信諾集團 (CI) 2023 Q1 法說會逐字稿

Ladies and gentlemen, thank you for standing by for the Cigna Group's First Quarter 2023 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 Ralph Giacobbe. Please go ahead.

女士們，先生們，感謝你們支持 Cigna Group 的 2023 年第一季度業績回顧。 （操作員說明）女士們先生們，本次會議（包括問答環節）正在錄製中。我們首先將會議轉交給 Ralph Giacobbe。請繼續。

Great. Good morning, everyone. Thanks 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, the Cigna Group's Chairman and Chief Executive Officer; and Brian Evanko, Chief Financial Officer. In our remarks today, David and Brian will cover a number of topics, including our first quarter financial results and our updated financial outlook for 2023.

偉大的。大家，早安。感謝您參加今天的電話會議。我是投資者關係高級副總裁 Ralph Giacobbe。今天早上和我一起在線的是 Cigna Group 的董事長兼首席執行官 David Cordani；首席財務官 Brian Evanko。在我們今天的講話中，David 和 Brian 將涵蓋許多主題，包括我們第一季度的財務業績和我們更新的 2023 年財務展望。

As noted in our earnings release, when describing our financial results, we use 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 thecignagroup.com. We use the term label 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，我們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公認的會計原則（也稱為 GAAP）確定的。這些措施分別與最直接可比的 GAAP 措施、股東淨收入和總收入的對賬包含在今天的收益報告中，該報告發佈在 thecignagroup.com 的投資者關係部分。我們使用術語標籤調整後的運營收入和調整後的每股收益，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 2023 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 results and uncertainties is contained in the cautionary note to today's earnings release and in our most recent reports filed with the SEC.

在我們今天的發言中，我們將做出一些前瞻性陳述，包括關於我們 2023 年展望和未來業績的陳述。這些陳述受風險和不確定因素的影響，可能導致實際結果與我們目前的預期存在重大差異。對這些結果和不確定性的描述包含在今天發布的收益報告和我們最近提交給美國證券交易委員會的報告中。

Regarding our results effective January 1, 2023, we adopted amended accounting guidance for long-duration insurance contracts, LDTI and related amendments. Our 2023 full year outlook included the impact of LDTI and prior results have been restated to reflect this change. There has been no material impact to our prior results, and this change will not materially impact our future operating results. Additionally, please note that when we make prospective comments regarding financial performance, including our full year 2023 outlook, we will do so on a basis that includes potential impact of future share repurchases and anticipated 2023 dividends.

關於我們自 2023 年 1 月 1 日起生效的業績，我們採用了針對長期保險合同、LDTI 和相關修訂的修訂會計指南。我們的 2023 年全年展望包括 LDTI 的影響，並且已重述之前的結果以反映這一變化。對我們之前的業績沒有重大影響，這一變化不會對我們未來的經營業績產生重大影響。此外，請注意，當我們對財務業績（包括我們的 2023 年全年展望）做出前瞻性評論時，我們將在包括未來股票回購的潛在影響和預期的 2023 年股息的基礎上這樣做。

With that, I'll call -- turn the call over to David.

有了這個，我會打電話 - 把電話轉給大衛。

Thanks, Ralph. Good morning, everyone, and thanks for joining today's call. We begin 2023 with momentum. And in the first quarter, we again delivered strong performance and continued our long track record of innovating for customers, clients and partners. Today, I'll discuss some of the key drivers fueling our growth during the quarter and I'll also talk about how we're leading the way to address evolving stakeholder needs with a flexible and agile model, providing multiple avenues to deliver and capture value. Specifically, I'll describe how the durable and flexible pharmacy benefit services we offer, Continue to drive in the marketplace. Brian will provide additional detail about our financial results and discuss our outlook for 2023, and then we'll take your questions.

謝謝，拉爾夫。大家早上好，感謝您參加今天的電話會議。我們以勢頭開啟 2023 年。在第一季度，我們再次取得了強勁的業績，並延續了我們為客戶、客戶和合作夥伴進行創新的長期記錄。今天，我將討論推動本季度增長的一些關鍵驅動因素，我還將討論我們如何通過靈活敏捷的模型引領解決不斷變化的利益相關者需求的方式，提供多種途徑來交付和捕獲價值。具體來說，我將描述我們提供的持久且靈活的藥房福利服務如何繼續推動市場發展。 Brian 將提供有關我們財務業績的更多詳細信息並討論我們對 2023 年的展望，然後我們將回答您的問題。

With that, let's get started. In the first quarter, we delivered $46.5 billion in total revenues, $5.41 in adjusted earnings per share, and we are raising our full year 2023 guidance for adjusted EPS, revenue and customer growth.

有了這個，讓我們開始吧。第一季度，我們實現了 465 億美元的總收入，調整後每股收益 5.41 美元，並且我們提高了 2023 年全年調整後每股收益、收入和客戶增長的預期。

We are pleased with the strong start across Evernorth Health Services and Cigna Healthcare. And we look forward -- as we look forward, we expect another very good year for the Cigna Group. Evernorth comprising pharmacy benefit services, Specialty Pharmacy and Evernorth Care, again contributed strong growth while retaining, expanding and winning new relationships for the employers, health plans and governmental organizations we serve. Our foundational Pharmacy Benefit Service business continued its strong performance, demonstrating the value we provide to our clients and patients. Specialty Pharmacy, which accounts for approximately 40% of Evernorth's total revenue drove outsized growth with a continued rise in new-to-market specialty drugs and increasing demand. Evernorth Care represents one of our most significant long-term growth opportunities given the growing needs in virtual care as well as, for example, behavioral health services.

我們對 Evernorth Health Services 和 Cigna Healthcare 的強勁開局感到高興。我們期待——正如我們期待的那樣，我們期待 Cigna Group 又是一個非常好的一年。 Evernorth 包括藥房福利服務、專業藥房和 Evernorth Care，再次貢獻了強勁的增長，同時為我們服務的雇主、健康計劃和政府組織保留、擴大和贏得了新的關係。我們的基礎藥房福利服務業務繼續保持強勁表現，展示了我們為客戶和患者提供的價值。專業藥房約佔 Evernorth 總收入的 40%，隨著新上市專業藥物的持續增長和需求的增加，推動了超額增長。考慮到虛擬護理以及行為健康服務等不斷增長的需求，Evernorth Care 代表了我們最重要的長期增長機會之一。

In Cigna Healthcare, our health benefits platform, we achieved another quarter of revenue and customer growth with strong performance across our U.S. commercial, U.S. government and international health businesses. With our focus on affordability and disciplined pricing, we are pleased with our medical cost performance and our medical care ratio, which was 81.3%. Our U.S. commercial business is at pace for another good year. Our affordability initiatives continue to strengthen our overall competitive position, and this has helped fuel our strong customer growth. Our momentum also is a reflection of how employers of all sizes rely upon our consultative approach and the breadth of our solutions to support the health, engagement and productivity of their workforces.

在我們的健康福利平台 Cigna Healthcare 中，我們的美國商業、美國政府和國際健康業務表現強勁，實現了又一個季度的收入和客戶增長。由於我們專注於負擔能力和嚴格的定價，我們對我們的醫療成本表現和我們的醫療保健比率感到滿意，該比率為 81.3%。我們的美國商業業務有望再創佳績。我們的負擔能力計劃繼續加強我們的整體競爭地位，這有助於推動我們強勁的客戶增長。我們的勢頭也反映了各種規模的雇主如何依賴我們的諮詢方法和我們解決方案的廣度來支持他們員工的健康、參與和生產力。

In the U.S. government, our Medicare Advantage business is achieving above-market growth in 2023 from our high-quality and affordable plans, our geographic expansion and the maturation of markets we previously expanded into. In the dynamic individual exchange market, we also have substantial growth in our Individual & Family Plan business, allowing us to bring Cigna Healthcare capabilities to a larger customer base. And in International Health, our earnings growth has been strong for the past few years, and we expect positive top line and bottom line contributions again in 2023 and given our high-quality and localized health insurance solutions supported by our global provider network. Overall, we're pleased with the quality, strength and resilience demonstrated in our results. And importantly, how they position us for another year of sustained growth and attractive value creation.

在美國政府，我們的 Medicare Advantage 業務將在 2023 年實現高於市場的增長，得益於我們高質量和負擔得起的計劃、我們的地域擴張以及我們之前擴展到的市場的成熟。在充滿活力的個人交易市場中，我們的個人和家庭計劃業務也有大幅增長，使我們能夠將 Cigna Healthcare 的能力帶給更大的客戶群。在國際健康方面，過去幾年我們的收入增長強勁，我們預計 2023 年將再次實現積極的收入和利潤貢獻，並在我們的全球供應商網絡支持下提供高質量和本地化的健康保險解決方案。總的來說，我們對結果中展示的質量、強度和彈性感到滿意。重要的是，他們如何為我們做好又一年的持續增長和有吸引力的價值創造。

Looking ahead, we are confident in our increased outlook for the year as well as our ability to sustainably deliver 10% to 13% compounded EPS growth over our strategic horizon, along with providing an attractive dividend.

展望未來，我們對今年的前景充滿信心，我們有能力在我們的戰略範圍內持續實現每股收益 10% 至 13% 的複合增長，同時提供有吸引力的股息。

Today, I want to spend a few minutes on Express Scripts, our pharmacy benefits business within Evernorth, including our recent announcements about how we are continuing to provide greater affordability, choice and transparency for our clients and customers. Pharmacy services have an essential and impactful role in a time when in medical care, physical or behavioral are increasingly relying upon the use of pharmaceutical interventions. It's also important to recognize that successful care coordination programs for pharmacy services often creates significant benefit and value for the medical services.

今天，我想花幾分鐘時間談談 Express Scripts，這是我們在 Evernorth 的藥房福利業務，包括我們最近宣布我們將如何繼續為我們的客戶和客戶提供更大的負擔能力、選擇和透明度。在醫療保健、身體或行為越來越依賴藥物干預的時代，藥房服務發揮著重要而有影響力的作用。同樣重要的是要認識到，成功的藥房服務護理協調計劃通常會為醫療服務創造巨大的利益和價值。

We recognize the ongoing attention and legislative debate regarding the rising cost of prescription drugs. We are taking an active leadership role, and I want to be clear about how we are using our differentiated capabilities to create and capture value out of the drug supply chain on behalf of our clients and customers.

我們認識到有關處方藥成本上升的持續關注和立法辯論。我們正在發揮積極的領導作用，我想清楚地說明我們如何利用我們的差異化能力代表我們的客戶和客戶從藥品供應鏈中創造和獲取價值。

First is the strength of our model. which is to deliver solutions and care coordination that address specific client needs and expand relationships with our full suite of services and capabilities, fueling our sustained attractive growth over time.

首先是我們模型的優勢。這是提供解決方案和護理協調，以滿足特定客戶的需求，並擴大與我們全套服務和能力的關係，隨著時間的推移推動我們持續有吸引力的增長。

Second, we are committed to enabling and prioritizing choice for our clients as we drive down costs.

其次，我們致力於在降低成本的同時為客戶提供選擇並優先選擇。

And third, we continue to build on our long track record of innovation to drive greater affordability, access, transparency and improved clinical outcomes.

第三，我們繼續鞏固我們長期的創新記錄，以提高可負擔性、可及性、透明度和改善臨床結果。

Stepping back, our pharmacy benefit service business is achieving attractive growth because we're able to secure a diverse group of any growing client base, leading with the strength of our supply chain, clinical and care management programs. With our proven model, Express Scripts' client retention rates are consistently in the mid-90s or higher, and we've been able to continuously grow our pipeline and win new business from medium-sized to the largest employers, from local health plans to national players and even the largest government-sponsored programs.

退一步說，我們的藥房福利服務業務正在實現有吸引力的增長，因為我們能夠確保任何不斷增長的客戶群的多元化群體，並以我們的供應鏈、臨床和護理管理計劃的實力領先。憑藉我們經過驗證的模型，Express Scripts 的客戶保留率始終保持在 90 年代中期或更高水平，並且我們能夠不斷擴大我們的管道並贏得從中型到最大雇主的新業務，從當地的健康計劃到國家參與者，甚至是最大的政府贊助項目。

We've expanded our efforts to advocate on behalf of our clients and customers, particularly as it relates to financing models, which are key areas of focus for some of the current legislative proposals. Express Scripts business model starts with the commitment to enabling and prioritizing choice in benefit design and financing options for clients who are the primary financers of their employee benefit programs. This includes providing them the option to finance the cost of their programs by allowing us to share in the discounts we secure on their behalf, be it rebates or spread pricing. Our clients choose amongst these models based upon their needs for managing risk and greater predictability for their pharmacy costs as well as their cash flow.

我們已經擴大了代表我們的客戶和客戶進行宣傳的努力，特別是與融資模式有關，這是當前一些立法提案的重點關注領域。 Express Scripts 商業模式始於承諾為作為員工福利計劃主要出資人的客戶啟用和優先選擇福利設計和融資方案。這包括通過允許我們分享我們代表他們獲得的折扣（無論是回扣還是價差定價），為他們提供為他們的計劃成本提供資金的選擇。我們的客戶根據他們對管理風險的需求以及對藥房成本和現金流的更高可預測性來選擇這些模型。

For context, across the breadth of our Express Scripts pharmacy benefit service portfolio today, over 95% of rebate dollars are passed through to clients. The key point is that each client chooses the financing mechanism that works best for them. They have choices in how they pay for the value we deliver and many find that using rebate sharing or spread pricing generate a stronger level of aligned incentives in addition to being able to plan for predictable cash flow that it generates. Proposes to limit the availability and scope of these options will result in less choice for thousands of employers, health plans and governmental clients we serve and increase their costs over time.

就上下文而言，在我們今天的 Express Scripts 藥房福利服務組合的範圍內，超過 95% 的回扣美元都傳遞給了客戶。關鍵是每個客戶選擇最適合他們的融資機制。他們可以選擇如何為我們提供的價值支付費用，許多人發現使用返利共享或價差定價除了能夠規劃其產生的可預測現金流之外，還能產生更強大的一致激勵。建議限制這些選項的可用性和範圍將導致我們服務的成千上萬的雇主、健康計劃和政府客戶的選擇減少，並隨著時間的推移增加他們的成本。

As it relates to Express Scripts, we are confident in our ability to earn sustainable and attractive margins for our services under a variety of legislative scenarios. We are able to create value through the breadth of our capabilities from supply chain to benefit design, driving competition amongst drug manufacturers to bring cost down and deliver better health outcomes through our clinical programs.

由於它與 Express Scripts 相關，我們相信我們有能力在各種立法情況下為我們的服務賺取可持續且有吸引力的利潤。我們能夠通過從供應鏈到利益設計的廣泛能力創造價值，推動藥品製造商之間的競爭，以通過我們的臨床項目降低成本並提供更好的健康結果。

One area of focus for multiple stakeholders has been the amount of income we earn for rebate retention and retail spread. To put this in context, we expect about 20% of Evernorth's 2023 pretax adjusted earnings to come from Express Scripts retention of rebates and retail spread. This percentage has trended down over time. and we expect it to continue trending downwards. This is fueled by our ongoing innovation and greater diversification of our Evernorth businesses.

多個利益相關者關注的一個領域是我們從保留回扣和零售價差中賺取的收入。綜上所述，我們預計 Evernorth 2023 年稅前調整後收益的約 20% 來自 Express Scripts 保留的回扣和零售價差。隨著時間的推移，這個百分比呈下降趨勢。我們預計它會繼續呈下降趨勢。這是由我們不斷創新和 Evernorth 業務更加多元化所推動的。

I would also remind you that these financing options that we provide to clients are developed in exchange for lower service fees. So said otherwise, if these programs decrease further over time, fee-based income would increase. Therefore, we are confident that some of these payment vehicles will reduce or remove our regulatory change or client preference. Express Scripts has a broad set of capabilities that create value and will continue to earn an attractive return.

我還要提醒您，我們為客戶提供的這些融資方案是為了換取較低的服務費用而開發的。換句話說，如果這些項目隨著時間的推移進一步減少，收費收入將會增加。因此，我們相信其中一些支付工具將減少或消除我們的監管變化或客戶偏好。 Express Scripts 擁有廣泛的創造價值的能力，並將繼續獲得有吸引力的回報。

Let me provide some specific examples that reinforce our flexibility and durable model and how we tap into our long track record of innovation for better outcomes on behalf of our customers and clients who are seeking greater affordability and transparency for prescription drugs. First, we are taking several steps to expand transparency. Express Scripts' new ClearCareRx fully demonstrates the flexibility we have for prescription drug benefits, where clients pay exactly what Express Scripts pays pharmacies for prescriptions. They receive 100% of drug rebates that Express Scripts obtains by negotiating with pharmaceutical companies. They pay one service fee to cover the administration of pharmacy benefits, product services, reporting analytics, and the programs supported by a fully audible mechanism. In addition, clients also benefit from guarantees to keep Express Scripts accountable for clinical and financial performance measures including improvements in overall adherence rates and patient outcomes. Additional steps to drive even greater transparency include providing clients with enhanced financial and fee disclosures regarding their spread pricing programs when they exist.

讓我提供一些具體的例子來加強我們的靈活性和持久性模式，以及我們如何利用我們長期的創新記錄來代表我們的客戶和尋求處方藥更高可負擔性和透明度的客戶取得更好的結果。首先，我們正在採取幾個步驟來擴大透明度。 Express Scripts 的新 ClearCareRx 充分展示了我們在處方藥福利方面的靈活性，客戶支付的費用與 Express Scripts 向藥店支付的處方藥費用完全相同。他們獲得 Express Scripts 通過與製藥公司談判獲得的 100% 的藥品回扣。他們支付一筆服務費來支付藥房福利、產品服務、報告分析以及由完全可聽機制支持的程序的管理。此外，客戶還受益於保證 Express Scripts 對臨床和財務績效措施負責，包括提高整體依從率和患者結果。提高透明度的其他措施包括為客戶提供有關其價差定價計劃（如果存在）的增強財務和費用披露。

Along with today's release about our first quarter financial results, you will also find additional disclosures we are providing about Express Scripts model in our quarterly regulatory filings and on our new micro site. We will also offer a new digital pharmacy benefit statement for customers, starting in 2024. The statement will share drug pricing information, out-of-pocket costs and the net value delivered by Express Scripts on behalf of customers.

除了今天發布的第一季度財務業績外，您還將在我們的季度監管文件和我們的新微型網站上找到我們提供的有關 Express Scripts 模型的其他披露。從 2024 年開始，我們還將為客戶提供新的數字藥房福利報表。該報表將代表客戶共享藥品定價信息、自付費用和 Express Scripts 交付的淨值。

With respect to the broader issue of drug pricing, to be clear, we are fully aligned with lowering cost of prescription drugs for customers. For example, Express Scripts patient assurance program launched in 2019, capped out-of-pocket costs for eligible members of select diabetes and cardiovascular medications. In 2022 alone, customers taking insulin saved more than $18 million because of this program. Now with the introduction of our new co-pay insurance plan, we are taking further action to cap out-of-pocket costs for customers in client prescription drug benefits. At $5 for generic drugs, $25 for preferred brand medications and $45 for preferred specialty medications.

關於更廣泛的藥品定價問題，需要明確的是，我們完全支持降低客戶處方藥的成本。例如，2019 年啟動的 Express Scripts 患者保障計劃限制了符合條件的特定糖尿病和心血管藥物會員的自付費用。僅在 2022 年，服用胰島素的客戶就因為該計劃節省了超過 1800 萬美元。現在，隨著我們新的共同支付保險計劃的推出，我們正在採取進一步行動來限制客戶在客戶處方藥福利方面的自付費用。仿製藥價格為 5 美元，首選品牌藥物價格為 25 美元，首選特殊藥物價格為 45 美元。

Finally, we also have a series of groundbreaking initiatives to further support pharmacists in the rural communities across the United States. We are offering increased reimbursement to true independent pharmacies and partnering opportunities to expand their clinical practices to further support care needs of the local communities. We are also convening an advisory committee of community pharmacies. These initiatives will encourage better care, expanded access to lower prices for rural Americans as well as increasingly more sustainable revenue stream for independent pharmacists. We are encouraged by how our recent actions have been received by a wide range of stakeholders, including clients, our pharmacy network partners and policymakers. They recognize our commitment as the leader and trusted partner that continues to create value through our deep expertise in designing programs for specific client needs, driving innovation and broadening our reach.

最後，我們還有一系列開創性的舉措來進一步支持美國農村社區的藥劑師。我們正在為真正的獨立藥房提供更多報銷，並提供合作機會以擴大他們的臨床實踐，以進一步支持當地社區的護理需求。我們還將召集社區藥房諮詢委員會。這些舉措將鼓勵更好的護理，擴大美國農村地區獲得較低價格的機會，並為獨立藥劑師提供越來越可持續的收入來源。包括客戶、我們的藥房網絡合作夥伴和政策制定者在內的廣大利益相關者對我們最近採取的行動的反應讓我們感到鼓舞。他們認識到我們作為領導者和值得信賴的合作夥伴的承諾，即通過我們在針對特定客戶需求設計項目、推動創新和擴大我們的影響力方面的深厚專業知識，繼續創造價值。

In summary, we are demonstrating our leadership in the competitive pharmacy benefits market that is such a critical building block for the American health care system. We are serving specific client needs through the strength of our model and the effectiveness of our care coordination programs, allowing us to drive sustained attractive growth. We are continuing to advocate for clients and their ability to choose the appropriate programs that work best for the business as we help lower costs. And we are continuing to innovate in driving greater affordability, transparency and improve outcomes for those we serve.

總之，我們正在展示我們在競爭激烈的藥房福利市場中的領導地位，該市場是美國醫療保健系統的重要組成部分。我們通過我們模型的優勢和護理協調計劃的有效性來滿足特定客戶的需求，從而使我們能夠推動持續的有吸引力的增長。在我們幫助降低成本的同時，我們將繼續倡導客戶及其選擇最適合業務的適當計劃的能力。我們正在繼續創新，以提高我們所服務的人的負擔能力和透明度並改善結果。

Now let me briefly recap our performance for the quarter and our outlook. In the first quarter, we continued to execute and perform well. We delivered for our customer clients and partners and our business kept our commitment to our shareholders. We delivered adjusted EPS of $5.41 per share, and we're pleased to have increased our full year outlook for adjusted EPS, revenue and customer growth as well as an improved medical care ratio. We are confident in our ability to continue to deliver and capture value into the dynamic and changing environment. We have shaped our business model to navigate varying economic conditions and our differentiated capabilities within Evernorth to provide us with the flexibility to meet unique client needs and potential changes caused by regulatory requirements. Additionally, our business is driving growth that is generating strong cash flows and we are confident that we will further create value through successful and effective capital deployment.

現在讓我簡要回顧一下我們本季度的表現和我們的展望。第一季度，我們繼續執行並表現良好。我們為我們的客戶和合作夥伴提供服務，我們的業務信守對股東的承諾。我們實現了每股 5.41 美元的調整後每股收益，我們很高興提高了調整後每股收益、收入和客戶增長以及醫療保健比率提高的全年預期。我們相信我們有能力繼續為動態和不斷變化的環境提供和獲取價值。我們塑造了我們的商業模式，以適應不同的經濟條件和我們在 Evernorth 內部的差異化能力，從而為我們提供靈活性，以滿足獨特的客戶需求和監管要求引起的潛在變化。此外，我們的業務正在推動增長，產生強勁的現金流，我們相信我們將通過成功和有效的資本配置進一步創造價值。

With that, I'll turn the call over to Brian.

有了這個，我會把電話轉給布賴恩。

Thank you, David. Good morning, everyone. Today, I'll review Cigna's first quarter 2023 results and discuss our updated outlook for the full year. We're pleased with our strong start to the year. The first quarter adjusted earnings per share were above our expectations demonstrating focused execution across our high-performing Evernorth and Cigna Healthcare businesses.

謝謝你，大衛。大家，早安。今天，我將回顧 Cigna 2023 年第一季度的業績，並討論我們更新後的全年展望。我們對今年的強勁開局感到滿意。第一季度調整後的每股收益超出了我們的預期，表明我們在表現出色的 Evernorth 和 Cigna Healthcare 業務中集中執行。

Looking at the quarter specifically, some key consolidated financial highlights include revenue growth of 6% to $46.5 billion. After-tax adjusted earnings of $1.6 billion, adjusted earnings per share of $5.41, and cash flow from operations of $5 billion. This performance gives us the confidence to increase our full year adjusted earnings outlook to at least $24.70 per share.

具體來看本季度，一些重要的綜合財務亮點包括收入增長 6% 至 465 億美元。稅後調整後收益為 16 億美元，調整後每股收益為 5.41 美元，運營現金流為 50 億美元。這一業績讓我們有信心將全年調整後的收益預期提高到至少每股 24.70 美元。

Before I discuss our Evernorth results, I'll build on David's comments regarding our recent announcement to advance transparency around our PBM, and I'll provide incremental details on our earnings drivers. I'd first start with a level setting that of our operating platform. Evernorth makes up approximately 60% of earnings and Cigna Healthcare is about 40%. Within Evernorth, our Express Scripts PBM is a foundational asset with a diverse set of earning sources, including service and administrative fees, clinical programs, and value-based care arrangements, along with retained rebates and retail spread. These earnings sources are a function of the choices made by our clients.

在我討論我們的 Evernorth 結果之前，我將以大衛關於我們最近宣布提高 PBM 透明度的評論為基礎，我將提供有關我們盈利驅動因素的增量細節。我首先從我們的操作平台的級別設置開始。 Evernorth 約佔收入的 60%，Cigna Healthcare 約佔 40%。在 Evernorth 內部，我們的 Express Scripts PBM 是一項基礎資產，具有多種收入來源，包括服務和行政費用、臨床計劃和基於價值的護理安排，以及保留的回扣和零售價差。這些收入來源取決於我們客戶的選擇。

As David referenced, approximately 20% of Evernorth's adjusted pretax earnings are comprised of PBM retained rebates and retail spread. This percentage has decreased over time. As we continue to expand fee-based client relationships and as our Evernorth portfolio becomes more diverse and continues to grow. Importantly, as Evernorth's business mix has changed over the years, margins have remained stable. This speaks to our flexibility to adapt to an ever-changing market and gives us confidence in our ability to navigate disruption in the operating or regulatory environment.

正如 David 所提到的，Evernorth 調整後的稅前收益中約有 20% 由 PBM 留存回扣和零售利差組成。隨著時間的推移，這個百分比有所下降。隨著我們繼續擴大收費客戶關係，以及我們的 Evernorth 投資組合變得更加多樣化並持續增長。重要的是，隨著多年來 Evernorth 的業務組合發生變化，利潤率一直保持穩定。這表明我們可以靈活地適應不斷變化的市場，並讓我們對自己應對運營或監管環境中斷的能力充滿信心。

As David mentioned and I would underscore, our foundational PBM asset will continue to create and deliver significant value, which will allow us to sustain growth at attractive competitive returns. Shifting to our current period Evernorth results. First quarter 2023 revenues grew 8% to $36.2 billion, and pretax adjusted earnings were $1.3 billion, in line with our expectations. Evernorth results in the quarter were driven by continued strong growth in our high-performing specialty pharmacy business and our focus on affordability and delivering lowest net cost solutions for our customers and clients. Additionally, we continue to build our cross-enterprise leverage capabilities, providing an additional avenue for growth as we further deepen our relationships across Evernorth and Cigna Healthcare.

正如大衛提到的那樣，我要強調的是，我們的基礎 PBM 資產將繼續創造和交付重要價值，這將使我們能夠以有吸引力的競爭回報維持增長。轉向我們當前的 Evernorth 結果。 2023 年第一季度收入增長 8% 至 362 億美元，稅前調整後收益為 13 億美元，符合我們的預期。 Evernorth 本季度的業績受到我們高性能專業藥房業務持續強勁增長以及我們對負擔能力的關注以及為我們的客戶和客戶提供最低淨成本解決方案的推動。此外，我們繼續建立我們的跨企業槓桿能力，隨著我們進一步深化我們在 Evernorth 和 Cigna Healthcare 之間的關係，提供額外的增長途徑。

We also continue to make strategic investments, which serve to strengthen and grow our client relationships, expand our portfolio of products and services and advance our digital capabilities. As it relates to our strategic partnerships, we remain on track in our implementation of the Centene contract that begins in 2024. And our collaboration with VillageMD is progressing and provides us an attractive opportunity to further accelerate our value-based care programs and capabilities. We will continue to expand these value-based solutions for the benefit of our Cigna Healthcare, U.S. commercial and U.S. government clients as well as other provider partners and Evernorth health plan clients. Additionally, we remain confident around the multiyear accelerating biosimilar opportunity with high visibility into expected savings for customers and clients in the second half of this year, consistent with our prior expectations and regardless of utilization shifts for product approvals in the market.

我們還繼續進行戰略投資，以加強和發展我們的客戶關係，擴大我們的產品和服務組合，並提升我們的數字能力。由於它與我們的戰略合作夥伴關係有關，我們在執行從 2024 年開始的 Centene 合同方面仍然走上正軌。我們與 VillageMD 的合作正在取得進展，並為我們提供了一個有吸引力的機會，以進一步加快我們基於價值的護理計劃和能力。我們將繼續擴展這些基於價值的解決方案，以造福我們的 Cigna Healthcare、美國商業和美國政府客戶以及其他供應商合作夥伴和 Evernorth 健康計劃客戶。此外，我們對多年加速的生物仿製藥機會充滿信心，對今年下半年客戶和客戶的預期節省具有高度可見性，這與我們之前的預期一致，無論市場上產品批准的使用情況如何變化。

Overall, Evernorth continues to perform very well. Our diversified set of earnings streams, along with flexible financing models enable us to innovate and adapt through dynamic environments.

總體而言，Evernorth 繼續表現出色。我們多元化的收入來源以及靈活的融資模式使我們能夠在動態環境中進行創新和適應。

Turning to Cigna Healthcare. First quarter 2023 adjusted revenues grew 12% to $12.7 billion, and pretax adjusted earnings were $1.1 billion, slightly above our expectations. The medical care ratio of 81.3% was better than expectations as overall utilization came in slightly favorable. This was reinforced by our clinical engagement models and related affordability initiatives as well as our continued pricing discipline.

求助於 Cigna Healthcare。 2023 年第一季度調整後收入增長 12% 至 127 億美元，稅前調整後收益為 11 億美元，略高於我們的預期。 81.3%的醫療保障率好於預期，整體利用率略有改善。我們的臨床參與模型和相關的負擔能力計劃以及我們持續的定價紀律加強了這一點。

Turning to medical customers. We ended the quarter with 19.5 million total medical customers, growth of approximately 1.5 million customers since the end of 2022. This strong growth demonstrates the continued differentiation of our market-leading products and services. Our commercial customers increased 8% year-to-date aided by the addition of a large fee-based health plan client that expands upon an existing Evernorth relationship. And even excluding this client win, we drove organic customer growth across all of our U.S. commercial market segments.

轉向醫療客戶。截至本季度末，我們的醫療客戶總數為 1950 萬，自 2022 年底以來增加了約 150 萬客戶。這一強勁增長表明我們市場領先的產品和服務的持續差異化。我們的商業客戶今年迄今增加了 8%，這得益於增加了一個基於現有 Evernorth 關係的大型收費健康計劃客戶。甚至不包括這個客戶的勝利，我們推動了我們所有美國商業細分市場的有機客戶增長。

In our U.S. government business, we saw considerable growth in our U.S. Individual and Medicare Advantage customers, with MA growth of 10% on a year-to-date basis.

在我們的美國政府業務中，我們看到我們的美國個人和 Medicare Advantage 客戶有可觀的增長，今年迄今 MA 增長了 10%。

Overall, Cigna Healthcare is off to a strong start in 2023 as we continue to deliver differentiated value and affordability to our customers and clients.

總體而言，Cigna Healthcare 在 2023 年開局良好，我們將繼續為客戶提供差異化的價值和可負擔性。

Across our Evernorth and Cigna Health care platforms, we delivered strong first quarter financial results driven by our diversified portfolio of foundational and accelerated growth businesses, further bolstered by cross enterprise leverage.

在我們的 Evernorth 和 Cigna Health 醫療保健平台上，我們在基礎和加速增長業務的多元化組合的推動下，在跨企業槓桿的進一步推動下，實現了強勁的第一季度財務業績。

Now turning to our outlook for full year 2023. We have increased our expectations for full year 2023 consolidated adjusted revenues to at least $188 billion, enabled by continued growth and deepening customer relationships in Cigna Healthcare and Evernorth. We are also increasing our adjusted earnings per share outlook to at least $24.70 per share.

現在轉向我們對 2023 年全年的展望。我們將對 2023 年全年合併調整後收入的預期提高到至少 1880 億美元，這得益於 Cigna Healthcare 和 Evernorth 的持續增長和深化客戶關係。我們還將調整後的每股收益預期上調至至少 24.70 美元。

Consistent with our prior commentary, we expect earnings this year to be back-half weighted in large part driven by Evernorth's earnings ramp over the course of the year with second half EPS contributing slightly below 55% of full year EPS.

與我們之前的評論一致，我們預計今年的收益將在很大程度上受到 Evernorth 全年收益增長的推動，下半年每股收益佔全年每股收益的比例略低於 55%。

In Evernorth, we expect continued strong performance, all while investing in growth and innovation. We continue to expect Evernorth full year 2023 adjusted earnings of at least $6.4 billion.

在 Evernorth，我們期待持續強勁的業績，同時投資於增長和創新。我們繼續預計 Evernorth 2023 年全年調整後收益至少為 64 億美元。

In Cigna Healthcare, we are raising our medical customer growth expectation to at least 1.3 million customers, an increase of 100,000 lives. We are improving our 2023 medical care ratio outlook to a range of 81.5% to 82.3%. And we are raising our expected full year 2023 adjusted earnings to at least $4.425 billion.

在 Cigna Healthcare，我們將醫療客戶增長預期提高到至少 130 萬客戶，增加 100,000 人的生命。我們正在將 2023 年的醫療保健比率預期提高到 81.5% 至 82.3% 的範圍。我們將 2023 年全年的預期調整後收益提高到至少 44.25 億美元。

Despite the dynamic macroeconomic environment, we have yet to see material impact to Cigna Healthcare enrollment levels. We remain prudent with respect to our enrollment outlook for the rest of the year as evidenced by our full year guidance relative to the first quarter customer growth results. To be clear, we continue to expect underlying organic employer client growth as we move through the year. And our outlook continues to assume some elevated dis-enrollment in the second half of the year corresponding with some expected softening in the economy. Additionally, as a reminder, our outlook does not contemplate incremental customer growth from Medicaid redeterminations.

儘管宏觀經濟環境充滿活力，但我們尚未看到對 Cigna Healthcare 入學水平的實質性影響。我們對今年剩餘時間的招生前景保持謹慎，我們對第一季度客戶增長結果的全年指導就證明了這一點。需要明確的是，我們繼續預計在這一年中潛在的有機雇主客戶會增長。我們的前景繼續假設今年下半年退學率有所上升，與預期的經濟疲軟相對應。此外，提醒一下，我們的展望並未考慮醫療補助計劃重新確定帶來的增量客戶增長。

Finally, when contemplating the Cigna Group's performance under various future economic scenarios, it's important to keep in mind that we have strategically positioned the company's portfolio of businesses to be more diversified than it was in prior economic downturns. This gives us confidence and resilience to weather dynamic macroeconomic environments. Switching gears.

最後，在考慮 Cigna Group 在各種未來經濟情景下的表現時，重要的是要記住，我們已將公司的業務組合戰略定位為比之前的經濟衰退時期更加多元化。這使我們有信心和彈性應對天氣動態的宏觀經濟環境。切換齒輪。

Let's move to our 2023 capital management position and outlook. Our debt to capitalization ratio is 42.2% as of March 31. We expect to lower this ratio over the balance of the year, and we continue to target a long-term debt to capitalization ratio of approximately 40%. Year-to-date through May 4, 2023, we have repurchased approximately 3.7 million shares of common stock for approximately $1.1 billion. And for full year 2023, we continue to expect at least $9 billion of cash flow from operations. Our balance sheet and our cash flow outlook remains strong benefiting from our highly efficient service-based model that drives strategic flexibility, strong margins and attractive returns on capital.

讓我們轉向我們的 2023 年資本管理立場和展望。截至 3 月 31 日，我們的債務資本化比率為 42.2%。我們預計將在今年餘下時間降低這一比率，我們繼續將長期債務資本化比率的目標定在 40% 左右。從年初至今到 2023 年 5 月 4 日，我們已經以大約 11 億美元的價格回購了大約 370 萬股普通股。對於 2023 年全年，我們繼續預計至少 90 億美元的運營現金流。我們的資產負債表和現金流前景依然強勁，這得益於我們高效的基於服務的模式，該模式推動了戰略靈活性、強勁的利潤率和有吸引力的資本回報。

So now to recap. First quarter results were above our expectations, reflecting strong contributions across our diversified portfolio of complementary businesses. Evernorth continued to deliver strong results with the first quarter in line with our expectations. While Cigna Healthcare had a strong start to the year, giving us confidence to deliver on our increased 2023 EPS guidance of at least $24.70. We continue to expect 2024 adjusted EPS of at least $28 consistent with our prior commentary. And over the long run, we continue to expect average annual EPS growth of 10% to 13% and are confident in our ability to adapt and navigate the operating and regulatory backdrop with our diversified business mix, and complementary capabilities across Evernorth and Cigna Healthcare.

所以現在回顧一下。第一季度的業績超出了我們的預期，反映出我們多元化互補業務組合的巨大貢獻。 Evernorth 第一季度繼續取得強勁業績，符合我們的預期。雖然 Cigna Healthcare 今年開局強勁，但讓我們有信心實現至少 24.70 美元的 2023 年每股收益增長指引。我們繼續預計 2024 年調整後的每股收益至少為 28 美元，這與我們之前的評論一致。從長遠來看，我們繼續預計每股收益年均增長率為 10% 至 13%，並且相信我們有能力通過我們多元化的業務組合以及 Evernorth 和 Cigna Healthcare 的互補能力來適應和駕馭運營和監管背景。

And with that, we'll turn it over to the operator for the Q&A portion of the call.

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 Ms. Lisa Gill with JPMorgan.

（操作員說明）我們的第一個問題來自摩根大通的 Lisa Gill 女士。

David, thank you for all the comments around the PBM and profitability, et cetera. I guess my first question is really to understand where do you think the disconnect is from a legislative standpoint versus how the PBMs actually operate? And then secondly, when we think about an employer, it feels to me that a lot of this legislation is going to take away that decision-making by the employer. What are employers saying to you around legislation? What are they saying to you around the selling season? And then also if you can just give us an update as to how you're thinking about the 2024 selling season?

大衛，感謝您對 PBM 和盈利能力等的所有評論。我想我的第一個問題真的是要了解您認為從立法的角度與 PBM 的實際運作方式之間存在脫節的地方在哪裡？其次，當我們想到雇主時，我覺得很多立法都會剝奪雇主的決策權。雇主在立法方面對您說了什麼？他們在銷售旺季對您說了什麼？然後，您能否向我們介紹一下您對 2024 年銷售季的看法？

Lisa, you put a lot in there and thanks for the questions. Let me try to touch on each. First, as we step back, as I noted, we're quite proud of the results that we have delivered and continue to deliver in view the PBMs using that acronym, but the pharmacy service organizations are the organizations that relentlessly work to improve affordability for the benefit of a broad constituency group. I think to your first question, if we step back, well, we could point to tremendous results in terms of clinical trends, outcome, affordability on average, less than $1 increase in out-of-pocket costs for individuals. We do recognize, and I think this is part of the legislation or the legislative energy, the program still don't work for everyone. So for example, while the programs are designed to generate overall affordability if there's a high deductible plan is an illustration and in the month of January, someone has -- is a deductible and has a significant out-of-pocket for our pharmaceutical experience that creates a financial dislocation for an individual, that's a failure of the system, right? We need to step up to that. We need to innovate because that's an unintended consequence of the failure of a system. So we could talk about the averages that we're proud of from an affordability, but we need to make sure we continue to innovate till it works for everyone or we could talk about the fact that we have leading breadth of network access through our pharmacy networks, coupled with our home delivery, yet when you look at the uniqueness of America, some rural locations may not have the access or accessibility in a specific case. And therefore, the market is not working for those individuals. Hence, you see some of the innovations we step forward out. Our copay assurance program directly goes at the out-of-pocket predictability for individuals under a variety of circumstances. Our rural pharmacy and independent pharmacy initiatives go directly at specific actions to support individuals. So the averages when we sit and look at the data is accepted, we need to do better, and we're stepping forward as a leader to do better from that standpoint.

麗莎，你在那裡投入了很多，感謝你提出問題。讓我試著談談每一個。首先，當我們退後一步時，正如我所指出的，我們對我們已經交付並繼續交付使用該首字母縮略詞的 PBM 的結果感到非常自豪，但藥房服務組織是不懈努力提高負擔能力的組織廣泛的選區群體的利益。我想關於你的第一個問題，如果我們退後一步，那麼，我們可以指出在臨床趨勢、結果、平均負擔能力方面的巨大成果，個人自付費用增加不到 1 美元。我們確實承認，我認為這是立法或立法能量的一部分，該計劃仍然不適用於所有人。因此，例如，雖然計劃旨在產生總體負擔能力，但如果有高免賠額計劃就是一個例證，並且在 1 月份，有人 - 是免賠額並且對我們的藥物體驗有很大的自付費用為個人造成財務混亂，那是系統的故障，對嗎？我們需要加強這一點。我們需要創新，因為這是系統故障的意外後果。因此，我們可以談論我們為負擔能力而自豪的平均水平，但我們需要確保我們繼續創新，直到它適用於每個人，或者我們可以談論我們通過藥房擁有領先的網絡訪問廣度這一事實網絡，再加上我們的送貨上門服務，但是當您看到美國的獨特性時，某些農村地區在特定情況下可能無法訪問或訪問。因此，市場對這些人不起作用。因此，您會看到我們向前邁出的一些創新。我們的共付額保證計劃直接針對個人在各種情況下的自付費用可預測性。我們的農村藥房和獨立藥房計劃直接針對支持個人的具體行動。因此，當我們坐下來查看數據時的平均值是可以接受的，我們需要做得更好，並且我們作為領導者正在向前邁進，從這個角度做得更好。

As it relates to employers, our retention rates and our new business growth rates reinforce the fact that by and large, employers see us as being successful. I would note that our ClearCareRx program that we just rolled out, that was two years in design. And we worked with about a dozen sophisticated large employers to design those programs to work for them and work for us and how we can roll those out and scale. And as we sit here today, we have hundreds of clients together with our Evernorth team and our Express Scripts team talking about future innovation. So there remains high receptivity and high receptivity to the advancements we're making in terms of further transparency in clinical programs, but they like their choice. They like having the choice of financing mechanisms, which were aligned with.

就雇主而言，我們的保留率和新業務增長率強化了這樣一個事實，即總的來說，雇主認為我們是成功的。我要指出的是，我們剛剛推出的 ClearCareRx 計劃已經設計了兩年。我們與大約 12 家經驗豐富的大型雇主合作設計了這些計劃，為他們工作並為我們工作，以及我們如何推廣和擴展這些計劃。當我們今天坐在這裡時，我們有數百名客戶與我們的 Evernorth 團隊和我們的 Express Scripts 團隊一起討論未來的創新。因此，就臨床項目的進一步透明度而言，我們正在取得的進步仍然具有很高的接受度和很高的接受度，但他們喜歡他們的選擇。他們喜歡選擇與之一致的融資機制。

And then finally, maybe just to manage time, on the '24 selling season, '24 will be another year of growth for us in the Evernorth service portfolio. We will see strong retention. As I noted, our retention has historically been in the mid-90s or better we will see strong retention, and we will see good growth as our products and programs resonate in the marketplace. Lisa, thanks for the questions.

最後，也許只是為了管理時間，在 '24 銷售季，'24 將是我們 Evernorth 服務組合增長的又一年。我們將看到強大的保留率。正如我所指出的，我們的保留率歷史上一直在 90 年代中期或更高，我們將看到強勁的保留率，並且隨著我們的產品和計劃在市場上引起共鳴，我們將看到良好的增長。麗莎，謝謝你的提問。

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。

So regarding the Evernorth results in the first quarter, you mentioned they were in line with the expectations. Just with the script volume, though being down, just curious to get more color on that? And also, I know you're not giving script volume guidance for the full year, but just curious if the trends in the first quarter are good run rates for the full year?

那麼關於 Evernorth 第一季度的業績，您提到它們符合預期。就腳本量而言，雖然下降了，但只是想在上面獲得更多顏色嗎？而且，我知道您不會提供全年的劇本量指導，只是想知道第一季度的趨勢是否適合全年的良好運行率？

Steve, it's Brian. Yes. As I mentioned earlier, our Evernorth results are very much in line with expectations for the quarter. One thing that's important to keep in mind, David mentioned 40% of the revenue in Evernorth now is derived from our Specialty Pharmacy business. And as you can appreciate, the Specialty Pharmacy script counts end up being dwarfed by the generics and the higher-volume script counts that come through the PBM. So it's a little bit misleading to look at the aggregate script counts for those reasons. And I'd note our -- the revenue in the Specialty Pharmacy grew mid-teens year-over-year. So it was a very strong grower. You saw strong script growth in specialty, but again, it was dwarfed by the big picture of the PBM generic volumes moving around a bit. And as you think about the overall script counts year-on-year, think of the client mix changes that occurred from '22 to '23 is driving a good bit of that. and that really drove the kind of flattish all-in script counts.

史蒂夫，是布萊恩。是的。正如我之前提到的，我們的 Evernorth 業績非常符合本季度的預期。需要牢記的一件事很重要，David 提到 Evernorth 現在 40% 的收入來自我們的專業藥房業務。正如您所理解的那樣，專業藥房的腳本數量最終與來自 PBM 的仿製藥和更高容量的腳本數量相比相形見絀。因此，出於這些原因查看聚合腳本計數有點誤導。我會注意到我們的 - 專業藥房的收入同比增長了十幾歲。所以它是一個非常強大的種植者。你看到了專業腳本的強勁增長，但又一次，它與 PBM 通用卷的大局相比相形見絀。當您考慮同比總體腳本數量時，想想從 22 年到 23 年發生的客戶組合變化正在推動這一點。這確實推動了那種扁平化的全包腳本計數。

Now as we look forward to '24, obviously, we prepare to onboard. Centene, you'll see a meaningful step-up in that metric. But as I mentioned earlier, with the specialty pharmacy growing at such an attractive rate, it's a bit masked when you look purely to script count metrics. So hopefully, that helps a bit. And when you put all those pieces together, we're getting confident and comfortable with the full year outlook in terms of Evernorth income.

現在，當我們期待 24 年時，顯然，我們準備加入。 Centene，您會在該指標中看到有意義的提升。但正如我之前提到的，隨著專業藥房以如此誘人的速度增長，當你純粹看腳本計數指標時，它有點被掩蓋了。所以希望這會有所幫助。當您將所有這些部分放在一起時，我們對 Evernorth 收入的全年前景充滿信心和滿意。

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。

I wanted to go back to the PBM and the regulatory focus, David. You mentioned that not all pharmacy benefit designs work for everyone. And the target, I think, of much of the legislation is focused on lowering out-of-pocket cost for patients. You've had plan options in the past that address some of these areas. I know you said that clients like having that choice. But are there -- is there any middle ground in terms of different solutions that you couldn't maybe roll out more broadly that would address some of these pain points kind of proactively ahead of maybe being forced legislatively? And I guess kind of my follow-up to that is client preferences, I think kind of changed relatively slowly over time. I guess if we did see legislation go in place, how quickly could you kind of shift the client -- shift clients to new payment models to kind of adjust to a new regulatory backdrop?

我想回到 PBM 和監管重點，大衛。您提到並非所有藥房福利設計都適用於所有人。我認為，大部分立法的目標都集中在降低患者的自付費用上。您過去曾有過解決其中一些領域的計劃選項。我知道你說過客戶喜歡有這樣的選擇。但是，在不同的解決方案方面是否有任何中間立場，您可能無法更廣泛地推出這些解決方案，從而在可能被立法強制之前主動解決其中一些痛點？我想我的後續行動是客戶偏好，我認為隨著時間的推移變化相對緩慢。我想如果我們確實看到立法到位，你能以多快的速度轉移客戶——將客戶轉移到新的支付模式以適應新的監管背景？

So first, on the affordability in the out-of-pocket, choice has been in the marketplace for some time. And important to note, by and large, as I noted before, on average, those programs are working well in terms of the balance of overall affordability. And plan sponsors make trade-offs in terms of how much is put in premiums, how much is put in the benefits, et cetera, from that standpoint. Two, just pointing you to specific because you said actions we could take. In 2019, we rolled out the first of its kind, the patient assurance program for insulin-dependent diabetics, cap monthly costs at $25 will stop. There's 11 million people benefiting from that program today as you see more focus relative to insulin. So we can have and will from that standpoint.

因此，首先，關於自付費用的可負擔性，市場上的選擇已經存在了一段時間。重要的是要注意，總的來說，正如我之前指出的那樣，平均而言，這些計劃在總體負擔能力的平衡方面運作良好。從這個角度來看，計劃發起人會在保費投入多少、福利投入多少等方面做出權衡。第二，只是向您指出具體情況，因為您說了我們可以採取的行動。 2019 年，我們推出了首個此類計劃，即針對胰島素依賴型糖尿病患者的患者保障計劃，每月費用上限為 25 美元的計劃將停止。今天有 1100 萬人從該計劃中受益，因為您會看到與胰島素相關的更多關注。因此，從這個角度來看，我們可以擁有並願意。

Second, as you click down because, in many cases, the devils in the details, as you roll out new programs, you learned that, for example, some of the copay assurance programs can work in an HRA program, but in some cases, don't work in an HSA program because of the regulatory requirement of the HSA program. They'll only work for preventative drugs, but they won't work for a broader class of drugs. So that now enables us to be more consultative with employers to make sure there's even a more pinpointed focus on benefit design and communication strategies as open enrollment happens because in some cases, an individual will enroll in an HSA, yet learn later that they have more dislocation in their out-of-pocket costs in a given month from the copay. So my point is actions taken, actions being taken, more precision that is necessary from that standpoint.

其次，當你點擊下來時，因為在很多情況下，細節決定成敗，當你推出新計劃時，你了解到，例如，一些共付額保證計劃可以在 HRA 計劃中發揮作用，但在某些情況下，由於 HSA 計劃的監管要求，不要在 HSA 計劃中工作。它們僅適用於預防性藥物，但不適用於更廣泛的藥物類別。因此，這使我們現在能夠與雇主進行更多協商，以確保在開放註冊時更加精確地關注福利設計和溝通策略，因為在某些情況下，個人會註冊 HSA，但後來才知道他們有更多他們在給定月份的自付費用與共付額的錯位。所以我的觀點是採取的行動，正在採取的行動，從那個角度來看需要更精確。

As it relates to the -- how quickly we could pivot, we've proven tremendous flexibility in our model. Some of the additional data we're providing, we noted even last year at our Investor Day, we would continue to push ourselves with expanded disclosures and you're seeing more and more. We can pivot, we will pivot, we will continue to offer choice and the tools exist today as exemplary with our ClearCareRx program to provide further choice that use different financing mechanisms. So we are confident that we will be able to flex rapidly, if necessary. But we want to also ensure that we are a voice for employers to still work to preserve choices for them as how they want to finance their programs, how they want to manage their overall cost and predictability from that standpoint. But to reassure you, we have ample flexibility to flex rapidly.

因為它涉及到——我們可以多快地進行調整，我們已經證明了我們模型的巨大靈活性。我們提供的一些額外數據，我們甚至在去年的投資者日就指出了，我們將繼續通過擴大披露來推動自己，你會看到越來越多。我們可以轉向，我們將轉向，我們將繼續提供選擇，並且今天存在的工具作為我們的 ClearCareRx 計劃的典範，可以提供使用不同融資機制的更多選擇。因此，我們有信心，如有必要，我們將能夠迅速調整。但我們也想確保我們是雇主的代言人，讓他們仍然努力為他們保留選擇，比如他們想如何為他們的項目融資，他們想如何管理他們的總體成本和從這個角度的可預測性。但為了讓您放心，我們有足夠的靈活性來快速調整。

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。瑞士信貸的大米。

I guess I'll try to pivot away from the PBM question. In the prepared remarks, you mentioned your ongoing discussions with VillageMD about putting in place value-based contracting. I wonder if you can give us any further update on that? When you start to think about your '24 bids commercially or an MA, will any of those arrangements be part of the package that you offer or a factor in your bids and -- so it's I'm asking about '24 anything on the MA final rate notice and whether that changes your view on growth or margin trajectory that you're on in MA?

我想我會嘗試擺脫 PBM 問題。在準備好的評論中，您提到了您與 VillageMD 正在進行的關於實施基於價值的合同的討論。我想知道你是否可以就此向我們提供任何進一步的更新？當您開始考慮商業或 MA 的 '24 出價時，這些安排中的任何一個是否會成為您提供的一攬子計劃的一部分或您的出價的一個因素 - 所以我在 MA 上詢問'24 任何事情最終利率通知，這是否會改變您對 MA 的增長或利潤率軌蹟的看法？

You tucked a lot of questions in there, but let me start from the top. Relative to value-based care, before I get to Village first, we've had a long commitment and positive track record relative to value-based care programs. our orientation, as you may recall, is oriented around partnering, using data in collaborating with additional care extended resources to drive better, more consistent clinical outcomes and, therefore, overall value. Today, think about order of magnitude approaching 75% of our MA lives are in a value-based program. And depending on what you're looking at commercial or individual exchange, 40% or 50% of lives benefiting from the value-based program. And I'd underscore we're seeing benefits from that in our continued market-leading lower medical cost trend.

你在那裡藏了很多問題，但讓我從頭開始。相對於基於價值的護理，在我第一次到達 Village 之前，我們在基於價值的護理計劃方面有著長期的承諾和積極的記錄。您可能還記得，我們的方向是以合作為導向，使用數據與額外的護理擴展資源合作，以推動更好、更一致的臨床結果，從而提高整體價值。今天，想想我們 MA 生活中接近 75% 的數量級都在基於價值的計劃中。根據您對商業或個人交易的看法，40% 或 50% 的人會從基於價值的計劃中受益。我要強調的是，我們在持續領先市場的較低醫療成本趨勢中看到了這一點的好處。

Specific to Village, we're pleased to advance and even further partnering more deeply with Village and collaborating with them. There are many ways in which we'll collaborate with Village to further accelerate value-based care traction off of their already successful model. I would note and highlight one of the portions that we are really excited about with Village is they've proven their current value-based care approach for commercial as well as Medicare Advantage. And our model with them has the ability to design and benefit from not only commercial and Medicare Advantage, but ASO and guaranteed cost as we bring more Evernorth services and collaborate with them as we curate more specialty networks, et cetera, going forward.

具體到 Village，我們很高興推進甚至進一步與 Village 更深入地合作並與他們合作。我們將通過多種方式與 Village 合作，以進一步加速基於價值的護理從他們已經成功的模式中脫穎而出。我要指出並強調我們對 Village 真正感到興奮的部分之一是他們已經證明了他們當前基於價值的商業和 Medicare Advantage 護理方法。我們與他們的模型不僅能夠設計並受益於商業和 Medicare Advantage，而且還能從 ASO 和保證成本中獲益，因為我們帶來了更多的 Evernorth 服務，並在我們策劃更多的專業網絡等方面與他們合作，向前發展。

As it relates to the part of your question, are there benefits in our current pricing as a result of our village initiative, they are starting to yield benefits already starting to contribute to pricing in specific markets where the initiatives are underway, is the headline.

由於它與您問題的一部分有關，我們目前的定價是否因我們的村莊倡議而受益，他們開始產生收益，已經開始為正在進行倡議的特定市場的定價做出貢獻，這是標題。

As it relates to your last question relative to big strategy, rate notice, et cetera, you should think about our view is, our net rate for 2024 approximates the industry average. We take all the puts and takes that are framed in.

由於它涉及到你關於大戰略、費率通知等的最後一個問題，你應該考慮我們的觀點是，我們 2024 年的淨利率接近行業平均水平。我們接受所有被框住的投入和投入。

Secondly, as you know, we're in the latter part of the bid cycle right now, so it would be premature and inappropriate for me to speak in any depth relative to our specific pricing strategy for 2024. We're pleased with our growth in 2023. We're pleased to see the 10% that we yielded to date and the traction in some of our markets that are maturing, and we will work on a market-by-market basis relative to the bid strategies and look forward to updates as we get into the second half of the year. Thanks, A.J.

其次，如您所知，我們現在正處於投標週期的後半部分，所以我現在就我們 2024 年的具體定價策略進行任何深入的討論還為時過早，也不合適。我們對我們的增長感到滿意2023 年。我們很高興看到我們迄今為止取得的 10% 的收益以及我們一些正在成熟的市場的牽引力，我們將根據投標策略逐個市場地開展工作，並期待進入下半年時更新。謝謝，A.J.

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。

And I'll just echo how much we appreciate the comments on the PBM transparency there. I wanted to follow up with a couple of things on the PBM. The first is -- and so 20% of your profits come from those spread contracts and rebates. If the government did price did pass what they're talking about this year, how would -- how are your contracts structured such that you could pivot away? Is that something that would have to happen over time? What would the near-term impact be versus the longer term?

我只是回應我們非常感謝那裡對 PBM 透明度的評論。我想跟進 PBM 上的幾件事。第一個是 - 因此您的利潤的 20% 來自這些價差合約和回扣。如果政府今年的價格確實超過了他們正在談論的內容，那麼您的合同將如何構建以便您可以擺脫困境？這是隨著時間的推移必鬚髮生的事情嗎？短期影響與長期影響是什麼？

And then secondly, I've gotten a lot of questions on 340B given one of your peers talked about is a pretty meaningful headwind versus their expectations this year. So curious if you can give us some color there in terms of maybe what percentage of earnings come from 340B or how your outlook has changed there within your [Express scripts PBM]?

其次，我收到了很多關於 340B 的問題，因為你們的一位同行談論的是與他們今年的預期相比非常有意義的逆風。很好奇你是否可以給我們一些顏色，比如 340B 的收入百分比可能是多少，或者你的 [Express scripts PBM] 中的前景如何改變？

Justin, I'm going to take your questions. It's David. I'll take your questions in reverse order. Specific to 340B, we've seen some recent extrapolation of what potential exposure could be for us based upon what some others said or the size of certain other programs. I would start by saying we think those estimates are overstated.

賈斯汀，我要回答你的問題。是大衛。我會以相反的順序回答你的問題。具體到 340B，我們已經看到一些最近的推斷，即根據其他人所說的或某些其他程序的規模，我們可能面臨的潛在風險。我首先要說我們認為這些估計被誇大了。

So now let me step back. By way of context, we do believe the 340B represents an important series of capabilities, in many cases, for hospitals to benefit from more affordable pharmaceuticals for underserved populations. Some pharmaceutical manufacturers have unilaterally removed or made it much more difficult for those hospitals to engender those benefits. By way of context, we saw deceleration, some deceleration in our volumes in the first half of 2022. We saw that deceleration trough mid-'22 and we saw volumes begin to increase in the second half of '22 is different data sharing and other activities move forward.

所以現在讓我退後一步。通過上下文，我們確實相信 340B 代表了一系列重要的能力，在許多情況下，醫院可以從為服務不足的人群提供更實惠的藥品中受益。一些製藥商已經單方面取消或使這些醫院更難獲得這些好處。通過上下文，我們看到了減速，2022 年上半年我們的交易量有所減速。我們看到 22 年中期減速，我們看到 22 年下半年交易量開始增加是不同的數據共享和其他活動向前推進。

As it relates to our impact, we have factored into our plan for the year. and our most recent updated outlook for the year, our best estimate, which includes some dampening of the overall program as it relates to our results, but I would stress some of these extrapolations based on the size of certain other programs, we think is overstated. This is manageable within our portfolio and not a material driver of the overall Evernorth portfolio.

由於它與我們的影響有關，我們已將其納入我們今年的計劃。以及我們最近更新的年度展望，我們的最佳估計，其中包括與我們的結果相關的整體計劃的一些抑制，但我會強調其中一些基於某些其他計劃的規模的推斷，我們認為被誇大了.這在我們的投資組合中是可管理的，而不是整個 Evernorth 投資組合的重要驅動力。

As it relates to your first question, which I really appreciate, Justin, I can't give you a precise answer to your question. If we take a theoretical and say that legislation is passed tomorrow, that creates an immediacy, which we do believe will transpire. In fact, if you could look at some of the most recent dialogue coming out of committees and otherwise for the consideration of consideration of consideration being implemented in the latter half of 2025, for example, we don't think that theoretical exists. Having said that, you should think that we have contractual by and large, contractual frameworks that take into consideration unanticipated immediate legislative or regulatory movement. We don't believe that is the case. We will continue to advocate for our clients. We will continue to work to ensure that choice exists. And as we made clear, even with our ClearCareRx program, we have the tools and flexibility to deliver what a client wants from a choice standpoint, with or without sharing and being able to earn a sustained attractive margin for the value we create. Thanks, Justin.

因為它涉及到你的第一個問題，賈斯汀，我真的很感激，我不能給你一個準確的答案。如果我們從理論上說立法將於明天通過，那就會產生一種我們相信會發生的緊迫性。事實上，如果你可以看看委員會最近的一些對話，或者考慮在 2025 年下半年實施的考慮，例如，我們認為理論上不存在。話雖如此，您應該認為我們總體上具有契約性的契約框架，這些框架考慮了未預料到的即時立法或監管運動。我們認為情況並非如此。我們將繼續為我們的客戶辯護。我們將繼續努力確保存在選擇。正如我們明確表示的那樣，即使有了我們的 ClearCareRx 計劃，我們也有工具和靈活性來從選擇的角度提供客戶想要的東西，無論是否分享，並能夠為我們創造的價值贏得持續的有吸引力的利潤。謝謝，賈斯汀。

Our next question comes from Ms. Erin Wright, Morgan Stanley.

我們的下一個問題來自摩根士丹利的 Erin Wright 女士。

You mentioned some elevated dis-enrollment in the second half embedded in your guidance from a softening economy and -- can you quantify that range? Or how are you thinking about that? And what are you seeing now? And how did that change relative to what you were anticipating previously?

你提到了下半年你對經濟疲軟的指導中的一些高退學率，你能量化這個範圍嗎？或者你是怎麼想的？你現在看到了什麼？相對於您之前的預期，這有何變化？

Erin, it's Brian. So first of all, I just would reiterate, we're really pleased with the strong growth momentum across the Cigna Healthcare portfolio. When you think of -- our U.S. commercial Medicare Advantage and our U.S. individual business is all showing strong year-to-date results running ahead of expectations in aggregate for enrollment levels. And that builds upon our really strong performance in '22, where we added nearly 1 million customers across the Cigna Healthcare platform. As I mentioned, we are not yet seeing signs of economic pressure in our book, for example, the dis-enrollment levels in the most recent months are very much in line with historical norms. But as I mentioned, we have assumed some level of elevated dis-enrollment in the back half of the year in order to be prudent. And in addition to that, we typically see some in-year attrition within the U.S. individual book over the course of a given calendar year. And as I mentioned, we still see organic growth in net client counts in the U.S. commercial business, particularly as the Select segment continues its sales cycle through the balance of the year.

艾琳，是布萊恩。因此，首先，我只想重申，我們對 Cigna Healthcare 產品組合的強勁增長勢頭感到非常滿意。當你想到——我們的美國商業 Medicare Advantage 和我們的美國個人業務都顯示出強勁的年初至今結果，總體上超出了入學水平的預期。這建立在我們在 22 年真正強勁的表現之上，我們在 Cigna Healthcare 平台上增加了近 100 萬客戶。正如我所提到的，我們在書中還沒有看到經濟壓力的跡象，例如，最近幾個月的退學率非常符合歷史常態。但正如我所提到的，為了謹慎起見，我們假設今年下半年的退學人數會有所增加。除此之外，我們通常會在給定日曆年的過程中看到美國個人書籍中的一些年內損耗。正如我所提到的，我們仍然看到美國商業業務淨客戶數量的有機增長，特別是當精選部門在今年餘下時間繼續其銷售週期時。

And finally, we have not yet incorporated any assumption of potential volume for Medicaid redetermination. So that represents pure upside for us. And so should we not see economic weakness transpire later in the year? Or should we pick up some unexpected customers from the Medicaid redeterminations? We may have some upside in our Cigna Healthcare customer accounts.

最後，我們還沒有為重新確定醫療補助計劃納入任何潛在數量的假設。所以這對我們來說代表了純粹的好處。那麼，我們難道不應該在今年晚些時候看到經濟疲軟嗎？還是我們應該從醫療補助重新確定中挑選一些意想不到的客戶？我們的 Cigna Healthcare 客戶賬戶可能有一些優勢。

Final comment I'll give you just in terms of sensitivities. In prior economic downturns, we've seen for every 1% change in the unemployment rate, our commercial employer levels enrollment levels will move by either 0.5% to 1% as it relates to 1% move in the unemployment rate. So it gives you a sense for the sensitivity relative to the size of the book as you think about how to model the rest of the year.

最後的評論我只會在敏感性方面給你。在之前的經濟衰退中，我們已經看到失業率每變化 1%，我們的商業雇主級別的入學水平將變化 0.5% 至 1%，因為這與失業率變化 1% 相關。因此，當您考慮如何為今年剩餘時間建模時，它可以讓您了解相對於書本大小的敏感性。

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. it seems like cost trend really wasn't a problem for you in the quarter, but still after earnings season is basically over, still trying to reconcile the strong numbers from the providers and the med tech companies with a relatively solid numbers from the managed care industry. Can you help reconcile what seems to be an apparent conflict? And any color on cost trend, particularly, I guess, through the quarter and into this quarter would be helpful.

偉大的。似乎成本趨勢在本季度對您來說真的不是問題，但在財報季基本結束後，仍在努力協調來自供應商和醫療技術公司的強勁數據與來自管理式醫療的相對穩定的數據行業。你能幫助調和看似明顯的衝突嗎？成本趨勢的任何顏色，特別是，我想，整個季度和本季度都會有所幫助。

Kevin, it's Brian. So just a few thoughts for you in terms of the reconciliation to the provider side, et cetera. I'd start by saying we're pleased to having delivered another strong quarter here of MCR performance in line or better than expected. So I'm pleased to start the year in that position. You can think of that as a function of the strong progress we've made in recent years with our affordability initiatives. So that includes items such as our provider contracting improvements, clinical program evolution, [site] care optimization, along with our continued pricing discipline. So all that served us well, all while allowing us to grow 1.5 million customers year-to-date.

凱文，是布萊恩。因此，就與供應商方面的對賬等方面的問題，我想為您提供一些想法。我首先要說的是，我們很高興在這裡實現了又一個強勁的 MCR 業績季度，符合或好於預期。所以我很高興以那個職位開始新的一年。您可以將其視為我們近年來在負擔能力計劃方面取得的巨大進步的結果。因此，這包括我們的供應商合同改進、臨床項目演變、[站點] 護理優化以及我們持續的定價紀律等項目。因此，所有這些都對我們很有幫助，同時讓我們今年迄今增加了 150 萬客戶。

As you think about the first quarter specifically, the favorability that we saw was driven by lighter-than-expected viral or respiratory claims. So in this case, think of COVID, flu, RSV in aggregate, running a little bit lower than what we had been expecting. Now on the nonviral side, we had planned in price or normalized utilization levels to transpire in 2023. And that were more consistent with pre-COVID levels. And during the first quarter, that's what we saw. We saw nonviral utilization, reflecting this more normalized pattern. But again, this was in line with our expectations that we had planned and price for stepping into the year.

當你具體考慮第一季度時，我們看到的青睞是由低於預期的病毒或呼吸道索賠推動的。因此，在這種情況下，將 COVID、流感、RSV 綜合考慮，比我們預期的要低一點。現在在非病毒方面，我們計劃在 2023 年實現價格或標準化利用率水平。這與 COVID 之前的水平更加一致。在第一季度，這就是我們所看到的。我們看到了非病毒利用，反映了這種更加規範化的模式。但同樣，這符合我們為進入這一年而計劃和定價的預期。

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

我們的下一個問題來自 Gary Taylor 先生和 Cowen。

Quick question. I do appreciate the PBM disclosure because obviously, if you're talking about 10% to 15% of the company's total earnings that you expect to retain? It seems like the down 26% stock price is quite overdone this year. So I appreciate that. Are we going to see some of that financial disclosure in the 10-Q when you talk about new disclosure? Will that be around some of the economics of retained spread in rebate?

快速提問。我很欣賞 PBM 的披露，因為很明顯，如果你談論的是你希望保留的公司總收益的 10% 到 15%？今年下跌 26% 的股價似乎有些過頭了。所以我很感激。當你談論新的披露時，我們是否會在 10-Q 中看到一些財務披露？這會涉及一些保留的回扣利差的經濟學嗎？

And then my second question is we did see the Florida all pass or I believe, is going to be signed or just was signed by the governor that would prohibit spread pricing in Florida across all lines of business. And just wondered what the -- if you knew what the implementation date on that was and just how quickly you had to sort of move to address that employer?

然後我的第二個問題是我們確實看到佛羅里達州全部通過，或者我相信州長將簽署或剛剛簽署，禁止在佛羅里達州所有業務範圍內進行差價定價。只是想知道 - 如果你知道那是什麼實施日期，以及你必須多快採取行動來解決那個雇主？

Gary, it's Brian. I'll take your first question. I think David will comment on the situation that you referenced in Florida. As it relates to the incremental disclosures. So really, those were designed today to give all of our investors some further context on the earnings sources within Evernorth, just given the amount of misinformation in the ecosystem. And so alongside our 10-Q that we filed today, you'll find a supplemental disclosure that provides some additional qualitative information as well as some metrics that we think are important to help various stakeholders understand what the PBM does and doesn't do. And hopefully, we find that investors look at that as useful information.

加里，是布萊恩。我會回答你的第一個問題。我想 David 會評論你提到的佛羅里達州的情況。因為它涉及增量披露。因此，實際上，今天設計這些是為了讓我們所有的投資者進一步了解 Evernorth 內部的收益來源，只是考慮到生態系統中的錯誤信息量。因此，除了我們今天提交的 10-Q 之外，您還會發現一份補充披露，其中提供了一些額外的定性信息以及一些我們認為對幫助各利益相關者了解 PBM 做什麼和不做什麼很重要的指標。希望我們發現投資者將其視為有用的信息。

As it relates to some of the additional data points David and I shared, for example, the 20% of pre-tax adjusted earnings associated with PBM retained rebates and spread. As we referenced, that percentage has declined over time. At this point, we're not necessarily intending to update that every quarter in the Q, but we will obviously give you context for how the earnings sources are evolving over time as that business continues to grow. David, do you want to comment on the...

因為它涉及到大衛和我分享的一些額外數據點，例如，與 PBM 相關的稅前調整後收益的 20% 保留回扣和利差。正如我們所提到的，該百分比隨著時間的推移而下降。在這一點上，我們不一定打算在 Q 中每個季度更新一次，但我們顯然會為您提供隨著該業務的持續增長，收入來源如何隨著時間的推移而演變的背景信息。大衛，你想對……發表評論嗎？

Sure, rich. Gary, relative to the Florida activity, one of the two components we talked about. We talked about rebates. This is specific to your question relative to spread. We're still working through the details from a state standpoint. Interesting timing as well. We literally have our large client gathering that is taking place as we speak. This is a topic of discussion for clients in terms of digesting the ramifications. We'll have the ability to flex our capabilities as I noted in prior questions relative to this one aspect as it's implemented. I don't want to go any further in terms of quantifying or otherwise. Big picture, it's manageable. Specifically, we'll work through client by client, the impacts relative to their respective Florida footprint and then considerations on a go-forward basis as to whether or not they want to flex financing mechanisms for other geographies going forward, using our capabilities. But we have the ability to flex, and we will be compliant, obviously, with the implementation time line.

當然有錢加里，相對於我們談到的兩個組成部分之一的佛羅里達活動。我們談到了回扣。這是特定於您關於傳播的問題。我們仍在從州的角度研究細節。有趣的時機也是如此。就在我們說話的時候，我們確實舉行了大型客戶聚會。就消化後果而言，這是客戶討論的話題。正如我在之前的問題中提到的那樣，我們將有能力發揮我們的能力，因為它已實施。我不想在量化或其他方面再進一步。大局觀，可控。具體來說，我們將逐個客戶研究與他們各自在佛羅里達州足跡相關的影響，然後在未來的基礎上考慮他們是否希望利用我們的能力為其他地區靈活調整融資機制。但我們有能力靈活調整，顯然我們會遵守實施時間表。

Our next question comes from Mr. Stephen Baxter with Wells Fargo.

我們的下一個問題來自 Wells Fargo 的 Stephen Baxter 先生。

Yes, I wanted to ask about ClearCareRx. I guess, first, how quickly do you think this model will be adopted? Is there any kind of target for this that you can share? And then obviously, your clients are sophisticating of access to pools to evaluate your economics during RFPs. But how do you think about competitive dynamics of the industry as a whole over time could be progressing to explicit fee-based pricing models?

是的，我想問一下 ClearCareRx。我想，首先，您認為這種模式將多快被採用？您是否可以分享任何類型的目標？然後很明顯，您的客戶正在完善對池的訪問，以在 RFP 期間評估您的經濟狀況。但是，隨著時間的推移，您如何看待整個行業的競爭動態可能會發展到明確的基於費用的定價模型？

Stephen, the ClearCareRx program, as I noted previously, we've worked for about two years with a small number, think of a dozen large sophisticated clients to design this program to work through the program to perfect aspects of the program, and we're excited to roll it out on a more extensive basis. Two, I would think about the addressable market as more the larger of the large clients working down given the immediacy of pass-through and then the potential cash flow management ramifications that it creates from that standpoint. So this will be another choice that's offered in the marketplace.

Stephen，ClearCareRx 程序，正如我之前提到的，我們已經與一小部分人合作了大約兩年，想到了十幾個複雜的大型客戶來設計這個程序，通過程序來完善程序的各個方面，我們'很高興能在更廣泛的基礎上推出它。第二，考慮到傳遞的即時性以及從該角度產生的潛在現金流管理後果，我認為可尋址市場更多的是更大的大客戶。所以這將是市場上提供的另一種選擇。

I think to your broader question -- inferred to your broader question, the relentless of ongoing commitment to innovation is mission-critical in any industry. In this subset of our industries, it's mission-critical. And we're proud of the fact that we had leadership relative to a variety of programs. As I mentioned, insulin programs, as we talked before about our Embark program on high-cost gene therapies, our SafeGuardRx program, that is benefiting all of our clients relative to care management programs. TRCs, as you know, more therapeutic resource groups and centers that come together and focus on specific diagnosis and have detailed expertise and then how they're coordinated with the medical professionals and how they coordinated with the behavioral professionals are mission critical. So the path of innovation and whether it is, to your point, a fee-based environment that transpires may transpire. However, having the choice, we think, is mission critical.

我認為對於你更廣泛的問題 - 推斷出你更廣泛的問題，對創新的持續承諾在任何行業都是關鍵任務。在我們這個行業的子集中，它是關鍵任務。我們為我們在各種項目中處於領先地位而感到自豪。正如我提到的，胰島素計劃，正如我們之前談到的關於高成本基因療法的 Embark 計劃，我們的 SafeGuardRx 計劃，這使我們所有與護理管理計劃相關的客戶受益。如您所知，TRC 聚集了更多的治療資源組和中心，專注於特定診斷並擁有詳細的專業知識，然後他們如何與醫療專業人員協調以及他們如何與行為專業人員協調是關鍵任務。因此，創新的道路以及它是否是，就你而言，一個基於費用的環境可能會發生。然而，我們認為，有選擇是關鍵任務。

Finally, for you and maybe the broader audience, we may see some similarities as we've seen in the medical space where as you think about our approach, I mean, the medical benefit space, our approach was broad funding mechanisms and financing mechanisms, an agnostic model, meaning we could flex in any of them, whether it's self-funded, self-funded with stop loss on risk management, a share return model or a guaranteed cost model. And we see those same trends manifesting in the pharmacy space, and we're in a position to lead there. So largest of large employers, 2 years in its design, it's perfected and it's ready to scale. We don't think the entire market shifts to this in 2024. We think there'll be more adoption of programs like ClearCareRx, and we're happy to be the leader in the space.

最後，對於您和更廣泛的受眾，我們可能會看到一些相似之處，就像我們在醫療領域看到的那樣，當您考慮我們的方法時，我的意思是，醫療福利領域，我們的方法是廣泛的籌資機制和融資機制，一個不可知論模型，這意味著我們可以靈活使用其中任何一個，無論是自籌資金、風險管理止損自籌資金、股票回報模型還是保證成本模型。我們看到藥房領域也出現了同樣的趨勢，我們有能力在這方面處於領先地位。如此最大的大型雇主，經過 2 年的設計，它已經完善並且可以擴展。我們認為整個市場不會在 2024 年轉向這種情況。我們認為會有更多人採用 ClearCareRx 等程序，我們很高興成為該領域的領導者。

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。

I was wondering if you could give us some more color on the individual book. It looks like it came in maybe 100,000 or so more than expected. Maybe where did those lives come from? And was that the reason for the increased total membership guidance? And then maybe any early signs on utilization and other metrics that give you comfort that you price that business correctly?

我想知道你是否可以在單本書上給我們一些更多的顏色。看起來它比預期多了 100,000 左右。也許那些生命是從哪裡來的？這是增加會員總數指導的原因嗎？然後，也許有任何關於利用率和其他指標的早期跡象讓您放心，您正確地為該業務定價了嗎？

Josh, it's Brian. So overall, the strong individual customer growth in 2023, you can think of as a combination of a few things. So one, obviously, the industry had some strong growth rates from '22 to '23. We also had some new market entries and there were some competitors that exited certain geographies where we participate in. And if you think about the sources of that, our growth came from a combination of existing geographies and those three new states that we stepped into, which were Texas, Indiana and South Carolina here in 2023. We did see the majority of our growth come from three states in particular. So Texas, Georgia and Florida drove the majority of the growth not any one specific city because we're in multiple locations in those states. Fortunately, we have a long history in these geographies that goes well beyond the U.S. individual business, meaning our commercial and MA businesses has been operating in those locations for some time. So our provider engagement and clinical programs should benefit these individual customers as well.

喬希，是布萊恩。所以總的來說，2023 年個人客戶的強勁增長，你可以認為是幾件事的結合。因此，很明顯，該行業從 22 歲到 23 歲有一些強勁的增長率。我們也有一些新的市場進入，並且有一些競爭對手退出了我們參與的某些地區。如果您考慮其來源，我們的增長來自現有地區和我們進入的三個新州的結合， 2023 年這裡是德克薩斯州、印第安納州和南卡羅來納州。我們確實看到我們的大部分增長來自三個州。因此，得克薩斯州、佐治亞州和佛羅里達州推動了大部分增長，而不是任何一個特定城市，因為我們在這些州的多個地點。幸運的是，我們在這些地區的歷史悠久，遠遠超出了美國的個體業務，這意味著我們的商業和 MA 業務已經在這些地區運營了一段時間。因此，我們的供應商參與和臨床計劃也應該使這些個人客戶受益。

Now for purposes of the claims experience and the margins, et cetera, for the '23 calendar year, we continue to expect the margins on this book will run below our long-term goal, which is 4% to 6% in our Cigna Health care income and MCR guidance reflects this. So we expect to run below that 4% to 6% long-term goal given the substantial amount of new customers we've added in 2023, we think this is a prudent assumption to make from the standpoint of the margin running below that long-term target.

現在，就 23 日曆年的索賠經驗和利潤率等而言，我們繼續預計這本書的利潤率將低於我們的長期目標，即我們 Cigna Health 的 4% 至 6%護理收入和 MCR 指南反映了這一點。因此，鑑於我們在 2023 年增加的大量新客戶，我們預計將低於 4% 至 6% 的長期目標，我們認為從利潤率低於該長期目標的角度來看，這是一個謹慎的假設-術語目標。

While it's early in the year so far, the claims are largely in line with our expectations through the first quarter. And importantly, as you think about the first quarter actuals as well as our full year outlook, we've assumed that we will be in a risk adjustment payable position for the 2023 plan year despite the fact that we were in a receivable position for the 2022 plan year. So again, we think that's a prudent assumption to make at this early juncture in the year until later. And in 2023 when we see some industry-wide risk adjustment data that will help us to recalibrate that assumption. As you think about the longer run, this is a book of business that does represent a source of future embedded earnings power that will help contribute to the segment's long-term margin expansion and income growth. So overall, a good start to the year. Still a long way to go for the full year, and we think we've taken a prudent posture as it relates to the accruals.

雖然今年年初至今，索賠基本符合我們對第一季度的預期。重要的是，當您考慮第一季度的實際情況以及我們的全年展望時，我們假設我們將在 2023 計劃年度處於風險調整應付狀態，儘管事實上我們處於應收狀態2022 計劃年。因此，我們再次認為，在今年的這個早期階段，直到晚些時候，這是一個謹慎的假設。到 2023 年，我們將看到一些全行業的風險調整數據，這將幫助我們重新校準該假設。從長遠來看，這是一本業務簿，它確實代表了未來嵌入式盈利能力的來源，這將有助於促進該部門的長期利潤率擴張和收入增長。總的來說，這是今年的一個良好開端。全年還有很長的路要走，我們認為我們在應計費用方面採取了謹慎的態度。

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

我們的下一個問題來自斯科特菲德爾先生和斯蒂芬斯。

I would be interested if you could maybe just drill in a bit more into your latest thinking on both the GLP-1 drugs and then the emerging Alzheimer's drugs, maybe give us just some insights from both the Cigna Healthcare and Evernorth business segment perspective?

如果您可以更深入地了解您對 GLP-1 藥物和新興阿爾茨海默氏症藥物的最新想法，我會很感興趣，也許可以從 Cigna Healthcare 和 Evernorth 業務部門的角度給我們一些見解？

Scott, it's David. Clearly, the GLP-1 drugs have been in the price pretty significantly. And by way of headline, we think the drugs and the treatment protocols represent a positive step forward. specifically for diabetics as such. We have coverage within our formulary. I would remind you that early on when the first within the class came out, we actually stepped in with some value-based care arrangements with pharmaceutical manufacturers and have seen positive contributions for both the benefit of patients as well as our clients. But to date, I'd also add that employers have had a more limited appetite to expand coverage beyond clinical diagnoses such as diabetes for certain lifestyle treatments. There has been some, but we've seen more limited adoption of that thus far. And on a go-forward basis, we would expect to have our P&T committee and our internal clinical oversight continue to monitor the progress relative to ongoing testing development in this important class. I would take that trend and carry it across similarly relative to the Alzheimer's space, clearly, a lot of interest excitement and demand for drugs within the Alzheimer's space to help a growing population confronting this challenging disease from that standpoint. We've seen more limited adoption thus far. We see some early data like you're seeing right now relative to next-in-class [drugs] seeming to demonstrate some promise going through FDA, working through CMS relative to Medicare reimbursement, and we will stay tightly aligned relative to that.

斯科特，是大衛。顯然，GLP-1 藥物的價格已經相當高了。通過標題，我們認為藥物和治療方案代表了向前邁出的積極一步。專門針對糖尿病患者。我們的處方集內有覆蓋範圍。我想提醒您，早在班級中的第一個出現時，我們實際上就與製藥商進行了一些基於價值的護理安排，並看到了對患者和我們客戶的利益的積極貢獻。但到目前為止，我還要補充一點，雇主對擴大覆蓋範圍的興趣有限，超出臨床診斷範圍，例如針對某些生活方式治療的糖尿病。有一些，但到目前為止，我們看到的採用情況更為有限。在前進的基礎上，我們希望我們的 P&T 委員會和我們的內部臨床監督繼續監測與這一重要類別的持續測試開發相關的進展。我會採用這種趨勢並將其與阿爾茨海默氏症領域類似地進行比較，顯然，從這個角度來看，阿爾茨海默氏症領域內對藥物的興趣和需求很多，以幫助不斷增長的人口應對這種具有挑戰性的疾病。到目前為止，我們已經看到了更有限的採用。我們看到一些早期數據，就像你現在看到的與同類 [藥物] 相關的數據似乎表明一些希望通過 FDA，通過 CMS 與 Medicare 報銷相關，我們將與此保持緊密一致。

On a final note, if you put a circle around this, I think you've heard in the latter part of your question, you can think about these drugs is, in some cases, creating cost on the benefit side of the equation with an offset of a benefit, clearly. But you should also think about the Cigna Group's portfolio because of Evernorth is having some dimension of a natural hedge given the size and sophistication and reach of our pharmacy and specialty pharmacy programs and the breadth of the clients we're able to serve within that portfolio. So we see this as a growth opportunity within the Evernorth portfolio and the clinical depth we have in there in terms of coordinating services for individuals will be helpful in terms of ensuring that the value is delivered.

最後一點，如果你把這個圈起來，我想你已經在問題的後半部分聽到了，你可以考慮這些藥物，在某些情況下，在等式的收益方面創造成本利益的抵消，很明顯。但您還應該考慮 Cigna Group 的投資組合，因為考慮到我們的藥房和專業藥房計劃的規模和復雜程度以及我們能夠在該投資組合中服務的客戶的廣度，Evernorth 具有某種程度的自然對沖.因此，我們將此視為 Evernorth 產品組合中的一個增長機會，我們在協調個人服務方面的臨床深度將有助於確保交付價值。

So emerging space in both categories, some promise, early adoption, some track record in value-based care. And importantly, I would underscore, we have a natural hedge relative to some cost pressure you would think about in the benefit space through our high-performing services space.

因此，這兩個類別的新興空間，一些承諾，早期採用，一些基於價值的護理的記錄。重要的是，我要強調的是，相對於您通過我們的高性能服務空間在收益空間中考慮的一些成本壓力，我們有一個自然的對沖。

Our last question comes from Kevin -- Mr. Kevin Caliendo with UBS.

我們的最後一個問題來自凱文——瑞銀的凱文卡連多先生。

Great. Getting back to the 20% of Evernorth earnings, does that include the ESI rebates and pass-through and spread? Does that also account for the medical profit like the pharmacy profit in the Medical segment as well? Or is that separate? And since you've been in such a giving mood, can you provide us -- is there any transparency on that number?

偉大的。回到 Evernorth 的 20% 收益，這是否包括 ESI 回扣以及轉嫁和差價？這是否也包括醫療部門的藥房利潤等醫療利潤？或者那是分開的？既然你一直有這樣的心情，你能告訴我們——這個數字是否透明？

Kevin, it's Brian. So the 20% that we made reference to is the PBM retained rebates and the retail spread that comprise the Evernorth segment's contribution specifically. So as with all of our clients of Evernorth, whether they be the Cigna Healthcare affiliated health plan or our unaffiliated health plan clients, they choose how they would like to use the pharmacy value that we create for them. So to your question, if there are pharmacy earnings in the Cigna Healthcare segment, that's not reflected in the 20% metric we're specifically dimensioning the Evernorth contribution. And then like I said, the Cigna Healthcare health plan decides how they choose to deploy any value that's created from Evernorth's sister company. David, maybe you want to pile on here?

凱文，是布萊恩。因此，我們提到的 20% 是 PBM 保留的回扣和零售價差，具體包括 Evernorth 部門的貢獻。因此，與我們 Evernorth 的所有客戶一樣，無論他們是 Cigna Healthcare 附屬健康計劃客戶還是我們的非附屬健康計劃客戶，他們都會選擇他們希望如何使用我們為他們創造的藥房價值。所以對於你的問題，如果 Cigna Healthcare 部門有藥房收入，那沒有反映在我們專門衡量 Evernorth 貢獻的 20% 指標中。然後就像我說的那樣，Cigna Healthcare 健康計劃決定了他們如何選擇部署 Evernorth 的姊妹公司創造的任何價值。戴維，也許你想在這堆東西？

And Kevin to add on that, as you think about the health plans that are served by Evernorth, if you consider the total cost of care, a health plan through their medical contracting, ancillary contracting, pharmacy contract behavioral contracting, aggregate a total cost of care to generate their price point. So in the case of a guaranteed cost offering or a risk-based offering, the cost of the pharmaceuticals are baked into that from that standpoint, whether that's commercial, individual exchange business. or Medicare Advantage business for health plan. So that's value delivered just like the value that's delivered for their medical contracting, their DME contracting, their behavioral contracting, et cetera, and part of their overall cost equation that they'll factor into the net pricing that they're offering to the marketplace.

凱文補充說，當你考慮 Evernorth 提供的健康計劃時，如果你考慮總護理成本，通過他們的醫療承包、輔助承包、藥房合同行為承包的健康計劃，總成本為關心產生他們的價格點。因此，在保證成本產品或基於風險的產品的情況下，從那個角度來看，藥品的成本被納入其中，無論是商業、個人交換業務。或健康計劃的 Medicare Advantage 業務。因此，這就是交付的價值，就像為他們的醫療合同、他們的 DME 合同、他們的行為合同等交付的價值，以及他們將考慮到他們提供給市場的淨定價的總成本等式的一部分.

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

我將把電話轉回給 David Cordani 作結束語。

Thanks again for joining our call today. Let me just reinforce a couple of quick points. One, we are confident that we will deliver our increased adjusted EPS, revenue and customer growth outlook for this year. To do that, our team remains focused on everyone we serve and is executing with good focus and discipline, all while we continue to innovate. We will also continue our leadership in working to improve health care, including our increased transparency, choice and clinical programs to drive down further drug costs for our customers, our patients and our clients. I would want to underscore that the progress we continue to make all starts with and is fueled by the dedication and commitment of our 70,000 coworkers around the world who I want to thank for their commitment and demonstration every day to working to make a very positive difference in the people's lives we are able to serve both formally through our commercial relationships as well as in the communities we serve each and every day.

再次感謝您今天加入我們的電話會議。讓我來強調幾點。第一，我們有信心實現今年調整後每股收益、收入和客戶增長預期的增長。為此，我們的團隊始終專注於我們服務的每一個人，並以良好的專注和紀律執行，同時我們繼續創新。我們還將繼續在改善醫療保健方面發揮領導作用，包括提高透明度、選擇和臨床計劃，以進一步降低我們的客戶、患者和客戶的藥物成本。我想強調的是，我們繼續取得的進展始於我們在世界各地的 70,000 名同事的奉獻和承諾，我要感謝他們的奉獻和承諾，他們每天都在努力做出非常積極的改變在人們的生活中，我們既可以通過我們的商業關係正式服務，也可以在我們每天服務的社區中提供服務。

Finally, and thank you for joining our call. And as always, we look forward to our continued discussions in the future.

最後，感謝您加入我們的電話會議。一如既往，我們期待著我們在未來繼續進行討論。

Ladies and gentlemen, this concludes the Cigna Group's First Quarter 2023 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 888-282-0036 or (203) 369-3022. There is no passcode required for this replay. Thank you for participating. We will now disconnect.

女士們，先生們，信諾集團 2023 年第一季度業績回顧到此結束。 Cigna 投資者關係部將很快回答其他問題。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 888-282-0036 或 (203) 369-3022 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。