德康醫療 (DXCM) 2016 Q4 法說會逐字稿

Welcome to the DexCom fourth-quarter and full-year 2016 earnings release conference call. My name is Ashley and I will be your operator for today's call. (Operator Instructions) Please note that this conference is being recorded.

歡迎參加 DexCom 2016 年第四季與全年財報發布電話會議。我是 Ashley，將擔任今天會議的接線員。(接線員指示) 請注意，本次會議將被錄音。

I will now turn the call over to Kevin Sayer, President and CEO. Mr. Sayer, you may begin.

現在我將把電話交給總裁兼執行長 Kevin Sayer。Sayer 先生，您可以開始了。

Thank you very much. And good afternoon, everyone. We appreciate you listening to our fourth-quarter 2016 earnings call.

非常感謝。各位下午好。感謝各位收聽我們 2016 年第四季財報電話會議。

We will start off with our Safe Harbor statement from Steve Pacelli.

我們將先由 Steve Pacelli 宣讀我們的安全港聲明。

Thanks, Kevin. Some of the statements that we will make in today's call may constitute forward-looking statements. These statements reflect management's intentions, beliefs, and expectations about future events, strategies, competition, products, operating plans, and performance.

謝謝你，Kevin。我們在今天電話會議中所做的部分陳述可能構成前瞻性陳述。這些陳述反映管理層對未來事件、策略、競爭、產品、營運計畫與績效的意圖、信念與預期。

All forward-looking statements included in this presentation are made as of the date hereof, based on information currently available to DexCom, and are subject to various risks and uncertainties. Actual results could differ materially from those anticipated in the forward-looking statement.

本簡報中所包含的所有前瞻性陳述均以本簡報日期為準，係基於 DexCom 目前可得之資訊，並受各種風險與不確定性影響。實際結果可能與前瞻性陳述中所預期者有重大差異。

The factors that could cause actual results to differ materially from those expressed or implied by any of these forward-looking statements are detailed in DexCom's annual report on Form 10-K, quarterly reports on Form 10-Q, and other filings with the Securities and Exchange Commission. Except as required by law, we assume no obligation to update any such forward-looking statements after the date of this presentation or to conform these forward-looking statements to actual results.

可能導致實際結果與任何此等前瞻性陳述所明示或暗示者有重大差異的因素，已詳載於 DexCom 的 Form 10-K 年度報告、Form 10-Q 季度報告，以及向美國證券交易委員會提交的其他文件中。除法律要求外，我們不承擔在本簡報日期後更新任何此等前瞻性陳述，或使該等前瞻性陳述與實際結果一致之義務。

Additionally, during the call, we will discuss certain financial measures that have not been prepared in accordance with GAAP with respect to our cash-based operating results. The presentation of this additional information should not be considered in isolation or as a substitute for results or superior to results prepared in accordance with GAAP.

此外，在本次電話會議中，我們將就以現金為基礎的營運結果討論若干未依 GAAP 編製的財務衡量指標。此等補充資訊之呈現不應被單獨看待，亦不應作為依 GAAP 編製之結果的替代，或被視為優於依 GAAP 編製之結果。

Kevin?

Kevin？

Thank you, Steve. Joining me today are Steve Pacelli, our Executive Vice President of Strategy and Corporate Development; Jess Roper, our Chief Financial Officer; and Kevin Sun, our Vice President of Finance.

謝謝你，Steve。今天與我一同出席的有：策略與企業發展執行副總裁 Steve Pacelli；財務長 Jess Roper；以及財務副總裁 Kevin Sun。

Before I begin, I would like to take this opportunity to congratulate Jess on his pending retirement. We wish Jess the best and thank him for his many important contributions over the past several years.

在我開始之前，我想藉此機會恭喜 Jess 即將退休。我們祝福 Jess 一切順利，並感謝他在過去數年所做的許多重要貢獻。

Jess has helped us scale through a period of tremendous growth and has assembled a very capable team, led by our VP of Finance, Kevin Sun, who will serve as our Interim CFO until we complete research for a new one.

Jess 協助我們在高速成長期間擴大規模，並建立了一支非常能幹的團隊，由我們的財務副總裁 Kevin Sun 領導；在我們完成新任財務長的遴選之前，Kevin 將擔任代理財務長。

Now let me highlight a few exciting recent developments for DexCom before I turn the call over to Steve to review our fourth-quarter 2016 financial results. 2016 was a very big year for us. In December, five months after a positive advisory panel meeting, we achieved a landmark milestone in obtaining the first-ever non-adjunctive or insulin-dosing indication from the Food and Drug Administration.

在我把電話交給 Steve 回顧我們 2016 年第四季財務結果之前，先讓我重點說明 DexCom 近期幾項令人振奮的進展。2016 年對我們而言是非常重要的一年。在 12 月，於諮詢委員會會議獲得正面結果的五個月後，我們達成一項里程碑：取得美國食品藥物管理局（FDA）史上首次核准的「非輔助（non-adjunctive）」或「胰島素劑量決策」適應症。

As a result of this approval, a new classification of therapeutic CGM has been established. This was a monumental achievement and I am very proud of the DexCom team, whose hard work over a number of years helped to make this a reality for our patients.

由於此項核准，已建立一個新的「治療型 CGM」分類。這是一項重大成就，我為 DexCom 團隊感到非常自豪；他們多年來的努力讓這一切得以成真，造福我們的病患。

DexCom G5 Mobile is the only glucose measurement device that is FDA approved for therapeutic decision-making. And in early January, as a direct result of our label expansion, Medicare issued a positive ruling providing us the opportunity to bring this life-saving technology to our senior population here in the United States.

DexCom G5 Mobile 是唯一獲 FDA 核准可用於治療決策的血糖測量裝置。而在 1 月初，作為我們標示擴增的直接結果，Medicare 做出正面裁定，讓我們有機會將這項救命技術帶給美國的高齡族群。

Together with the advances we are making to our technology platform, we see a clear path to making the vision we had when the Company first started this journey a reality, eliminating finger sticks altogether. As you can probably tell, we have never been more excited about the work we are doing here at DexCom for people with diabetes.

結合我們在技術平台上的進展，我們清楚看到一條可行路徑，能將公司在這段旅程一開始所描繪的願景化為現實：徹底消除指尖採血。各位大概也看得出來，我們從未像現在這樣，對 DexCom 為糖尿病患者所做的工作感到如此振奮。

With that, I will now turn the call over to Steve for a review of our financials, after which I will expand on these accomplishments and provide a business update.

接下來，我將把電話交給 Steve 回顧我們的財務狀況；之後我會進一步說明這些成果並提供業務更新。

Thanks, Kevin. DexCom reported revenue of $171 million for the fourth quarter of 2016 compared to $131 million for the same quarter in 2015, a $40 million or 31% increase. This is slightly ahead of the $168 million revenue estimate we provided in early January during our preannouncement. Sequentially, revenue for Q4 was up approximately 15% from the prior quarter.

謝謝你，Kevin。DexCom 2016 年第四季營收為 1.71 億美元，較 2015 年同期的 1.31 億美元增加 4,000 萬美元，增幅 31%。這略高於我們在 1 月初預先公告時提供的 1.68 億美元營收預估。以季比季來看，第四季營收較前一季約成長 15%。

Our fourth-quarter gross profit was $117 million, generating a gross margin of 68% compared to a gross profit of $91 million and a gross margin of 70% for the same quarter in the prior year. On a year-over-year basis, our hardware gross margin was negatively impacted by sales of our G5 Mobile transmitter, which has a shorter useful life and lower ASP.

我們第四季毛利為 1.17 億美元，毛利率 68%；相較之下，去年同期毛利為 9,100 萬美元、毛利率 70%。以年比年來看，我們的硬體毛利率受到 G5 Mobile 發射器銷售的負面影響，因其使用壽命較短且平均售價（ASP）較低。

In addition, although we are seeing some improvement in our warranty expense rates, we are still experiencing warranty expenses at higher-than-historical levels. This includes the impact of our receiver replacement efforts in certain European markets.

此外，雖然我們看到保固費用率有所改善，但目前保固費用仍高於歷史水準。其中包括我們在部分歐洲市場進行接收器更換作業所帶來的影響。

Note that we reserved for our current estimated exposure for this issue throughout 2016 and do not anticipate a material impact on our financial statements in the future. Going forward, we anticipate continued decreases in our warranty expense rates throughout 2017.

請注意，我們已在 2016 年期間就此議題的目前估計曝險全數提列準備，且預期未來不會對我們的財務報表造成重大影響。展望未來，我們預期 2017 年全年保固費用率將持續下降。

Some final thoughts on our revenues and our gross profit. Our mix between durable and consumable products was within our normal historical range in Q4, at approximately 30% durable and 70% consumable. The ASP for our hardware has remained stable and sensor pricing remains within an ASP range of $70 to $75 per sensor.

關於我們的營收與毛利，最後補充幾點。第四季耐久財與耗材產品的組合落在我們過往正常區間內，約為 30% 耐久財、70% 耗材。我們硬體的平均售價維持穩定，而感測器定價仍落在每個感測器 70 至 75 美元的 ASP 區間。

Finally, our international business showed continued year-over-year growth, generating $21 million in revenue during the quarter, up 28% from last year and 15% sequentially. For the year, OUS revenues grew 38% and represented 13% of our overall revenue.

最後，我們的國際業務持續呈現年比年成長，本季創造 2,100 萬美元營收，較去年成長 28%，較前一季成長 15%。就全年而言，美國以外（OUS）營收成長 38%，占我們總營收的 13%。

Research and development expense totaled $44 million for Q4 of 2016 compared to $29 million in Q4 of 2015 and flat sequentially. As we have said on prior calls, we continue to make investments in a number of important initiatives. These include the G6 pivotal study and multiple submissions with the FDA, including efforts associated with our recently approved non-adjunctive claim.

2016 年第四季研發費用合計 4,400 萬美元，較 2015 年第四季的 2,900 萬美元增加，且與前一季持平。如同我們在先前電話會議中所說，我們持續在多項重要計畫上進行投資。其中包括 G6 關鍵性研究，以及向 FDA 提交的多項申請，包含與我們近期獲核准之非輔助（non-adjunctive）主張相關的工作。

We continue to make progress on our advanced product pipeline. And we incurred expenses associated with our Verily partnership, our next-generation sensor technology, and the buildout of our data platform.

我們在先進產品研發管線方面持續取得進展。同時，我們也產生了與 Verily 合作夥伴關係、下一代感測器技術，以及資料平台建置相關的費用。

Selling, general, and administrative expense totaled $79 million in Q4 of 2016 compared to $61 million during the same quarter in 2015, with the increase due primarily to year-over-year increases in headcount in our customer support organizations as well as a ramp in our patient-focused marketing expenses, higher IT costs, and our OUS expansion.

2016 年第四季銷售、一般及行政費用合計 7,900 萬美元，較 2015 年同期的 6,100 萬美元增加；增加主因為客服支援組織的人力編制年比年提升，以及以病患為中心的行銷費用增加、IT 成本提高，以及我們在美國以外（OUS）的擴張。

During Q4, we also increased our US field-based sales force to approximately 130 reps to support our growth in 2017 and beyond. And remind investors that we did not add any sales reps last year.

在第四季期間，我們也將美國以外勤為主的銷售團隊擴編至約 130 名業務代表，以支援我們在 2017 年及往後的成長。並提醒投資人，我們去年並未新增任何業務代表。

Our GAAP net loss was $7 million in the fourth quarter of 2016, which included $34 million in non-cash expenses consisting primarily of non-cash share-based compensation expense across all functional areas of our business. For the year, our net loss was wider than our original expectations.

2016 年第四季，我們的 GAAP 淨損為 700 萬美元，其中包含 3,400 萬美元的非現金費用，主要為涵蓋公司各職能領域的非現金股份基礎給付薪酬費用。就全年而言，我們的淨損幅度較原先預期更大。

As we stated on prior calls, although we budgeted a significant incremental investment in a number of new programs at the beginning of the year, over the course of the year, we made the decision to spend beyond these levels in order to support the growth opportunities we see in front of us. These include the expansion of our customer ops and tech support infrastructure to support anticipated growth; increased direct-to-consumer marketing, which has demonstrated very positive results so far and will continue to grow in 2017; and continued investment in IT initiatives to support our anticipated growth.

如同我們在先前電話會議中所述，儘管年初我們為多項新計畫編列了可觀的增量投資預算，但在年度進行過程中，我們決定將支出提高至超出這些水準，以支持我們所看到的成長機會。這些包括：擴充客戶營運與技術支援基礎設施以支援預期成長；增加直接面向消費者的行銷投入，迄今已展現非常正面的成果，並將在 2017 年持續成長；以及持續投資 IT 計畫以支援我們的預期成長。

Our Q4 operating expenses also include an increased spend on the four strategic investments that we outlined at the beginning of the year: our Verily relationship; building out our data analytics capabilities; international expansion; and our new manufacturing facility in Arizona.

我們第四季的營運費用亦包含對年初所概述四項策略性投資的支出增加：我們與 Verily 的合作關係；建置我們的資料分析能力；國際擴張；以及我們位於亞利桑那州的新製造設施。

Absent non-cash charges, non-GAAP cash-based net income was $27 million for Q4. Our GAAP loss per share for the quarter was $0.09. We ended the fourth quarter with $124 million in cash and marketable securities.

若排除非現金費用，第四季非 GAAP、以現金為基礎的淨利為 2,700 萬美元。本季 GAAP 每股虧損為 0.09 美元。第四季末，我們持有 1.24 億美元的現金及有價證券。

With respect to 2017 guidance, we provided a detailed outlook early in the year, including anticipated revenues of $710 million to $740 million, reflecting growth of approximately 25% to 30%. As in prior years, we anticipate the first quarter to be sequentially down due to typical seasonality associated with the annual reset of deductibles.

關於 2017 年財測指引，我們已在年初提供詳細展望，包括預期營收為 7.10 億至 7.40 億美元，反映約 25% 至 30% 的成長。如同以往年度，我們預期第一季將因與年度自付額重設相關的典型季節性因素而呈現季減。

We remind investors that we have historically seen 18% to 20% of our annual revenues in the first quarter, building throughout the year. We also remind investors that we grew 60% year over year in Q1 last year as we rolled out the G5 Mobile, making for a tougher year-over-year comparison.

我們提醒投資人，歷史上第一季通常約占我們全年營收的 18% 至 20%，並在全年逐步攀升。我們也提醒投資人，去年第一季因推出 G5 Mobile 而年增 60%，使得今年的年對年比較更具挑戰。

And as a final reminder, although revenues decline sequentially from Q4 to Q1, operating expenses will continue to increase. We expect a 25% to 25% sequential increase from Q4 to Q1, due in part to approximately $10 million in payroll tax expenses related to annual share vesting as well as one-time charges associated with retirement, severance, and restructuring. For the full year, guidance for OpEx remains a year-over-year increase of 20% to 25% versus 2016.

最後再提醒一次，雖然營收會從第四季到第一季呈現季減，但營運費用仍將持續增加。我們預期從第四季到第一季的營運費用將季增 25% 至 25%，部分原因是約 1,000 萬美元與年度股份歸屬相關的薪資稅費用，以及與退休、資遣與重整相關的一次性費用。就全年而言，營運費用（OpEx）指引仍為相較 2016 年年增 20% 至 25%。

With that, I'll turn the call back to Kevin for a business update.

接下來，我把電話會議交回給 Kevin，請他更新業務進展。

Thank you, Steve. As I said in my introductory remarks, we are very proud of the milestones we achieved over the past few months, particularly with our non-adjunctive client and Medicare's rapid response to cover CGM as a result.

謝謝你，Steve。如我在開場致詞中所說，我們對過去幾個月達成的里程碑感到非常自豪，特別是我們取得非輔助（non-adjunctive）適應症主張，以及 Medicare 因此迅速回應並將 CGM 納入給付。

The dosing claim represents a paradigm shift in diabetes management. These events are the culmination of a long and thoughtful process, and we appreciate the collaborative efforts of both the FDA and CMS as well as our patient advocates to bring this technology to a population that desperately needs it.

劑量（dosing）主張代表糖尿病管理典範的轉變。這些事件是長期且審慎流程的成果，我們感謝 FDA 與 CMS 的協作努力，以及病友倡議者的支持，讓這項技術得以提供給迫切需要的族群。

We estimate Medicare-age patients represent approximately 20% of the overall Type 1 market, or as many as 300,000 patients in the US. Intensive-insulin-using Type 2 Medicare patients could be an even larger addressable patient population over time.

我們估計 Medicare 年齡層患者約占整體第一型市場的 20%，在美國最多可達 30 萬名患者。隨著時間推進，使用強化胰島素治療的第二型 Medicare 患者，可能會成為更大的可服務患者族群。

Looking ahead, we are engaging with the MACs to establish the scope of coverage and facilitate reimbursement for our patients on a broader basis later this year. We believe these achievements were fundamentally driven by the strong performance of our CGM platform, both in clinical trials and in the real world.

展望未來，我們正與 MACs 合作，以建立給付範圍並促進今年稍晚能更廣泛地為患者辦理報銷。我們相信，這些成就根本上是由我們 CGM 平台在臨床試驗與真實世界中的強勁表現所驅動。

Notably, this performance is driving clinical outcomes. In January, data from both the first phase of our DIaMonD study and the GOLD trial were published in JAMA. Each trial demonstrated that CGM can significantly improve A1C in MDI patients. We are already seeing the benefits of this message in our business today, where the majority of our new patient additions are MDI patients.

值得注意的是，這樣的表現正在推動臨床結果改善。1 月時，我們 DIaMonD 研究第一階段與 GOLD 試驗的數據皆已發表於《JAMA》。兩項試驗均顯示，CGM 能在 MDI 患者中顯著改善 A1C。我們已在當前業務中看到此訊息帶來的效益，目前新增患者中多數為 MDI 患者。

The publication of DIaMonD and GOLD, both prospective, randomized, controlled trials in a highly respected peer-reviewed journal, will accelerate our awareness campaigns with physicians, patients, and payers.

DIaMonD 與 GOLD 的發表——兩者皆為前瞻性、隨機、對照試驗，且刊登於備受尊敬的同儕審查期刊——將加速我們對醫師、患者與支付方的認知推廣活動。

In addition, we saw an abundance of DexCom CGM data at the Advanced Technologies and Treatments for Diabetes, or ATTD, conference in Paris earlier this month. Additional data from DIaMonD was presented and concluded that Type 2 patients on MDI also experienced a statistically significant reduction in A1C. And, although Type 1 patients who switched from MDI to pump therapy did see a slight improvement in time and range, overall the data showed no incremental benefit in A1C reduction and showed increased hypoglycemic time in the pump cohort.

此外，本月稍早在巴黎舉行的 Advanced Technologies and Treatments for Diabetes（ATTD）大會上，我們也看到了大量 DexCom CGM 的相關數據。會中發表了 DIaMonD 的更多數據，並得出結論：採用 MDI 的第二型患者同樣出現具統計顯著性的 A1C 降幅。另外，雖然從 MDI 轉換為幫浦治療的第一型患者在「達標時間（time in range）」方面確實略有改善，但整體數據顯示在 A1C 降幅上並無額外增益，且在幫浦組別中低血糖時間增加。

Clearly, CGM can provide an overwhelming benefit regardless of a patient's preference for insulin delivery. And as a side benefit, we demonstrated that patient adherence to DexCom CGM is very strong, even after a year of wear. We hope to see additional DIaMonD data published in the near future.

顯然，無論患者偏好何種胰島素輸注方式，CGM 都能帶來極大的效益。此外，我們也證明患者對 DexCom CGM 的依從性非常強，即使配戴一年後仍然如此。我們希望在不久的將來能看到更多 DIaMonD 數據發表。

Overall, these data continue to build support for our CGM First message. Let us be very, very clear. Based upon the data we currently see, the most significant benefit to the patient in the intensive management of their diabetes comes from CGM.

整體而言，這些數據持續強化我們「CGM First」的主張。讓我們非常、非常清楚地說明。根據我們目前所見的數據，在糖尿病的強化管理中，對患者最顯著的效益來自 CGM。

Also at ATTD, there were continued discussions surrounding the establishment of industry standards for CGM performance. We support these efforts 100%. However, we believe any performance thresholds must properly mitigate the risks to people with diabetes who rely on these technologies for their health and safety, particularly if they are dosing insulin.

在 ATTD 上，也持續討論建立 CGM 表現的產業標準。我們百分之百支持這些努力。然而，我們認為任何效能門檻都必須妥善降低依賴這些技術以維護健康與安全的糖尿病患者所面臨的風險，特別是在他們用以計算胰島素劑量時。

We were perplexed during a session at ATTD, where several of our purported competitors together proposed raising the minimum threshold for performance from the traditionally accepted threshold of 20/20. For example, a 90% 40/40 threshold was proposed.

在 ATTD 的一場議程中，我們感到困惑的是，數家自稱為我們競爭對手的公司共同提議，將最低效能門檻從傳統上被接受的 20/20 提高。例如，有人提出 90% 40/40 的門檻。

This would mean that only 90% of the glucose values from a system would fall within 40%, or 40 milligrams per deciliter, of a reference value. 90% within 40/40 is certainly well below what we believe and historical data demonstrate a reliable CGM must provide. And the fact that others in the industry would promote such a standard concerns us.

這意味著某系統的葡萄糖數值中，只有 90% 會落在參考值的 40% 以內，或在 40 毫克/分升以內。我們認為 90% 落在 40/40 之內，明顯低於可靠 CGM 所必須提供的水準，而歷史數據也證明了這一點。而產業中其他公司竟會推動這樣的標準，令我們感到憂心。

Just as a point of reference, our G5 Mobile is achieving 20/20 performance of approximately 93% and our G6 pre-pivotal data has our sensor achieving 20/20 performance over 96% of the time. With our non-adjunctive claim for G5 Mobile and our future public platform that I will discuss momentarily, we are confident DexCom has set an appropriate standard for accuracy, manufacturability, and other performance metrics.

作為參考，我們的 G5 Mobile 目前達到約 93% 的 20/20 表現，而我們 G6 的關鍵性試驗前（pre-pivotal）數據顯示，我們的感測器在超過 96% 的時間達到 20/20 表現。憑藉 G5 Mobile 的非輔助（non-adjunctive）主張，以及我稍後將談到的未來公開平台，我們有信心 DexCom 已為準確度、可製造性及其他效能指標訂立了適當的標準。

We will continue to work to bring together the FDA, industry, and clinical societies to drive standards and provide transparency across the industry while maintaining an appropriate level of patient safety. Leaving ATTD, it was clear to us the DexCom CGM has and will continue to raise the bar on CGM performance.

我們將持續努力促成 FDA、產業界與臨床學會的合作，以推動標準制定並提升全產業的透明度，同時維持適當水準的病患安全。離開 ATTD 時，我們清楚感受到 DexCom 的 CGM 已經並將持續提高 CGM 效能的標竿。

As many of you have seen, we presented data from our G6 pre-pivotal, both with our intended initial one-calibration-per-day label as well as data using the G6 sensor with no calibrations. The initial accuracy data from these studies is very encouraging, and we are increasingly confident that we can ultimately deliver a no-calibration sensor while maintaining market-leading CGM performance.

如各位所見，我們發表了 G6 關鍵性試驗前（pre-pivotal）的數據，包含我們預計初期標示為「每日一次校正」的數據，以及使用 G6 感測器「不需校正」的數據。這些研究的初步準確度數據非常令人鼓舞，我們也愈來愈有信心，最終能在維持市場領先的 CGM 效能下，推出不需校正的感測器。

It has been a very exciting few months, to say the least. Beyond these strategic developments, we generated significant commercial growth last year. We finished 2016 with approximately 200,000 patients worldwide. To put things in perspective, our fourth-quarter revenue exceeded what we generated in sales for all of 2013.

可以說，過去幾個月非常令人振奮。除了這些策略性進展之外，我們去年也帶動了顯著的商業成長。我們在 2016 年底全球約有 200,000 名病患。為了讓各位有個概念，我們第四季的營收已超過 2013 年全年的銷售額。

This growth has not been without its challenges, however. For example, as we stated previously, we believe our receiver recall accounted for at least $10 million in lost revenue in 2016 and a significant increase to our warranty expenses.

然而，這樣的成長並非沒有挑戰。例如，如我們先前所述，我們認為接收器召回在 2016 年造成至少 1,000 萬美元的營收損失，並使我們的保固費用大幅增加。

We also had to make unplanned investments in our customer support structure to handle the challenges associated with this level of growth and our shift to a mobile platform. We have certainly come a long way in a very short period of time, and we continue to see a significant long-term growth opportunity for many years to come.

我們也必須對客服支援架構進行非計畫性的投資，以因應此成長規模以及我們轉向行動平台所帶來的挑戰。我們確實在很短的時間內走了很長一段路，且我們仍看見未來多年可觀的長期成長機會。

Internationally we are pleased with our continued growth, as our OUS business kept pace with our robust US growth. Looking ahead, we are very pleased with Germany's positive national reimbursement decision to cover CGM.

在國際市場方面，我們對持續成長感到滿意，因為我們的美國以外（OUS）業務與美國強勁成長同步。展望未來，我們對德國做出涵蓋 CGM 的正向全國性給付決策感到非常欣喜。

We remind investors that the initial decision includes both Type 1 and Type 2 insulin-using patients and defines real-time CGM as systems that provide alerts and alarms. We have signed our initial German payer contracts and will have a more substantial portion in the market covered as we exit 2017.

我們提醒投資人，初步決策同時涵蓋第一型與使用胰島素的第二型病患，並將即時 CGM 定義為可提供提示與警報的系統。我們已簽署首批德國支付方合約，並將在 2017 年結束時，使市場中更大比例的族群獲得給付涵蓋。

We are also making steady progress in obtaining reimbursement in other international markets and will provide future updates as appropriate. All in all, we are very pleased with the continued pace of CGM adoption and anticipate ending the year with approximately 270,000 patients globally.

我們也在其他國際市場取得給付方面穩步推進，並將在適當時機提供後續更新。總體而言，我們對 CGM 持續採用的速度感到非常滿意，並預期年底全球病患數約達 270,000 人。

Now for an update on our product pipeline. We have a number of submissions in front of the FDA that will enhance our G5 Mobile platform, including a new, more reliable touchscreen receiver; our new insertion system and corresponding smaller transmitter; our Android platform, which we hope to launch in the US by midyear; and additional enhanced versions of our G5 Mobile app to provide additional features and functionality, including the incorporation of insulin data.

接下來更新我們的產品研發管線。我們已向 FDA 提交多項申請，將強化我們的 G5 Mobile 平台，包括：新的、更可靠的觸控螢幕接收器；我們新的插入系統及相對應更小的發射器；我們的 Android 平台（希望於年中在美國上市）；以及 G5 Mobile App 的其他強化版本，以提供更多功能與特性，包括整合胰島素數據。

Our gen 6 pivotal trial continues to make good progress. Our goal is to file the G6 PMA by the end of Q3 2017, which would allow us to launch in 2018, assuming a positive review by the Agency.

我們第六代（gen 6）關鍵性試驗持續取得良好進展。我們的目標是在 2017 年第三季末前提交 G6 的 PMA，若主管機關審查結果正面，將可於 2018 年上市。

As I mentioned earlier, the early data from G6 has been very impressive. Assuming this performance is replicated in the pivotal trial, we believe G6 will represent the next major paradigm shift in continuous glucose monitoring performance standards. G6 will allow us to reduce calibrations initially and provide the foundation for our no-calibration technology.

如我先前提到，G6 的早期數據非常亮眼。若此表現能在關鍵性試驗中重現，我們相信 G6 將代表連續血糖監測效能標準的下一次重大典範轉移。G6 將使我們能在初期降低校正次數，並為我們的不需校正技術奠定基礎。

Turning to our Verily partnership, our collaboration to develop simple, low-cost, disposable CGM systems continues to make good progress. To remind investors, our initial joint product offering with Verily will be a no-calibration CGM platform based on G6 sensor technology.

談到我們與 Verily 的合作夥伴關係，我們共同開發簡單、低成本、一次性 CGM 系統的合作持續取得良好進展。提醒投資人，我們與 Verily 的首款聯合產品將是不需校正的 CGM 平台，並以 G6 感測器技術為基礎。

We believe the products we develop in our Verily partnership will drive the entry of CGM into the non-insulin using Type 2 market and someday become the basis to establish CGM as a standard of care for these patients as well. In our experience to date, real-time CGM has demonstrated an ability to significantly improve a patient's average glucose values, time in range, and provide a holistic view of the effectiveness of a patient's treatment regime.

我們相信，與 Verily 合作開發的產品將推動 CGM 進入未使用胰島素的第二型市場，並在未來某一天成為將 CGM 建立為這些病患標準照護（standard of care）的基礎。依我們目前的經驗，即時 CGM 已展現能顯著改善病患的平均血糖值、目標範圍內時間（time in range），並提供對病患治療方案有效性的整體視角。

As we explore this market further, it is becoming clear to us that CGM, when combined with knowledge-based decision support tools, will help Type 2 patients optimize their diabetes therapy through better medication management and behavior modification. Ultimately we look to demonstrate not only CGM's clinical value in this category, but also its impact on the expense of treating one of today's most costly conditions.

隨著我們進一步探索此市場，我們愈來愈清楚，CGM 若結合以知識為基礎的決策支援工具，將可透過更佳的用藥管理與行為調整，協助第二型病患最佳化其糖尿病治療。最終，我們希望不僅能證明 CGM 在此類別的臨床價值，也能證明其對於治療當今成本最高的疾病之一所帶來的費用影響。

From a product perspective, we believe our first Verily product should be commercialized by the end of 2018, and anticipate that the second-generation device will be available in the 2020-2021 time frame. We continue to conduct human pilot studies with the first-generation device, and we have completed our initial feasibility studies for the second Verily product and remain excited about continued progress on our collaboration this year.

從產品角度來看，我們認為第一款 Verily 產品應可在 2018 年底前商業化，並預期第二代裝置將於 2020-2021 年期間推出。我們持續以第一代裝置進行人體先導研究（human pilot studies），也已完成第二款 Verily 產品的初步可行性研究，並對今年合作的持續進展感到振奮。

Turning to our insulin delivery partners, our G4 integrated pump offerings remain well liked by our mutual patients. And we see continued progress in our other integrations with both G5 and G6, with advanced insulin delivery systems, including pumps, smart pens, and other connected diabetes management platforms. We expect to be able to highlight more specific progress on these integrated systems -- as these integrated systems approach clinical trials and commercial launch.

再談到我們的胰島素輸注合作夥伴，我們的 G4 整合式幫浦產品仍深受雙方病患喜愛。我們也看到在 G5 與 G6 的其他整合上持續取得進展，並與先進胰島素輸注系統合作，包括幫浦、智慧胰島素筆，以及其他連網的糖尿病管理平台。隨著這些整合系統接近臨床試驗與商業上市，我們預期能分享更具體的進展。

In conclusion, with our non-adjunctive claim and subsequent positive reimbursement ruling by Medicare as well as our international expansion, our commercial team has plenty to keep them busy over the next several quarters. Additionally, the data published in JAMA and presented at ATTD were powerful.

總結而言，憑藉我們的非輔助（non-adjunctive）主張、Medicare 隨後做出的正向給付裁定，以及我們的國際擴張，我們的商業團隊在未來幾個季度將有許多工作要推進。此外，發表於《JAMA》並在 ATTD 上呈現的數據也相當有力。

The more DexCom CGM is studied, the more we see the value it brings across the diabetes healthcare continuum to patients, to payers, and to providers, all with minimal training and minimal investment along the way. With real-world studies like DIaMonD and GOLD, we have never been in a better position to drive CGM penetration and capitalize on a healthcare payer environment that increasingly calls for outcomes to bring economic value.

DexCom CGM 研究得愈多，我們愈能看見它在糖尿病醫療照護的整體連續體中，為病患、支付方與醫療提供者帶來的價值，而且所需訓練與投入都很少。透過像 DIaMonD 與 GOLD 這類真實世界研究，我們從未像現在這樣具備更佳條件來推動 CGM 滲透率，並把握醫療支付環境日益要求以結果創造經濟價值的趨勢。

I would now like to open the call up for Q&A.

接下來我想開放電話會議進行問答。

(Operator Instructions) Mike Weinstein, JPMorgan.

（接線員指示）Mike Weinstein，摩根大通（JPMorgan）。

Just maybe want to start, Kevin, with reimbursement. And let's cover, if we can, the progress both in the US and in Germany. So I heard your comments on both. How should we think about the timing of getting reimbursement from all the MACs? When do you think you will have that process effectively complete?

Kevin，我想先從給付談起。如果可以的話，也請談談美國與德國兩邊的進展。我有聽到你對兩者的評論。我們應該如何看待從所有 MACs 取得給付的時程？你認為何時能讓這個流程實質上完成？

And then, second, in Germany, could you just give us a sense of how much -- give us a percentage of coverage that you may now have in place and how you expect that you track over the course of the year. I know you made comments earlier in the year when you were in San Francisco about how strong December was, in particular, for Germany. So would love to get your updated thoughts there.

第二，在德國方面，你能否讓我們了解一下——你們目前大概已取得多少覆蓋率（以百分比表示），以及你們預期在一年當中會如何推進。我知道你今年稍早在舊金山時曾提到，德國在 12 月表現特別強勁。所以也很希望聽到你最新的看法。

Well, things continue to go well in Germany as reimbursement expands. We only have a partial group of the payers covered with specific contracts at this point in time and we are reaching out to the rest of them.

嗯，隨著給付擴大，德國的進展持續良好。目前我們只有部分付款方透過特定合約納入給付範圍，我們也正與其餘付款方接洽。

Those efforts will continue over the course of the year, Mike. And certainly we like to have a large percentage of them. I can't really give you where that is. Obviously we will shoot for 100%. But inevitably, there ends up being nits along the way.

Mike，這些努力會在今年持續進行。當然，我們希望能涵蓋其中很大比例。我目前無法確切告訴你進度到哪裡。顯然我們會以 100% 為目標。但過程中難免會有一些小問題。

But so far, so good. The growth has been very good so far in Germany; the product's being very well received, as I said back in January. We are doing well with CGM in Germany.

但到目前為止一切順利。德國迄今的成長非常好；如我在一月提到的，產品反應非常熱烈。我們在德國的 CGM 表現不錯。

With respect to the MACs, we are just starting those discussions. And I believe, as I said back in January, as a goal for us, we would love to have all this resolved by the middle of the year. But again, I also said in January that we were not expecting approval until 2018. So I -- we have plans we are working on, on presentations, meetings, etc. We'll go as quick as we can.

至於 MACs，我們才剛開始進行這些討論。而且我相信，如同我在一月所說，作為我們的目標，我們希望能在年中前把這些都解決。但同樣地，我一月也說過，我們不預期會在 2018 年之前獲得核准。所以我——我們正在規劃並推進簡報、會議等安排。我們會盡可能加快。

But obviously, we're not going to see any benefit from the Medicare expansion this quarter? If we see a benefit, it will start to accrue in the second quarter? Is that fair?

但顯然，本季我們不會看到 Medicare 擴大給付帶來的任何效益？如果會看到效益，將會從第二季開始逐步反映？這樣理解合理嗎？

Yes, there is no benefit in this quarter. The only thing that I would note, though, is that we are getting a lot of phone calls from Medicare patients who would like it. So we are optimistic for the opportunity, once we can really go out and market this and present it to more. And we have a lot of opportunities today in the pipeline waiting for the coverage.

是的，本季沒有任何效益。不過我想補充的是，我們接到很多 Medicare 病患來電表示想使用。因此一旦我們能真正開始對外行銷並向更多人介紹，我們對這個機會感到樂觀。而且目前管線中已有許多機會在等待給付覆蓋。

The G6 filing and the Verily G1 filing -- are you going to do those in tandem? Is that possible in your dialogue with the FDA? Or are you going to space those out?

G6 送件以及 Verily G1 送件——你們會同步進行嗎？在與 FDA 的溝通中這可行嗎？還是你們會把它們錯開？

We will file the G6 system first. That trial will be done first. And then the Verily filing will reference the G6 filing, particularly all the manufacturing of the sensor. And then we will see where the filings go and what additional work we have to do.

我們會先送件 G6 系統。那個試驗會先完成。接著 Verily 的送件會引用 G6 的送件內容，特別是感測器的所有製造相關資料。然後我們會看送件審查進展，以及還需要做哪些額外工作。

Obviously, we will have to validate and verify all the electronics configurations and probably run some kind of study with that system since it will be a no-calibration system. And it will be labeled different, more than likely, than the G6 because of the calibrations. So we will file G6 first, but the Verily configuration will come certainly not too long after that. Well, we will push pretty hard.

顯然，我們必須驗證並確認所有電子配置，並且可能需要用該系統進行某種研究，因為它將是免校正系統。而且由於校正方式不同，它的標示很可能也會與 G6 不同。所以我們會先送 G6，但 Verily 的配置也肯定會在不久之後跟進。我們會非常積極推進。

Okay. And then last topic is I know there was some question on the Street in terms of what impact Medicare reimbursement would have on your outlook for the year. Obviously, it's only late February at this point and you still have to discuss with the MACs.

了解。最後一個主題：我知道市場上有人在問 Medicare 給付對你們今年展望會有什麼影響。顯然目前才二月下旬，你們仍需與 MACs 討論。

So the question I think probably people have is, one, are you seeing any impact of the FDA label change prior to getting the reimbursement from the MACs? Separate topics there. So are you seeing any benefit from that? And is your confidence in the initial guidance you gave at the start of the year the same, unchanged, or is it higher as a result of the Medicare reimbursement?

所以我想大家可能有兩個問題：第一，在 MACs 給付核定之前，你們是否已經看到 FDA 標示變更帶來的任何影響？這是不同的議題。所以你們有看到任何好處嗎？另外，你們對年初給出的初始財測信心是否相同、沒有改變，或是因 Medicare 給付而更有信心？

Let's start with the non-adjunctive labeling change. For any of you who have seen our marketing campaigns, we have been marketing to that. And the response from the public has been very well in our DTC campaigns with the non-adjunctive claim and therapeutic use of CGM. So we are seeing some benefit to that right now.

先談非輔助（non-adjunctive）標示變更。如果各位看過我們的行銷活動，我們一直在以此作為行銷訴求。在我們以非輔助主張與 CGM 治療用途為訴求的 DTC（直接面向消費者）活動中，市場反應非常好。因此我們現在確實看到一些效益。

With respect to our guidance for the year, we reaffirmed in our call our guidance for the year. We have not really considered Medicare in those numbers at this point in time, and there will be moving pieces once Medicare gets approved. And we will update everybody after we have that.

至於我們今年的財測，我們在電話會議中已重申全年指引。截至目前，我們並未把 Medicare 納入那些數字考量；一旦 Medicare 獲得核准，會有一些變動因素。等到那時我們會再向大家更新。

I think Medicare will be very good for us, but we really need to know what group of patients is going to be covered so we can peg it to a population and look at how many of those patients we can add. And we don't have that guidance yet, Mike. And when we get that, we will provide you guys with more information.

我認為 Medicare 對我們會非常有利，但我們確實需要知道將涵蓋哪一群病患，才能對應到特定族群，並評估我們能新增多少病患。Mike，我們目前還沒有那方面的指引。等我們拿到之後，會提供各位更多資訊。

Very helpful. Thank you, guys. I'll let some others jump in.

非常有幫助。謝謝各位。我讓其他人接著提問。

Ben Andrew, William Blair.

Ben Andrew，William Blair。

Couple questions from me. Kevin, maybe is there an update on the G5x timing? And how do you think about the magnitude of the impact of that as you roll that out over the course of presumably the year or back half of the year?

我有幾個問題。Kevin，G5x 的時程是否有更新？以及當你們在今年（或可能是下半年）逐步推出時，你怎麼看它影響幅度的大小？

I don't have an update on timing. We received questions from the FDA and we are finishing our response to those. We will submit those. I would tell you the only factor in G5x timing for us -- this is a very complicated change for us, as I've talked about it before. We have to change pretty much every manufacturing process that we do with respect to G5x to get that thing launched. So the sooner we can get started, the better.

我目前沒有時程更新。我們收到了 FDA 的提問，正在完成回覆。我們會提交這些回覆。我想說，影響我們 G5x 時程的唯一因素——這對我們而言是非常複雜的變更，我之前也談過。為了讓它上市，我們幾乎必須更改所有與 G5x 相關的製造流程。所以我們越早能開始越好。

But it is complicated because patients will be on G5 and G4 and G5x. And so there's a very detailed plan that we have to roll out. I don't have a timing update today. We will see how our responses are received by the FDA.

但它之所以複雜，是因為病患會同時使用 G5、G4 以及 G5x。因此我們必須推出一個非常細緻的計畫。我今天沒有時程更新。我們會看 FDA 對我們回覆的接受程度。

And combine that with the complexity of just receiving a non-adjunctive claim as well. So this is a very thoughtful process by the FDA that they are putting us through and that we are going through and it needs to align with everything that we do.

再加上剛取得非輔助主張本身的複雜性。所以這是 FDA 讓我們經歷、我們也正在經歷的一個非常審慎的流程，而且必須與我們所做的一切相互一致。

Okay. And then on the reimbursement discussion, with the payers relative to the DIaMonD and the GOLD data, particularly the new DIaMonD data, Kevin, how have your conversations changed now that you have that data in hand? Does it embolden you to consider risk-sharing contracts sooner than you might otherwise? And can you build on the notion of CGM First as you go through those conversations?

了解。接著談給付：就 DIaMonD 與 GOLD 數據（特別是新的 DIaMonD 數據）而言，Kevin，現在你們手上有這些數據後，與付款方的對話有什麼改變？這是否讓你們更有底氣，考慮比原本更早推動風險分攤合約？以及在這些對話中，你能否進一步闡述「CGM First」的概念？

We've had numerous discussions. Now that the DIaMonD data has rolled out, it does become a very strong talking point that we've never had before.

我們已經進行了多次討論。現在 DIaMonD 數據已經公布，這確實成為一個我們以前從未擁有過、非常有力的溝通重點。

I would tell you, Ben, internally, we are not opposed to risk-sharing arrangements with the payers, particularly as we look at the DIaMonD data and the type of A1c reduction we achieved, the minimal amount of severe hypoglycemic events that have gone on in our past experience in our studies, where our patients have very few severe hypoglycemic events and not a lot of hospitalization costs as well.

我會告訴你，Ben，就內部而言，我們並不反對與支付方採取風險分攤安排，特別是當我們檢視 DIaMonD 數據以及我們達成的 A1c 降幅、以及在我們過往研究經驗中發生的嚴重低血糖事件極少；在我們的研究裡，患者的嚴重低血糖事件非常少，住院成本也不高。

The challenge for us in these types of contracts has not been our willingness to accept risk, it has been figuring out how to structure them based on the information that the payers have about their patients, combined with the information that we have regarding the performance of our systems.

對我們來說，這類合約的挑戰不在於我們是否願意承擔風險，而在於如何根據支付方掌握的患者資訊，結合我們對系統表現的資訊，來設計合約架構。

I'll give you a simple example. If a payer says: I'll do a risk-sharing arrangement with you, but you have to produce a report from the patient. And if that patient chooses to use the receiver instead of the phone app, we don't necessarily have that patient's data readily accessible. So it creates some different types of scenarios.

我給你一個簡單的例子。如果某個支付方說：我願意跟你做風險分攤安排，但你必須提供由患者產出的報告。而如果那位患者選擇使用接收器而不是手機 App，我們未必能即時取得該患者的資料。因此就會產生一些不同的情境。

And so we are pursuing all of those. We've had very active discussions. They are interactive. They are lively. We are willing to accept some risk there, it's we just need to get a few of these done. I'm hoping for some really good outcomes over the course of 2017 on that front.

所以我們正在推進所有這些事項。我們已經進行了非常積極的討論。這些討論是互動式的。也很熱烈。我們願意在那裡承擔一些風險，只是我們需要把其中幾個案子真正落地完成。我希望在 2017 年這方面能取得非常好的成果。

Okay, and then last one from me. You talked about increasing the field organization to 130, I think. I thought I heard you say that was in Q1. And what was the number before? Was it around 110?

好的，然後我最後一個問題。你提到把外勤組織擴增到 130 人，我想是這個數字。我以為我聽到你說那是在第一季。那之前的人數是多少？大約是 110 人左右嗎？

It was closer to 100, between 100 and 110. And most of those reps were added over the course of Q4 and early in Q1. So we have been through our training and got these people on the street and going.

更接近 100 人，在 100 到 110 之間。而且其中大多數業務代表是在第四季期間以及第一季初加入的。所以我們已完成訓練，並讓這些人員上線、開始跑市場。

And I would tell you, whatever you have an expansion of this nature, it is a bit disruptive. It will take the new ones a bit of time to get up to speed and our existing sales force a bit of time to get used to the readjusted territories.

我會告訴你，任何這種性質的擴編都會有點干擾。新進人員需要一些時間才能上手，而我們既有的銷售團隊也需要一些時間來適應重新調整後的區域劃分。

Okay. Thank you.

好的。謝謝。

Chris Cooley, Stephens Inc.

Chris Cooley，Stephens Inc.。

Appreciate you taking the questions. Could you just remind us, maybe Steve, a little bit more in terms of the metrics that you had relative to the 2017 guide? And maybe more specifically, what you are expecting for attrition rates relative to year-end run rates as we play through the year? Then I had just one other quick follow-up.

感謝你回答問題。能否請你提醒我們一下，也許 Steve，就你們相對於 2017 年指引所採用的衡量指標再多說一點？更具體來說，隨著今年推進，你們對流失率相對於年末運行水準（run rate）的預期是什麼？然後我還有一個很快的追問。

Yes. So we have never broken out what specifically went into the guide. Obviously, you can assume obviously US ramp, continued US ramp. Penetration in MDI patients is something we've talked quite a bit about as we've more recently added a majority of MDI versus pump patients. That was factored in. Germany is obviously going to ramp over the course of the year.

好的。我們從未拆解過指引中具體包含哪些項目。顯然，你可以假設美國市場的爬坡、持續的美國市場爬坡。在 MDI（多次每日注射）患者中的滲透率是我們談了很多的，因為我們最近新增的患者中，MDI 相對於幫浦患者已占多數。這些都已納入考量。德國市場顯然也會在今年逐步爬坡。

We didn't, obviously, when we gave the guidance early this year, at that same time we estimated that Medicare was coming in 2018. So you should assume in the current guidance there is no ramp from Medicare this year. But it's kind of the usual stuff.

另外，顯然在我們今年年初給出指引時，我們當時同時預估 Medicare 會在 2018 年到來。所以你應該假設目前的指引中，今年不包含來自 Medicare 的爬坡。但大致上就是那些常見的因素。

And then -- sorry; tell me the second part of your question. On attrition rates?

然後——抱歉；請再告訴我你問題的第二部分是什麼。是關於流失率嗎？

Yes.

是的。

So we have never disclosed a specific attrition rate. But the color we tried to give at the beginning of this year and in the 8-K, I was trying to let you triangulate it. Attrition is a complex problem. It's a complex thing to analyze here because you have different time frames in which we have different attrition metrics, and we are not going to go into that level of detail.

所以我們從未披露過一個具體的流失率。但我們在今年年初以及在 8-K 中試圖提供的補充說明，是希望你們能自行推算出來。流失是一個複雜的問題。在這裡要分析它也很複雜，因為我們在不同時間區間有不同的流失衡量口徑，而我們不會深入到那種細節層級。

But what we tried to triangulate you guys to was an attrition rate that you could calculate, giving you a single number of somewhere between 8% and 12% on an annual basis. I know that's a bit of a range, but that was what we were trying to triangulate when we talked about net new adds in 2016 and anticipated gross adds plus net new adds, net total at the end of the year of around 275. That can get you to a once-a-year attrition rate of somewhere between 8% to 12%.

但我們試圖引導你們推算的是：你們可以計算出一個單一數字的流失率，大約在年化 8% 到 12% 之間。我知道這個區間有點大，但這就是我們在談到 2016 年淨新增（net new adds）以及預期的總新增（gross adds）加上淨新增、以及年底淨總量約 275 時，所試圖讓你們推算出的結果。那樣可以推導出一年一次的流失率大約在 8% 到 12% 之間。

Thank you. Just wanted to verify that. And then, secondly, could you just maybe comment -- and I realize this is a longer-term growth opportunity, but how you would see the potential benefit of, shall we say, smart pens going forward and helping further drive growth for CGM, especially as you are starting to see more of your patients come from the MDI population?

謝謝。只是想確認一下。第二個問題，你能否評論一下——我知道這是較長期的成長機會——你如何看待所謂智慧胰島素筆（smart pens）未來可能帶來的效益，並進一步推動 CGM 的成長，特別是當你開始看到更多患者來自 MDI 人群時？

Yes, we think the opportunity is huge, particularly as we look to the future. And we know ultimately the day will come where this fight is going to be fought, if not being fought today at the payer level even more so. It's not just in the US, but in the OUS markets, where pumps are really probably less than 10% penetrated and in many markets far less than that.

是的，我們認為這個機會非常巨大，尤其是展望未來。而且我們知道，最終會有一天，這場仗將會在支付方層級被打得更激烈——即便今天在支付方層級可能就已經在打了。這不僅是在美國，也包括美國以外（OUS）的市場；在那些市場中，胰島素幫浦的滲透率很可能不到 10%，而在許多市場甚至遠低於此。

We are very bullish on the opportunity for smart pens. We believe many companies, both insulin companies and non-insulin companies, are working on smart pen development. A number have licensed or are working and announced publicly they are working with different algorithms and different software developers. So I think over the next 18 to 24 months, it will be pretty exciting to see some of the products that can come to market.

我們非常看好智慧胰島素筆的機會。我們相信許多公司，不論是胰島素公司或非胰島素公司，都在進行智慧筆的開發。其中有不少已取得授權，或正在合作，並且已公開宣布正與不同的演算法與不同的軟體開發商合作。因此我認為在接下來 18 到 24 個月，看到一些產品上市會相當令人振奮。

I think, much like our sensors driving some of the work we are doing on the automated insulin delivery systems with some of the pump partners, you are going to see really the real value in these systems. We will be integrating that insulin-on-board information from a smart pen together with our CGM data in a single unified app on the phone, and we can do some pretty powerful stuff there.

我認為，正如我們的感測器推動了我們與部分幫浦合作夥伴在自動化胰島素輸送系統上的一些工作一樣，你將會看到這些系統真正的價值所在。我們會把智慧筆提供的體內胰島素量（insulin-on-board）資訊與我們的 CGM 數據整合，在手機上一個單一、統一的 App 中呈現，而我們可以在那裡做出相當強大的功能。

So when you start demonstrating outcomes with a smart pen together with CGM data and providing patients with dosing support information, behavior modification information, really at a fraction of cost of some more complex systems, I think we really have a home run there.

所以當你開始展示智慧筆結合 CGM 數據的成效，並為患者提供劑量支持資訊、行為改變資訊，而且成本只是某些更複雜系統的一小部分時，我認為我們真的會有一個「全壘打」的成果。

Thank you.

謝謝。

Kyle Rose, Canaccord Genuity.

Kyle Rose，Canaccord Genuity。

Thanks for taking the question. I know it's still early days with regards to the CMS and the Medicare opportunity. But just wanted to take a step back and think from a high level. One of the things, I think, or takeaways from 2016 was just the changing needs of the new patients that are adopting the technology at this pace. Obviously, there was some big customer service investments took place last year.

謝謝讓我提問。我知道就 CMS 與 Medicare 的機會而言，現在仍屬早期階段。但我想先退一步，從更高層次來思考。我認為 2016 年的一個重點或收穫，是以這樣的速度採用這項技術的新患者，其需求正在改變。顯然，去年進行了一些重大的客戶服務投資。

How do you -- when you think about the CMS population and that being a different demographic just from a user base, just what type of investments do you foresee from an infrastructure standpoint? And how do you view those patients just from a potential utilization perspective different than some of the previous patients you'd seen in prior years?

當你思考 CMS 族群、以及那相較於一般使用者基礎而言屬於不同的人口結構時，從基礎設施的角度來看，你預期會需要進行哪些類型的投資？另外，從潛在使用量（utilization）的角度，你如何看待這些病患，與你們過去幾年所見到的部分病患相比，會有哪些不同？

From a customer service perspective, obviously, we need to be ready on the phone to talk to these people. And we've made a lot of investments just in underlying IT tools to make our team more effective and enable them to handle more calls and have more of a knowledge-based type system as they address with and work with these patients.

從客戶服務的角度來看，很明顯地，我們必須準備好在電話上與這些人溝通。而我們也在底層 IT 工具方面做了大量投資，以提升團隊效率，讓他們能處理更多來電，並在與這些病患互動與服務時，具備更偏知識型（knowledge-based）的系統。

And we believe we are ready for this. We are also expanding our call center operations. In Q2, we are going to take our facility in Arizona and have a second call center over there. Several of our people actually are moving from San Diego over there to man that.

我們相信我們已經為此做好準備。我們也正在擴充我們的客服中心營運。在第二季，我們會啟用亞利桑那州的據點，在那裡設立第二個客服中心。我們有幾位同仁實際上會從聖地牙哥搬過去，負責那邊的運作。

So we won't have a bunch of startup time to get up and running. We will have some great people over there working, and that will help us as well.

因此我們不會需要花很長的啟動時間才能上軌道。那邊會有一些非常優秀的人員在工作，這也會對我們有所幫助。

With respect to utilization, it has been interesting. As we have gone through analytics on our patient base, forever our most loyal patient group has been the over-50. The over-50 patients, while they are on this, they have not left us. They have been very, very loyal.

就使用量而言，這點很有意思。當我們對病患基礎做分析時，一直以來我們最忠誠的病患族群都是 50 歲以上。50 歲以上的病患一旦開始使用，就沒有離開我們。他們非常、非常忠誠。

So I think what you'll see with these patients is very similar to what Steve talked about as we broaden the patient base. It will probably be a function of -- they will start up and if they don't like it, they will quit fast. And if they like it, we think we can keep them on for a very long time.

所以我認為，隨著我們擴大病患基礎，這些病患的情況會很像 Steve 提到的。很可能會是這樣的模式——他們會先開始使用，如果不喜歡，就會很快停止。如果喜歡，我們認為就能讓他們長期持續使用。

And it's our job and our challenge to make sure that quit fastening doesn't happen. And we have to make our system -- we have a team called DexCom Care that reaches out to patients and can train them directly on tools like Skype and FaceTime and things like that.

而我們的工作與挑戰，就是確保不會發生「很快就停止」的情況。我們必須讓我們的系統——我們有一個名為 DexCom Care 的團隊，會主動聯繫病患，並可透過 Skype、FaceTime 等工具直接訓練他們。

We need to make sure that group is heavily involved with our senior population as we ramp them up. And we will do that, and we are working on that. So we are optimistic that they will stay.

在我們協助年長族群上手、逐步導入時，我們必須確保那個團隊能深度參與。我們會做到這點，而且我們正在推進相關工作。因此我們樂觀認為他們會留下來持續使用。

Okay, that's very helpful. And then just another one there. When we read the CMS rule, it provided reimbursement on a monthly basis. That includes some of the other related supplies.

好的，這非常有幫助。接著再問一個。我們在閱讀 CMS 規則時，看到它是按月提供給付（reimbursement）。其中也包含一些其他相關耗材。

I know you are putting the business model together now. But from a long-term perspective, do you envision a plan where you will provide some of the other ancillary supplies for calibration and things of that sort, at least in the near term? Or do you plan a partner to add some of those incremental products? How do you view that getting distributed to the customer?

我知道你們現在正在建立商業模式。但從長期角度來看，你們是否會規劃至少在近期提供一些其他用於校正等用途的周邊耗材（ancillary supplies）？或者你們會找合作夥伴來補齊這些增量產品？你們如何看待這些產品最後交付給客戶的方式？

Yes. In the near term, it will probably be in partnership with one of our DME suppliers. But over time, who knows? I think that looking at the economics broadly speaking, I think particularly as we look to some of our future sensor products which go to 10 days or 14 days, the economics are quite favorable to us. I think we are pretty happy there.

會的。短期內，可能會與我們的某一家 DME 供應商合作來進行。但長期來看，誰知道呢？我認為從整體經濟性（economics）來看，尤其是我們未來的一些感測器產品可延長到 10 天或 14 天時，對我們而言經濟性相當有利。我想我們對那部分相當滿意。

Okay, great. And then just the last question from me is, just any expectations to see the initial feasibility data from the Verily? You know, G1 at some point this year. And if so, is ADA the most likely place we should think about that?

好的，很好。我最後一個問題是：對於 Verily 的初步可行性（feasibility）數據，你們是否預期今年某個時間點會看到？例如 G1 在今年某個時候。如果會的話，ADA 是否是我們最可能看到的場合？

Probably not. Not ADA, and hopefully we can see something before the end of the year. We have initial data in-house, but it's in a limited number of patients, so it's not something that we are -- we typically wait until a study is pretty well baked. We don't attend patients' in-house studies. It's something we spent a lot of time talking about.

可能不會。不會在 ADA，而且希望我們能在年底前看到一些東西。我們內部已經有初步數據，但病患數量有限，所以這不是我們——我們通常會等到研究相當成熟後才會對外分享。我們不會出席病患的內部研究。這是我們花了很多時間討論的一件事。

I can tell you there's a lot of people at Google who walk around with this thing as well. There's a pretty good data set. But we are not -- probably not at ADA, maybe later in the year.

我可以告訴你，Google 那邊也有很多人身上帶著這個裝置走來走去。資料集相當不錯。但我們不會——大概不會在 ADA，可能會在今年稍晚。

Great. Thank you very much for taking the questions.

很好。非常感謝你們回答問題。

David Lewis, Morgan Stanley.

Morgan Stanley 的 David Lewis。

Maybe just two questions for Kevin, one tactical, one strategic. Kevin, just given the changing competitive dynamics were a big focus last quarter, I wonder if you could just update us on these dynamics in the US and ex-US in the fourth quarter or perhaps early 2017 relative to your commentary in the third quarter. And what assumptions, if any, were made for 670G or Libre timing in the 2017 guide. And I had a quick strategic follow-up.

我想對 Kevin 問兩個問題，一個偏戰術、一個偏策略。Kevin，鑑於競爭態勢的變化在上季是很大的焦點，我想請你更新一下：在第四季或 2017 年初，美國與美國以外市場的競爭動態，相較於你在第三季的評論，有哪些變化？另外，在 2017 年的財測（guide）中，對 670G 或 Libre 的上市時點（timing）做了哪些假設（如果有的話）？我還有一個很快的策略追問。

With respect to our 2017 guidance, we built out the model based on what we think we can achieve. And we do consider the fact that these other products will be out. I think a lot will depend on how their labeled and how they are going to be used and timing. So we built our models out with the best assumptions we had at hand, and leave them at that. So we did consider some of those things.

關於我們 2017 年的指引，我們是基於我們認為自己能達成的目標來建立模型。而且我們確實把其他產品會上市這件事納入考量。我認為很大程度取決於它們的標示適應症（labeled）、將如何被使用，以及時程。因此我們用當時手上最好的假設來建模，並就此作為基礎。所以我們確實考量了其中一些因素。

We do not let competitors drive our growth assumptions. We hold our people to a standard that this technology and this therapy is important for everybody. So we don't get to sit back and say, well, there's competition, I'll take my foot off the gas. We don't do that. We do consider it, and that would be where that would land.

我們不會讓競爭對手來主導我們的成長假設。我們要求團隊遵循一個標準：這項技術與這種治療對每個人都很重要。所以我們不會坐著說，嗯，有競爭，那我就鬆油門。我們不會這麼做。我們會把競爭納入考量，而這就是它在模型中會落點的位置。

I'm sorry. I forgot the other part of your question.

抱歉。我忘了你問題的另一部分。

Sure. So you'd say competitive dynamics, Kevin, were pretty stable in the fourth quarter relative to your commentary in the third?

當然。所以你會說，Kevin，相較於你在第三季的評論，第四季的競爭動態算是相當穩定？

Go ahead, Steve.

Steve，你來回答。

I'd say, coming into that third-quarter call, remember, the 670G had just been approved. So I think there was considerable additional noise at that point in time. That has largely died down, I would argue.

我會說，在第三季電話會議之前，記得 670G 才剛獲得核准。所以在那個時間點確實有相當多額外的雜音。我認為那已經在很大程度上消退了。

We were just at a big diabetes conference in Paris. And without patting ourselves on the back, I would say DexCom was again the shining star, particularly in terms of our sensor, sensor performance, and the data we released. So I think it is quieted down quite a bit on that front.

我們剛在巴黎參加了一個大型糖尿病會議。不自誇地說，我會認為 DexCom 再次成為最亮眼的焦點，特別是在我們的感測器、感測器表現，以及我們發布的數據方面。所以我認為在那一塊已經安靜了不少。

Kevin, just real quick strategically -- I apologize; I'm at an airport here. But this announced divestiture of J&J, this J&J divestiture has ignited a debate around integrated products.

Kevin，策略上我很快問一下——抱歉；我現在在機場。不過這次宣布的 J&J 資產剝離，這項 J&J 的剝離已引發了關於整合式產品的辯論。

And I feel like there's two camps. Right? Some see value in a second integrated pump CGM player, and others say, given the DIaMonD study and the market opportunity at MDI and T2, why bother with pumps? I wonder if you provide us your updated perspective. And I'll jump back in queue. Thank you.

我覺得大致上有兩派。對吧？有些人認為第二個整合式幫浦 CGM 參與者有其價值；也有人說，考量 DIaMonD 研究以及在 MDI 與 T2 的市場機會，何必還要做幫浦？想請你提供一下最新的看法。我會回到隊列。謝謝。

We continue to support several integrated insulin delivery systems and we will continue to do so. We have built our Company on the concept that our goal is CGM first. And as these guys will tell you, I walk around the hall all day long and saying sell more sensors, sell more sensors, sell more sensors.

我們持續支持多個整合式胰島素輸注系統，未來也會繼續如此。我們公司建立在一個概念上：我們的目標是以 CGM 為先。而且這些人會告訴你，我整天在走廊走來走去，一直說多賣感測器、多賣感測器、多賣感測器。

I think there will be some benefit to the integrated systems. We have to drive our business based on the information, the reimbursement, and sales dynamics that we have today. And so we will focus on that and we will see where our investments and our relationships and partnerships pay off over time.

我認為整合式系統會帶來一些好處。我們必須根據目前掌握的資訊、給付（報銷）情況以及銷售動態來推動業務。因此我們會聚焦在這些面向，並觀察我們的投資、關係以及合作夥伴關係隨時間推移能帶來哪些回報。

Jayson Bedford, Raymond James.

Jayson Bedford，Raymond James。

Thanks for taking the questions. Just a few cleanup-type questions. Just to clarify, the expected year-end installed base is still 270,000, correct?

謝謝讓我提問。我有幾個收尾式的問題。先確認一下，預期年底的裝機基數仍是 270,000，對嗎？

270,000, yes.

270,000，沒錯。

Okay. In terms of the new transmitter and inserter, do you plan on waiting for the G6 to launch these products or are you going to launch them as they get approved?

好的。關於新的發射器與插入器，你們是打算等到 G6 上市時一起推出，還是會在它們獲准後就推出？

It will depend upon timing of the approval and the timing of the G6 filing and a number of factors. Our plan today is launch when they get approved. But we will consider all that, Jayson, as we look out over the course of the year.

這要看核准時點、G6 送件時點以及其他一些因素。我們目前的計畫是獲准後就上市。但我們會把這些因素都納入考量，Jayson，並在接下來一年中持續評估。

Okay, fair enough. And on Germany, of the contracts that you've signed, are they covering both Type 1 and insulin-dependent Type 2?

好的，合理。再問德國，你們已簽的合約是否同時涵蓋第一型與需胰島素治療的第二型？

Yes, they are.

是的，都涵蓋。

And then just lastly for me, on the Medicare opportunity, are you actively selling or marketing into this market opportunity right now? Or do those efforts get kickstarted maybe in the second quarter?

最後一個問題，關於 Medicare 的機會，你們現在是否正積極在這個市場機會中進行銷售或行銷？還是要到第二季才會啟動？

We are not really actively marketing. We are getting a lot of inquiries about that. And it is indicated as CMS approves, so if people call and ask us to market that, the position, individuals can get approved CMS reimbursement on their own if they apply and go through the process of getting individual reimbursement.

我們其實沒有在積極行銷。不過我們收到很多相關詢問。而且這是依 CMS 核准的適應症來進行，所以如果有人來電並要求我們推廣，個別人士可以自行申請並走完個別給付流程，以取得 CMS 的報銷核准。

We are not leading those efforts. We are guiding towards getting more clarification from the MACs and CMS in general so we can get it approved and make it easier for the entire population.

我們並不是主導這些工作。我們正在引導方向，爭取從各地 MAC 與 CMS 整體獲得更明確的說明，好讓它能被核准，並讓整體族群的申請更容易。

Okay, that's fair. Thank you.

好的，合理。謝謝。

Danielle Antalffy, Leerink Partners.

Danielle Antalffy，Leerink Partners。

Thanks so much for taking the question. Kevin, this question is for you. As we get closer to a Verily product, closer to a real Type 2 opportunity, how do you see DexCom as a company from a scale perspective, both manufacturing, distribution, etc., evolving? And how much lead time do you need to get there to where you can handle what is potentially a massive opportunity?

非常感謝讓我提問。Kevin，這題是問你的。隨著我們更接近 Verily 產品、更接近真正的第二型機會，你如何看 DexCom 以公司規模的角度（製造、配送等）將如何演進？以及你們需要多少前置時間，才能達到足以承接可能非常龐大機會的能力？

That's a fantastic question and one that we debate and struggle with. And one of the reasons, quite frankly, you'll see over the next several quarters large capital equipment investments for us as we build out an alternative manufacturing facility in Arizona.

這是個非常棒的問題，也是我們一直在辯論、也很掙扎的問題。坦白說，其中一個原因是，接下來幾個季度你會看到我們在資本設備上有大筆投資，因為我們正在亞利桑那州建置另一座替代製造設施。

We need to be ready to handle this type of volume. And it is going to be different. Many of these patients, for example, won't wear sensors all the time. They may wear four sensors a year. So even our relationship with these patients is going to be different. The call will be different.

我們必須準備好處理這種量級。而且它會不一樣。例如，許多這類病患不會一直配戴感測器。他們可能一年只戴四個感測器。所以我們與這些病患的互動關係也會不同。來電內容也會不同。

We're doing a lot of studies and a lot of work right now to figure out what that market is going to look like. We think a lot of it will be payer-driven. These patients don't spend a lot of money on finger sticks today. For us to go in and offer a solution similar to what Type 1 patients are paying we know doesn't work. So intermittent CGM will be a reality for these patients.

我們目前正在做很多研究與大量工作，來釐清那個市場會長什麼樣子。我們認為其中很大一部分會由支付方（payer）驅動。這些病患目前在指尖採血（finger sticks）上的花費不高。我們知道，如果我們進去提供一個與第一型病患目前支付水準相近的解決方案，是行不通的。因此，間歇式 CGM 將會是這些病患的現實選項。

And how much are we going to spend a year, and how many sensors are patients going to wear? And what we are working on is just developing thoughts as to what those programs look like and what type of benefit they can provide.

那我們一年要花多少？病患會配戴多少個感測器？我們正在做的，是形成一些想法：這些方案會長什麼樣子，以及它們能提供什麼樣的效益。

But again, as we've shown in our investor slides, in a two- to four-week period, we can see some of these patients taking their estimated A1C down more than a full point. And their average glucose values move down significantly because they don't get feedback from anything like CGM.

但再說一次，正如我們在投資人簡報中展示的，在兩到四週的期間內，我們可以看到部分病患把他們的估計 A1C 降低超過整整一個百分點。而他們的平均血糖值也顯著下降，因為他們過去沒有任何像 CGM 這樣的回饋。

And it really enables patients to pull the three levers that there are in taking care of Type 2 diabetes: medication, exercise, and diet. And by pulling those three levers and getting real-time feedback in a mechanism that's easy to look at -- their phones -- say hey, well, maybe I ought to do something a little bit different.

這確實讓病患能夠拉動照護第二型糖尿病的三個槓桿：用藥、運動與飲食。透過拉動這三個槓桿，並以一種容易查看的方式——手機——獲得即時回饋，病患會想：嘿，也許我應該做一些不一樣的調整。

We see dramatic results. In fact, somebody I talked to the other day was looking at Type 2 study data and said: You realize this is more significant than any Type 2 drug I've ever seen? And I said: Yes, I do.

我們看到非常顯著的結果。事實上，我前幾天跟某人聊到他在看第二型研究數據，他說：你知道這比我看過的任何第二型藥物都更顯著嗎？我說：是的，我知道。

And so we know some of the opportunities there. It is going to be different business model, Danielle. And we really have to give it a lot of thought and go pretty quickly and develop a lot of data.

所以我們知道那裡有一些機會。Danielle，這將會是不同的商業模式。我們真的必須投入大量思考，並且要相當快速地推進、累積大量數據。

I think there will be a lot of exciting announcements from us. We are going to have to be creative. We're going to have to think differently than we have in the past, but we are preparing to do that and having a lot of fun trying to put it together.

我想我們會有很多令人振奮的公告。我們必須有創意。我們必須用不同於過去的方式思考，但我們正在為此做準備，也很享受把它拼湊起來的過程。

All right, thanks so much for that. And then just a follow-up on the Type 2 opportunity. Do you think the first-gen Verily product that we could see in 2018 -- at the end of 2018, I guess I should say -- is that going to be a product that can open up that Type 2 market? Or will that be limited to maybe insulin-dependent Type 2s? Or how do we think about that product and approaching Type 2s in a real way?

好的，非常感謝你的分享。接著追問第二型的機會。你認為我們可能在 2018 年看到的第一代 Verily 產品——我想應該說是 2018 年底——會是一個能打開第二型市場的產品嗎？還是會僅限於例如需胰島素治療的第二型？或者我們該如何看待那個產品，並以真正的方式切入第二型族群？

We hope to open up the market with that product. We are doing work now with our gen 5 product, even with the two calibrations a day, and getting very good results from that.

我們希望用那項產品來打開市場。我們目前正在進行第 5 代產品的工作，即使每天進行兩次校準，也能取得非常好的結果。

That is one thing we would certainly like to focus on. If we could accelerate and go faster with our current configuration, we can. But we are somewhat cost-constrained today due to the cost of hardware and the fact that it is reusable now.

那是我們 निश्चित會想要聚焦的一件事。如果我們能在目前的配置下加速、跑得更快，我們可以。但就目前而言，我們在成本上有些受限，原因在於硬體成本以及它現在是可重複使用的。

That is a product we will certainly drive this market with. The app, for example, could look a little different than what we have today, but still provide the same data, just maybe in a little different format. There's a lot of decisions to be made as we go forward.

那是一項我們肯定會用來推動這個市場的產品。例如，App 可能會看起來與我們今天的版本有些不同，但仍會提供相同的資料，只是可能以稍微不同的格式呈現。隨著我們往前推進，還有很多決策要做。

Thank you so much.

非常感謝。

Doug Schenkel, Cowen and Company.

Doug Schenkel，Cowen and Company。

Thank you for taking the questions. Maybe my first one is just another one on Medicare. Given the pent-up demand, upcoming reimbursement, and the huge clinical need for these patients, why can't penetration move to where the broader market rate is today pretty rapidly? Maybe not this year, but in 2018-2019?

謝謝你們回答問題。我第一個問題可能還是關於 Medicare。考量到累積的需求、即將到來的給付，以及這些病患巨大的臨床需求，為什麼滲透率不能相當快速地提升到目前整體市場的水準？也許不是今年，但在 2018-2019 年呢？

I think that the biggest gating factor would be just education. We have not at all targeted this patient population historically. In fact, we spent a lot of time targeting younger patients when we got our pediatric approval.

我認為最大的限制因素會是教育。我們過去從未真正鎖定這個病患族群。事實上，當我們取得兒科核准時，我們花了很多時間鎖定較年輕的病患。

So I think there's going to be an element of education. Right now, most folks probably still believe there is not reimbursement for the over-65 patient population. So it's going to take a little time.

所以我認為會有一部分是教育的問題。目前，大多數人可能仍然相信 65 歲以上的病患族群沒有給付。因此這需要一點時間。

I absolutely think we can get there, if not even higher.

我完全相信我們可以達到那個水準，甚至更高。

Certainly, with the demand we've seen generated just at the early stages here, yes, that's right.

當然，以我們在這個早期階段所看到被帶動的需求來看，是的，沒錯。

Okay, thanks for that. And then I guess a follow-up on some of the Type 2 questions. You've discussed ongoing programs with commercial payers in the US in an effort to improve Type 2 reimbursement. Can you give us a status update on these programs? And do you believe broader Type 2 commercial coverage could come faster than you've previously discussed, given the progress with CMS?

好的，謝謝你的說明。接著我想追問一些關於第二型糖尿病的問題。你們談到在美國與商業保險支付方進行中的計畫，目的是改善第二型糖尿病的給付。能否提供這些計畫的最新進度？另外，鑑於 CMS 的進展，你們是否認為更廣泛的第二型商業保險涵蓋可能會比你們先前討論的更快到來？

No. Again, we're still waiting to see what the ultimate scope of coverage looks like out of CMS. But I think on the private payer side, my belief is that we still need some more data.

不會。同樣地，我們仍在等待 CMS 最終的涵蓋範圍會是什麼樣子。但我認為在民間支付方這一側，我的看法是我們仍需要更多資料。

The DIaMonD Type 2 data was great. We showed benefit in that patient population, but I think we are going to need some additional larger studies, particularly as we look outside of the intensively managed Type 2 population into folks on orals or diet and exercise. We've got to show not just outcomes, we've got to show cost-benefit.

DIaMonD 的第二型資料很棒。我們在那個病患族群中顯示了效益，但我認為我們還需要一些額外、更大型的研究，特別是當我們把目光從密集管理的第二型族群，延伸到使用口服藥或僅靠飲食與運動的人。我們不只要證明結果，我們還必須證明成本效益。

And that's some of the initiatives we have internally. I'm not going to get into details, but some of the things we're working on internally, we are really starting to look at that data and look at how we will present it to the payers. But it's certainly not a this-year event.

這也是我們內部正在推動的一些計畫。我不會談細節，但我們內部正在做的一些事情，確實開始在檢視那些資料，並思考要如何向支付方呈現。但這肯定不是今年就會發生的事。

No, there's a lot of work to do. I agree, Steve. Although I guess the caveat that I would add -- if we went by the assumption that Type 2 intensive is insulin using CMS patients without access to CGM, and we could see very positive outcomes there as we gather data from the phone systems, in particular, we would have a very good case to go back to payers with that we don't have today. So this might provide us a wonderful opportunity to go do that. We just need to see how it plays out.

不，還有很多工作要做。我同意，Steve。不過我想補充一個但書——如果我們假設第二型的密集治療族群是使用胰島素、且在 CMS 之下但無法使用 CGM 的病患，而我們能在蒐集（特別是）手機系統資料的過程中看到非常正面的結果，那麼我們就能帶著一個我們今天還沒有的、非常有力的論點回去和支付方溝通。所以這可能會給我們一個很好的機會去做這件事。我們只是需要看看實際會如何發展。

Okay, super helpful. Thank you.

好的，非常有幫助。謝謝。

Joanne Wuensch, BMO Capital Markets.

Joanne Wuensch，BMO Capital Markets。

The new hires that happened in the fourth quarter, could you help me understand how these people are going to be focused? Is it more educational? Is it more regional? And is it more countered, detailing all the competitive launches which are currently happening and expected to?

第四季的新進人員，你能幫我理解這些人將如何被配置重點嗎？是更偏向教育嗎？是更偏向區域性嗎？還是更偏向反制式的產品說明（counter detailing），用來應對目前正在發生以及預期將發生的各種競品上市？

No. These are folks that -- so as Kevin alluded to when he described the existing sales force getting used to new territories, what happens when we do a field sales force expansion is many territories will end up shrinking. Quotas go up and territories shrink. And that's just the nature of a growth business like this.

不是。這些人——正如 Kevin 在描述現有銷售團隊適應新區域時所提到的，當我們擴編外勤銷售團隊時，很多區域最後會縮小。配額提高、區域縮小。這就是像我們這樣的成長型業務的常態。

So no, the people that we added Q4 and maybe a little bit in Q1, these are quota-carrying sales reps who will have their own territory. Their primary detail will be doctors, will be endocrinologists.

所以不是，我們在第四季、以及可能第一季又增加的一些人，都是負責業績配額的業務代表，他們會有各自的負責區域。他們主要的拜訪對象會是醫師，會是內分泌科醫師。

In terms of counter detailing, no; we don't spend our time bashing the competition. Because frankly, right now, we don't have much competition. We are out detailing the benefits of our product to doctors.

至於反制式產品說明，不會；我們不把時間花在貶低競爭對手上。因為坦白說，就目前而言，我們沒有太多競爭。我們是在向醫師說明我們產品的優勢。

So these people -- as Kevin said, it takes a little time to get them ramped up. But they've gone through sales force training and they are currently in the field, so we will start to look for contribution as we look into the latter parts of 2017.

所以這些人——如 Kevin 所說，需要一點時間讓他們上手。但他們已經完成銷售團隊訓練，目前也已在第一線，因此當我們進入 2017 年後段時，會開始期待他們帶來貢獻。

Terrific. And then just a follow-up question. It sounds like some of the noise that we talked about on the third-quarter call has quieted down. Anything particular that drove that other than -- I won't even answer my own question. What caused that quieter or calmer moment?

太好了。接著再追問一題。聽起來我們在第三季電話會議上談到的一些雜音已經安靜下來了。除了——我甚至不自己回答了。是什麼造成那段比較安靜或比較平穩的時刻？

The news is out between particularly with respect to 670G. There was a pretty broad-based media blips surrounding 670G, both from Medtronic and some from other industry advocacy groups.

消息已經出來了，特別是關於 670G。圍繞 670G 有相當廣泛的媒體短暫報導，既有來自 Medtronic 的，也有一些來自其他產業倡議團體。

So it's just quieted down at this point. They still haven't launched the product and still remains to be seen when they will actually start the commercial launch and to what scale and scope that commercial launch will be when they actually do launch it. So I think just the noise has certainly died down in the clinics and otherwise.

所以目前就是安靜下來了。他們仍然還沒有推出該產品，至於他們何時會真正開始商業化上市，以及一旦上市其商業化推廣的規模與範圍會到什麼程度，仍有待觀察。因此我認為這些雜音在診所內外確實都已經消退了。

Very helpful. Have a good evening, thank you.

非常有幫助。祝你晚上愉快，謝謝。

Tom Bakas, Piper Jaffray.

Tom Bakas，Piper Jaffray。

Thanks for squeezing me in. My first question -- I just want to make sure I heard you correctly. Did you say that the second-generation Verily product is now potentially a 2021 product? And if so -- go ahead, sorry.

謝謝讓我插個問題。我的第一個問題——我只是想確認我聽得沒錯。你是說第二代 Verily 產品現在可能會是 2021 年的產品嗎？如果是的話——請繼續，不好意思。

We are focused on 2020. We added 2021 to be conservative, just in case. Our focus is 2020 right now.

我們專注於2020年。我們把2021年也加進去是為了保守起見，以防萬一。我們目前的重點是2020年。

Okay.

好的。

And we just -- you know what? We did that to give ourselves a bit of a hedge. I don't think anybody would be happy if we are at 2021. But you know what? There's a lot going on in our industry that will be moving between now and when that product gets launched. And there's a lot of variables that are not under our control at this point in time.

而且我們只是——你知道嗎？我們這麼做是為了給自己留一點避險空間。我不認為如果我們落到2021年，會有人高興。但你知道嗎？我們產業在現在到那個產品上市之間，會有很多事情在變動。而且目前有很多變數不在我們的控制之下。

So we did that to be a little conservative. We have very aggressive timelines for that system and we will stick with them.

所以我們這麼做是為了稍微保守一點。我們對那套系統有非常積極的時程規劃，而且我們會堅持照著做。

Okay, that makes sense. Thank you. And then I guess just given all the other developments that have come up over the last few quarters, the transition to the pharmacy seems to sort of taken a backseat. Just hoping you can update us on the progress of that channel shift and just how important this is moving forward for the Company.

好的，這很合理。謝謝。接著我想，考量過去幾季出現的其他各項進展，轉向藥局通路似乎有點被擱置了。希望你能更新一下這個通路轉移的進度，以及這件事對公司未來的重要性。

Of all the issues we've started, this is the one that has moved, quite frankly, slower than anything that we've wanted to. And the key -- there have been two factors that have made it slower than we'd like.

在我們啟動的所有議題中，坦白說，這一項的進展比我們想要的任何事情都慢。關鍵——有兩個因素讓它比我們希望的更慢。

Number one, we want to maintain a certain level of pricing. So we've had opportunities to move from time to time where pricing is just prohibitive and we are not willing to accept those options.

第一，我們希望維持一定的定價水準。所以我們有時候確實有機會轉移，但價格實在高得令人卻步，我們不願意接受那些選項。

And the other one, in all honesty, our providers, our payers, everybody does not share the same sense of urgency with our technology that we do. Whereas we see this opportunity to make it wonderful for people to go to the drugstore and pick this up, by the time somebody from accounting goes back and figures out how many Type 1 patients they have in the system and how many Type 1 patients use CGM, it takes time.

第二，老實說，我們的醫療服務提供者、付款方（payers）、所有人，對我們技術的急迫感並不像我們一樣。我們看到的是一個讓人們可以很棒地去藥局取貨的機會；但等到會計部門的人回頭去算系統裡有多少第一型患者、又有多少第一型患者使用CGM，這需要時間。

And we've had numerous creative proposals by our payer team to get us to pharmacy, to move more of that, that literally have -- they haven't died, they are just being evaluated beyond belief. And we would love to go there.

而且我們的付款方團隊提出了許多有創意的方案，想把我們帶進藥局通路、把更多量移過去；但這些方案真的——它們沒有死掉，只是被評估得超乎想像地久。我們也很想走到那一步。

I think as we go forward, in 2020, when we are selling the Verily Band-Aid type product, or 2021 if I go with the conservative, that has to be sold at the drugstore. We can't handle the demand that we're going to have for this number of patients, even in Type 2. With 20 million patients, as you look at penetrating that in rates of intermittent use much higher than what we have now, those products all have to be sold on the direct store and the reimbursement channel has to change.

我認為往後看，在2020年，當我們銷售Verily的OK繃（Band-Aid）式產品時——或者如果我採取保守說法是2021年——那就必須在藥局販售。以我們將面對的患者數量需求，我們無法承受那樣的需求量，即便是在第二型。以2,000萬名患者來看，當你思考以遠高於目前的間歇性使用滲透率去切入時，這些產品都必須透過零售通路銷售，而且報銷通路必須改變。

For our current Type 1 population, that change has not happened as quickly as we would like it. And quite frankly, it hasn't had to to sustain our growth. Over time, we believe that's where our technology needs to be. And we are going to look at some different approaches, some different contract type approaches, and maybe, quite frankly, keeping some of it in the DME and trying to get it easier for patients to get to system.

對我們目前的第一型族群而言，這個改變並沒有如我們所希望的那麼快發生。坦白說，為了支撐我們的成長，它也不一定非得立刻發生。但長期來看，我們相信我們的技術需要走向那個方向。我們會考慮一些不同的方法、一些不同的合約型態做法；也可能，坦白說，讓其中一部分仍留在DME（耐用醫療設備）通路，同時努力讓患者更容易取得這套系統。

One of the things we see in the first quarter as deductibles reset, my emails, my negative emails, bounce around as to what I get. Now, in the first quarter, what I get from everybody is: Hey, why can't I get my stuff? And usually the responses from customer service, because their deductible reset, because we have to get all this new documentation and stuff.

我們在第一季看到的一件事是，當自付額（deductibles）重置時，我收到的電子郵件——那些負面郵件——會隨之大量出現。第一季大家傳給我的內容都是：嘿，為什麼我拿不到我的東西？而客服通常的回覆是：因為你的自付額重置了，因為我們必須取得所有新的文件等等。

So I think what you'll see from us going forward, we will continue to try and go to pharmacy where it makes sense. In those cases where we are just not going to crack that barrier, what we want to do is decrease the documentation load to try and get it easier for patients to get on and to stay on and make it easier for them to buy the system.

所以我認為你們會看到我們接下來會持續在合理的情況下推進藥局通路。在那些我們就是無法突破障礙的情況下，我們想做的是降低文件負擔，讓患者更容易開始使用、持續使用，也讓他們更容易購買這套系統。

Thanks, appreciate that. Have a great night.

謝謝，感謝你的說明。祝你今晚愉快。

Tao Levy, Wedbush Securities.

Tao Levy，Wedbush Securities。

Maybe a quick clarification. I'm still obligated to ask this question, so I apologize ahead of time. The agreement that you have with the European countries that's not the same as in the US regarding the receiver, can you explain that briefly, if possible?

也許快速釐清一下。我仍然有義務問這個問題，所以先跟你致歉。你們與歐洲各國之間關於接收器（receiver）的協議，和美國的不一樣；可以的話，能否簡要說明一下？

Yes. So in essence, it is the same. In Europe, it is also a voluntary recall. But what we did agree, and we agreed in a couple countries, to affirmatively bring product back. You're going to see other countries posting similar notifications is my guess over the next months, probably. But as we mentioned in the prepared remarks, we have already -- we accrued for any potential exposure in 2016 and it shouldn't have any impact going forward.

可以。所以本質上是一樣的。在歐洲這也是自願性召回。但我們確實同意——而且是在幾個國家同意——主動把產品收回。我猜接下來幾個月你會看到其他國家也發布類似通知。但如同我們在事先準備的講稿中提到的，我們已經——我們在2016年就已就任何潛在曝險提列了準備，因此未來不應該有任何影響。

Got you. So if you have to replace those receivers in the international markets, that shouldn't have a financial impact going forward?

了解。所以如果你們必須在國際市場更換那些接收器，未來不會有財務影響？

Yes, in the selected financial markets. And again, remember, we launched the new configuration of our receiver in the fall. And so as we've sold more receivers, as we've grown since last fall, those receivers won't be subject to this initiative.

是的，在特定的國際市場。另外請記得，我們在秋季推出了新版配置的接收器。因此，隨著我們自去年秋季以來賣出更多接收器、業務成長，那些接收器不會受到這項措施影響。

But the patients in Europe got the same letter the patients did in the US when we started the recall procedure. This isn't anything new to us, and we have been talking with many of the countries for months. And many of the countries have signed off on what we did in the US and felt it was good enough.

不過，歐洲的患者在我們啟動召回程序時，收到的信件與美國患者收到的是一樣的。這對我們來說不是新鮮事，我們也已經與許多國家溝通了好幾個月。而且許多國家已經同意我們在美國所做的處理，並認為那樣就足夠。

We continue to have a patient paper in the sensor box reminding people: please test the autofunctionality of your receiver. Many of the countries felt that was good enough. Some of the others are still evaluating. Some, including the one that we read about recently, have decided it isn't. They want us to recall the devices that may be subject to autofailure and replace them with the newer configuration in the interest of patient safety. And we will do that.

我們也持續在感測器盒內放入一張給患者的紙本提醒：請測試你的接收器自動功能是否正常。許多國家認為那樣就足夠。其他一些國家仍在評估。有些國家——包括我們最近讀到的那個——已經決定那樣不夠。他們希望我們為了患者安全，召回可能會發生自動故障（autofailure）的裝置，並以新版配置替換。我們會照做。

Got you. Okay. And I didn't hear whether you reiterated your gross margin guidance that you provided at the beginning of the year, that [67% to 70%].

了解。好的。另外我沒有聽到你們是否重申年初提供的毛利率指引，也就是[67%到70%]。

We didn't change anything.

我們沒有改變任何內容。

Okay. And then lastly, you provided in your guidance for the installed base to grow around 35% this year. But your sales guidance is only -- you are guiding for 25% to 30%. What's the difference there? Because normally when I've gone back historically, those two numbers of growth rates are pretty close to each other. And this year, there seems to be a wider delta. Thanks.

好的。最後，你們在指引中提到今年裝機基礎（installed base）將成長約35%。但你們的銷售指引只有——你們預估成長25%到30%。兩者差異在哪裡？因為我回頭看過去的歷史，這兩個成長率通常相當接近。但今年看起來差距更大。謝謝。

It's primarily timing driven. When we add the new patients, we ramp over the course of the year. And the fourth quarter is always the largest number by sometimes a fair margin, the largest number of new patient additions during a given year. But those guys don't contribute from a sensor disposable perspective like patients that are already on board.

這主要是由時點所驅動。當我們新增新病患時，我們會在一年期間逐步爬升。而第四季一向是全年新增病患數最多的季度，有時甚至明顯高出許多，是某一年中新增病患最多的季度。但這些人從感測器耗材的角度來看，貢獻不像已經在使用中的病患那麼大。

I guess the other thing I would add is just the size of the installed base already. Even as we look at our monthly and quarterly numbers, new patients don't move the needle as much as they did in the past because the installed base purchase is so much of the product that's there. So I think the timing, combined with more from our installed base, are what make those numbers a little different.

我想我還要補充的另一點是，既有裝機基礎的規模已經很大。即使我們看每月與每季的數字，新病患對整體的拉動已不像過去那麼明顯，因為既有裝機基礎的採購已占了現有產品很大一部分。所以我認為，時點因素加上既有裝機基礎貢獻增加，讓那些數字看起來有些不同。

Okay, great. Thank you.

好的，很棒。謝謝。

Jeff Johnson, Robert Baird.

Jeff Johnson，Robert Baird。

Just a couple of last-minute questions here, maybe. So on CMS, I know we've talked about it a lot. But Kevin, when the document first came out in January, it looked like it included both T1 and T2 coverage.

這裡可能還有幾個臨時的最後問題。關於 CMS，我知道我們談了很多。但 Kevin，當文件在一月剛出來時，看起來同時包含了 T1 與 T2 的給付範圍。

I'm assuming that's probably a negotiated point, though, with the MACs. Just maybe your latest feeling on do we see T2 coverage early on once some of the coverage starts coming in?

我猜這可能是與 MACs 協商後的結果。想請你談談你最新的看法：一旦一些給付開始落地，我們是否會在初期就看到 T2 的給付？

And then I had heard -- and I don't remember where I heard this, but that you are maybe not having to negotiate with all 12 MACs, that there's more consolidated negotiating point there that you are dealing with. Can you just flesh that out for me a little bit?

另外我有聽說——我不記得是在哪裡聽到的——你們可能不需要和全部 12 家 MACs 都逐一協商，而是有一個更集中的協商窗口在對接。你能不能再多說一點，幫我釐清？

Yes, it's Steve. I would say it's too early to tell on the first part of your question. We are not deep enough in discussions to know what the scope is going to look like. But you are correct in that under Part B, where we reside, there are only four MACs that we need to actually work together with. So it's a much more efficient process than under Part D.

是的，我是 Steve。我會說，就你問題的第一部分而言，現在還太早下結論。我們的討論還不夠深入，還不知道範圍最後會長什麼樣子。但你說得沒錯，在我們所屬的 B 部分（Part B）之下，實際上我們只需要與 4 家 MACs 合作即可。所以相較於 D 部分（Part D），流程效率高得多。

That's what I was going to say: just more efficient, easier to get these agreements put in place. And then Kevin, you talked about your 50-year-old and older patient base being the most loyal portion of the wearers.

這正是我想說的：更有效率，也更容易把這些協議建立起來。另外 Kevin，你提到 50 歲以上的病患族群是配戴者中最忠誠的一群。

I don't know that I've asked this question before, but as patients age into the Medicare population at 65, what is the dropout rate? Is it a very high dropout rate? Or said another way, I'd assume your penetration rate in the Medicare population is pretty low. I just don't know if I've ever heard you answer that question.

我不確定以前有沒有問過這個問題，但當病患年齡到了 65 歲、進入 Medicare 人口時，流失率是多少？流失率會很高嗎？或者換個說法，我猜你們在 Medicare 人口中的滲透率應該很低。我只是想不起來是否聽過你回答過這題。

It's been very low because they don't have reimbursement. So our dropout rate has been relatively high unless they want to pay cash. So it has been a challenge for us.

一直都很低，因為他們沒有給付。所以除非他們願意自費，我們的流失率就相對偏高。因此這對我們來說一直是個挑戰。

Yes, and I guess that was my question. You said they were very loyal after 50. So most of them know they are loyal until 65 and then they do drop out, so this is a very low penetration rate.

是的，我想這就是我在問的。你說他們在 50 歲之後非常忠誠。所以他們大多在 65 歲之前都很忠誠，但到了 65 歲就會流失，因此滲透率非常低。

And we get heartbreaking emails from them or from their spouses all the time.

而且我們經常收到他們或他們配偶寄來令人心碎的電子郵件。

Yes, understood. I just wanted to make sure. Thanks, guys.

是的，了解。我只是想確認一下。謝謝各位。

They just can't afford it.

他們就是負擔不起。

Thank you. We have no further questions at this time.

謝謝。目前沒有其他問題。

You know what? I'm going to offer some concluding remarks and then we'll be done. Thanks, everybody, for the questions and for listening. Year-end earnings calls are a great time of reflection as we look back at the accomplishments of another year and a year of much confusion and turmoil in the diabetes industry.

你知道嗎？我會做一些結語，然後我們就結束。謝謝大家的提問與收聽。年終財報電話會議是很好的反思時刻，讓我們回顧又一年的成果——同時也是糖尿病產業充滿困惑與動盪的一年。

DexCom grew our revenues more than 40%, an annual increase of approximately $170 million in worldwide revenue. A number that's, quite frankly, more amazing than the percentage when you compare DexCom to everybody else in our industry. We received our non-adjunctive claim, CMS approval came right after the end of the year, and significant advancements have been made on the international reimbursement front.

DexCom 的營收成長超過 40%，全球年營收增加約 1.7 億美元。坦白說，當你把 DexCom 與產業中其他公司相比時，這個數字本身甚至比百分比更令人驚嘆。我們取得了非輔助（non-adjunctive）宣稱，CMS 的核准在年底剛過後不久就到位，且在國際給付方面也取得了重大進展。

All these things point to realization of our vision: that CGM will become the standard of care for diabetes, and this is going to happen very quickly. No company has a product pipeline like ours, and the investments we have made in products, facilities, people, processes, our Verily relationship, and other relationships will put us in a position to remain a leader in this industry and continue to have a major impact on the lives of people affected by diabetes, their healthcare providers, and ultimately upon reducing the cost associated with diabetes across the board. Thank you very much.

這些都指向我們願景的實現：CGM 將成為糖尿病的標準照護，而這將非常快速地發生。沒有任何公司擁有像我們這樣的產品研發管線；而我們在產品、設施、人員、流程、與 Verily 的合作關係以及其他合作關係上的投資，將使我們得以持續保持產業領導地位，並持續對受糖尿病影響的人、他們的醫療照護提供者產生重大影響，最終也將全面降低與糖尿病相關的成本。非常感謝。

Thank you. Ladies and gentlemen, this concludes today's conference. Thank you for participating. You may now disconnect.

謝謝。各位女士、先生，今天的會議到此結束。感謝各位參與。您現在可以掛線。