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Amazon Hastens Retail Pharma's Last Stand

Jul. 15, 2018 11:28 AM ETAmazon.com, Inc. (AMZN)COR, AET, CVS, JPM, RAD, WBA45 Comments
Douglas Adams profile picture
Douglas Adams


  • Amazon continues to startle markets with its market performance to date, leaping almost 52% through Friday's market close.
  • Amazon's partnership with JP Morgan Chase and Berkshire Hathaway has markets speculating on the path the company will take in applying its resources to the US healthcare leviathan;
  • Amazon's most recent foray into the retail pharmaceutical space with the purchase of closely held PillPack now gives the giant the necessary regulatory licensing to compete in 49-states;
  • Retail pharma's biggest players continue the consolidation process with vertical and horizontal integration schemes to slow the pace of the Amazon competitive threat;
  • Investors remain wary as Amazon's pace gathers momentum.

Amazon’s (NASDAQ:AMZN) interest in the $450 billion US pharmaceutical market is long-standing. The company already sells over-the-counter medicines like aspirin and antihistamines, to go along with its copious offerings of supplements and vitamins on its worldwide platform. It already has licensing to sell pharmaceuticals in 12 states (Nevada, Arizona, North Dakota, Louisiana, Alabama, New Jersey, Michigan, Connecticut, Idaho, New Hampshire, Oregon, Tennessee, with an application pending in Maine). And now with the purchase of the closely held, online, Manchester New Hampshire-based PillPack that will clear in the latter part of the year, Amazon with the stroke of a pen has the necessary licensing to sell pharmaceuticals in 49-states. Investors were certainly quick to notice and the reaction hit markets with tsunami force. With the 28th of June announcement, brick and mortar stalwarts of the pharmaceutical retail world like Walgreens Boots Alliance (WBA), CVS Health (CVS) and Rite Aid (RAD) collectively shed about $11 billion in market value.

Amazon’s renown logistical efficiencies and willingness to sacrifice short-term margins for long-term market share were at the fore of the market move. Most prescriptions in the US are still filled in person and the delivery of scripts remains highly fragmented. If Amazon did nothing else but centralize the distribution of pharmaceuticals, this alone could likely apply enough downward price pressure on the cost of drugs to deliver real savings to US consumers. Centralizing and organizing existing data is the most likely front of significant cost savings and returns for both the end user and company alike. It could provide augmented negotiating clout to force better pricing deals on drug manufacturers. Even if mere convenience becomes the watchword of the makeover, laying the groundwork for cost reductions in the delivery of pharmaceuticals to those in medical need is a worthy endeavor for a country that spends almost 18% of its total annual

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Douglas Adams profile picture
Douglas Adams specializes in macro-economic research and turning theory into practical portfolio applications for clients over the past seventeen years. Mr. Adams recently formed Charybdis Investments International based in High Falls, New York where he is the managing director of a fee-only investment advisory practice with clients throughout the United States. As an author, Mr. Adams has commented widely on a diverse array of topics from Brexit to monetary policy to forex to labor productivity and wage growth. He holds an undergraduate degree from the University of California, a master’s degree from the University of Washington and an MBA in finance from Syracuse University.

Analyst’s Disclosure: I am/we are long AMZN. I wrote this article myself, and it expresses my own opinions. I am not receiving compensation for it (other than from Seeking Alpha). I have no business relationship with any company whose stock is mentioned in this article.

Seeking Alpha's Disclosure: Past performance is no guarantee of future results. No recommendation or advice is being given as to whether any investment is suitable for a particular investor. Any views or opinions expressed above may not reflect those of Seeking Alpha as a whole. Seeking Alpha is not a licensed securities dealer, broker or US investment adviser or investment bank. Our analysts are third party authors that include both professional investors and individual investors who may not be licensed or certified by any institute or regulatory body.

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Comments (45)

Rite Aid The company’s stock performance to date is still searching for rock bottom through Friday’s market close (13 July). Little wonder the company was put up for sale. That CEO John Standley, who took home $7.6 million in total compensation last year while skillfully steering the company into its current market abyss, has been tapped to run the combined company, defies discernible logic.
It's still searching for rock bottom because there is NO TRUE VALUE to the market worth of Albertson's.

It's like selling your car to a naked man for whatever change is in his pockets.

It's a bad deal.
Logistics Trends & Insights profile picture
Very nice analysis by Douglas and I will add a couple of points:

• Amazon wants to own the entire consumer-based healthcare products space in the US.
• UPS and FedEx covet this segment as the revenue yields are high and they will be hurt as Amazon mines the opportunity.
• Growing their presence in this space will allow Amazon to further scale the difficult-to-scale, Home Delivery and reduce overall transportation unit cost.
• Amazons leverage will really kick in once they open their Air Hub in Kentucky, buy more aircraft and build-out an over-night, on-line pharmacy that will sell and manage shipment of traditional consumer pharmaceuticals, specialty and compounded pharmaceuticals.

Finally, redefining the PBM model will be difficult but Amazon is up to the task.
And this will take years.... They will be down the line on aircraft orders, pilots are not just standing on street corners plus it takes huge dollars to train them, landing rights are tough to get, you're talking tens of billions of dollars and many years to replicate a FedEx, UPS, or USPS. For lower margins on drug cost? Doesn't seem like a smart idea.

Putting a Rite Aid in peoples' neighborhoods with immediate access and a $5 billion dollar investment seems a lot more cost effective and possibly immediately accretive. JMHO.
The Quant Investor profile picture
I doubt PBMs will allow chronic meds to be filled outside of their own mail order pharmacies. I think the well-established players are going to flex their muscles on this one.
Douglas Adams profile picture
No doubt true. This will be a political decision as to whether such a hurdles of entry start falling protecting current players in the equation. The 2016 presidential election was waged on both sides with calls for the cutting of drug prices to end users. The call was well received on both sides of the aisle. What we have seen since is a good deal of consolidation with offers of more of the same, only with fewer players.

Amazon's foray into retail pharmaceuticals will be a long play with many regulatory hurdles to overcome all along the way. Yet no other player in the mix is offering anything new that markets haven't seen time and again with few signs of any relief on down stream pricing. Amazon's quest is in the very beginning innings. Its partnership with JP Morgan and Berkshire will provide the format that will be the basis of its national launch. The revamping of drug ordering, packaging, dispensing and delivery will form an integral component of this new mix as PillPack designs go national scaling the concept deserves.
Steve Krol profile picture
Douglas Adams

Thorough article, but disagree with some of your assertions, i.e. Amazon will have to do a whole lot more than acquiring PillPack for anyone to notice sufficiently, since the knee jerk reaction when the PillPack acquisition was announced.

One of your stated facts is also incorrect. The FTC did not block Walgreens full acquisition of Rite Aid in June of 2017; rather Walgreens and Rite Aid pulled the deal in favor of the Asset Purchase Agreement that the FTC quickly approved for a little less than half of Rite Aid's stores. Indeed, in the first of its kind according to the press, the following day The FTC issued a press release making it crystal clear that within days, the full merger might have been automatically approved short of filing suit to stop it, upon the expiration of the time for The FTC to review it. Clearly, there were irregularities in the parties various attempts to gain approval and with the pulling of the merger, after the parties caused shareholders to wait 1 1/2 years for The FTC decision, something was clearly wrong here.

Fortunately, Walgreens defendant motion to dismiss in the original lawsuit filed, for statements Walgreens made along the way in particular how things were going at The FTC was DENIED last week, so it is likely we will eventually find out in discovery what really happened here, and the extent, if any, that Walgreens damaged Rite Aid shareholders, as Plaintiff in this class action. I expect that Mr. Pessina CEO of Walgreens will be the star witness in that case and perhaps another related to the Albertsons offer to merge with Rite Aid. It is a shame that Mr. Standley, Chairman/CEO of Rite Aid attracts lawyers like a magnet, rather than run a large drugstore chain for success.

As to the current Albertsons offer to acquire the remaining Rite Aid stores, whose shareholder vote is not until August 9, 2018, my crystal ball is telling me that existing complications, and lack of full disclosure will make this anything but a done deal, even if the vote happens as currently scheduled.
Interesting piece, though Amazon has a long way to go before becoming the force you imply.

PillPack is still just PillPack, with a new owner. No one feared them before and few fear them now. To be a force, Amazon needs to open pharmacies in each WholeFoods, and their ain't enough of them to exert much more than a glancing blow.

Your comment on Rite Aid's CEO, John Standley, however, is spot on re: a not-as-yet shareholder-approved proposal to merge with financially struggling Albertsons:

" That CEO John Standley, who took home $7.6 million in total compensation last year while skillfully steering the company into its current market abyss, has been tapped to run the combined company, defies discernible logic." RAD shareholders, including Institutional investors, would think it even understated.

Another point, your: "Walgreens agreed to less robust purchase of Rite Aid assets two months later which included 1,932 Rite Aid stores and three distribution centers in Connecticut, Pennsylvania and South Carolina for a sum of $4.4 billion, about 42% of Rite Aid’s total marketable assets." From that, one could deduce the remaining 52%, less outstanding debt, somewhere just north of $3 a share book value, not even close to total enterprise value estimated between $5-6 per share. Another reason for RAD shareholders to vote down the merger.

I pick on this because the way Amazon COULD shake the pharmacy tree is to buy Rite Aid itself, dispose of the incompetent management, and tie in with Whole Foods. Just putting the name Amazon above the store will send sales and volumes skyward. Especially when Amazon technology is tied in with home reorder convenience.

BTW, if anyone has to take different medicines at different times of the day, especially if the amounts vary, PillPack offers no particular benefit. You still have to check each and every one.
longnose profile picture
in fact RAD can be used as Amazon's drop ship, return processing, drone pickup AND PBM AND pharma and anything else they can dream of - oh ya quick shop - whatever
Steve Krol profile picture

The fact that the author , Douglas Adams , can not understand how Mr. Standley could become the CEO of the combined company is only a function of his lack of knowledge on the numerous conflicts on the board, Albertsons senior management, the negotiation committee, etc., etc. Not to worry Mr. Adams, I have a feeling you will soon find out and you will not be scratching your head much longer, trying to find the answer-Why oh why!
Germiz profile picture
SC the author was implying that it is unbelievable thing after all the damage he caused to RAD not that he doesn't know about the management and BOD SHAMELESS actions. Nobody with their right mind will hire this man with his record.
15 Jul. 2018
Maybe I am wrong, but, I don’t see Whole Foods doing much since they joined amzn. I think pharmacies may be similar
Douglas Adams profile picture
This is not a process where results are readily evident in overnight tweaks. I haven't looked at the Whole Foods scenario as yet. The grocery business is notorious for thin margins and price volatility in the best of times, the latter being why core is a much more important number than headline in determining overall price inflation in the greater economy.
A long, but enlightening article. It falls right in line with my comment on the previous article, dated 7-13-18, "Pfizer Is Not An All-Powerful Price-Hiker". There are too many middlemen and distribution entities between manufacturers and ultimate consumers.
Douglas Adams profile picture
Your point goes to the heart of the issue at hand.

If Amazon is able to begin the process of whittling away at the intermediaries that stand between drug manufacturer and end user via consolidatiion, they will go a long way toward dramatically lowering the cost of drug delivery in the US. I think this is precisely the area where Amazon excels and precisely where costs savings could be wrung from the current drug delivery paradigm--and still maintain sufficient payback schedules to promote research in the next generation of treatments.
Germiz profile picture
/don't you think Amazon need heft in this area to be able to do that? they should have acquired mismanaged RAD TO ACCOMPLISH THAT
WBA is an average traditional pharmacy retail store with nothing special about it. Most of the items they sell are over priced. It is not run efficiently and at best it has an average stewardship and management. If Amazon is serious to enter in that space, it will affect WBA negatively. In terms of stock price appreciation, there is not even a comparison. AMZN has left WBA in the dusts.I think WBA will lag S&P.
Douglas Adams profile picture
I would readily agree. Amazon already is applying price pressure on WAB front end sales. Ditto with CVS. RAD is still looking for a market bottom.

When Amazon gives market and logistical scale to PillPack's innovative packaging designs and weds them with Amazon's delivery process, I don't see how the billions upon billions that CVS and WBA are spending on their respective integration strategies will create long-term market value on price to the end user. One could argue that the current financial headwinds each of these companies are facing stem in large part to brand drugs being upended by generics once their market exclusivity comes to an end. Drug pipelines are rather sparse of late and the erosion of brand drug prices are frequently cited as headwinds to current revenue streams. Amazon is in the position to hasten that process to its logical conclusion.
Serious questions for the author

1. Do we know if Amazon is in talks with the major insurance carriers, for adding Pillpack/Amazon to the insurance companys’ approved prescription vendor list? For example I have Cigna, and they are currently contracted with CVS only, for my particular policy.

2. Are there federal mandates in place for shipping controlled substances (class II-IV) via mail. Are class II drugs like opiates allowed to be shipped via mail relative to federal regulatory standards and agencies? I don’t have such prescriptions, but I’m curious in the context of surgical procedures, emergencies, etc...

3. Is pillpack/Amazon intended to be USA domestic only shipping or will its jurisdiction cover international shipping.?

4. Are there any pharmacist services that are bundled with Amazon/pillpack services? Who does one call to insure drug contraindications are not being violated. Many drugs are dangerous when taken with other drugs. I assume pillpack has access to the patient’s current drug list from the same database that pharmacists do, and that they have staff for this?

5.Are there any brick and mortar outlets with pillpack for extremely urgent emergency situations such as after an ER visit prescription request ?

6. Is pillpack/Amazon meant to be a secondary prescription service that is only used for drugs that are refilled on a periodic basis? Not for post surgical prescription services, and one time prescriptions? And if so, are they working with the insurance companies in this manner, ie as a secondary prescription service?
Douglas Adams profile picture
Excellent questions all.

The points are precisely the logistics Amazon and its partners are going to work to solve in the first stage of this project, namely with the employees of Amazon, JP Morgan Chase and Berkshire Hathaway. There is a literal myriad regulatory issues to be resolved before something like what I have briefly sketched out before the reality of day-stamped pill packs start arriving on your stoop.

I have every confidence that Amazon will be able to handily handle such complexity within its AWS platform. The logistical part of the equation, indeed, plays to Amazon's current strengths. The regulatory hurdles, on the other hand, are headwinds with a capital "H", make no mistake. In the long run, these headwinds will be tamed or minimized by the political process as they are decisions regarding existing laws and regulatory procedures as they pertain to the handling and distribution of drugs across state lines. Reducing the cost of drugs is a hot political item and a company with the logistical and financial wherewithal to put into place a workable platform to reduce the heavy burden of treating health issues in this country will likely be richly rewarded. Where we can likely all agree is the present system does not work from just about every measure.

That leaves a lot of room for innovation and trying new methodologies with the end goal of reducing costs over time. That is what the Amazon, JP Morgan Chase and Berkshire Hathaway experiment is all about.
BA Man profile picture
I’ve had most of these same questions, plus one I don’t think AMZN/PillPack can answer. Many older customers (who spend a lot more at the pharmacy than the millennials that Bezos is courting, and who will themselves become older people someday too) view a trip to the pharmacy as somewhat of a social event, as they have a chance for some human interaction. How are they going to replace that?
I would add another. Pillpack presents tremendous child safety concerns - drugs in easy to open plastic bags - this type of dispensing should be limited to those that have trouble opening child resistant containers or agree to the liability
Grocery is actually the last line of defense for retailers
Long on Walgreens I prefer going there and making sure they are rite rather then mailorder where errors are hard to fix
Teutonic Knight profile picture
Can AMZN lower drug prices?

How? Can they sell at wholesale prices eventually? How?

It would be great tidings if they could achieve this in time.
The only way Amazon cal lower prices is to get rid of PBM’s, wholesalers and go directly to the manufacturers. This will NEVER happen because of the structural way US healthcare works. What pillpack does is make Amazon another mailorder drugstore, nothing more.
Teutonic Knight profile picture
Get rid of the PBM's? Never say never. The Alliance of AMZN JPM and Buffet is powerful and Buffet and JPM have friends in high places. Bezos is a hostile target with Trump though because of WaPo

Time will tell but AMZN always surprises.
Douglas Adams profile picture
That is my bet.

Amazon's move into the retail pharmaceutical space will revolutionize the supply chain that delivers drugs from manufacturers to end users. By eliminating the intermediaries in the supply chain and applying the well-honed logistics of Amazon's delivery processes, economies of scale, captured cost efficiencies and the breaking down of the myriad regulatory protections ensconced in local, state and national laws could bring down the cost of drugs considerably over the course of time.

I would argue that investors have already sniffed the premise out in their continuing support of Amazon shares. At the same time, RAD, CVS and WBA struggle with a platform that hasn't changed measurably in recent history. There is a reason RAD, CVS and WBA lost about $11 billion in market capitalization with the announcement of Amazon's purchase of PillPack. Perhaps it is time to look for different paradigms for growth.
josephaoppenheim profile picture
WBA is 7.8% of my 18 stock DGI portfolio, and I plan to hold it forever as long as it remains a Dividend Aristocrat. WBA currently yields me about 5% on cost.

AMZN has been a great speculation, but that is what it is, a speculation. I prefer investing. I think CVS just froze their dividend, I guess to afford Aetna. Assuming the deal completes, it will be mostly an insurance company, Caremark and Aetna, maybe a great insurance company, but not what I want.

Sure, Walgreen is being disrupted, but that’s nothing new for Walgreen, with over 100 years of surviving disruptions. I do worry, that’s why I won’t be buying more WBA, but I love those dividends.
would never underestimate amzn but they are facing off with two heavyweight companies that wont go away easily
Edward J. Roche profile picture
The CVS purchase of AMZN was done largely because UNH/Optum was taking many contracts away from them. It was not done primarily as a response to AMZN.

Your discussion confuses Amazon, the company, with its stock price. This is a major mistake in investment thinking. AMZN stock price is being irrationally driven up by speculation.
Douglas Adams profile picture
Thanks for your comment. Of course, I would disagree with your surmise.

While AMZN most certainly attracts a good deal of speculative attention, the area under consideration here is the company's entry into one of the last retail spaces where it lacks much of a presence to date. What I tried to present here is an industry where old-world thinking of markets, economies of scale and synergies is being upstaged by a player with both financial wherewithal and technological prowess that has the potential to provide scale to a company (PillPack) that could revolutionize how pharmaceuticals are ordered, packaged, dispensed and delivered, the likes of which the industry as currently configured has never seen before. In the process, economies of scale and cost efficiencies take on an entirely new dimension that could go a long way toward shrinking the 18% of total GDP that we as a country spend on healthcare. And along the way, shareholder value is created--as evident by investors large and small that continue to bid Amazon skyward. But the most interesting piece of the equation in my opinion, is the efficiencies Amazon could potentially create in bringing down the cost of drugs and healthcare to the consuming public.

The agreement with Berkshire, JP Morgan Chase will be a test run on just how technology and logistics will be brought to bear on the delivery of healthcare in the US. Consolidating the PBM format will undoubtedly be an important component of the exercise, and Pill Pack will for the basis of the thrust, first with the employees of the three component companies, which will be the launching pad for the national format that will be introduced in the aftermath. AWS will form the technical backbone of the company's healthcare platform.

There is no confusion between Amazon, the company and its stock price. Amazon has been very successful in the markets it has entered, introducing unheard of efficiencies to the way and manner goods and services are delivered to consumers. The company's financial wherewithal to forego short-term margins for long-term market share has historically has been a winning combination that investors have been more than willing to support which is reflected in its outsized stock valuation. With competition of this nature and scope pitted against the vertical and/or horizontal integration strategies being proposed by the likes of CVS, RAD, WBA in the selling of pharmaceuticals, over the course of time my bet, wholeheartedly, is with Amazon coming up with an outsized piece of that retail pharma pie--most likely at the expense of the current retail pharmaceutical players.

This is not mistaken investment thinking. Rather, I would call it vision.
To Edward J. Roche --

I think you mean to say the CVS purchase of AET (not AMZN). And I do generally agree with your point about the authors conflating of stock price and stock reaction with longer term business strategy by key existing large scale players in the pharmacy business. Obviously, AMZN has been sniffing around pharmacy for a long time, but despite the authors verbiage on logistics, efficiency and purchasing scale (and its not as if the 3 major PBMs don't have immense purchasing power -- they certainly do), I'm not sure that AMZN has figured out how to enter or what it wants to be in this market. I'm not exactly sure what owning a mail order drug business does for them (except create some buying opportunity in drugstore and PBM stocks) in the larger scheme of things. I wouldn't downplay their efforts or the potential to have some impact on the margins, but if they were really serious they would have purchased ESRX (or Catamaran before UNH got to it). Being a mail order supplier is not going to give them critical traction in healthcare, particularly as the overall health delivery industry consolidates and skinnies down networks to reduce cost.

But to get to your point, I don't believe the CVS purchase (still pending) of AET was done specifically because UNH/OptumRx was taking a lot of contracts from CVS -- they are not. In fact, Caremarks (CVS's PBM that competes with OptumRx) has experienced good retention of its PBM contracts. I believe the AET acquisition by CVS (which of course has yet to close) and the subsequent (and still pending) acquisition of ESRX by CI reflects (1) the fact that UNH has been successful with OptumRx and that clients (i.e., employer payors) don't necessarily value the independence of the PBM and (2) more importantly, that scale -- both size and breadth -- will increasingly be key to success in the healthcare industry. Also, specifically with respect to CVS's acquisition of AET, combining with a managed care organization was the best way for CVS to leverage its 1,000+ MinuteClinics. Emergent care clinics are nice and convenient for minor and/or after-hour issues when you don't want to go to an emergency room. Integrating these clinics into an actual health network (i.e., Aetna) makes a lot of sense in terms of cutting down on expensive emergency room visits and provides potential value (lower expenses) to the client/payor of the health plan. To the extent that managed care/PBM consolidation reflects concerns about AMZN, it would be ironic because greater consolidation will end up being a larger barrier to AMZN's success.

Also, as I'm sure you're aware, just because we'll now have the three major PBMs (ESRX. CVS' Caremark, and OptumRx) each associated with a managed health care organization (and let's not forget Anthem using CVS to build out its own PBM), it obviously doesn't mean that when an employer selects UNH it automatically uses OptumRx as its PBM. For example, my health insurer is UNH but my PBM is CVS Caremark. The employer/client/payor makes the decision. Health care and PBM services will be sold separately, but each of the three existing/emerging managed care/PBM groupings will obviously try and figure out ways to better integrate the health care and PBM offerings to make them more attractive to payors.

Finally, the negative issues that CVS has been having are more related to the drug store chain, where certain plans opted for a skinnier retail pharmacy network, and where CVS got cut out of several contracts, which stalled profit growth in the retail segment (not the PBM segment). The biggest hit to CVS retail pharmacies came from TRICARE (for which the PBM is ESRX) and where Walgreens presumably offered significant concessions so that they were able to get the CVS retail pharmacies kicked out of the network.

In any event, a lot of what we're seeing now from PBMs (and other health care organizations) are "value" focused programs meaning that there are either implicit or explicit guarantees to payors that if the payor adopts certain programs and offers them to plan members, the provider will provide some form of guarantee to the payor that it will ultimately reduce costs through lower rates of emergency room visits, hospitalizations, adherence, etc. Offering these types of programs requires organizations to have a deep level of experience in health care and drug utilization and cost efficiency. This is the type of knowledge that AMZN doesn't have and won't have unless it makes a significant commitment and investment in the industry. Playing on the periphery and being opportunistic may not be enough.
I think you touch on a major point when you mention the inefficiencies in traditional retail pharmacy. I have friends who are pharmacists and they bemoan having to work a drive-up window and run a cash register while prescriptions are waiting to be filled. This is terribly inefficient on a number of levels. First, you are paying pharmacist wages for a cashier's job. Second, the bottleneck analysis says you try to streamline and not interrupt the rate limiting step in a process. This is the pharmacist checking the prescription. Anyone can answer the phone, run the register. or man the drive-up. If the pharmacist is doing these activities, your prescription volume drops. Why do you think doctors don't answer the phone, take payments, process insurance, or make appointments. If they did. they sure wouldn't see many patients. Finally, according to my pharmacist friends, studies show the number one cause of prescription drug errors is interruptions in the process. This of course besides the obvious incident of harming another individual opens you up to litigation as well as negative press.
Evil Enantiomer profile picture
Which is why you almost always buy the amazon scare dip, $WBA, has gained almost 10% since the announcement.
Tigerkz3434 profile picture
I was just thinking.. someone needs to come up with an ETF that buys stock in companies that have recently been negatively affected by some type of amazon news. Then sell it when it gets back to where it was... you would make a fortune in investing in that type of ETF! I’ve made plenty doing it on my own!
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