德康醫療 (DXCM) 2018 Q4 法說會逐字稿

Welcome to the DexCom Fourth Quarter and Full Year 2018 Earnings Release Call. My name is Adrian, and I'll 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, Vice President, Corporate Development. Please go ahead, sir.

歡迎參加 DexCom 2018 年第四季及全年財報發布電話會議。我是 Adrian，將擔任今天會議的接線員。(接線員指示) 請注意，本次電話會議將被錄音。現在我將把電話交給企業發展副總裁 Matt Dolan。先生，請開始。

Thank you, operator, and welcome to DexCom's Fourth Quarter 2018 Earnings Call. We will begin our prepared remarks with Kevin Sayer, DexCom's Chairman, President and CEO, who will provide a summary of the quarter and fiscal year. This will be followed by a review of our financials and 2019 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. Following our prepared remarks, we'll open up the call for your questions. (Operator Instructions) With that, let's review our safe harbor statement.

謝謝，接線員，歡迎參加 DexCom 2018 年第四季財報電話會議。我們的預備發言將由 DexCom 董事長、總裁兼執行長 Kevin Sayer 開始，他將提供本季與本會計年度的摘要。接著由我們的執行副總裁兼財務長 Quentin Blackford 回顧財務表現並說明 2019 年展望；然後由策略與企業發展執行副總裁 Steve Pacelli 提供策略更新。在預備發言之後，我們將開放提問。(接線員指示) 接下來，讓我們回顧安全港聲明。

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.

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, and actual results could differ materially from those anticipated in the forward-looking statements. 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.

本簡報中所包含的所有前瞻性陳述，均係截至本簡報日期，基於 DexCom 目前可得資訊所作出，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中所預期者有重大差異。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 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，我們將就非 GAAP 結果討論若干未依 GAAP 編製的財務衡量指標。此額外資訊之呈現不應被單獨視為，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 measure.

請參閱我們的財報新聞稿中的表格以及我們網站的投資人關係專區，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 today as we discuss our year-end results. Simply put, 2018 was an incredible year for DexCom on several fronts. First and foremost, we broke through $1 billion in annual revenue. Very few, if any, medical device companies have reached the $1 billion revenue mark, while growing revenues organically at greater than 40% year-over-year. Clearly, the fourth quarter exceeded our expectations, delivering growth of over 50% compared to the same period a year ago. The company also posted its most profitable non-GAAP fourth quarter and full year on record, as we continue to focus on growth while demonstrating leverage.

感謝各位今天加入我們，一同討論我們的年終業績。簡而言之，2018 年對 DexCom 而言在多個面向都是非凡的一年。首先也是最重要的，我們年度營收突破 10 億美元。幾乎沒有醫療器材公司能在年營收超過 10 億美元的同時，仍以超過 40% 的年增率實現有機成長。顯然，第四季表現超出我們的預期，較去年同期成長超過 50%。公司也創下歷來最獲利的非 GAAP 第四季與全年表現，我們在持續聚焦成長的同時，也展現了規模效益。

Beyond the numbers, we received FDA approval for our G6 system in late March. With G6 becoming a Class II system and being the first to meet the agency's newly established special controls for iCGM. We launched G6 in the U.S. around mid-year and continue to roll it out to additional markets globally. Initial patient feedback for G6 has been outstanding.

除了數字之外，我們在 3 月底獲得 FDA 對 G6 系統的核准。G6 成為第二類（Class II）系統，並且是首個符合主管機關新建立之 iCGM 特別管制要求的產品。我們約在年中於美國推出 G6，並持續在全球更多市場推廣上市。病患對 G6 的初期回饋非常出色。

G6 has truly redefined best-in-class CGM and provides us with a platform that we believe will drive continued growth opportunities for DexCom. Beyond G6, we saw significant increases in adoption in both the Medicare and international markets, both of which remains significantly under penetrated. We advanced our interoperability and decision support initiatives, including the acquisition of TypeZero. And we solidified our product pipeline by amending our agreement with Verily and strengthened our balance sheet with the convertible note financing that we did late in the fourth quarter.

G6 確實重新定義了同級最佳的 CGM，並為我們提供一個平台，我們相信這將推動 DexCom 持續的成長機會。除 G6 之外，我們也看到 Medicare 與國際市場的採用率大幅提升，而這兩個市場的滲透率仍明顯偏低。我們推進互通性與決策支援計畫，包括收購 TypeZero。我們也透過修訂與 Verily 的協議來鞏固產品研發管線，並在第四季末完成可轉換公司債融資以強化資產負債表。

All of these accomplishments have positioned us for continued success in 2019 and beyond. The team at DexCom has worked incredibly hard for these achievements. And I must recognize all of the effort needed to make this happen. The organization is achieving milestones that few companies ever do, which is gratifying and comes with significant dedication and determination from our team. But going forward that will not be enough. We must put the infrastructure in place for this business to scale through its full potential. This need in part drove the additional announcement that we made today. In light of our meaningful uptick in demand, we have set the aggressive internal goal to double our G6 production capacity by year-end. We need to expand our footprint dedicated to manufacturing within the Arizona facility, both to meet our G6 goals and in anticipation of a late 2020 launch of G7.

所有這些成就使我們在 2019 年及未來持續成功的道路上占有有利位置。DexCom 團隊為達成這些成果付出了極大的努力。我必須肯定為促成此事所需的所有付出。本組織正在達成少有公司能達到的里程碑，這令人欣慰，也代表我們團隊投入了高度的奉獻與決心。但展望未來，僅靠這些仍不夠。我們必須建立基礎設施，使這項業務能擴展至其全部潛力。這項需求部分促成了我們今天所做的額外宣布。鑑於需求顯著上升，我們設定了積極的內部目標：在年底前將 G6 產能加倍。我們需要擴大亞利桑那廠區內專用於製造的占地，以達成 G6 目標，並為 2020 年底推出 G7 做準備。

Similar to our scaling and manufacturing capacity, we have had to rethink how we build our customer-facing infrastructure to better serve our rapidly growing patient base, not just for today, but also to build the sustainable infrastructure for the future. We have, therefore, expanded and reorganized our customer support efforts, which includes an increase of resources on our new Philippines location as well as outsourcing other functions through third parties. This move will provide the ability to serve our customers with the same high level of quality that they've become accustomed to and grow in a much more efficient manner. This expansion will result in organizational changes, including a reduction in certain staff at both our San Diego and Arizona facilities, despite an expected overall increase in employee numbers in these locations this year.

如同擴充規模與製造產能一樣，我們也必須重新思考如何建立面向客戶的基礎設施，以更好地服務快速成長的病患群，不僅是因應當下，也要打造可持續的未來基礎設施。因此，我們擴大並重整了客戶支援工作，包括增加我們在菲律賓新據點的資源，以及透過第三方外包其他職能。此舉將使我們能以客戶已習慣的同等高品質水準提供服務，並以更高效率的方式成長。這項擴張將帶來組織調整，包括在聖地牙哥與亞利桑那兩處據點縮減部分人員，儘管我們預期今年這些地點的員工總數仍將整體增加。

These types of decisions are always difficult as we have had to increase our support staff significantly over the past several years and have relied on such individuals to meet the demand of our customers. This is a necessary step to continue to adapt and further differentiate our business by maintaining our focus on the patient experience. These changes will occur during a transition period and we have taken the necessary steps to ensure that they occur as seamlessly as possible, while being open with our employees and supporting those impacted over the next several months. Quentin will walk you through the financial implications in this effort.

這類決策一向艱難，因為過去幾年我們已大幅增加支援人員，並仰賴這些同仁來滿足客戶需求。這是持續調整並進一步差異化我們業務的必要步驟，同時維持我們對病患體驗的專注。這些變更將在過渡期間進行，我們已採取必要措施，確保變更盡可能順利進行，同時對員工保持透明，並在未來數月支持受影響的同仁。Quentin 將向各位說明此項工作的財務影響。

To sum up, DexCom continues to deliver strong results. And our recent initiatives leave us well positioned to execute over the next several years.

總結而言，DexCom 持續交出強勁成果。而我們近期的各項計畫，使我們在未來幾年具備良好條件以落實執行。

I will now turn the call over to Quentin for a financial update.

現在我把電話交給 Quentin 進行財務更新。

Thank you, Kevin. As a reminder, some of the figures that I will refer to on a non-GAAP basis in reconciliations to our GAAP results are available on our website.

謝謝你，Kevin。提醒各位，我將以非 GAAP 口徑提及的一些數字，以及與 GAAP 結果的調節資訊，已公布於我們的網站。

Today, we reported record worldwide revenue of $338 million for the fourth quarter of 2018 compared to $221 million for the same quarter in 2017, representing growth of 53% over the same quarter a year ago, on both the reported and constant-currency basis, a clear acceleration that drove us to $1,032,000,000 in revenue for the year.

今天，我們公布 2018 年第四季全球營收創新高，達 3.38 億美元，相較 2017 年同季的 2.21 億美元，年增 53%；無論以公告口徑或以固定匯率（constant-currency）口徑計算皆同，這項明顯的加速成長推動我們全年營收達到 1,032,000,000 美元。

Sequentially, revenue was up 27% over the third quarter. This growth was driven by the sustained ramp and awareness that we saw building throughout 2018, particularly in our U.S. commercial business, which was the primary driver of the upside. Notably, this growth materialized despite a decline in revenue per patient, which was in line with our expectations provided on the third quarter call. As a result of our continued shift in channel mix, including continued growth of the international and Medicare businesses as well as our proactive attempt to move commercial payer contracts into the pharmacy channel, we expected to see some overall pressure on revenue per patient.

按季而言，營收較第三季成長27%。此成長主要來自我們在2018年全年持續推進的放量與市場認知提升，尤其是在美國商業業務方面，這是超出預期的主要驅動因素。值得注意的是，儘管每位病患的營收下滑（與我們在第三季電話會議中提供的預期一致），此成長仍然實現。由於我們持續調整通路組合，包括國際與Medicare業務的持續成長，以及我們主動將商業保險支付方合約轉移至藥局通路，我們預期每位病患營收整體將面臨一定壓力。

Nonetheless, we realized accelerating growth throughout the back half of the year, as we saw these headwinds begin to play out and delivered an outstanding 2018. And we're particularly pleased with achieving 50% growth in our U.S. business in the fourth quarter.

儘管如此，我們在下半年實現了加速成長，因為我們看到這些逆風因素開始逐步顯現，同時交出亮眼的2018年成績。我們尤其對第四季美國業務達成50%的成長感到非常滿意。

International sales in the quarter were consistent with our expectations and were up 72% over Q4 2017 on a reported basis or 75% excluding the impact of foreign exchange rate changes. Consistent with the first 3 quarters of the year, our fourth quarter growth continued to be driven by our direct markets.

本季國際銷售符合我們的預期；以申報口徑計，較2017年第四季成長72%，若排除匯率變動影響則成長75%。與今年前三季一致，我們第四季的成長仍主要由我們的直營市場所帶動。

Fourth quarter gross margins improved from the third quarter as expected to 66%, resulting in a gross profit of $223 million. Operating expenses were $387 million for Q4 2018, including a $218 million onetime noncash research and development charge related to the amendment of our Verily agreement. Apart from this nonrecurring charge, fourth quarter operating expenses were $170 million compared to $142 million in Q4 of 2017. This reflects an increase of 20% year-over-year and compares favorably to our 53% revenue growth in the quarter. For the full year, we realized growth of 44%, while non-GAAP operating expenses, which adjust for the noncash charge related to amended agreement with Verily grew at less than half of that rate at 18%.

第四季毛利率如預期較第三季改善至66%，毛利達2.23億美元。2018年第四季營業費用為3.87億美元，其中包含一筆2.18億美元的一次性非現金研發費用，與修訂我們與Verily的協議相關。扣除此一次性費用後，第四季營業費用為1.70億美元，較2017年第四季的1.42億美元增加。這反映年增20%，相較本季53%的營收成長，表現良好。全年而言，我們實現44%的成長；而非GAAP營業費用（調整與Verily修訂協議相關的非現金費用）增幅為18%，不到該成長率的一半。

In addition to the better-than-expected revenue result, the organization did a great job of controlling spend in 2018 and delivered meaningful improvements in our profitability profile. Importantly, adjusted EBITDA, which excludes the impact of share-based compensation and the noncash research and development fee, was $86.3 million or 25.5% of revenue for the fourth quarter, demonstrating the profitability profile that this business is capable of consistently producing over time.

除了營收表現優於預期之外，組織在2018年也有效控管支出，並在獲利結構上帶來顯著改善。重要的是，調整後EBITDA（排除股份基礎給付及非現金研發費用影響）第四季為8,630萬美元，占營收25.5%，展現此業務長期可持續產生的獲利能力。

Our non-GAAP net income was $48.9 million or $0.54 per share. We're incredibly happy with the progress being made on the profitability front and remain comfortable with the long-term financial goals laid out at our Investor Day back in December of 2018. We fortified our balance sheet, having ended the quarter with nearly $1.4 billion in cash and equivalents, which includes roughly $700 million in net proceeds following our convertible note offering and share repurchase in Q4 of 2018. This offering provides a financial stability and flexibility we need to invest in our key strategic initiatives. We continue to have full availability of our $200 million revolving line of credit.

我們的非GAAP淨利為4,890萬美元，或每股0.54美元。我們對獲利面的進展感到非常振奮，並持續對2018年12月投資人日所提出的長期財務目標保持信心。我們強化了資產負債表，本季末現金及約當現金接近14億美元，其中包含2018年第四季可轉換公司債發行及股份回購後約7億美元的淨募資款。此項發行為我們提供投資關鍵策略計畫所需的財務穩定性與彈性。我們仍可全額動用2億美元的循環信用額度。

Turning to 2019, as we provided in early January, we anticipate full year revenues of between $1,175,000,000 and $1,225,000,000. This outlook assumes a higher rate of patient volume growth offset by headwinds associated with the decreased revenue per patient related to shift in channel mix. As you saw in our press release and as Kevin summarized, we announced a corporate initiative earlier today that will better position us to meet the increasing demands of growth in our business. As a result, we expect to incur roughly $25 million in restructuring-related charges that will primarily be incurred in the first half of 2019 and will be excluded from our non-GAAP financial results going forward.

展望2019年，如同我們在1月初所提供的指引，我們預期全年營收介於11.75億至12.25億美元之間。此展望假設病患量將以較高速度成長，但會被通路組合轉移所導致的每位病患營收下降等逆風所部分抵銷。如同你們在新聞稿中所見、以及Kevin所摘要的，我們今天稍早宣布一項公司層級的計畫，將使我們更能因應業務成長帶來的日益增加需求。因此，我們預期將產生約2,500萬美元的重整相關費用，主要發生在2019年上半年，且未來將自我們的非GAAP財務結果中排除。

With that consideration, we anticipate the following full year 2019 non-GAAP financial results. Gross margin improving to approximately 65%, operating margin increasing to approximately 5.5%, and adjusted EBITDA margin expanding to roughly 18%. We have included a reconciliation of GAAP versus non-GAAP results in our website as well as the historical trend presenting non-GAAP financial results on a consistent basis for comparability purposes.

在此考量下，我們預期2019年全年非GAAP財務結果如下：毛利率提升至約65%，營業利益率提高至約5.5%，調整後EBITDA利潤率擴大至約18%。我們已在網站上提供GAAP與非GAAP結果的調節表，並提供以一致基礎呈列的非GAAP財務結果歷史趨勢，以利可比性。

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 continued rollout of G6 remains a primary strategic priority for DexCom at the outset of 2019. In the U.S., we plan to begin shipping G6 to our Medicare patients in the near term, and we have multiple OUS introductions planned for the balance of the year.

謝謝你，Quentin。在2019年初，持續推進G6的上市與導入仍是DexCom的首要策略重點。在美國，我們計畫在近期開始向Medicare病患出貨G6，並且在今年剩餘期間規劃多項美國以外（OUS）的上市導入。

2018 was a year of great progress for our insulin delivery partners, and we look forward to the launch of Tandem's Control-IQ system later this year, which includes our G6 sensor platform as well as our recently acquired hybrid closed-loop algorithm from TypeZero. We're excited about the continued progress we are making with Insulet on the Horizon platform as well as Lilly as they look to bring both connected pumps and pens to market.

2018年對我們的胰島素輸注合作夥伴而言是進展顯著的一年；我們期待Tandem的Control-IQ系統於今年稍晚推出，該系統包含我們的G6感測器平台，以及我們近期自TypeZero收購的混合式閉環演算法。我們也對與Insulet在Horizon平台上的持續進展，以及與Lilly合作、推動其將連網胰島素幫浦與胰島素筆推向市場，感到振奮。

Our smart pen integration program with Novo Nordisk continues to advance since we announced that partnership in October. We will continue to push these and other collaborations forward in 2019 and expect to see DexCom integrated smart pen systems that are commercially available in 2020.

自我們於10月宣布與Novo Nordisk的合作以來，我們的智慧胰島素筆整合計畫持續推進。我們將在2019年持續推動這些及其他合作，並預期在2020年看到已整合DexCom的智慧胰島素筆系統實現商業化上市。

As we many of you saw in November, we amended our collaboration agreement with Verily, strengthening our product development goals and further aligning our interest as we work toward the commercialization of a fully disposable real-time CGM. This amendment eliminates all future royalty payments, significantly improving our long-term profitability outlook. Our next-generation or G7 system remains on track for a late 2020 or early 2021 release. With G7 on the horizon, we continue to collaborate on pilot efforts in the non-intensive type 2 population working with UnitedHealthcare, Onduo and others as they utilize CGM as a core tool in programs to drive health and economic benefits for people with type 2 diabetes.

如同許多人在11月所見，我們修訂了與Verily的合作協議，強化產品開發目標，並在推動全拋棄式即時CGM商業化的過程中，進一步使雙方利益更一致。此修訂取消所有未來權利金支付，顯著改善我們的長期獲利展望。我們的下一代（G7）系統仍按計畫於2020年末或2021年初推出。在G7即將到來之際，我們持續與UnitedHealthcare、Onduo等合作，在非重度治療的第二型糖尿病族群中進行試點，將CGM作為計畫核心工具，以為第二型糖尿病患者帶來健康與經濟效益。

In addition, we are on track to hit our studies this year for applications in both the hospital and gestational markets. Both of these represent new markets in which uncontrolled glucose presents a major impediment to patient health and an economic burden to the health system. While we remain in the early stages, we are well positioned to leverage G6 as a platform technology that enables us to answer key questions and determine next steps. We look forward to providing updates as these studies progress.

此外，我們也按計畫在今年啟動針對住院與妊娠市場應用的研究。這兩者皆為新市場，在這些市場中，血糖失控對病患健康構成重大阻礙，並對醫療體系造成經濟負擔。雖然我們仍處於早期階段，但我們已具備良好條件，能以G6作為平台技術，協助我們回答關鍵問題並決定下一步。我們期待在研究進展過程中提供更新。

As you can see, we continue to drive a number of important strategic initiatives, and we're excited about the pipeline and market expansion opportunities ahead.

如各位所見，我們持續推動多項重要策略計畫，並對未來的產品管線與市場擴張機會感到振奮。

With that, I will pass it back to Kevin.

接下來，我將把會議交回給Kevin。

Thank you, Steve. 2018 will stand as a year of historic milestones for DexCom, and in diabetes technology, in general. Our outlook for 2019 contemplates the growing awareness to the value of CGM. Our leadership position based on G6 technology, the increasingly competitive landscape and our own proactive moves to optimize distribution channels and position DexCom for long-term operating efficiency.

謝謝你，Steve。2018年將成為DexCom以及整體糖尿病科技領域具有歷史里程碑的一年。我們對2019年的展望納入了市場對CGM價值認知的提升。我們基於G6技術的領導地位、日益競爭的市場環境，以及我們主動優化配銷通路並使DexCom具備長期營運效率的各項作為。

Given the growing awareness of the benefits of CGM and our accelerating growth throughout 2018, we enter 2019 with excitement around the opportunity that lies ahead.

鑑於市場對 CGM 益處的認知日益提升，以及我們在 2018 年全年的加速成長，我們帶著對前方機會的期待與興奮進入 2019 年。

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

我現在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。(Operator Instructions) 接線員，請提供完整的問答說明。

(Operator Instructions) And our first question comes from Jeff Johnson from Baird.

(Operator Instructions) 我們的第一個問題來自 Baird 的 Jeff Johnson。

Can you hear me, okay?

你們聽得到我嗎？

Yes, no problem.

是的，沒問題。

All right. Great. So I'm sure there's going to be some revenue questions and things like that. So I was thinking I was going to be deeper in the queue but, so my question is pretty simple. Just have you heard anything from Medicare on any kind of updated hospital CGM use initiatives that they could be looking to put in place that you guys could participate in over the next year or 2?

好。很好。我確定接下來會有人問一些營收之類的問題。我原本以為我會排在更後面，但我的問題很簡單。你們是否有從 Medicare 那邊聽到任何消息，關於他們可能要推出、並讓你們在未來 1 到 2 年內可以參與的任何更新版院內 CGM 使用倡議？

Yes, nothing specifically. Jeff, this is Steve. Nothing specifically in terms of programs, but we are aware that that CMS has a particular focus on glucose control in the inpatient setting that we think will absolutely lend itself to that business evolving in the relatively near term. You've heard mentioned before of readmissions as a result of poor glucose control not being paid for. We're seeing hypoglycemia as a new focal point for CMS. And then you should expect that that would obviously trickle down into the core commercial payers as well. So it's a pretty exciting opportunity. It's still early, but we're all over it.

是的，沒有特別具體的消息。Jeff，我是 Steve。就計畫而言沒有特定的方案，但我們知道 CMS 特別聚焦於住院環境的血糖控制，我們認為這將絕對有助於該業務在相對不久的將來發展演進。你之前也聽過提到，因血糖控制不佳導致再入院的情況，可能不會獲得給付。我們也看到低血糖正成為 CMS 新的關注重點。接著你也應該預期，這些趨勢顯然也會向下影響到主要的商業保險支付方。所以這是一個相當令人振奮的機會。目前仍在早期階段，但我們已全面投入。

Yes. And then Quentin, we're 2 months into the quarter, and obviously, the 2019 guidance looks to a lot of us to be at least somewhat conservative here. Just any kind of update on gaiting and should we be thinking of kind of higher first half growth versus second half? Or just how we should be setting that model at this point?

是的。另外 Quentin，我們這一季已經過了 2 個月，而顯然 2019 年的指引在我們很多人看來至少有點保守。能否更新一下成長節奏（cadence），以及我們是否應該預期上半年成長較高、下半年較低？或者此刻我們應該如何設定模型？

Yes. We feel good about where we're at as we start into 2019 here. I think just given the tougher comps that we're up against in the back half of 2019, given the accelerating growth we saw over the course of 2018, you naturally would see lower growth rate. So I think, you should expect higher growth rates in the first half, lower in the back half. In terms of the cadence, I would just point out, we would expect that the seasonal trends in the business to reflect more of what we saw in '16 and '17. '18 was a year of tremendous acceleration in the growth profile over the course of the year, which caused the seasonality trend to look a little bit different. So I think, thinking about 20%-or-so of revenue in the first quarter, which is in line with '16 and '17, is probably the right way to think about it.

是的。我們對 2019 年開始時的狀況感到樂觀。我想，考量到 2019 年下半年我們將面對較嚴峻的比較基期（tougher comps），以及我們在 2018 年期間看到的加速成長，你自然會看到較低的成長率。因此我認為，你應該預期上半年成長率較高、下半年較低。就節奏而言，我只想指出，我們預期業務的季節性趨勢會更接近我們在 2016 年與 2017 年所看到的情況。2018 年是全年成長曲線大幅加速的一年，導致季節性趨勢看起來有些不同。所以我認為，把第一季營收視為約占 20% 左右（與 2016 年與 2017 年一致）可能是較合適的思考方式。

And our next question comes from Margaret Kaczor from William Blair.

下一個問題來自 William Blair 的 Margaret Kaczor。

Maybe just to start off with just a follow-up on the guidance question. You guys obviously delivered 2x the original 2018 growth guidance. So as you look at 2019 and the assumptions that you guys made, how do those differ this year relative to last year, including kind of the risk weighting as you were, Quentin, you were looking into last year relative to this year?

我先從指引問題的追問開始。你們顯然交出了原先 2018 年成長指引的 2 倍表現。那麼在看 2019 年以及你們所做的假設時，這些假設相較去年有哪些不同，包括你們在評估風險權重時（Quentin，你在看去年相較今年）有什麼差異？

Yes, I think, if you go back to the beginning of last year, we laid out some of the headwinds that we anticipated may show up in the business over the course of the year. I think when you start to look back at it, those headwinds did in fact show up, but they showed up much later in the year than what we originally anticipated. So we were very clear early on, we expected that there could be revenue per patient headwinds in the business. We didn't start to really see those until the third quarter, and then really a full quarter's worth in the fourth quarter. So I think, we were contemplating all the right things. It's just the timing of when they started to be impactful is probably a little bit later than we originally expected. When I think about 2019, we're approaching the year in a somewhat similar manner with respect to how we think about the revenue per patient headwinds that we know are in the business. Although what's different now is we know they are playing out. We saw it in Q4. We expect they're going to continue to play into 2019. And so when you look at the absolute dollar growth in our guidance, we're guiding to about $150 million to $200 million of absolute dollar growth, but we've been clear there's about a $100 million of revenue per patient headwinds in that guidance. So if you were to normalize back for that, you've actually got a gross increase of about $300 million over the course of the year, which is more or less right in line with what we just delivered in 2018. So the absolute dollar growth is pretty consistent. The growth rate is coming down, obviously, on a much more difficult base that we're growing off of. But I think it starts to make a lot of sense when you look at it that way.

是的，我想如果你回到去年年初，我們提出了一些我們預期在一年當中可能會出現在業務上的逆風。回頭看，這些逆風確實出現了，但出現的時間點比我們原先預期的更晚。所以我們很早就很清楚地說過，我們預期業務中可能會有「每位病患營收」的逆風。我們直到第三季才真正開始看到這些影響，第四季則完整反映了一整季的影響。因此我認為，我們考量的方向都正確。只是它們開始產生實質影響的時間點，可能比我們原先預期的稍晚一些。談到 2019 年，我們在面對這一年時，對於我們已知存在於業務中的每位病患營收逆風，採取的思考方式在某種程度上相似。但不同之處在於，我們現在知道它們正在發生。我們在第四季看到了。我們預期它們會延續到 2019 年。因此當你看我們指引中的絕對金額成長時，我們指引約為 1.5 億到 2 億美元的絕對金額成長，但我們也已清楚說明，該指引中包含約 1 億美元的每位病患營收逆風。所以如果你把這部分調整回來（normalize back），你其實會看到全年約 3 億美元的總增量，這大致上與我們在 2018 年剛交出的表現相當一致。因此絕對金額成長相當一致。成長率當然會下降，因為我們是在更困難的基期上成長。但我認為用這種方式看，就會變得很合理。

Okay. That's helpful. And then just kind of -- I guess, a little bit going on that vein, as a follow up, can you guys give us an update on the percent of lives that are under pharmacy right now, I think it's about 20% last quarter. And then as you're seeing that grow as a percentage of the mix coverage, have you seen any change in terms of the patient add mix driven by pharmacy yet? And how do you expect that plays out throughout 2019?

好的。這很有幫助。接著再延伸追問一下：你們能否更新一下目前有多少比例的受保人數（lives）是在藥局通路下，我記得上季大約是 20%。另外，當你們看到這個比例在整體覆蓋組合中提高時，你們是否已看到由藥局通路帶動的新增病患組合（patient add mix）出現任何變化？你們預期這在 2019 年會如何發展？

Yes, I'll take that. Margaret, this is Kevin. Our covered lives are over 50% now, slightly above that. And again, let me remind you, just because we have a covered lives over 50% doesn't mean they all process through pharmacy. Most of our pharmacy plans have a dual benefit with DME and pharmacy. And then it's up to us to drive awareness. So physicians and patients know that they can be covered through that vehicle. We expect that to continue to accelerate over the course of the year. We've had some very good discussions and some wins with the local, regional and national payer level over the past several months and have some really exciting things on tap going into 2019. And I think as Quentin talked about earlier, channel mix, we are expecting channel mix to shift in that direction. We see a tremendous opportunity for patients so they can pick their product up at the drugstore rather than call us and go through the DME process, which is alive and well in the first quarter. We're in a much better position. So we're definitely driving and shifting the business there and encouraging our field team to do so as well.

是的，我來回答。Margaret，我是 Kevin。我們的受保人數覆蓋率現在已超過 50%，略高於此。再提醒一次，受保人數覆蓋率超過 50% 並不代表它們全部都透過藥局通路處理。我們多數的藥局方案同時具備 DME 與藥局的雙重給付。接著就取決於我們去推動認知。讓醫師與病患知道他們可以透過該管道獲得給付。我們預期這在今年會持續加速。過去幾個月，我們在地方、區域與全國層級的支付方都進行了一些非常好的討論並取得一些成果，進入 2019 年也有一些令人振奮的事項正在籌備中。而且如同 Quentin 先前提到的，通路組合（channel mix）方面，我們預期通路組合會朝那個方向轉移。我們看到這對病患而言是很大的機會，因為他們可以在藥局直接取貨，而不是打電話給我們並走 DME 流程；而 DME 流程在第一季仍然運作良好。我們的處境已經好很多。所以我們確實在推動並把業務轉向那邊，也鼓勵我們的前線團隊同樣這麼做。

And our next question comes from Raj Denhoy from Jefferies.

我們的下一個問題來自 Jefferies 的 Raj Denhoy。

What if I could ask about the international performance. You know, again, very strong in the quarter. Are there other countries contemplated in the near term in terms of establishing reimbursement? Or is it still just mostly coming from Germany and some of the markets you're already in?

如果我可以問一下國際市場的表現。你知道，本季再次非常強勁。就建立給付（reimbursement）而言，短期內是否有其他國家在規劃中？還是說目前主要仍是來自德國以及你們已經進入的一些市場？

Yes, the growth in our guidance is primarily coming from the existing countries that we are operating within, I think, we've talked about the fact that we're seeing opportunities open up into countries like Japan, Korea, or there's been regulatory approval more recently. We don't expect those to be big contributors to the overall revenue number in 2019. And I think we'll let the product get into the market and see how it performs and then we can start to think about how it becomes additive to the overall numbers. But it's all incremental opportunity as far as we're concerned when we look out into the future.

是的，我們指引中的成長主要來自我們目前已在營運的既有國家。我想我們也談過，我們看到像日本、韓國等國家出現機會，或是近期已取得監管核准。我們不預期它們在 2019 年會對整體營收數字有很大的貢獻。我想我們會先讓產品進入市場、觀察其表現，之後再開始思考它如何能對整體數字帶來額外貢獻。但就我們展望未來而言，這些都屬於增量性的機會。

Are there specific countries though know that you've targeted here for '19 where you expect to establish more routine reimbursement that could be larger contributors? I think in the past, you mentioned U.K. and some other large markets that might open up.

不過，有沒有你們在 2019 年鎖定的特定國家，預期能建立更常態性的給付，並可能成為較大的貢獻來源？我記得過去你們提過英國以及其他一些可能開放的大型市場。

We're certainly making progress in the U.K. We continue to make progress in Italy. There are a couple of geographies where there are large government-funded CGM initiatives, where they're announcing funding over several years and expanding the available population where CGM is available. For example, many of these countries will fund CGM for peds only. And now they're saying, okay, we'll expand this to adults and cover more. So we'll take advantage of those opportunities. They are competitive bidding situations. So I'm not going to go into those details and say where they all are, but we will aggressively pursue those opportunities. We had a situation, for example, in Australia, several years ago, where they opened up for bid and said, they were going to cover not even 10 million in CGM. And within 60 days, we had eaten up pretty much that entire budget as patients flocked to DexCom CGM. So we take advantage of those opportunities rapidly and we'll take care of the -- advantage of those where we can next year.

我們在英國確實正在取得進展；在義大利也持續有進展。有幾個地區存在大型的政府資助 CGM 計畫，他們會宣布在數年內提供資金，並擴大可使用 CGM 的族群。例如，許多國家一開始只資助兒科（peds）使用 CGM。而現在他們表示，好，我們會擴大到成人並涵蓋更多人。因此我們會把握這些機會。這些通常是競標的情境。所以我不會深入細節、也不會說它們都在哪些地方，但我們會積極追逐這些機會。例如，幾年前在澳洲有一次情況，他們開放投標並表示將為 CGM 提供的給付預算甚至不到 1,000 萬。而在 60 天內，隨著病患湧向 DexCom CGM，我們幾乎把整個預算都用完了。所以我們會迅速把握這些機會，並且明年在可行之處也會把握這些——利用這些機會。

And our next question comes from Steven Lichtman from Oppenheimer.

我們的下一個問題來自 Oppenheimer 的 Steven Lichtman。

You've talked in the past that your discussions with payers revolve around the pharmacy course. And I think also expanding into the intensive type 2s, want to ask about that second opportunity. How much progress are you making on getting coverage for intensive type 2s and could that start becoming more of a revenue contributor this year?

你們過去談到，與支付方（payers）的討論主要圍繞在藥局通路（pharmacy）上。我想也包括擴展到第二型糖尿病重度（intensive type 2）族群，我想問的是這第二個機會。你們在為第二型糖尿病重度族群爭取給付方面進展如何？而這是否可能在今年開始成為更重要的營收貢獻來源？

We think that it will become more of a revenue contributor. The Medicare coverage decision has been helpful, but it takes a while to get that Medicare coverage decision pushed down to all the individual payers and expand access. A lot of this is in conjunction with all of our pricing and overall access discussions as we ask for access to more patients than what is the pricing model, what is the business model for these people. And so all of these variables are in play and they've been -- we've been talking through all of them. We believe, we'll increase our type 2 intensive access. I'd love it to be faster than it is. But in all candor, with Medicare type 2 intensive insulin access, you have a very large portion of the type 2 insulin intensive using population covered already. We just need really to increase awareness within patients and physicians that they can have access to that technology now under Medicare coverage.

我們認為它會成為更重要的營收貢獻來源。Medicare 的給付決定確實有所幫助，但要把這個 Medicare 給付決定落實到各個個別支付方並擴大可近性，需要一些時間。其中很大一部分也會與我們所有的定價與整體可近性（access）討論一起進行：當我們要求讓更多病患取得可近性時，定價模式是什麼、這些人的商業模式是什麼。因此這些變數都在運作中，我們也一直在逐一討論。我們相信我們會提高第二型糖尿病重度族群的可近性。我希望它能比現在更快。但坦白說，在 Medicare 對第二型糖尿病重度胰島素使用者的可近性方面，你已經有很大一部分第二型糖尿病重度胰島素使用族群被涵蓋了。我們真正需要的是提高病患與醫師的認知：他們現在在 Medicare 給付下就能取得這項技術。

Got it. And then as a follow up, will we potentially get any update on the United non-intensive study and outcome there this year?

了解。那接著追問一下，今年我們是否可能會得到任何關於 United 非重度（non-intensive）研究及其結果的更新？

You know, again, we've said this before, Steve, it's not really a -- don't think of it as a study with an -- with a principal investigator and something that's going to be published into a medical journal. This is real world. But the work we're doing, not just with United, but on a number of fronts on the type 2 non-intensive, kind of type 2 non-insulin taking patients is really real world, think of them as real world, but very reasonably large pilot study. Frankly, the last thing any of these guys want to do is share their findings with the rest of the world, right, because these guys are all competitors and they hold this data and the programs that are evolving out of these pilots to be very proprietary. And so I don't think you're going to see, or certainly, we're going to be permitted to publish anything about the United pilot. I can't imagine United is going to be too vocal about it. So I think the answer is probably not.

你知道，我們之前也說過，Steve，這其實不是——不要把它想成一個有——有主要研究者（principal investigator）並且會發表在醫學期刊上的研究。這是實際世界（real world）的資料。但我們正在做的工作，不只是與 United 合作，而是在多個面向針對第二型糖尿病非重度、也就是某種第二型糖尿病非胰島素使用者族群所做的，確實是實際世界的——把它們視為實際世界、但規模相當合理的大型試點研究。坦白說，這些人最不想做的事情就是把他們的發現分享給全世界，對吧？因為他們彼此都是競爭對手，而他們會把這些資料以及從這些試點所演進出的計畫視為高度專有（proprietary）。因此我不認為你會看到，或至少我們會被允許發表任何關於 United 試點的內容。我也很難想像 United 會對此太過高調。所以我想答案大概是否定的。

And our next question comes from Danielle Antalffy from Leerink.

我們的下一個問題來自 Leerink 的 Danielle Antalffy。

I was just curious and I guess it's more specific to Europe right now than the U.S. But any change in the competitive landscape that you're seeing? I mean, obviously, it is not impacting your growth trajectory. That's the first question specifically as it relates to a -- the updated Abbott product? And then the follow-up question I have is, how do we think about pricing longer term in the U.S.? So I appreciate what you're saying here for 2019. Is it right to think that that sort of pricing headwind will repeat itself each year and get incrementally worse? Or is this kind of like end and we're at the bottom for price increase?

我只是好奇，我想這目前可能更偏向歐洲而非美國。但你們看到的競爭態勢有任何變化嗎？我的意思是，顯然它並沒有影響你們的成長軌跡。第一個問題是，特別是與——更新版的 Abbott 產品相關的競爭情況？接著我的追問是，我們該如何看待美國長期的定價？所以我理解你們對 2019 年的說法。是否可以認為這種定價逆風會每年重複發生並逐步惡化？還是說這差不多就是終點，我們已經在價格下調的底部了？

This is Kevin. I'll try and take that Danielle. That's a very good question. With respect to competition, we take competition seriously all the time. While it hasn't slowed our growth trajectory, I would say, if anything, our vision and our focus on the competitive environment is much greater than it's been before. And as we design our products and our future pipeline, we want to take advantage of those things that we do well to continue to forward competition. With respect to pricing in the U.S., as Quentin often says, pricing by channel for us has remained relatively consistent. But as we move more business into other channels, for example, the pharmacy channel, and currently the Medicare channel has lower price than we've recognized in the past. We're preparing as we talked at our Analyst Day over long term to be a viable competitor in the pricing environment whatever it turns out to be. We talked about doubling the capacity of our Arizona factory for G6. We talked about building out the G7 lines. As we look at our cost profile going forward, we're preparing for whatever the market brings. We believe CGM is a very valuable technology. And the fact is, what we've seen in Europe so far is the reimbursement as a way to recognize the value of our technology over others on the market and we've continued to get a premium price. We will work to those models -- we'll work to those models in the U.S. We will grow and adapt to where it ends, but we do think our product with its accuracy, its performance, its connectivity and its features has been worthy of the premium price that we have received. And so far the payers have been amicable to that. That being said, as we've also talked about, if we can increase access and make it easier for patients to get and decrease our operating expenses through better channel mix, we're all for it. And we will take advantage of those opportunities as well.

我是 Kevin。Danielle，這題我來回答。這是個非常好的問題。就競爭而言，我們一直都非常重視競爭。雖然競爭並未放緩我們的成長軌跡，但我會說，如果有什麼改變的話，那就是我們的願景以及對競爭環境的專注程度，比以往任何時候都更高。而在我們設計產品與未來產品管線時，我們希望善用我們擅長的事，持續推進競爭。就美國的定價而言，正如 Quentin 常說的，我們按通路的定價一直相對一致。但隨著我們把更多業務轉移到其他通路，例如藥局通路，而目前 Medicare 通路的價格也低於我們過去所認列的水準。正如我們在分析師日所談到的，從長期來看，我們正在做準備，以便在不論最終定價環境如何的情況下，都能成為具競爭力的參與者。我們談到要把亞利桑那州工廠的 G6 產能加倍。我們談到要建置 G7 產線。當我們展望未來的成本結構時，我們正在為市場可能帶來的任何情況做準備。我們相信 CGM 是一項非常有價值的技術。事實上，我們目前在歐洲看到的是，給付制度會以某種方式反映我們技術相較於市場上其他產品的價值，因此我們持續獲得溢價。我們也會在美國朝那些模式努力——我們會在美國推動那些模式。我們會成長並適應最終的結果，但我們確實認為，我們的產品在準確度、效能、連線能力與功能方面，值得我們所獲得的溢價。到目前為止，付款方也對此持友善態度。話雖如此，正如我們也談過的，如果我們能提高可近性、讓病患更容易取得，並透過更好的通路組合降低營運費用，我們完全支持。我們也會把握那些機會。

Yes. Danielle, I would just add, I think, we're so early in the opportunity of converting folks from traditional fingersticks to CGM. That the opportunity in the way of volume growth from the adoption of the CGM technology is so significant that while there's going to be revenue per patient headwinds over time, I think the volume opportunity significantly more outweighs any of those headwinds. And I think as you open up some of these other markets that go beyond the intensive world of diabetes, you may see a different revenue per patient profile there, but the volume numbers again are so significant that, I think there's tremendous runway in front of us from a growth perspective for years to come.

是的。Danielle，我想補充的是，我們在把人們從傳統指尖採血轉換到 CGM 的機會上，仍然非常早期。由於 CGM 技術採用所帶來的量的成長機會非常可觀，因此即使隨著時間推移，每位病患的營收會面臨逆風，我認為量的機會將大幅超過任何這些逆風。而且我認為，當你開拓一些超越糖尿病重度治療領域的其他市場時，你可能會看到不同的每位病患營收結構，但量的數字同樣非常可觀，所以我認為，從成長角度來看，我們未來多年仍有非常長的跑道。

And our next question comes from Kyle Rose from Canaccord.

下一個問題來自 Canaccord 的 Kyle Rose。

Great. Can you hear me all right?

很好。你們聽得到我說話嗎？

Yes.

聽得到。

Yes.

聽得到。

Great. So I just wanted to dig back into the product cadence here over the course of the next 12 to 18 months. I mean, obviously, the G6 rollout globally and the Medicare is the priority. I think you reaffirmed that the G7 time lines for late 2020, early 2021. I'm just kind of wondering, is there anything that we should be expecting over the interim period there, whether it would be the lower cost transmitter, G6 professional version, potentially getting an extended wear time on the G6. Just kind of help us understand what some of the near-term product milestones may be? And then I just have 1 more question on longer-term margins.

很好。我想再深入了解一下未來 12 到 18 個月的產品推出節奏。我的意思是，很明顯，G6 的全球推廣以及 Medicare 是優先事項。我想你們也再次確認 G7 的時程是在 2020 年底、2021 年初。我只是想了解，在這段過渡期間，我們是否應該期待有什麼進展，例如更低成本的發射器、G6 專業版，或是可能讓 G6 的配戴時間延長。能否幫助我們理解一些短期的產品里程碑可能會是什麼？然後我還有一個關於較長期毛利率的問題。

That's a great question, and certainly a fun one for me. We always look at interim improvements for our product. If you look at everything we've ever done, every generation we launch, we come with, for example, with an algorithm that significantly improves performance. Not long after we launch because once we have all these data, we can really go model and figure out where it is. So we are exploring new algorithms with our G6 technology. We are also exploring longer wear time. We have the caveat around meeting iCGM standards, with that longer wear time, we want to make sure we can meet iCGM standards for that full longer period, whatever that may be. We do have the lower cost transmitter that will be out certainly in broad scale during the second half of 2019. We've got through the inventory we have that, but that will certainly be a cost reduction and a help for us. And remember, one of our key features and differentiators is the patient experience and our ability to iterate through software changes. We are really focusing tremendously on software development and offering our patients a better experience and better tools to manage their condition. Certainly, not tomorrow, but as we look at the TypeZero acquisition and the tools they developed -- excuse me, the tools they developed for decision support and offering patients information to manage their condition better, we intend to bring those tools to market. If we can get them done with G6, we'll get them done and get them in there. If we have to wait till G7, we will do so. But make no mistake about it, we want to make this patient experience more meaningful and better for them each and every day.

這是個很棒的問題，對我來說也確實很有趣。我們一直都在尋找產品的階段性改良。如果你回顧我們做過的一切，每一代產品上市時，我們都會帶來例如能顯著提升表現的演算法。而且通常在上市不久後，因為一旦我們取得所有這些資料，就能真正去建模並找出最佳化方向。因此，我們正在以 G6 技術探索新的演算法。我們也在探索更長的配戴時間。但前提是要符合 iCGM 標準；在延長配戴時間的同時，我們要確保在整個延長期間（不論最終是多長）都能符合 iCGM 標準。我們確實有更低成本的發射器，將在 2019 年下半年以更大規模推出。我們會先消化現有庫存，但那將確實帶來成本下降並對我們有所幫助。另外請記得，我們的一個關鍵特色與差異化優勢，是病患體驗，以及我們透過軟體變更持續迭代的能力。我們正把非常多的重點放在軟體開發上，為病患提供更好的體驗與更好的工具來管理他們的病況。當然不是明天就能做到，但隨著我們收購 TypeZero，以及他們所開發的工具——抱歉，是他們為決策支援所開發、並向病患提供資訊以更好管理病況的工具——我們打算把這些工具推向市場。如果能在 G6 上完成，我們就會完成並把它整合進去。如果必須等到 G7，我們也會那麼做。但毫無疑問，我們希望讓病患體驗每天都更有意義、也更好。

And then from an operating perspective, I mean, obviously taking into your term charges to you expand some of the operations internationally. But maybe, Quentin, can you kind of help us understand how we should think about going to a lower cost region when you're building up some of those operational capabilities? Just how that should impact margins over the long term? And then any CapEx guidance this year as you invest in the manufacturing the capacity?

接著從營運角度來看，我的意思是，顯然你們在國際上擴張部分營運能力，因此會有一些一次性費用。但也許 Quentin，你能否幫助我們理解，當你們建立那些營運能力時，應該如何看待轉移到較低成本地區？這在長期上應該如何影響毛利率？另外，今年在投資製造產能方面，有沒有任何資本支出（CapEx）指引？

Yes, sure. So I think, consistent with what we kind of talked about back at our Investor Day in December, gross margin expectations for us are to continue in that mid-60s range over the next 5 years or so. There are several levers that will allow us to improve that in terms of taking cost out of the product, including this lower cost transmitter that we expect later in the year, but we also assume that there's going to be lower revenue per patient headwinds that we're going to be dealing with as well. And so I think the cost savings will ultimately offset the -- those benefits will offset the headwinds that come from the lower revenue per patient. So think about that as being relatively consistent with where we're at now. And if we can deliver or execute better than great, there is upside to it. I think one of the big areas of opportunity, and Kevin hit on it, is really focusing on how we double our capacity over the course of the year. We see tremendous opportunities in the markets in front of us. Markets that we're not yet in but believe there's real potential to be in and we want to make sure that we have the capacity to address that. So you're going to see some significant CapEx spend over the course of this year well north of a $100 million to build out automated lines, stand up incremental clean rooms in our Mesa facility and ensure that we're building out capacity just as fast as we possibly can. So I think that's the way to think about it. In terms of operating margin cadence, we laid out a plan to get the 15% over a 5-year horizon. That's roughly 300 basis points a year. We're not committed to 300 basis points necessarily each and every year, but I think we're making great progress towards it here in 2019 with our guidance that delivers roughly 200 basis points. And that's in the midst of a year that we are incredibly focused on getting G7 far down the pathway and getting that to market in late 2020 as well as the fact that we laid out this reorganization today. And I think it's important that we all understand. We're committed to ensuring that the patient experience is a good one through this transition. And therefore, we're not looking at any reduction in workforce along the way until we're performing at equivalent or better levels than where we're performing in the company today. And then resources can start to come down. And so you got a bit of cost in the P&L this year that I would call duplicative just to make sure that there's a smooth transition year here. Otherwise, you would see more leverage coming through the P&L this year alone. But we feel great about where we're at. We're confident we can get to that long-term plan that we laid out and feel good about it.

是的，當然。所以我認為，與我們在12月投資人日所討論的內容一致，我們對毛利率的預期是在未來約5年持續維持在60%中段的區間。有幾個槓桿可以讓我們在降低產品成本方面改善毛利率，包括我們預期在今年稍晚推出的較低成本發射器，但我們也假設每位病患的收入會面臨下降的逆風。因此我認為，成本節省最終將抵銷——這些效益將抵銷來自每位病患收入下降的逆風。所以可以把它視為與我們目前水準大致一致。而如果我們能交付或執行得比預期更好，則仍有上行空間。我認為其中一個很大的機會領域，Kevin也提到了，就是專注於我們如何在一年內將產能翻倍。我們在眼前的市場看到巨大的機會。也有一些我們尚未進入、但相信具有真正潛力的市場，我們希望確保有足夠產能去因應。因此，今年你會看到相當可觀的資本支出（CapEx），遠高於1億美元，用於建置自動化產線、在我們Mesa廠區增設額外無塵室，並確保我們以最快可能的速度擴充產能。所以我認為可以這樣理解。就營業利益率的節奏而言，我們提出了一個在5年期間達到15%的計畫。這大約相當於每年提升300個基點。我們不一定承諾每一年都必然是300個基點，但我認為我們在2019年已朝此目標取得很大進展，因為我們的指引大約可帶來200個基點的提升。而這是在我們極度專注於推進G7、並在2020年末將其推向市場的一年之中，同時我們今天也公布了這項重組。我認為重要的是我們都要理解。我們承諾在這次轉型期間確保病患體驗良好。因此，在我們的表現達到與公司目前相當或更好的水準之前，我們不會在過程中進行任何人力縮減。之後資源才可能開始下降。因此，今年損益表（P&L）上會有一些我稱之為重複性的成本，只是為了確保今年是一個平順的轉型年度。否則，單就今年而言，你會看到更多的槓桿效益反映在損益表上。但我們對目前的狀況感到非常好。我們有信心能達成我們所提出的長期計畫，並且對此感到樂觀。

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

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

This is Jay Chadha in for David. Just one for me and one follow-up I've got. Is there any update on the trials for the 14-day sensor for G6? And is that something we could see an approval for later this year?

我是代替David的Jay Chadha。我有一個問題，另外還有一個追問。關於G6的14天感測器試驗，有沒有任何更新？以及我們是否可能在今年稍晚看到其獲得核准？

We're not going to comment specifically on the timing, but it's certainly something that's in the near-term pipeline.

我們不會就時程做具體評論，但這確實是近期產品管線中的一項。

Okay. And then the pharmacy channel that you had 50% covered lives today, 40% last quarter. Should we think about 10 percentage point increase quarterly going forward? Or would you expect that pace to increase over the course of the year?

好的。接著關於藥局通路，你們目前覆蓋的受保人數（covered lives）是50%，上一季是40%。我們是否應該把未來視為每季增加10個百分點？或者你們預期這個速度會在今年內加快？

It's just not that predicable. I mean, we continue to push as hard as we can to transition the business into the pharmacy channel. And remember, important thing Kevin said, that the important thing to remember is, when we say we have 50% of the commercial lives that have a pharmacy benefit, that doesn't mean we're processing 50% of our commercial business through the pharmacy channel yet. So it's not just the addition of additional covered lives under contract. It's also then transitioning those folks into the pharmacy channel through education and otherwise.

這真的沒那麼可預測。我的意思是，我們會持續盡最大努力把業務轉移到藥局通路。而且請記得Kevin說的一個重點：當我們說有50%的商業保險受保人具有藥局給付（pharmacy benefit），並不代表我們已經把50%的商業保險業務透過藥局通路在處理。所以不只是新增合約下涵蓋的受保人數。也包括透過教育等方式，將這些人實際轉換到藥局通路。

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

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

I had a question about iCGM. I think we can debate all day if another competitor can get there or not. But just wanted to ask on a big picture, if one of your larger competitors does get iCGM, how do you think that changes the conversation for payers, patients and patients? Does it have an impact on the conversation that you're having with those customers?

我有一個關於iCGM的問題。我想我們可以爭論一整天，另一個競爭對手是否能做到。但我想從大方向請教，如果你們較大的競爭對手之一也取得iCGM，你認為這會如何改變與付款方、病患以及病患之間的對話？這是否會影響你們與這些客戶的溝通內容？

Yes. This is Kevin. I'll take that. Honestly, the iCGM designations sets some wonderful standards for us to get products approved and get them through the system quicker. I don't believe, as I sit here today, as we butt up against our competitors in the various payer channel and payer meetings that they really know that much about what iCGM means other than they know about the performance of DexCom sensor. Where iCGM becomes extremely relevant is on 2 fronts, as I said earlier. Standards for us to shoot for when we get future product iterations approved. For example, the 14-day product we're talking about, we know exactly how many data points we need to have and how that product needs to perform before we file with the FDA to get that designation. We love that clarity and we intend to operate in that space. Number two, when we get into interoperability with various software systems and software around our insulin pens, software around the sensor-augmented pump systems and sensor-assisted pump systems and various AP algorithms. Then with an iCGM, you can drop in a different CGM into different systems if they're already approved. And this will give us and others that they can attain that designation, the opportunity to go partner with more people. We're evaluating that designation. We already partner with a number of people. And it helps us go faster in all honesty. We try and help our partners go faster all the time now anyway. When it becomes significant is when we change our technology, so when we go to the G7 platform, for example, or we go to a 14-day platform, somebody like Tandem because we're iCGM or Insulet, when they are out on the market, kind of, immediately incorporate our iCGM technology into their system without running another clinical study, just showing that the sensor works properly. In the past, we literally sat in meetings with former partners and they chose not to integrate our technology with future offerings because they didn't want to do a trial and run a filing -- and do a filing. So this -- that's where the iCGM comes in. I don't know that it is a big driver on the sales side. DexCom performance has always been a driver. And we've always led with that.

是的。我是Kevin。我來回答。老實說，iCGM的認定為我們提供了一些很棒的標準，讓我們能更快地讓產品獲得核准並更快通過體系。以我今天坐在這裡的觀察，當我們在各種付款方通路與付款方會議中與競爭對手交鋒時，我不認為他們真的很了解iCGM的意義；他們更了解的是DexCom感測器的表現。iCGM會變得極其相關，主要在兩個面向，如我先前所說。第一，是作為我們未來產品迭代取得核准時可追求的標準。例如我們正在談的14天產品，我們清楚知道在向FDA遞交申請以取得該認定之前，需要多少數據點，以及該產品必須達到何種表現。我們很喜歡這種清晰度，並打算在這個框架下運作。第二，當我們進入與各種軟體系統的互通性，包括我們胰島素筆的相關軟體、感測器增強型幫浦系統與感測器輔助幫浦系統的軟體，以及各種AP演算法。那麼有了iCGM，如果不同系統已經獲得核准，你就可以把不同的CGM直接置入不同系統中。這將讓我們以及其他能取得該認定的業者，有機會與更多夥伴合作。我們正在評估這項認定。我們已經與多家夥伴合作。而坦白說，它能幫助我們加快速度。我們現在也一直在努力幫助合作夥伴加快速度。它真正變得重要的時點，是當我們更換技術時，例如我們轉向G7平台，或轉向14天平台時，像Tandem（因為我們是iCGM）或Insulet這樣的公司，在他們產品已在市場上時，可以幾乎立即把我們的iCGM技術整合進他們的系統，而不需要再做另一個臨床試驗，只要證明感測器運作正常即可。過去，我們真的曾在與前合作夥伴的會議中，他們選擇不把我們的技術整合到未來產品中，因為他們不想做試驗並進行申報——以及完成申報。所以——這就是iCGM發揮作用的地方。我不確定它在銷售端是否是很大的驅動因素。DexCom的表現一直都是驅動因素。而我們也一直以此作為主軸。

And a question, one of your competitors is also talking about preferred co-pays. Is that something you're seeing gaining traction in the payer community at all? And how important do you think that is in changing customer behavior?

還有一個問題，你們的一位競爭對手也在談所謂的優先自付額（preferred co-pays）。你們是否看到這在付款方社群中有任何程度的推動或採用？你認為這在改變客戶行為方面有多重要？

Yes, I think, there is some of that that probably goes both ways quite honestly between the different competitors that are out there. I think keep in mind, there's well north of a 1,000 different payer policies and contracts that we're all working through. There is nothing of significance that we could point to in either direction where we've been advantaged or any other competitor has been advantaged to our knowledge. So we hear rumblings of it here or there, usually, it's on a very small scale. So I'm sure it's out there in pockets, but nothing of significance and nothing that concerns us.

是的，我認為，老實說，這種情況在不同競爭對手之間可能是雙向的。我想請記住，我們大家正在處理的付款方政策與合約有遠超過 1,000 種。就我們所知，沒有任何具重大意義的事情可以指向任何一方，說我們獲得了優勢或其他競爭對手獲得了優勢。所以我們偶爾會聽到一些風聲，但通常規模都很小。因此我確信在某些局部市場是存在的，但沒有什麼重大到值得一提，也沒有什麼讓我們擔心的。

And our next question comes from JP McKim from Piper Jaffray.

下一個問題來自 Piper Jaffray 的 JP McKim。

I wanted to ask, just given, Kevin, kind of Tandem strength from [base like] you, now that you're connected with that and then the incoming control like you. Have you seen any difference in your patient adds from MDIs, pumps, any notable shift in the recent months?

我想問一下，Kevin，考量到 Tandem 的強勢（從你們的[基礎用戶群之類]）——現在你們與那邊有連結，還有像你提到的即將導入的控制功能。你們是否看到來自 MDI（多次每日注射）、幫浦等不同來源的新增病患有任何差異？最近幾個月有沒有明顯的轉變？

No, I think, I mean, what we've been seeing and we did see a shift over the last several years, where historically, we had been more heavily weighted to pump users I think. And again, it's mostly anecdotal. We don't have perfect data, but it appears that we're basically tracking our patient adds to what the market represents, which is in the U.S. kind of 65%, 70% of our new patients are MDI patients and the balance are pump patients.

沒有。我想，我是說，我們看到的情況——而且過去幾年我們確實看到過一個轉變——歷史上我們的比重可能更偏向幫浦使用者。再說一次，這多半是軼聞觀察。我們沒有完美的數據，但看起來我們的新增病患基本上是在跟隨市場的結構；在美國，大約 65% 到 70% 的新病患是 MDI 病患，其餘則是幫浦病患。

Okay. That's helpful. And then just one on the pharmacy. You hear more and more of these Walgreens and these large centers that are actually talking to G6 in-house and so. I'm wondering how much of a, I don't want to say revenue contributor or how much of a strategy push that is? Is it material enough to call out at this point? Or is it just kind of the strategy you have and you'll see how it evolves going forward?

好的。這很有幫助。接著再問一個關於藥局通路的問題。你越來越常聽到像 Walgreens 以及這些大型中心，實際上在內部推廣 G6 之類的。我想知道這在多大程度上——我不想說是營收貢獻——或在多大程度上是策略推動？就目前而言，這重要到足以特別提出來嗎？還是說這只是你們既定的策略，然後再觀察它未來如何演變？

Yes, look, we -- there has been no shift in our business model towards stocking distributors or no incremental contribution that would skew the results in any way from stocking-type relationships or orders that would have come through. As a matter of fact, if they were significant enough and meaningful enough, you'd see us call those out in our MD&A of our Qs and our Ks, and that's not the case. So we don't have any of that driving the results at this point. You go back into the fourth quarter, I think what was most encouraging is the number of new patient additions was well beyond what we had anticipated. And honestly, it's accelerated every single quarter of the year. So the momentum has been tremendous there. And I think that's really the driver. There is not anything from a stocking perspective that's drove any of these results.

是的，你看，我們——我們的商業模式並沒有轉向讓經銷商備貨，也沒有任何額外貢獻會以任何方式扭曲結果，來自這類備貨型的合作關係或相關訂單。事實上，如果它們足夠重大且有意義，你會看到我們在季度與年度申報（MD&A、10-Q、10-K）中把它們特別提出來，但並沒有。所以目前並沒有任何這類因素在推動結果。回到第四季，我認為最令人鼓舞的是，新病患新增數遠超過我們的預期。而且老實說，這一整年每一季都在加速。所以那邊的動能非常強。我認為那才是真正的驅動因素。從備貨的角度來看，並沒有任何事情推動了這些結果。

And your next question comes from Joanne Wuensch from BMO Capital.

下一個問題來自 BMO Capital 的 Joanne Wuensch。

This is Matt in for Joanne. My question is with regards to the -- expanding the capacity in Arizona, how that could impact gross margins in 2019 and 2020? Are you guys able to quantify that?

我是代 Joanne 提問的 Matt。我的問題是關於——在亞利桑那州擴充產能，這可能如何影響 2019 與 2020 年的毛利率？你們能量化這個影響嗎？

What I'll lay out for you is kind of how we think about the different moving pieces. In 2019, there's not a lot of incremental weight being put on the gross margin profile from standing up that Mesa, Arizona facility. It's already been stood up to a degree and we're just adding incremental capacity into there at a faster clip, but the unit production is increasing with it. So you're absorbing all that incremental costs. So you don't get any more incremental weight put on your gross margin. What you have planned out over the course of 2019 is really you're going to get a benefit as a result of this lower cost transmitter that we've designed and will roll out in the back half of the year. That benefit though will be offset by the headwinds associated with the revenue per patient impacts as channel mix continues to shift. Not getting too far ahead out into 2020, but now you're going to have a full year of 2020 with a benefit, the lower cost transmitter, you're going to have a more full year impact of the Mesa facility, but you will continue to have some of the channel shifts as the international business grows faster as you now have a full year of pharmacy transitioned probably baked into the results. Again, I think the right way to think about the long-term gross margin is in that mid-60s, but you will have those different levers playing out over time.

我先為你說明我們如何看待不同的變動因素。在 2019 年，啟用亞利桑那州梅薩（Mesa）廠對毛利率結構不會帶來太多額外壓力。該廠在某種程度上已經建置完成，我們只是以更快的節奏增加那邊的額外產能，但單位產量也會同步提升。因此你能吸收所有這些增量成本。所以毛利率不會因此承受更多額外壓力。你在 2019 年規劃的部分，主要是你會因為我們設計的低成本發射器（transmitter）並在下半年推出，而獲得一些效益。不過，這個效益會被每位病患營收（revenue per patient）所面臨的逆風所抵銷，因為通路組合（channel mix）持續轉移。不把話說得太早到 2020 年，但到了 2020 年，你會有一整年的效益：低成本發射器；你也會更完整地反映梅薩廠的全年影響；但隨著國際業務成長更快，以及藥局通路轉換在結果中可能已經完整反映，你仍會持續面臨一些通路轉移。再說一次，我認為看待長期毛利率的正確方式是落在 60% 中段，但這些不同的槓桿會隨時間推移而發揮作用。

That's helpful. And then just my follow-up. One of your competitors made an announcement that they are partnering up with Novo Nordisk as well. Does that have any impact with your strategy with them?

這很有幫助。接著追問一下。你們的一位競爭對手也宣布他們同樣與 Novo Nordisk 合作。這會對你們與他們的策略造成任何影響嗎？

No. Not at all. I mean, as you know, they just announced that relationship. We announced our relationship with Novo back in October. And I can tell you, we've been working with Novo for far longer than that. We continue to push forward to develop software tools, robust software tools to integrate our CGM together with their intelligent insulin pen technologies that will be coming to market. So no, I don't think that announcement earlier this week has any impact.

不會。完全不會。我的意思是，如你所知，他們才剛宣布那段關係。我們在去年 10 月就宣布了與 Novo 的合作關係。而且我可以告訴你，我們與 Novo 的合作時間遠比那更久。我們會持續推進，開發軟體工具、強健的軟體工具，把我們的 CGM 與他們即將上市的智慧胰島素筆技術整合在一起。所以不，我不認為本週稍早的那項宣布會有任何影響。

And our next question comes from Robbie Marcus from JP Morgan.

下一個問題來自 JP Morgan 的 Robbie Marcus。

This is actually Christian on for Robbie. Just had a question on how you think about the development of the overall CGM market? Abbott put out that they now have 1.3 million active users. I know it's been harder for you to track user numbers. But where do see overall penetration levels for type 1 diabetics for CGM in the markets you compete in? And where do you see that moving to over the course of 2019 versus the very rapid acceleration we saw in 2018? And then I just have one follow-up.

其實我是代 Robbie 提問的 Christian。我想問一下你們如何看待整體 CGM 市場的發展？Abbott 表示他們現在有 130 萬名活躍使用者。我知道你們比較難追蹤使用者數字。但在你們競爭的市場中，就第一型糖尿病患者而言，你認為 CGM 的整體滲透率目前大概在哪個水準？以及相較於 2018 年我們看到的非常快速加速，你認為 2019 年的走勢會如何？然後我還有一個追問。

I'm not going to comment specifically on Abbott's patient numbers because I think much of that will come down to how you actually define what is an active patient using your technology. But what we've seen, we contract the Abbott prescriptions here in the U.S. and kind of what we know about our patient base, I think from a type 1 perspective, we're probably pushing 30% penetration, far lower than that in the intensive and non-intensive type 2 space. It's a little harder to track. In Europe, I think, Abbott's been -- they've been at it a little bit longer in Europe, so their patient installed base is probably a little larger over there, but kind of hard to tell. I think we still -- really the story is that we're all still in our infancy here in terms of addressable patients. So we've got a long way to go.

我不會特別評論 Abbott 的病患數，因為我認為那在很大程度上取決於你如何定義「活躍病患」正在使用你的技術。但就我們所看到的——我們在美國這裡追蹤 Abbott 的處方量，以及我們對自身病患基礎的了解——我認為從第一型的角度來看，我們的滲透率可能正逼近 30%；在需要密集治療與非密集治療的第二型族群中則遠低於此。這部分比較難追蹤。在歐洲，我認為 Abbott 在那邊投入得更久，所以他們的既有病患裝機基礎（installed base）可能在那邊稍微更大，但也很難判斷。我認為我們仍然——真正的重點是，就可觸及的病患而言，我們大家都還在非常早期的階段。所以我們還有很長的路要走。

And then my follow-up is just on, May you have the launch of Control-IQ coming up midway through this year with Tandem. How should we be thinking about that launch in terms of ASP of sensors that you will sell through that system? And have you baked in any incremental sales for the launch of Control-IQ of -- an uptick in the business that you do with Tandem versus your other partners?

接著我的追問是，您們與 Tandem 合作的 Control-IQ 預計在今年年中推出。就透過該系統銷售的感測器 ASP（平均銷售單價）而言，我們應該如何看待這次上市？另外，對於 Control-IQ 上市，您是否已將任何增量銷售納入考量——也就是相較於其他合作夥伴，您與 Tandem 的業務是否會出現上升？

Yes. So we're not going to break down the components of our guidance. Certainly that launch is one of the many things that is anticipated in the guidance that we gave you for this year. But in terms of ASPs on the sensors, there will be no change whatsoever. I mean that's the way we process through, either the pharmacy or DME won't change with respect to that product, as we said, in the relatively near term. So there wouldn't be any delta there.

是的。我們不會拆解我們指引中的各個組成項目。當然，這次上市是我們今年提供給各位的指引中所預期的眾多事項之一。但就感測器的 ASP 而言，將完全不會有任何變化。我的意思是，我們的處理方式，不論是透過藥局或 DME（耐用醫療設備）通路，短期內就該產品而言都不會改變，正如我們所說的，在相對接近的期間內。因此那方面不會有任何差異。

And the next question comes from Ravi Misra from Berenberg Capital.

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

So Quentin, just I wanted to kind of get -- you have kind of a range on revenues, but a point figure on gross margin. So I guess, my first kind of question is, how do we think about that between the kind of bottom of the range, top of the range, any of the cadence there? And is it right to kind of think of, okay, well, you're taking a little bit of a haircut on a per patient revenue, but your margin year-over-year is essentially flat because of these lower cost transmitters. I mean, is that kind of like-for-like reduction? And then maybe my follow-up is around the restructuring. If you could just help us understand a little bit more around -- give us the upfront investment that you're putting forward in the severances there. What kind of savings are you expecting there? And then how does that tie into, as you look at risk to continue the tremendous growth that you have in driving?

Quentin，我想先釐清一下——你們對營收給了一個區間，但對毛利率給的是一個點估。所以我第一個問題是，在區間下緣、上緣之間，我們應該如何理解毛利率的變化或節奏？另外，是否可以這樣理解：每位病患的營收你們會稍微讓利一些，但由於這些較低成本的發射器，你們的毛利率年對年基本持平。我的意思是，這是否算是一種一對一、同口徑的下降？然後我的追問是關於重整（restructuring）。能否請你們協助我們更了解——你們在資遣費用方面的前期投入是多少？預期可帶來多少節省？以及當你們評估持續推動目前這種強勁成長的風險時，這些又是如何連結在一起的？

Yes, so there is a lot there, I'll try to hit on it and you can remind me if I don't hit on a part of it. With respect to the lower cost transmitter and how that's planned through the margins, we're only getting the back half of the benefit for that, and that's kind of offsetting a full year impact of the continued transition through the pharmacy channel or towards the pharmacy channel. So it's not a like-for-like, one-for-one, necessarily if it was a full year annualized basis of all items being considered. In terms of the range on revenue and the point on the gross margin, I think, we came and said approximately 65%. I think you'll find it's going to round into their based upon the different revenue ranges. So we could flex a little bit, but we feel pretty good, it's going to right around that 65% whether it was on the low end or the high end of that range. With respect to the reorganization that we talked about today, there's going to be about $25 million of restructuring costs that we will incur this year, that's primarily related to both severance and retention. Most of that's going to be incurred in the first half of the year as we work through the transition. And most of those costs are triggered when we identify the individuals impacted and we've set a date, which most of that has now happened or happened today. So you've triggered a good part of that expense upon that communication. Therefore, it's going to happen or the expense is going to be recorded in the first half, although those people were continuing to be with us over the course of some part of the year until, like I mentioned earlier, we get performance metrics in line or better than what we currently run at today. So we did not separate out any of the duplicative costs. We've left all of those in our non-GAAP results. We're holding ourselves accountable to those, to managing those well. But first and foremost is ensuring a good experience for the patients through this transition. And then we'll start to remove costs where it makes sense. We're not going to quantify exactly what that is. We're not going to quantify that benefit for 2020 at this point, but it certainly will be a nice enabler of helping us to achieve that longer-term 15% operating margin goal and 25% EBITDA margin goal we put out there over that 5-year horizon.

是的，內容很多，我會盡量逐一回應；如果我漏掉某一部分，你可以提醒我。關於較低成本的發射器，以及它如何反映在毛利率規劃上，我們只會在下半年取得那部分效益，而這大致上會抵銷我們持續轉向藥局通路（或透過藥局通路）的全年影響。因此，若把所有項目都以全年年化基礎來看，這不一定是完全一對一、同口徑的對應。至於營收區間與毛利率點估，我想我們說的是約 65%。我認為你會發現，依不同的營收區間，它會四捨五入落在那個水準附近。所以我們可能會有些微彈性，但我們相當有信心，不論是在區間低端或高端，毛利率都會大致落在 65% 左右。關於我們今天談到的組織重整，今年我們將產生約 2,500 萬美元的重整成本，主要與資遣與留任（retention）相關。其中大部分會在上半年發生，因為我們會在過渡期間逐步完成轉換。而且多數成本是在我們確認受影響的個人並設定日期時觸發；目前大部分已經發生，或就在今天發生。因此，在那次溝通時點，你就已觸發了相當一部分費用。所以費用將在上半年入帳，儘管這些人仍會在今年的某段期間繼續與我們共事，直到——如我先前提到的——我們把績效指標拉到與目前相當或更好的水準。因此，我們沒有把任何重複性的成本另外拆出來。我們把這些都保留在我們的 non-GAAP 結果中。我們也要求自己對這些成本負責，並妥善管理。但首要之務是確保病患在這次轉換期間能有良好的體驗。接著我們會在合理之處開始移除成本。我們不會精確量化那會是多少。此刻我們也不會量化 2020 年的效益，但這無疑會成為一個很好的推動力，協助我們在 5 年期的時間軸上達成我們提出的長期 15% 營業利益率目標與 25% EBITDA 利潤率目標。

And our next question comes from Doug Schenkel from Cowen and Company.

下一個問題來自 Cowen and Company 的 Doug Schenkel。

This is Ryan on for Doug. It appears like your installed base grew 50% in 2018. Is that correct? And I'm looking at 2019, even factoring in the revenue per patient headwinds, the high end of your guidance seems to imply that installed base growth just always a decent amount versus that 50% this year. Is that correct? And if so, why would that occur? I know it's a tough comparison, but it doesn't seem like momentum is slowing?

我是 Ryan，代 Doug 提問。看起來你們的裝機基礎（installed base）在 2018 年成長了 50%。這是正確的嗎？我看 2019 年，即使把每位病患營收的不利因素納入考量，你們指引的高端似乎仍暗示裝機基礎成長率會比今年的 50% 低不少。這是正確的嗎？如果是，為什麼會這樣？我知道這是個艱難的比較，但看起來動能並沒有放緩？

Yes, so we're not going to talk about the installed base of the patient number. I think Steve laid out earlier the differences and how each of the different players in the market tend to look at it, and everyone's got a different definition tied into it. I think the way to think about it and we've been pretty clear in our guidance, our volume assumptions in our guidance is about 25% to 30% growth. We've layered on top of that the 10 points of potential headwinds coming from revenue per patient or price headwinds that take that down to the 15% or 20%. So our guidance from a volume perspective up 25% to 30% on yes, what was much stronger in 2018, but I think you got to keep in mind a couple of different things. You got a much different base that you're growing off of. It was much more difficult in 2019 growing off of 44% growth base than what '18 was that grew off the 25% base. And you also had the G6 launch in 2018 that we don't repeat in 2019. So there are a couple of reasons why it might slow a bit. I still think 25% to 30% volume growth is something we're going to be very happy with. And if you can deliver more than that, then terrific. There's a lot of opportunities there.

是的，我們不會談論裝機基礎或病患數的具體數字。我想 Steve 先前已說明各種差異，以及市場上不同參與者通常如何看待它；每家公司對此都有不同的定義。我認為應該這樣理解，而且我們在指引中也講得很清楚：我們指引中的量（volume）假設約為 25% 到 30% 的成長。在此之上，我們再疊加了每位病患營收或價格逆風可能帶來的 10 個百分點影響，使其降至 15% 或 20%。所以從量的角度，我們的指引是成長 25% 到 30%；是的，相較於 2018 年確實更強，但我認為你必須記住幾點。你所成長的基期已經很不一樣。2019 年在 44% 成長的基期上再成長，會比 2018 年在 25% 基期上成長困難得多。而且 2018 年有 G6 的上市，2019 年不會再重複一次。所以有幾個原因可能會讓成長稍微放緩。我仍然認為 25% 到 30% 的量成長是我們會非常滿意的結果。如果你能交出高於此的成績，那就太好了。那裡有很多機會。

Okay. And then can you talk about Onduo's expansion plans for 2019? How broadly do you expect them to expand in the U.S.? And can you talk about how they're using DexCom CGM within their program? How often annually per patient on average? And is this only for a specific high-risk patients or more broadly?

好的。那你能談談 Onduo 在 2019 年的擴張計畫嗎？你們預期他們在美國會擴張到多廣？也能談談他們在其方案中如何使用 DexCom CGM 嗎？平均每位病患每年使用頻率大概是多少？以及這是否只針對特定高風險病患，還是更廣泛適用？

We're not privy all of Onduo's plans. We do talk with them, work with them. We provide them sensors. I believe they'll grow as quickly as they possibly can. Their use of CGM is very much is an educational tool and something to reset the bar for people with type 2 diabetes. Similar to other programs that we've worked with, the type 2 patients typically has not had any information like a CGM ever to help them manage their condition. They're told, eat less, exercise more and take your pills. And when you get on a CGM, you can figure out, well, gee, this is what exercise more does, this is what eat a little different does. And this is what happens when I take my medications or when I change my medications. We believe CGM will be a critical component in all type 2 diabetes management. There's nothing that can give a patient the information that CGM does, absolutely nothing. And if we present it properly in a manner where patients can implement this information to make changes in their lifestyle and routines, it's going to be fantastic. The question then becomes, how many a year do they use? And what is the business model? And I think that's going to be worked out by a number of players through studies over time. And it'll be working out by us as we look at potential different -- excuse me, different product offerings to serve this market. We view it as a big one and we view it as something that can make a huge difference.

我們並不完全掌握 Onduo 的所有計畫。我們確實會與他們溝通、與他們合作。我們提供他們感測器。我相信他們會以他們所能做到的最快速度成長。他們對 CGM 的使用，很大程度上是一種教育工具，也是為第二型糖尿病患者重新設定標準的一種方式。類似於我們合作過的其他方案，第二型患者通常從未有過像 CGM 這樣的資訊來協助他們管理病況。他們被告知：少吃、多運動、按時吃藥。而當你使用 CGM 時，你就能弄清楚：嗯，原來多運動會帶來這樣的效果，稍微改變飲食會帶來那樣的效果。以及當我服藥或更換用藥時會發生什麼。我們相信 CGM 將成為所有第二型糖尿病管理中的關鍵組成。沒有任何東西能像 CGM 一樣提供病患這些資訊，絕對沒有。如果我們能以適當的方式呈現，讓病患能運用這些資訊去改變生活型態與日常作息，那將會非常棒。接下來的問題就變成：他們一年會使用多少？以及商業模式是什麼？我認為這將會由多方參與者透過長期研究逐步釐清。而我們也會在評估潛在的不同——不好意思，不同的產品方案以服務這個市場時，一併把它釐清。我們認為這是一個很大的市場，也認為它能帶來巨大的改變。

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

下一個問題來自高盛（Goldman Sachs）的 Isaac Ro。

Maybe first question, if you can just give us an update for -- on the Verily program. In loose terms, what some of the key milestones are for development this calendar year in terms of what's baked in your expectations? That will be a great starting point.

第一個問題，能否請你們就 Verily 計畫提供最新進度？概略來說，今年曆年在開發上有哪些關鍵里程碑已納入你們的預期？這會是一個很好的切入點。

Yes. So Isaac, this is Steve. What you heard us talk about in the prepared remarks was G7 and committing to the time line of launching G7 by the end of next year or the first part of 2020, and that remains on track. That is -- will be the first launch of a product that incorporates our technology together with Verily. We're not referring to it specifically as the Verily platform anymore. It really is a DexCom product.

是的。Isaac，我是 Steve。你在我們事先準備的發言中聽到的是 G7，以及我們承諾在明年年底或 2020 年初推出 G7 的時間表，而目前仍按計畫進行。那將會是第一個把我們的技術與 Verily 結合在一起的產品上市。我們不再特別把它稱作 Verily 平台。它其實就是一個 DexCom 產品。

It's G7.

就是 G7。

And we're going to call it G7 going forward. In terms of milestones, we're not going to comment specifically on the path in terms of clinical trial or regulatory filings at this point, but we'll probably update you guys as the year goes on.

我們接下來會稱它為 G7。就里程碑而言，目前我們不會針對臨床試驗或法規申報的路徑做具體評論，但我們可能會在今年進行的過程中再向各位更新。

That's fine. And Quentin, a question for you on the guidance. Just given the velocity of top line growth, if we combine that with all the moving parts on the P&L from pharmacy and just funding the growth of the business. Can you just help us think a little bit about the quarterly cadence of operating margin this year? So you made that may or may not be kind of aligned with revenue seasonality. It'd just be helpful, if there is any kind of revenue to expense mismatch this year that could be a little bit nonobvious to us here in the beginning of the year?

了解。Quentin，我有一個關於財測的問題。考量營收端的成長速度，再加上損益表上藥局通路等各種變動因素，以及為業務成長投入資金。你能否協助我們理解一下今年營業利益率在各季度的節奏？也就是說，它可能會或可能不會與營收的季節性一致。如果今年在年初有任何收入與費用之間不易察覺的錯配，能否請你說明一下？

Yes, I think back to this whole point of ensuring that we have a smooth transition in the workforce into our Philippines and third-party service providers, we're going to be willing to run duplicative costs through the P&L for a period of time, which really starts in the first half of the year and is going to continue to be that way through the first half and then start to alleviate towards the mid part, the late part of Q3 and into Q4. And so with those headwinds, I don't think that you should necessarily expect you're going to have significant improvements in operating margin year-over-year in the first half of the year, but you ought to see sequential improvements in the operating margin take place over the course of the year.

是的。我回到我們確保人力能平順轉移到菲律賓以及第三方服務供應商這一點，我們願意在一段時間內在損益表上承擔重複成本；這其實從上半年開始，並會在上半年持續如此，之後在第三季中後段開始緩解，並延續到第四季。因此在這些逆風之下，我不認為你應該預期上半年營業利益率會有顯著的年對年改善，但你應該會看到營業利益率在今年過程中逐季改善。

Your next question comes from Matthew Taylor from UBS.

下一個問題來自瑞銀（UBS）的 Matthew Taylor。

Matt, are you there?

Matt，你在線上嗎？

Okay. We will move on. Next question comes from Chris Pasquale from Guggenheim.

好的。我們先往下進行。下一個問題來自 Guggenheim 的 Chris Pasquale。

I appreciate the sensitivity around the installed base number, but you guys have also provided some color on new patient adds in the past. Now we think at least there, definitions would be pretty consistent. Anything you're willing to share for 2018 to help us true-up our models on that metric?

我理解你們對於已裝機用戶基數（installed base）數字的敏感性，但你們過去也曾就新增病患數提供一些說明。至少在那個指標上，我們認為定義應該相當一致。你們是否願意分享 2018 年的任何資訊，幫助我們在該指標上校準模型？

Well, I'd just -- I'll tell you that new patient adds was a primary driver of overall growth, but very similar to the installed base. I think the definition of a new patient is very different across the players in this space. We don't consider a new patient really a patient of ours until they're actually repurchasing and buying a normal purchase patterns for a period of time. I'm not sure if that's consistent across the universe. So even how we define new patients, I think, is very different across the players in this space.

嗯，我只能——我可以告訴你，新增病患數是整體成長的主要驅動因素，但它與已裝機用戶基數非常類似。我認為在這個領域，不同業者對「新病患」的定義差異很大。我們不會把某位新病患真正視為我們的病患，直到他們實際開始回購，並在一段時間內呈現正常的購買模式。我不確定這是否與整個市場一致。所以即便是我們如何定義新病患，我認為也與這個領域的其他業者非常不同。

Okay. And then Quentin, just trying to nail down the impact of the transmitter and that how that flows through. Can you share anything in terms of actually quantifying the magnitude of the cost reduction on the transmitter from where you are today to what this next gen looks like?

了解。接著 Quentin，我想釐清發射器（transmitter）的影響，以及它如何反映在財務上。你能否分享任何資訊，量化發射器成本從目前水準到下一代設計的降幅大概有多大？

Yes, we haven't quantified where it can go. It's significant, I will tell you that that the problem with it is the more volume that you're able to push through the plant and the more that you're absorbing in the way of cost, the better it gets. And so we're not going to see the full benefit of it in 2019 as we get the full production capacity with it in '20, it becomes more meaningful to us. But we're not going to identify the complete difference or the total difference in that new structure -- new cost structure.

是的，我們尚未量化它最終能降到哪裡。但我可以告訴你，幅度很可觀；問題在於，你能夠讓工廠跑過的產量越大、能吸收的成本越多，效果就越好。因此我們在 2019 年不會看到全部效益；當我們在 2020 年達到完整產能時，對我們而言就會更有意義。但我們不會揭露這個新結構——新成本結構的完整差異或總差異。

And our next question comes from Matt Wizman from Raymond James.

下一個問題來自 Raymond James 的 Matt Wizman。

I'm on for Jayson Bedford. My question is really about retention levels. So are you seeing with the G6 increased compliance among user base relative to G5 and G4? And how is it here trended? And do you still kind of see room for improved retention levels going forward, maybe with the G7?

我代替 Jayson Bedford 提問。我的問題主要是關於留存率。所以，相較於 G5 和 G4，你們是否看到 G6 在用戶群中的依從性（compliance）有所提升？目前趨勢如何？以及你們是否仍認為未來留存率還有提升空間，例如在 G7 上？

Our retention levels, we've been very pleased with what we've seen with G6. And the teams here have done a really nice job being focused on it and watching it. We have seen some improvements in our ability to retain folks, although we've always done a really nice job retaining patients once they've got on to our DexCom technology, but there has been a bit of improvement there.

我們對 G6 的留存率表現非常滿意。而這裡的團隊在聚焦與追蹤這件事上做得非常好。我們確實看到留住用戶的能力有所改善；雖然一旦病患開始使用我們的 DexCom 技術，我們一向就很擅長留存，但確實有一些提升。

Yes. This is Kevin. The one thing I will add is, our retention has largely been a factor of economic circumstances as well. And what will be interesting for us as we map and chart G6, particularly as the majority of those patients use the phone app, much more than our G5 patients before, I think we can have better pictures going forward in time as we look at what happens in the first quarter where co-pays and deductibles reset. I think G6 -- anecdotally, we hear everybody likes it a lot better. We still need more data. I mean, with all those sales in Q4, we don't know whether those patients are coming back yet. And the biggest reason we lose a patient is money. It's not been the product performance. It's what they can afford and what they can do.

是的。我是 Kevin。我想補充的一點是，我們的留存率在很大程度上也受到經濟環境的影響。而對我們來說有趣的是，當我們規劃並追蹤 G6 時，尤其是因為多數患者使用手機 App 的比例遠高於先前的 G5 患者，我認為當我們往前看、觀察第一季自付額（co-pay）與自負額（deductible）重置時會發生什麼，我們將能更清楚地掌握情況。我認為 G6——就軼聞而言，我們聽到大家都更喜歡它。我們仍需要更多數據。我的意思是，第四季有那麼多銷售，我們還不知道那些患者是否已經回流。而我們流失患者的最大原因是錢。並不是產品表現。而是他們負擔得起什麼、以及他們能做什麼。

Your next question comes Suraj Kalia from Northland Securities.

下一個問題來自 Northland Securities 的 Suraj Kalia。

Sure. So Kevin, a lot of pointers you all have provided and I'm trying to get my hands around it. Let me reassume FY '19 around $1.25 billion, right, revenues. Can you give us directionally in terms of what the expectation is for the pharmacy channel? And the subpart of that question is, I don't remember you guys giving us a delta between the DME and the pharmacy channel. I guess, the reason I'm trying to ask is, from, let's say, 6 quarters ago to now gross margins are down roughly 500 bps. I understand the channel mix. I understand the movement of manufacturing, how you're all trying to move the OpEx line item, agreed. Help us understand or reconcile how your outlook is for the pharmacy channel? And what the price delta is so that we can at least kind of put it into a model and makes sense of that.

好的。Kevin，你們提供了很多線索，我正在試著把它理清楚。讓我先假設 2019 財年營收約為 12.5 億美元，對吧。你能否就藥局通路（pharmacy channel）的預期，給我們一些方向性的指引？以及這個問題的延伸是，我不記得你們曾提供過 DME 與藥局通路之間的價差（delta）。我之所以想問，是因為從大約 6 個季度前到現在，毛利率大約下降了 500 個基點。我理解通路組合（channel mix）。我也理解製造端的變動，以及你們如何試圖調整營業費用（OpEx）項目，這點我同意。請幫我們理解或對齊你們對藥局通路的展望？以及價差是多少，好讓我們至少能把它放進模型裡，並讓整體更合理。

This is Kevin. I will take that one. I'll go back to my old CFO days, Quentin, but I won't throw a bunch of numbers out. At the end of the day, when we talk about channel mix and channel shifting and the effect on margin with average revenue per patient is not just the pharmacy channel. Again, a larger percentage of our business continues to go through foreign markets. And those foreign markets do have lower average revenue per patient per year. And as that increases, our margins, in fact, do come down. Medicare, as we started was a lower-average revenue per year per patient based on the goods that we ship them versus other ones. That was kind of a margin deterrent in the beginning. We think over time as our costs come down, Medicare margins will be very good. With respect to pharmacy and DME mix, we've never disclosed that, and there is no magic formula for what the difference is between DME and pharmacy. It literally varies contract. The contract and how we structure each of these arrangements. I think we can do it over time.

我是 Kevin。這題我來回答。我會回到我以前當 CFO 的思維，Quentin，但我不會丟出一堆數字。歸根結底，當我們談到通路組合與通路轉移，以及其對毛利的影響時，影響每位患者平均收入的不只是藥局通路。再說一次，我們業務中有更高比例仍是透過海外市場。而那些海外市場每位患者每年的平均收入確實較低。隨著該比例提高，我們的毛利率確實會下降。Medicare 在我們剛開始時，基於我們出貨給他們的產品組合，相較其他通路每位患者每年的平均收入較低。這在一開始算是對毛利率的抑制因素。我們認為隨著成本下降，Medicare 的毛利率隨時間推進會非常好。至於藥局與 DME 的組合，我們從未揭露過，而且 DME 與藥局之間的差異也沒有什麼神奇公式。它確實會因合約而異。取決於合約內容以及我們如何設計每一項安排。我認為我們可以隨時間推進做到。

Yes, Suraj, I will just add to it. The pharmacy model is a very attractive model to us. From an operating margin perspective, we're convinced, we can make more profit dollars in that business than we can in the DME channel. So we will continue to push for it hard. And while it might weigh on the gross margin a bit, it's going to ultimately be a tailwind for the operating margin. So at the end of the day, it's the right thing to be looking at and it's going to be a value creator for us over the long term.

是的，Suraj，我再補充一下。藥局模式對我們而言是非常有吸引力的模式。從營業利益率（operating margin）的角度來看，我們確信在那個業務中能創造的利潤金額（profit dollars）會高於 DME 通路。因此我們會持續大力推動。雖然它可能會對毛利率造成一些壓力，但最終會成為營業利益率的順風（tailwind）。所以歸根結底，這是正確的觀察重點，並且長期而言將為我們創造價值。

And the next question comes from Matt Taylor from UBS.

下一個問題來自 UBS 的 Matt Taylor。

This is [Yee] on for Matt. Sorry, I was on mute. I have 2 quick ones. The first, what's the percentage of patients currently on G6 plus this early generation of device? And also, can you give us more color on the feedback you've received so far for your pilot activities with this disposable G6 CGM?

我是代替 Matt 的 [Yee]。抱歉，我剛剛在靜音。我有兩個簡短問題。第一個，目前使用 G6 加上這一代早期裝置的患者比例是多少？另外，你能否就你們一次性（disposable）G6 CGM 的試點活動（pilot activities）迄今收到的回饋，提供更多細節？

Well, I can tell you, the G6 in the U.S. business, the majority of folks have moved towards G6 in our U.S. commercial business. Obviously, Medicare is still a G5 product. And in the international space, we still have a lot of markets that utilize G5, but transitioning to G6. But in the U.S., it's now moved into the majority of folks on G6 in the U.S. You're going to have to repeat your second question. I didn't get it.

我可以告訴你，在美國業務方面，我們美國商業業務中的大多數人已經轉向 G6。顯然，Medicare 仍是 G5 產品。而在國際市場，我們仍有許多市場使用 G5，但正在轉換到 G6。但在美國，目前美國多數使用者已經是 G6。你得再重複一次你的第二個問題。我沒聽清楚。

I'm sorry. So the second question is just the feedback you've got so far from your pilot activities with your disposable G6 CGM?

抱歉。第二個問題就是，你們在一次性 G6 CGM 的試點活動中，到目前為止收到的回饋是什麼？

It's really very small. Nothing really to report there.

其實規模非常小。目前沒有什麼可報告的。

And that concludes the question-and-answer session. I'll turn the call back over to Kevin Sayer for final comments.

問答環節到此結束。我把電話交回給 Kevin Sayer 作最後結語。

Thank you, everybody, for participating in our call today. Something you may not know is this year is actually DexCom's 20th birthday, our anniversary. We launched our first product in 2006, and after 10 years of commercial activity, we hit the $500 million in annual revenues. But we picked up the next $500 million in annual revenues over the last 2 years. We're positioning the company for the next billion dollars in revenues and beyond and now it's going to go much faster. This is never easy, but we are fully, fully committed to having the ideal technology in our pipeline to capitalize on this massive opportunity. As you heard today, much of our focus this year, in addition to growing our business and pushing the product pipeline, is to build the infrastructure necessary to enable us to meet those goals. We look forward to a great 2019, and want to thank everybody once again. Have a great day.

感謝各位今天參與我們的電話會議。你們可能不知道的是，今年其實是 DexCom 的 20 週年，也就是我們的周年紀念。我們在 2006 年推出第一個產品，在 10 年的商業化運作後，我們達到年營收 5 億美元。但在過去 2 年裡，我們又新增了下一個年營收 5 億美元。我們正在為下一個 10 億美元的營收以及更高目標來定位公司，而接下來的成長速度會快得多。這從來都不容易，但我們完全、完全致力於在研發管線中擁有理想的技術，以把握這個巨大的機會。如同你們今天所聽到的，今年我們的重點除了擴大業務與推進產品研發管線之外，也在於建立必要的基礎設施，以使我們能達成這些目標。我們期待 2019 年會很精彩，也再次感謝各位。祝各位有美好的一天。

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，現在可以掛線。