信諾集團 (CI) 2022 Q3 法說會逐字稿

Ladies and gentlemen, thank you for standing by Cigna's Third Quarter 2022 Results Review. (Operator Instructions) As a reminder, ladies and gentlemen, this conference including the Q&A session is being recorded. We'll begin by turning the conference over to Mr. Ralph Giacobbe. Please go ahead, Mr. Giacobbe.

女士們，先生們，感謝您支持 Cigna 的 2022 年第三季度業績審查。 （操作員說明）作為提醒，女士們，先生們，本次會議包括問答環節正在錄製中。我們首先將會議交給 Ralph Giacobbe 先生。請繼續，賈科比先生。

Great. Thanks. Good morning, everyone, and thank you for joining today's call. I'm Ralph Giacobbe, Senior Vice President of Investor Relations. With me on the line this morning are David Cordani, Cigna's Chairman and Chief Executive Officer; and Brian Evanko, Cigna's Chief Financial Officer. In our remarks today, David and Brian will cover a number of topics, including Cigna's third quarter 2022 financial results as well as an update on our financial outlook for 2022.

偉大的。謝謝。大家早上好，感謝您加入今天的電話會議。我是投資者關係高級副總裁 Ralph Giacobbe。今天早上與我同線的是 Cigna 的董事長兼首席執行官 David Cordani；和 Cigna 的首席財務官 Brian Evanko。在我們今天的講話中，David 和 Brian 將涵蓋多個主題，包括 Cigna 的 2022 年第三季度財務業績以及我們對 2022 年財務展望的更新。

As noted in our earnings release, when describing our financial results, Cigna uses certain financial measures, adjusted income from operations and adjusted revenues, which are not determined in accordance with accounting principles generally accepted in the United States, otherwise known as GAAP. A reconciliation of these measures to the most directly comparable GAAP measures, shareholders net income and total revenues, respectively, is contained in today's earnings release, which is posted in the Investor Relations section of cigna.com. We use the term labeled adjusted income from operations and adjusted earnings per share on the same basis as our principal measures of financial performance.

正如我們在收益發布中指出的那樣，在描述我們的財務業績時，Cigna 使用了某些財務指標、調整後的運營收入和調整後的收入，這些指標不是根據美國普遍接受的會計原則（也稱為 GAAP）確定的。這些指標分別與最直接可比的 GAAP 指標、股東淨收入和總收入的對賬包含在今天的收益發布中，該發布發佈在 cigna.com 的投資者關係部分。我們使用標有調整後運營收入和調整後每股收益的術語，其基礎與我們衡量財務業績的主要指標相同。

In our remarks today, we will be making some forward-looking statements, including statements regarding our outlook for 2022 and future performance. These statements are subject to risks and uncertainties that could cause actual results to differ materially from our current expectations. A description of these risks and uncertainties is contained in the cautionary note to today's earnings release and in our most recent report filed with the SEC.

在我們今天的講話中，我們將發表一些前瞻性陳述，包括關於我們對 2022 年的展望和未來業績的陳述。這些陳述受到風險和不確定性的影響，可能導致實際結果與我們當前的預期存在重大差異。這些風險和不確定性的描述包含在今天收益發布的警告說明和我們最近提交給美國證券交易委員會的報告中。

Before turning the call over to David, I will cover a few items pertaining to our financial results and disclosures. Regarding our results, in the third quarter, we recorded after-tax special item charges of $23 million or $0.07 per share for integration and transaction-related costs. We also recorded an after-tax special item benefit of $1.4 billion or $4.52 per share associated with the sale of our international life accident and supplemental businesses to Chubb. As described in today's earnings release, special items are excluded from adjusted income from operations and adjusted revenues in our discussion of financial results.

在將電話轉給大衛之前，我將介紹一些與我們的財務業績和披露有關的項目。關於我們的業績，在第三季度，我們記錄了 2300 萬美元或每股 0.07 美元的稅後特殊項目費用，用於整合和交易相關成本。我們還記錄了與向安達出售我們的國際人壽事故和補充業務相關的 14 億美元或每股 4.52 美元的稅後特殊項目收益。正如今天的收益發布中所述，在我們對財務業績的討論中，特殊項目不包括在調整後的運營收入和調整後的收入中。

Additionally, please note that when we make prospective comments regarding financial performance, including our full year 2022 outlook, we will do so on a basis that includes the potential impact of future share repurchases and anticipated 2022 dividends. With that, I'll turn the call over to David.

此外，請注意，當我們對財務業績（包括我們的 2022 年全年展望）發表前瞻性評論時，我們將在包括未來股票回購的潛在影響和預期的 2022 年股息的基礎上這樣做。有了這個，我會把電話轉給大衛。

Thanks, Ralph. Good morning, everyone, and thank you for joining today's call. Our team is performing well in a dynamic environment, and we delivered another strong quarter of revenue, earnings and cash flows. I'm going to spend a few minutes highlighting key drivers of our results in the third quarter and while we are once again raising our 2022 full year outlook for adjusted earnings per share as well as for growth in medical customers and enterprise revenues. Then I'll address how we continue to expand and enhance our capabilities for the evolving market needs, and I'll also provide some initial perspective relative to 2023.

謝謝，拉爾夫。大家早上好，感謝您加入今天的電話會議。我們的團隊在瞬息萬變的環境中表現良好，我們又實現了強勁的季度收入、收益和現金流。我將花幾分鐘時間強調我們第三季度業績的關鍵驅動因素，同時我們再次提高調整後每股收益以及醫療客戶和企業收入增長的 2022 年全年展望。然後我將討論我們如何繼續擴展和增強我們的能力以滿足不斷變化的市場需求，我還將提供一些與 2023 年相關的初步觀點。

Brian will share more details about our third quarter results and our outlook for the rest of the year. Then we'll take your questions. With that, let's get started.

布賴恩將分享有關我們第三季度業績和今年剩餘時間展望的更多細節。然後我們會回答你的問題。有了這個，讓我們開始吧。

During the third quarter, we delivered results that were better than our expectations, including total revenues of $45.3 billion, and adjusted earnings per share of $6.04. We continued to building out our momentum this year, and we are confident we will deliver on our increased full year 2022 adjusted EPS guidance of at least $23.10. We also expect to continue advancing our capital deployment strategy, including investing in our business to drive innovation and growth and repurchasing at least $7 billion of our shares this year, all while paying a meaningful dividend.

在第三季度，我們的業績好於我們的預期，包括 453 億美元的總收入和 6.04 美元的調整後每股收益。今年我們繼續擴大勢頭，我們相信我們將實現至少 23.10 美元的 2022 年全年調整後每股收益指引。我們還期望繼續推進我們的資本部署戰略，包括投資我們的業務以推動創新和增長，並在今年回購至少 70 億美元的股票，同時支付有意義的股息。

Our performance in the quarter reinforces the impact of our sustained commitment to service and innovation, our progress in retaining clients and expanding relationships with additional services as well as winning new business. Evernorth, our health service platform performed well again with solid top line and bottom line results driven by our market-leading innovation and affordability across our pharmacy benefit services, specialty pharmacy and Evernorth Care Solutions.

我們在本季度的表現加強了我們對服務和創新的持續承諾、我們在留住客戶和擴大與其他服務的關係以及贏得新業務方面取得的進展的影響。 Evernorth 是我們的健康服務平台，在我們的藥房福利服務、專業藥房和 Evernorth 護理解決方案的市場領先創新和可負擔性的推動下，我們的健康服務平台再次表現出色，實現了穩健的頂線和底線結果。

Cigna Healthcare, our benefits portfolio also was key to continuing our momentum in the quarter. Our U.S. commercial business is having a very good year with solid client retention levels and new business wins, particularly in the middle market and select segments, leading us to once again raise our full year outlook for medical customers. Our medical care ratio for Cigna Healthcare was better than expectations at 80.8% in the third quarter demonstrating the effectiveness of our affordability initiatives and targeted pricing actions.

Cigna Healthcare 是我們的福利組合，也是本季度繼續保持勢頭的關鍵。我們的美國商業業務今年表現非常好，客戶保留水平穩定，新業務獲勝，特別是在中間市場和精選細分市場，這使我們再次提高了對醫療客戶的全年展望。第三季度，我們為 Cigna Healthcare 提供的醫療保健比率為 80.8%，好於預期，證明了我們的負擔能力計劃和有針對性的定價行動的有效性。

Overall, we're very pleased with the third quarter results. Now I'll take a few minutes to walk through how we are well positioned going forward with Evernorth and Cigna Healthcare. Within both platforms, we have differentiated businesses and a clear, durable 3-part growth framework. First, through our foundational businesses, including our Pharmacy Benefit Services, U.S. Commercial and International Health Businesses. With these mature scale businesses, we established core relationships with corporate clients, health plans and governmental entities. Our capital-efficient operating models will further support steady growth as well as strategic and financial flexibility for our company.

總體而言，我們對第三季度的業績非常滿意。現在，我將花幾分鐘時間來介紹一下我們如何在 Evernorth 和 Cigna Healthcare 方面處於有利地位。在這兩個平台中，我們都有差異化的業務和清晰、持久的三部分增長框架。首先，通過我們的基礎業務，包括我們的藥房福利服務、美國商業和國際健康業務。通過這些成熟的規模業務，我們與企業客戶、健康計劃和政府實體建立了核心關係。我們的資本高效運營模式將進一步支持我們公司的穩定增長以及戰略和財務靈活性。

As we look ahead for these businesses, in 2023, Pharmacy Benefit Services, we're expecting another year of high client retention levels complemented with new business wins. We're also very pleased with our solid start to the selling season for 2024, including our new multiyear agreement for Express Scripts to be the pharmacy benefits and specialty services provider for Centene. Working with Centene, we will make prescription drugs more affordable and accessible for approximately 20 million Centene members. The strategic collaboration with Centene builds on Express Scripts' track record as a partner of choice and will present growth opportunities to provide additional Evernorth Health services over time. We continue showing how we have a unique ability to partner across the healthcare landscape, expanding our reach and impact to more customers and patients, and with this new health plan relationship, we are building on our previous collaborations such as Prime Therapeutics, Oscar and Kaiser Permanente.

當我們展望這些業務時，在 2023 年，藥房福利服務，我們預計客戶保留水平將再高一年，並獲得新的業務勝利。我們也對 2024 年銷售旺季的良好開端感到非常高興，包括我們與 Express Scripts 簽訂的新的多年期協議，將成為 Centene 的藥房福利和專業服務提供商。與 Centene 合作，我們將為大約 2000 萬 Centene 會員提供更實惠和更容易獲得的處方藥。與 Centene 的戰略合作建立在 Express Scripts 作為首選合作夥伴的往績基礎之上，並將提供增長機會，隨著時間的推移提供額外的 Evernorth Health 服務。我們繼續展示我們如何在醫療保健領域擁有獨特的合作能力，擴大我們對更多客戶和患者的影響力和影響力，並且通過這種新的健康計劃關係，我們正在建立我們之前的合作，如 Prime Therapeutics、Oscar 和 Kaiser永久的。

For U.S. commercial, we are driving strong customer growth with wins throughout 2022, enabled by our consultative sales approach and our affordability gains, enhancing more competitiveness in more geographies, all while maintaining ongoing pricing discipline. The sales and net growth in our National Accounts segment are solid and outpaced prior year results, and we are confident this momentum carries into 2023. And in international health, we are sharpening our healthcare focus for targeted growth opportunities in serving individuals, employers seeking healthy and productive employees and governmental entities that value our care management programs. We have momentum this year in customer growth, revenue and earnings and expect to sustain these results and performance throughout 2023.

對於美國商業，我們在整個 2022 年推動了強勁的客戶增長，這得益於我們的諮詢式銷售方法和我們的可負擔性收益，在更多地區增強競爭力，同時保持持續的定價紀律。我們國民賬戶部門的銷售和淨增長穩健，超過了上一年的業績，我們有信心這種勢頭將持續到 2023 年。在國際健康方面，我們正在加強我們的醫療保健重點，為尋求健康的個人和雇主提供有針對性的增長機會以及重視我們的護理管理計劃的高效員工和政府實體。今年，我們在客戶增長、收入和收益方面保持強勁勢頭，並有望在 2023 年全年保持這些業績和業績。

The second way we drive growth is through our Accelerated businesses, which include Accredo Specialty Pharmacy, Evernorth Care Services and our U.S. government business. These businesses have outsized opportunities to grow with compelling secular tailwinds as well as differentiated capabilities that benefit our clients and customers. Looking forward for our Accelerated businesses, we continue to be excited about the value creation opportunities in specialty pharmaceuticals, including biosimilars over the next several years. With our leading capabilities and expertise, we expanded our relationship to be the exclusive specialty pharmacy provider for the Department of Defense starting in 2023.

我們推動增長的第二種方式是通過我們的加速業務，其中包括 Accredo Specialty Pharmacy、Evernorth Care Services 和我們的美國政府業務。這些企業擁有巨大的發展機會，具有令人信服的長期順風以及使我們的客戶和客戶受益的差異化能力。展望我們的加速業務，我們繼續對未來幾年特種藥物（包括生物仿製藥）的價值創造機會感到興奮。憑藉我們領先的能力和專業知識，我們從 2023 年開始擴大我們的關係，成為國防部的獨家專業藥房供應商。

This is further reinforcement to how we fuel sustained long-term growth in Evernorth by improving clinical quality for the benefit of patients and achieving significant savings for our clients. In Evernorth Care Services, we are advancing our care management and delivery strategies. One area of focus is enhancing virtual care that strengthens relationships between patients and their physicians to better anticipate health issues and intervene earlier.

這進一步強化了我們如何通過提高臨床質量以造福患者並為我們的客戶實現顯著節省來推動 Evernorth 的持續長期增長。在 Evernorth 護理服務中，我們正在推進我們的護理管理和交付策略。一個重點領域是增強虛擬護理，以加強患者與其醫生之間的關係，以更好地預測健康問題並及早進行干預。

For example, with MDLIVE, we are providing better experiences and improved affordability with personalized care that is more convenient and effective in directing patients to the most appropriate care settings. When a person -- when in-person care is needed, MDLIVE successfully guide patients to urgent care facilities or other alternative sites to care, decreasing avoidable emergency room visits by at least 10%. We intend to further build on this progress by enhancing our virtual primary care offerings for patients with chronic conditions by providing continuous engagement with their physician, remote monitoring with connected devices and real-time interventions between appointments.

例如，通過 MDLIVE，我們通過個性化護理提供更好的體驗和更高的負擔能力，從而更方便、更有效地將患者引導至最合適的護理環境。當一個人需要親自護理時，MDLIVE 成功地將患者引導到緊急護理設施或其他替代地點進行護理，將可避免的急診室就診次數減少至少 10%。我們打算通過提供與他們的醫生的持續接觸、使用連接設備的遠程監控以及預約之間的實時干預來增強我們為慢性病患者提供的虛擬初級保健服務，從而進一步鞏固這一進展。

In U.S. government, we are continuing to make investments, positioning us to grow in 2023 and beyond. We are strengthening this business by building on our high-quality affordable Medicare Advantage benefits we offer with geographic and network expansion as well as further product enhancements.

在美國政府中，我們繼續進行投資，使我們能夠在 2023 年及以後實現增長。我們通過地理和網絡擴展以及進一步的產品增強提供的高質量負擔得起的 Medicare Advantage 福利來加強這項業務。

Finally, the third way we drive growth is through a cross-enterprise leverage. Here, we harness capabilities across our company to accelerate innovation and have a greater impact than any individual could have on its own. Our opportunities here are driven in part by a rich longitudinal data and information we have to accelerate the development of new, more effective solutions for our clients and customers. Our Pathwell programs are a good example. With Pathwell Specialty, we're working across the medical and pharmacy benefits to reduce the cost of specialty infusions and injectables. In our Pathwell Bone and Joint program, we harness Evernorth digital navigation and advanced predictive analytical capabilities to reduce unnecessary musculoskeletal surgeries and provide better coordinated care. There is a significant addressable market for these programs as 50% of adults suffer from bone, joint and muscle conditions, and these are major drivers to U.S. healthcare costs.

最後，我們推動增長的第三種方式是通過跨企業槓桿。在這裡，我們利用整個公司的能力來加速創新，並產生比任何個人單獨產生的更大的影響。我們在這裡的機會部分是由豐富的縱向數據和信息驅動的，我們必須為我們的客戶和客戶加速開發新的、更有效的解決方案。我們的 Pathwell 計劃就是一個很好的例子。借助 Pathwell Specialty，我們正在跨越醫療和藥房的利益，以降低專業輸液和注射劑的成本。在我們的 Pathwell 骨骼和關節項目中，我們利用 Evernorth 數字導航和先進的預測分析能力來減少不必要的肌肉骨骼手術並提供更好的協調護理。這些項目有一個重要的潛在市場，因為 50% 的成年人患有骨骼、關節和肌肉疾病，這些是美國醫療保健成本的主要驅動力。

Additionally, we continue to take an enterprise view of our client relationships and successfully broaden and deepen them with our overall suite of capabilities. This has supported a number of attractive wins and a good example is a very large new fee-based relationship for 2023 in our U.S. commercial team that has secured this offering by bringing a solution to a long-standing Express Scripts client. With our Evernorth and Cigna Healthcare platforms and our growth framework, we anticipate driving another year of earnings, customer and revenue growth in 2023.

此外，我們繼續從企業角度看待我們的客戶關係，並通過我們的整體能力成功地擴大和深化它們。這支持了許多有吸引力的勝利，一個很好的例子是我們的美國商業團隊在 2023 年建立了一個非常大的新的基於費用的關係，通過為 Express Scripts 的長期客戶提供解決方案來確保這一產品。憑藉我們的 Evernorth 和 Cigna Healthcare 平台以及我們的增長框架，我們預計 2023 年將推動另一年的收益、客戶和收入增長。

We will provide detailed guidance as we always do on our fourth quarter earnings call. Having said that, I'll provide a view of some of the tailwinds and headwinds we see for 2023, which are largely consistent with the points we highlighted at our Investor Day in June. With a strong selling season, we anticipate a tailwind of continued growth across both our Evernorth and Cigna Healthcare platforms. We expect additional margin improvement in Cigna Healthcare and with our leading position in the rapidly growing specialty pharmaceuticals market will begin capturing value from biosimilars.

我們將一如既往地在第四季度財報電話會議上提供詳細的指導。話雖如此，我將提供我們在 2023 年看到的一些順風和逆風的觀點，這與我們在 6 月投資者日強調的要點基本一致。由於銷售旺季強勁，我們預計 Evernorth 和 Cigna Healthcare 平台將繼續增長。我們預計 Cigna Healthcare 的利潤率將進一步提高，並且憑藉我們在快速增長的特種藥品市場中的領先地位，我們將開始從生物仿製藥中獲取價值。

Relative to anticipated headwinds, we will make meaningful strategic investments in our accelerated growth businesses. We will have additional costs as well as we prepare to support renewed and expanded relationships with the Department of Defense and Prime Therapeutics. And a new development since Investor Day is our exciting strategic win with Centene, which will create a 1-year headwind as we onboard this new partner. Putting all that together, we anticipate that these tailwinds and headwinds will largely balance themselves off next year with the exception of our Centene headwind, which represents incremental cost for us in 2023.

相對於預期的逆風，我們將對加速增長的業務進行有意義的戰略投資。我們將承擔額外費用，並準備支持與國防部和 Prime Therapeutics 重新和擴大關係。自投資者日以來的一個新發展是我們與 Centene 的激動人心的戰略勝利，這將在我們加入這個新合作夥伴時創造 1 年的逆風。綜上所述，我們預計明年這些順風和逆風將在很大程度上平衡，除了我們的 Centene 逆風，這代表我們在 2023 年的增量成本。

Now I'll briefly summarize. Overall, our strong performance in the quarter and throughout the year shows how we are addressing the most pressing needs of our customers and clients and growing our business. We're investing in innovation to enhance our capabilities for future growth and continue delivering for all of our stakeholders. We're confident we remain on track for our full year 2022 commitments, including our increased adjusted EPS guidance for this year of at least $23.10. And with that, I'll turn the call over to Brian.

現在我將簡要總結一下。總體而言，我們在本季度和全年的強勁表現表明我們如何滿足客戶和客戶最緊迫的需求並發展我們的業務。我們正在投資於創新，以增強我們未來增長的能力，並繼續為我們所有的利益相關者提供服務。我們有信心，我們將繼續履行我們 2022 年全年的承諾，包括我們將今年調整後的每股收益指引至少提高到 23.10 美元。有了這個，我會把電話轉給布賴恩。

Thank you, David, and good morning, everyone. Today, I'll review key aspects of Cigna's third quarter 2022 results, and I'll discuss our updated outlook for the full year. We're proud of another strong quarter and are pleased to drive continued momentum from the first half of 2022, with third quarter adjusted earnings per share exceeding our expectations. With that, we are again increasing our full year adjusted 2022 earnings outlook to at least $23.10 per share, representing growth of 13% of our reported full year 2021 adjusted EPS. Looking at the quarter specifically, key consolidated financial highlights include total revenues of $45.3 billion, after-tax adjusted earnings of $1.9 billion and adjusted earnings per share of $6.04.

謝謝你，大衛，大家早上好。今天，我將回顧 Cigna 2022 年第三季度業績的關鍵方面，並討論我們對全年的最新展望。我們為又一個強勁的季度感到自豪，並很高興從 2022 年上半年開始繼續保持勢頭，第三季度調整後的每股收益超出了我們的預期。因此，我們再次將調整後的 2022 年全年盈利展望提高至每股至少 23.10 美元，相當於我們報告的 2021 年全年調整後每股收益的 13% 的增長。具體來看本季度，主要合併財務亮點包括總收入 453 億美元、稅後調整後收益 19 億美元和調整後每股收益 6.04 美元。

Regarding our segments, I'll first comment on Evernorth. We are pleased with the continued profitable growth in Evernorth, with our client-centric approach, deep pharmacy expertise and strong track record of service continues to resonate with new and existing clients. One good example of this is our recently announced partnership with Centene that will deliver greater prescription drug affordability and access for their approximately 20 million customers starting in January of 2024.

關於我們的部分，我將首先評論 Evernorth。我們對 Evernorth 的持續盈利增長感到高興，我們以客戶為中心的方法、深厚的藥學專業知識和良好的服務記錄繼續引起新老客戶的共鳴。這方面的一個很好的例子是我們最近宣布與 Centene 建立合作夥伴關係，從 2024 年 1 月開始，這將為他們的大約 2000 萬客戶提供更高的處方藥負擔能力和獲取途徑。

This mutually beneficial partnership will bring significant revenue and will be financially accretive over the course of the multiyear contract term. Turning to third quarter results for Evernorth. Revenues grew 6% over third quarter 2021 to $35.7 billion, and pretax adjusted earnings were $1.6 billion. Evernorth's results in the quarter were driven by continued expansion of our Accelerate growth businesses led by our specialty pharmacy, as well as our focus on affordability and delivering lowest net cost solutions for our clients and customers.

這種互惠互利的合作夥伴關係將帶來可觀的收入，並將在多年合同期內實現財務增值。談到 Evernorth 的第三季度業績。收入比 2021 年第三季度增長 6% 至 357 億美元，稅前調整後收益為 16 億美元。 Evernorth 本季度的業績是由我們的專業藥房領導的加速增長業務的持續擴張，以及我們對可負擔性和為客戶和客戶提供最低淨成本解決方案的關注所推動的。

We also continue to make meaningful strategic investments to both sustain and create new sources of differentiation. These include investments, which serve to deepen our client relationships and expand our services portfolio and digital capabilities. Overall, Evernorth delivered another quarter of strong results, consistent with our expectations.

我們還將繼續進行有意義的戰略投資，以維持和創造新的差異化來源。其中包括用於加深我們的客戶關係並擴展我們的服務組合和數字能力的投資。總體而言，Evernorth 又取得了四分之一的強勁業績，符合我們的預期。

Turning to Cigna Healthcare. Our 2021 results presented an opportunity to expand future margins, and our team has executed extremely well and achieved both strong membership growth and improved profitability here in 2022. Third quarter 2022 performance continued this pattern as adjusted revenues were $11.2 billion, pretax adjusted earnings were $1.1 billion and the medical care ratio was 80.8%. Our medical care ratio was better than expectations and continues to demonstrate the impact of our affordability initiatives and pricing discipline. The favorable medical costs in the quarter were partially offset by lower net investment income.

轉向信諾醫療。我們 2021 年的業績為擴大未來利潤率提供了機會，我們的團隊執行得非常出色，在 2022 年實現了強勁的會員增長和盈利能力的提高。2022 年第三季度的業績延續了這一模式，調整後收入為 112 億美元，稅前調整後收益為 1.1 美元億元，醫療保障率為80.8%。我們的醫療保健比率好於預期，並繼續證明我們的負擔能力計劃和定價紀律的影響。本季度有利的醫療成本被較低的淨投資收入部分抵消。

Turning to medical customers. We ended the quarter with 18 million total medical customers, growth of 873,000 customers or 5% year-to-date. We continue to drive strong customer and client growth in our U.S. Commercial and International Health businesses. Overall, Cigna Healthcare results reflect continued execution against our commitment to increasing both customer relationships and profit margins in 2022. For corporate and other operations, the third quarter 2022 pretax adjusted loss was $299 million. As a reminder, this segment previously included our earnings contributions from the international life, accident and supplemental benefits businesses that we divested to Chubb on July 1, 2022. Overall, we delivered strong third quarter financial results that exceeded our expectations, continuing our momentum with contributions across our foundational and accelerated growth businesses.

轉向醫療客戶。截至本季度末，我們共有 1800 萬醫療客戶，增長了 873,000 名客戶，今年迄今增長了 5%。我們繼續在美國商業和國際健康業務中推動強勁的客戶和客戶增長。總體而言，Cigna Healthcare 的業績反映了我們在 2022 年增加客戶關係和利潤率的承諾的持續執行。對於企業和其他業務，2022 年第三季度調整後的稅前虧損為 2.99 億美元。提醒一下，這部分之前包括我們在 2022 年 7 月 1 日剝離給安達的國際人壽、事故和補充福利業務的收益貢獻。總體而言，我們實現了超出預期的強勁第三季度財務業績，繼續保持我們的勢頭對我們基礎業務和加速增長業務的貢獻。

Now turning to our outlook for full year 2022. We have positioned the enterprise for continued strong performance in these dynamic times. As demonstrated by our strong year-to-date results and heightened reinvestment into our business. With that said, we remain mindful of the current economic backdrop and utilization environment heading into the upcoming winter months.

現在轉向我們對 2022 年全年的展望。我們已將企業定位為在這些動態時期繼續保持強勁表現。正如我們年初至今的強勁業績和對我們業務的加大再投資所證明的那樣。話雖如此，我們仍然關注即將到來的冬季月份的當前經濟背景和利用環境。

In light of these moving pieces, we are increasing our outlook for full year adjusted revenue and adjusted earnings per share. We now expect full year 2022 consolidated adjusted revenues of at least $179 billion, enabled by continued growth and deepening of customer and client relationships in both Evernorth and Cigna Healthcare.

鑑於這些變動因素，我們正在提高對全年調整後收入和調整後每股收益的展望。我們現在預計 2022 年全年合併調整後收入至少為 1790 億美元，這得益於 Evernorth 和 Cigna Healthcare 的持續增長和客戶與客戶關係的深化。

We are also raising our adjusted earnings per share guidance to at least $23.10 per share, representing growth of 13% over reported full year 2021 adjusted EPS. In Cigna Healthcare, we expect to continue to grow customers while expanding margins over 2021. We are improving our expected 2022 medical care ratio outlook to 81.5% to 82.2%. We are raising our expected full year 2022 adjusted earnings to approximately $4.05 billion. And we are raising our medical customer growth expectation to approximately 900,000 customers, which reflects strong new business growth and attractive retention levels in our U.S. commercial and international health businesses.

我們還將調整後的每股收益指引至少提高到每股 23.10 美元，比報告的 2021 年全年調整後每股收益增長 13%。在 Cigna Healthcare 中，我們預計將在 2021 年擴大利潤率的同時繼續增加客戶。我們正在將 2022 年的醫療保健比率展望提高至 81.5% 至 82.2%。我們將預期的 2022 年全年調整後收益提高至約 40.5 億美元。我們正在將我們的醫療客戶增長預期提高到大約 900,000 名客戶，這反映了我們在美國商業和國際健康業務中強勁的新業務增長和有吸引力的保留水平。

Our full year 2022 enterprise SG&A ratio is now expected to be approximately 7.3%, an increase compared to our prior guidance as we further accelerate investments into our business. Now moving to our 2022 capital management position and outlook. Year-to-date through November 3, 2022, we expect to have repurchased approximately 22 million shares of common stock for $5.8 billion, including the accelerated share repurchase agreements announced in June. We also continue to expect to deploy at least $7 billion to share repurchases for the full year 2022. And during the third quarter, we delivered strong cash flow from operations of $3.3 billion. We remain on track for another strong year of cash generation, providing us the fuel and flexibility for ongoing capital deployment opportunities.

我們現在預計 2022 年全年企業 SG&A 比率約為 7.3%，與我們之前的指導相比有所增加，因為我們進一步加快了對業務的投資。現在轉到我們 2022 年的資本管理職位和展望。年初至今，截至 2022 年 11 月 3 日，我們預計將以 58 億美元的價格回購約 2200 萬股普通股，其中包括 6 月宣布的加速股票回購協議。我們還繼續預計將部署至少 70 億美元用於 2022 年全年的股票回購。在第三季度，我們從運營中獲得了 33 億美元的強勁現金流。我們仍有望迎來又一個強勁的現金生成年，為我們持續的資本部署機會提供動力和靈活性。

Our balance sheet and cash flow outlook remains strong, benefiting from our asset-light framework that drives strategic flexibility, dollar margins and attractive returns on capital.

我們的資產負債表和現金流前景依然強勁，這得益於我們推動戰略靈活性、美元利潤率和有吸引力的資本回報的輕資產框架。

Now to recap. Results in the third quarter were above expectations, reflecting strong growth across our diversified portfolio. Evernorth continues to deliver attractive results while Cigna Healthcare continues to grow and expand both customer relationships and margins, giving us confidence we will deliver on our increased 2022 adjusted EPS guidance of at least $23.10 per share. We remain well positioned and expect another year of customer, revenue and earnings growth in 2023.

現在回顧一下。第三季度的業績超出預期，反映了我們多元化投資組合的強勁增長。 Evernorth 繼續提供有吸引力的結果，而 Cigna Healthcare 繼續發展和擴大客戶關係和利潤率，使我們有信心實現我們提高的 2022 年調整後每股收益至少 23.10 美元的指導。我們仍然處於有利地位，並預計 2023 年客戶、收入和收益將再增長一年。

Relative to 2023, we deem the current consensus EPS to be reasonable when excluding the Centene contract win. Although consistent with our historical approach, our initial guidance would have likely started more prudently. As David mentioned, Centene implementation-related costs introduced a net new headwind for our 2023 financials. That said, we expect the 2-year compounded EPS growth rate from 2022 to 2024 to be within our long-term average 10% to 13% annual range, driven by the strong earnings contribution from our broad portfolio as well as 2024 contributions from the Centene contract win, following the implementation cost impact that we will incur in 2023.

相對於 2023 年，我們認為排除 Centene 合同獲勝後的當前共識 EPS 是合理的。儘管與我們的歷史方法一致，但我們最初的指導可能會更謹慎地開始。正如大衛所說，與 Centene 實施相關的成本為我們 2023 年的財務狀況帶來了新的阻力。儘管如此，我們預計 2022 年至 2024 年的 2 年復合每股收益增長率將在我們的長期平均 10% 至 13% 的年度範圍內，這得益於我們廣泛的投資組合對盈利的強勁貢獻以及 2024 年來自在我們將在 2023 年產生的實施成本影響之後，Centene 贏得了合同。

We look forward to providing you with more detailed 2023 guidance during our fourth quarter call. And with that, we'll turn it over to the operator for the Q&A portion of the call.

我們期待在第四季度電話會議上為您提供更詳細的 2023 年指導。有了這個，我們將把它交給接線員進行電話的問答部分。

(Operator Instructions) Our first question comes from Mr. Stephen Baxter with Wells Fargo.

（操作員說明）我們的第一個問題來自 Wells Fargo 的 Stephen Baxter 先生。

I just wanted to ask you -- and congratulations on the Centene contract win. I wanted to ask specifically, is it too early to have a view on what you're expecting the implementation cost to be in 2023? It sounds like you're kind of suggesting that we should potentially add that back to 2023 to kind of create a jump-off point. Is it too early to think that 2024, we'll see the contract to be financially accretive? Basically, how should we be thinking about that? Is 2024 too early to think about accretion? .

我只是想問你——祝賀 Centene 贏得合同。我想特別問一下，現在對您預計 2023 年的實施成本有什麼看法還為時過早嗎？聽起來您似乎在暗示我們應該將其添加到 2023 年以創建一個起點。現在認為到 2024 年我們會看到合同在財務上增值還為時過早嗎？基本上，我們應該如何考慮呢？ 2024 年考慮吸積還為時過早嗎？ .

Stephen, it's Brian. I appreciate the question very much. So maybe I'll give you a little bit of a flavor for the multiyear view here. So I'd be remiss if I didn't start by saying this is a huge win for the organization and a great validation of the value proposition in the Evernorth segment of our company, and in particular, the Express Scripts team did a great job partnering with our new client here. And we'll be laser-focused on successfully implementing the new client over the course of the next 14 months to ensure a smooth execution of their $20 million customers.

斯蒂芬，是布賴恩。我非常感謝這個問題。所以也許我會給你一點關於這裡的多年觀點的味道。因此，如果我不首先說這對組織來說是一個巨大的勝利，並且很好地驗證了我們公司 Evernorth 部門的價值主張，那我就是失職了，特別是 Express Scripts 團隊做得很好在這裡與我們的新客戶合作。在接下來的 14 個月內，我們將專注於成功實施新客戶，以確保順利執行其 2000 萬美元的客戶。

And as I mentioned over the lifetime of the contract, the relationship will be accretive to our financials. But you should think of the profit margin percentage being below the book average as is typical for a contract of this size and scale. But in terms of the year-by-year pattern and how to think about that, you should think of 2023 being a headwind, as both David and I said, due to the implementation related costs that are incurred prior to any revenue being received. We're currently sizing that at about $200 million for the 2023 year.

正如我在合同的整個生命週期中提到的那樣，這種關係將增加我們的財務狀況。但是您應該認為利潤率百分比低於賬面平均水平，這對於這種規模和規模的合同來說是典型的。但就逐年模式以及如何考慮這一點而言，您應該將 2023 年視為逆風，正如大衛和我所說的那樣，因為在收到任何收入之前會產生與實施相關的成本。我們目前將 2023 年的規模估計為 2 億美元左右。

Given we're only a week or so into the contract award, we still have a lot of detailed planning to do to refine that. But that's our current best estimate for what 2023 implementation-related costs will look like. For 2024, we are currently expecting to be in a neutral to a small positive contribution standpoint in terms of the income. So you can think of that 2023 headwind essentially unwinding in the 2024 financials. And then for 2025 in the subsequent years, we would expect to be at approximately run rate contribution levels on the relationship.

鑑於我們距離合同授予只有一周左右的時間，我們仍然有很多詳細的計劃要做來完善它。但這是我們目前對 2023 年實施相關成本的最佳估計。對於 2024 年，我們目前預計在收入方面將處於中性至小的積極貢獻的立場。因此，您可以認為 2023 年的逆風基本上在 2024 年的財務狀況中得到緩解。然後在接下來的幾年中，到 2025 年，我們預計這種關係的貢獻率將接近於運行率。

Our next question comes from Mr. A.J. Rice with Credit Suisse.

我們的下一個問題來自 A.J. 先生。瑞信的賴斯。

Maybe just to ask, I know last year or coming into '22, you made a comment that you wouldn't be doing any larger deals, and I think you define that as anything north of $10 billion in acquisitions. I wonder as you think about '23 now, a lot's changed over the course of the year. You've been very active on the share repurchase front. What is your current thinking about whether you'd be open to transactions? Any comment about priorities or the pipeline and what that looks like? And then the flip side, of course, is your ongoing share repurchase activity. When you're giving these '23 comments, do you have any sense of where you might size share repurchase activity and all of that?

也許只是想問一下，我知道去年或進入 22 年，您發表評論說您不會進行任何更大的交易，我認為您將其定義為超過 100 億美元的收購。我想知道當您現在想到 23 年時，這一年發生了很多變化。你在股票回購方面非常活躍。您目前對是否願意接受交易有什麼想法？關於優先事項或管道以及它的樣子有什麼評論嗎？當然，另一方面是您正在進行的股票回購活動。當你發表這些 '23 評論時，你是否知道你可以在哪裡調整股票回購活動的規模以及所有這些？

A.J., it's David. So let me provide a couple of landing points there. First, stepping back relative to our capital priorities, our capital priorities remain consistent, which is, first and foremost, to make sure the ongoing growth of the underlying business continues to be funded properly from a capital standpoint as well as from investments in innovation; second, to obviously service very attractive dividend; and then third, we selectively pursue strategically attractive and financially attractive M&A and/or return excess capital to our shareholders through share repurchase.

A.J.，是大衛。所以讓我在這裡提供幾個著陸點。首先，相對於我們的資本優先事項，我們的資本優先事項保持一致，這首先是確保基礎業務的持續增長繼續從資本角度以及創新投資獲得適當的資金；第二，明顯服務於非常有吸引力的紅利；第三，我們有選擇地進行具有戰略吸引力和財務吸引力的併購和/或通過股票回購將多餘的資本返還給我們的股東。

Specific to M&A priorities. As we discussed at our Investor Day, you can think about our M&A priorities, largely focused on our Accelerated business and within the Accelerated businesses, a bit more pinpointed within Evernorth Care in our U.S. government business. We may do tuck-ins in other aspects of our portfolio that are highly financially attractive, but the strategic accelerants would be more in the Accelerated business. To your question relative to earlier this calendar year, we deem 2022 to be a bit unique for ourselves in that as we step into fiscal year 2022, we had the strong operating cash flow that Brian articulated earlier as well as the anticipated inflow from the divestiture of a portion of our international business at Chubb. So those 2 numbers created well in excess of $10 billion that we had to [steward] forward.

特定於併購優先事項。正如我們在投資者日討論的那樣，您可以考慮我們的併購優先事項，主要集中在我們的加速業務和加速業務中，在我們美國政府業務的 Evernorth Care 中更加精確。我們可能會在我們投資組合中極具財務吸引力的其他方面進行整合，但戰略加速器將更多地出現在加速業務中。對於您與本日曆年早些時候相關的問題，我們認為 2022 年對我們自己來說有點獨特，因為隨著我們進入 2022 財年，我們擁有布萊恩早些時候表達的強勁運營現金流以及資產剝離的預期流入我們在 Chubb 國際業務的一部分。因此，這兩個數字創造了超過 100 億美元，我們必須 [管家] 向前推進。

That, coupled with our view of the price of our equity at that point in time led us to create as much clarity as possible for our shareholders in '22 relative to our commitment to share repurchase that we're on track for. Looking forward, we'll maintain the capital discipline. We will be open to strategic M&A that advances us in the Accelerated businesses. And then the final note you asked relative to '23, as you have in the past, you just think about we will deploy capital in the way I talked about before, either in a shareholder accretive way to achieve through the shareholder share repurchase and/or through accretive M&A and our contribution to our EPS growth rate in the 3% to 5% range year in, year out from the successful capital deployment that remains intact.

再加上我們當時對股票價格的看法，使我們在 22 年盡可能地為我們的股東創造了與我們正在進行的股票回購承諾相關的清晰度。展望未來，我們將保持資本紀律。我們將對戰略併購持開放態度，以推動我們在加速業務中的發展。然後你問的關於 '23 的最後一點，就像你過去一樣，你只是想我們將按照我之前談到的方式部署資本，或者以股東增值的方式通過股東股票回購和/或通過增值併購和我們對每股收益增長率的貢獻，年復一年地保持在成功的資本部署的 3% 至 5% 範圍內。

Our next question comes from Mr. Justin Lake with Wolfe Research.

我們的下一個問題來自 Wolfe Research 的 Justin Lake 先生。

Just a couple of numbers questions. First, the accelerated growth in your stop loss revenue has been impressive this year. Just wanted to get some color on what's driving that? And do you think it continues at, we'll call it, a solid double-digit pace into 2023. And Then quickly, your medical cost reserves were down about 5% in the quarter. Just curious if there was anything driving that. .

只是幾個數字問題。首先，今年止損收入的加速增長令人印象深刻。只是想了解是什麼推動了這一點？您是否認為它會繼續以兩位數的速度持續到 2023 年。然後很快，您的醫療成本儲備在本季度下降了約 5%。只是好奇是否有什麼驅動它。 .

Justin, it's Brian. On the stop loss, yes, we're really pleased with the strong growth that we've shown this year as you can see, both in terms of the quarter-over-quarter and the year-over-year premium growth with 13% and 12% growth, respectively, on that. Important to keep in mind, there's a few components that drive that. One is we've shown a very strong growth in our fee-based Cigna Healthcare customers this year, and many of those bring with them a stop-loss contracts. So there's some additional units, if you will, of stop-loss that are embedded in the year-over-year growth rate. On top of that, we have had strong firm price increases on our existing client base. And as you noted, now in the double-digit level with the 13% quarter-over-quarter, representing some of the later 2022 renewal dates, seeing strong price increases.

賈斯汀，是布賴恩。關於止損，是的，我們對今年的強勁增長感到非常滿意，正如你所看到的，無論是環比還是同比保費增長 13%和 12% 的增長，分別。重要的是要記住，有一些組件可以驅動它。一是今年我們的收費 Cigna Healthcare 客戶增長非常強勁，其中許多客戶都帶來了止損合同。因此，如果您願意的話，還有一些額外的止損單位，它們嵌入在同比增長率中。最重要的是，我們現有客戶群的價格強勁上漲。正如您所指出的，現在處於兩位數水平，環比增長 13%，代表了 2022 年後期的一些續訂日期，價格上漲強勁。

And then finally, we have seen a bit of increased penetration on our existing ASO clients as well of the stop-loss products. So a few different factors that drove that strong growth. As we talked about in prior calls, we still have some margin expansion opportunity in our stop-loss book of business as we head into '23. So we would expect another year of strong growth in premiums for the stop-loss product in the 2023 calendar year.

最後，我們看到現有 ASO 客戶以及止損產品的滲透率有所提高。因此，有一些不同的因素推動了強勁的增長。正如我們在之前的電話會議中談到的那樣，當我們進入 23 年時，我們的止損業務簿中仍有一些保證金擴張機會。因此，我們預計 2023 日曆年止損產品的保費將再次強勁增長。

On the reserve side, there's really nothing in particular I'd call to your attention there. We continue to employ a consistent methodology to establishing our reserves. There will be some natural variability just between product mix shift and inventory levels changing from quarter-to-quarter. And overall, we feel good about the appropriateness of our reserves, and if you look year-over-year at the reserve levels, they -- all the key metrics that we evaluate screen appropriate and prudent.

在預備隊方面，我真的沒有什麼特別要提請你注意的。我們繼續採用一致的方法來建立我們的儲備。僅在產品組合轉變和庫存水平逐季度變化之間就會存在一些自然變化。總體而言，我們對儲備的適當性感到滿意，如果您逐年查看儲備水平，它們 - 我們評估的所有關鍵指標都會篩選適當和謹慎的。

Our next question comes from Mr. Kevin Fischbeck with Bank of America.

我們的下一個問題來自美國銀行的 Kevin Fischbeck 先生。

Great. Maybe just a quick fact question and then jump into the other question. But can you help us size the revenue that gets a little bit of difference on how Centene talks about the revenue contribution versus what it looks like CBS was booking from a revenue perspective. So can you help us size from a revenue perspective with the Centene contract and whether you get all of that in '24, whether that ramps up? And then I guess like my main question is just going to be about maybe going back to the M&A point, I just find it very interesting that you've got some competitors who are just out there constantly buying things and adding capabilities and other companies focusing more on share repurchase and selective smaller acquisitions.

偉大的。也許只是一個簡單的事實問題，然後跳到另一個問題。但是，您能否幫助我們確定收入的規模，這在 Centene 如何談論收入貢獻與 CBS 從收入角度預訂的方式上有所不同。那麼，您能否從 Centene 合同的收入角度幫助我們確定規模，以及您是否在 24 年獲得所有這些，是否會增加？然後我想我的主要問題可能是回到併購點，我覺得很有趣的是，你有一些競爭對手，他們不斷地購買東西並增加能力，而其他公司則專注於更多關於股票回購和選擇性較小的收購。

I guess, -- do you not see this as an arms race. It almost feels to me like a lot of companies are out there building capabilities. Do you feel when you think about M&A that potentially not pursuing M&A will be a disadvantage over the next 3 to 5 years if you're not doing deals today?

我猜，你不認為這是一場軍備競賽嗎？我幾乎覺得很多公司都在構建能力。當您考慮併購時，如果您今天不進行交易，您是否認為在未來 3 到 5 年內不進行併購可能會成為劣勢？

Kevin, it's David. On your first piece, again, we'll look forward to providing you a lot more detail as we get into 2023 relative to 2024. At a macro level, I think the 2 data points to think about relative to the size of the relationship. And at today's state, there's about $40 billion relative to spend capacity. And as I noted in the prepared remarks, approximately 20 million customer relationships that will evolve and change over time. And as we provide more detailed guidance going forward, we'll try to separate that versus the revenue contribution.

凱文，是大衛。在您的第一篇文章中，我們期待在 2023 年相對於 2024 年為您提供更多詳細信息。在宏觀層面上，我認為這兩個數據點需要考慮相對於關係的大小。在今天的州，相對於支出能力，大約有 400 億美元。正如我在準備好的評論中指出的那樣，大約 2000 萬客戶關係將隨著時間的推移而發展和變化。隨著我們提供更詳細的指導，我們將嘗試將其與收入貢獻區分開來。

To your strategic question relative to M&A, first and foremost, I think you're framing is quite important. I wouldn't call it an arms race, I would call it stepping back. The marketplace demand for further value creation is and will remain consistently aggressive from that standpoint. Hence, innovation, additional value creation, strong operating execution and then selectively expanding your addressable market demand the strategy we deem to be mission-critical.

對於您與併購相關的戰略問題，首先，我認為您的框架非常重要。我不會稱之為軍備競賽，我會稱之為後退。從這個角度來看，市場對進一步創造價值的需求現在並將繼續保持積極進取。因此，創新、額外價值創造、強大的運營執行以及選擇性地擴展您的潛在市場需要我們認為對任務至關重要的戰略。

Two, now stepping back to ourselves, as we discussed in our Investor Day, we're positioned with strong performing foundational businesses and well positioned to accelerate business. Those accelerated businesses are in sectors that have secular tailwinds. And then to the core of your point, how do we fuel additional capability growth. I'd ask you to think about it in a multipronged approach as opposed to M&A, yes or no.

第二，現在回到我們自己，正如我們在投資者日所討論的那樣，我們的基礎業務表現強勁，並且有能力加速業務發展。那些加速發展的業務屬於具有長期順風的行業。然後是您的核心觀點，我們如何推動額外的能力增長。我希望您以多管齊下的方式來考慮它，而不是併購，是或否。

One is significant targeted ongoing organic investment back into ourselves with new innovations and some of which I talked about today, some of which we profiled at our Investor Day, our new Pathwell programs, our unique longitudinal programs that take into consideration data, navigation support, best-in-class clinical engagement with physicians and will increase value by taking costs out of the system through improving clinical quality.

一個是通過新的創新進行重大有針對性的持續有機投資，其中一些是我今天談到的，其中一些是我們在投資者日介紹的，我們的新 Pathwell 計劃，我們考慮數據的獨特縱向計劃，導航支持，與醫生進行一流的臨床合作，並將通過提高臨床質量從系統中降低成本來增加價值。

So organic investments are number one; two, is smartly and successfully leveraging our ventures capabilities to partner up with organizations to accelerate innovation; and the third is M&A. We remain quite open to M&A. We do not deem it to be a silver bullet. It's a part of the growth support strategy. So organic execution, investments in organic innovation, smart leverage of our ventures capabilities as well as M&A over time.

所以有機投資是第一位的；第二，巧妙而成功地利用我們的風險投資能力與組織合作以加速創新；三是併購。我們對併購持相當開放的態度。我們不認為它是靈丹妙藥。這是增長支持戰略的一部分。因此，有機執行、有機創新投資、我們風險投資能力的巧妙利用以及隨著時間的推移進行併購。

And I would just come back and anchor it. Hence, our track record of strong top line growth, and strong bottom line growth with tremendous cash flow generation over the last decade by playing that recipe through which we will on a go-forward basis.

我會回來並錨定它。因此，我們在過去十年中實現了強勁的收入增長和強勁的底線增長以及巨大的現金流產生，通過我們將繼續前進的配方。

Our next question comes from Ms. Lisa Gill with JPMorgan.

我們的下一個問題來自摩根大通的 Lisa Gill 女士。

I just really wanted to better understand as we think about the comment on the tailwind for 2023 around biosimilars. As you think about the plan design for '23, are you seeing employers and health plans willing to put the biosimilars on the formulary? I mean how much color and visibility do you have to that tailwind for '23? And is that primarily HUMIRA? Or are we thinking about other biosimilars as well?

當我們思考關於 2023 年生物仿製藥順風的評論時，我真的想更好地理解。當您考慮 23 年的計劃設計時，您是否看到雇主和健康計劃願意將生物仿製藥列入處方集？我的意思是你對 23 年的順風有多少顏色和能見度？那主要是修美樂嗎？或者我們是否也在考慮其他生物仿製藥？

Lisa, it's David. First, relative to the category, as you know from prior conversations, we deem the category to be a net positive from a client, patient and customer standpoint as we look forward, '23 and beyond. As it relates to further improvements in affordability. And given the positioning of our Accredo capabilities, a net positive for ourselves. So just grounding on that for starters in terms of the capabilities to bring this to bear.

麗莎，是大衛。首先，相對於該類別，正如您從之前的對話中所知道的那樣，我們認為該類別從客戶、患者和客戶的角度來看是一個淨正面的，因為我們期待 23 年及以後。因為它涉及到可負擔性的進一步改善。鑑於我們 Accredo 能力的定位，對我們自己來說是一個淨積極因素。因此，就實現這一點的能力而言，對於初學者來說，只是以此為基礎。

Second, 2023 represents the start of another step function, but the start of another step function as it relates to the biosimilars.

其次，2023 年代表另一個階梯函數的開始，但又是另一個階梯函數的開始，因為它與生物仿製藥有關。

Third, we will communicate our national formulary conclusions later this quarter as you very well know, that's 1 dimension. And then there's client-specific formularies, decisions that are made that are underway.

第三，如您所知，我們將在本季度晚些時候傳達我們的國家處方集結論，這是一維的。然後是針對特定客戶的公式，正在進行的決策。

So to the core of your question, it will vary in 2023 between international formulary as well as client-specific formularies on a go-forward basis. We deem it to be a net positive for the franchise in 2023. As I noted, it will present a tailwind for us in 2023. That is HUMIRA-specific or the category specific, but others will begin to ramp as we move through 2023 into 2024.

因此，對於您問題的核心，2023 年國際處方集和客戶特定處方集之間的未來將有所不同。我們認為這對 2023 年的特許經營權是一個淨積極因素。正如我所指出的，它將在 2023 年為我們帶來順風。這是特定於 HUMIRA 或特定類別的，但隨著我們進入 2023 年，其他人將開始增加2024 年。

So a transitional -- I view '23 as a transitional year for the space with acceleration. Our decisions are about to be communicated and finalized relative to formulary decisions, and they're varied at an employer or health plan level. Our national formulary decisions will be consistent across that subset of our portfolio.

所以一個過渡期——我認為 23 年是加速發展的空間的過渡年。我們的決定將與處方決定進行溝通和最終確定，並且在雇主或健康計劃級別上有所不同。我們的國家處方集決定將在我們投資組合的那個子集中保持一致。

Our next question comes from Mr. Josh Raskin with Nephron Research.

我們的下一個問題來自 Nephron Research 的 Josh Raskin 先生。

So the $200 million you mentioned for Centene preparation costs, is that pretax or after-tax? And then my real question is the outlook for Medicare Advantage for 2023. I'm curious, I know you've made some investments through this year, and you've talked about opportunities for margin next year, but I'd be curious on the growth front. And if you could just give us some color on how some of the newer county expansions have gone in recent years, that would be helpful.

所以你提到的 2 億美元用於 Centene 的製備成本，是稅前還是稅後？然後我真正的問題是 2023 年 Medicare Advantage 的前景。我很好奇，我知道您今年已經進行了一些投資，並且您談到了明年的保證金機會，但我很好奇增長前沿。如果你能給我們一些關於近年來一些較新的縣擴張的情況，那將是有幫助的。

Josh, it's Brian. I'll take the first part of your question, and I think David will comment on the Medicare Advantage component. The $200 million that we quoted is a pretax figure. And again, as we work through the detailed implementation plans in terms of rate and pace. We'll continue to refine that estimate. But you should think of that as a $200 million pretax number for 2023 specifically. David, do you want to talk about Medicare? .

喬希，是布賴恩。我將回答您問題的第一部分，我認為 David 會評論 Medicare Advantage 組件。我們引用的 2 億美元是稅前數字。再次，當我們在速度和速度方面製定詳細的實施計劃時。我們將繼續完善該估計。但是您應該將其視為 2023 年的 2 億美元稅前數字。大衛，你想談談醫療保險嗎？ .

Sure. So specific to Medicare Advantage, let me take it maybe a little bit in reverse order to your question. Because as you articulate, we've been systematically adding new geographies -- net new geographies and adjacent counties over the last several years and successfully opening those counties in those markets. Second, as you would expect, your early sales in a net new market would tend to have a lower contribution than your sales in mature existing markets. The sheer nature of the operating cost environment and getting those businesses up and running from that standpoint.

當然。如此具體到 Medicare Advantage，讓我稍微與您的問題相反。因為正如您所說，我們一直在系統地添加新的地區——在過去的幾年裡，我們一直在系統地增加新的地區和相鄰的縣，並成功地在這些市場中打開了這些縣。其次，正如您所預料的那樣，您在淨新市場中的早期銷售額往往比您在成熟現有市場中的銷售額貢獻更低。從這個角度來看，運營成本環境的本質以及讓這些業務正常運行。

Having said that, while we are very early in the 2023 decision-making process cycle as everyday kicks on, early presence reporting are positive as it relates to our current net growth algorithm and both in mature counties and markets as well as some of our new market entries. Looking at 2023, given the continued geographic expansion, we've made network improvement. We've made investment in distribution and marketing support as well as more resources and capabilities to begin to harness some of the commercial agents to Medicare, we expect 2023 to be a year of growth for our Medicare Advantage portfolio, and we look forward to updating you on that as we get through the latter part of this year.

話雖如此，雖然我們在 2023 年的決策過程週期中處於非常早期的階段，但早期存在報告是積極的，因為它與我們當前的淨增長算法以及成熟的縣和市場以及我們的一些新的市場進入。展望 2023 年，鑑於持續的地域擴張，我們已經對網絡進行了改進。我們已經在分銷和營銷支持以及更多資源和能力方面進行了投資，以開始利用一些商業代理到 Medicare，我們預計 2023 年將是我們的 Medicare Advantage 產品組合增長的一年，我們期待更新當我們度過今年下半年的時候，你就知道了。

Our next question comes from Mr. Nathan Rich with Goldman Sachs.

我們的下一個問題來自高盛的 Nathan Rich 先生。

This is Lindsay Golub on for Nate. Congratulations again on the Centene contract win. Could you talk through some of the opportunities for future Evernorth service expansion and just strategic collaboration with Centene?

這是內特的 Lindsay Golub。再次祝賀 Centene 合同獲勝。您能否談談未來 Evernorth 服務擴展以及與 Centene 的戰略合作的一些機會？

Lindsay, it's David. Thank you for the acknowledgment. And as Brian noted earlier, we're excited and we're proud to be given the opportunity, and we'll seek to earn that opportunity day in, day out. And as Brian noted, before going to the core of your question, the team is 110% focused on a successful implementation and initiation of the relationship on January 1, 2024, and is heads down relative to that.

林賽，是大衛。感謝您的認可。正如布賴恩之前所說，我們很興奮，也很自豪能得到這個機會，我們會日復一日地努力爭取這個機會。正如布賴恩指出的那樣，在談到你的問題的核心之前，團隊 110% 專注於在 2024 年 1 月 1 日成功實施和啟動這種關係，並且相對於此。

As it relates to future opportunities, I want to get ahead of ourselves relative to that, but we've demonstrated over time when we successfully partner and successfully collaborate, we have an opportunity to broaden and deepen relationships. And we enter this relationship with Centene, First and foremost, needing to, wanting to and fully committed to performing on the existing commitment. And then availing Centene as a partner relative to our Evernorth capabilities and our broad service capabilities to co-collaborate and innovate. So we see opportunity over time, but we're not getting ahead of ourselves. We're focused on the present and the present is a significant win for us.

由於它關係到未來的機會，我想在這方面超越自己，但隨著時間的推移，我們已經證明，當我們成功合作並成功協作時，我們就有機會擴大和加深關係。我們與 Centene 建立這種關係，首先，需要、想要並完全致力於履行現有的承諾。然後利用 Centene 作為與我們 Evernorth 能力和我們廣泛的服務能力相關的合作夥伴，以進行合作和創新。因此，隨著時間的推移，我們看到了機會，但我們並沒有超越自己。我們專注於現在，而現在對我們來說是一個重大的勝利。

I would wrap around it. Our track record demonstrates deepening of relationships and broadening relationships like co-collaboration and co-development, and that's what we will seek to do with Centene after we successfully deliver on this promise.

我會環繞它。我們的往績記錄表明，合作和共同發展等關係的深化和擴大，這就是我們在成功兌現這一承諾後將尋求與 Centene 做的事情。

Our next question comes from Mr. Scott Fidel with Stephens.

我們的下一個問題來自 Scott Fidel 先生和斯蒂芬斯。

Wanted to talk -- ask about the ACA exchange market and how you're thinking about the setup for 2023 there. Obviously, some moving pieces on the competitive chessboard that should be favorable for potential enrollment growth. So interested in how you're thinking about enrollment growth for 2023 and then confidence in your pricing set up for 2023, if you do end up adding more membership than expected given some of the competitor exits confidence in also achieving your target margins for that segment as well?

想談談 - 詢問 ACA 交易所市場以及您如何考慮 2023 年的設置。顯然，競爭棋盤上的一些移動棋子應該有利於潛在的招生增長。對您如何考慮 2023 年的招生增長以及對 2023 年定價設置的信心非常感興趣，如果您最終增加的會員數量超過預期，因為一些競爭對手退出了對實現該細分市場目標利潤率的信心也？

Scott, it's David. So broadly speaking, we have viewed this space as a space where we have an opportunity to grow over time. And as you all know, there's been a little bit of volatility since its inception, and we were -- we entered at inception and remained in the marketplace and continue to systematically grow. We'll grow our geographies as we step into 2023. As it relates to the volume, we would expect to have net customer growth. Our current outlook is to have net customer growth in 2023, and we would expect that there would be a positive margin contribution.

斯科特，是大衛。從廣義上講，我們將這個空間視為我們有機會隨著時間的推移而成長的空間。眾所周知，自成立以來一直存在一些波動，我們是 - 我們從一開始就進入並留在市場上並繼續系統地增長。隨著我們進入 2023 年，我們將擴大我們的地域範圍。由於它與數量有關，我們預計會有淨客戶增長。我們目前的展望是在 2023 年實現客戶淨增長，我們預計會有積極的利潤率貢獻。

As Brian and I both noted, we expect the Cigna Healthcare portfolio in aggregate to have some further margin expansion opportunity. We believe that this subset of our space will have net positive margin contribution going forward. I'm not going to comment in terms of the latter part of your question went back to target margins as we continue to invest in, we know what the underlying book is performing at and what we expected to perform at. We'll make investment decisions in 2023 for 2024. That may dampen a little bit of the margins. Those are discretionary decisions for ongoing growth.

正如布賴恩和我都指出的那樣，我們預計 Cigna 醫療保健產品組合總體上會有一些進一步的利潤率擴張機會。我們相信，我們空間的這一部分將在未來產生淨正利潤率貢獻。隨著我們繼續投資，我不會就您問題的後半部分回到目標利潤率發表評論，我們知道基礎賬簿的表現以及我們預期的表現。我們將在 2023 年為 2024 年做出投資決定。這可能會削弱一點利潤。這些是持續增長的酌情決定。

But headline is well positioned for '23, expect to have net growth and expect to have good margin performance for the portfolio.

但標題為 23 年做好了準備，預計將實現淨增長，並有望為投資組合帶來良好的利潤率表現。

Our next question comes from Mr. Gary Taylor with Cowen.

我們的下一個問題來自 Cowen 的 Gary Taylor 先生。

One quick one for Brian and one for David. Brian, just on investment income in the quarter, looked a little light, even accounting for divested assets, the return looked a little light. So just wondering if there was something there, perhaps a little nonrecurring in terms of potential run rate on investment income.

一份給布賴恩，一份給大衛。布賴恩，單看本季度的投資收益，顯得有些清淡，即使算上剝離的資產，回報也顯得有些清淡。所以只是想知道那裡是否有什麼東西，也許就投資收入的潛在運行率而言有點非經常性。

And then for David, I had a couple of clients ask lately about the DOJ intervening in the AMA lawsuit as well as the AMA joining the class action on the multiplan lawsuit. I guess the question really is just the legal profile of the company changed in any material way. I just wanted to give you a chance to comment on those.

然後對於大衛，我最近有幾個客戶詢問司法部干預 AMA 訴訟以及 AMA 加入多計劃訴訟的集體訴訟。我想問題真的只是公司的法律形象發生了任何重大變化。我只是想讓你有機會評論這些。

Gary, as it relates to our investment income, within the third quarter, in aggregate, the investment income did slightly trail our expectations, but that shortfall was more than offset by the favorable medical care ratio performance within Cigna Healthcare, which allowed us to outperform both our Cigna Healthcare and Enterprise income outlook. Two things that are important to keep in mind as you reflect on that, and you referenced this in your question. The first one is the Chubb divestiture that was completed on July 1, resulted in a step-down of our investment income, and you can think of that as in the range of $50 million to $60 million per quarter. That's essentially removed starting in the third quarter. So any comparisons to historical periods need to normalize for that factor.

Gary，因為它與我們的投資收入有關，在第三季度，總體而言，投資收入確實略低於我們的預期，但這一缺口被 Cigna Healthcare 內良好的醫療保健比率表現所抵消，這使我們能夠跑贏大盤我們的 Cigna 醫療保健和企業收入展望。當您對此進行反思時，需要牢記兩件事，並且您在問題中引用了這一點。第一個是 7 月 1 日完成的安達資產剝離，導致我們的投資收入下降，您可以將其想像為每季度 5000 萬至 6000 萬美元。從第三季度開始，這基本上被取消了。因此，任何與歷史時期的比較都需要針對該因素進行標準化。

The second area is within our alternative asset portfolio, which consists of think of this is private market, noncoupon assets. And this represents a minority of our invested assets, but it's subject to mark-to-market accounting for U.S. GAAP requirements. And given some of the challenges in the public capital markets this year, we had expected some downward mark-to-market adjustments in the third quarter and the fourth quarter, and that did transpire. Some of the downward marks were a little bit larger than what we had been projecting.

第二個領域是我們的另類資產組合，包括認為這是私人市場的非息票資產。這代表了我們投資資產的一小部分，但它受制於美國公認會計原則要求的按市值計價會計。鑑於今年公共資本市場面臨的一些挑戰，我們曾預計第三季度和第四季度會出現一些向下的盯市調整，而這確實發生了。一些向下的標記比我們預測的要大一些。

But as I said earlier, strong medical care ratio performance in the quarter allowed us to exceed our overall income and EPS outlook. And as you think about the future and trying to run rate this, if you were to remove the Chubb-related contributions from 2022, the all-in net investment income for '23, you can think of it as approximately similar to the all-in 2022 investment income. So either a tailwind or a headwind as we step into '23 and the investment income line.

但正如我之前所說，本季度強勁的醫療保健比率表現讓我們超越了我們的整體收入和每股收益前景。當您考慮未來並嘗試對此進行評估時，如果您要從 2022 年刪除與 Chubb 相關的貢獻，即 23 年的全部淨投資收入，您可以認為它與所有- 2022年投資收益。因此，當我們進入 23 年和投資收益線時，要么順風，要么逆風。

David, I'll let you comment on the Medicare Advantage.

大衛，我會讓你評論一下醫療保險優勢。

Thanks, Brian. Gary, your broader framework, Gary, I'd step back and say, we have -- we do and we continue to operate in an active regulated space. Two, I'd point to, as we look at today in the past, we have a strong track record as an organization of being well governed and strong, healthy compliance-related programs. To that point and to the core of your question, I do not deem that the legal exposure, I think, is where you're going after with the profile of the company has changed meaningfully. And in some ways, given the strategic positioning of our franchise being more services-based, I would make the argument that the legal exposure footprint on a relative basis to the space is lighter from that standpoint, given the services-based nature of our portfolio is more intense and heavy. But no doubt, it's an active space has been, is and will continue to be an active space, but we're proud of our governance and compliance functions and capabilities. .

謝謝，布賴恩。加里，你更廣泛的框架，加里，我會退後一步說，我們已經 - 我們這樣做了，我們繼續在一個積極的監管空間中運作。第二，我要指出，正如我們今天所看到的那樣，作為一個管理良好的組織以及強大、健康的合規相關計劃，我們擁有良好的記錄。就這一點和您問題的核心而言，我認為法律風險並不是您所追求的公司形象發生了有意義的變化。在某些方面，鑑於我們特許經營權的戰略定位更加基於服務，我認為從這個角度來看，相對於空間的法律曝光足跡更輕，因為我們的投資組合基於服務的性質更加激烈和沈重。但毫無疑問，它是一個活躍的空間，過去、現在並將繼續是一個活躍的空間，但我們為我們的治理和合規職能和能力感到自豪。 .

Our next question comes from Ms. Ricky Goldwasser with Morgan Stanley.

我們的下一個問題來自摩根士丹利的 Ricky Goldwasser 女士。

Yes. So a couple of follow-up questions here. Just to clarify, for 2023, is the EPS starting point that we should use is the $23.10. And then as we think about the Centene headwind, if it's $200 million, around 2% of earnings growth. Are you assuming that excluding Centene, sort of the core business would have grown at that long-term target of 10% to 13%?

是的。所以這裡有幾個後續問題。澄清一下，對於 2023 年，我們應該使用的 EPS 起點是 23.10 美元。然後，當我們考慮 Centene 的逆風時，如果它是 2 億美元，大約是盈利增長的 2%。您是否假設不包括 Centene，某種核心業務會以 10% 至 13% 的長期目標增長？

Ricky, it's Brian. So let me try to clarify some of the comments I made earlier as it relates to our 2023 outlook. So prior to the Centene contract award, the current 2023 consensus EPS estimate we see is reasonable. And so the last I looked this was in the range of $25.30, give or take a few cents. With the recently announced Centene contract, this will create an incremental 2023 headwind that will essentially need to be deducted from that 2023 earnings per share figure that I just referenced.

瑞奇，是布賴恩。因此，讓我試著澄清我之前發表的一些評論，因為它與我們的 2023 年展望有關。因此，在 Centene 合同授予之前，我們看到的當前 2023 年每股收益共識估計是合理的。所以我最後一次看到的價格在 25.30 美元的範圍內，給或拿幾美分。隨著最近宣布的 Centene 合同，這將在 2023 年產生增量逆風，這基本上需要從我剛剛提到的 2023 年每股收益數字中扣除。

And then as I mentioned, as is normal, we typically start with our initial guide having some level of prudence in it, particularly since we have an at least EPS convention with the way that we communicate our outlook. So those are the different moving pieces that I would point to as you think about 2023. And then as I said earlier, relative to the 2-year 2022 to '24 growth rate, we would expect that to be within our 10% to 13% compounded annual EPS growth rate range.

然後正如我所提到的，通常情況下，我們通常會從我們的初始指南開始，其中包含一定程度的審慎，特別是因為我們在傳達我們的前景的方式上至少有一個 EPS 慣例。因此，當您考慮 2023 年時，我會指出這些不同的移動因素。然後正如我之前所說，相對於 2022 年到 24 年的 2 年增長率，我們預計這將在 10% 到 13 年之間% 複合年 EPS 增長率範圍。

Okay. And then just one quick follow-up question. As we think about the Centene contract, is there any leverage that you gain with the additional scale that you'll see across the rest of the Evernorth book of business?

好的。然後只是一個快速的後續問題。當我們考慮 Centene 合同時，您是否會通過在 Evernorth 業務手冊的其餘部分中看到的額外規模獲得任何影響？

It's David. Broadly speaking, a framework of growth always presents opportunity. So I think your basic tenant is positive here. Additionally, our opportunity to further enhance the value we're able to deliver to existing clients especially those with higher government portfolios of business and/or strengthen our value proposition even further relative to winning new clients on a go-forward basis. So I would give you a directional answer, not a yes, no answer, but a directional answer that growth is a net positive, whether it's the ongoing investment back in innovation, the capabilities in subsectors of the space in terms of being much more government intensive within this portfolio or otherwise, I would say, net directional positive. .

是大衛。從廣義上講，增長框架總是提供機會。所以我認為你的基本租戶在這裡是積極的。此外，我們有機會進一步提高我們能夠為現有客戶提供的價值，尤其是那些擁有較高政府業務組合的客戶和/或進一步加強我們的價值主張，以進一步贏得新客戶。所以我會給你一個方向性的答案，不是肯定的，不是的，而是一個方向性的答案，即增長是淨積極的，無論是對創新的持續投資，還是在更多政府方面的空間子部門的能力在這個投資組合中密集或其他，我會說，淨方向積極。 .

Our next question comes from Mr. Steven Valiquette with Barclays.

我們的下一個問題來自巴克萊銀行的 Steven Valiquette 先生。

I guess with the increase in membership guidance for '22 and the Commercial risk membership growth year-over-year actually accelerating as the year progresses. Just curious to hear a little more color just on the positive tailwinds there, kind of what's driving the extra commercial risk membership success?

我想隨著 22 年會員指南的增加以及商業風險會員的逐年增長，實際上隨著時間的推移而加速。只是想在積極的順風中聽到更多的色彩，是什麼推動了額外的商業風險會員成功？

Steven, it's David. Let me talk a little bit more about the selling season, the dynamic in the process. As I noted in my opening, 2022 results for commercial portfolio business. First and foremost, we're pleased with the MLR performance. We're pleased with the retention. We're pleased with the net growth too in '22. A primary driver of that growth is good performance in our middle market and sustained success in our Select segment. Within our Select segment, we regularly offer ASO or self-funded with stop-loss, shoulder-to-shoulder with derivatives of and specific risk alternatives. And we provide choice, we provide choice declines relative to funding.

史蒂文，是大衛。讓我多談談銷售季節，以及過程中的動態。正如我在開幕式中指出的，2022 年商業投資組合業務的結果。首先，我們對 MLR 的性能感到滿意。我們對保留感到滿意。我們也對 22 年的淨增長感到滿意。這種增長的主要驅動力是我們在中間市場的良好表現和我們在精選領域的持續成功。在我們的精選部分中，我們定期提供 ASO 或自籌資金的止損，與衍生品和特定風險替代品並肩作戰。我們提供選擇，我們提供相對於資金的選擇下降。

We've designed our sales process, our underwriting process. and our solutioning process, we're able to put that choice forward. And year in, year out, it ebbs and flows between a different mix between ASO and stop-loss and risk business. We're pleased with the net risk results that underline that. But I think the overall headline is to sustain strong success of the Select segment. Now more broadly, as you look at the portfolio, our fee-based business continues to grow. [Prior] point it back to the meaningful growth in stop-loss. And finally, in my comments pointing toward 2023, we will have a very good national account, January 1. That's largely fee-based business. That's retention, it's expansion and this new business has as well as addition of large, what we would call middle market fee-based relationships going forward. So the underlying net growth is consistent. The quality is there in the MLR and our risk business, you see is really fundamental strength within our Select segment.

我們設計了我們的銷售流程，我們的承保流程。以及我們的解決方案過程，我們能夠提出這個選擇。年復一年，它在 ASO 與止損和風險業務之間的不同組合之間起起落落。我們對強調這一點的淨風險結果感到滿意。但我認為總體標題是維持精選部分的強勁成功。現在更廣泛地說，當您查看投資組合時，我們的收費業務繼續增長。 [之前] 將其指向止損的有意義的增長。最後，在我對 2023 年的評論中，我們將在 1 月 1 日擁有一個非常好的國民賬戶。這主要是收費業務。這是保留，這是擴展，這項新業務具有以及增加大量的，我們稱之為中間市場基於費用的關係。因此，潛在的淨增長是一致的。 MLR 和我們的風險業務的質量是存在的，您會看到，這確實是我們精選部門的基本實力。

Our next question comes from Mr. Lance Wilkes with Bernstein.

我們的下一個問題來自伯恩斯坦的蘭斯威爾克斯先生。

Yes. Congratulations on that Centene win, a great job. Two just cleanup questions. One is in Evernorth, just understanding the driver of fees in the Evernorth segment? And the other is just a comment on utilization. Obviously, MLR was really down this quarter. Just interested in getting any comments on relative to maybe a baseline or kind of pre-COVID levels for commercial, public exchange and Medicare Advantage contrasted with sort of the nonmedical products. Like what's kind of the environment you're operating in, they're seeing right now?

是的。祝賀 Centene 獲勝，做得很好。兩個只是清理問題。一個是在 Evernorth，只是了解 Evernorth 細分市場的費用驅動因素？另一個只是對利用率的評論。顯然，MLR 在本季度確實下跌了。只是有興趣就商業、公共交換和醫療保險優勢與非醫療產品形成對比的基線或 COVID 之前的水平獲得任何評論。比如你在什麼樣的環境中運作，他們現在看到的是什麼？

It's Brian. So as it relates to the fees in Evernorth and you can see the strength in this line, if you look at the statistical supplement in terms of fees and other revenue with strong 16% quarter-over-quarter, 21% year-to-date growth. There's a few different components that contribute to this. So one, this is where our MDLIVE business shows up, and we've continued to see strong growth throughout the year in utilization of our MDLIVE services.

是布賴恩。因此，它與 Evernorth 的費用有關，如果您查看費用和其他收入方面的統計補充數據，您可以看到這條線的優勢，環比增長 16%，年初至今增長 21%生長。有幾個不同的組件對此有所貢獻。因此，這就是我們的 MDLIVE 業務出現的地方，並且我們在全年使用 MDLIVE 服務方面繼續保持強勁增長。

Secondly, we have a number of Express Scripts or pharmacy benefit services clients who choose a pure fee-based relationship with us. So we offer a choice relative to how they want to work with us as some of them might want a formulary or a network-only relationship. And so that shows up in this line item. And then also our Evercore business in terms of medical benefit management, some of the post-acute care solutions, et cetera, all roll up into this line item. So all these things in totality are showing nice growth for the Evernorth business.

其次，我們有許多 Express Scripts 或藥房福利服務客戶選擇與我們建立純粹的收費關係。因此，我們提供了一個相對於他們希望如何與我們合作的選擇，因為他們中的一些人可能想要一個公式或僅網絡的關係。所以這顯示在這個行項目中。此外，我們在醫療福利管理方面的 Evercore 業務、一些急性後護理解決方案等都納入了這一項目。因此，所有這些總體上都顯示出 Evernorth 業務的良好增長。

As it relates to your second question, I think that was pointed at Cigna Healthcare more specifically in terms of utilization environment. Third quarter did run favorable to our expectations. Most of that favorability was in the U.S. commercial book of business with our government lines essentially in line with expectations. And within the quarter, both COVID and non-COVID costs in the U.S. commercial book were favorable to our expectations. Non-COVID favorability was predominantly driven by inpatient and emergency room. And on the COVID side of the house, we saw third quarter COVID-related costs running at a very comparable level to what they were in the second quarter, whereas we had assumed a bit of an uptick.

由於它與您的第二個問題有關，我認為這在使用環境方面更具體地指向了 Cigna Healthcare。第三季度的運行確實符合我們的預期。這種好感大部分來自美國商業商業賬簿，我們的政府部門基本上符合預期。在本季度內，美國商業賬簿中的 COVID 和非 COVID 成本均符合我們的預期。非 COVID 的青睞主要是由住院和急診室推動的。在房屋的 COVID 方面，我們看到第三季度與 COVID 相關的成本與第二季度的水平非常相似，而我們假設會有所上升。

So broadly speaking, that's how I would summarize what we saw in the third quarter. All in, our commercial book of business is running just slightly above what a pre-pandemic baseline would have been trended forward to your question there with Medicare a touch below that.

從廣義上講，這就是我總結我們在第三季度看到的情況的方式。總而言之，我們的商業業務書的運行速度略高於大流行前基線的趨勢，而醫療保險略低於該基線。

Our last question comes from Dave Windley with Jefferies.

我們的最後一個問題來自傑富瑞的戴夫溫德利。

I joined late, so I apologize if this has been asked. But as you think about 2023 and kind of Fed pushing to slow labor market and potential recession implications, will you be thinking about recession possibilities as you set your guidance for '23? And how do you think the business is positioned to be resilient against that?

我加入晚了，所以如果有人問我，我很抱歉。但是，當您考慮 2023 年以及美聯儲推動放緩勞動力市場和潛在的衰退影響時，您在為 23 年設定指導時是否會考慮衰退的可能性？您認為企業如何應對這種情況？

It's David. So I think a really important question and that we didn't spend time on that. So thanks for the opportunity. First, from our point of view, there's little doubt the economy has been confronting some challenges. So recession, nonrecession, there's been some challenges. And to date, [important] grounding, we've seen little direct impact for the demand of our services or the underlying performance for our portfolio, right? Movement in costs here or there. But broadly speaking, we've seen a little direct impact.

是大衛。所以我認為這是一個非常重要的問題，我們沒有花時間在這個問題上。所以感謝這個機會。首先，從我們的角度來看，毫無疑問，經濟一直面臨一些挑戰。所以衰退，非衰退，有一些挑戰。迄今為止，[重要] 基礎，我們幾乎沒有看到對我們的服務需求或我們投資組合的基本性能的直接影響，對吧？這里或那裡的成本變動。但從廣義上講，我們已經看到了一些直接的影響。

As we look forward, by and large, we still see an environment where net-net employers are more oriented in terms of maintaining and/or hiring employees seeking to get to full employment. We do see instances where that has slowed. We do see instances where employers are putting freezes. But when you balance the portfolio as a whole right now, there's still a net hiring environment that sits in front of us, not to today.

正如我們展望的那樣，總的來說，我們仍然看到淨雇主在維持和/或僱用尋求充分就業的員工方面更加註重的環境。我們確實看到了放緩的情況。我們確實看到了雇主凍結的情況。但是，當您現在平衡整個投資組合時，仍然有一個淨招聘環境擺在我們面前，而不是今天。

As we look forward, we absolutely play through scenarios that could have further softening of the economy or recessionary impact. At this point, we believe, given the visibility we have into the starting point of 2023 with the net growth we expect to step in the year with, coupled with the strength that we expect in 2022 with, those 2 points and the various levers we have within our diverse services portfolio and benefits portfolio, we believe we'll be in a position to deliver another strong 2023.

展望未來，我們絕對會考慮可能導致經濟進一步疲軟或衰退影響的情景。在這一點上，我們相信，鑑於我們對 2023 年起點的可見性以及我們預計將在這一年實現的淨增長，再加上我們預計 2022 年的實力，這兩個點以及我們的各種槓桿在我們多樣化的服務組合和福利組合中，我們相信我們將能夠在 2023 年實現另一個強勁的發展。

Ending with, we acknowledge the fact that the economy is in a bit of a challenged environment in the current state. But all in, we believe our portfolio will be durable and is in a position to perform next year because of the strong start we'll have to the year and the various levers we have to manage in our portfolio.

最後，我們承認經濟在當前狀態下處於一個有點挑戰的環境中。但總而言之，我們相信我們的投資組合將是持久的，並且能夠在明年表現出色，因為我們今年將擁有強勁的開端以及我們必須在投資組合中管理的各種槓桿。

I will now turn the call back over to David Cordani for closing remarks.

我現在將把電話轉回給 David Cordani 以作結束髮言。

First, let me thank everybody for joining our call today, and I'll just wrap up with a few thoughts. First, our business is performing well. Our new collaboration with Centene is great evidence of the strength of our value proposition and how it continues to resonate in the market. We're growing with high levels of retention and winning new clients. We're performing well in this dynamic environment and our sustained disciplined execution is benefiting those we serve as well as our shareholders.

首先，讓我感謝大家今天加入我們的電話會議，我將總結一些想法。首先，我們的業務表現良好。我們與 Centene 的新合作很好地證明了我們的價值主張的力量以及它如何繼續在市場上引起共鳴。我們正在以高水平的保留率和贏得新客戶的方式發展。我們在這個動態的環境中表現良好，我們持續的紀律執行使我們所服務的人和我們的股東受益。

We are delivering for our shareholders and remain on track for our full year adjusted EPS outlook of at least $23.10, which is elevated from our prior outlook, and we are confident we are well positioned over the long term to continue to deliver on our annual adjusted EPS growth of 10% to 13% plus our meaningful dividend. This is all possible because of the breadth of capabilities we have across our organization, our proven commitment to innovation, but most importantly, the dedication of our more than 70,000 coworkers across the globe.

我們正在為我們的股東提供服務，並保持全年調整後每股收益至少 23.10 美元的預期，這高於我們之前的展望，我們相信我們在長期內處於有利地位，可以繼續實現我們的年度調整後每股收益增長 10% 至 13%，加上我們有意義的股息。這一切都是可能的，因為我們在整個組織中擁有廣泛的能力，我們對創新的堅定承諾，但最重要的是，我們在全球 70,000 多名同事的奉獻精神。

I personally appreciate our team and what they do everyday for our clients, our partners, our customers and patients and I thank them for the commitment to making a positive impact on people's lives each and every day. We thank you again for your interest in Cigna, and we look forward to continuing our conversation as we go into the latter part of this year. Have a good day.

我個人感謝我們的團隊以及他們每天為我們的客戶、我們的合作夥伴、我們的客戶和患者所做的一切，我感謝他們致力於每天對人們的生活產生積極影響的承諾。我們再次感謝您對 Cigna 的關注，我們期待在今年下半年繼續我們的對話。祝你有美好的一天。

Ladies and gentlemen, this concludes Cigna's Third Quarter 2022 Results Review. Cigna Investor Relations will be available to respond to additional questions shortly. A recording of this conference will be available for 10 business days following this call. You may access the recorded conference by dialing (800) 819-5739 or (203) 369-3350. There is no pass code required for this replay. Thank you for participating. We will now disconnect.

女士們先生們，Cigna 的 2022 年第三季度業績審查到此結束。 Cigna 投資者關係部將很快回復其他問題。本次會議的錄音將在本次電話會議後的 10 個工作日內提供。您可以撥打 (800) 819-5739 或 (203) 369-3350 訪問錄製的會議。此重播不需要密碼。感謝您的參與。我們現在將斷開連接。