信諾集團 (CI) 2023 Q3 法說會逐字稿

Ladies and gentlemen, thank you for standing by for the Cigna Group's Third Quarter 2023 Results Review.

女士們、先生們，感謝你們耐心等待 Cigna 集團 2023 年第三季業績回顧。

(Operator Instructions) As a reminder, ladies and gentlemen, this conference, including the Q&A session, is being recorded.

（操作員說明）女士們先生們，請注意，本次會議，包括問答環節，正在錄製中。

We'll begin by turning the conference over to Ralph Giacobbe. Please go ahead.

我們先將會議交給 Ralph Giacobbe。請繼續。

Great. Thanks. Good morning, everyone. 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, the Cigna Group's Chairman and Chief Executive Officer; Brian Evanko, Chief Financial Officer; and Eric Palmer, President and Chief Executive Officer of Evernorth Health Services.

偉大的。謝謝。大家，早安。感謝您參加今天的電話會議。我是拉爾夫‧賈科布 (Ralph Giacobbe)，投資人關係資深副總裁。今天早上與我通話的是 Cigna 集團董事長兼執行長 David Cordani；布萊恩‧埃萬科 (Brian Evanko)，財務長；埃里克·帕爾默 (Eric Palmer)，Evernorth Health Services 總裁兼執行長。

In our remarks today, David and Brian will cover a number of topics, including our third quarter financial results and our updated financial outlook for 2023. Following their prepared remarks, David, Brian and Eric will be available for Q&A.

在今天的演講中，David 和 Brian 將討論許多主題，包括我們第三季度的財務業績和 2023 年最新的財務展望。在他們準備好的演講之後，David、Brian 和 Eric 將接受問答。

As noted in our earnings release, when describing our financial results, we use certain financial measures including 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.

正如我們在財報中所指出的，在描述我們的財務表現時，我們使用了某些財務指標，包括調整後的營運收入和調整後的收入，這些指標並非根據美國普遍接受的會計原則（也稱為GAAP）確定。

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 the cignagroup.com.

這些指標分別與最直接可比較的 GAAP 指標、股東淨收入和總收入進行了調節，分別包含在今天的收益報告中，該報告發佈在 Cignagroup.com 的投資者關係部分。

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.

我們使用「調整後營業收入」和「調整後每股盈餘」這個術語作為我們衡量財務表現的主要指標。

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 risks and uncertainties is contained in the cautionary note to today's earnings release and in our most recent reports filed with the SEC.

在今天的演講中，我們將做出一些前瞻性聲明，包括有關我們對 2023 年和未來業績的展望的聲明。這些陳述存在風險和不確定性，可能導致實際結果與我們目前的預期有重大差異。對這些風險和不確定性的描述包含在今天的收益發布的警示說明以及我們向美國證券交易委員會提交的最新報告中。

Before turning over the call, I will cover a few items pertaining to our financial results. In the third quarter, we recorded an after-tax special item charge of $171 million or $0.58 per share for charges primarily associated with our Medicare litigation settlement.

在轉交電話之前，我將介紹一些與我們的財務表現有關的項目。第三季度，我們記錄了 1.71 億美元的稅後特殊項目費用，即每股 0.58 美元，主要與我們的醫療保險訴訟和解相關。

We also recorded an after-tax special item charge of $19 million or $0.06 per share associated with the sale of our international life accidental and supplemental business to Chubb, and an after-tax special item charge of $9 million or $0.03 per share for integration and transaction-related cost.

我們也記錄了與將我們的國際人壽意外險和補充業務出售給Chubb 相關的稅後特殊項目費用1900 萬美元或每股0.06 美元，以及用於整合和整合的稅後特殊項目費用900 萬美元或每股0.03 美元。交易相關成本。

As described in today's release, special items are excluded from adjusted income from operations and adjusted revenues in our discussion of financial 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 the potential impact of future share repurchases and anticipated 2023 dividends.

正如今天的新聞稿所述，在我們討論財務表現時，特殊項目不包括在調整後的營運收入和調整後的收入中。此外，請注意，當我們對財務業績（包括 2023 年全年展望）做出前瞻性評論時，我們將基於未來股票回購和預期 2023 年股息的潛在影響。

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

這樣，我就把電話轉給大衛。

Thanks, Ralph. Good morning, everyone, and thank you for joining today's call. We had another quarter of strong performance, and we remain on pace for a year of sustained momentum in 2023.

謝謝，拉爾夫。大家早安，感謝您參加今天的電話會議。我們又一個季度表現強勁，並將在 2023 年保持持續成長勢頭。

With the strength of capabilities across our health services and benefits platforms, we are continuing to deliver on our mission for those we serve as we continue to grow our company.

憑藉我們健康服務和福利平台的強大能力，我們在不斷發展公司的同時，將繼續為我們服務的人們履行我們的使命。

Today, I'll highlight key drivers supporting our performance during the quarter, our priorities and opportunities for expanding our impact and continue to advance, our growth and our view of 2024, including some of the expected tailwinds and headwinds.

今天，我將重點介紹支持我們本季業績的關鍵驅動因素、我們的優先事項和擴大影響力並繼續前進的機會、我們的成長以及我們對2024 年的看法，包括一些預期的有利因素和不利因素。

Brian will share additional perspective about our third quarter performance as well as our outlook for the rest of the year. So with that, let's get started.

布萊恩將分享有關我們第三季業績以及今年剩餘時間的展望的更多觀點。那麼，讓我們開始吧。

In the third quarter, we delivered $49 billion in total revenue, adjusted earnings per share of $6.77, continued strong cash flow generation across our franchise, all while continuing to reinvest back in our business to fund growth, expansion and ongoing innovation.

第三季度，我們實現了490 億美元的總收入，調整後每股收益為6.77 美元，整個特許經營業務持續產生強勁的現金流，同時繼續對我們的業務進行再投資，為成長、擴張和持續創新提供資金。

These results are strong, and they show how we're continuing our track record of strong, sustained performance.

這些結果非常強勁，它們顯示我們如何持續保持強勁、持續的業績記錄。

With our Evernorth Health Services and Cigna Healthcare Benefits platform, we are executing well in a dynamic period and fueling customer growth with our deep clinical expertise, innovative solutions and breadth of market-leading capabilities.

憑藉我們的 Evernorth Health Services 和 Cigna Healthcare Benefits 平台，我們在充滿活力的時期表現良好，並憑藉深厚的臨床專業知識、創新的解決方案和廣泛的市場領先能力推動客戶成長。

Our results during the quarter demonstrate how we're continuing to deliver on our commitments for our customers and patients, our clients, as well as our shareholders. We are raising our full year 2023 outlook for EPS, customer and revenue growth, as well as cash flow from operations.

我們本季的表現證明了我們如何繼續履行對客戶和患者、客戶以及股東的承諾。我們上調了 2023 年全年每股收益、客戶和收入成長以及營運現金流的預期。

With our continued affordability initiatives, we are also now guiding to an improved medical care ratio for 2023. Our businesses are performing well, and we now expect to deliver adjusted earnings per share of at least $24.75 for full year 2023.

透過我們持續的負擔能力計劃，我們現在還指導提高 2023 年的醫療保健比率。我們的業務表現良好，我們現在預計 2023 年全年調整後每股收益至少為 24.75 美元。

Now I'll turn to how we are working to sustain our growth and impact. With our durable strategic growth framework, we harness complementary capabilities from across the Cigna Group. We have scale to mature businesses that drive foundational growth, and businesses in faster-growing market segments that contribute accelerated growth.

現在我將談談我們如何努力維持我們的成長和影響。憑藉我們持久的策略成長框架，我們利用整個 Cigna 集團的互補能力。我們擁有推動基礎性成長的成熟業務的規模，以及有助於加速成長的快速成長細分市場的業務。

We fuel additional growth through cross enterprise leverage as we bring together the power of our talent, client relationships, differentiated capabilities and innovation from across our company.

我們透過跨企業槓桿推動額外成長，因為我們匯集了整個公司的人才、客戶關係、差異化能力和創新的力量。

Next, I'll share how we have deliberately shaped our portfolio of businesses that are well positioned for today's market needs. Additionally, I'll highlight some of the ways we continue to drive our sustained success as we look to the future.

接下來，我將分享我們如何精心塑造能夠很好地滿足當今市場需求的業務組合。此外，我將重點介紹我們在展望未來時繼續推動持續成功的一些方法。

Evernorth Health Services continues to demonstrate a proven ability to create value with differentiated pharmacy, care and benefits capabilities. We had a strong pharmacy benefit selling season for 2024, and our teams are already actively engaged into 2025 season.

Evernorth Health Services 繼續證明其透過差異化的藥房、護理和福利能力創造價值的能力。 2024 年我們的藥品福利銷售季表現強勁，我們的團隊已經積極投入 2025 年銷售季。

We are continuing to innovate and provide our clients with expanded choice as well as market-leading value.

我們不斷創新，為客戶提供更多選擇和市場領先的價值。

Many of the clients we serve leverage Evernorth's unique suite of solutions to support the needs of their customers. Centene is one new relationship we discussed before, and our teams have been collaborating effectively on implementation work, which is going very well as we prepare to serve approximately 20 million Centene customers beginning in January.

我們服務的許多客戶都利用 Evernorth 獨特的解決方案套件來滿足客戶的需求。 Centene 是我們之前討論過的新關係，我們的團隊一直在實施工作上進行有效協作，進展非常順利，我們準備從 1 月開始為大約 2000 萬 Centene 客戶提供服務。

We have a leadership position in addressing a substantial market opportunity with the expanded wave of pharmacological innovation that is reshaping the health care landscape. Many of the treatments that are coming to market are pressuring affordability with high list prices from drug manufacturers.

隨著不斷擴大的藥理創新浪潮正在重塑醫療保健格局，我們在抓住巨大的市場機會方面處於領先地位。許多即將上市的治療藥物因藥品製造商的高標價而對承受能力造成壓力。

At Evernorth, we are driving better experience, clinical outcome and affordability for patients and clients, given our deep clinical expertise, strong relationships with pharmaceutical manufacturers, as well as with physicians.

在 Evernorth，憑藉我們深厚的臨床專業知識以及與製藥商和醫生的牢固關係，我們正在為患者和客戶提供更好的體驗、臨床結果和負擔能力。

The surge of demand for the GLP-1 drug class for weight management offers a good example of how we provide value. Our EnCircleRx program is an innovative solution that addresses the complexity and costs associated with obesity, diabetes and cardiovascular disease, a prevalent combination of conditions that's also known as cardio diabesity. Growing at Evernorth's clinical expertise, breadth and depth of data and analytical insights, EnCircleRx guides patients to the most effective care and helps improve affordability for clients.

對用於體重管理的 GLP-1 藥物類別的需求激增為我們如何提供價值提供了一個很好的例子。我們的 EnCircleRx 計畫是一種創新解決方案，可解決與肥胖、糖尿病和心血管疾病（一種常見的疾病組合，也稱為心臟糖尿病）相關的複雜性和成本。 EnCircleRx 憑藉 Evernorth 的臨床專業知識、數據的廣度和深度以及分析見解的不斷發展，指導患者獲得最有效的護理，並幫助提高客戶的負擔能力。

Beyond the GLP-1 drug class, we expect to see many different manufacturers bringing forth a growing number of new drugs, including gene therapies, additional treatments for cancer as well as others for Alzheimer's and other conditions.

除了 GLP-1 藥物類別之外，我們預計許多不同的製造商將推出越來越多的新藥，包括基因療法、癌症的其他治療方法以及阿茲海默症和其他疾病的其他治療方法。

We are uniquely well positioned to make medicine more accessible, affordable and clinically coordinated for those we serve as well as to continue to drive growth for our company.

我們擁有得天獨厚的優勢，可以讓我們所服務的人更容易獲得、負擔得起藥物並進行臨床協調，並繼續推動我們公司的成長。

Now in our international health business, another foundational business within a portfolio. We are supporting continued growth in target markets and expanding our portfolio of solutions. During the quarter, for example, we introduced a new affordable health plan, customized specifically for the globally mobile seniors population.

現在我們的國際健康業務是投資組合中的另一個基礎業務。我們支持目標市場的持續成長並擴大我們的解決方案組合。例如，在本季度，我們推出了一項新的負擔得起的健康計劃，專為全球流動老年人口量身定制。

Additionally, in the foundational portfolio, our U.S. commercial business continues to harness cross-enterprise leverage capabilities for the benefit of their clients.

此外，在基礎投資組合中，我們的美國商業業務繼續利用跨企業槓桿能力為客戶謀取利益。

As we looked forward in 2024, we know that additional -- in addition to affordability, one of the top priorities for many employers is expanding access, coordination and overall effectiveness of behavioral health programs and solutions.

展望 2024 年，我們知道，除了負擔能力之外，許多雇主的首要任務之一是擴大行為健康計畫和解決方案的獲取、協調和整體有效性。

The benefit of our commercial clients to customers, we are leveraging innovations and capabilities that exist in our accelerate businesses. For example, stress, anxiety among other mental health conditions create challenges for employers who need a healthy, engaged workforce, and we continue to expand the behavioral health solutions we offer through Evernorth Care businesses.

為了讓我們的商業客戶為客戶帶來好處，我們正在利用我們加速業務中存在的創新和能力。例如，壓力、焦慮等心理健康狀況給需要健康、敬業的員工隊伍的雇主帶來了挑戰，我們繼續擴大透過 Evernorth Care 業務提供的行為健康解決方案。

One of the newer solutions is Confide behavioral health navigator. It's resonating well with clients, helping us both retain and win new business. Confide is guided by a proven model of a more proactive high-touch service level, effective monitoring and targeted follow-up engagement.

較新的解決方案之一是 Confide 行為健康導航器。它與客戶產生了良好的共鳴，幫助我們保留並贏得了新業務。 Confide 以經過驗證的模型為指導，提供更主動的高接觸服務水準、有效的監控和有針對性的後續參與。

We will launch additional enhancements next year to provide digital tools that are personalized to the needs of individual patients that improve matching them with the right therapists and also offer greater convenience and accelerated scheduling opportunities.

我們將在明年推出更多增強功能，提供根據患者個別需求進行個人化的數位工具，從而改善患者與合適治療師的匹配，並提供更大的便利和加速安排的機會。

Additionally, as we continue to advance our focus on vitality, including our latest research addressing the capacity of individuals across multiple dimensions, it reinforces that mental health, for example, is one of the most significant drivers. We know that adults without significant mental health challenges are 10x more likely to have high vitality.

此外，隨著我們繼續推進對活力的關注，包括我們針對個人在多個維度的能力的最新研究，它強化了心理健康是最重要的驅動因素之一。我們知道，沒有重大心理健康問題的成年人擁有高活力的可能性高出 10 倍。

Now if you're an employer, this means higher engagement, higher productivity, lower turnover as well as lower medical costs.

現在，如果您是雇主，這意味著更高的敬業度、更高的生產力、更低的流動率以及更低的醫療成本。

In addition to addressing growing behavior health needs in Evernorth Care, we are also acting as a positive disruptor in care delivery and care management to improve experience, outcomes and access from a patient's perspective. We're developing innovative care models and clinical programs with continued investments, for example, to expand our digital and virtually-led capabilities, while making sure they are coordinated and connected with physical sites of care. For example, we continue to innovate and build on MDLIVE's leading virtual care platform and plan to further accelerate new capabilities in 2024.

除了滿足 Evernorth Care 不斷增長的行為健康需求外，我們還在護理服務提供和護理管理方面發揮積極的顛覆作用，從患者的角度改善體驗、結果和訪問。我們正在開發創新的護理模式和臨床項目，並持續投資，例如，擴大我們的數位和虛擬主導能力，同時確保它們與實體護理場所協調和連結。例如，我們在 MDLIVE 領先的虛擬護理平台上繼續創新和構建，並計劃在 2024 年進一步加速新功能的開發。

Turning to another accelerated growth business. I'll touch on specialty pharmacy. Last quarter, we talked with you about Accredo's extensive clinical expertise in the assets that provide us with a competitive advantage in this fast-growing specialty pharmacy market, which continues to be an important source of growth for our company.

轉向另一項加速成長的業務。我會談談專業藥局。上個季度，我們與您討論了 Accredo 在資產方面豐富的臨床專業知識，這些專業知識為我們在這個快速成長的專業製藥市場提供了競爭優勢，而該市場仍然是我們公司成長的重要來源。

We also have additional capabilities contributing to our leadership and growth opportunities in this space. Accredo focuses predominantly on supporting patients who receive specialty drugs in their home. Sometimes, these complex medications also need to be administered in physician's offices or hospital outpatient settings.

我們還擁有其他能力，有助於我們在這一領域的領導地位和成長機會。 Accredo 主要致力於支持在家中接受特殊藥物的患者。有時，這些複雜的藥物也需要在醫生辦公室或醫院門診環境中使用。

Today, we support providers and health systems with our CuraScript specialty distribution capability and we continue to see meaningful growth in this aspect of our specialty pharmacy services.

今天，我們透過 CuraScript 專業分銷能力為提供者和衛生系統提供支持，並且我們繼續看到我們的專業藥房服務在這方面的有意義的增長。

Finally, an additional accelerated business is our U.S. government portfolio of services. We are pleased with our recent Medicare Stars quality rating showing that we again have over 2/3 of our members in 4-star or higher plans. This is recognition of the value we provide to seniors in supporting access as well as high-quality care.

最後，另一個加速業務是我們的美國政府服務組合。我們對最近的 Medicare 星級品質評級感到滿意，這表明我們再次有超過 2/3 的會員加入了 4 星級或更高級別的計劃。這是對我們為老年人提供支持和高品質護理的價值的認可。

With open enrollment now underway for both Medicare Advantage and the individual exchange business, we are balancing competitive benefit offerings, targeted market expansion and pricing discipline activity.

隨著 Medicare Advantage 和個人交換業務的公開註冊正在進行，我們正在平衡有競爭力的福利產品、有針對性的市場擴張和定價紀律活動。

So to summarize, we are performing well across our diverse enterprise. And these highlights reinforce how our strategic framework guides us in accelerating innovation, expanding client relationships and continuing to broaden our reach.

總而言之，我們在多元化的企業中表現良好。這些亮點強化了我們的策略框架如何引導我們加速創新、擴大客戶關係並持續擴大我們的影響力。

Now as we look to 2024, we expect another strong year of performance for the Cigna Group as we build on momentum with EPS, revenue and cash flow growth. We'll share more detailed guidance with you on our fourth quarter earnings call as we always do.

現在，展望 2024 年，我們預期 Cigna 集團將在每股盈餘、營收和現金流成長動能的基礎上再創強勁業績。我們將一如既往地在第四季度財報電話會議上與您分享更詳細的指導。

The tailwinds and headwinds we expect in the year ahead remain largely consistent with our prior conversation, and we continue to be confident in our ability to deliver adjusted EPS of at least $28 per share in 2024.

我們預計未來一年的順風和逆風與我們之前的談話基本一致，我們仍然對我們在 2024 年實現至少 28 美元每股調整後每股收益的能力充滿信心。

Notable tailwinds include growth-related contributions, including the full launch of Centene, which starts on January 1, a growing positive impact of biosimilar contributions, and an improved margin profile in our individual exchange business.

值得注意的推動因素包括與成長相關的貢獻，包括從 1 月 1 日開始全面推出 Centene、生物相似藥貢獻日益增長的正面影響，以及我們個人交易所業務利潤狀況的改善。

In terms of headwinds, we will continue to make strategic investments across our portfolio of businesses to drive sustained innovation as well as position ourselves for long-term growth.

就逆風而言，我們將繼續對業務組合進行策略性投資，以推動持續創新並為長期成長做好準備。

Now I'll just briefly summarize our performance for the quarter. We had another strong quarter, and it builds on good momentum throughout the course of the year. We delivered adjusted EPS of $6.77, as well as strong customer, revenue and cash flow growth.

現在我將簡要總結我們本季的業績。我們又經歷了一個強勁的季度，並且它建立在全年的良好勢頭之上。我們實現了 6.77 美元的調整後每股收益，以及強勁的客戶、收入和現金流成長。

Our company continues to deliver for the benefit of those we serve, and we have been able to increase our outlook for adjusted EPS to at least $24.75 for full year 2023, and we expect to deliver adjusted EPS of at least $28 in 2024, which is consistent with our past discussions.

我們公司將繼續為我們所服務的人們帶來利益，我們已經能夠將 2023 年全年調整後每股收益的預期提高到至少 24.75 美元，我們預計 2024 年調整後每股收益至少為 28 美元，即與我們過去的討論一致。

We are well positioned with a clear durable strategic framework that leverages the power of our differentiated services within our benefits portfolio and services portfolio.

我們擁有清晰持久的策略框架，充分利用我們的福利組合和服務組合中差異化服務的力量。

And now Brian will share additional perspective about our performance in the quarter and our outlook for the rest of the year. Brian?

現在，布萊恩將分享有關我們本季業績和今年剩餘時間前景的更多觀點。布萊恩？

Thank you, David. Good morning, everyone. Today, I'll review the Cigna Group's third quarter 2023 results and discuss our updated outlook for the full year.

謝謝你，大衛。大家，早安。今天，我將回顧 Cigna 集團 2023 年第三季的業績，並討論我們最新的全年展望。

We are proud to deliver another strong quarterly performance, including all of our most critical metrics running in line or favorable to expectations. With this performance, we are increasing our full year adjusted 2023 earnings outlook to at least $24.75 per share.

我們很自豪能夠再次實現強勁的季度業績，包括我們所有最關鍵的指標均符合或有利於預期。鑑於此業績，我們將 2023 年全年調整後獲利預期上調至至少每股 24.75 美元。

Now looking at the quarter specifically, some key consolidated financial highlights include revenue growth of 8% to $49 billion, after-tax adjusted earnings growth of 8% to $2 billion, adjusted earnings per share growth of 12% to $6.77, and cash flow from operations of $2.8 billion.

現在具體來看本季度，一些重要的綜合財務亮點包括營收成長 8% 至 490 億美元、稅後調整後獲利成長 8% 至 20 億美元、調整後每股盈餘成長 12% 至 6.77 美元，以及來自營業額達28億美元。

Our 2 growth platforms continue to perform well, with Evernorth posting a bottom line growth rate that improved sequentially as expected, and Cigna Healthcare delivering results ahead of expectations.

我們的兩個成長平台持續表現良好，Evernorth 的淨利潤成長率按預期連續改善，Cigna Healthcare 的業績超出預期。

Regarding our growth platforms, I'll first comment on Evernorth. Evernorth continues to deliver strong results, with third quarter 2023 revenues growing 8% to $38.6 billion, and pretax adjusted earnings growing 6% to $1.7 billion in line with expectations.

關於我們的成長平台，我先評論Evernorth。 Evernorth 繼續取得強勁業績，2023 年第三季營收成長 8%，達到 386 億美元，稅前調整後收益成長 6%，達到 17 億美元，符合預期。

Evernorth's results in the quarter were driven by strong performance in our Specialty Pharmacy business, which continues to see double-digit year-over-year revenue growth. We continue to provide a variety of differentiated services and solutions that drive affordability and value for our customers and our clients, while also enhancing cross enterprise leverage across our Evernorth and Cigna Healthcare growth platforms.

Evernorth 本季的業績得益於我們的專業藥房業務的強勁表現，該業務的收入繼續實現兩位數的同比增長。我們持續提供各種差異化的服務和解決方案，為我們的客戶和我們的客戶提高負擔能力和價值，同時也增強我們 Evernorth 和 Cigna Healthcare 成長平台的跨企業槓桿作用。

In addition, we continue to make strategic investments to support onboarding of new clients and expansion of existing client relationships, all while advancing our digital and care solutions capabilities to enhance customer experiences and provide clients with greater options to achieve their critical goals of access, quality outcomes and affordability.

此外，我們繼續進行策略性投資，以支持新客戶的入職和擴大現有客戶關係，同時提高我們的數位和護理解決方案能力，以增強客戶體驗，並為客戶提供更多選擇，以實現其訪問、品質等關鍵目標結果和承受能力。

Overall, Evernorth delivered strong third quarter results, consistent with expectations, and we remain well positioned as we look to the remainder of the year.

整體而言，Evernorth 第三季業績強勁，符合預期，展望今年剩餘時間，我們仍處於有利地位。

Turning to Cigna Healthcare. Third quarter 2023 adjusted revenues grew 14% to $12.8 billion. Pretax adjusted earnings grew 16% to $1.2 billion, and the medical care ratio was 80.5%. Our medical care ratio was better than expectations, driven by our U.S. commercial business. More specifically, our favorable MCR performance was a reflection of ongoing disciplined pricing and continued affordability initiatives, ensuring patients get quality care in appropriate settings.

轉向 Cigna 醫療保健。 2023 年第三季調整後營收成長 14%，達到 128 億美元。稅前調整後獲利成長16%，達12億美元，醫療保健比例為80.5%。在美國商業業務的推動下，我們的醫療保健比率比預期好。更具體地說，我們良好的 MCR 表現反映了持續嚴格的定價和持續的負擔能力舉措，確保患者在適當的環境中獲得優質護理。

An example of this is Pathwell Specialty, our site of care program that aligns patients who have high-cost specialty conditions with high quality, yet cost-effective care settings.

Pathwell Specialty 就是一個例子，它是我們的護理計劃網站，旨在為患有高成本專業疾病的患者提供高品質且具有成本效益的護理環境。

Moving to Cigna Healthcare Medical customers. We ended the quarter with 19.6 million total medical customers, which represents growth of approximately 1.6 million customers year-to-date. On a sequential basis, we delivered medical customer growth across all businesses within Cigna Healthcare, ahead of expectations.

轉向 Cigna Healthcare 醫療客戶。截至本季末，我們的醫療客戶總數為 1,960 萬，這意味著年初至今增加了約 160 萬客戶。從環比來看，我們在 Cigna Healthcare 的所有業務中實現了醫療客戶成長，超出了預期。

Overall, Cigna Healthcare continues to provide differentiated value and drive affordability for our customers and clients, and the results in the quarter demonstrate our strong underlying fundamentals.

總體而言，Cigna Healthcare 繼續為我們的客戶和客戶提供差異化價值並提高其負擔能力，本季的業績證明了我們強大的基本面。

Now turning to our outlook for full year 2023. We have increased our expectations for full year 2023 consolidated adjusted revenues to at least $192 billion, driven by strong growth across our businesses. And we are increasing our full year 2023 adjusted earnings outlook to at least $24.75 per share.

現在轉向我們對 2023 年全年的展望。在我們業務強勁成長的推動下，我們將 2023 年全年合併調整後營收的預期提高到至少 1,920 億美元。我們將 2023 年全年調整後獲利預期上調至至少每股 24.75 美元。

In Evernorth, we continue to expect full year 2023 adjusted earnings of at least $6.4 billion. This implies mid- to high single-digit growth in the fourth quarter, consistent with our prior commentary.

我們繼續預計 Evernorth 2023 年全年調整後收益至少為 64 億美元。這意味著第四季度將實現中高個位數成長，與我們先前的評論一致。

In Cigna Healthcare, we are raising our medical customer growth expectation to at least 1.6 million customers. This updated outlook represents the third consecutive quarter we have increased our customer growth despite the dynamic economic backdrop. We now expect our medical care ratio to be within a range of 81.5% to 82%, an improvement of 30 basis points from the high end of the prior range. And we continue to expect full year 2023 adjusted earnings of at least $4.425 billion.

在 Cigna Healthcare，我們將醫療客戶成長預期提高到至少 160 萬名客戶。儘管經濟背景充滿活力，但這項更新後的展望代表我們連續第三個季度實現了客戶成長。我們現在預計我們的醫療保健比率將在81.5%至82%的範圍內，比之前範圍的高端提高30個基點。我們繼續預計 2023 年全年調整後收益至少為 44.25 億美元。

This outlook reflects our continued focus and execution across our Cigna Healthcare businesses.

這一前景反映了我們對 Cigna Healthcare 業務的持續關注和執行。

Additionally, our full year 2023 enterprise adjusted SG&A ratio is now expected to be approximately 7.4%, an increase compared to our prior guidance as we further accelerate investments across both our Evernorth and Cigna Healthcare platforms.

此外，隨著我們進一步加快 Evernorth 和 Cigna Healthcare 平台的投資，我們 2023 年全年企業調整後的 SG&A 比率目前預計約為 7.4%，與我們先前的指導相比有所增加。

And finally, our full year 2023 adjusted tax rate is now expected to be in the range of 20.5% to 21%.

最後，我們預計 2023 年全年調整後稅率將在 20.5% 至 21% 的範圍內。

Turning to our 2023 capital management position and outlook. Year-to-date through November 1, 2023, we have repurchased approximately 7.7 million shares of our common stock for approximately $2.2 billion. The continued strength of our cash generation gives us the confidence to increase our full year 2023 expected cash flow from operations by $1 billion to at least $10.5 billion for full year 2023. And our updated guidance assumes full year 2023 weighted average shares outstanding to now be in the range of 296 million to 298 million shares.

轉向我們 2023 年的資本管理狀況和展望。年初至今，截至 2023 年 11 月 1 日，我們已回購約 770 萬股普通股，價值約 22 億美元。我們現金流的持續強勁使我們有信心將2023 年全年的預期營運現金流增加10 億美元，達到2023 年全年至少105 億美元。我們更新的指導假設2023 年全年已發行加權平均股數為範圍為2.96億股至2.98億股。

Our healthy balance sheet and cash flow outlook benefit from our efficient service-based model that drives strategic flexibility, strong margins and attractive returns on capital.

我們健康的資產負債表和現金流前景受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。

Now to recap. Third quarter results were strong, reflecting execution across our diverse portfolio of businesses, giving us confidence to deliver on our increased 2023 adjusted EPS guidance of at least $24.75. While we will provide formal 2024 guidance on our fourth quarter call, we continue to expect 2024 adjusted EPS of at least $28.

現在回顧一下。第三季業績強勁，反映了我們多元化業務組合的執行力，使我們有信心實現 2023 年調整後每股收益至少 24.75 美元的成長預期。雖然我們將在第四季度電話會議上提供正式的 2024 年指引，但我們仍然預計 2024 年調整後每股收益至少為 28 美元。

That said, I'd like to expand upon the tailwinds and headwinds David spoke to earlier. Our tailwinds include revenue growth, inclusive of the full launch of our Centene relationship starting January 1, and continued momentum of the biosimilar opportunity to drive more savings to benefit our patients and clients.

也就是說，我想詳細闡述大衛之前談到的順風和逆風。我們的有利因素包括收入成長，包括從 1 月 1 日起全面啟動 Centene 關係，以及生物相似藥機會的持續勢頭，以推動更多節省，使我們的患者和客戶受益。

We also anticipate improvement in our individual exchange margins next year driven by our pricing actions taken in targeted geographies. Given these actions, we are likely to have fewer customers in the individual exchange business relative to where we are in 2023.

我們也預計，由於我們在目標地區採取的定價行動，明年我們的個別交易所利潤率將有所改善。鑑於這些行動，與 2023 年相比，我們在個人交易所業務中擁有的客戶可能會減少。

These tailwinds will be partially offset by continued strategic investments across our portfolio of businesses to drive sustained innovation and long-term growth.

這些有利因素將被我們業務組合的持續策略投資所部分抵消，以推動持續創新和長期成長。

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

我們期待為第四季度的電話會議提供詳細的指導。這樣，我會將其轉交給接線員以進行通話的問答部分。

(Operator Instructions) Our first question comes from 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。

I just really wanted to focus on a couple of things. One would be potential PBM legislation as we think about potentially an end of year bill.

我只是想專注於幾件事。其中之一是潛在的 PBM 立法，因為我們正在考慮可能的年底法案。

What are your thoughts on what could be included on the PBM side?

您對 PBM 方面可以包含哪些內容有什麼想法？

And then secondly, David, you talked about EnCircleRx and talked about GLP-1. I think this is a real benefit, especially when I think about your PBM business for the self-insured market.

其次，David，您談到了 EnCircleRx 並談到了 GLP-1。我認為這是一個真正的好處，特別是當我考慮到你們針對自保市場的 PBM 業務時。

Can you maybe just talk about the opportunities that you see there? And how you see that going forward? Are we seeing more people sign up for this in '24, et cetera?

您能談談您在那裡看到的機會嗎？您如何看待未來的發展？我們是否看到更多的人在 24 年等等註冊了此計畫？

Lisa, it's David. I'll take the legislative question, a little tee up relative to the GLP-1 question in the broader marketplace, and I'll ask Eric to expand on the EnCircleRx program.

麗莎，是大衛。我將討論立法問題，與更廣泛市場中的 GLP-1 問題相關，我將請 Eric 擴展 EnCircleRx 計劃。

Specific to legislation, as you know, we haven't continued to expect to operate in a very active regulatory and legislative environment. As a result, we remain active and constructively engaged in the ongoing dialogue. And by way of framing, before I get the specific, potential legislative activities, we positioned our company with a breadth of capabilities, both modular configured and otherwise, and value creation and value capture capabilities that we believe will be able to thrive and grow under a variety of environments.

具體到立法，如您所知，我們並沒有繼續期望在非常活躍的監管和立法環境中運作。因此，我們仍然積極並建設性地參與正在進行的對話。透過框架的方式，在我獲得具體的、潛在的立法活動之前，我們為我們的公司定位了廣泛的能力，包括模組化配置和其他能力，以及價值創造和價值捕獲能力，我們相信這些能力將能夠在這些能力下蓬勃發展和發展。各種環境。

I'd highlight an area where we have a lot of passion, and that is to ensure that and amplify the fact that any legislative or regulatory activity should not remove choice, especially from the commercial market for employers as well as health plans given that they are large, sophisticated organizations and fund the vast majority of the comprehensive benefit costs.

我想強調一個我們充滿熱情的領域，那就是確保並擴大這樣一個事實：任何立法或監管活動都不應該剝奪選擇權，特別是雇主的商業市場以及健康計劃，因為它們是大型、複雜的組織，承擔了絕大多數綜合福利成本。

Having said that, there is intensified activity around transparency, and we are highly supportive of transparency so long it is targeted and constructive, meaning it could drive requisite level of actions on a go-forward basis.

話雖如此，圍繞透明度的活動正在加強，只要透明度具有針對性和建設性，我們就高度支持透明度，這意味著它可以在前進的基礎上推動必要的行動。

As it relates to the innovation that's taking place, as I noted in my prepared remarks, we believe we are exceptionally well positioned. We took very deliberate actions 5 years ago by acquiring Express Scripts, 3 years ago by launching Evernorth, our continued ongoing investment in our specialty capabilities, et cetera, are all oriented around positioning toward both today's class of drugs that we're seeing like the GLP-1s, but future innovations, be they for Alzheimer's, additional cancer therapies, gene therapies, et cetera. And we believe we're well positioned to support both commercial clients as well as health plans.

正如我在準備好的演講中指出的那樣，因為它與正在發生的創新有關，所以我們相信我們處於非常有利的位置。 5 年前，我們採取了非常慎重的行動，收購了Express Scripts，3 年前推出了Evernorth，我們對專業能力的持續投資等等，都是圍繞著我們所看到的當今類別的藥物的定位而展開的。GLP-1，但未來的創新，無論是針對阿茲海默症、其他癌症療法、基因療法等。我們相信我們有能力支持商業客戶和健康計劃。

EnCircleRx is a wonderful new innovation. It's the first of its kind in the marketplace and highly supportive of clients.

EnCircleRx 是一項精彩的創新。這是市場上同類產品中的第一個，並且得到了客戶的大力支持。

Eric, can I ask you to expand on that?

艾瑞克，我可以請你詳細說明一下嗎？

Sure, David. Thank you. Lisa, It's Eric. As you can imagine, there is significant interest and need from our clients on the EnCircleRx program and helping them with GLP-1s more broadly. They're looking for our help with managing the affordability and ensuring that they get good outcomes from the spending on these treatments.

當然，大衛。謝謝。麗莎，我是艾瑞克。正如您可以想像的那樣，我們的客戶對 EnCircleRx 計劃非常感興趣並需要幫助他們更廣泛地使用 GLP-1。他們正在尋求我們的幫助來管理負擔能力並確保他們從這些治療的支出中獲得良好的結果。

As David teed up, I'm really excited about, and I think the EnCircleRx program is a great example of the power of the collective capabilities that we have within Evernorth. It's the first of its kind, comprehensive solution that brings together our supply chain and procurement expertise, along with our clinical capabilities to target the right patient population, the relevant clinical markers, it targets the pharmacy network management, working to eliminate any waste or abuse in the system, and it works to engage patients with additional support that they need to help make changes that makes the impact last here. And we wrap this all with a guarantee of clinical outcomes and such for our clients as well.

當 David 準備好時，我真的很興奮，我認為 EnCircleRx 計劃是我們 Evernorth 內部集體能力的一個很好的例子。這是同類中的第一個綜合解決方案，匯集了我們的供應鏈和採購專業知識以及我們針對正確患者群體和相關臨床標誌物的臨床能力，它針對藥房網絡管理，致力於消除任何浪費或濫用它致力於為患者提供所需的額外支持，幫助他們做出改變，從而使影響持續下去。我們也為我們的客戶提供臨床結果等的保證。

So we're -- in short, we're really optimistic and excited about the opportunity for this product brings to self-funded markets and would expect additional growth as we look into 2024 and beyond.

因此，簡而言之，我們對該產品為自籌資金市場帶來的機會感到非常樂觀和興奮，並預計在展望 2024 年及以後會出現額外的成長。

And this question comes from Justin Lake with Wolfe Research.

這個問題來自沃爾夫研究中心的賈斯汀·萊克。

I wanted to focus on the individual market for a second. Membership was up pretty significantly there, almost 100,000 members. Curious if that's what's driving your 200,000 member guidance increase? You're expecting another big slug of those members in the fourth quarter.

我想暫時關註一下個人市場。那裡的會員人數顯著增加，接近 10 萬名會員。想知道這是否是推動您的會員人數增加 20 萬人的原因嗎？你預計這些成員會在第四季再次出現猛烈的攻擊。

And then can you remind us where you are on margins relative to target this year, and where you kind of -- you talked about improving that? Do you expect to get into target margins next year? That would be helpful.

然後您能否提醒我們，相對於今年的目標，您的利潤率在哪裡？您談到如何改善這一點？您預計明年能達到目標利潤嗎？那會有幫助的。

Justin, it's Brian. Just to clarify, your second question was specifically on the individual exchanges, correct, in terms of the margin profile?

賈斯汀，我是布萊恩。澄清一下，您的第二個問題是專門針對各個交易所的保證金情況，對嗎？

Exactly.

確切地。

Yes. Yes. So first off, as it relates to the Cigna Healthcare customer guide increasing by 200,000 customers, I'd start by saying we're really pleased with the strong momentum across the health care book with our year-to-date customers running ahead of expectations. And that builds off a really strong year we had in 2022, where we added nearly 1 million customers in the Cigna Healthcare business, primarily in our U.S. commercial business.

是的。是的。首先，由於涉及 Cigna Healthcare 客戶指南增加了 20 萬名客戶，我首先要說的是，我們對整個醫療保健手冊的強勁勢頭感到非常高興，我們今年迄今為止的客戶超出了預期。 2022 年是我們非常強勁的一年，我們的 Cigna Healthcare 業務（主要是我們的美國商業業務）增加了近 100 萬客戶。

To your point, we have continued to show sequential growth in our U.S. government businesses in the third quarter, particularly individual exchanges. But we've also seen favorability in our U.S. commercial membership, as we have not seen the disenrollment levels we had incorporated into our prior outlook.

就您而言，第三季我們的美國政府業務（尤其是個人交易所）持續呈現環比成長。但我們也看到了對我們的美國商業會員的青睞，因為我們沒有看到我們先前的展望中納入的退出水平。

You may recall that we had been anticipating some economic weakness late in 2023, but this has not yet materialized in any notable impact on our customer volumes. So all in, we're really pleased with 9% projected full year customer growth in Cigna Healthcare, a portion of which is related to the individual exchanges, but a portion of which is related to the strength in our U.S. commercial business.

您可能還記得，我們​​一直預期 2023 年末會出現一些經濟疲軟，但這尚未具體化，對我們的客戶量產生任何顯著影響。總而言之，我們對 Cigna Healthcare 預計全年客戶成長 9% 感到非常滿意，其中一部分與個人交易所有關，但另一部分與我們美國商業業務的實力有關。

As it relates to the individual exchange margin profile, just for a little bit of context, you can think of this as being approximately a $5 billion block of business for us in 2023. And as we shared in our second quarter call, we anticipate the individual exchange book to run below our target margins in 2023, and our long-term target for this business is 4% to 6%.

由於它與個別交易所的保證金狀況相關，僅就一點背景資訊而言，您可以將其視為我們在2023 年的大約50 億美元的業務。正如我們在第二季度電話會議中分享的那樣，我們預計到 2023 年，個人交換簿的利潤率將低於我們的目標利潤率，我們對該業務的長期目標是 4% 至 6%。

A primary driver of this is the increased risk adjustment payable that we expect to owe, with the majority of that impact driven by our 2 largest states, notably Texas and Georgia.

造成這種情況的一個主要驅動因素是我們預期應付的風險調整增加，其中大部分影響是由我們最大的兩個州，特別是德克薩斯州和喬治亞州造成的。

Now for 2024, we've taken sizable price increases in both of these 2 large states, and we would expect some degree of margin expansion in the individual book overall. The exact amount of the margin improvement will be a function of our geographic mix and our duration mix in 2024, and we're likely to have fewer customers in the individual exchange products in 2024 compared to where we are in 2023. But hopefully, that helps a bit, as you think about how to model the '24 Cigna Healthcare outlook.

現在，到 2024 年，我們已經在這兩個大州進行了大幅價格上漲，並且我們預計個別書籍的總體利潤率將出現一定程度的增長。利潤率改善的具體金額將取決於我們 2024 年的地理組合和久期組合，與 2023 年相比，2024 年單一交易所產品的客戶可能會減少。但希望如此當您考慮如何對'24 Cigna Healthcare 前景進行建模時，這會有所幫助。

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

我們的下一個問題來自美國銀行的 Kevin Fischbeck。

Great. In the tailwind side of things. You talked about revenue growth, including the Centene launch. You've talked so far about the exchanges as well as kind of other kind of one-time items.

偉大的。在事物的順風側。您談到了營收成長，包括 Centene 的推出。到目前為止，您已經討論了交換以及其他類型的一次性項目。

Does that mean that we should generally think about the rest of the businesses growing more or less in line with those long-term growth targets? Or is there any other business where you would highlight a specific headwind or tailwind to the revenue growth outlook for next year?

這是否意味著我們應該普遍考慮其他業務的成長或多或少符合這些長期成長目標？或者是否有其他業務您會強調明年收入成長前景的特定逆風或順風？

Kevin, it's David. I'd ask you to step back and first look at the consistency of our performance over the years relative to the portfolio. And if you look at the -- our EPS CAGR, even over the past several years, with a slight downtick this year because of the investments we've made to onboard Centene and our outlook for 2024, we remain consistently within our growth algorithm of 10% to 13% on average EPS CAGR as we've delivered that over the last 3 years, 5 years and 10-year time horizon.

凱文，我是大衛。我想請您退後一步，首先看看我們多年來的業績相對於投資組合的一致性。如果你看看我們的每股收益複合年增長率，即使在過去的幾年裡，由於我們對 Centene 的投資以及我們對 2024 年的展望，今年略有下降，我們仍然始終遵循我們的增長算法我們在過去3 年、5 年和10 年的時間範圍內實現了平均EPS 複合年增長率10% 至13%。

We called out a few of the headwinds and tailwinds to try to amplify some of the components. I would suggest that the first component, the outsized growth, and specifically the Centene contribution, given the offset in 2023, you can view that one as more directionally additive. That pushes us to the high end of the range from an EPS growth standpoint versus the low end of the range.

我們指出了一些不利因素和有利因素，試圖放大一些因素。我建議第一個組成部分，即超額成長，特別是 Centene 的貢獻，考慮到 2023 年的抵消，您可以將其視為更具方向性的累積。從每股收益成長的角度來看，這將我們推向了該範圍的高端，而不是該範圍的低端。

The other items that we've talked about are largely contemplated in the core parts of our business and the core parts of our operations on a go-forward basis. And as Brian and I both noted, we'll give you more detailed guidance on our fourth quarter call, as we typically do.

我們討論的其他項目主要是在我們業務的核心部分和我們未來營運的核心部分中考慮的。正如布萊恩和我都指出的那樣，我們將像往常一樣，為您提供有關第四季度電話會議的更詳細指導。

Our next question comes from AJ Rice with UBS.

我們的下一個問題來自瑞銀集團的 AJ Rice。

Just to maybe continue to focus on some of those potential tailwinds for next year. I think the investment to get that large Centene contract up and running for this year was about $0.50 drag roughly $200 million pretax.

只是也許會繼續關註明年的一些潛在的推動因素。我認為今年 Centene 大型合約的啟動和運行的投資約為 0.50 美元，稅前約為 2 億美元。

When you think about that for next year, should we just assume that, that drag goes away? I know PBM contracts typically ramp up over time. Or is there some potential level of profit contribution, so the swing is greater than $0.50?

當你考慮明年的情況時，我們是否應該假設這種阻力會消失？我知道 PBM 合約通常會隨著時間的推移而增加。或者是否存在某種潛在的利潤貢獻水平，因此波動大於 0.50 美元？

And then on the biosimilar comment. I know this year, in the second half, you'd included some benefit from the HUMIRA conversion or having some biosimilar competition. Should we think of -- what you're thinking about as a tailwind of just annualizing that? Or are there other opportunities that go beyond just annualizing the second half benefit from that HUMIRA conversion?

然後是關於生物相似藥的評論。我知道今年下半年，您包括了 HUMIRA 轉換或一些生物相似藥競爭帶來的一些好處。我們是否應該考慮一下——您認為將其年化的推動因素是什麼？或者，除了將下半年從 HUMIRA 轉換中受益之外，還有其他機會嗎？

AJ, it's David. You've packed a lot in there. I'm going to ask Brian to start by framing the economics year-over-year on the Centene relationship, our investment, the year-over-year performance, et cetera.

阿傑，我是大衛。你在裡面裝了很多東西。我將請 Brian 首先根據 Centene 關係、我們的投資、年比績效等來建構逐年的經濟狀況。

Asking to transition that over to Eric, he could talk about how the relationship is going importantly. And I'll ask Eric to amplify a little bit relative to the biosimilar impact we're seeing in the latter part of this year and into next year. Brian?

當要求將其轉交給埃里克時，他可以談論這段關係的進展。我會請艾瑞克稍微放大一下我們在今年下半年和明年看到的生物相似藥的影響。布萊恩？

Thanks, David. AJ, as it relates to the Centene economics, your math is broadly right. We continue to expect to spend about $200 million this year in the process of preparing for the onboarding.

謝謝，大衛。 AJ，因為它與 Centene 經濟學相關，所以你的數學基本上是正確的。我們預計今年將花費約 2 億美元來準備入職流程。

We expect next year to be approximately breakeven or slightly positive. So that's the way to think about the modeling of that, '25, we continue to expect, it will be at run rate profitability.

我們預計明年將大致實現損益平衡或略有成長。這就是思考 25 年建模的方式，我們繼續預計，它將按運行率獲利。

As it relates to the biosimilars component, for '24, we expect it to largely be a HUMIRA driven biosimilar story. So that the '25, and thereafter biosimilars will be further accretive to Evernorth in time, but '24 is really going to be primarily driven by the annualization of the HUMIRA related biosimilar benefit.

由於它與生物相似藥成分相關，對於 24 年，我們預計它將主要是 HUMIRA 驅動的生物相似藥故事。因此，'25 及之後的生物仿製藥將進一步增加 Evernorth 的時間，但'24 實際上將主要由 HUMIRA 相關生物仿製藥效益的年度化驅動。

Eric, do you want to pick up?

艾瑞克，你要接電話嗎？

Sure. Thanks, Brian and AJ, we've said from the beginning that the adoption of biosimilars is going to be more extended and slower process. And the experience to date has been consistent with our expectations. We've driven meaningful savings for the benefit of our customers and clients so far this year, and we continue to see this opportunity ramp throughout the course of next year, and as part of the market ongoing.

當然。謝謝 Brian 和 AJ，我們從一開始就說過，生物相似藥的採用將是一個更廣泛、更緩慢的過程。迄今為止的體驗與我們的預期一致。今年到目前為止，我們已經為我們的客戶和客戶的利益實現了有意義的節省，並且我們將在明年繼續看到這種機會的增加，並且作為市場持續發展的一部分。

We've talked in other settings about the meaningful opportunity for biosimilars, not only for (inaudible) but for other (inaudible) conditions, and expect there to be more competition over time where up to 25% or 30% of the spend in the specialty market, we'll have competition, compared to something like less than 10% today.

我們在其他場合討論了生物相似藥的有意義的機會，不僅針對（聽不清楚）而且針對其他（聽不清楚）條件，並預計隨著時間的推移，競爭將更加激烈，其中高達25% 或30% 的支出用於生物相似藥。專業市場，我們將面臨競爭，而今天的競爭不到 10%。

So in short, this is an area that we're well positioned to drive meaningful value for the benefit of our customers and clients that we have seen unfolding consistent with our expectations. And we're positioned to lead through over the course of the coming years.

簡而言之，我們在這個領域處於有利地位，可以為我們的客戶和客戶的利益帶來有意義的價值，我們看到這些價值的發展符合我們的期望。我們已準備好在未來幾年中保持領先地位。

Our next question comes from Stephen Baxter with Wells Fargo.

我們的下一個問題來自富國銀行的史蒂芬‧巴克斯特。

I was hoping you could expand a little bit on the MLR outperformance in the quarter. I guess, could you talk a bit more about what you saw on utilization? I guess, how did the seasonal patterns and the third quarter compared to a more normal pre-COVID environment?

希望您能詳細介紹本季國土資源部的優異表現。我想，您能多談談您在利用率方面看到的情況嗎？我想，與新冠疫情爆發前更正常的環境相比，第三季的季節性模式如何？

And then, it looks like you assuming decent step-up in Q4, pretty consistent with what you've seen in the past couple of years. Can you talk a little bit about the assumptions there on utilization?

然後，看起來你假設第四季度會有不錯的提升，這與你過去幾年所看到的非常一致。您能談談關於利用率的假設嗎？

Steven, it's Brian. So I'll start again, just reiterating how pleased we are to have delivered another strong quarter of MCR performance in Cigna Healthcare, which was favorable to expectations and drove really the income outperformance that we saw in the Cigna Healthcare segment.

史蒂文，是布萊恩。因此，我將重新開始，重申我們對 Cigna Healthcare 再次實現強勁的 MCR 業績季度感到非常高興，這符合預期，並真正推動了我們在 Cigna Healthcare 部門看到的收入表現。

Just as a reminder, if you rewind the clock a bit here, we planned in price for more normalized utilization levels coming into 2023. And our claims experience is largely consistent with that expectation.

提醒一下，如果你把時間倒回一點，我們計劃在 2023 年實現更正常化的利用率水準。我們的索賠經驗與這一預期基本一致。

Now within the quarter specifically, our government product lines, you can think of the Medicare lines and individual exchange lines ran largely in line with expectations, while our U.S. commercial business drove the favorability in the medical care ratio.

現在，具體而言，在本季度內，我們的政府產品線、醫療保險線和個人交換線的運作基本上符合預期，而我們的美國商業業務推動了醫療保健比率的好感度。

As it relates to the full year MCR outlook, we have improved the expectation by 15 basis points at the midpoint, reflecting the favorable third quarter experience, but no significant change in our fourth quarter MCR outlook compared to our prior expectations. So that's the way I'd encourage you to think about the 3Q versus 4Q dynamics.

由於與全年 MCR 前景相關，我們將預期中位數提高了 15 個基點，反映了良好的第三季經驗，但與我們先前的預期相比，我們第四季度 MCR 前景沒有重大變化。因此，這就是我鼓勵您思考第三季與第四季動態的方式。

As it relates to specific utilization patterns and categories and such, I actually wouldn't call out any specific categories in terms of driving outsized favorability. We did see some modest amount of inpatient favorability in the third quarter, particularly on higher unit cost procedures, which did contribute to that MCR outperformance.

由於它與特定的使用模式和類別等相關，因此我實際上不會在推動巨大的好感度方面指出任何特定的類別。我們確實在第三季度看到了一些住院患者的好感度，尤其是單位成本較高的手術，這確實促成了 MCR 的優異表現。

But I'd also note that our site of care strategies continue to produce really strong results. A tangible example we often talk about is shifting inpatient procedures to outpatient, for example, on orthopedics. But the site of care strategies have advanced in many other areas as well. For example, Pathwell Specialty, which I talked about earlier, program we introduced that optimizes site of care for high-cost infusions of specialty drugs. Historically, these have been administered in the hospital outpatient setting. However, certain patients can experience equal or better clinical quality at a lower cost by having the infusion in their home.

但我也要指出，我們的護理策略網站持續產生非常強勁的成果。我們經常談論的一個具體例子是將住院程序轉移到門診，例如骨科。但護理策略的現場在許多其他領域也取得了進展。例如，我之前談到的 Pathwell Specialty 計畫是我們推出的，旨在優化高成本特殊藥物輸注的照護場所。從歷史上看，這些都是在醫院門診進行的。然而，某些患者可以在家中進行輸注，以較低的成本體驗到相同或更好的臨床品質。

So that's just an example of something that has continued to build over time and contributed to the favorable MCR performance we saw in the quarter.

因此，這只是隨著時間的推移而不斷發展並為我們在本季度看到的良好 MCR 業績做出貢獻的一個例子。

So just to summarize, we're pleased with the performance, U.S. commercial drove the majority of the favorability in the third quarter. And as noted, the fourth quarter MCL is very consistent with our prior expectations.

總而言之，我們對業績感到滿意，美國商業推動了第三季的大部分好評。如上所述，第四季度 MCL 與我們先前的預期非常一致。

Our next question comes from Josh Raskin with Nephron Research.

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

I didn't hear in the prepared remarks anything about commercial, large group membership to start the year. So I'm curious on that. But my real question is, if you could compare and contrast the traction you're getting around VillageMD in the commercial markets versus the Medicare markets, I'd be specifically interested in the appetite from large employers. And if there's any sort of pull for demand? Or are you getting more traction when you're presenting what those arrangements can look like?

我在準備好的演講中沒有聽到任何有關新年伊始的商業、大型團體會員資格的內容。所以我對此很好奇。但我真正的問題是，如果您可以比較和對比 VillageMD 在商業市場和醫療保險市場中獲得的吸引力，我會對大型雇主的興趣特別感興趣。是否有任何形式的需求拉動？或者，當您展示這些安排時，您是否會獲得更多關注？

Josh, it's David. Let me speak to the commercial large market, and then frame your specific question relative to early traction with Village. And then I'm going to ask Eric to just describe a little bit more broadly the evolving relationship and the strategic work we continue to advance with Village.

喬什，我是大衛。讓我談談商業大市場，然後提出與 Village 早期吸引力相關的具體問題。然後我將請艾瑞克更廣泛地描述一下不斷發展的關係以及我們與 Village 繼續推進的策略工作。

First, specific to the commercial marketplace and the selling season. You did miss it, we didn't profile the 2024 outlook in any level of detail.

首先，具體到商業市場和銷售季節。您確實錯過了，我們沒有詳細介紹 2024 年的前景。

Stepping back, as Brian noted in his prior comment, we're really pleased with the 2023 results, now increasing the outlook for our overall lives for our Cigna Healthcare care portfolio, yet again, in excess of 1.5 million lives, and coming off of a 2022 number, approaching 1 million lives.

退一步來說，正如布萊恩在之前的評論中指出的那樣，我們對2023 年的結果感到非常滿意，現在我們的Cigna 醫療保健組合的整體生命前景再次提高，超過150 萬人的生命，並且擺脫了2022 年的數字接近 100 萬人。

For 2024, I give you some directional indicators at this point in time. First, big picture for the enterprise. We expect it to be another attractive year of growth for the Cigna Group in aggregate, specific to the commercial marketplace, we expect within the commercial marketplace portfolio, our results continue to be led by our sustained strong performance. The combination of our select segment and our middle market segment where our value proposition and our products and services are resonating quite well. Strong retention and good new business adds within that portfolio.

對於2024年，我在這個時間點給你一些方向指標。首先，企業的大局觀。我們預計，對於 Cigna 集團而言，今年將是另一個具有吸引力的成長年，具體到商業市場，我們預計在商業市場投資組合中，我們的業績將繼續以我們持續強勁的業績為主導。我們的精選細分市場和中間市場區隔的結合，我們的價值主張以及我們的產品和服務引起了很好的共鳴。強大的保留率和良好的新業務增加了該投資組合。

And then specific to National Accounts. Currently, our outlook for 2024 is on the benefit side of the equation, after some outsized growth in 2023, 2024 will look a little bit more normalized relative to prior years. And to remind you, strategically for that segment, we've expected to see that segment be a flat to slightly shrinking segment in the market in aggregate within the employer landscape. Our strategy has us maintaining share and deepening our relationship with our clients through our further expanding portfolio of specialty services.

然後具體到國民帳。目前，我們對 2024 年的展望是有利的，在 2023 年大幅成長之後，2024 年將比前幾年更加正常化。並提醒您，從戰略上講，對於該細分市場，我們預計該細分市場在雇主領域總體上將持平甚至略有萎縮。我們的策略要求我們透過進一步擴大專業服務組合來維持市場份額並加深與客戶的關係。

So to put a circle around it, it will be another strong year of growth for the Cigna Group in aggregate, and the commercial portfolio in 2024 will be led by the sustained strength of the select and the middle market business.

因此，總而言之，這將是 Cigna 集團整體成長強勁的一年，2024 年的商業投資組合將由精選和中階市場業務的持續強勁主導。

Specific to Village, a quick tee up to your comment. Our commercial employers today already are seeing a step function to benefit from our relationship with Village and then the Village Summit acquisition in the nature in which we've structured that relationship. So we were able to deliver a step function of value to our commercial clients already, be they self-funded, be they shared returns, be they guarantee cost from that standpoint.

針對 Village，快速了解您的評論。今天，我們的商業雇主已經看到了從我們與 Village 的關係中受益的階梯功能，以及我們構建這種關係的本質上對 Village Summit 的收購。因此，我們已經能夠為我們的商業客戶提供階梯式的價值功能，無論他們是自籌資金、共享回報還是從這個角度保證成本。

And then the team is aggressively at work to further enhance the value proposition there.

然後團隊正在積極工作，以進一步增強那裡的價值主張。

And Eric, I'll just ask you to provide a little color in terms of the way in which the teams are working together to advance the value-based care traction.

艾瑞克，我只想請您提供一些有關團隊如何共同努力推進基於價值的護理牽引力的資訊。

Sure. Thanks, David and Josh, stepping back a bit for Village, have you think about both the financial and the strategic component of our relationship with Village, as you know, we got a minority stake of ownership now. And so that's performing consistent with our expectations.

當然。謝謝大衛和喬什，請為 Village 退一步，你們是否考慮過我們與 Village 關係的財務和戰略組成部分，如您所知，我們現在擁有少數股權。因此，這與我們的預期一致。

From a strategic perspective, think of our work with Village is one Village and us being committed partners to work together. We're working to build an alignment of an ecosystem of high-performing providers where we can ramp Village and Summit's operations with some of our clinical assets, wrapped and support with the data and insights from both organizations to help to ensure patients can get to you, the best care they need, the best specialists they need, the highest quality, et cetera.

從策略角度來看，我們與 Village 的合作是一個 Village，我們是共同努力的忠實合作夥伴。我們正在努力建立一個由高績效提供者組成的生態系統，我們可以利用我們的一些臨床資產來提升Village 和Summit 的運營，並利用兩個組織的數據和見解進行包裝和支持，以幫助確保患者能夠獲得治療您、他們需要的最好的護理、他們需要的最好的專家、最高的品質等等。

And I really think of that as ultimately applicable across commercial or government plans. Our focus in the near term has been, I'll say, more skewed towards the commercial market, but it's an approach that works across any payer here, right, because it focuses on getting to the highest quality, best care available for an individual. And that transcends across all the markets.

我確實認為這最終適用於商業或政府計劃。我想說，我們近期的重點更偏向商業市場，但這是一種適用於任何付款人的方法，對吧，因為它專注於為個人提供最高品質、最好的護理。這超越了所有市場。

Over time, we'll work to continue to expand this. But to date, off to a good start and pleased with the progress and the momentum that we're building with our partnership with Village.

隨著時間的推移，我們將努力繼續擴大這一範圍。但迄今為止，我們已經有了一個良好的開端，並對我們與 Village 合作所取得的進展和勢頭感到滿意。

Our next question comes from Scott Fidel with Stephens.

我們的下一個問題來自斯科特·菲德爾和史蒂芬斯。

I was hoping maybe we could just toggle over to MA for a second, and maybe just give us sort of a framing of uppers on how sort of MLR was performing, and pretax margin sort of baseline versus the long-term government 3% to 5% target for '23?

我希望我們可以暫時切換到 MA，也許只是給我們一個關於 MLR 表現的上限框架，以及與長期政府 3% 到 5 相比的稅前利潤率基線。 '23 的目標百分比？

And then, if you want to give us some initial observations on how the AEP seems to be developing for you, and how you feel about MA growth next year versus, let's call it, the industry forecast around 7% growth.

然後，如果您想向我們提供一些初步觀察，了解 AEP 的發展情況，以及您對明年 MA 成長的看法，以及產業預測的 7% 左右的成長。

Scott, it's David. Just a couple of comments, and I'll ask Brian to peel back a couple of your specific points.

斯科特，這是大衛。只是一些評論，我會請布萊恩回顧你的一些具體觀點。

First, as I noted in my prepared remarks, we're pleased with the Stars position, the stable, strong Stars position we have, and continued traction of our ongoing focus to expand our geographic footprint. And then I'll ask Brian to expand on a little bit more significantly, as well as our ongoing investments in terms of our broad set of capabilities.

首先，正如我在準備好的發言中指出的那樣，我們對星級地位、我們擁有的穩定、強大的星級地位以及我們持續關注擴大地理足跡的持續牽引力感到滿意。然後我會請布萊恩更重要地擴展一點，以及我們在廣泛的能力方面的持續投資。

2023 was a very good year of growth for us in terms of this business portfolio, and our market expansion plans are on track for 2024.

就業務組合而言，2023 年是我們成長非常好的一年，我們的市場擴張計畫將於 2024 年按計畫進行。

Brian, could I ask you to expand on that a little bit?

布萊恩，我可以請你詳細說明一下嗎？

Sure, David. Scott, maybe I'll take your questions in a little bit of a reverse order, and start with AEP and the growth expectations, then I'll get to the margin profile.

當然，大衛。史考特，也許我會以稍微相反的順序回答你的問題，從 AEP 和成長預期開始，然後我會討論利潤概況。

As David just referenced, we're really pleased with the growth in the MA book year-to-date. Customers are up 13% year-to-date 2023. And since 2019, as you know, we've gradually expanded our geographic footprint in this business, from covering just 20% of Medicare Advantage eligibles in 2019 to over 40% today. And for 2024, we have some further expansion transpiring, and we'll now have offerings in about 45% of the addressable market.

正如大衛剛才提到的，我們對今年迄今為止 MA 書籍的成長感到非常滿意。 2023 年迄今，客戶數量增加了13%。如您所知，自2019 年以來，我們逐漸擴大了在該業務中的地理覆蓋範圍，從2019 年僅覆蓋Medicare Advantage 資格的20% 到如今超過40% 。到 2024 年，我們將進行進一步的擴張，現在我們將在約 45% 的目標市場提供產品。

As we approach the 2024 bid cycle, we employed a micro market posture as we always do, and this resulted in stable benefits in most geographies and a few areas where we had targeted pullbacks and benefits in light of the funding environment.

隨著 2024 年投標週期的臨近，我們一如既往地採用了微觀市場態勢，這在大多數地區以及我們根據融資環境進行了有針對性的回調和收益的一些領域中帶來了穩定的收益。

Now it's really early in the AEP, as you can appreciate, and there's still several weeks to go. But taken all together, based on what we know today, we would expect to see net customer growth again in 2024.

正如您所理解的，現在 AEP 還處於早期階段，而且還有幾週的時間。但總而言之，根據我們目前所知，我們預計 2024 年淨客戶將再次成長。

As it relates to the margin profile, as we expected, our 2023 margins continue to be below our long-term target margin range, which is 4% to 5% on this book of business. You can think of this as primarily driven by administrative expenses as we have outsized investment spend and geographic expansion, product expansion and new capabilities.

由於它與利潤率狀況相關，正如我們預期的那樣，我們 2023 年的利潤率繼續低於我們的長期目標利潤率範圍，在本業務中，該目標利潤率範圍為 4% 至 5%。您可以認為這主要是由管理費用驅動的，因為我們擁有龐大的投資支出和地理擴張、產品擴展和新功能。

So you should think of the MA margins as representing a source of future embedded earnings power that will contribute toward our long-term growth in Cigna Healthcare segment income over a multiyear basis.

因此，您應該將 MA 利潤率視為未來嵌入獲利能力的來源，這將有助於我們 Cigna Healthcare 部門收入的長期長期成長。

For 2024, we expect to continue running below our long-term target margin range in this business. The final projected margin here will also be a function of geographic mix, product mix and customer duration mix, depending on how that shakes out in the AEP and across the balance of the year.

2024 年，我們預計該業務的利潤率將繼續低於我們的長期目標利潤範圍。這裡的最終預期利潤率也將是地理組合、產品組合和客戶持續時間組合的函數，具體取決於 AEP 和全年剩餘時間的變化。

So we'll certainly be prepared to give you more detailed guidance during the fourth quarter call, but hopefully, that helps turn out.

因此，我們肯定會準備在第四季度的電話會議期間為您提供更詳細的指導，但希望這會有所幫助。

Our next question comes from Gary Taylor with Cowen.

我們的下一個問題來自加里·泰勒和考恩。

I just wanted to go back and ask one more question about the exchange business and expectations for next year.

我只是想回去再問一個關於交易所業務和明年的期望的問題。

When we look at the pricing actions you guys took about across markets, it looks very, very outsized versus what the rest of the industry did. So I think that's a huge positive in terms of the margin expectation.

當我們觀察你們在各個市場採取的定價行動時，我們發現與行業其他公司的做法相比，它看起來非常非常過大。所以我認為這對於利潤率預期來說是一個巨大的正面因素。

But historically, companies that have done that have seen really significant deterioration of enrollment.

但從歷史上看，這樣做的公司的入學率確實顯著下降。

So I guess the question is, how much of the at least $28 in 2024 is dependent upon exchange earnings? If we saw the enrollment decline by 30%, 40%, something like that, yet the margin was better, is that impactful to getting to the '24 guidance? Like how much should we care about where we see the enrollment numbers come in?

所以我想問題是，2024 年至少 28 美元中有多少取決於外匯收入？如果我們看到入學人數下降了 30%、40% 之類的，但利潤率更好，這對達到 24 小時指導方針有影響嗎？例如我們應該在多大程度上關心我們看到的入學人數？

Gary, it's Brian. So certainly, your point is well taken in terms of large price increases can have impacts on the customer volumes in disproportionate ways. We have to see how this cycle plays out in terms of the elasticity of the customer growth relative to those pricing actions.

加里，是布萊恩。當然，您的觀點是正確的，因為價格大幅上漲可能會對客戶數量產生不成比例的影響。我們必須看看這個週期如何在客戶成長相對於這些定價行為的彈性方面發揮作用。

To David's comments earlier on our tailwinds, this is one of several tailwinds that we have. So I would encourage you not to over-index on the customer volumes in terms of our ability to deliver against the $28 of earnings per share.

根據大衛之前對我們的順風的評論，這是我們擁有的幾個順風之一。因此，我鼓勵您不要過度考慮客戶數量，以衡量我們交付 28 美元每股收益的能力。

Just if you think about the context of this, it's a $5 billion block of business. Target margins, that's $250 million of profit. The midpoint of the 4% to 6% range. So if you think about the delta there, relative to the year-over-year, we're talking about $100 millions of income growth at the enterprise level.

只要你考慮一下這個背景，你會發現這是一個價值 50 億美元的事業。目標利潤率，即 2.5 億美元的利潤。 4% 至 6% 範圍的中點。因此，如果你考慮相對於去年同期的增量，我們談論的是企業層面的 1 億美元收入成長。

So I just -- I would encourage you not to over index on this one specific factor. But we're confident we're going to see the margin expansion. We're confident we'll see the income tailwind, and we'll give you more updated guidance on the fourth quarter call.

所以我只是——我鼓勵你不要過度關注這特定因素。但我們有信心看到利潤率擴大。我們有信心看到收入順風，我們將在第四季度電話會議上為您提供更多最新指導。

Our next question comes from Nathan Rich with Goldman Sachs.

我們的下一個問題來自高盛的內森·里奇。

I wanted to follow up on the comments around GLP-1 through obesity, and the potential value of Evernorth can deliver for clients there.

我想透過肥胖來跟進有關 GLP-1 的評論，以及 Evernorth 可以為那裡的客戶帶來的潛在價值。

I guess, could you go into a little bit more detail on the nature of discussions you're having with the drug manufacturers right now on pricing and getting that to a level that could expand access?

我想，您能否更詳細地介紹一下您目前與藥品製造商就定價問題進行的討論的性質，並將其提高到可以擴大獲取範圍的水平？

And what role, maybe, the outcomes trials will play in those discussions in terms of potentially -- from your kind of commercial customers, their desire to expand access to these therapies for their populations?

也許，結果試驗將在這些討論中發揮什麼作用——從你的商業客戶的角度來看，他們希望擴大其人群獲得這些療法的機會？

It's David. Just a little framing. And consistent with prior conversations we've had. To date, within our benefits portfolio, you could think about 10% to 20% of our clients currently having adopted an optional buy-up or coverage for weight management outside of the already formulary positioning for diabetes for the drug class, number one.

是大衛。只是一個小框架。並且與我們之前的對話一致。到目前為止，在我們的福利組合中，您可能會想到，目前我們的客戶中有 10% 到 20% 已經在第一類藥物的糖尿病處方定位之外採用了可選的購買或承保體重管理方案。

On the Evernorth side of the equation, as we've discussed before, the percentage is higher, and you can think about why the difference. The difference is within the Evernorth portfolio, the commercial employer landscape is larger employer size on average versus the diversity that exists on the Cigna Healthcare care side. And then within the health plan portfolio, enabling some aspect of it from an access. So that gives you little stage setting of the fluidity of the current environment.

正如我們之前討論的，在等式的 Evernorth 一側，百分比更高，您可以思考為什麼會出現這種差異。不同之處在於 Evernorth 投資組合內，商業雇主景觀平均雇主規模較大，而 Cigna Healthcare 照護方面則有多樣性。然後在健康計劃組合中，透過存取啟用它的某些方面。因此，這為您提供了當前環境流動性的一些舞台設置。

Your question comes down to a fair amount of detail relative to pricing and working with the manufacturers. I'll ask Eric to talk just more broadly, this is an area where, as we discussed in our prepared remarks, where the broad capabilities of our Evernorth portfolio significantly thrive in terms of data clinical aspects, clinical coordination, relationship with pharmaceutical manufacturers and importantly, relationship with practicing physicians to get the best coordinated care.

您的問題歸結為與定價和與製造商合作相關的大量細節。我將邀請埃里克（Eric）更廣泛地談論這一領域，正如我們在準備好的演講中所討論的那樣，我們的Evernorth 產品組合的廣泛功能在數據臨床方面、臨床協調、與製藥商的關係以及重要的是，與執業醫生建立關係以獲得最佳的協調護理。

So Eric, could I ask you to expand on that a little bit?

艾瑞克，我可以請你詳細說明一下嗎？

Great. Thanks, David and Nate, so with respect to this, stepping back, I would have you think about the impact here that will need to unfold, will be around improving affordability. As has been said and reported across a variety of different channels, these therapies are effective, but they're also very expensive. We would expect that over time, we'll be well positioned to harness the power of competition to improve the affordability to bring the cost down. And that's an important element.

偉大的。謝謝大衛和內特，所以關於這一點，退後一步，我希望你們考慮一下這裡需要展開的影響，將圍繞提高負擔能力。正如各種不同管道的說法和報道，這些療法是有效的，但也非常昂貴。我們預計，隨著時間的推移，我們將能夠充分利用競爭的力量來提高負擔能力，從而降低成本。這是一個重要的因素。

But then in addition to that, we're positioned to wrap and support these patients with additional services, clinical services, the right approach, the right targeting to ensure the maximum effectiveness here.

但除此之外，我們還準備透過額外的服務、臨床服務、正確的方法、正確的目標來包裝和支持這些患者，以確保最大的有效性。

So I don't know that it's constructive to talk about any of the kind of ongoing dialogue with manufacturers. But rest assured, that we are very engaged with the variety of pharma manufacturers in this space, looking at ways to expand access and improve affordability, just like Express Scripts is a long history of doing, as new innovations have come to the market and the pharmacy space, and we'll continue to be a leader there.

所以我不知道談論與製造商正在進行的任何對話是否具有建設性。但請放心，我們與該領域的各種製藥製造商密切合作，尋找擴大可及性和提高負擔能力的方法，就像 Express Scripts 長期以來所做的那樣，隨著新的創新進入市場，並且藥房領域，我們將繼續成為該領域的領導者。

Our next question comes from Dave Windley with Jefferies.

我們的下一個問題來自傑弗里斯的戴夫·溫德利。

Mostly a clarification. On the government utilization, maybe particularly Medicare Advantage, it sounds like it was in line with your expectations. But I wondered if you could comment if you are seeing elevated -- in the elevated outpatient that gets called out by others in the space, and that was just, again, in line with your expectations.

主要是澄清。關於政府的利用，也許特別是醫療保險優勢，聽起來符合您的預期。但我想知道你是否可以發表評論，如果你看到升高的門診病人被該領域的其他人稱為，這再次符合你的期望。

And then in terms of managing utilization in site of service. You mentioned good success in managing site of service and Pathwell. Is Pathwell the primary vehicle by which you're doing that? And what is the kind of customer adoption or the penetration, I guess, of Pathwell in your site of service utilization management?

然後在管理服務站點的使用率方面。您提到在管理服務站點和 Pathwell 方面取得了巨大成功。 Pathwell 是您執行此操作的主要工具嗎？我猜，Pathwell 在您的服務利用管理站點中的客戶採用率或滲透率是怎樣的？

Dave, it's Brian. So on your first question on the MA utilization patterns, as I mentioned earlier, when we stepped into 2023, we expected more normalized utilization levels across all of our different product lines, and the claims experience is broadly in line with that.

戴夫，這是布萊恩。因此，關於您關於MA 利用率模式的第一個問題，正如我之前提到的，當我們進入2023 年時，我們預計所有不同產品線的利用率水平將更加標準化，並且索賠經驗與此大致一致。

And within the MA book specifically, throughout the entire year, we've seen elevated utilization in both outpatient and professional services in particular. But again, within the context of what we had forecasted and planned for. So the third quarter, our government lines ran broadly in line with where we expected them to. And as I said earlier, our U.S. commercial business really drove the favorability.

特別是在 MA 書中，全年我們都看到門診和專業服務的使用率有所提高。但同樣，在我們預測和計劃的背景下。因此，第三季度，我們的政府政策與我們的預期基本一致。正如我之前所說，我們的美國商業業務確實推動了人們的好感。

So again, the MA patterns were broadly a continuation of what we saw in the first half of the year, and our 2023 guidance and 2024 bids anticipate that these dynamics will continue as opposed to assuming any meaningful amount of cost abatement occurs.

因此，MA 模式基本上是我們在今年上半年看到的情況的延續，我們的 2023 年指導和 2024 年出價預計這些動態將持續下去，而不是假設發生任何有意義的成本削減。

On your second question on site of service, I did call out the Pathwell specialty example. But you should think of that as one of the many arrows that we have in the quiver, if you will. So the work we've been doing over the past several years has largely been moving inpatient to outpatient. We've been moving things from emergency rooms to urgent care, moving things from physician offices to virtual.

關於你關於服務現場的第二個問題，我確實提到了 Pathwell 專業的例子。但如果你願意的話，你應該將其視為我們箭袋中的眾多箭頭之一。因此，我們過去幾年所做的工作主要是將住院病人轉移到門診病人。我們一直在將事情從急診室轉移到緊急護理，將事情從醫生辦公室轉移到虛擬。

So Pathwell Specialty is another example of the evolution of our site of care program. So I wouldn't view that as the silver bullet here by any means, but it's an incremental contributor to the strategy we had in place for several years now.

因此，Pathwell Specialty 是我們護理站點計畫發展的另一個例子。因此，無論如何，我都不認為這是靈丹妙藥，但它是我們多年來實施的策略的增量貢獻者。

Our last question comes from Lance Wilkes with Bernstein.

我們的最後一個問題來自伯恩斯坦的蘭斯威爾克斯。

Yes. Just wanted to turn to the PBM within Evernorth. And kind of 2 elements to the question. One was, if you could just talk a little about the strategic role of Part D, both for the PBM and for health care for driving kind of MA business going forward? And how you see that going forward, given some of the changes in the Part D program.

是的。只是想求助於 Evernorth 內部的 PBM。這個問題有兩個要素。一是，您能否簡單談談 D 部分對於 PBM 和醫療保健的策略作用，以推動 MA 業務的發展？考慮到 D 部分計劃中的一些變化，您如何看待未來的發展。

And then the specific question was on adjusted home delivery and specialty scripts. There were some drops in that. I was just interested if that was a driver -- if that was driven by the prime relationship and any sort of in-sourcing that's going on there? Or what the other drivers of that move was?

然後具體的問題是關於調整後的送貨上門和專業腳本。其中有一些滴。我只是感興趣這是否是一個驅動因素——是否是由主要關係和那裡正在進行的任何形式的內包驅動的？或者這項舉措的其他驅動因素是什麼？

Lance, it's David. I'll take the first part of your question. I'll ask Brian to address the second part of your question.

蘭斯，我是大衛。我將回答你問題的第一部分。我會請布萊恩回答你問題的第二部分。

First, specific to Part D broadly, with the size, shape and scope of our enterprise today, it's a portion of our enterprise, but I would call it as not a significant part of our overall portfolio. That's not to dismiss the importance of it from a societal standpoint, by any stretch of imagination. But when you look at the scope of our enterprise approaching $200 billion of revenue this year, I would not call it as a significant component.

首先，具體到 D 部分，從我們今天企業的規模、形狀和範圍來看，它是我們企業的一部分，但我認為它不是我們整體投資組合的重要組成部分。這並不是說從社會的角度來看，無論怎麼想都可以忽略它的重要性。但當你看到我們企業今年收入接近 2000 億美元的規模時，我不會稱之為重要組成部分。

Secondly, inferred in your question, I would submit that we've underrealized or underleveraged the potential to effectively convert PDP lives or enroll PDP lives into MA. That's an untapped opportunity that exists within our portfolio today relative to our level of activity and initiation.

其次，根據您的問題推斷，我認為我們沒有充分認識到或沒有充分利用有效轉變 PDP 生命或將 PDP 生命納入 MA 的潛力。相對於我們的活動和啟動水平，這是我們今天的投資組合中存在的一個尚未開發的機會。

Lastly, in your comment, we do recognize that the PDP landscape is disrupted, based on some of the legislative and policy activities that have transpired. And we will effectively position our portfolio, obviously, to be responsive to that disruption. But we have the tools to be able to manage within our portfolio in totality.

最後，在您的評論中，我們確實認識到，基於已經發生的一些立法和政策活動，PDP 的格局已被擾亂。顯然，我們將有效地定位我們的投資組合，以應對這種破壞。但我們擁有能夠對我們的整體投資組合進行管理的工具。

I'll ask Brian to pick up the second piece of your question, just relative to the script volume and the puts and takes in the portfolio this past quarter.

我會請布萊恩回答你的第二個問題，只是與上個季度的腳本量以及投資組合中的看跌期權和看跌期權有關。

Yes, Lance, as it relates to the adjusted home delivery and specialty scripts, you can think of a couple of different drivers in there. Specialty scripts continue to grow at attractive rates, so I think mid- to high single-digit-type unit growth. But given the relatively small numbers there, they're outweighed by what happens in home delivery.

是的，蘭斯，因為它涉及調整後的送貨上門和專業腳本，你可以想到其中有幾個不同的司機。專業腳本繼續以有吸引力的速度增長，因此我認為單位數量的增長處於中高水平。但考慮到那裡的數量相對較少，它們的重要性不及送貨上門的情況。

So in that line item, you can think of 95% plus of the volume is home delivery, and less than 5% is specialty scripts, but attractive growth in specialty, which continues to drive the double-digit revenue growth that we've seen in that business all year.

因此，在該訂單項中，您可以認為95% 以上的銷量是送貨上門，不到5% 是專業腳本，但專業領域的成長頗具吸引力，這將繼續推動我們所看到的兩位數收入增長全年都從事這項業務。

The specific driver of the home delivery decrease, just to put a finer point on it, is we had a transitioning client that we've known about for several years, [that lasted 11/23] that had some outsized home delivery volumes, but we'll see some improvement in that on a go-forward basis with additional clients coming in.

送貨上門減少的具體驅動因素（更詳細地說）是我們有一個我們認識多年的轉型客戶，[持續了 11/23]，該客戶的送貨上門量很大，但是隨著更多客戶的加入，我們將看到這方面的一些改進。

Thank you. I'll now turn the call back over to David Cordani for closing remarks.

謝謝。現在我將把電話轉回大衛·科達尼 (David Cordani) 作結束語。

First and foremost, thank you again for joining our call today and for the ongoing conversation.

首先，再次感謝您今天加入我們的電話會議並進行持續的對話。

Just to highlight and summarize our dialogue today, we are very pleased with our performance for the quarter and the momentum we've been able to carry now through 3 quarters of the year. And we remain on track to deliver our overall commitments for 2023.

只是為了強調和總結我們今天的對話，我們對本季的表現以及我們現在能夠在今年三個季度保持的勢頭感到非常滿意。我們仍有望兌現 2023 年的整體承諾。

We increased our outlook for adjusted EPS to at least $24.75 for full year 2023, as well as increasing the overall outlook we have for revenue, customer lives and cash flow based on our strong performance. And remain committed to our 2024 EPS objective of at least $28.

我們將 2023 年全年調整後每股收益的預期上調至至少 24.75 美元，並基於我們強勁的業績，上調了我們對收入、客戶生命和現金流的整體預期。並持續致力於實現 2024 年每股收益至少 28 美元的目標。

I do want to pause for a moment and thank my colleagues around the world. The health care landscape continues to change, with accelerated forces impacting our clients, our customers, our patients and our partners. And our team leans in day in, day out, working to make a positive difference, for those we have the benefit to serve, those we have the benefit to partner with, as well as our orientation around making a positive difference in the communities we work, serve and play in each and every day.

我確實想暫停一下，感謝世界各地的同事。醫療保健格局不斷變化，加速影響我們的客戶、我們的患者和我們的合作夥伴。我們的團隊日復一日地努力，努力產生積極的影響，為那些我們有利於服務的人、那些我們有利於合作的人，以及我們圍繞在我們的社區中產生積極影響的方向而努力。每一天都在工作、服務和娛樂。

So I want to call out and thank our colleagues that continue to make such a positive difference in the marketplace each and every day.

因此，我想向我們的同事表示感謝，他們每天都在為市場帶來正面的影響。

With that, we look forward to our ongoing conversation and our future dialogues, both in person and investor events as well as our fourth quarter conversation coming up. Have a great day.

因此，我們期待我們正在進行的對話和未來的對話，無論是面對面的對話還是投資者活動以及即將到來的第四季度對話。祝你有美好的一天。

Ladies and gentlemen, this concludes the Cigna Group's Third Quarter 2023 Results Review.

女士們、先生們，信諾集團 2023 年第三季業績回顧到此結束。

Cigna Group's 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) 839-1171 or (203) 369-3030. There is no passcode required for this replay.

Cigna Group 的投資者關係部門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 10 個工作天內提供。您可以撥打 (800) 839-1171 或 (203) 369-3030 存取錄製的會議。此重播不需要密碼。

Thank you for participating. We will now disconnect.

感謝您的參與。我們現在將斷開連接。