterwards Nov 2007: Amazon launches Kindle. Sold out in six hours 2007-2017: Barnes & Noble store-count drops. Amazon gradually starts selling more e-books than physical books Feb 2017: Amazon accounts for 80+% of e-book sales Source: Tech Crunch. A decade of Amazon Kindle Adoption factor Description Relative Advantage Shows the innovation’s superiority over • Shows the innovation’s superiority over whatever whatever it replaces and/or competes with it replaces and/or competes with Compatibility The innovation must be an appropriate fit with • Reviewers praised Kindle for holding thousands the intended audience of books while fitting into a purse Complexity The easier it is to implement the innovation, the • Limited functionality to simplify operations. (Simplicity) more likely it will get adopted Designed for book worms alone Trial-ability Can the innovation be tried before the decision • Test at Amazon’s retail shops & Best Buy to fully commit? • Trial offer for Amazon Prime members Observability Will the innovation produce tangible results? • Announcement from Amazon blasted how the Kindle was its top-selling product Cost Lower monetary and nonmonetary cost makes • Far cheaper than tablets and phones, most adoption more likely books are less expensive than paperback https://inmediatum.com/en/blog/trends/5-ways-to-improve-adoption-rate/ https://sites.google.com/site/internatinnovators/diffusion-1 …and Amazon Pharmacy also starts from a strong position Adoption factor Description Relative Advantage Shows the innovation’s superiority over • Allows price comparison from the safety of your whatever it replaces and/or competes with home • One-stop shop convenience for existing users • Prescription delivery is a necessity for some due to the pandemic Compatibility The innovation must be an appropriate fit with • For Amazon Prime members: Fits into the intended audience routine easily (# of U.S. households with Prime membership at a record 70M) • For others: May be difficult to rewire existing prescription logistics routine • As of launch, not yet compatible with drug manufacturer copay cards Complexity The easier it is to implement the innovation, the • Simple interface; familiar user experience; skip (Simplicity) more likely it will get adopted the lines at the pharmacy Trial-ability Can the innovation be tried before the decision • Amazon Prime Free Trial lasts for 30 days to fully commit? • Savings card works for Amazon and 50,000 pharmacies Observability Will the innovation produce tangible results? • Rural areas may be one of the main beneficiaries • Prime Air will soon allow delivery of goods via drone Cost Lower monetary and nonmonetary cost makes • Especially beneficial to patients who have adoption more likely insurance with high deductibles and patients who are uninsured How to determine the impact on your brand The easier it is to fill your script, the easier for your patient. To see if Amazon can have an impact on your brand, ask yourself: • Is your brand available at the Amazon pharmacy? • What age demo is your patient/caregiver? • Highest Amazon Prime usage exists in adults ages 18-35, which may indicate a faster adoption curve among the millennial audience E-Marketer. Amazon Prime Day 2020 Kicks Off an Early Holiday Season • That said, penetration among 35-54 and 55+ age groups is estimated to be higher today than in early 2020 • Do copay cards greatly impact patient choice? As Amazon Pharmacy does not take copay cards, this can negatively impact a brand if a patient wants to use Amazon services • Do you have a lot of cash-paying customers or ones on high-deductible plans who can benefit from Amazon savings? Other considerations Amazon Pharmacy may… • Create an illusion of fulfillment help without