信諾集團 (CI) 2024 Q1 法說會逐字稿

Ladies and gentlemen, thank you for standing by for The Cigna Group's First Quarter 2024 Results Review. (Operator Instructions) As a reminder, ladies and gentlemen, this conference, including the Q&A session, is being recorded.

女士們、先生們，感謝你們耐心等待 Cigna 集團 2024 年第一季業績回顧。 （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。

Good morning. 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 of The Cigna Group and President and Chief Executive Officer of Cigna Healthcare; and Eric Palmer, President and Chief Executive Officer of Evernorth Health Services.

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； Brian Evanko，Cigna Group 財務長兼 Cigna Healthcare 總裁兼執行長；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 first quarter financial results and our updated financial outlook for 2024. 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，包括我們第一季的財務表現和 2024 年最新的財務展望。

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. A reconciliation of these measures to the most directly comparable GAAP measures, shareholders net income or loss and total revenues, respectively, is contained in today's earnings release, which is posted in the Investor Relations section of the cignagroup.com. We use the terms labeled adjusted income from operations and adjusted earnings per share on the same basis as our principal measures of financial performance.

正如我們在財報中所指出的，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。這些指標分別與最直接可比較的 GAAP 指標、股東淨收入或虧損以及總收入進行了調節，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。我們使用調整後營業收入和調整後每股盈餘的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 2024 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陳述，包括有關我們對 2024 年和未來業績的展望的陳述。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 the call over, I will cover a few items pertaining to our GAAP financial results. In the first quarter, we recorded shareholders' net loss of $277 million or $0.97 per share. This is driven by noncash after-tax, net realized investment loss of $1.8 billion or $6.31 per share, primarily related to a VillageMD impairment charge. This is excluded from adjusted income from operations and adjusted earnings per share in our discussion of financial results. We also recorded an after-tax net special item charge of $3 million or $0.01 per share. Details of the special items are included in our quarterly financial supplement.

在轉交電話之前，我將介紹一些與我們的 GAAP 財務表現相關的項目。第一季度，我們的股東淨虧損為 2.77 億美元，即每股虧損 0.97 美元。這是由 18 億美元或每股 6.31 美元的非現金稅後淨實現投資損失推動的，主要與 VillageMD 減損費用相關。當我們討論財務表現時，這不包括在調整後的營運收入和調整後的每股盈餘中。我們還記錄了 300 萬美元的稅後淨特殊項目費用，即每股 0.01 美元。特別項目的詳細資訊包含在我們的季度財務補充中。

As described in today's release, special items are excluded from adjusted income from operations, adjusted earnings per share 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 2024 outlook, we will do so on a basis that includes the potential impact of future share repurchases and anticipated 2024 dividends.

如同今天的新聞稿所述，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、調整後的每股盈餘和調整後的收入中。此外，請注意，當我們對財務業績（包括 2024 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 2024 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 our call. In the first quarter, our company continued delivering differentiated value for our clients, customers, patients and partners. And we posted strong results for the quarter as we continue to build on our momentum coming into 2024. Today, I'll discuss our quarterly performance and key strategic drivers of our growth. Specifically, I'll spend a few minutes talking about our Specialty business and our focus on biosimilars to drive greater affordability in the market for the benefit of those we serve. Then Brian will review additional details about our financial results during the quarter, our increased outlook for full year 2024 and from our capital position, and then we'll take your questions. So let's get started.

謝謝，拉爾夫。大家早安，感謝您加入我們的通話。第一季度，我們公司繼續為我們的客戶、顧客、患者和合作夥伴提供差異化的價值。隨著我們在 2024 年繼續保持勢頭，我們在本季度公佈了強勁的業績。具體來說，我將花幾分鐘時間討論我們的特種業務以及我們對生物相似藥的關注，以提高市場的可承受性，從而造福我們所服務的人群。然後，Brian 將審查有關我們本季度財務業績、我們對 2024 年全年的展望以及我們的資本狀況的更多詳細信息，然後我們將回答您的問題。那麼就讓我們開始吧。

In the quarter, I'm pleased to report that The Cigna Group delivered total revenue of $57.3 billion, adjusted earnings per share of $6.47. And given our momentum and strong start to the year, we have increased our guidance for full year adjusted earnings per share to at least $28.40. These positive results demonstrate our differentiated capabilities, innovative approaches and disciplined execution during a dynamic and disruptive time for our industry. Our results also speak to our diverse and well-balanced portfolio as we invest in our high-growth businesses, which continue to benefit from secular tailwinds and ensure our foundational businesses are positioned for continued success.

我很高興地報告，本季 Cigna Group 的總收入為 573 億美元，調整後每股收益為 6.47 美元。鑑於我們今年的勢頭和強勁開局，我們將全年調整後每股收益的指引上調至至少 28.40 美元。這些積極的成果證明了我們在產業充滿活力和顛覆性的時期的差異化能力、創新方法和嚴格的執行力。我們的業績也證明了我們多元化且均衡的投資組合，因為我們投資於高成長業務，這些業務繼續受益於長期的順風車，並確保我們的基礎業務能夠持續成功。

In Evernorth Health Services, we're pleased with our results that are in line with our expectations. Starting with our Pharmacy Benefit Services, our foundational businesses, our innovative solutions continue to gain traction with health plans, large commercial employers and government organizations. A recent example of how we continue to drive greater access and affordability in a rapidly evolving pharmaceutical landscape is EnCircleRx. This solution focuses on Cardiodiabesity, adds value for our clients and patients by providing predictability, reducing cost and enhancing outcomes related to GLP-1 drug coverage. We're pleased with the strong interest in EnCircleRx from our clients with more than 1 million lives already enrolled. EnCircleRx is made possible given our decade-plus track record of offering new solutions built on data-driven insights and our deep supply chain expertise. Said otherwise, we have a proven innovation platform.

在 Evernorth Health Services，我們對符合我們預期的結果感到滿意。從我們的藥房福利服務、我們的基礎業務開始，我們的創新解決方案繼續受到健康計劃、大型商業雇主和政府組織的關注。 EnCircleRx 是我們如何在快速發展的製藥領域繼續推動更廣泛的可及性和可負擔性的最新例子。此解決方案專注於心臟糖尿病，透過提供可預測性、降低成本和增強與 GLP-1 藥物覆蓋範圍相關的結果，為我們的客戶和患者增加價值。我們很高興看到我們的客戶對 EnCircleRx 產生了濃厚的興趣，已經有超過 100 萬人註冊。鑑於我們十多年來提供基於數據驅動的洞察力和深厚的供應鏈專業知識的新解決方案的記錄，EnCircleRx 成為可能。換句話說，我們擁有一個經過驗證的創新平台。

In our Accelerated Growth Specialty Care and Services businesses, our results were in line with our expectations, reflecting strong double-digit adjusted revenue growth. As a reminder, this set of businesses is diverse and includes Accredo, CuraScript Specialty Distribution and our emerging Care Service businesses. I'll talk more about specialty in a few moments.

在我們的加速成長專業護理和服務業務中，我們的業績符合我們的預期，反映出強勁的兩位數調整後營收成長。提醒一下，這組業務是多元化的，包括 Accredo、CuraScript Specialty Distribution 和我們新興的護理服務業務。稍後我將詳細討論專業。

In Care Services, we are investing in a number of areas, including accountable care, virtual, home base and behavioral care. We're pleased with the progress our Evernorth Behavioral Care Group is making since its launch in 6 states plus the District of Columbia, and we have already expanded access and convenience for patients with our program.

在護理服務方面，我們正在多個領域進行投資，包括責任護理、虛擬護理、家庭護理和行為護理。我們對 Evernorth 行為護理小組自在 6 個州和哥倫比亞特區推出以來所取得的進展感到高興，並且我們已經透過我們的計劃擴大了患者的訪問範圍和便利性。

In Cigna Healthcare, our health benefits platform, we achieved another quarter of strong performance. With our focus on affordability and disciplined pricing, we are pleased with our strong medical cost performance and medical care ratio, which was 79.9%. Our U.S. employer business is outpaced for another good year as we continue to leverage our high-performing networks and digitally enabled services to expand access and overall value.

在我們的健康福利平台 Cigna Healthcare 中，我們又實現了一個季度的強勁業績。由於我們注重負擔能力和嚴格的定價，我們對強勁的醫療性價比和醫療保健比率（79.9%）感到滿意。我們的美國雇主業務又迎來了一個好年頭，因為我們繼續利用高效能網路和數位化服務來擴大存取範圍和整體價值。

At our Investor Day, we discussed the strong results we've seen with our Pathwell suite of solutions, including Pathwell Specialty, which drives value by reducing costs associated with specialty drugs and therapies and improving care experiences and outcomes for patients. Also within the Pathwell suite is our Pathwell Bone & Joint solution, which we piloted in 2023 and is now being rolled out for broader client adoption.

在投資者日，我們討論了 Pathwell 解決方案套件所取得的強勁成果，其中包括 Pathwell Specialty，它透過降低與特殊藥物和療法相關的成本以及改善患者的護理體驗和結果來推動價值。 Pathwell 套件中還有我們的 Pathwell 骨骼和關節解決方案，我們於 2023 年進行了試點，現在正在推出以供更廣泛的客戶採用。

For context, 1 in 2 adults suffer from a musculoskeletal condition, which results in more than $500 billion of annual spend. Our solution uses a curated national network, combined with clinical and digital services to guide patients with spine knee, hip and shoulder conditions to the right pathway of care at the right time. We're already seeing strong results, and our personalized concierge experience has resulted in 96% patient satisfaction while also delivering meaningful savings for our clients from this innovative program.

就背景而言，二分之一的成年人患有肌肉骨骼疾病，導致每年花費超過 5000 億美元。我們的解決方案使用精心策劃的全國網絡，結合臨床和數位服務，指導患有脊椎、膝蓋、臀部和肩部疾病的患者在正確的時間獲得正確的護理途徑。我們已經看到了顯著的成果，我們的個人化禮賓體驗使患者滿意度達到 96%，同時也透過這項創新計畫為我們的客戶節省了大量費用。

Turning to international health. Our results continue to be strong given our focus on localized health solutions and high-quality services for the globally mobile population. In our individual exchange business, we continue to sharpen our focus by repositioning our book through targeted actions in certain geographies. It's also important to note, we are making good progress toward our sale of our Medicare businesses to HCSC. The sale of these businesses to HCSC remains on track with the expiration of the waiting period under Hart-Scott-Rodino Act, which occurred on April 17.

轉向國際衛生。鑑於我們專注於為全球流動人口提供在地化健康解決方案和高品質服務，我們的業績持續強勁。在我們的個人交易所業務中，我們透過在某些地區採取有針對性的行動來重新定位我們的書籍，從而繼續加強我們的重點。同樣值得注意的是，我們在向 HCSC 出售醫療保險業務方面取得了良好進展。隨著 4 月 17 日《哈特-斯科特-羅迪諾法案》規定的等待期到期，這些業務向 HCSC 的出售仍在進行中。

As such, the regulatory review of this transaction by the DOJ is complete. The transaction is expected to close in the first quarter of 2025 as planned. After closing, we will continue to serve Medicare Advantage customers through our Evernorth broad suite of high-performing services. And under our agreement with HCSC, these include services for the seniors who will transition with the [divested] businesses. Taken together, we're pleased with our results for the first quarter. They reflect the quality and strength of our businesses and position us well for another year of sustained growth and attractive value creation.

至此，美國司法部對本次交易的監管審查已完成。該交易預計將按計劃於 2025 年第一季完成。交易完成後，我們將繼續透過 Evernorth 廣泛的高性能服務套件為 Medicare Advantage 客戶提供服務。根據我們與 HCSC 的協議，其中包括為將與[剝離的]企業過渡的老年人提供服務。總的來說，我們對第一季的業績感到滿意。它們反映了我們業務的品質和實力，並為我們在新的一年持續成長和創造有吸引力的價值奠定了良好的基礎。

Now I want to spend a few minutes on our specialty businesses within Evernorth, which is already a large and well-established portfolio of services, yet represents accelerated growth opportunity as we look forward. Overall, the specialty market is large at about $400 billion today and is fast growing, and Evernorth is the industry leader. Our performance continues to be strong with double-digit revenue growth in the first quarter.

現在，我想花幾分鐘談談 Evernorth 的專業業務，該業務已經是一個龐大且完善的服務組合，但正如我們所期待的，它代表著加速成長的機會。總體而言，目前專業市場規模約為 4000 億美元，並且正在快速成長，而 Evernorth 是行業領導者。我們的業績持續強勁，第一季營收實現兩位數成長。

Our combination of Accredo, CuraScript Specialty Distribution and Care Path offers something truly unique in the market, built over decades with assets and capabilities that are highly differentiated. And while we are the leader in the industry, we continue to innovate our capabilities and offerings and expand our reach and impact. For example, just last week, Evernorth announced that we will have an interchangeable HUMIRA biosimilar available for a $0 out-of-pocket cost for eligible Accredo patients.

我們將 Accredo、CuraScript Specialty Distribution 和 Care Path 結合在一起，提供了市場上真正獨特的產品，這些產品經過數十年的積累，擁有高度差異化的資產和功能。雖然我們是行業的領導者，但我們不斷創新我們的能力和產品，並擴大我們的影響力和影響力。例如，就在上週，Evernorth 宣布我們將為符合條件的 Accredo 患者提供一種可互換的 HUMIRA 生物仿製藥，自付費用為 0 美元。

Currently, more than 100,000 Accredo patients use either HUMIRA or one of the biosimilars. They are supported by specialty trained pharmacists and nurses in Accredo's Therapeutic Resource Center for inflammatory conditions who are available to serve and support these patients around the clock, meet the individual needs of our patients while driving significant savings for them and their health plans. We will be able to provide both high and low concentration interchangeable biosimilars, or put another way, varying dosage levels based on patient needs.

目前，超過 10 萬名 Accredo 患者使用 HUMIRA 或其中一種生物相似藥。他們得到 Accredo 發炎性疾病治療資源中心經過專業培訓的藥劑師和護士的支持，他們可以全天候為這些患者提供服務和支持，滿足患者的個人需求，同時為他們及其健康計劃節省大量費用。我們將能夠提供高濃度和低濃度的可互換生物相似藥，或者換句話說，根據患者的需求改變劑量水平。

To accomplish this, we have agreements in place with multiple manufacturers who will produce biosimilars for Evernorth's private label pharmaceutical distributor, Quallent Pharmaceuticals, which we launched back in 2021. The biosimilars will be priced at about 85% lower than HUMIRA and we estimate that individual patients will save on average of $3,500 per year.

為了實現這一目標，我們與多家製造商簽訂了協議，這些製造商將為Evernorth 的自有品牌藥品分銷商Quallent Pharmaceuticals 生產生物仿製藥，Quallent Pharmaceuticals 是我們於2021 年推出的。價格將比HUMIRA 低約85%，我們估計個別患者每年平均可節省 3,500 美元。

And in addition to Accredo patients, all of our pharmacy benefit service clients and patients will have access to these biosimilars. Importantly, the biosimilar opportunity goes well beyond HUMIRA. By 2030, we expect to see biosimilars or generics introduced for nearly half of the top 25 specialty drugs in the United States. This translates to over $100 billion in annual spend, subject to additional choice and competition. The introduction of biosimilars creates a multiyear tailwind that enables us to continue to drive growth and value creation for the benefit of those we serve.

除了 Accredo 患者之外，我們所有的藥房福利服務客戶和患者都將可以獲得這些生物相似藥。重要的是，生物相似藥的機會遠遠超出了 HUMIRA 的範疇。到 2030 年，我們預計美國排名前 25 名的特種藥物中近一半將推出生物相似藥或仿製藥。這相當於每年超過 1000 億美元的支出，但會受到更多選擇和競爭的影響。生物相似藥的推出創造了多年的順風車，使我們能夠繼續推動成長和價值創造，造福我們所服務的人。

Clearly, we're very excited about the growth opportunities we see ahead in specialty. Our specialty businesses are a cornerstone of the accelerated growth within Evernorth and our confidence in our leading position and capabilities will continue to fuel innovation, such as the biosimilar launch I just discussed.

顯然，我們對專業領域未來的成長機會感到非常興奮。我們的特種業務是 Evernorth 加速成長的基石，我們對自己的領先地位和能力的信心將繼續推動創新，例如我剛才討論的生物相似藥的推出。

Now to wrap up, let me recap our performance for the quarter. In the quarter, we continued to execute well and perform well. We met the evolving needs of our clients, customers, patients and partners in the midst of a dynamic marketplace. We delivered on our financial commitments, including adjusted EPS of $6.47 and we've increased our guidance for full year adjusted earnings per share to at least $28.40. This performance puts us toward the higher end of our 10% to 14% long-term average annual EPS growth commitment.

現在，讓我回顧一下我們本季的業績。本季度，我們繼續執行良好，表現良好。我們在充滿活力的市場中滿足客戶、顧客、患者和合作夥伴不斷變化的需求。我們兌現了財務承諾，包括 6.47 美元的調整後每股收益，並將全年調整後每股收益指引提高至至少 28.40 美元。這一業績使我們朝著 10% 至 14% 的長期平均年 EPS 成長承諾的高端邁進。

Looking ahead, we remain focused on meeting our commitments as we execute our strategy by creating value for the benefit of those we serve by driving greater affordability and access expansion, and delivering innovations that continue to grow market share over time in Evernorth and in Cigna Healthcare.

展望未來，我們在執行策略時仍然專注於履行我們的承諾，透過推動更大的可負擔性和覆蓋範圍的擴大，並提供創新，為我們所服務的人的利益創造價值，隨著時間的推移，Evernorth 和Cigna Healthcare 的市佔率將持續成長。

With that, I'll turn it over to Brian.

有了這個，我會把它交給布萊恩。

Thank you, David. Good morning, everyone. We're pleased to report a strong start to the year with first quarter pretax adjusted earnings above expectations, reflecting (inaudible) across our 2 growth platforms, Evernorth and Cigna Healthcare.

謝謝你，大衛。大家，早安。我們很高興地報告今年開局強勁，第一季稅前調整後收益高於預期，這反映了我們的兩個成長平台 Evernorth 和 Cigna Healthcare（聽不清楚）。

Key consolidated financial highlights for the first quarter include: revenue of $57.3 billion, which represents 23% year-over-year growth; adjusted earnings per share of $6.47 or 20% year-over-year growth; and cash flow from operations of $4.8 billion. The continued momentum and strong fundamentals of our businesses give us the confidence to increase our full year 2024 adjusted earnings per share outlook to at least $28.40. Before I turn to our segment results, I'd like to briefly discuss the impact of the changed health care disruption in the first quarter. We experienced incremental operating expenses that are reflected in our first quarter results.

第一季的主要綜合財務亮點包括： 營收 573 億美元，年增 23%；調整後每股收益為 6.47 美元，年增 20%；營運現金流為 48 億美元。我們業務的持續成長動能和強勁的基本面使我們有信心將 2024 年全年調整後每股收益展望提高至至少 28.40 美元。在討論我們的部門業績之前，我想簡要討論第一季醫療保健中斷變化的影響。我們的營運支出有所增加，這反映在我們第一季的業績中。

And within Cigna Healthcare, we had some disruption to claim submissions and payments that I'll discuss further in a few moments. Despite these unexpected events, we delivered a very strong start to the year and are proud of our teams managing through a dynamic operating environment. Now turning to our segment results.

在 Cigna Healthcare 內部，我們在索賠提交和付款方面遇到了一些中斷，我將在稍後進一步討論。儘管發生了這些意外事件，我們還是在今年取得了非常強勁的開局，並為我們的團隊在動態營運環境中進行管理感到自豪。現在轉向我們的部門業績。

First, I'll comment on Evernorth. First quarter 2024 Evernorth revenues were $46.2 billion and pretax adjusted earnings were $1.4 billion, in line with expectations. As discussed at our Investor Day in March, starting this quarter, we're providing revenue and pretax adjusted earnings for our 2 operating segments within Evernorth, namely Pharmacy Benefit Services and Specialty and Care Services.

首先，我要評論一下Evernorth。 2024 年第一季 Evernorth 營收為 462 億美元，稅前調整後盈餘為 14 億美元，符合預期。正如我們在三月投資者日所討論的那樣，從本季度開始，我們將為 Evernorth 內的兩個營運部門（即藥品福利服務以及專業和護理服務）提供收入和稅前調整後的收益。

For the quarter, Pharmacy Benefit Services revenue increased 43%, driven by new business wins, including Centene starting on January 1. Pretax adjusted earnings were $513 million, reflecting growth offset by the net impact of client onboarding and implementation costs. Specialty and Care Services revenue increased 12%. And pretax adjusted earnings grew to $788 million, in line with expectations. Overall, Evernorth continues to perform well, and we're pleased with the results to start the year.

本季度，藥品福利服務收入成長了43​​%，這得益於新業務的成長，包括1 月1 日開始的Centene。淨影響所抵消。專業和護理服務收入成長 12%。稅前調整後獲利成長至 7.88 億美元，符合預期。總體而言，Evernorth 繼續表現良好，我們對年初的業績感到滿意。

Turning to Cigna Healthcare. First quarter 2024 adjusted revenues were $13.3 billion, and pretax adjusted earnings were $1.3 billion. Cigna Healthcare first quarter results were better than expectations, driven by a favorable medical care ratio, partially offset by higher SG&A expenses and lower net investment income. The first quarter medical care ratio of 79.9% benefited from our focus on affordability initiatives and effective pricing execution as we planned and price for the continuation of elevated cost trend levels the industry experienced in 2023.

轉向 Cigna 醫療保健。 2024 年第一季調整後營收為 133 億美元，稅前調整後盈餘為 13 億美元。 Cigna Healthcare 第一季業績優於預期，得益於良好的醫療保健比率，但部分被較高的 SG&A 費用和較低的淨投資收入所抵消。第一季 79.9% 的醫療照護比率受益於我們對負擔能力計劃和有效定價執行的關注，正如我們為 2023 年行業經歷的成本趨勢水平持續升高所計劃和定價的那樣。

As noted earlier, the Change Healthcare incident caused some disruption to first quarter operations, including claims processing and submissions. Within the quarter, we booked approximately $650 million in incremental reserves in Cigna Healthcare relating to this disruption. Approximately 2/3 of the incremental reserve pertains to claims that we received but were not paid out as of March 31. The claims have since been paid out to providers.

如前所述，Change Healthcare 事件對第一季的營運造成了一些幹擾，包括索賠處理和提交。在本季度內，我們在 Cigna Healthcare 中登記了與此中斷相關的約 6.5 億美元的增量準備金。大約 2/3 的增量準備金涉及我們收到但截至 3 月 31 日尚未支付的索賠。

The balance of the incremental reserve represents an estimate of first quarter claims incurred but not yet reported, specifically pertaining to the Change Healthcare disruption. We remain confident in our reserve posture and cost trend projections over the balance of the year.

增量準備金的餘額代表了對第一季已發生但尚未報告的索賠的估計，特別是與 Change Healthcare 中斷相關的索賠。我們對今年剩餘時間的儲備狀況和成本趨勢預測仍然充滿信心。

Moving to Cigna Healthcare medical customers. We ended the quarter with 19.2 million total medical customers. This is in line with our expectations and includes a reduction to our individual exchange enrollment, following the repositioning of our book in certain geographies to improve overall profitability. Overall, Cigna Healthcare delivered strong results in the quarter. Our Cigna Healthcare results continue to benefit from our decade-plus track record of value-based care.

轉向 Cigna Healthcare 醫療客戶。本季結束時，我們的醫療客戶總數為 1,920 萬人。這符合我們的預期，包括在我們的書籍在某些地區重新定位以提高整體盈利能力之後，減少我們的個人交易所註冊人數。總體而言，Cigna Healthcare 在本季取得了強勁的業績。我們的 Cigna Healthcare 業績繼續受益於我們十多年來基於價值的護理記錄。

We have continued to further evolve this strategy with Evernorth Accountable Care and remain committed to driving affordability and quality outcomes for our clients and patients through our partnership-oriented value-based care framework. As Ralph mentioned in his opening comments, during the quarter, we recognized a noncash impairment charge related to VillageMD, which is excluded from our adjusted earnings.

我們繼續與 Evernorth Accountable Care 一起進一步發展這項策略，並繼續致力於透過我們以合作夥伴為導向的基於價值的護理框架，為我們的客戶和患者提供負擔能力和高品質的結果。正如拉爾夫在開場白中提到的那樣，在本季度，我們確認了與 VillageMD 相關的非現金減值費用，該費用不包括在我們調整後的收益中。

This accounting item does not alter our forward-looking value-based care strategy. where we continue to make progress in aligning incentives with providers, including with VillageMD. Our partnership has already launched and targeted geographic markets, and we will seek to build upon that early progress.

此會計項目不會改變我們基於價值的前瞻性護理策略。我們在與提供者（​​包括 VillageMD）協調激勵措施方面繼續取得進展。我們的合作夥伴關係已經啟動並瞄準了地理市場，我們將尋求在早期進展的基礎上再接再厲。

Now turning to our outlook for full year 2024. We continue to expect strong underlying growth in Evernorth and Cigna Health Care. We now expect full year 2024 consolidated adjusted income from operations to be at least $8.065 billion or at least $28.40 per share, an increase from our prior outlook. We expect the 2024 adjusted earnings per share cadence to be approximately 45% in the first half and the remaining 55% in the second half.

現在轉向我們對 2024 年全年的展望。我們現在預計 2024 年全年合併調整後營運收入將至少為 80.65 億美元，或至少每股 28.40 美元，高於我們先前的預期。我們預計 2024 年調整後每股盈餘節奏將在上半年約為 45%，下半年為其餘 55%。

Now turning to our 2024 outlook for each of our growth platforms. In Evernorth, we continue to expect full year 2024 adjusted earnings of at least $7 billion. We expect Evernorth's second quarter pretax adjusted earnings to grow mid-single digits year-over-year. For Cigna Healthcare, we now expect full year 2024 adjusted earnings of at least $4.775 billion, an increase from our prior guidance to reflect the strength of our first quarter results and continued confidence for the rest of the year.

現在轉向我們對每個成長平台的 2024 年展望。我們繼續預計 Evernorth 2024 年全年調整後收益至少為 70 億美元。我們預計 Evernorth 第二季度稅前調整後獲利將年增中個位數。對於 Cigna Healthcare，我們現在預計 2024 年全年調整後收益至少為 47.75 億美元，較之前的指引有所增加，以反映我們第一季業績的強勁勢頭以及對今年剩餘時間的持續信心。

We expect Cigna Healthcare pretax adjusted earnings in the second quarter to be approximately 25% of full year pretax adjusted earnings. We also now expect our full year 2024 medical care ratio to be in the range of 81.7% to 82.5%, an improvement of 20 basis points from the high end of the prior range. Additionally, we expect our second quarter medical care ratio to be within our full year guidance range.

我們預期 Cigna Healthcare 第二季稅前調整後盈餘將約為全年稅前調整後獲利的 25%。我們現在也預計 2024 年全年醫療保健比率將在 81.7% 至 82.5% 之間，比之前範圍的高端提高 20 個基點。此外，我們預計第二季的醫療保健比率將在全年指導範圍內。

Turning to our 2024 capital management position. Our debt-to-capitalization ration was 44.3% as of March 31 compared to 40.1% as of December 31, 2023. The increase primarily reflects the timing of debt issuance, in part due to the accelerated share repurchase agreement we entered in February. We continue to target a long-term debt-to-capitalization ratio of approximately 40%. We continue to expect at least $11 billion of cash flow from operations and we continue to expect to use the majority of our discretionary cash flow for share repurchase this year.

轉向我們 2024 年的資本管理狀況。截至3 月31 日，我們的債務與資本比率為44.3%，而截至2023 年12 月31 日為40.1%。票回購協議。我們繼續將長期債務與資本比率的目標定為約 40%。我們仍然預計營運現金流至少為 110 億美元，我們仍然預計今年將大部分可自由支配現金流用於股票回購。

Additionally, our guidance continues to assume full year weighted average shares outstanding to be in the range of 282 million to 286 million shares. Our balance sheet and cash flow outlook remains strong driven by the strength of our highly efficient service-based model.

此外，我們的指引繼續假設全年加權平均流通股在 2.82 億股至 2.86 億股之間。在我們高效率的服務模式的推動下，我們的資產負債表和現金流前景依然強勁。

Now to recap. Our first quarter consolidated results were ahead of expectations, driven by the strength of our medical care ratio within Cigna Healthcare. And our 2024 outlook reflects the sustained momentum and strong fundamentals of our 2 growth platforms, Evernorth and Cigna Healthcare, while continuing to maintain a prudent posture in this dynamic environment. We're confident in our ability to deliver on our updated full year 2024 adjusted earnings of at least $28.40 per share.

現在回顧一下。在 Cigna Healthcare 醫療保健比例強勁的推動下，我們第一季的綜合業績超出了預期。我們的 2024 年展望反映了我們的兩個成長平台 Evernorth 和 Cigna Healthcare 的持續勢頭和強勁的基本面，同時在這個充滿活力的環境中繼續保持審慎的態度。我們有信心能夠實現更新後的 2024 年全年調整後每股收益至少 28.40 美元。

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

這樣，我們會將其轉交給接線員進行通話的問答部分。

(Operator Instructions) Our first question comes from Justin Lake with Wolfe Research.

（操作員說明）我們的第一個問題來自 Wolfe Research 的 Justin Lake。

I wanted to ask about your early view on membership for and PBM kind of RFP cycle into 2025. Just given the strength you've had this year, curious of your view on 2025 kind of RFPs. Any kind of big wins or losses that you kind of know about so far in terms of maybe on the managed care side, bigger RFP stuff on the PBM and then the national account?

我想詢問您對 2025 年 RFP 週期的會員資格和 PBM 類型的早期看法。到目前為止，您所了解的任何重大勝利或損失，可能是在管理醫療方面、PBM 上更大的 RFP 內容以及國民帳戶方面？

Justin, it's David. Let me ask Eric to start through the Evernorth framework for (inaudible) activity. And then Brian to come in from the Cigna Healthcare, specifically National Accounts framework.

賈斯汀，我是大衛。讓我請 Eric 從 Evernorth 框架開始進行（聽不清楚）活動。然後布萊恩從 Cigna Healthcare 進來，特別是國民帳戶框架。

Justin, it's Eric. Overall, I would note that the selling season's off to a good start. We operate in a competitive market. The strength of our solutions continues to resonate. So feel good about our positioning. There's no specific transactions that I would call out on either the win or the loss side but would note that we are feeling quite good about our ability to continue to retain our existing clients.

賈斯汀，我是艾瑞克。總的來說，我注意到銷售季節有了一個好的開始。我們在競爭激烈的市場中運作。我們的解決方案的力量繼續引起共鳴。所以對我們的定位感到滿意。我不會指出具體的交易是贏還是輸，但我會指出，我們對繼續留住現有客戶的能力感到非常滿意。

Our retention rates are remaining really strong. We expect we'll end up in the mid-90s or better for 2025, consistent with our performance in the last number of years from a number perspective. I would also note that our portion of our book of business out to bid for 2025 is actually a little bit smaller as we look at 2025 when compared to prior years as well. But in aggregate, I'm feeling quite good about its positioning. No major headwinds or tailwinds or specific clients I'd call out, and we'll deliver a strong retention result going into the year next year.

我們的保留率仍然非常高。我們預計到 2025 年，我們的業績將達到 90 年代中期或更好，從數字角度來看，這與我們過去幾年的表現一致。我還要指出的是，我們在 2025 年的業務中競標的部分實際上比前幾年要小一些，因為我們展望 2025 年。但總的來說，我對它的定位感覺很好。我不會指出任何重大的逆風或順風或特定客戶，我們將在明年提供強勁的保留結果。

Brian, Cigna Healthcare?

布萊恩，信諾醫療保健公司？

Thanks, Eric. Justin, so relative to Cigna Healthcare in terms of 2025, to David's point, we're really only deep into the cycle for our national accounts business, which certainly is an important component of our U.S. employer business, but also less than half of our total Cigna Healthcare customers. That said, a few points I'd offer. We do have an uptick in RFP volumes this year compared to last year at this time, which is directionally good just in terms of the number of FX, if you will, that we have. And in terms of our existing clients, we have a similar amount that's out to bid at this point in the year as we did last year at this time.

謝謝，埃里克。賈斯汀，相對於Cigna Healthcare 而言，就2025 年而言，就David 而言，我們實際上只是深入國民帳戶業務的周期，這當然是我們美國雇主業務的重要組成部分，但還不到我們的一半。也就是說，我想提出幾點。與去年相比，今年我們的 RFP 數量確實有所增加，就我們擁有的外匯數量而言，這在方向上是有利的。就我們現有的客戶而言，今年這個時候我們的投標金額與去年同期的金額相似。

Now each of these national accounts tend to have unique needs as you can appreciate, but a few themes that continue to bubble up that I think are indicative of where the market's headed. Many large employers tend to be looking for opportunities to consolidate vendors or point solutions, something we've been calling point solution fatigue. We're also seeing more and more demand for mental health and substance use benefits, particularly as an after effect from the pandemic. And then finally, there's continued demand for digitally enabled care navigation capabilities. along with consumer empowerment. So those are themes we're seeing but big picture, I'm feeling good about where we sit here as we prepare ourselves for 2025.

現在，正如您所理解的那樣，這些國民帳戶中的每一個往往都有獨特的需求，但我認為一些繼續出現的主題表明了市場的發展方向。許多大型雇主傾向於尋找整合供應商或單點解決方案的機會，我們稱之為單點解決方案疲勞。我們也看到對心理健康和藥物使用福利的需求越來越多，特別是作為大流行的後遺症。最後，對數位化護理導航功能的需求持續成長。以及消費者賦權。這些是我們看到的主題，但總體而言，我對我們在為 2025 年做準備時所處的位置感到滿意。

Our next question comes from Lisa Gill with JPMorgan.

我們的下一個問題來自摩根大通的麗莎吉爾。

I really want to focus on the Specialty business for a minute and the biosimilar opportunity. You talked about the HUMIRA opportunity that they brought to the market. But I really want to understand about profitability. So as we think about -- David, you talked about $100 billion by 2030. When I think about that opportunity over the next several years, can you maybe just layout how we see the margin progression? Is this a better margin opportunity? Is this a better opportunity to get incremental market share when we think about the Specialty business and the benefits to the patients? So if you can just help us to lay some of those opportunities out.

我真的想專注於特種業務和生物仿製藥機會。您談到了他們為市場帶來的 HUMIRA 機會。但我真的很想了解獲利能力。因此，當我們思考時，大衛，您談到到 2030 年將達到 1000 億美元。這是一個更好的利潤機會嗎？當我們考慮專業業務和為患者帶來的好處時，這是一個獲得增量市場份額的更好機會嗎？因此，如果您能幫助我們提供一些機會。

Lisa, it's David. Let me start, and then I'll ask Eric to expand a little bit. First, I think some of the attributes you put in your framing are quite helpful. So stepping back, we've called this opportunity out for quite some time. We've also been very clear that this would be an evolutionary and accelerating phase. Not a nice switch cutover 1.1.24 or prior to that. And we're into that phase pretty meaningfully.

麗莎，是大衛。讓我開始吧，然後我會請艾瑞克擴充一下。首先，我認為你在框架中加入的一些屬性非常有幫助。因此，退一步來說，我們已經放棄這個機會相當長一段時間了。我們也非常清楚，這將是一個進化和加速的階段。 1.1.24 或之前的版本不是一個很好的切換。我們進入這個階段是非常有意義的。

And I think there's 3 things I would highlight at a macro level. One, first and foremost, the specialty marketplace, as it stands today, is quite large. It's $400 billion and it's growing meaningfully, high single digit. Our growth rate is above that. given the breadth of our capabilities. Two, the innovations that are coming forward require significant both precise use of data, supply chain relationships, but the clinical expertise and physician engagement and pharmacist engagement expertise, which we have to be able to facilitate programs like our HUMIRA $0 copay at a variety of dosage levels on a go-forward basis.

我認為在宏觀層面上我要強調三件事。首先，目前的專業市場規模相當大。其價值達 4000 億美元，並且正在以高個位數的速度顯著增長。我們的成長率高於此。考慮到我們能力的廣度。第二，即將到來的創新不僅需要大量精確使用數據、供應鏈關係，還需要臨床專業知識、醫生參與和藥劑師參與專業知識，我們必須能夠以各種方式促進像我們的HUMIRA 0 美元共付額這樣的專案未來的劑量水準。

And then lastly, directionally, as I hand it over to Eric, I'd ask you to think about, as we've discussed this before, the profitability to us is highly correlated on our ability, obviously, to create value for our clients and patients. We see the specialty and the biosimilar opportunity to be equal or potentially greater per unit, so long as we're able to create that differentiated value from a contribution per unit of service as we go forward.

最後，從方向上講，當我將其交給埃里克時，我請您考慮一下，正如我們之前討論過的那樣，我們的盈利能力顯然與我們為客戶創造價值的能力高度相關和病人。我們認為，只要我們能夠在前進的過程中從每單位服務的貢獻中創造出差異化的價值，我們就可以看到每單位的專業和生物仿製藥的機會是相同的或可能更大。

So high growth, very attractive place to a significant amount of capabilities that one needs that we have, and we see both the demand and opportunity to create value is significant. Eric, I'll ask you to peel that back a little bit.

如此高的成長速度，對我們所需要的大量能力非常有吸引力，我們看到創造價值的需求和機會都是巨大的。艾瑞克，我請你把它剝開一點。

Great. Thanks, David. Lisa, I think David set up a really great framework there. Lisa, there's maybe 2 dynamics I'd call out as places where Evernorth is particularly well positioned to create value for our clients and that then enables us to earn attractive margins in our ability. One of those is in the capabilities we've assembled around these complicated rare high-cost conditions, right? And there's a tremendous pipeline of drugs coming in the coming years as I'm sure you know. We have the capabilities to get those all the way from the manufacturer through CuraScript, to our capabilities at Accredo, to a patient with the right controls around all of the handling, with the things that are temperature-sensitive, et cetera, that the logistics that are required and some of these therapies are really quite intense.

偉大的。謝謝，大衛。麗莎，我認為大衛在那裡建立了一個非常好的框架。麗莎，我可能會指出兩種動力，因為 Evernorth 在為我們的客戶創造價值方面處於特別有利的位置，從而使我們能夠憑藉我們的能力賺取有吸引力的利潤。其中之一是我們圍繞著這些複雜的罕見高成本條件而聚集的能力，對吧？我相信您知道，未來幾年將會有大量的藥物上市。我們有能力透過 CuraScript 從製造商處獲得這些信息，再到我們在 Accredo 的能力，再到對所有處理進行正確控制的患者，以及對溫度敏感的物品等等，物流這是必需的，而且其中一些療法確實非常強烈。

So the capabilities we have there position us to uniquely serve the market. And when we're in a position to uniquely serve the market, that sets us up to drive an attractive result. Similarly on biosimilars, the sets of capabilities that we've assembled, our most recent example here in terms of the options we're bringing to market for HUMIRA are another good example of capabilities we've assembled that puts us in a position to uniquely drive superior value.

因此，我們擁有的能力使我們能夠以獨特的方式服務市場。當我們能夠為市場提供獨特的服務時，我們就能達到有吸引力的結果。同樣，在生物相似藥方面，我們已經整合的一系列能力，我們最近為HUMIRA 推向市場的選項的例子，是我們已經整合的能力的另一個很好的例子，這些能力使我們能夠以獨特的方式推動卓越價值。

Our proposition for Humana at a $0 patient out-of-pocket as an attractive plan sponsor cost and brought together, we think, is a really attractive offering. As that hits, the market that drives attractive margins. Now those are all factored into the margins that we've set and the expectations we set for the segment, but those are a couple of the areas that will be tailwinds over a multiyear basis for the Evernorth Specialty businesses in the coming years, and we think we're positioned really well there.

我們對 Humana 的建議是，患者自付費用為 0 美元，作為一項有吸引力的計劃發起人成本，並且我們認為，將其整合在一起是一項非常有吸引力的產品。隨著這種情況的發生，市場將帶來誘人的利潤。現在，這些都已納入我們設定的利潤率和我們為該細分市場設定的預期中，但這些領域將在未來幾年內對 Evernorth Specialty 業務產生長期推動作用，我們我認為我們在那裡處於非常有利的位置。

Our next question comes from Andrew Mok with Barclays.

我們的下一個問題來自巴克萊銀行的安德魯·莫克。

I was hoping you could elaborate on MLR trends in the quarter. Can you share which segments are cost categories came in better than expectations. And then can you help us understand where your individual ACA margins are tracking relative to your target range of 4% to 6%?

我希望您能詳細說明本季的 MLR 趨勢。您能否分享一下哪些細分市場的成本類別表現優於預期？那麼您能否幫助我們了解您的個人 ACA 利潤率相對於 4% 至 6% 的目標範圍的追蹤情況如何？

Andrew, it's Brian. So first off, I'd just reiterate how pleased we are to have delivered another strong quarter of medical care ratio performance better than expectations, which helped to lead to our income outperformance in the quarter. And despite the disruption associated with the Change Healthcare incident, we delivered good results in Cigna Healthcare in the quarter.

安德魯，是布萊恩。首先，我想重申，我們非常高興能夠再次實現優於預期的強勁季度醫療保健比率表現，這有助於我們在本季度實現收入優異。儘管與 Change Healthcare 事件相關的中斷，我們在本季 Cigna Healthcare 取得了良好的業績。

So as it relates specifically to utilization patterns across the product lines, just a few highlights that I'd share. Within our U.S. employer book of business, inpatient facility claims remained elevated throughout the first quarter, but that was consistent with expectations. We did see some modest favorability in the U.S. employer book in the outpatient as well as surgical categories, where the cost trends showed some level of deceleration in comparison to recent periods and also relative to projections. But in light of the Change Healthcare disruption, the quarter end reserves included a provision for IBNR that's based upon historical patterns of utilization in these categories. So taken all together, the first quarter U.S. employer performance is broadly in line with expectations as well as our pricing assumptions.

由於它與整個產品線的利用模式特別相關，因此我只想分享一些亮點。在我們的美國雇主業務記錄中，住院設施索賠在整個第一季仍然較高，但這與預期一致。我們確實看到美國雇主在門診和手術類別方面有一些適度的好感，與最近時期和預測相比，這些類別的成本趨勢顯示出一定程度的減速。但鑑於 Change Healthcare 的中斷，季末儲備金包括一項基於這些類別的歷史使用模式的 IBNR 準備金。總而言之，第一季美國雇主的表現大致符合預期以及我們的定價假設。

Now within the individual exchange book, we did have a mix-related timing benefit in the first quarter. More specifically, we have a higher percentage of bronze plans in 2024 than what we had projected, which resulted in a greater degree of seasonality this year. So that created a timing-related benefit in the Cigna Healthcare MCR and income in the first quarter. But I'd note that the underlying performance of the individual exchange business was broadly in line with expectations for that book. And then finally, our Medicare and International businesses were also broadly in line with expectations for the first quarter. As it relates to the margins on the individual exchange business and kind of how that is shaping up, let me just start with some context.

現在，在個人交易簿中，我們確實在第一季獲得了與混合相關的時間優勢。更具體地說，我們 2024 年的青銅級計畫比例高於我們的預期，這導致今年的季節性更大。因此，這為 Cigna Healthcare MCR 和第一季的收入創造了與時間相關的效益。但我要指出的是，個人交易所業務的基本表現與該書的預期基本一致。最後，我們的醫療保險和國際業務也基本上符合第一季的預期。由於它涉及個人交易所業務的利潤及其形成方式，因此讓我先介紹一些背景。

You might recall during 2023, we had about $5 billion of premium, and that business is running below our long-term target profit margins of 4% to 6%. And specifically, that was weighed down by 2 large states where we had a higher-than-expected risk adjustment payable. So we subsequently took corrective pricing actions that were designed to improve our margins, understanding that this would likely result in some customer loss. And this strategy is broadly playing out as we expected. So you see our membership is down sequentially, but we are tracking toward margin improvement in the book for 2024. And our current planning assumptions are assuming that margins will end slightly below the target margin range of 4% to 6%. What we saw in the first quarter is consistent with that expectation.

您可能還記得，2023 年我們有大約 50 億美元的溢價，而該業務的運作低於我們 4% 至 6% 的長期目標利潤率。具體來說，這是受到兩個大州的拖累，我們的應付風險調整額高於預期。因此，我們隨後採取了糾正定價措施，旨在提高我們的利潤率，因為我們知道這可能會導致一些客戶流失。這一戰略正在如我們預期的那樣廣泛發揮作用。所以你會看到我們的會員數量連續下降，但我們正在追蹤 2024 年利潤率的改善。我們在第一季看到的情況與預期一致。

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 just maybe if you could double-click on the VillageMD situation. I know that Brian talked about the strategy being the same post the impairment, but just in the context that there may be sort of more limited resources to some degree for Village Health. Maybe can you talk about what your key priorities would be to see Village focusing on right now, that would align the best with what you've been hoping to get out of that investment.

我希望您能雙擊 VillageMD 情況。我知道布萊恩談到了損害後的策略是相同的，但只是在鄉村衛生部門的資源在某種程度上可能更加有限的背景下。也許您能談談您現在希望 Village 重點關注的重點是什麼，這將與您希望從投資中獲得的最佳效果保持一致。

And then just on the investment itself. Wondering if you could just give us the updated carrying value of the investment and then how the dividend stream at this point would be working? I know that originally, there was going to be a 5.5% dividend stream. So just curious if there's any impact to that from the noncash write-down.

然後就是投資本身。想知道您是否可以向我們提供最新的投資帳面價值以及此時的股息流將如何運作？我知道最初會有 5.5% 的股息流。所以只是好奇非現金減記是否對此有任何影響。

Scott, it's David. Let me start on the first part of your question, and then I'll ask Brian to pick up the second part of your question. First, at the macro level, our strategic direction in terms of what we were seeking to innovate with Village has not changed, despite the write-down of the asset. No one likes a write-down in the asset. If you step back, the write-down is largely driven by some broader market dislocation that is hitting the space, no doubt, relative to that as well as Village determining that they are going to, I would say, pulling the supply lines and constrain some of the growth in some of the new clinics that they were establishing. As I like to put it, where more thin footprint versus their go-deep markets were highly established value-based care markets.

斯科特，這是大衛。讓我從你問題的第一部分開始，然後我會請布萊恩回答你問題的第二部分。首先，在宏觀層面，儘管資產減記，但我們尋求與Village進行創新的策略方向並沒有改變。沒有人喜歡資產減記。如果你退後一步，減記很大程度上是由一些更廣泛的市場混亂所推動的，毫無疑問，相對於這一點，以及村莊確定他們將拉動供應線並限制他們正在建立的一些新診所的一些增長。正如我喜歡說的那樣，與深入的市場相比，足跡更薄的地方是高度成熟的基於價值的護理市場。

Taking that point, our strategy with Village is to take our proven value-based care model that aligns incentives. It uses data to drive more precision in terms of -- in most cases, specialty and subspecialty engagement to improve overall quality and affordability, but highly data-driven and precise process. And then care extenders to build off of Village's very strong performance already in the go-deep markets, and accelerate that performance even further.

鑑於這一點，我們與 Village 的策略是採用我們經過驗證的基於價值的護理模式，以調整激勵措施。在大多數情況下，它使用數據來推動更精確的專業和子專業參與，以提高整體品質和負擔能力，但高度數據驅動和精確的流程。然後，護理延伸者將在 Village 已經在深入市場中表現強勁的基礎上再接再厲，並進一步加速這一業績。

That's off of the Evernorth Accountable Care chassis. And then as we build that process as we're building in 4 of their go-deep markets, which continue to evolve at a very positive pace, those capabilities are able to be brought to other care providers that we would partner with going forward with risk-bearing entities and the precision of our MSO capabilities and our value-based care capabilities.

這是 Evernorth Accountable Care 底盤的一部分。然後，當我們在他們的 4 個深入市場中建立這個流程時，這些市場繼續以非常積極的速度發展，這些能力能夠被帶到我們將與之合作的其他護理提供者中風險承擔實體以及我們MSO能力和基於價值的護理能力的精確度。

So in a nutshell, while we don't like a write-down of an asset, the strategic direction hasn't changed because our focus has been on the highly established go-deep markets where Village continues to grow and perform well. And we're helping to accelerate some of that performance.

簡而言之，雖然我們不喜歡資產減記，但策略方向沒有改變，因為我們的重點一直是 Village 持續成長和表現良好的高度成熟的深入市場。我們正在幫助提高其中一些性能。

Brian, why don't you talk more about the investment itself?

布萊恩，為什麼不多談談投資本身呢？

Scott, on the financial components, the new carrying value is just slightly above $900 million on the balance sheet. And as it relates to the dividend as part of the impairment assessment, we have concluded that the dividend is collectible when due to us in the future, and we continue to accrue that within the net investment income line in the P&L.

史考特，就財務部分而言，資產負債表上的新帳面價值略高於 9 億美元。由於它與作為減損評估一部分的股息有關，我們得出的結論是，股息在未來到期時可以收取，並且我們繼續在損益表的淨投資收益線內累積該股息。

Our next question comes from Sarah James with Cantor.

我們的下一個問題來自莎拉詹姆斯和康托爾。

So you've talked about the importance of having vary dosages available for the HUMIRA biosimilar. I'm wondering in this new venture, are you able to take that one step further using data or AI and look at dosage efficiency? Is there something to be gained there? And maybe if you could give us an idea what are the next couple of big drug categories we should be looking at after HUMIRA.

您已經談到了 HUMIRA 生物相似藥具有不同劑量的重要性。我想知道在這項新事業中，您是否能夠使用數據或人工智慧進一步邁出一步並查看劑量效率？那裡有什麼收穫嗎？也許您能給我們一個想法，繼 HUMIRA 之後我們應該關注的下幾個主要藥物類別是什麼。

It's David. Let me start by -- with your first question and then I'll ask Eric to expand a little bit on the second dimension of your question. A couple of different points you made. I think you referenced new capabilities or new structure. Important to note that our Specialty business from Accredo to CuraScript, to Qual, that we made reference to all this established back in 2021. The breadth of our capabilities is well established and our performance is proven. So the capabilities are not new.

是大衛。讓我從你的第一個問題開始，然後我會請艾瑞克對你問題的第二個維度進行一些擴展。您提出了幾個不同的觀點。我認為您提到了新功能或新結構。值得注意的是，我們的專業業務從 Accredo 到 CuraScript，再到 Qual，我們都參考了 2021 年建立的所有這些業務。所以這些功能並不新鮮。

The opportunities that we're talking to with the precision of your question are new opportunities, but we've been well established here for quite some time. Second, and I appreciate you coming into the variety of dosage levels. Important point one before I come to the AI dimension is the dosage levels put us in position to be able to support patients at all need levels, not to support patients at some need levels. And that's very important. And that's very important, and that's our multi-manufacturer relationship that we've been able to establish.

我們根據你的問題的精確性所討論的機會是新的機會，但我們已經在這裡建立了相當長的一段時間了。其次，我感謝您了解各種劑量水平。在談到人工智慧維度之前，重要的一點是劑量水平使我們能夠支援所有需求水平的患者，而不是支持某些需求水平的患者。這非常重要。這非常重要，這就是我們已經能夠建立的多製造商關係。

Now lastly to the last part of your question and the core of it. The way we think about the AI opportunity that sits in front of us, starting from machine learning through AI, through generative AI, we think about it in terms of there's a 3-tier dimension to oversimplify. One is, I'll tie your question is generative AI, for example, presents the opportunity for us to do what we do today, better, faster, more efficiently, better value. And there's a variety of initiatives as you might expect that are driving through in the industry and for us that will create additional value.

現在最後是你問題的最後一部分及其核心。我們思考擺在我們面前的人工智慧機會的方式，從機器學習到人工智慧，再到生成式人工智慧，我們認為有一個 3 層維度來過度簡化。一是，我將你的問題與生成式人工智慧聯繫起來，例如，它為我們提供了更好、更快、更有效率、更有價值地做我們今天所做的事情的機會。正如您所期望的那樣，行業中正在推行各種舉措，這將為我們創造額外的價值。

Second tranche is more personalization. The decision to take more variability out or more averages out and drive more specific personalization back to individual solutions, networks, interventions, predictability, which points a little bit to where you came through.

第二部分則更加個人化。決定消除更多的可變性或更多的平均值，並將更具體的個人化帶回個人解決方案、網絡、幹預措施、可預測性，這在一定程度上表明了你的經歷。

And then third is in clinical intervention. Either predictability of clinical intervention or precision in terms of direction. If you think about where we are in the curve, we're furthest along in the first, entering in the second and cautiously testing the third because the third requires significant amount of human oversight in intervention as we go forward. Having said that, there's a significant amount of promise to bring it even more precision as we go forward. And we're excited about that and the breadth of our capabilities are well positioned to be able to do so. Eric, why don't you just expand a little more on the dosages.

第三是臨床介入。臨床介入的可預測性或方向的精確性。如果你想想我們在曲線上的位置，我們在第一個曲線中走得最遠，進入第二個曲線並謹慎地測試第三個曲線，因為第三個曲線在我們前進的過程中需要大量的人工監督幹預。話雖如此，隨著我們的前進，我們有很大的希望能夠使其更加精確。我們對此感到興奮，並且我們的能力範圍足以做到這一點。艾瑞克，你為什麼不擴大一點劑量呢？

Great. Thanks, David. Sara, I think this actually touches on exactly an area where we're focused on positioning Evernorth. Evernorth has the positioning with the capabilities, the information, the data, the clinical depth and the touch points with both the prescribers and the patients to really have direct impact on such here. So that's an exciting opportunity broadly. Specific to your question, our solution that we introduced last week is the first solution to bring interchangeable biosimilar adalimumab across all the concentrations. We've got the maximum number of available dosages in the market. And those elements, coupled with our robust supply chain, coupled with the proposition we put together, will be really effective for the market overall.

偉大的。謝謝，大衛。薩拉，我認為這實際上觸及了我們重點定位 Evernorth 的一個領域。 Evernorth 的定位是能力、資訊、數據、臨床深度以及與處方者和患者的接觸點，真正對此產生直接影響。因此，從廣義上講，這是一個令人興奮的機會。針對您的問題，我們上週推出的解決方案是第一個在所有濃度下提供可互換生物相似藥阿達木單抗的解決方案。我們擁有市場上最大數量的可用劑量。這些要素，加上我們強大的供應鏈，再加上我們提出的建議，將對整個市場真正有效。

So we're excited about that. I think in that clinical opportunity, coupled with our data, coupled with the technology to ensure we're working with precision to get our patients, the medicines they need is really the theme at every takeaway. In terms of other things in the pipeline. Just a handful that come to mind that think about Neulasta, Stelara, Prolia (inaudible) Eylea, all these things coming in the next couple of years.

所以我們對此感到興奮。我認為，在這個臨床機會中，加上我們的數據，再加上確保我們精確地為患者提供服務的技術，他們所需的藥物確實是每次外賣的主題。就管道中的其他事情而言。我想到的只有少數幾個，像是 Neulasta、Stelara、Prolia（聽不清楚）Eylea，所有這些東西都將在未來幾年內推出。

And as David noted in his prepared remarks, if you look at the top 25 specialty drugs by spend, we see the biosimilar or biosimilar options coming to market for 50% or more of that spend over the course of the next 5 or 6 years. So really excited about the opportunity for this to be a lever to drive improved access and approved affordability to these life-changing medicines for the benefit of our patients and plan sponsors.

正如David 在他準備好的演講中指出的那樣，如果您按支出查看前25 種特種藥物，我們會發現在未來5 到6 年內，生物仿製藥或生物仿製藥選擇將占到市場支出的50%或更多。非常高興有機會成為一個槓桿，推動改善這些改變生活的藥物的獲取和批准的可負擔性，以造福我們的患者和計劃發起人。

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. If I could do a couple of questions here. I guess, first on change, you mentioned there's some extra costs related to that. Can you spike out how much that was and just get a sense today where you think your visibility and claim submission is post change? And then a question on the Specialty Care and Services. First time we're seeing that kind of the margins, the margins were down year-over-year. I get why the pharmacy margins were down with the implementation costs? Is this a similar dynamic on Specialty? Or is there something else driving the margin there?

偉大的。如果我可以在這裡問幾個問題的話。我想，首先關於改變，你提到有一些與此相關的額外成本。您能否找出具體金額，並了解今天您認為您的可見性和索賠提交是在更改後的情況？然後是關於特殊護理和服務的問題。我們第一次看到這種利潤率，利潤率較去年同期下降。我明白為什麼藥局利潤會隨著實施成本而下降？專業領域是否也有類似的動態？還是有其他因素推動了利潤率的成長？

Let me just frame a little bit on the macro aspect to change and then ask Brian to peel back the specifics of your question. First and foremost, indisputably, the disruption was felt across the industry. And I just want to underscore how proud I am of how our team prioritize, first and foremost, access-to-care prioritization. In addition to that, member service and then working tirelessly relative to health care professional service and support. And our team had, as you might expect, flex a variety of programs, operational leverage, where possible, flex to other vendors to enable us to be able to continue to do what we need to do. And then expand staffing levels. Part of that comes back to your cost dimension. As Brian steps in, we'll separate through the reserving piece that he walked through, but I'll ask him to reamplify the way we look at the medical cost side of the equation. And then our SG&A ratio is up in the first quarter, and we ensure that we were positioned to deliver the services that were necessary. Part of that is influenced by the change disruption, Brian?

讓我先對要改變的宏觀方面進行一些框架，然後請布萊恩詳細說明您的問題。首先，毫無疑問，整個產業都感受到了這種顛覆。我只是想強調，我對我們的團隊如何優先考慮獲得護理的優先順序感到非常自豪。除此之外，會員服務以及與醫療保健專業服務和支援相關的不懈努力。正如您所期望的那樣，我們的團隊靈活運用了各種計劃、營運槓桿，在可能的情況下，靈活運用於其他供應商，以使我們能夠繼續做我們需要做的事情。然後擴大人員配置水準。其中一部分又回到了成本維度。當布萊恩介入時，我們將透過他走過的保留部分分開，但我會請他重新闡述我們看待等式的醫療成本方面的方式。然後我們的銷售、管理及行政費用比率在第一季有所上升，我們確保我們有能力提供必要的服務。部分原因是受到變革中斷的影響，布萊恩？

Yes. Thanks, David. Kevin, so these comments might be a little bit redundant what I covered earlier, Kevin, but I think it's important to reamplify. So we did have some disruption to claims submissions and payments in the quarter. And we did have some level of incremental operating expenses across the enterprise, all of which, we were able to manage through successfully and are reflected in our results. The $650 million of additional reserves that I flagged earlier, specific specifically associated with the Change Healthcare dynamic.

是的。謝謝，大衛。凱文，所以這些評論可能有點多餘，凱文，但我認為重新闡述很重要。因此，本季的索賠提交和付款確實受到了一些幹擾。我們整個企業確實有一定程度的增量營運費用，所有這些我們都能夠成功管理並反映在我們的業績中。我之前提到的 6.5 億美元額外準備金，特別與 Change Healthcare 動態相關。

About 2/3 of that is purely a timing issue where the claims were submitted late in the quarter and had not yet been paid. Those are now essentially all paid. So that's kind of purely a timing issue. The other, call it, 1/3 of the incremental reserve associated with the Change Healthcare item is our estimate of claims that were incurred but not yet reported over and above the normal IBNR, due to disruptive provider workflows.

其中大約 2/3 純粹是時間問題，即索賠是在本季末提交且尚未支付的。現在這些基本上都是付錢的。所以這純粹是時間問題。另一個，與「改變醫療保健」項目相關的增量準備金的 1/3 是我們對因供應商工作流程中斷而發生但尚未報告的索賠的估計，超出了正常的 IBNR。

Now we're a month plus out from the end of the quarter and have a better level of visibility as it relates to all of that and feel good about the full year outlook we put forward. Feel good about our cost trend expectations and our reserving posture. I'd also note that during the quarter, our clinical programs and protocols operated as expected. So while we certainly prioritize access to care when the disruption occurred, we do not estimate that it resulted in higher utilization than what would have otherwise transpired within the quarter. So we're proud of the way the Cigna team rallied here and delivered a good quarter despite the disruption.

現在距離本季結束還有一個月多的時間，我們有了更好的可見性，因為它與所有這些相關，並對我們提出的全年前景感到滿意。對我們的成本趨勢預期和我們的儲備態度感到滿意。我還想指出，在本季度，我們的臨床計劃和方案按預期運作。因此，雖然我們在發生中斷時當然會優先考慮獲得醫療服務，但我們並不認為它會導致利用率高於本季內發生的情況。因此，我們對 Cigna 團隊在受到干擾的情況下團結一致並交付出色的季度業績感到自豪。

As it relates to the Specialty and Care Services segment within Evernorth. We're, first of all, very pleased with the performance of this business. You can see it over a multiyear period and our 8% to 12% average annual growth for the Specialty and Care Services operating segment going forward is something that we feel really good about, as was indicated by some of the prior questions as well. You'll also note there was 12% year-over-year revenue growth in the first quarter, after several years of double-digit revenue growth previously.

因為它與 Evernorth 內的專業和護理服務部門相關。首先，我們對這項業務的表現非常滿意。您可以在多年的時間內看到這一點，我們對專業和護理服務業務部門未來 8% 至 12% 的平均年增長率感到非常滿意，正如之前的一些問題所表明的那樣。您還會注意到，繼之前幾年的兩位數收入成長之後，第一季的營收年增了 12%。

Now income at the operating segment level within Evernorth will show some quarter-to-quarter variability. And in particular, the first quarter growth rate in income for Specialty and Care Services was impacted by a particularly strong first quarter 2023 income performance in this operating segment, which included some timing-related impacts in SG&A and other items. So while the margin is down a bit year-over-year, I would not read anything into that in terms of any onetime factors that caused it, more of a matter of quarter-to-quarter variability.

現在，Evernorth 營運部門的收入將出現一些季度與季度的變化。特別是，專業和護理服務第一季的營收成長率受到該營運部門 2023 年第一季特別強勁的營收表現的影響，其中包括 SG&A 和其他專案的一些與時間相關的影響。因此，雖然利潤率同比略有下降，但我不會從任何導致利潤率的一次性因素角度解讀任何內容，更多的是季度與季度之間的變化問題。

Our next question comes from A.J. Rice with UBS.

我們的下一個問題來自 A.J.賴斯與瑞銀。

Let me go back to the capital deployment question. I know, Brian, you mentioned that the majority of discretionary cash flow for the back half of the year would go to repurchases. And that coming into the year, you guys gave a target for how much you would do in share repurchase in the first half. Do you have an updated estimate as to how much you might end up doing for the entirety of 2024? And then as you think about the landscape in the market, is anything on capital priorities or the ability to potentially do transactions that would fit those priorities? Any updated thoughts on all of that?

讓我回到資本配置問題。我知道，布萊恩，你提到下半年的大部分可自由支配現金流將用於回購。進入今年，你們給了上半年股票回購的目標。您對 2024 年一整年可能要做的事情有最新的估計嗎？然後，當您考慮市場格局時，是否有任何關於資本優先事項或可能進行符合這些優先事項的交易的能力的事情？對這一切有什麼更新的想法嗎？

A.J., it's David. Let me take the second part of your question first and then ask Brian to pick up on the first portion of your question. The second portion of your question upfront are capital priorities. Big picture capital priorities have not changed, continue to ensure the business has the assets that needs to grow, innovate, et cetera. So capital underlying our growth, CapEx budget, et cetera. Second, we always systematically continue to look at opportunities for M&A. I'll come back to that strategic and financially attractive. And third, return excess capital to shareholders. 2024 is another year where a significant portion of our excess capital will be returned to shareholders through share repurchase, on top of our very attractive dividend.

A.J.，我是大衛。讓我先回答你問題的第二部分，然後請布萊恩回答你問題的第一部分。您前面問題的第二部分是資本優先事項。大局資本優先事項沒有改變，持續確保企業擁有需要成長、創新等的資產。因此，我們的成長背後的資本、資本支出預算等等。其次，我們始終有系統地繼續尋找併購機會。我會回到策略和財務上的吸引力。第三，將多餘的資本回饋給股東。 2024 年，除了極具吸引力的股利外，我們還將透過股票回購將大部分超額資本返還給股東。

Specific to the M&A portion of the priorities. As we discussed at our recent Investor Day, the underpinnings of our growth strategy is grounded in our proven organic growth model. So our ability to continue to harness the performance of our foundational businesses and continue to innovate them and bring new services to market, coupled with the acceleration of our attractive accelerated businesses couples and drives our very attractive sustained organic growth profile, and we're excited about the outlook.

具體到優先事項的併購部分。正如我們在最近的投資者日討論的那樣，我們的成長策略的基礎是基於我們經過驗證的有機成長模型。因此，我們有能力繼續利用我們的基礎業務的業績，繼續對其進行創新，並將新服務推向市場，再加上我們有吸引力的加速業務的加速發展，推動我們非常有吸引力的持續有機增長，我們感到很興奮關於前景。

Our cash flow production is estimated to be about $60 billion over the next 5 years as we look forward and project. And is related to M&A, as we discussed at Investor Day, we'll continue to be open, yet disciplined relative to evaluating either capability or reach expansion, addressable market expansion capabilities. But again, the growth strategy is grounded in that strong performing organic portfolio. Brian, I'll ask you to talk about our share repurchase and the outlook for the year.

根據我們的預期和預測，未來 5 年我們的現金流量預計約為 600 億美元。與併購相關，正如我們在投資者日討論的那樣，我們將繼續保持開放的態度，但在評估能力或範圍擴張、可尋址市場擴張能力方面仍保持紀律。但同樣，成長策略的基礎是表現強勁的有機投資組合。布萊恩，我會請你談談我們的股票回購和今年的展望。

Broadly speaking, what we conveyed at our Investor Day continues to guide our actions in terms of our framework for capital deployment. So our capital health remains very strong. We continue to expect at least $11 billion of cash flow from operations here in 2024. And our strong cash generation is one of the company's greatest strengths. So the capital deployment priorities continue to focus, first and foremost, on internal reinvestment. Following that, we remain committed to an attractive shareholder dividend. Of course, we'll repay debt to maintain our targeted 40% debt-to-cap ratio over time. And then the balance of our deployable capital will be utilized for strategic M&A or share repurchase.

從廣義上講，我們在投資者日所傳達的訊息繼續引導我們在資本部署框架方面的行動。因此，我們的資本健康狀況仍然非常強勁。我們仍然預計 2024 年這裡的營運現金流將至少達到 110 億美元。因此，資本配置的重點仍首先是內部再投資。此後，我們仍然致力於提供有吸引力的股東股息。當然，隨著時間的推移，我們將償還債務以維持 40% 的債務上限比率目標。然後我們的可動用資金的餘額將用於策略併購或股票回購。

Now specific to 2024. We remain on track to execute against the share repurchase plans for the year, which includes completing at least $5 billion by the end of June as it relates to share repurchase. And as David said, we continue to expect the majority of our discretionary cash flow in 2024 to be used for share repurchase, and that's all reflected in our full year weighted average shares outstanding guide as well as the EPS guide. Thanks for the question.

現在具體到 2024 年。正如 David 所說，我們仍然預計 2024 年的大部分可自由支配現金流將用於股票回購，這一切都反映在我們的全年加權平均流通股指南以及每股盈餘指南中。謝謝你的提問。

Our next question comes from George Hill with Deutsche Bank.

我們的下一個問題來自德意志銀行的喬治·希爾。

I guess I'd like to ask a little bit more about the specialty opportunity, particularly as it relates to HUMIRA. And I guess as you evaluate the different strategies in the market, I guess, David, maybe would you talk about do you see a better opportunity to more align with a limited number of manufacturers? Or is the better opportunity kind of around maybe even a single manufacturer or kind of using the sole source strategy as a way to both kind of drive lower cost for patients and kind of drive margin for the company?

我想我想多詢問一些有關專業機會的信息，特別是與 HUMIRA 相關的信息。我想，當你評估市場上的不同策略時，我想，大衛，也許你會談談你是否看到了與有限數量的製造商更加協調的更好機會？或者，更好的機會可能是單一製造商，還是使用單一來源策略作為既降低病患成本又提高公司利潤的一種方式？

George, it's Eric. Thanks for the question. Stepping back a bit here, we have set up our portfolio set up, I would say, our approach here broadly is one that's grounded in providing choice and working to ensure that we've got a choice. And that applies to a maximum number of choices available, in this space. It applies to how we have our clients fund their benefit programs, et cetera. But specifically on specialty, the approach we've taken here is one that works to assemble a robust set of supply and suppliers and not become dependent on a single thread or sole sort of approach.

喬治，是埃里克。謝謝你的提問。退一步來說，我們已經建立了我們的投資組合，我想說，我們在這裡的方法大體上是基於提供選擇並努力確保我們有選擇。這適用於這個空間中可用的最大數量的選擇。它適用於我們如何讓客戶為其福利計劃提供資金等等。但特別是在專業方面，我們在這裡採取的方法是致力於組建一組強大的供應商和供應商，而不是依賴單一線程或單一類型的方法。

And so this is an approach that we think positions us really well. We think we've assembled a really attractive value proposition here on the biosimilar HUMIRA. As I noted before, with the $0 patient cost share, an attractive price for plan sponsors that will save (inaudible) on average, $3,500 per patient when taken all together so -- per year. So that approach with it will drive maximal choice, maximum clinical effectiveness and maximum flexibility for us to continue to stay well positioned as new entrants and new therapies continue to come to the market.

因此，我們認為這種方法對我們來說非常有利。我們認為我們已經在生物相似藥 HUMIRA 上提出了一個非常有吸引力的價值主張。正如我之前提到的，患者費用分攤為 0 美元，這對計劃發起人來說是一個有吸引力的價格，平均每年可以為每位患者節省（聽不清楚）3,500 美元。因此，這種方法將推動最大的選擇、最大的臨床有效性和最大的靈活性，使我們在新進入者和新療法不斷進入市場時繼續保持良好的地位。

Our next question comes from Erin Wright with Morgan Stanley.

我們的下一個問題來自摩根士丹利的艾琳賴特。

A little bit on GLP-1s. And just can you talk a little bit about the traction you're seeing the economics around sort of the program? How that's playing out relative to your expectations? And just do you see similar opportunities as it sort of unfolds in other therapeutic categories? I understand GLP-1s are a little bit unique, though.

關於 GLP-1 的一些知識。您能談談您所看到的該項目的經濟效益嗎？與您的期望相比，情況如何？您是否在其他治療類別中看到了類似的機會？不過，我知道 GLP-1 有點獨特。

Erin, it's Eric. Yes, so with respect to GLP-1s as you can imagine, there's a significant interest in need from our clients here. They're looking for help with managing the affordability of these medicines. Our EnCircleRx solution, which we've talked about for a bit of time now, and we really highlighted at our Investor Day is a solution that's set up to be really a value for our clients here. It's first of its kind. It brings together our supply chain and procurement expertise and our clinical capabilities, and works to get patients with the right clinical markers managed within the right pharmacy kind of network constructs and then supports them with additional clinical resources to help make sure that the impacts are lasting.

艾琳，我是埃里克。是的，正如您可以想像的那樣，我們的客戶對 GLP-1 的需求非常感興趣。他們正在尋求幫助來管理這些藥物的負擔能力。我們的 EnCircleRx 解決方案已經討論了一段時間，並且在投資者日上重點強調了這個解決方案，它為我們的客戶提供了真正的價值。這是同類產品中的首創。它匯集了我們的供應鏈和採購專業知識以及我們的臨床能力，致力於讓患者在正確的藥房類型的網絡結構中管理正確的臨床標誌物，然後為他們提供額外的臨床資源，以幫助確保影響是持久的。

When you put that all together, our capabilities position us to be in a position to guarantee outcomes to our clients. And that's formed and guarantee that is based in the fees our clients pay to us to effectively manage this program. And if we don't meet up to our commitments to our clients, our clients get their fees back or get a return guaranteed on those fees. So this is unique in this space on GLP-1s, but I would note this is not the first time we've done a program like this. Express Scripts and Evernorth of a long history of clinically oriented value-based outcomes-oriented programs on specific conditions, or to move on specific markers, and we think we're well positioned to deliver against this. David, anything else you'd add?

當你把所有這些放在一起時，我們的能力使我們能夠保證為客戶帶來成果。這是基於我們的客戶支付給我們以有效管理該計劃的費用而形成和保證的。如果我們沒有履行對客戶的承諾，我們的客戶將收回費用或獲得這些費用的保證回報。因此，這在 GLP-1 領域是獨一無二的，但我要指出的是，這並不是我們第一次完成這樣的程序。 Express Scripts 和 Evernorth 長期以來一直致力於針對特定條件或針對特定標記進行以臨床為導向、以價值為基礎、以結果為導向的計劃，我們認為我們有能力應對這一挑戰。大衛，你還有什麼要補充的嗎？

Sure, thank you. And Erin, just to put the wrap over the top of it, as we've discussed before, we identified many years ago that we believe that the pathway of pharmacological innovation was going to define the next decade. You can use the GLP-1 conversation we just had as an illustration of it or previously the biosimilar conversation, or reflect back on the fact that there's 21 gene therapies in the market today and almost 1,000 in the pipeline.

當然可以，謝謝。艾琳，只是為了把它覆蓋起來，正如我們之前討論過的那樣，我們多年前就確定，我們相信藥理學創新的途徑將定義下一個十年。您可以使用我們剛剛進行的 GLP-1 對話作為說明，或使用先前的生物相似藥對話，或回顧一下這樣的事實：當今市場上有 21 種基因療法，並且有近 1,000 種基因療法正在研發中。

So the point is the ability to harness the capabilities, a data-driven clinically precise, physician-engaged patient-centric model is mission-critical to the future, and we're very pleased with the multiple years of investment that we've made to put us in a position today. And the GLP-1s are a great example of how we're able to convert good innovation for the benefit of clients today and into the future.

因此，關鍵是能夠利用這些功能，數據驅動的臨床精確、醫生參與的以患者為中心的模型對於未來至關重要，我們對多年來所做的投資感到非常滿意讓我們處於今天的位置。 GLP-1 是我們如何能夠將優秀創新轉化為客戶當前和未來利益的一個很好的例子。

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。

Three-parter but all just numbers-related. First on MA. I know Brian said in line with expectations. But was there a material MA -- MLR headwind absorbed in the quarter? And I know it's held for sale on the balance sheet as of 3/31, will MA continue to be included in the both the adjusted and unadjusted P&L the rest of the year? Two, fourth quarter had a big benefit from a stop-loss true-up. Are we back to sort of a normal year-to-year stop-loss MLR? And then finally, to Kevin's question on the specialty margin, I heard Brian's answer, but just wonder how do we think about seasonality in that business? Would it normally be just ramping all year long, like the PBM business? Or would it reflect kind of stronger first quarter, fourth quarter in general?

三部分，但都只與數字相關。首先是MA。我知道Brian說的符合預期。但是，本季是否吸收了重大的 MA - MLR 逆風？我知道截至 3/31，它在資產負債表上持有待售，MA 是否會在今年剩餘時間繼續包含在調整後和未調整的損益表中？第二，第四季從停損調整中獲益良多。我們是否回到了正常的逐年止損MLR？最後，對於凱文關於專業利潤的問題，我聽到了布萊恩的回答，但只是想知道我們如何看待這項業務的季節性？它通常會像 PBM 業務一樣全年都在成長嗎？或者它會反映出第一季和第四季總體上的強勁表現嗎？

Gary, it's Brian. I'll try to take each of those questions one-by-one here. So as it relates to Medicare, that continues to be reflected in the Cigna Healthcare segment until the business is divested to HCSC. And you can see, for example, in the quarterly financial supplement, you'll see on Page 9, I think it is the premium breakdown. It represents about 20% of the overall premium for Cigna Healthcare, such as given the relatively small presence, it doesn't move the needle as much relative to the overall Cigna Healthcare results as our U.S. employer business, which represents the majority.

加里，是布萊恩。我將嘗試在這裡一一回答這些問題。因此，由於它與 Medicare 相關，這將繼續反映在 Cigna Healthcare 部門中，直到該業務剝離給 HCSC。例如，您可以看到，在季度財務補充中，您將在第 9 頁看到，我認為這是保費細分。它約佔 Cigna Healthcare 整體保費的 20%，鑑於其規模相對較小，它相對於 Cigna Healthcare 整體業績的影響並不像我們佔多數的美國雇主業務那麼大。

As I said, the overall performance of that business is broadly in line with expectations through the first quarter of the year, which comes back to the fact that we had anticipated higher levels of utilization in 2023, and that continuing into 2024. And you can also see associated with that, our membership is down a bit, whereas the overall market is up and some others up more than that.

正如我所說，該業務的整體業績與今年第一季的預期基本一致，這源於我們預計 2023 年利用率會更高，並且這種情況會持續到 2024 年。的是，我們的會員資格有所下降，而整體市場卻在上漲，而其他一些市場的漲幅則更大。

As it relates to the stop loss book of business. You're right. In the fourth quarter, we had some favorable claims experience that came through. and actually drove that product line to be above target profitability in 2023 and our 2024 expectation, as that it will normalize back to target profit margin levels. So far, that's consistent with what we're seeing. It's early in the year. And obviously, we have an appropriate level of prudence in our guidance on both the medical care ratio and the income for the full year. But so far so good as it relates to the stop loss performance.

因為它涉及到業務的停損簿。你說得對。在第四季度，我們取得了一些有利的索賠經驗。實際上推動該產品線在 2023 年的獲利能力目標和我們 2024 年的預期之上，因為它將正常化回目標利潤率水準。到目前為止，這與我們所看到的一致。現在是年初。顯然，我們對全年醫療比例和收入的指導都有適當的審慎程度。但到目前為止，它與停損性能有關。

And then finally, as it relates to the Specialty and Care Services margin profile, income seasonality, et cetera. To your point about the pharmacy benefit services operating segment. That business tends to see a ramp in income over the course of the year. So more specifically, when you think about how to model that, the pharmacy benefit services income will show sequential growth in income every quarter through the end of the year. The Specialty and Care Services business, tend to have more variability from quarter-to-quarter. So as you think about how to model that for '24, it's not as much of an upward slope. But over time, we fully expect the 8% to 12% average annual income growth rate in that business to be achieved.

最後，因為它與專業和護理服務的利潤狀況、收入季節性等有關。關於您關於藥品福利服務營運部門的觀點。該業務往往會在一年中看到收入的成長。因此，更具體地說，當您考慮如何建模時，藥品福利服務收入將顯示每季到年底的收入連續成長。專業和護理服務業務每季的變化往往更大。因此，當您考慮如何為 24 年建立模型時，您會發現它並不是一個向上的斜坡。但隨著時間的推移，我們完全預期該業務將實現 8% 至 12% 的年均收入成長率。

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。

Great. I've got a question on go-to-market strategy and insights. And I was just wondering for value-based care, what are the characteristics of employers that are interested in those sorts of solutions with you? And then similarly on your GLP-1 guaranteed product. Are there particular characteristics of employers or employer size or whatnot, that are more interested in that? And maybe as a tag along, if you could just give your update on what coverage trends for GLP-1s look like for '25? That would also be helpful.

偉大的。我有一個關於上市策略和見解的問題。我只是想知道對於基於價值的護理，對您提供的此類解決方案感興趣的雇主有哪些特點？然後對於您的 GLP-1 保證產品也是如此。是否有雇主或雇主規模等的特定特徵對此更感興趣？也許作為一個標籤，您能否提供有關 25 年 GLP-1 覆蓋率趨勢的最新資訊？這也會有幫助。

Lance, it's David. Let me take the first portion of your question relative to the VBC a little bit more broadly. And then ask Eric to talk about the GLP-1 questions specifically. You're looking for employer characteristics, which is an interesting question. I think I would click it down a couple of notches in terms of the value creation. So our VBC strategy, our value creation opportunity, you think about it is twofold. First broadly, for the commercial portfolio, an illustration.

蘭斯，我是大衛。讓我更廣泛地回答您問題中與 VBC 相關的第一部分。然後請Eric具體談談GLP-1的問題。您正在尋找雇主特徵，這是一個有趣的問題。我想我會在價值創造方面將其降低幾個檔次。所以我們的VBC策略，我們的價值創造機會，你想想它是雙重的。首先，就商業投資組合而言，舉個例子。

We've been at this for about 15 years. Partnering with medical cost professionals working to align incentives, data flows and care extenders, help to close gaps in care in a more accelerated level and/or bring more precision to specialty care interventions more likely than not to get the best possible quality outcome and overall affordability and value. It manifests itself in a variety of items, including avoided emergency room visits, less one-day admits, less readmissions and a whole variety of items that come through relative to that.

我們在這方面已經從事了大約 15 年。與醫療成本專業人士合作，致力於協調激勵措施、數據流和護理延伸服務，幫助更快地縮小護理差距和/或提高專科護理幹預的精確度，更有可能獲得最佳的品質結果和整體效果負擔能力和價值。它體現在各種各樣的項目上，包括避免急診室就診、減少一日入院、減少再入院以及與此相關的各種項目。

So that broad-based approach resonates with most employers because it's not restrictive. It's not a network restrictive. It's not a product restrictive design in any way, shape or form. I add to it for a moment now our Pathwell program, which, in some ways, you could view as value-based care. It also takes now an episode of care or unique specific care state and it seeks to redesign not the health plan offering in totality, but for that care state, taking data and guiding with more precision to the highest performance, highest quality outcome.

因此，這種廣泛基礎的方法引起了大多數雇主的共鳴，因為它沒有限制性。這不是網路限制。它不是任何方式、形狀或形式的產品限制性設計。我現在加入我們的 Pathwell 計劃，在某些方面，您可以將其視為基於價值的護理。現在，它還需要一段護理或獨特的特定護理狀態，它尋求的不是重新設計整體的健康計劃，而是針對該護理狀態，獲取數據並更精確地指導以獲得最高績效、最高品質的結果。

Those employers tend to be initially larger employers. They are spending a bit more time in the precision of their -- our benefit design. And our ability is to now package those solutions and have them in a more coordinated way for small to midsized employers going forward.

這些雇主最初往往是規模較大的雇主。他們在我們的福利設計的精確度上花了更多的時間。我們現在的能力是將這些解決方案打包，並以更協調的方式為中小型雇主提供支援。

As I noted, we're really pleased that patient satisfaction, for example, and the musculoskeletal program was fully 96%. So broadly speaking, the opportunity to create more value, our VBC strategy is not restrictive. It's inclusive from a network standpoint, brings more precision, hence, resonates, broadly speaking with employers. Pathwell brings a level of trade-offs in terms of how an employer wants to factor that in, and we're able to essentially to begin to package that within our Select segment as well. I'll ask Eric to talk a little bit more broadly about your GLP-1 question.

正如我所指出的，我們非常高興患者的滿意度，例如，肌肉骨骼計畫的滿意度高達 96%。所以從廣義來說，創造更多價值的機會，我們的VBC策略是沒有限制性的。從網路的角度來看，它具有包容性，帶來了更高的精確度，因此，從廣義上講，它與雇主產生了共鳴。 Pathwell 在雇主希望如何考慮這一因素方面帶來了一定程度的權衡，而且我們基本上也能夠開始將其打包到我們的精選細分市場中。我將請 Eric 更廣泛地談談您的 GLP-1 問題。

Great. Thanks, David. Lance, on GLP-1s broadly and covering GLP-1s for weight loss specifically, it's certainly true in our book of business that larger clients tend to cover more, but having to think about have it grounded not just in the size of the number of employees, but really on the approach that an employer wants to take to their benefits. And I would note that, that's in turn, driven by whether or not they tend to have lower or higher amounts of employee turnover, tend to see more spend, more coverage for employers with lower levels of turnover.

偉大的。謝謝，大衛。 Lance，就廣泛的GLP-1 以及具體涵蓋用於減肥的GLP-1 而言，在我們的業務手冊中，大客戶往往會涵蓋更多，這確實是事實，但必須考慮它不僅僅基於數量的大小員工，但實際上是雇主希望採取的為他們謀福利的方法。我要指出的是，這反過來又取決於他們的員工流動率是否較低或較高，是否傾向於為流動率較低的雇主提供更多的支出和更多的保險。

We tend to see variations depending upon the underlying clinical needs and clinical conditions of the employee base and their dependents and such as well. So it really does come down to employer buying, employer-type of decision but those would be couple of the dimensions that come to mind. In terms of the overall coverage level. We had noted that last year that we saw in the Express Scripts employer book, about 40% to 50% of our employer relationships covering GLP-1s for weight loss. That's actually trended moderately higher. I'd call it about 50% now. So moving up from 40% to 50% right to about 50%. So a modest increase. And as I noted earlier and David noted in his prepared remarks, seeing a high degree of interest and engagement with the EnCircle program, and so we expect that will continue to provide additional access for patients over time.

我們往往會看到根據員工基礎及其家屬等的潛在臨床需求和臨床狀況而有所不同。因此，這確實取決於雇主的購買、雇主類型的決定，但這些只是我想到的幾個維度。從整體覆蓋水平來看。我們注意到，去年我們在 Express Scripts 雇主手冊中看到，大約 40% 到 50% 的雇主關係涵蓋了用於減肥的 GLP-1。這實際上呈現適度走高的趨勢。我現在稱之為大約 50%。所以從 40% 到 50% 上升到大約 50%。所以略有增加。正如我之前和 David 在他準備好的演講中指出的那樣，我們看到了人們對 EnCircle 計劃的高度興趣和參與，因此我們預計隨著時間的推移，該計劃將繼續為患者提供更多機會。

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

謝謝。現在，我將把電話轉回給大衛·科達尼 (David Cordani)，他將發表結束語。

Thanks, Kit, for your time this morning. I just want to make a few points to wrap up. Broadly speaking, we're pleased to have delivered another strong quarter, which built on a track record of growth, and we were able to increase our guidance for adjusted earnings per share to at least $28.40. Our team continues to navigate a very dynamic environment and is executed with focused discipline across our portfolio of businesses, and we seek to accelerate our momentum further into 2024.

謝謝基特今天早上抽出時間。我只想提出幾點來總結。總的來說，我們很高興又一個強勁的季度，這是建立在成長記錄的基礎上的，並且我們能夠將調整後每股收益的指導提高到至少 28.40 美元。我們的團隊繼續在一個充滿活力的環境中前行，並在我們的業務組合中以集中的紀律執行，我們力求在 2024 年進一步加快我們的勢頭。

I do want to pause and thank my colleagues around the world who wake up every day on behalf of our clients, our customers, our patients and partners with the objective of serving. And I'm proud of what we've delivered and the positive difference we make in people's lives each and every day.

我確實想停下來感謝我世界各地的同事，他們每天都代表我們的客戶、我們的顧客、我們的患者和合作夥伴醒來，以服務為目標。我為我們所做的一切以及我們每天為人們的生活帶來的積極變化感到自豪。

We thank you for your time, and we look forward to talking to you again as we continue to execute against our strategy.

感謝您抽出寶貴時間，我們期待在繼續執行我們的策略時再次與您交談。

Ladies and gentlemen, this concludes The Cigna Group's First Quarter 2024 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.

女士們、先生們，信諾集團 2024 年第一季業績回顧到此結束。 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 10 個工作天內提供。

You may access the recorded conference by dialing (866) 407-9272 or (203)-369-0617. There is no passcode required for this replay.

您可以撥打 (866) 407-9272 或 (203)-369-0617 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。