德康醫療 (DXCM) 2018 Q3 法說會逐字稿

Welcome to the DexCom Third Quarter 2018 Earnings Release Conference Call. My name is Adrian, and I will be your operator for today's call. (Operator Instructions) Please note this conference is being recorded. I'll now turn the call over to Matt Dolan. Matt Dolan, you may begin.

歡迎參加 DexCom 2018 年第三季財報發布電話會議。我是 Adrian，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。現在我將把電話交給 Matt Dolan。Matt Dolan，您可以開始了。

Thank you, operator, and welcome to the DexCom's Third Quarter 2018 Earnings Call. Our agenda begins with Kevin Sayer, DexCom's Chairman, President and CEO, who will provide a summary of the quarter; followed by a financial review and outlook from Quentin Blackford, our Executive Vice President and CFO; and then a strategic update from Steve Pacelli, our Executive Vice President of Strategy and Corporate Development.

謝謝，接線員，歡迎參加 DexCom 2018 年第三季財報電話會議。我們的議程首先由 DexCom 董事長、總裁兼執行長 Kevin Sayer 開場，提供本季摘要；接著由我們的執行副總裁兼財務長 Quentin Blackford 進行財務回顧與展望；然後由我們的策略與企業發展執行副總裁 Steve Pacelli 提供策略更新。

Following our prepared remarks, we will open up the call for your questions. (Operator Instructions)

在我們的準備發言之後，我們將開放提問。(接線員指示)

Before we dive in, I'm also pleased to announce that DexCom will be hosting an investor meeting next month on Tuesday, December 4 in Orange County, California, where we will discuss our business and long-term outlook in more detail. The event will be available by webcast. Attendance in person is by invitation-only and space is limited. So please make sure to reach out to us directly with any questions. We look forward to seeing a number of you there and diving deeper into the opportunities we see ahead of us.

在我們開始之前，我也很高興宣布 DexCom 將於下個月在加州橘郡於 12 月 4 日（週二）舉辦投資人會議，屆時我們將更詳細地討論我們的業務與長期展望。本活動將提供網路直播。現場出席採邀請制，且名額有限。因此如有任何問題，請務必直接與我們聯繫。我們期待在現場見到各位中的許多人，並更深入探討我們所看到的未來機會。

With that, let's review our Safe Harbor statement. 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. All forward-looking statements included in this presentation are made as the date hereof based on information currently available to DexCom and are subject to various risks and uncertainties, and actual results could differ materially from those anticipated in the forward-looking statements.

接下來，我們來回顧我們的「安全港」聲明。我們在今天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。本簡報所包含的所有前瞻性陳述均以本簡報日期為準，係基於 DexCom 目前可得資訊作出，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前瞻性陳述所明示或暗示者產生重大差異的因素，已詳載於 DexCom 的 Form 10-K 年報、Form 10-Q 季報及其他向美國證券交易委員會提交的文件中。除法律要求外，我們不承擔在本簡報日期之後更新任何此類前瞻性陳述，或使該等前瞻性陳述與實際結果一致的義務。

Additionally, during the call, we will discuss certain financial measures that have not been prepared in accordance with GAAP with respect to our non-GAAP and cash-based results and our rate of growth in our revenues. 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，我們將討論若干未依 GAAP 編製的財務衡量指標，涉及我們的非 GAAP 與以現金為基礎的結果，以及我們營收的成長率。此額外資訊的呈現不應被孤立看待，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。

Please refer to the tables in our earnings release and the Investor Relations portion of our website for a reconciliation of these measures to their most directly comparable GAAP financial measures.

請參閱我們的財報新聞稿中的表格，以及我們網站「投資人關係」專區，以取得這些衡量指標與其最直接可比之 GAAP 財務衡量指標的調節表。

Now I will turn it over to Kevin.

現在我把電話交給 Kevin。

Thank you for joining us. I'm excited to report that DexCom has maintained a strong momentum that we have seen all year with third quarter sales up 45% over the same period last year on a constant currency basis. Both the U.S. and OUS businesses were solid, driven by a continued increase and awareness around the value and convenience of real-time CGM.

感謝各位加入我們。我很高興報告，DexCom 延續了我們今年以來所見的強勁動能，第三季銷售額在固定匯率基礎上較去年同期成長 45%。美國與美國以外（OUS）業務皆表現穩健，主要受惠於市場對即時連續血糖監測（CGM）價值與便利性的認知與採用持續提升。

The G6 launch has been well received, helping to drive strong new patient additions. To give you some perspective, our U.S. commercial new patient pipeline has more than doubled as compared to this time last year, and our Medicare business continues to build nicely.

G6 的上市反應良好，有助於帶動強勁的新病患新增。提供一些背景，我們美國商業端的新病患管線相較去年同期已增加逾一倍，而我們的 Medicare 業務也持續穩健成長。

Our OUS business grew faster this quarter than in any period over the last 5 years. Remember, of course, that the franchise was much smaller 5 years ago. Our investments in the international infrastructure are clearly paying off as all of our key markets showed growth in the quarter. As noted from our numbers, demand continues to outpace expectations. We have been moving aggressively to build up incremental capacity and are making meaningful investments to ramp production and service capabilities.

本季我們的 OUS 業務成長速度為過去 5 年任何期間之最。當然要記得，5 年前該業務規模小得多。我們對國際基礎建設的投資顯然正在開花結果，所有主要市場在本季皆呈現成長。從我們的數字可見，需求持續超出預期。我們一直積極擴增額外產能，並進行具實質意義的投資，以提升產量並擴充服務能力。

From a comps perspective, DexCom remains committed to demonstrating leverage. Revenue growth exceeded the increase in operating expenses by more than 2x for both the third quarter and our year-to-date results.

從可比性角度來看，DexCom 仍致力於展現營運槓桿。無論是第三季或年初至今，營收成長均超過營運費用增幅 2 倍以上。

Quentin will provide you with more detail around our financial performance and outlook in a moment.

Quentin 稍後將就我們的財務表現與展望提供更多細節。

The G6 system is already available in 14 countries and we will continue to roll it out globally in 2019.

G6 系統目前已在 14 個國家上市，我們將在 2019 年持續於全球推廣。

As part of our plans, we recently announced that CMS has approved G6 and we intend to bring this great technology to our Medicare eligible customers in early 2019.

作為我們計畫的一部分，我們近期宣布 CMS 已核准 G6，我們打算在 2019 年初將這項卓越技術帶給符合 Medicare 資格的客戶。

All in all, we put up a fantastic quarter. Considering the significant level of demand for DexCom's CGM and the benefits of the new product cycle, we have again increased our revenue outlook. 2018 has exceeded our expectations in every way.

總而言之，我們交出了一個非常出色的季度成績。考量 DexCom CGM 的顯著需求水準以及新產品週期帶來的效益，我們再次上調營收展望。2018 年在各方面都超出我們的預期。

In G6, we have the technology to build on our industry-leading sensor performance and truly enhances the patient experience more than anything we have ever done. But most importantly, we are only 5 months into the launch and see significant potential in this platform over the next several years.

在 G6 上，我們擁有可在業界領先的感測器效能基礎上持續精進的技術，並且相較以往任何產品都更能真正提升病患體驗。但最重要的是，我們距離上市僅 5 個月，並看見此平台在未來數年具備顯著潛力。

With that, I will now turn the call over to Quentin for a review of our financials.

接下來，我把電話交給 Quentin，請他回顧我們的財務表現。

Thank you, Kevin. Today we reported worldwide revenue of $266.7 million for the third quarter of 2018 compared to $184.6 million for the same quarter in 2017, reflecting growth of 44% on a reported basis or 45% excluding the impact of currency, and representing the fourth quarter in a row of accelerating growth.

謝謝你，Kevin。今天我們公布 2018 年第三季全球營收為 2.667 億美元，對比 2017 年同季的 1.846 億美元；以報告基礎計算成長 44%，若排除匯率影響則成長 45%，並且是連續第四個季度成長加速。

Notably, our key indicators including growth in sensor volumes, international revenue and our global patient installed base all drove our third quarter growth rate in a sequential quarterly increase in revenue of 10%.

值得注意的是，我們的關鍵指標（包括感測器出貨量成長、國際營收以及全球病患裝機基礎）皆推動第三季成長率，使營收在季度環比上升 10%。

Notwithstanding a terrific result for the quarter and consistent with previous commentary around our guidance, we began to realize reduced revenue per patient for a few reasons: International continues to become a larger part of our business; Medicare continues to become a bigger part of the U.S. franchise; and we have had success in moving some of our commercial payer contracts into the pharmacy channel.

儘管本季成果非常亮眼，且與我們先前對財測的評論一致，我們開始因幾個原因而看到每位病患的營收下降：國際業務持續成為我們業務中更大的一部分；Medicare 持續成為美國業務版圖中更大的一部分；以及我們成功將部分商業保險支付方合約轉移至藥局通路。

Adjusting for those headwinds, our U.S. revenues would have grown approximately 40% in the quarter versus the 34% reported.

若調整上述逆風因素，我們美國營收在本季的成長約可達 40%，而非報告的 34%。

International sales were up 93% over Q3 2017 on a reported basis or 95%, excluding the impact of foreign currency and grew 22% quarter-over-quarter. International hit another high watermark as it represented 24% of worldwide sales in the quarter with all major markets nearly doubling from the prior year.

國際銷售額在報告基礎上較 2017 年第三季成長 93%，若排除外幣影響則成長 95%，且季度環比成長 22%。國際業務再創新高水位，本季占全球銷售的 24%，所有主要市場幾乎較去年同期倍增。

Our third quarter gross profit was $168.6 million, resulting in a gross margin of 63.2% for the quarter and in line with our expectations.

我們第三季毛利為1.686億美元，使本季毛利率達63.2%，符合我們的預期。

As anticipated on our last call, the teams have been working hard to eliminate the inefficiencies of ramping production in starting new production lines, which allowed us to exit the quarter with production deals back in line with historic levels and positioning us well to see an improving gross margin in the fourth quarter.

如同我們上次電話會議所預期，各團隊一直努力消除在擴產與啟動新產線時的低效率，讓我們在季末時的生產良率已回到歷史水準，並使我們具備良好條件在第四季看到毛利率改善。

Operating expenses were $154.7 million for Q3 2018 compared to $127.5 million for Q3 2017. This reflects an increase of 21% year-over-year and compares favorably to our revenue growth of 44%.

這反映年增21%，相較於我們44%的營收成長，表現更為有利。

For the first 9 months of the year, we have realized top line growth of 39%, while operating expenses have grown at less than half of that rate at 18%. This comes even as we continue to invest in key strategic initiatives that positions DexCom well for the future.

今年前9個月，我們的營收成長達39%，而營業費用僅以18%的速度成長，不到其一半。即便如此，我們仍持續投資於關鍵策略性計畫，使DexCom在未來具備良好定位。

Adjusted EBITDA, which excludes the impact of share-based compensation, foreign currency losses and $35 million of investment income, was $48.8 million or 18% of revenue for the third quarter, an improvement of 250 basis points year-over-year and 700 basis point sequentially.

調整後EBITDA（排除股份基礎給付、外匯損失及3,500萬美元投資收益的影響）為4,880萬美元，約占第三季營收的18%，年增改善250個基點，且較前一季改善700個基點。

Our GAAP net income was $46.6 million or $0.52 per share. Adjusting to exclude the $35 million of investment income and $3 million of noncash interest expense related to our convertible notes, non-GAAP net income was $15.1 million or $0.17 per share.

依GAAP計算，我們的淨利為4,660萬美元，或每股0.52美元。若調整排除3,500萬美元投資收益，以及與可轉換公司債相關的300萬美元非現金利息費用，非GAAP淨利為1,510萬美元，或每股0.17美元。

Our balance sheet remains strong having ended the quarter with $669 million in cash and equivalents and full availability of our $200 million revolving line of credit.

我們的資產負債表仍然強健，本季末現金及約當現金為6.69億美元，且2億美元循環信用額度仍可全額動用。

Turning to guidance. We are increasing our annual revenue forecast by $50 million to $975 million reflecting a reported growth of 36%, essentially 2x our original growth outlook at the beginning of the year.

接著談財測。我們將全年營收預估上調5,000萬美元至9.75億美元，反映報告口徑成長36%，基本上是年初原先成長展望的2倍。

As we planned at the beginning of the year and realized in the third quarter, we expect the impact of lower revenues per patient to continue into the fourth quarter.

如同我們年初規劃並在第三季所實現的，我們預期每位病患的收入下降所帶來的影響將延續至第四季。

In line with our previous comments, we anticipate gross margin to rebound in the fourth quarter to approximately 65%, resulting in a gross margin of 64% for the full year.

與我們先前的評論一致，我們預期第四季毛利率將回升至約65%，使全年毛利率達64%。

Despite the $50 million increase in our annual top line expectation, we are not revising our overall operating expense outlook and continue to expect GAAP operating expenses will increase by approximately 18% for the full year. This includes both our core operating expenses as well as investments being made for new market opportunities.

儘管我們將全年營收預期上調5,000萬美元，我們不調整整體營業費用展望，仍預期全年GAAP營業費用約增加18%。這包含核心營運費用，以及為新市場機會所進行的投資。

As I reflect on my first full year as CFO, I could not possibly be more excited about top line growth prospects, ever-increasing opportunities for innovation that will continue to set us apart and importantly, our commitment to becoming more efficient in how we conduct our business.

回顧我擔任CFO的第一個完整年度，我對營收成長前景、持續讓我們脫穎而出的創新機會，以及更重要的是我們致力於提升營運效率的承諾，感到無比振奮。

Notably, the teams are demonstrating a strong desire to manage spend appropriately, allowing us to make investments where necessary and deliver an improving profitability profile at the same time, setting up for an exciting future.

值得注意的是，各團隊展現出強烈意願以適當方式管理支出，使我們能在必要處進行投資，同時交付更佳的獲利能力輪廓，為令人期待的未來奠定基礎。

With that, I will now turn the call over to Steve for a strategic update.

接下來，我將把電話會議交給Steve，請他提供策略更新。

Thank you, Quentin. The launch of G6 remains DexCom's primary strategic priority for the remainder of 2018 and into 2019.

謝謝你，Quentin。G6的上市推進仍是DexCom在2018年剩餘期間及進入2019年的首要策略重點。

Beyond G6, we are thrilled to welcome TypeZero Technologies to the DexCom family, following our acquisition of the company in August. The team and the company's technology align well with our strategy. Specifically, the inControl closed-loop algorithm provides DexCom with a medical clinical component in an automated delivery system.

除了G6之外，我們也非常高興在8月完成收購後，歡迎TypeZero Technologies加入DexCom大家庭。該團隊與公司的技術與我們的策略高度契合。具體而言，inControl閉環演算法為DexCom在自動化給藥系統中提供了醫療臨床組件。

We look forward to first bringing it to market with our [San Diego neighbors and then] (inaudible). In addition, TypeZero will advance our decision to support the road map, which includes both our core intensive business and other non-intensive programs.

我們期待首先與我們的[聖地牙哥鄰居，然後]（聽不清）一起將其推向市場。此外，TypeZero也將推進我們對產品路線圖的支持，其中包含我們的核心重度（intensive）業務以及其他非重度（non-intensive）計畫。

The TypeZero acquisition was catalyzed, in part, by the FDA's iCGM classification for G6, which we believe will help bring a greater number of insulin delivery solutions integrated with DexCom's CGM platform to market over the next couple of years.

TypeZero的收購部分是受到FDA對G6授予iCGM分類的推動；我們相信這將在未來幾年協助更多與DexCom CGM平台整合的胰島素給藥解決方案推向市場。

The shift towards CGM integrated systems is advancing quickly, including both automated insulin delivery and smart pens, and we are confident in the competitive position that we have developed through our collaborative strategy.

朝向CGM整合式系統的轉變正在快速推進，涵蓋自動化胰島素給藥與智慧胰島素筆等領域；我們對透過協作策略所建立的競爭地位充滿信心。

In addition to Tandem, we are encouraged that Insulet and Lilly continue to progress well for product offerings that will simplify diabetes management. And at DAST last month, Novo Nordisk announced that they have added DexCom as a partner in its connected pen offerings.

除了Tandem之外，我們也樂見Insulet與Lilly在可簡化糖尿病管理的產品供應方面持續取得良好進展。此外，在上個月的DAST會議上，Novo Nordisk宣布已將DexCom納入其連網胰島素筆產品的合作夥伴。

Our vision for DexCom role in insulin delivery is crystal (inaudible). Whether patients just prefer that their insulin is delivered by pump or pen, we are ensuring that their integrated systems can be driven by DexCom sensor technology, and that their data can be presented and assessed in one complete picture.

我們對DexCom在胰島素給藥領域所扮演角色的願景非常清晰（聽不清）。無論病患偏好以幫浦或胰島素筆注射胰島素，我們都在確保其整合式系統能由DexCom感測器技術驅動，並讓其數據能以單一完整圖像呈現與評估。

Beyond our core insulin business, we continue to explore new market opportunities that will expand DexCom's long-term growth profile. For example, many of these other recent 510(k) clearances we've received for devices supporting our development efforts outside of our intensive business. The first clearance relates to a software application based on our core G6 sensor and algorithm and had certain features that are tailored to people with diabetes in the nonintensive population. And the second is a fully disposable glucose recording device indicated for all people, 2 years and older, not exclusively to people with diabetes. We believe this product is the first set in making CGM a valuable diagnostic tool across all of health care. This is a great example of the advantage of our Class 2 designation as we can rapidly iterate the 510(k) route while meeting the stringent performance criteria managed by special controls. And although we are still early, we believe the G6 system is truly a platform technology and you will see us continue to invest in these initiatives over the next few years.

除了核心胰島素業務之外，我們持續探索新的市場機會，以擴大DexCom的長期成長輪廓。例如，我們近期取得的多項510(k)核准，支持我們在重度業務之外的開發工作。第一項核准與一款基於我們核心G6感測器與演算法的軟體應用程式相關，並具備針對非重度族群糖尿病患者量身打造的特定功能。第二項則是一款完全拋棄式的葡萄糖記錄裝置，適用對象為所有2歲以上人群，而非僅限糖尿病患者。我們相信此產品是讓CGM成為全醫療照護領域有價值診斷工具的第一步。這也很好地展現我們Class 2分類的優勢：我們能在符合由特殊管制（special controls）所管理之嚴格性能標準的同時，透過510(k)途徑快速迭代。雖然仍處於早期階段，但我們相信G6系統確實是一項平台技術，未來幾年你們將看到我們持續投資這些計畫。

As you can see, we have made significant progress with our pipeline, building on the capability of our G6 platform. We will begin using disposable G6 CGMs in various pilot activities in 2019 and beyond. Additionally, with respect to our product collaboration with Verily, we continue to consider options to utilize the first-generation system. But we have shifted significant resources to the second generation device, which is on track for a late 2020 or early 2021 commercial release.

如各位所見，我們在產品管線方面已取得顯著進展，並以G6平台能力為基礎持續建構。我們將在2019年及之後，於各種試點活動中開始使用拋棄式G6 CGM。此外，關於我們與Verily的產品合作，我們仍在評估如何利用第一代系統的選項。但我們已將大量資源轉向第二代裝置，並正按計畫於2020年末或2021年初進行商業化上市。

With that, I will pass it back to Kevin.

接下來我把時間交還給Kevin。

Thank you, Steve. We are very pleased with DexCom's performance through the first 9 months of 2018 and continue to push the team to ramp up G6 production to meet demand. As you can tell, we've exceeded growth expectations as CGM accelerates, and patients realize the clear benefits of DexCom's capabilities. With respect to our outlook, our new growth guidance is twice what we anticipated at the beginning of the year. And we're still only scratching the surface of the opportunity for CGM and remain confident in our ability to grow over time.

謝謝你，Steve。我們對DexCom在2018年前9個月的表現非常滿意，並持續推動團隊提升G6產能以滿足需求。如各位所見，隨著CGM加速成長、病患也認知到DexCom能力的明確效益，我們已超越成長預期。就展望而言，我們最新的成長指引是年初預期的兩倍。而我們對CGM的機會仍只是觸及皮毛，並對我們隨時間推進持續成長的能力保持信心。

With a number of market dynamics still in play, we will remain thoughtful in how we establish our forward expectations. To the DexCom team, what a year so far, and let's finish strong. The company's leadership is incredibly grateful for everyone's hard work this year throughout the world, including our new friends at TypeZero in Charlottesville, Virginia.

在多項市場動態仍在發酵之際，我們將持續審慎地建立對未來的預期。致 DexCom 團隊：今年迄今為止表現非凡，讓我們強勢收尾。公司管理團隊對全球各地每一位同仁今年的辛勤付出深表感謝，也包括我們在維吉尼亞州夏洛茨維爾 TypeZero 的新夥伴。

To wrap up, 2018 is proving to be a wonderful year thus far for DexCom and we remain in the early stages of the launch of G6 and the growth of real-time CGM. We look forward to seeing many of you next month in our industry day. We would now like to open up the call for Q&A. Matt?

總結來說，2018 年迄今對 DexCom 而言是非常精彩的一年，而我們仍處於 G6 上市推進與即時 CGM 成長的早期階段。我們期待下個月在產業日與各位中的許多人見面。現在我們想開放電話會議進入問答環節。Matt？

Thank you, Kevin. (Operator Instructions) Operator, please provide the complete Q&A instructions.

謝謝你，Kevin。（接線員指示）接線員，請提供完整的問答說明。

(Operator Instructions) And the first question comes from JP McKim from Piper Jaffray.

（接線員指示）第一個問題來自 Piper Jaffray 的 JP McKim。

I actually wanted to start first talking about the approval that you have out there. A, I didn't know you were working on your own disposable, and so if you could elaborate on that? And then maybe two, you had a lot of conversation with payers lately in terms of changing the business model and are they open to covering this noninvasive (sic) [nonintensive] patient population at this time or are they waiting for future clinical data?

我其實想先從你們目前取得的核准談起。第一，我不知道你們也在做自家的拋棄式產品，所以能否請你們多說明一下？第二，最近你們與付款方就商業模式調整有很多討論；他們目前是否願意承保這個非侵入式（原文誤稱）[非密集]的病患族群，還是他們在等待未來的臨床數據？

This is Steve. I'll take the first part and I'll let Kevin handle the insurance reimbursement portion. So yes, I mean, we've always maintained that G6 is a platform technology, right? So what you saw in the [510(k)] is nothing more than really an extension of the core G6 platform. But quite frankly, we expect to ride this platform for a number of years just seeing it follows that the transition from kind of G4, G5 to G6 just didn't happen overnight. So while we're still big believers in that second generation Verily disposable, we thought it best to leverage something particularly in the IT scale world where we consider it very rapidly off of our existing platform. We thought it was in our best interest to start learning and advancing our strategies outside of our core intensive insulin [formulas]. So with respect to churn, I mean, we've got a number of pilots in the works. You guys know about the [pen] pilot. Kevin, I'll let you...

我是 Steve。我先回答第一部分，保險給付的部分我讓 Kevin 來說。是的，我們一直強調 G6 是一個平台技術，對吧？所以你在 [510(k)] 看到的，其實只是核心 G6 平台的延伸。但坦白說，我們預期會在這個平台上運行好幾年；因為從 G4、G5 過渡到 G6 並不是一夕之間完成的。因此，雖然我們仍然非常看好第二代 Verily 拋棄式產品，但我們認為最好是善用既有平台，特別是在我們認為能夠非常快速擴張的 IT 規模世界中。我們認為，開始在核心的密集胰島素[方案]之外學習並推進我們的策略，符合我們的最大利益。至於流失率（churn），我們正在進行多個試點。各位也知道那個[胰島素筆]試點。Kevin，我交給你……

With respect to the non-intensive world, we do believe that payers will eventually cover that. It depends upon the form of the program and how the CGM is going to be used. I think one of the 510(k)s that you saw approved where we have a device that could be used across all segments of the health care world, not just patients with diabetes is a good step in that as a diagnostic product as well. We do believe we will get payment for that but that's going to take years to develop. I mean, we're several years into getting CGM reimbursement in the Type 1 and intensive space for now and that's going to take a while also, but we're optimistic. We're very confident it will happen.

就非密集治療領域而言，我們確實相信付款方最終會予以承保。這取決於方案的形式以及 CGM 將如何被使用。我認為你們看到獲批的其中一個 510(k)，我們的裝置可用於醫療照護世界的所有區隔，不僅限於糖尿病患者，作為診斷產品也是朝這方向邁出的良好一步。我們相信我們會獲得相應的支付，但這需要多年時間來發展。我的意思是，我們在第 1 型與密集治療領域爭取 CGM 給付也已經推進了好幾年，這也還需要一段時間，但我們保持樂觀。我們非常有信心這一定會發生。

That's helpful. And then maybe can you just give like broader base, I know you're -- like where are you at in terms of your covered lives in terms of unique channels like the pharmacy versus subscription? Like are you 30% of your volumes go that way? The rest all goes to DME? Like how long could this revenue per patient kind of be a little bit of a headwind? And are you getting more active in the volumes to offset that?

這很有幫助。接著能否請你們從更宏觀的角度說明一下：我知道你們——就你們的承保人數（covered lives）而言，在藥局通路相對於訂閱制等獨特通路方面，目前進展到哪裡？例如是否有 30% 的出貨量走那條路？其餘都走 DME（耐用醫療設備）？每位病患收入（revenue per patient）這種逆風大概還會持續多久？你們是否透過更積極的出貨量來抵消它？

This is Quentin here. Good question. We're north of 40% of our lives -- covered lives are through the pharmacy channel now. I would say that G6 is in the majority of all of those. So we made great progress in bringing G6 into that channel, if you will, and there is a lot of benefit that comes with it. Obviously, ease of access for the patients, which we believe over time can improve utilization trends and they'll become easier for the physicians who subscribe as well, which we think has implications on volume and then just generally trying to expand the coverage universe as we move into that channel also. So our view is, we're starting to realize some of the revenue per patient headwinds that we started to communicate at the beginning of the year. Obviously, we're navigating that quite well with the 44% growth in the quarter. We believe we can continue to do that as volume remains very strong. So highly confident in our ability to navigate through it, but we're going to see it in the fourth quarter. You'll probably see a bit of it in Q1 and Q2 of next year, then we start to anniversary out what we just saw in Q3 and will have seen in Q4. So that's what we think about it.

我是 Quentin。好問題。目前我們超過 40% 的承保人數——也就是 covered lives——是透過藥局通路。我會說其中大多數都是 G6。因此，我們在把 G6 導入該通路方面取得了很大進展，而且這帶來許多好處。顯然，病患取得更便利；我們相信長期而言可改善使用趨勢；對開立處方的醫師也更容易，我們認為這會影響出貨量；同時，隨著我們進入該通路，也能整體擴大承保範圍。因此，我們的看法是：我們開始看到年初就已溝通過的每位病患收入逆風逐步顯現。顯然，我們透過本季 44% 的成長相當順利地應對。我們相信只要出貨量仍然非常強勁，就能持續做到。所以我們對於穿越這段逆風的能力非常有信心，但第四季仍會看到其影響。明年第一季與第二季可能也會看到一些，之後我們就會開始與今年第三季所見、以及第四季將見到的情況形成同比基期（anniversary out）。這就是我們的看法。

And our next question comes from Joanne Wuensch from BMO Capital Markets.

下一個問題來自 BMO Capital Markets 的 Joanne Wuensch。

I have a few questions. The first one has to do with the way that you provided guidance and that you're growing at 2x your initial growth rate. While I'm thrilled about that, don't get me wrong, where do you think it's different today than when you first set it up?

我有幾個問題。第一個與你們提供的財測指引有關：你們的成長速度是最初成長率的 2 倍。雖然我對此很振奮，但不要誤會我的意思，你認為現在與你們一開始設定指引時相比，差異在哪裡？

This is Quentin. Obviously, we talked about price or channel mix headwinds being roughly 5 to 10 points in that initial guidance at the beginning of the year. And I think what you're seeing play out -- or did play out over the course of the year, those headwinds didn't start to hit in Q1 or Q2. They've really started here in the third quarter and fourth quarter. So those pricing channel mix headwinds weren't as significant as we originally thought. That accounts for a portion of it, but the vast majority, far and away, there's just no way around it, is truly a volume increase in the overall business. And I think that comes back to the point we've talked about historically, which is where the value of CGMs becoming more and more prevalent. People are understanding it to a much greater degree and that's what really has driven the upside over the course of the year to the majority of the extent.

我是 Quentin。顯然，我們在年初的初始指引中提到，價格或通路組合的逆風大約會影響 5 到 10 個百分點。而你們看到今年的發展——或者說今年確實發生的情況是，這些逆風在第一季或第二季並未開始顯現。它們其實是在第三季與第四季才真正開始出現。因此，這些價格/通路組合逆風並沒有我們原先想像的那麼顯著。這解釋了其中一部分，但絕大多數、遠遠超過其他因素，坦白說無可迴避，是真正來自整體業務出貨量的增加。我認為這回到我們過去談過的一點：CGM 的價值正變得越來越普及。人們對它的理解程度大幅提升，而這正是今年大部分上修動能的主要驅動因素。

And my follow-up question has to do with Verily. Can you walk us through what are the steps to bring this to market? And if I read between the lines in your comments, you may not bring Type 1 to the market or did I read that wrong?

我的追問與 Verily 有關。你能否帶我們梳理一下把它推向市場需要哪些步驟？另外，如果我從你們的評論中讀出弦外之音，你們可能不會把第 1 型推向市場，還是我理解錯了？

This is Kevin. We continue to explore options with the first-generation product. We've always indicated that, that was never going to be a huge revenue producer for us. In all candor, we're all hands on deck with the G6 launch right now. So we're exploring options with product 1. Product 2 is a completely new platform, very similar to G6. We're not going to go to all the details regarding it. But suffice it to say with new electronics, new insertion system, new sensors, pretty much everything. There are going to be a lot of steps, there will be a large clinical study and there are things we're working on. That project is going very well right now and then we are on schedule with our internal plans, but it's going to be a big move-the-earth effort similar to what we've had to do with G6.

我是 Kevin。我們持續就第一代產品探索各種選項。我們一直都表示，那個產品不會成為我們很大的營收貢獻來源。坦白說，我們目前全力投入 G6 的上市推進。因此我們正在為產品 1 探索選項。產品 2 則是全新的平台，與 G6 非常相似。我們不會就此提供所有細節。但簡而言之，會有新的電子元件、新的植入系統、新的感測器，幾乎所有東西都是新的。會有很多步驟，將會有一項大型臨床研究，且有一些事項正在推進中。該專案目前進展非常順利，我們也依照內部計畫的時程在走，但這將是一項「移山」等級的大工程，類似我們為 G6 所做的努力。

And the next question comes from Robbie Marcus from JPMorgan.

下一個問題來自摩根大通（JPMorgan）的 Robbie Marcus。

This is actually Christian on for Robbie. Wanted to start first on the OUS business, I think that was probably the biggest upward surprise in the quarter, almost double the business year-over-year on a constant currency basis. What countries are you seeing being really strong growth internationally right now? And what are the opportunities for expansion that you still have ahead of you with G6 going into 2019?

其實我是代替 Robbie 的 Christian。我想先從美國以外（OUS）的業務談起，我認為這可能是本季最大的正向驚喜，以固定匯率計算，年對年幾乎翻倍。目前你們看到哪些國家在國際市場的成長特別強勁？以及在 2019 年推進 G6 時，你們在擴張方面還有哪些機會？

So when you look at the international business, it was really strength across the entire board. All of our major markets for the most part were double where they were at from the year before. So it wasn't any one particular market that outdrove or outpaced growth. This is the others that, that really drove the overall result. It was very widespread and really across all regions for that matter. So I'm very happy with what we're seeing play out in that international space. A lot of opportunity continues in front of us yet. We've gotten approval into the Japan market, same with the Korean market. Those become significant opportunities for growth into the future. We're not yet selling into those. So those become exciting opportunities. And there are several EU countries that remain opportunities for us as well. So I think, we're still in the very early stages of where that international business can grow. Obviously, having tremendous success and it is really is widespread at this point.

當你看國際業務時，基本上是全面性的強勁表現。我們大多數主要市場的表現幾乎都是去年的兩倍。因此並不是某一個特定市場帶動或超越了成長。而是其他市場共同推動了整體結果。成長非常廣泛，實際上涵蓋所有區域。所以我對我們在國際市場的發展非常滿意。我們前方仍有很多機會。我們已取得日本市場的核准，韓國市場也是如此。這些都將成為未來重要的成長機會。我們目前尚未在這些市場銷售。因此這些都是令人振奮的機會。此外，歐盟仍有數個國家對我們而言也是機會。所以我認為，我們仍處於國際業務可成長空間的非常早期階段。顯然目前已取得巨大成功，而且此刻確實是全面性的。

And then maybe turning to the U.S. Given your results and the very positive results from competitors in U.S. in the CGM space, obviously utilization has ticked up pretty significantly. Do you have an updated estimate of where type 1 CGM utilization stands in the U.S. and where you see that going, going forward?

接著談到美國市場。鑑於你們的表現，以及競爭對手在美國 CGM 領域也有非常正面的成果，顯然使用率已相當明顯地上升。你們是否有更新的估計：美國第一型糖尿病（type 1）的 CGM 滲透率目前大約是多少？以及你們認為未來會如何發展？

I think you are asking for penetration in type 1, not utilization. When we talk about utilization it's really utilization of vendors on a per patient basis. It's hard to [copy] because they're not great numbers from specific numbers out of Avid or Medtronic but we estimated the category somewhere in the 25% to 30% range in type 1. So very little penetration even in the tentative type 2 and we're just getting our feet wet in nonintensive type 2 beyond that. So probably our best estimate.

我想你問的是第一型的滲透率（penetration），而不是使用率（utilization）。當我們談 utilization 時，指的是以每位病患為基礎的供應商使用情況。這很難[copy]，因為從 Avid 或 Medtronic 並沒有很好的具體數字，但我們估計第一型整體類別大約在 25% 到 30% 的區間。因此即便在（所謂）密集型第二型（type 2）也只有很低的滲透率，而在非密集型第二型方面，我們也才剛開始起步。所以這大概是我們最好的估計。

And the next question comes from Jeff Johnson from Baird.

下一個問題來自 Baird 的 Jeff Johnson。

Quentin, maybe I want to follow up first on your 40% or greater than 40% of covered lives through pharmacy at this point. We often have this pollyannaish view that once you go to pharmacy, a doc will just have to write a script and the patient will walk out the door and go down to CVS or Walgreens and get that filled. Is that truly that 40% of U.S. commercial covered lives right now could really get CGMs that easily? Are there other hurdles there? And if there are other hurdles even in pharmacy, just kind of how do you expect that to play out over the next couple of years? Does it continue to get easier and easier for these patients?

Quentin，我想先追問一下你提到目前有 40% 或超過 40% 的受保人數（covered lives）是透過藥局通路。我們常常抱持一種過度樂觀的看法，認為一旦走藥局通路，醫師只要開處方，病患走出診間就能到 CVS 或 Walgreens 直接領到並完成配藥。目前美國商業保險的受保人數中，那 40% 真的能那麼容易就取得 CGM 嗎？是否還有其他障礙？如果即便在藥局通路仍有其他障礙，你們預期未來幾年會如何演變？對這些病患而言，是否會變得愈來愈容易？

I think that's the right way to think about it. Certainly it's much easier. Every payer has a little bit of a nuance of what they require, but the way you described it there is very much in line with how we see it moving over time and that is the ease of access that comes through the pharmacy channel and that's why we think incremental volume or even utilization trends can change for patients, which drives incremental volume over time and that becomes the attractive nature of it. And obviously, with that then comes the opportunity to reduce the back office overhead cost of administering a pharmacy claim versus a DNE claim. So you described it accurately. That's the excitement we have around that channel and that's why we think long term it is a better channel for the company to be pursuing.

我認為這樣理解是對的。確實容易得多。每個付款方（payer）在要求上都有些細微差異，但你剛才的描述非常符合我們對其隨時間推進的看法，也就是：透過藥局通路帶來的取得便利性；這也是我們認為病患的增量用量（volume）或甚至使用趨勢（utilization trends）可能會改變，進而隨時間推動增量用量，而這正是其吸引力所在。而且顯然，隨之而來的是：相較於 DNE 理賠，處理藥局理賠在後勤辦公室的管理成本更低的機會。所以你描述得很準確。這就是我們對該通路感到興奮的原因，也因此我們認為長期而言，這對公司來說是更值得追求的通路。

That's helpful. And then Kevin or Steve, maybe just would love -- we're all out there trying to talk to docs and understand the competitive environment and things like that. But as you're out there talking to your prescribers and maybe some competitive docs who are using other products, just what are you hearing out in the field with -- between Libre -- probably more Libre than the [panic] sensor at this point, but just is it truly all the market expansion? Is there some overlap where you guys are competing aggressively head-to-head for a Libre versus a G6 patient? Just any update there would be helpful.

這很有幫助。接著 Kevin 或 Steve，我也很想請教——我們都在外面試著和醫師交流、了解競爭環境等等。但當你們在外面與開立處方的醫師、以及可能使用其他產品的競品醫師交流時，你們在第一線聽到的情況是——在 Libre（目前可能更多是 Libre 而不是 [panic] 感測器）之間——這真的完全是市場擴張嗎？還是存在一些重疊，你們正在與 Libre 針對同一位病患（Libre vs. G6）進行更積極的正面競爭？任何更新都會很有幫助。

Yes, I'll take that one. As I've said about the 1% is very clear and these are 2 very different products. We are a continuous glucose monitor, which provides a continuous data feed with alerts and alarms and with a level of accuracy and standards we have to adhere to with iCGM that Libre doesn't. The providers understand that. They understand what a patient is going to get. They understand all the features that we have. We recently, for example, reviewed some Net Promoter Scores today coming from independent source, and our G6 Net Promoter Scores were off the chart. And I would tell you just anecdotally, the feedback we're getting on G6 is unlike anything we've ever done. I made the statement on the earnings call that this is a patient experience unlike anything we've ever done before and it's absolutely true. The features we put in that system make it very, very desirable. At the end of the day, we've talked about the things we need to drive more awareness and more access to get this available and get it on to more people, and we continue to do that. And so -- but we've had great response so far in our markets and we think we can take G6 to a number of places.

是的，這題我來回答。如同我提過的，那 1% 非常清楚，而且這是兩種非常不同的產品。我們是連續血糖監測（CGM），提供連續的資料流，具備提示與警報，並且在準確度與 iCGM 所要求我們必須遵循的標準方面，Libre 並不具備同等條件。醫療提供者了解這點。他們了解病患會得到什麼。他們了解我們具備的所有功能。例如，我們今天剛檢視了一些來自獨立來源的淨推薦值（Net Promoter Scores），我們的 G6 淨推薦值高得驚人。而且我可以用一些軼事來說，我們目前收到對 G6 的回饋，是我們過去從未有過的。我在財報電話會議上曾說，這是一種前所未有的病患體驗，而這完全屬實。我們在該系統中加入的功能，使其非常、非常具有吸引力。歸根結底，我們也談過需要做哪些事情來提升認知與可近性，讓更多人能取得並使用它，而我們也持續在做。因此——到目前為止，我們在各市場的反應都非常好，我們也認為可以把 G6 推向更多地方。

And our next question comes from Jayson Bedford from Raymond James.

我們的下一個問題來自 Raymond James 的 Jayson Bedford。

Just a couple. In terms of the reduction in revenue per patient, it's a bit of a -- I don't remember you calling that out, at least quantifying it in the past. Do you see any headwind in the second quarter? Or is all this tied to the G6 launch?

只有幾個問題。就每位病患營收下降而言，這有點——我不記得你過去有特別提到，至少沒有量化說明。你們在第二季是否看到任何逆風？還是這一切都與 G6 上市有關？

Yes. I think the way to think about it is -- let's separate price from mix for just a second. When we look at price at a same store, same product or same channel, very consistent view of it, we're actually seeing very good trends in the business. Price is holding in flat if not even slightly up in some of the business, particularly on the sensor side. So price itself is holding in just fine. Where you're seeing the pressure of lower revenue per patient is really from a mix perspective. That's the combination of international being larger as a portion of the overall business. That's Medicare growing faster than the overall business. But what we really saw in Q3 that became unique relative to other quarters was our approach to really push into the pharmacy channel and lead with G6. So where we were willing to concede some price for the G6 system in lieu of broader access or moving out of DME into pharmacy over time because we believe that, ultimately, incremental volumes are going to result from that. And as the volume increase will more than offset the price that we're willing to give up. So that was really a Q3 phenomenon that started to pick up. We hadn't seen it in the prior quarters. And to our guidance, we expect it to be there in Q4. So that's why we're talking about trying to describe -- it really is more of a mix issue versus pure price. Price has hung in there pretty well.

是的。我認為可以這樣理解——先把價格與組合（mix）暫時分開來看。當我們以同店、同產品或同通路來看價格，並以非常一致的方式檢視時，我們其實看到業務有非常好的趨勢。價格基本持平，甚至在部分業務略有上升，特別是在感測器端。所以就價格本身而言，維持得很好。你看到每位病患營收較低的壓力，主要其實是來自組合面。那是國際市場在整體業務中的占比提高的組合效應。也是 Medicare 成長速度快於整體業務所造成的組合效應。但我們在 Q3 看到、相較其他季度較為獨特的是，我們採取的策略是大力推進藥局通路，並以 G6 作為主打。因此，對於 G6 系統，我們願意在價格上做出一些讓步，以換取更廣泛的可及性，或隨時間推進將業務從 DME 轉向藥局通路，因為我們相信最終會因此帶來增量的出貨量。而且出貨量的增加將遠遠抵銷我們願意讓出的價格。所以那確實是從 Q3 開始出現並逐步加速的現象。在之前幾個季度我們並沒有看到。依照我們的指引，我們預期 Q4 也會持續存在。因此我們才會試著描述——這其實更像是組合問題，而不是純粹的價格問題。價格表現其實相當穩健。

Okay. That's helpful. And then just as a bit of a follow-up. Receiver growth accelerated quite a bit in the quarter. Was that a pretty clean number? Or was there a bit of a catch-up from any type of deferred revenue?

好的。這很有幫助。接著再追問一下。本季接收器（receiver）成長加速得相當明顯。那個數字是很乾淨的嗎？還是有一些來自任何類型遞延收入的追認（catch-up）？

No, no catch-up. I mean, just to be clear, on the deferred revenue or any catch-up, there was roughly $3 million in the quarter. You guys recall back in Q2, we talked about the G6 promotion program that we had. We did see $3 million come through in the quarter, but what really drove the receiver growth relative to the back end was outpaced compared to the other categories is really twofold. One, new patient additions are up significantly, and that pipeline is more than double what it was the prior year. So you're seeing the new patient realization come through that number. It shows up very clearly. And then you also have folks upgrading from the G5 to the G6 program, which, again, very encouraging for us as we think into the future as they're going to stay on that G6 system, possibly translates into other product revenue for us.

沒有，沒有追認。我的意思是，先說清楚，關於遞延收入或任何追認，本季大約是 300 萬美元。各位還記得在 Q2 時，我們談到過我們的 G6 促銷方案。本季確實有 300 萬美元入帳，但真正推動接收器成長、相較後端（back end）且超過其他類別的原因，主要有兩點。第一，新病患新增量顯著上升，而那個管線（pipeline）比去年同期多出一倍以上。所以你會看到新病患轉化的成果反映在那個數字上。表現得非常清楚。第二，也有使用者從 G5 升級到 G6 的方案；這同樣讓我們非常振奮，因為展望未來，他們會持續使用 G6 系統，並且可能為我們帶來其他產品的營收。

And our next question comes from Travis Steed from Bank of America.

我們的下一個問題來自美國銀行（Bank of America）的 Travis Steed。

I wanted to follow up on the new patient funnel. You mentioned the pipeline of new patients more than doubled. Can you maybe comment on how long it takes to convert these patients into new users and then if you can take your predictive metrics, are there any changes that would suggest that the recent momentum won't continue into 2019?

我想追問一下新病患漏斗（funnel）。你提到新病患管線增加到兩倍以上。你能否談談把這些病患轉換成新使用者大概需要多久？另外，如果你們看預測性指標，是否有任何變化顯示近期的動能不會延續到 2019 年？

Let's stick to 2018 for today. With respect to converting these patients, we do have metrics and a lot of that varies depending upon the payer mix within that pipeline. Some of the payers require much more extensive documentation than others. Others require very little and we really don't disclose that number. We have had a bit of a delay in our patient pipeline in all candor due to product availability on our side and so that has been a little slower in some cases. But by and large, referrals are coming in at a faster rate than they ever have for us, both from the payer community and from our direct-to-consumer advertising campaigns. People very much enjoy G6 and word is getting out there. We're hopeful that it's very strong in '19, but we'll wait for early '19 to give you more feedback on that.

我們今天先聚焦在 2018 年。關於把這些病患轉換成使用者，我們確實有相關指標，而其中很大一部分會因該管線中的付款方組合（payer mix）不同而有所差異。有些付款方要求更繁複的文件資料。也有些要求很少，而我們不會披露那個數字。坦白說，我們的病患管線確實因我們這邊的產品供應狀況而出現一些延遲，因此在某些情況下轉換速度稍慢。但整體而言，轉介（referrals）進來的速度比我們以往任何時候都更快，來源包括付款方社群以及我們的直接面向消費者（direct-to-consumer）的廣告活動。大家非常喜歡 G6，口碑正在擴散。我們希望 2019 年會非常強勁，但我們會等到 2019 年初再給各位更多回饋。

Okay, that's fair. And in terms of the 6-point headwind in the U.S., I don't know, Quentin, if you would be willing to split that out between the impact of Medicare versus the pharmacy channel. And also, the 40% of your business that is in pharmacy now, if you could give us a sense for maybe where that was at the beginning of the year. Just give us a sense of how quickly the business has been shifting. And also, as you're making headwinds in the pharmacy channel, can you maybe comment on margins, both gross and operating margin in that segment of the business?

好的，這樣很合理。另外，關於美國市場 6 個百分點的逆風，我不確定 Quentin 你是否願意把它拆分成 Medicare 的影響與藥局通路的影響。還有，目前你們有 40% 的業務在藥局通路，如果可以的話，能否提供一下年初大概是多少？讓我們了解業務轉移的速度有多快。另外，當你們在藥局通路面臨逆風時，能否談談該業務區塊的毛利率與營業利益率（operating margin）？

That's about 6 questions in there. Look, I'll tackle a few of those. In terms of the revenue per patient headwind in the quarter, when we normalize that U.S. growth rate to say that -- reported with that 34%, excluding the revenue per patient headwind, we would have been up around 40%. That was really all the pharmacy channel headwind for the most part, and nearly all of it was driven by that. So that was the big aspect to that. In terms of the coverage, we've seen the coverage increase. We said north of 40%. So obviously, coming into the year, we were south of there. We're seeing good progress. I think what is becoming apparent to us is that there are certainly some payers who are not going to move into the pharmacy channel. They prefer to be a DME benefit and that's how they're going to continue to adjudicate us. So we know that we're not going to see that go to 100% over time, but we do expect it will continue to do uptick and improve beyond the 40% that we see today. I think that addressed most of the questions you had in there.

你這裡大概問了 6 個問題。你看，我先回答其中幾個。就本季每位病患營收的逆風而言，若我們把美國成長率做常態化來看——也就是在已報告的 34% 基礎上，排除每位病患營收逆風的影響，我們本來大約會成長到 40%。那幾乎主要都是藥局通路的逆風，幾乎全部都由此驅動。所以那是其中最大的因素。至於覆蓋率（coverage），我們看到覆蓋率提升。我們說已超過 40%。所以很顯然，年初時我們低於那個水準。我們看到不錯的進展。我想我們逐漸明白的是，確實有一些付款方不會轉到藥局通路。他們偏好以 DME 給付，並會持續以那種方式來核定（adjudicate）我們的產品。因此我們知道，隨時間推進不會到 100%，但我們確實預期會持續上升，並在目前看到的 40% 之上進一步改善。我想這回答了你大部分的問題。

And our next question comes from Doug Schenkel from Cowen.

我們的下一個問題來自 Cowen 的 Doug Schenkel。

This is Ryan on for Doug. Exciting to see the pharmacy progress you've made. Can you talk a bit more about access changes with G6, particularly for intensively managed type 2 patients in the U.S.? Medicare coverage has been in place now for a bit, but have you seen any progress for intensively managed type 2 patients among private payers?

我是 Ryan，代替 Doug 發言。很高興看到你們在藥局通路所取得的進展。你能否再多談一些 G6 在可近性（access）方面的變化，特別是針對美國接受密集管理的第二型糖尿病患者？Medicare 的給付已經實施一段時間了，但在民間保險（private payers）方面，你們是否看到針對密集管理第二型糖尿病患者的任何進展？

Yes. This is Kevin. I'll take that. We have seen some increase in type 2 intensive insulin patient coverage. It is up. It's certainly not all of them yet, but we have used this opportunity to get to more of those patients. So that has increased.

是的。我是 Kevin。我來回答。我們確實看到第二型、密集胰島素治療患者的給付覆蓋有所增加。確實在上升。當然目前還沒有涵蓋到所有人，但我們利用這個機會觸及到更多這類患者。所以這方面確實增加了。

That's great. And then you mentioned the Novo announcement regarding connected insulin pens in your prepared remarks, but no time lines were provided regarding business decisions and support solutions [directing] those Bluetooth-enabled pens driven by DexCom CGM. Is this something that could be launched in 2019, whether with Novo or other partners? Or will it take a bit longer?

太好了。另外，你在事先準備的發言中提到 Novo 關於連網胰島素筆（connected insulin pens）的公告，但並未提供任何時間表，說明由 DexCom CGM 驅動、支援這些具藍牙功能的胰島素筆之商業決策與支援解決方案。這是否有可能在 2019 年推出，不論是與 Novo 或其他合作夥伴？還是會需要更久一些？

Yes, and we certainly hope to start running. In fact, we're running some smaller pilot studies today. But you may see some commercial activity in 2019. Certainly by 2020, we expect to start to roll these out on a broader commercial basis.

是的，我們當然希望能開始加速推進。事實上，我們目前已在進行一些較小規模的試點研究。不過你可能會在 2019 年看到一些商業活動。而到了 2020 年，我們預期會開始以更廣泛的商業規模推出。

And our next question comes from Danielle Antalffy from Leerink Partners.

下一個問題來自 Leerink Partners 的 Danielle Antalffy。

Really strong quarter. Just wanted to ask Quentin about -- I appreciate you're not going to provide color on 2019 specifically, but given all the moving parts here, if you think about volumes versus price, what do you think is a sustainable growth rate going forward kind of longer term? And I know you're going to get into this more at the analyst meeting in December, but curious what you can comment now and how to think about all the puts and takes to the numbers?

這一季表現非常強勁。我想問 Quentin 一個問題——我理解你不會特別針對 2019 年提供更多細節，但在這裡有這麼多變動因素的情況下，如果從出貨量（volumes）相對於價格（price）來看，你認為未來較長期而言可持續的成長率大概會是多少？我知道你們會在 12 月的分析師會議上更深入說明，但我想了解你現在能評論哪些，以及該如何看待這些數字背後的各種拉鋸因素？

Sure. Look, I think, we've talked a little bit, Danielle, already about the fact that we're not going to get out and provide '19 guidance just yet, but I've given you a little bit of color already around some of the revenue per patient headwinds. And clearly, we saw it starting Q3. We expect that to accelerate a bit into Q4. And as a result, we would think that it's going to play out in Q1 and Q2 of next year and we start to anniversary it in Q3 and Q4. So we think it's very navigable and we feel very good about our ability to see volumes continue to be very strong and offset those pricing pressures. And we know where the Street's at relative to the '19 models at this point in time, sitting around the $1.125 billion. I'm not uncomfortable with that. We feel good about that number, but we'll give more clarity and more specific updated guidance in the future when we're ready to talk about that in line with where we have historically done that. But we feel good about where they're at, at this point in time.

當然。Danielle，你看，我想我們之前已稍微談到，我們目前還不會提供 2019 年的指引（guidance），但我也已經就每位患者營收（revenue per patient）所面臨的一些逆風給了你一些方向。而且很明顯地，我們在第三季開始看到這個趨勢。我們預期在第四季會稍微加速。因此，我們認為它會在明年第一季與第二季反映出來，並在第三季與第四季開始進入同比基期（anniversary）。所以我們認為這是非常可控的，我們也對出貨量能持續非常強勁、並抵銷這些價格壓力的能力感到很有信心。我們也知道目前市場（Street）對 2019 年模型的預期大約在 11.25 億美元左右。我對這個數字並不感到不安。我們對這個數字感覺良好，但等到我們準備好、並依照我們過去一貫的時點來談時，我們會在未來提供更清楚、更具體的更新指引。但就目前而言，我們對他們現在的位置感覺不錯。

Okay, that's helpful. And then just one quick follow-up as we look at the December 4 analyst meeting, which I'm very excited about, by the way. What can we expect to see there? So you mentioned long-term growth outlook, a little bit more color there. What about from the pipeline? I assume that's going to come into color a little bit more clearly. And then, also, anything on type 2 and the partnership with UNH there that we could expect to see at the Analyst Meeting?

好的，這很有幫助。接著再追問一個：展望 12 月 4 日的分析師會議——順帶一提，我非常期待。我們可以期待在那裡看到什麼？你提到長期成長展望，會提供更多細節。那在產品研發管線（pipeline）方面呢？我猜那部分也會更清楚一些。另外，關於第二型糖尿病以及與 UNH 的合作夥伴關係，在分析師會議上是否也有機會看到相關內容？

We're putting that agenda together right now. Suffice it to say, you'll probably hear a little bit on all those fronts. We're just getting our ducks lined up in a row, get everything ready for presentation. Certainly, you'll hear the product pipeline. You'll certainly hear our launch review of our business. That remains very bullish and then some of the other things moving forward.

我們現在正在整理議程。簡單說，你大概會在上述各個面向都聽到一些內容。我們只是把各項準備工作排好，讓一切都能就緒、可以上台呈現。你一定會聽到產品研發管線。你也一定會聽到我們對業務的上市/推廣回顧（launch review）。那部分仍然非常看多（bullish），以及一些接下來的其他事項。

(technical difficulty)

（技術問題）

And your next question comes from the line of Steven Lichtman with Oppenheimer.

下一個問題來自 Oppenheimer 的 Steven Lichtman。

Just as a first question, if you can hear me, on the pharmacy channel shift, are you already at a point where you can start leveling off incremental investment in back-office functions given the smoother nature of that process? Or is that something we should potentially look for in the future?

作為第一個問題，如果你聽得到我：關於藥局通路的轉移（pharmacy channel shift），鑑於流程已更順暢，你們是否已經到了可以開始讓後台職能（back-office functions）的增量投資趨於平緩的階段？還是說這可能要等到未來才會看到？

Yes. This is Kevin. I'll take that. We are trying to optimize our back-office support right now. And again, while we have many, many covered lives, not 40% of everything goes through that channel right now. There's still some mix between DME and pharmacy in some of those payers. This business is not any less confusing than it was 6 months ago. We just feel like we're making really good progress on our major strategic initiatives here. Over time, that back-office can come down, but there are several elements to our back-office support as well. There is not only back-office sales support for reorders, there's new customers, there's new patients, there's training, there's tech support. There's a number of areas. And we're looking to streamline all of those operations, make them more efficient. But we're also looking to make sure we take care of our patients and make sure they have a good experience with us. So we have to balance them. Over time, obviously, we would like to be more efficient, but we'll just play it out. There's nothing in our numbers that would reflect any of that at this point in time.

是的。我是 Kevin。我來回答。我們目前正在嘗試最佳化後台支援。再說一次，雖然我們覆蓋了非常非常多的受保人（covered lives），但目前並不是所有業務的 40% 都走這個通路。在某些付款方（payers）之間，DME 與藥局通路仍然有一些組合（mix）。這個業務並不比 6 個月前更不令人困惑。我們只是覺得在這些主要策略性計畫上取得了非常好的進展。隨著時間推進，後台成本可以下降，但我們的後台支援也包含好幾個要素。不只有針對再訂購（reorders）的後台銷售支援，還有新客戶、新患者、訓練、技術支援。有很多面向。我們正在檢視如何精簡所有這些營運、提升效率。但我們也要確保照顧好患者，並確保他們與我們互動時有良好的體驗。所以我們必須在兩者之間取得平衡。長期來看，我們當然希望更有效率，但我們會讓它自然推進。就目前而言，我們的數字中還沒有任何會反映出這些變化的項目。

Got it. And then just a quick one on the pipeline. Is the 14-day label something we could potentially see over the next year? What's your latest thoughts on bringing that or going after that extension?

了解。接著再快速問一個關於研發管線的問題。14 天使用標示（14-day label）是否有可能在未來一年內看到？你們目前對於推進或爭取這項延長（extension）的最新想法是什麼？

Yes. This is Kevin. I'll take that one, too. Extended wear certainly is something we are looking at. We're evaluating the performance of our current G6 system against the iCGM standards that we remain adherent to. We're very happy to play in the 510(k) world. We have to make sure we create a patient experience on the extended wear that is really superb for them. One of our biggest issues, it doesn't take a lot to [raise], is our adhesive. We have new adhesion in the pipeline that will be coming out in the not-too-distant future. We wouldn't, for example, go to an extended wear until we have the new adhesion into our manufacturing processes to get better "stick 'em" on the product. And so we're evaluating that. It certainly is something we will do. It's just a question of when and what modifications we have to make in the system to go there.

是的。我是 Kevin。這題我也來回答。延長配戴（extended wear）確實是我們正在評估的方向。我們正在以 iCGM 標準來評估目前 G6 系統的表現，而我們也會持續遵循這些標準。我們很樂意在 510(k) 的框架下運作。我們必須確保延長配戴能為患者帶來非常出色的使用體驗。我們最大的問題之一——其實不需要太多就會[引發]——是我們的黏著劑（adhesive）。我們的研發管線中有新的黏著方案，將在不久的將來推出。例如，在我們把新的黏著方案導入製造流程、讓產品有更好的「黏性」之前，我們不會推進到延長配戴。因此我們正在評估中。這確實是我們會做的事。只是問題在於何時，以及我們需要對系統做哪些修改才能達成。

And your next question comes from David Lewis from Morgan Stanley.

您的下一個問題來自摩根士丹利（Morgan Stanley）的 David Lewis。

Quentin, maybe just one for you and a related follow-up. I know we're not going to talk about '19, but just taking the fourth quarter guidance, obviously, it implies an implied slowdown and that's sort of been your tactic sort of all year. You wanted to maintain that flexibility. But there's 2 months left in the year (technical difficulty) how much you don't understand, pricing is stable, you understand the Medicare headwind, so the only dynamic in the fourth quarter seems to be greater progression to the pharmacy channel. So that 6-point separation, Quentin, 34% to 40%, are you expecting that to widen in the fourth quarter? And if it does widen in the fourth quarter, does it widen still into the first and second quarter? Or do you see that 6-point separation as pretty stable?

Quentin，可能先問你一個問題，並有一個相關的追問。我知道我們不會談到 2019 年，但如果只看第四季的指引，顯然它暗示成長放緩，而這也算是你們今年一整年採取的策略。你們希望維持那種彈性。但今年只剩 2 個月了（技術問題），你不理解的部分有多少？定價是穩定的，你也理解 Medicare 的逆風，所以第四季唯一的變動因素似乎是更多轉向藥局通路。所以那個 6 個百分點的差距，Quentin，34% 到 40%，你預期第四季會擴大嗎？如果第四季確實擴大，第一季和第二季還會繼續擴大嗎？還是你認為這 6 個百分點的差距會相當穩定？

Yes. So let me -- I'll just walk you through kind of how we think about that fourth quarter and the revised estimate to our guidance. So obviously, our guidance implies roughly 25% growth in the fourth quarter coming off of what is 44% in the third quarter. I think, one, you've got to keep in mind that fourth quarter has witnessed its toughest comp of the entire year and the comp alone is going to account for roughly 5 points of growth headwinds in terms of year-over-year growth. And then we believe there's probably 10 points of price headwinds or revenue per patient headwinds coming from that pharmacy channel. So the 2 -- those 2 items together give you roughly 15 basis points of headwinds that if you took the 25% in our guidance, normalize it back so that you're up around 40% and getting pretty comparable to where we were at in the third quarter and even in the second quarter. I think the one other thing to point out is OUS, obviously, was a tremendous growth quarter for us in the third quarter, up 93%. Very bullish on what's going on there, but also not willing to call 93% growth a trend just yet. That business has grown somewhere around 75% in the first 9 months of the year. We think we'll replicate something like that in the fourth quarter. But I think, you take those moving pieces that I just gave you right there and the guidance in the fourth quarter starts to make a lot of sense for you.

是的。我先帶你走一遍我們如何看待第四季，以及我們對指引所做的修正估計。很明顯，我們的指引意味著第四季約 25% 的成長，相較於第三季的 44%。我想第一點你要記得，第四季面臨的是全年最艱難的比較基期（comp），僅比較基期本身就會在年對年成長上帶來約 5 個百分點的逆風。接著我們認為，來自藥局通路的價格逆風或每位病患收入（revenue per patient）逆風大概還有 10 個百分點。所以這兩項合計大約帶來 15 個基點的逆風；如果你把我們指引中的 25% 做正常化調整，你會回到大約 40% 左右，與第三季、甚至第二季的水準相當接近。另外還有一點要指出的是，海外（OUS）在第三季對我們來說是非常亮眼的成長季度，成長 93%。我們對那邊的進展非常樂觀，但也還不願意把 93% 的成長稱作一個趨勢。該業務在今年前 9 個月的成長大約在 75% 左右。我們認為第四季會複製類似的表現。但我想，把我剛剛給你的這些變動因素放在一起看，第四季的指引就會變得很合理。

That's super, super helpful, Quentin. Actually, very clear, more than I was hoping for. And just a related question on profitability. So this pharmacy benefit channel has always been talked about as a significant profit driver for the business. So as I think about the third quarter, you made money. Some of that was lower spending with United. But is this the inflection quarter, Quentin, with 40% pharmacy channel penetration where you build from here heading into 2019 given the success you've had in that channel?

這非常、非常有幫助，Quentin。其實非常清楚，比我原本期待的還要多。再問一個與獲利能力相關的問題。這個藥局福利通路一直被談到是公司重要的獲利驅動因素。所以當我看第三季時，你們是有賺錢的。其中一部分是與 United 相關的支出較低。但這是否就是轉折點的一季，Quentin？在藥局通路滲透率達到 40% 的情況下，基於你們在該通路的成功，是否能在邁向 2019 年時從這裡開始持續提升？

We're going to talk a lot more about profitability and the path forward at the Analyst Day. I think what we're seeing right now in the business is a couple of things. One, the organization is doing a tremendous job of instilling the discipline around controls of spending and then ultimately where we invest for the greatest opportunity to drive growth into the future, but those opportunities are significant. There's all kinds of alternative market opportunities, new markets that we're not in today. And we think our technology has a tremendous opportunity to really differentiate and make a significant difference for patients. And we're going to continue to pursue those. So I think, on a go-forward basis, it's all about growth for us. At the same time, it's creating the opportunity internally to make sure that the spend is going into those opportunities that give us the greatest opportunity to drive significant growth. And that's how we're thinking about profitability right now is we'll [drop it,] move, the investment opportunities are there but we want to fine-tune our operations to make sure we're investing in what is the greatest chance of success in the future.

我們會在分析師日（Analyst Day）更深入談獲利能力以及未來的路徑。我認為我們目前在業務上看到幾件事。第一，組織在建立支出控管的紀律方面做得非常好，並且最終能把投資放在最能推動未來成長的最大機會上，而那些機會是相當可觀的。有各式各樣的替代市場機會、以及我們目前尚未進入的新市場。我們認為我們的技術有很大的機會真正形成差異化，並為病患帶來顯著的改變。我們也會持續追求這些機會。所以我想，從未來角度來看，對我們而言一切都圍繞著成長。同時，也是在內部創造機會，確保支出投入到那些能讓我們最有機會推動顯著成長的機會上。這就是我們目前對獲利能力的思考方式：我們會[把它放下，]前進，投資機會確實存在，但我們希望微調營運，確保我們投資在未來成功機率最高的項目上。

And your next question is from Brandon Vazquez.

您的下一個問題來自 Brandon Vazquez。

I wanted to kind of go back and focus on international markets. It's been obviously a really strong point for DexCom in the past several quarters. And specifically, what kind of investment have you made in the channel in the last 12 to 18 months? And can you just give us an update on how big your direct presence is in the international markets and maybe which of those regions you might want to look to invest more going forward?

我想回到國際市場並聚焦在那裡。過去幾個季度，這顯然一直是 DexCom 非常強勁的亮點。具體來說，過去 12 到 18 個月你們在通路方面做了哪些投資？另外也請你們更新一下，你們在國際市場的直營布局規模有多大，以及未來可能想在哪些地區加大投資？

I will take the first one...

我先回答第一個……

Well, I'll take the second one.

那我來回答第二個。

Yes, if you look at, Germany, for example, a market that we made an acquisition of a distributor a little over a year ago, we continue to invest in building out that infrastructure and really position us for success well into the future. We're seeing great benefit as a result of that and the growth there has been phenomenal. If you look at the U.K., which is a direct markets, seeing the same thing. So I would say we're very happy with those investments. We know the long-term opportunity of being direct in those large markets outweighs the -- not the indirect. So excited about what we're seeing there. Steve, maybe...

是的，如果以德國為例，我們在一年多前收購了一家經銷商，之後我們持續投資建置那套基礎設施，並真正讓我們在未來很長一段時間都能站穩成功的位置。我們因此看到很大的效益，那裡的成長也非常驚人。如果看英國，那是一個直營市場，也看到同樣的情況。所以我會說我們對這些投資非常滿意。我們知道，長期來看，在那些大型市場採取直營的機會大於——而不是間接模式。所以我們對目前看到的進展感到興奮。Steve，也許……

We would look to be opportunistic where we see reimbursement coming into play. So for example, our path into Korea was actually much more rapid than we expected. And together with that, actually came some initial reimbursement. So then Japan, same thing. We entered into Japan, a professional market where there is reimbursement for a professional-type product. But we also entered into a cycle where we think over the next maybe 18 to 24 months, we would be in a position to have reimbursement for consumers use for CGM, which should line up nicely with when we expect to have a G6 launch into that market. So certainly, all that being opportunistic before we go direct with these markets.

我們會在看到報銷（reimbursement）開始發揮作用的地方，採取更具機會性的做法。例如，我們進入韓國的進程其實比預期快得多。同時也帶來了一些初步的報銷。日本也是一樣。我們進入日本時先從專業市場切入，那裡對專業型產品是有報銷的。但我們也進入了一個週期：我們認為在接下來大約 18 到 24 個月內，我們有機會讓消費者使用的 CGM 也獲得報銷，這應該會與我們預期在該市場推出 G6 的時間點很好地對齊。所以在我們對這些市場轉為直營之前，確實會以這種機會性方式來推進。

Great. And as a follow-up, can I -- going to the G6, can you just talk about maybe how G6 upgrades are tracking within your legacy G5 installed base? And maybe if you don't want to break out what percentage of your installed base is on G6? So maybe -- when do you expect the majority of your G5 patients to be upgraded to G6?

很好。作為追問，回到 G6，你能否談談 G6 升級在你們既有的 G5 裝機基礎（installed base）中的進展情況？如果你不想拆分揭露目前有多少比例的裝機基礎已在使用 G6，那麼——你們預期何時大多數的 G5 病患會升級到 G6？

This is Kevin. I'll take that. I can tell you that we have more G6 users than we have G5 and G6 sensors accounted for a larger percentage of our sensor volumes than G5 did in this quarter. But there are still quite a few G5 patients out there, as transmitters have to expire as the Medicare patients use the system. So it will be certainly a period of time before G5 is insignificant with our business. We still have commitments in some foreign markets and with some other patients to whereby we'll support it for a while, but the change is happening very rapidly.

我是 Kevin。我來回答。我可以告訴你，我們的 G6 使用者比 G5 多，而且本季 G6 感測器占我們感測器出貨量的比例也比 G5 在本季所占的比例更高。但外面仍然有相當多的 G5 病患，因為隨著 Medicare 病患使用系統，發射器必須到期更換。因此，在一段時間內，G5 才會在我們的業務中變得不再重要。我們在一些海外市場以及部分其他病患方面仍有承諾，會在一段時間內持續支援，但轉換正在非常快速地發生。

And your next question comes from Rajbir Denhoy from Jefferies.

下一個問題來自 Jefferies 的 Rajbir Denhoy。

Anthony for Raj. Maybe a question back on the pharmacy channel, just in terms of co-pay assistance. It sounds like Avid has taken a page out of the pharma book and has a co-pay assistance program in there with Libre. I'm just wondering where DexCom stands with co-pay assistance? And if it does have one in place, does it essentially walk down the co-pay to 0?

我是 Anthony，代 Raj 提問。想再問一下藥局通路，主要是關於自付額（co-pay）補助。聽起來 Avid 借鑑了藥廠的做法，針對 Libre 推出了自付額補助方案。我想請問 DexCom 在自付額補助方面的立場是什麼？如果你們確實有相關方案，是否本質上會把自付額降到 0？

We've had programs like that over time, Raj (sic) [Anthony]. And it's not unusual to have that. So we have done some things like that in the past. That isn't how we've been running it, but that has been a portion of our business before.

我們過去一段時間確實有過那類方案，Raj（誤稱）[Anthony]。而且有那樣的方案並不罕見。所以我們以前做過一些類似的事情。目前我們不是用那種方式在運作，但那曾經是我們業務的一部分。

Okay. And then maybe at this point, can you maybe speak to the price difference that's out there in the market today, which is the numerous offerings out there? The new data point on this call, at least one of them was the nonintensive initiative. I know it's early days there, but can you maybe help us think about how to think of sort of the size of that opportunity and maybe timing when that actually becomes a part of the business?

好的。另外，或許此刻你能談談目前市場上存在的價格差異嗎？市場上有很多不同的產品方案。這通電話裡的新資訊點之一，至少其中一個，是非密集（nonintensive）計畫。我知道那還在早期，但你能否幫我們思考一下，該如何看待那個機會的規模，以及大概什麼時點它會真正成為業務的一部分？

Yes. I mean, nonintensive revenue is, right now, a stretched material at this point. I think 2019 is probably still going to be a year of learning in terms of more frequent pilot studies and really continues to be an investment year on the nonintensive side with the hope of coming out of 2019. We have a little more defined what our -- where our go-to-market strategy is. I'm not going to actually comment on what we think and what we're thinking because we don't need to give competitors our playbook here. But it's really probably 2020 and beyond where you start seeing the nonintensive piece of the business become a little more and more material. I don't remember what the other part of the question was.

是的。我的意思是，非密集收入目前來看，還算是被拉得很勉強、尚未具實質性。我認為 2019 年大概仍會是學習的一年，會有更頻繁的試點研究；在非密集領域也仍然是一個投資年，希望在 2019 年結束時，我們能更清楚界定我們的——我們的市場進入（go-to-market）策略會是什麼。我不會實際評論我們認為什麼、正在想什麼，因為我們不需要在這裡把作戰手冊交給競爭對手。但大概是 2020 年及之後，你才會開始看到非密集這一塊業務變得越來越具實質性。我不記得問題的另一部分是什麼了。

(inaudible) I'm not going to get into discussing the price differences at this point. We're still in the early stages of deciding how we approach those markets.

(聽不清) 我目前不打算討論價格差異。我們仍處於決定如何切入那些市場的早期階段。

Your next question comes from Ravi Misra from Berenberg Capital.

下一個問題來自 Berenberg Capital 的 Ravi Misra。

Just want to throw out -- you guided $975 million. And Quentin, I think, you talked a little bit about channel and price mix headwinds that hit later on in the year, much later than you'd expected. How do you factor those headwinds into the fourth quarter guide -- implied guide? And then second, just on the kind of the European outperformance, you have a complementary technology with Tandem launching into Europe right now. Can you kind of show us any detail on what kind of attachment rates you're seeing there with their pump kind of installed? And how does that compare to attachment rates in the U.S.?

我想提出——你們指引為 9.75 億美元。而 Quentin，我想你提到了一些通路與價格組合（price mix）的逆風，發生在今年較後段，而且比你原先預期晚很多。你們如何把這些逆風納入第四季的指引——也就是隱含的指引？第二個問題，關於歐洲的超預期表現，你們有一項互補技術：Tandem 目前正在歐洲上市。你能否提供一些細節，說明在他們的幫浦裝機基礎下，你們看到的搭載率（attachment rates）大概是多少？以及這和美國的搭載率相比如何？

Yes. On the first part of that question, Ravi, we talked about roughly 10 points of headwinds in that fourth quarter. So you can do the math on that number, but that's really what's contemplated in our guidance there. It would be a bit of acceleration off of Q3, not because we view revenue per patient really moving any further down, but more because it's a full quarter that we'd have an inflation now in the fourth quarter whereas the third quarter was just a partial quarter. In terms of the second question, I'll let Kevin answer...

好的。關於第一部分，Ravi，我們談到第四季大約有 10 個百分點的逆風。所以你可以用那個數字自行計算，但那確實就是我們指引中所考量的內容。相較 Q3 會有些加速，不是因為我們認為每位病患的收入還會再往下走，而是因為第四季會是完整一季承受這個影響，而第三季只是部分季度。至於第二個問題，我讓 Kevin 來回答……

This is Kevin. I'll take that, on the Tandem side. Certainly, Tandem is selling pumps in Europe. And pumps integrated with G6 is going to help us across all markets, but it isn't going to drive any of our revenues through the roof in the near term. And I mean, for example, to the extent Tandem picks up an Animas upgrade, it's highly probable that, that Animas patient is already using DexCom sensors. And that's why they're using Animas pump over in Europe. So we'll get to keep them and they will continue to have great experience with our system, but we won't be picking up revenues there. We think over time as both they and we grow, those integrated systems will be very additive to our revenue base and that's why we continue to be very supportive there and work with those 2 partners because they're both doing well for us. But as far as the big pickup for us in Q4, we don't see one.

我是 Kevin。我來回答 Tandem 的部分。確實，Tandem 正在歐洲銷售幫浦。而與 G6 整合的幫浦將在所有市場上對我們有幫助，但短期內不會讓我們的營收大幅飆升。我的意思是，例如在 Tandem 承接 Animas 升級的情況下，很可能那位 Animas 病患本來就已在使用 DexCom 感測器。這也是他們在歐洲使用 Animas 幫浦的原因。因此我們能留住他們，他們也會持續對我們的系統有很好的使用體驗，但我們不會因此在那裡增加營收。我們認為，隨著他們與我們雙方的成長，這些整合式系統會隨時間推進對我們的營收基礎帶來很大的增量，因此我們持續非常支持並與那兩個合作夥伴合作，因為他們兩者對我們的表現都很好。但就第四季對我們而言的大幅拉升，我們看不到。

We want them to keep going.

我們希望他們繼續前進。

And your next question comes from Isaac Ro from Goldman Sachs.

下一個問題來自 Goldman Sachs 的 Isaac Ro。

Maybe, Quentin, a couple of questions for you on the margin side. A lot of moving parts this year with all the growth as well as the investment. Just trying to think through where you guys are on the gross margin side as it relates to supply, both for G5 and G6. I know last quarter, you guys were in a hurry to catch up with G5, and now you're bringing on G6. I just wanted to get a sense of, from a supply standpoint, where you are actually in the quarter and basically what's assumed for the rest of this calendar year?

Quentin，或許有幾個關於毛利率面的問題想請教你。今年隨著成長以及投資，有很多變動因素。我想釐清你們在毛利率方面、就供應而言（G5 與 G6 兩者）目前處於什麼狀態。我知道上季你們急著追上 G5 的供應，而現在又在導入 G6。我想了解的是，從供應角度來看，你們在本季實際處於什麼位置，以及對今年剩餘日曆年度的假設基本上是什麼？

Yes. So while we assume 64% gross margin for the full year, which when you drop in your models, is going to imply 65% or so in Q4, which is a 200 basis point improvement from what we've been running for the last few quarters, down in Q2 and Q3. I think we've made tremendous progress. The teams have done a great job to get our production yields back in line as we exit Q3 with where we had been historically. If you recall back in the second quarter, we talked about our yields being down just from the incremental impact of trying to keep up with the higher demand than what we had assumed originally. We're bringing new lines up to meet that demand. We were ramping up in Mesa, Arizona. So those naturally created some inefficiencies, but the team did a good job of getting that back under control. And we exited the third quarter kind of in line from a yield perspective with where we wanted to be and feel good about the ability to deliver 65%, a nice improvement in the fourth quarter. I think the reality continues to exist though that the overall awareness of CGM continues to grow and the volume surpassed our expectations. It's hard to keep up with that. The teams have done all they can to continue to keep up with it, but we're bringing more new incremental lines on faster than what we have ever anticipated. And so just continue to navigate through that, create some challenges for the team, but they've done a good job thus far. And like I said, in the fourth quarter, we'll be right back in the mid-60s. And I think that's the right way to think about it into the future, but it is not without some challenges.

是的。因此，雖然我們假設全年毛利率為64%，當你把它放進你的模型時，將意味著第四季約為65%，相較於我們過去幾個季度（第二季與第三季）所呈現的水準，提升了200個基點。我認為我們已取得巨大的進展。團隊做得非常出色，讓我們在第三季結束時的生產良率回到與過往歷史水準一致。如果你還記得在第二季時，我們談到良率下滑，主要是因為為了跟上高於我們原先假設的需求所帶來的額外影響。我們正在啟用新產線以滿足該需求。我們也在亞利桑那州梅薩（Mesa）進行產能爬坡。因此這些自然會造成一些效率不彰，但團隊做得很好，把狀況重新控制住。而我們在第三季結束時，從良率角度來看大致符合我們想要達到的水準，並對在第四季交付65%（中肯的改善）充滿信心。不過我認為現實仍是，市場對CGM的整體認知持續提升，且出貨量超出我們的預期。要跟上這樣的成長很不容易。團隊已盡其所能持續跟上，但我們正在以比以往任何時候預期更快的速度導入更多新增產線。因此在持續應對這些情況的過程中，確實會為團隊帶來一些挑戰，但截至目前他們做得很好。而如我所說，第四季我們會回到60%中段。我認為未來也應該用這種方式來看待，但這並非沒有一些挑戰。

Got it. And then just a follow-up on the Analyst Meeting next month. Just kind of curious, what we should reasonably expect for the agenda, and specifically, whether or not that'll be the right forum to talk a little bit about 2019 guidance, either for sales, margins or otherwise?

了解。接著想追問一下下個月的分析師會議。我有點好奇，我們合理可以期待議程會涵蓋哪些內容，特別是，這是否會是談一談2019年指引（不論是營收、毛利率或其他）的合適場合？

Yes, like, I think it was someone else asked that question. We're still working on the agenda for the Analyst Meeting. I think we're going to -- certainly Quentin is going to go in depth with a little longer outlook on the financials. You're going to meet a couple of other people from the senior management team. I doubt we'll give any more color on 2019 guidance. We typically do that in the first part of January at a conference. That's probably what we'll do again. So we'll let you know when we get closer to Analyst Day.

是的，就像我想之前也有人問過這個問題。我們仍在規劃分析師會議的議程。我想我們會——當然Quentin會更深入地分享較長期的財務展望。你也會見到資深管理團隊中的另外幾位成員。我不認為我們會對2019年指引提供更多細節。我們通常會在一月上旬的一場會議上提供。我們大概也會再照這樣做。所以等接近分析師日的時候，我們會再通知你。

And this concludes our question-and-answer session. I'm going to turn the call back over for final remarks.

以上為我們的問答環節。我將把電話交回去進行最後的結語。

Thank you very much, and thanks everyone for participating in our call today and for all your questions. As you can see from our continuing performance, DexCom is at an amazing place. To put things in proper perspective, revenue this quarter exceeded all of 2014, which is not that long ago. As we look to the future, the things we've done have driven our success today are the things that will drive our success going forward: Our commitment to patients, our incredible employees and our world-leading technologies. Our future efforts we discussed on our call today focus on enhancing the patient experience, building infrastructure, [nuance-driven] decision support, leading-edge technology partnerships integration with insulin delivery systems, even simplification and distribution channels. Accurate, timely glucose information will drive everything in the future diabetes ecosystem. And the DexCom patient experience is only going to get better and more important going forward. We know that we pushed out teams to the limit this year. Launching G6 significantly earlier than we had initially planned has created manufacturing and operational and customer support challenges. We did the right thing. People needed access to this amazing technology as soon as we can get it. And on top of our accelerated launch, our volume growth has significantly exceeded our actual revenue growth over the course of year as well. We appreciate everybody's efforts this year. Thank you, again.

非常感謝，也謝謝各位今天參與我們的電話會議並提出所有問題。從我們持續的表現可以看出，DexCom正處於非常出色的位置。為了讓大家有正確的比較基準，本季營收已超過2014年全年，而那其實也不是很久以前。展望未來，我們過去所做、並推動我們今日成功的事情，也將持續推動我們未來的成功：我們對病患的承諾、我們優秀的員工，以及我們世界領先的技術。我們在今天電話會議中討論的未來工作重點，聚焦於提升病患體驗、建置基礎設施、[nuance-driven]決策支援、與胰島素輸送系統整合的尖端技術合作夥伴關係，甚至包括簡化與通路/配送渠道。準確且即時的葡萄糖資訊，將驅動未來糖尿病生態系中的一切。而DexCom的病患體驗在未來只會變得更好、也更重要。我們知道今年我們把團隊推到了極限。G6的上市時間大幅早於我們最初的規劃，帶來了製造、營運以及客戶支援方面的挑戰。我們做了正確的事。人們需要盡快取得這項令人驚豔的技術。此外，除了我們加速上市之外，我們今年的出貨量成長也顯著超過實際營收成長。我們感謝大家今年的努力。再次謝謝。

And finally, on the technology front, G6 is just the beginning. You heard about our recent 510(k) approvals, our investment to enhance the future experience, our many strategic relationships. We have all the technology features necessary to take the CGM everywhere it needs to go, across all of health care. Thank you.

最後，在技術方面，G6只是開始。你們也聽到了我們近期取得的510(k)核准、我們為提升未來體驗所做的投資，以及我們眾多的策略合作關係。我們具備所有必要的技術特性，能把CGM帶到它需要去的每個地方，涵蓋整個醫療照護領域。謝謝。

Thank you, ladies and gentlemen. This concludes today's conference. Thank you for participating. And 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。