信諾集團 (CI) 2024 Q2 法說會逐字稿

Ladies and gentlemen, thank you for standing by for the Cigna Group second-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 Group 2024 年第二季業績審查。 （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 call over to Ralph Giacobbe. Please go ahead.

我們先將電話轉給 Ralph Giacobbe。請繼續。

Thank you. Good morning, everyone. Thanks for joining today's call. I'm Ralph Giacobbe, Senior Vice President of Investor Relations. With me on the line this morning are David Cordani, the Cigna Group's Chairman and Chief Executive Officer; 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.

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； Brian Evanko，Cigna 集團財務長兼 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 second quarter financial results and our 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，包括我們第二季度的財務業績和 2024 年的財務前景。

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.

正如我們在收益報告中所指出的，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，這些指標並不是根據美國公認的會計原則（也稱為GAAP）確定的。

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. 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.

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。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 2024 and future performance. These statements are subject to risks and uncertainties that could cause actual results to differ materially from our current expectations.

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 2024 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。

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. Regarding our results in the second quarter, we recorded an after-tax net special item charge of $64 million or $0.23 per share.

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。關於我們第二季的業績，我們記錄的稅後淨特殊項目費用為 6,400 萬美元，即每股 0.23 美元。

Details of the special items are included in our quarterly financial supplement. Additionally, please note that we will 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.

特別項目的詳細資訊包含在我們的季度財務補充中。此外，請注意，我們將對財務業績做出前瞻性評論，包括我們的 2024 年全年展望，我們將在包括未來股票回購和預期 2024 年股息的潛在影響的基礎上這樣做。

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

然後，我會將電話轉給大衛。

Thanks, Ralph. Good morning, everyone, and thank you for joining our call today. For the second quarter, we again delivered strong performance as we continue to build on our momentum. Today, I'll discuss our performance for the quarter and key strategic drivers of our growth, demonstrate how the strength and durable nature of our model is fueling our success. Then Brian will review additional details on our results and our outlook for the rest of the year, and we'll move to your questions. So let's get started.

謝謝，拉爾夫。大家早安，感謝您今天加入我們的電話會議。第二季度，我們持續保持強勁勢頭，再次取得強勁業績。今天，我將討論我們本季的業績以及成長的關鍵策略驅動因素，展示我們模式的優勢和持久性如何推動我們的成功。然後布萊恩將回顧我們的業績和今年剩餘時間的前景的更多詳細信息，然後我們將討論您的問題。那麼就讓我們開始吧。

For the second quarter, I'm pleased to report that the Cigna Group delivered total revenue of $60.5 billion and adjusted earnings per share of $6.72. We achieved these positive overall results in a dynamic environment, and I'm proud of our team for continuing to focus on those we serve, ensuring that they get care of the need, to get their medications at an affordable cost and they get the support they need in order to make the best decisions about their health and vitality.

我很高興地報告第二季 Cigna 集團的總收入為 605 億美元，調整後每股收益為 6.72 美元。我們在充滿活力的環境中取得了這些積極的總體成果，我為我們的團隊繼續關注我們所服務的人感到自豪，確保他們得到滿足的需求，以負擔得起的成本獲得藥物並獲得支持他們需要做出有關他們的健康和活力的最佳決定。

All of this requires a relentless focus on innovation, disciplined execution and a passionate commitment to our mission. During the quarter, our Evernorth Health Service businesses demonstrated continued strength with our market-leading specialty and pharmacy benefit services capabilities. Within Evernorth, I'll start with our accelerated growth specialty and care businesses, which provides specialty drugs for the treatment of complex and rare diseases, distribution of specialty pharmaceuticals as well as clinical programs to help clients improve health and vitality.

所有這一切都需要對創新的不懈關注、嚴格的執行以及對我們使命的熱情承諾。本季度，我們的 Evernorth 健康服務業務憑藉市場領先的專業和藥品福利服務能力展現了持續的實力。在Evernorth，我將從我們加速成長的專業和護理業務開始，該業務提供用於治療複雜和罕見疾病的特殊藥物、特殊藥物的分銷以及幫助客戶改善健康和活力的臨床項目。

We saw strong growth in the quarter with adjusted income growing 12% year-over-year, reflecting continued demand for our services while we also continue to invest in broadening our offerings and expanding our reach. In Accredo, our specialty business, our growth continues to be fueled by secular tailwinds as well as Accredo's differentiated strength which makes us the market leader in the space. Biosimilars, for example, represent a force of change and a substantial opportunity for continued growth and impact.

本季我們實現了強勁成長，調整後營收年增 12%，反映出對我們服務的持續需求，同時我們也持續投資擴大我們的產品和範圍。在我們的專業業務 Accredo 中，我們的成長繼續受到長期順風以及 Accredo 的差異化優勢的推動，這使我們成為該領域的市場領導者。例如，生物相似藥代表了變革的力量以及持續成長和影響的重大機會。

At the end of June, we began dispensing our interchangeable biosimilar for Humira. Our program has $0 out-of-pocket cost for patients, saving them on average $3,500 per year. To deliver these savings, we have agreements in place with multiple manufacturers that will produce biosimilars for Evernorth pharmaceutical distributor, Quallent Pharmaceuticals.

六月底，我們開始分發修美樂的可互換生物相似藥。我們的計劃為患者提供 0 美元的自付費用，平均每年為他們節省 3,500 美元。為了實現這些節省，我們與多家製造商簽訂了協議，為 Evernorth 藥品經銷商 Quallent Pharmaceuticals 生產生物仿製藥。

Now the biosimilar opportunity goes well beyond Humira. By 2030, we expect an additional $100 million of annual specialty drug spend in the US will be subject to biosimilar and generic competition. And Accredo is well positioned to deliver differentiated value for our clients, customers and patients. In our care services businesses, we are continuing to grow and expand in key areas of increased demand, including behavioral health, virtual and home care.

現在，生物相似藥的機會遠遠超出了 Humira 的範圍。到 2030 年，我們預計美國每年將有額外 1 億美元的特種藥物支出面臨生物相似藥和仿製藥的競爭。 Accredo 處於有利地位，可為我們的客戶、消費者和患者提供差異化價值。在我們的護理服務業務中，我們正在需求增加的關鍵領域繼續發展和擴張，包括行為健康、虛擬和家庭護理。

For example, in summer, we further expanded Evernorth behavioral care group to an additional seven states. We are seeing positive patient outcomes from our unique clinician matching capabilities based on individual needs and preferences with fully 84% of patients experiencing clinically significant reductions in the depression and anxiety symptoms.

例如，在夏天，我們進一步將 Evernorth 行為護理小組擴展到另外七個州。我們獨特的臨床醫生根據個人需求和偏好進行匹配的能力，讓我們看到了積極的患者治療結果，84% 的患者的憂鬱和焦慮症狀在臨床上顯著減輕。

Now shifting to Express Scripts, our foundational pharmacy benefit services businesses, we are seeing continued strong client demand given our breadth of clinical and supply chain expertise as well as our proven partnership orientation. This quarter, Express Scripts built on a long track record of innovating for those we serve with continued enhancements and new solutions. For example, given the high cost of GLP-1 drugs, we're continuing to see meaningful interest from our clients in EnCircleRx, now with more than 2 million lives already enrolled.

現在轉向我們的基礎藥房福利服務業務 Express Scripts，鑑於我們廣泛的臨床和供應鏈專業知識以及我們經過驗證的合作夥伴關係，我們看到了持續強勁的客戶需求。本季度，Express Scripts 憑藉持續的增強功能和新的解決方案，為我們所服務的客戶提供了長期的創新記錄。例如，鑑於 GLP-1 藥物的高昂成本，我們持續看到客戶對 EnCircleRx 產生濃厚的興趣，目前已有超過 200 萬人參與其中。

Our program starts with our longitudinal data to target patients who will most benefit from these medications and we provide patients with resources to make lasting changes to help maximize the effectiveness of these medications, both in the short and long-term. Another example of our innovation orientation is a recent announcement of Express Scripts oncology benefit services, which will be available in 2025.

我們的計劃從縱向數據開始，瞄準最能從這些藥物中受益的患者，並為患者提供資源，以做出持久的改變，以幫助最大限度地提高這些藥物的短期和長期有效性。我們創新導向的另一個例子是最近宣布的 Express Scripts 腫瘤學福利服務，將於 2025 年推出。

Our new solution helps patients navigate the challenges of cancer care by providing a single oncology benefit, integrating pharmacy, medical and behavioral health treatments. Our patient centered approach will help to ensure the earliest possible detection guide individuals to high-quality providers and coordinate care across clinical teams.

我們的新解決方案透過提供單一的腫瘤學益處，整合藥學、醫療和行為健康治療，幫助患者應對癌症護理的挑戰。我們以患者為中心的方法將有助於確保儘早檢測，指導個人找到高品質的醫療服務提供者，並協調臨床團隊的照護。

Now moving to Cigna Healthcare, our health benefits platform, we continue to deliver solutions that create value and better outcomes for clients and customers, coupled with highly competitive total cost of care. Similar to others in the industry and as we've anticipated, we are seeing increased utilization in our book of business. I would note that our results are largely in line with the elevated levels in our planning and pricing assumptions.

現在轉向我們的健康福利平台 Cigna Healthcare，我們繼續提供為客戶和顧客創造價值和更好結果的解決方案，以及極具競爭力的總護理成本。與業內其他公司類似，正如我們預期的那樣，我們的業務簿中的利用率有所增加。我要指出的是，我們的結果很大程度上符合我們規劃和定價假設中的較高水準。

Our US employer foundational growth business continues to perform in line with our expectations. Over this year, I've met with hundreds of clients across the US and globally. And while the needs of every client are unique, there are a few consistent themes across every discussion.

我們的美國雇主基礎成長業務持續符合我們的預期。今年，我會見了美國和全球數百名客戶。雖然每個客戶的需求都是獨特的，但每次討論都有一些一致的主題。

First, continued focus on affordability, particularly in light medications like GLP-1 and gene therapies coming to market. Next, an increased need of improved access and importantly, coordination of behavioral health services. Third is mounting point solution fatigue. And fourth, the opportunity and need for leverage of our longitudinal data and clinical programs to help keep people healthy and vital.

首先，繼續關注可負擔性，特別是在上市的 GLP-1 等輕型藥物和基因療法方面。其次，越來越需要改善行為健康服務的可近性，更重要的是，協調行為健康服務。三是安裝點解決疲勞。第四，利用我們的縱向數據和臨床計畫來幫助人們保持健康和活力的機會和需求。

Our solutions continue to resonate well given our highly consultative approach to help clients choose the right set of solutions, our proven capabilities to support their workforce and our innovative programs that help to keep costs down. As a result, we are further gaining share and continue to see outsized opportunities, for example, in our Select segment.

我們的解決方案繼續引起廣泛反響，因為我們以高度諮詢的方式幫助客戶選擇正確的解決方案，我們經過驗證的能力支持他們的員工隊伍，我們的創新計劃有助於降低成本。因此，我們正在進一步獲得份額，並繼續看到巨大的機會，例如在我們的精選細分市場中。

Another capability of our US employer business to deliver integrated and tailored benefits for our clients and customers, our modular solutions that incorporate innovative services from Evernorth, including Behavioral health, virtual care and pharmacy.

我們美國雇主業務的另一項能力是為我們的客戶和顧客提供全面和客製化的福利，我們的模組化解決方案融合了 Evernorth 的創新服務，包括行為健康、虛擬護理和藥房。

Our Pathwell suite of solution, which continues to drive exceptional value is a prime example. Pathwell specialty is another way we are reducing costs associated with specialty drug therapies, while also providing improved care and clinical outcomes for patients. With our Accredo nurses, nearly 50% of our Pathwell specialty patients, who've transitioned their site of care, now receive treatment in the comfort and convenience of their home. We are pleased with how the market continues to recognize the value we are delivering through solutions like Pathwell.

我們的 Pathwell 解決方案套件不斷推動卓越價值，就是一個很好的例子。 Pathwell 專業是我們降低與專業藥物治療相關的成本的另一種方式，同時也為患者提供更好的護理和臨床結果。在我們的 Accredo 護理師的幫助下，近 50% 的 Pathwell 專科患者已經轉移了護理地點，現在可以在舒適方便的家中接受治療。我們很高興市場繼續認可我們透過 Pathwell 等解決方案提供的價值。

Turning to our Medicare Advantage business. We continue to make great progress regarding the sale of this business, and I'm pleased that we remain on track to close in the first quarter of 2025 as planned. Next, I want to take a few minutes to talk about the current environment surrounding pharmacy benefit managers and the relative landscape. At the heart of this debate is the cost of pharmaceuticals. As we previously discussed, a key force of change in health care is the surge of pharmacological innovation.

轉向我們的 Medicare Advantage 業務。我們在出售這項業務方面繼續取得巨大進展，我很高興我們仍有望按計劃在 2025 年第一季完成交易。接下來，我想花幾分鐘時間談談目前圍繞著藥品福利管理者的環境和相關情況。這場爭論的核心是藥品的成本。正如我們之前所討論的，醫療保健變革的關鍵力量是藥理學創新的激增。

For context, prescription drug coverage is the most frequently used care benefit. And on average, it used 15x per year per person resulting in billions of dollars -- billions of prescriptions per year annually in the United States. Today, and for the foreseeable future, and most meaningful advances extending and improving quality of life will come through gene therapies, breakthrough and treatments for cancers and other conditions as well as personalized medicines.

就上下文而言，處方藥承保是最常用的護理福利。平均而言，每人每年使用 15 次，產生數十億美元——在美國每年有數十億處方藥。今天以及在可預見的未來，延長和改善生活品質的最有意義的進步將透過基因療法、癌症和其他疾病的突破和治療以及個人化藥物來實現。

In the US, for example, there are already more than 20 gene therapy and cell therapies available. However, there are nearly 1,000 more in the pipeline. Additionally, as we know, GLP-1s are growing rapidly, helping to treat diseases and complications that stem from obesity and diabetes. This class of drug is on tap to be the #1 pharmacy benefit trend driver for plans of all sizes this year. And the impact will grow with some forecasting nearly 10% of the US population using GLP-1s in the next 10 years or sooner.

例如，在美國，已有 20 多種基因療法和細胞療法可用。然而，還有近 1,000 個項目正在籌備中。此外，據我們所知，GLP-1 正在迅速增長，有助於治療肥胖和糖尿病引起的疾病和併發症。此類藥物有望成為今年各種規模計畫的第一大藥房福利趨勢驅動因素。有些人預測，在未來 10 年或更短時間內，將有近 10% 的美國人口使用 GLP-1，其影響將會更大。

The applications rippling from these fast-growing pharmaceutical trends across the entire health care system are undeniable. And one of the biggest unanswered questions is how could society afford this continued trajectory? Our role is to negotiate with pharmaceutical manufacturers as well as pharmacies to ensure that individuals are able to access pharmacological innovations at a fair and affordable price.

不可否認的是，這些快速成長的製藥趨勢在整個醫療保健系統中產生的應用程式是不可否認的。最大的懸而未決的問題之一是社會如何承受這種持續的發展軌跡？我們的角色是與藥廠和藥局進行談判，以確保個人能夠以公平且負擔得起的價格獲得藥理創新。

In fact, pharmacy benefit companies are the only part of the drug supply chain who work to drive cost down. To underscore this, new drugs coming to market with unsustainable prices in 2023, were up $300,000 on a median basis, up over 35% over 2022. And last year, median brand drug price increases were greater than 5% more than the rate of inflation. Let me repeat this. Last year, the median annual price for new drugs coming to market was $300,000, up 35% over 2022.

事實上，藥品福利公司是藥品供應鏈中唯一致力於降低成本的部分。為了強調這一點，2023 年上市的新藥價格中位數將上漲 30 萬美元，比 2022 年上漲 35% 以上。讓我重複一遍。去年，上市新藥的年價格中位數為 30 萬美元，比 2022 年上漲 35%。

Meanwhile, in 2023, Express Scripts change in pace and cost sharing was relatively flat on average. Express Scripts patients with employer sponsored drug coverage pay, on average, $15 out of pocket for a 30 day supply. And for clients, Express Scripts delivered more than $38 billion in savings annually. Stepping back, our industry negotiations to drive these results can at times generate friction in the system. Friction that is spilled into and now has reached tightened levels in the political arena and media with industry winners and losers being declared at every report and every headline.

同時，2023 年 Express Scripts 的變動速度和成本分攤平均而言相對穩定。接受雇主贊助藥物承保的 Express Scripts 患者平均需要自掏腰包 15 美元購買 30 天的藥物。 Express Scripts 每年為客戶節省超過 380 億美元。退一步來說，我們為推動這些結果而進行的產業談判有時會在系統中產生摩擦。政治舞台和媒體上的摩擦已經達到了愈演愈烈的程度，每一份報告和每一個頭條新聞都會宣布行業的贏家和輸家。

We believe that the facts and results and outcomes delivered to our clients, customers and patients will rule the day. However, the environment calls on us to be more proactive. This means ensuring that what we do and the value we bring is more widely and better understood. And we continue to evolve our model to address legitimate pain points and opportunities.

我們相信，向我們的客戶、顧客和患者提供的事實、結果和結果將決定一切。然而，環境要求我們要更加積極主動。這意味著確保我們所做的事情和我們帶來的價值得到更廣泛和更好的理解。我們繼續發展我們的模型，以解決合理的痛點和機會。

For example, in 2023, 1% of the patients in the United States experienced out-of-pocket costs above $2,000 a year. From our point of view, that's too many. We accept the responsibility to accelerate innovation to make medications more affordable, while continuing to improve health outcomes in finding solutions for every person we serve.

例如，2023 年，美國 1% 的患者每年的自付費用超過 2,000 美元。從我們的角度來看，這太多了。我們有責任加速創新，使藥物變得更便宜，同時繼續改善健康狀況，為我們服務的每個人尋找解決方案。

Make no doubt our team will continue to lean into the challenge for the benefit of our patients, clients and the health care ecosystem and we are proud of the work that our team does every day and the role we play and the results we're able to achieve.

毫無疑問，我們的團隊將繼續迎接挑戰，造福我們的患者、客戶和醫療保健生態系統，我們為我們團隊每天所做的工作、我們所扮演的角色以及我們能夠取得的成果感到自豪實現。

Now let me pause and summarize before transitioning to Brian. When you combine our compelling growth potential and strong execution focus, we have confidence in our ability to meet our 2024 and long-term growth targets. We have a proven track record of delivering differentiated value for those we serve by innovating new solutions like in EnCircleRx and our Pathwell suite as well as expanding meaningful partnerships.

現在讓我在轉向布萊恩之前暫停一下並總結一下。當您將我們引人注目的成長潛力和強大的執行重點結合起來時，我們對實現 2024 年和長期成長目標的能力充滿信心。透過創新新解決方案（例如 EnCircleRx 和 Pathwell 套件）以及擴大有意義的合作夥伴關係，我們在為我們服務的客戶提供差異化價值方面擁有良好的記錄。

As a result, in the second quarter, we delivered on our financial commitment with adjusted EPS of $6.72, and we remain on track to deliver our guidance for full year adjusted earnings per share of at least $28.40 for 2024.

因此，我們在第二季度兌現了財務承諾，調整後每股收益為 6.72 美元，我們仍有望實現 2024 年全年調整後每股收益至少 28.40 美元的指導。

Further, our company has attractive sustainable growth opportunities over the long-term, and we remain on track to deliver average annual adjusted EPS growth of 10% to 14% and building on our track record of achieving 13% adjusted EPS growth over the last decade, all while we generate cumulative operating cash flow of $60 billion over the next five years, while continuing to meaningfully invest capital for the benefit of shareholders.

此外，我們公司擁有有吸引力的長期永續成長機會，我們仍有望實現年均調整後每股收益成長10% 至14%，並在過去十年實現13% 調整後每股收益成長的記錄基礎上再接再厲。

We also continue to make strategic investments in strengthening our capabilities in our foundational and accelerated growth business and remain focusing on harnessing the breadth of our capabilities of our organization to meet the evolving needs of those we serve. Overall, our strong performance through the first half of the year reflects the balance in our company portfolio and the significant value creation that positions us for sustained and differentiated growth.

我們也持續進行策略性投資，以加強我們在基礎和加速成長業務方面的能力，並繼續專注於利用我們組織的廣泛能力來滿足我們服務對像不斷變化的需求。總體而言，我們上半年的強勁業績反映了我們公司投資組合的平衡以及顯著的價值創造，使我們能夠實現持續和差異化的成長。

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. Today, I'll review Cigna's second quarter 2024 results and discuss our outlook for the full year. We're pleased with our strong second quarter results, reflecting growth across Evernorth and Cigna Healthcare. The results underpin the strength and the stability of our diversified portfolio of businesses in a dynamic environment and demonstrate continued execution against our operating and financial commitments.

謝謝你，大衛。大家，早安。今天，我將回顧 Cigna 2024 年第二季的業績，並討論我們對全年的展望。我們對第二季的強勁業績感到滿意，這反映出 Evernorth 和 Cigna Healthcare 的成長。這些結果鞏固了我們多元化業務組合在動態環境中的實力和穩定性，並證明了我們對營運和財務承諾的持續執行。

Key consolidated financial highlights for the second quarter include revenue of $60.5 billion, which represents 25% year-over-year growth and adjusted earnings per share of $6.72 or 10% year-over-year growth. With the strong first half performance, we continue to have confidence in our full year 2024 adjusted earnings per share outlook of at least $28.40, which represents more than 13% year-over-year growth in EPS.

第二季的主要綜合財務亮點包括營收 605 億美元，年增 25%，調整後每股收益 6.72 美元，年增 10%。憑藉上半年的強勁表現，我們繼續對 2024 年全年調整後每股收益至少 28.40 美元的前景充滿信心，這意味著每股收益同比增長超過 13%。

Now turning to our segment results. I'll first comment on Evernorth. Evernorth continues to deliver strong results driven by both of its operating segments. Second quarter 2024 revenues grew to $49.5 billion, while pretax adjusted earnings grew 7% to $1.6 billion, slightly ahead of expectations. Specialty and Care Services showed strong growth with revenue up 18% to $22.9 billion, and pretax adjusted earnings were up 12% to $756 million, at the high end of our long-term target growth range. This performance is a demonstration of our robust and diversified capabilities, as we delivered broad-based growth across our specialty businesses,

現在轉向我們的部門業績。我首先評論Evernorth。 Evernorth 繼續在其兩個營運部門的推動下取得強勁業績。 2024 年第二季營收成長至 495 億美元，稅前調整後收益成長 7% 至 16 億美元，略高於預期。專業和照護服務呈現強勁成長，營收成長 18%，達到 229 億美元，稅前調整後收益成長 12%，達到 7.56 億美元，處於我們長期目標成長範圍的高端。這一業績證明了我們強大和多元化的能力，我們的專業業務實現了廣泛的成長，

Accredo and CuraScript as well as in our care services businesses. Pharmacy Benefit Services also posted strong revenue growth, driven by the addition of new business wins and expansion of existing relationships. Pretax adjusted earnings increased to $798 million as our innovative capabilities continue to drive value for our clients, customers and patients. Overall, we're pleased with Evernorth's second quarter results and continue to expect strong income growth in the second half of the year.

Accredo 和 CuraScript 以及我們的護理服務業務。在新業務的增加和現有關係的擴展的推動下，藥房福利服務也實現了強勁的收入成長。由於我們的創新能力持續為我們的客戶、顧客和患者創造價值，稅前調整後收益增至 7.98 億美元。總體而言，我們對 Evernorth 第二季業績感到滿意，並繼續預計下半年營收將強勁成長。

Turning to Cigna Healthcare. Second quarter 2024 revenues were $13.2 billion and pretax adjusted earnings were $1.2 billion. Second quarter earnings were in line with expectations and included approximately $50 million of unfavorable prior year impact related to Medicare Advantage risk adjustment.

轉向 Cigna 醫療保健。 2024 年第二季營收為 132 億美元，稅前調整後盈餘為 12 億美元。第二季收益符合預期，並包括約 5,000 萬美元的去年與 Medicare Advantage 風險調整相關的不利影響。

The second quarter medical care ratio of 82.3% was within our expected range, inclusive of the aforementioned unfavorable prior year impact of approximately $50 million or 40 basis points on the medical care ratio. Absent this item, the underlying medical care ratio was broadly in line with expectations. As noted previously, we had planned and priced for 2024 medical cost trend to be above 2023 levels, which took into account both unit cost inflation as well as continued elevated utilization.

第二季醫療保健比率為 82.3%，在我們的預期範圍內，其中包括上述上年對醫療保健比率約 5,000 萬美元或 40 個基點的不利影響。若剔除該項目，基本醫療比率基本上符合預期。如前所述，我們計劃並定價 2024 年的醫療成本趨勢將高於 2023 年的水平，其中考慮了單位成本通膨以及利用率的持續提高。

Year-to-date, we have seen elevated cost trends, consistent with our planning and pricing assumptions. The net medical cost payable at the end of the second quarter was $5.04 billion, compared to $5.66 billion at the end of the first quarter. As noted previously, in the first quarter, we had booked approximately $650 million in incremental reserves relating to the Change Healthcare disruption. Those reserves have since developed in line with expectations and claims payments have returned to more normalized levels. driving the sequential decline in net medical cost payable.

今年迄今為止，我們已經看到成本上升的趨勢，這與我們的規劃和定價假設一致。第二季末應付淨醫療費用為50.4億美元，而第一季末為56.6億美元。如前所述，在第一季度，我們已預訂了約 6.5 億美元的與 Change Healthcare 中斷相關的增量準備金。此後，這些準備金的發展符合預期，索賠支付也恢復到更正常的水平。推動應付淨醫療費用連續下降。

Moving to Cigna Healthcare Medical Customers. We ended the quarter with 19 million total medical customers. We expect growth in Cigna Healthcare medical customers for the remainder of the year, primarily driven by growth in our US employer Select and Middle market segments. Overall, Cigna Healthcare delivered consistent results in a dynamic operating environment.

轉向 Cigna Healthcare 醫療客戶。本季結束時，我們的醫療客戶總數為 1,900 萬人。我們預計 Cigna Healthcare 醫療客戶在今年剩餘時間內將出現成長，這主要是由我們的美國雇主精選和中間市場領域的成長所推動的。總體而言，Cigna Healthcare 在動態的營運環境中取得了一致的結果。

Now turning to our outlook for full year 2024. With our continued strong underlying performance in Evernorth and Cigna Healthcare, we are reaffirming our full year 2024 expectation for consolidated adjusted income from operations of at least $8.065 billion or at least $28.40 per share. Regarding cadence of earnings, we expect the third quarter adjusted earnings per share to be approximately 25% of the full year outlook.

現在轉向我們對 2024 年全年的展望。 憑藉 Evernorth 和 Cigna Healthcare 持續強勁的基本業績，我們重申 2024 年全年合併調整後營運收入至少為 80.65 億美元或至少每股 28.40 美元的預期。關於獲利節奏，我們預期第三季調整後每股盈餘將約為全年預期的25%。

Now turning to our 2024 outlook for each of our growth platforms. In Evernorth, we continue to expect full year 2024 pretax adjusted earnings of at least $7 billion. This reflects continued momentum into the second half, with third quarter Evernorth earnings expected to accelerate to high single-digit year-over-year growth, in part due to an increase in adoption of our interchangeable biosimilar offering.

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 年全年稅前調整後收益至少為 70 億美元。這反映了下半年的持續成長勢頭，第三季度 Evernorth 盈利預計將加速至個位數同比增長，部分原因是我們的可互換生物仿製藥產品的採用率有所增加。

For Cigna Healthcare, we continue to expect full year 2024 pretax adjusted earnings of at least $4.775 billion, and we expect the third quarter adjusted earnings to be approximately 25% of the full year outlook. We continue to expect the full year medical care ratio within the range of 81.7% to 82.5%. With the first half medical care ratio coming in at 81.1%, the midpoint of our guidance implies an 83.1% medical care ratio for the second half of the year. We would expect the third quarter to be slightly below that level.

對於 Cigna Healthcare，我們繼續預計 2024 年全年稅前調整後收益至少為 47.75 億美元，並且我們預計第三季調整後收益將約為全年前景的 25%。我們繼續預期全年醫療比率在81.7%至82.5%的範圍內。由於上半年醫療保健比率為 81.1%，我們指引的中點意味著下半年醫療保健比率為 83.1%。我們預計第三季將略低於該水準。

Turning to our 2024 capital management position. As of July 31, we have repurchased 14.7 million shares of common stock or approximately $5 billion, consistent with our previous commentary. We continue to expect at least $11 billion of cash flow from operations. Our balance sheet and cash flow outlook remains strong, benefiting from our efficient asset-light framework that drives attractive returns on capital.

轉向我們 2024 年的資本管理狀況。截至 7 月 31 日，我們已回購 1,470 萬股普通股，約 50 億美元，與我們先前的評論一致。我們仍然預計營運現金流至少為 110 億美元。我們的資產負債表和現金流前景依然強勁，這得益於我們高效的輕資產框架，可帶來有吸引力的資本回報。

Now to recap. Our first half 2024 consolidated results reflect strong contributions and execution from both Evernorth and Cigna Healthcare. Our 2024 outlook reflects the sustained momentum and strong fundamentals of our two growth platforms, which gives us confidence to deliver on our full year 2024 adjusted earnings per share outlook of at least $28.40.

現在回顧一下。我們 2024 年上半年的綜合業績反映了 Evernorth 和 Cigna Healthcare 的強大貢獻和執行力。我們的 2024 年展望反映了我們兩個成長平台的持續勢頭和強勁的基本面，這使我們有信心實現 2024 年全年調整後每股收益至少 28.40 美元的前景。

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)

（操作員說明）

Justin Lake, Wolfe Research.

賈斯汀·萊克，沃爾夫研究中心。

Appreciate the commentary on cost trend. Maybe you can give us an update on what you're seeing by business line and also how things have trended 2Q versus 1Q? When you say it's in line with your pricing and your expectations, is that a year-to-date discussion? Or is that where trend is running today coming out of the second quarter? Is that in line? Or is that more or less elevated versus what you expected?

欣賞對成本趨勢的評論。也許您可以向我們介紹您所看到的業務線的最新情況以及第二季度與第一季的趨勢如何？當你說它符合你的定價和期望時，這是今年迄今為止的討論嗎？或者這就是第二季當前的趨勢嗎？就這樣排隊嗎？或與您的預期相比，這或多或少有所升高？

Justin, it's Brian. So I'll start by saying we're pleased to have delivered another solid quarter of MCR performance at Cigna Healthcare which ran toward the lower end of our MCR guidance range when you exclude the prior year Medicare risk adjustment revenue impacts in the quarter that I mentioned earlier. Now within the quarter, total cost of care was broadly in line with expectations. There are a few puts and takes that I call out if we get into specific cost drivers.

賈斯汀，我是布萊恩。因此，我首先要說的是，我們很高興 Cigna Healthcare 再次實現了穩健的 MCR 業績季度，當您排除上一年 Medicare 風險調整收入影響時，該季度的 MCR 業績已接近我們 MCR 指導範圍的下限。之前提到。現在，在本季度內，總護理成本基本上符合預期。如果我們涉及特定的成本驅動因素，我會提出一些看法。

So we continue to see elevated usage of facility-based services, including emergency room. Additionally, we saw a continuation of elevated utilization of mental health care services, which we do see as a positive over the longer term given the correlation to whole person health. You'll recall in the first quarter, I highlighted slowing growth in surgical costs.

因此，我們繼續看到基於設施的服務（包括急診室）的使用量不斷增加。此外，我們看到精神健康保健服務的使用率持續上升，考慮到與整體健康的相關性，我們確實認為從長遠來看這是積極的。您會記得在第一季度，我強調了手術費用成長放緩。

During the second quarter, we continued to see abatement in the rate of growth of surgical costs although costs still didn't grow. Now taken all together, we are seeing sustained high cost trends, yet these are broadly in line with our guidance as we planned and priced for the elevated utilization levels that began in 2023 to continue throughout 2024.

在第二季度，我們繼續看到手術費用成長率放緩，儘管費用仍然沒有成長。現在總而言之，我們看到了持續的高成本趨勢，但這些趨勢與我們的指導大致一致，因為我們對從 2023 年開始並持續到 2024 年的高利用率水平進行了規劃和定價。

Now specifically in the second quarter, we did not witness aggregate acceleration or deceleration of care patterns within the quarter. I also would not note any month-to-month variability relative to the year-to-date experience that we've seen. So overall, we remain confident in the full year MCR range outlined in our guidance.

現在，特別是在第二季度，我們沒有看到本季護理模式的整體加速或減速。我也不會注意到與我們所看到的年初至今的經驗相比有任何每月的變化。因此，總體而言，我們對指導中概述的全年 MCR 範圍仍然充滿信心。

Lisa Gill with JPMorgan

麗莎吉爾與摩根大通

I want to start with the 2025 selling season on the pharmacy side. You made comments around GLP-1. We continue to see new indications there. I'm just curious, one, when we think about the opportunities in '25, how would you characterize that to what kind of programs are people buying going into 2025?

我想從藥局方面的 2025 年銷售季開始。您對 GLP-1 發表了評論。我們繼續在那裡看到新的跡象。我只是好奇，第一，當我們思考 25 年的機會時，您如何將其描述為人們在 2025 年購買什麼樣的項目？

And then lastly, David, you made a comment that the facts need to be more widely understood when it comes to the pharmacy business. What are your plans around making those facts more wiping known? Because as you know, I agree with you that both Congress as well as the media reports don't fairly reflect what the benefits are of the business.

最後，大衛，您評論說，在製藥業務方面，需要更廣泛地了解事實。您有什麼計劃讓這些事實更為人所知？因為如您所知，我同意您的觀點，國會和媒體報道都沒有公平地反映企業的利益。

Lisa, it's Eric. I'll start then maybe invite David to add some additional comments on the end here. But overall, our foundational pharmacy benefit services business, Express Scripts is off to a really good start for 2025. We've got strong new sales and our 2025 retention rate is going to be consistent with three years and the mid-90s or better.

麗莎，是艾瑞克。我將開始然後也許邀請大衛在最後添加一些額外的評論。但總體而言，我們的基礎藥房福利服務業務Express Scripts 在2025 年有了一個非常好的開始。保持一致。

Stepping back a little bit, Evernorth overall is continues to be well positioned to grow. The specialty business is also positioned for strong growth with significant growth driven by our pharmacy benefits clients electing to use our specialty capabilities as well as strong growth in services sold directly to health systems and other health plans.

退一步來說，Evenorth 總體上仍處於成長的有利位置。專業業務也有望實現強勁增長，我們的藥房福利客戶選擇使用我們的專業能力以及直接銷售給衛生系統和其他健康計劃的服務的強勁增長推動了顯著增長。

So overall, we are quite excited about the strength of the solutions and how they continue to resonate with the market overall. The themes or specific programs that I would point to come back to areas that help to make the value of the dollar spent on medicine is more effective.

總的來說，我們對這些解決方案的實力以及它們如何繼續與整個市場產生共鳴感到非常興奮。我想指出的主題或具體計劃回到有助於使花在醫藥上的美元價值更有效的領域。

So programs like our EnCircleRx program that helps to effectively manage weight loss medication GLP-1 or our most recent oncology benefit offering that David mentioned a bit ago in his prepared remarks. So targeted specific types of programs that work really well with the broader suite of benefit offerings continue to resonate really well in that scenario we continue to invest in. David, do you want to take a bit on the broader environment comment?

因此，像我們的 EnCircleRx 計劃這樣的計劃有助於有效管理減肥藥物 GLP-1 或我們最近的腫瘤學福利產品，大衛之前在他準備好的發言中提到過。因此，在我們繼續投資的情況下，與更廣泛的福利產品組合真正發揮作用的有針對性的特定類型計劃將繼續產生很好的共鳴。 ？

I appreciate the call out. First and foremost, let me reiterate we're proud of the work we do daily, and I'm greatly appreciative of our team that gets up everyday serving our patients and customers through employer relationships, health plane relationships, governmental entity relationships and increasingly through partnerships and collaborations to health care professionals.

我很感謝您的呼籲。首先，讓我重申，我們為我們每天所做的工作感到自豪，我非常感謝我們的團隊，他們每天都透過雇主關係、醫療機構關係、政府實體關係以及越來越多的方式為我們的患者和客戶提供服務。

Second, we will and need to continue to innovate for the benefit of those we serve, whether that's through the likes of ClearCareRx, our patient insurance program, our EnCircle program, our independent pharmacy program, all of which are first in the space.

其次，我們將並且需要繼續創新，以造福我們所服務的人，無論是透過 ClearCareRx、我們的患者保險計劃、我們的 EnCircle 計劃、我們的獨立藥房計劃等，所有這些都是該領域的首創。

Now specific to your question, we challenged ourselves to be much more aggressive and complete relative to communication and engagement in support of our clients, be they employers or health buying customers collaborate even more deeply and intensely with the independent pharmacies and subsegmenting the independent pharmacists who are truly independent and rural working on the hill, of course.

現在針對您的問題，我們挑戰自己，在支持客戶的溝通和參與方面更加積極和全面，無論是雇主還是健康購買客戶，都與獨立藥房進行更深入、更密切的合作，並對獨立藥劑師進行細分當然，他們是真正獨立的農村人，在山上工作。

And then lastly, more aggressively leveraging credible third-party independent analysis of what our industry does and specifically what we do on behalf of those we serve in a fact-based incredible way. So you should expect to see us a bit more complete and aggressive ensuring that we're amplifying that. But make no doubt, we also need to continue to innovate as we have, and we will continue to innovate for the benefit of those we serve.

最後，更積極地利用可靠的第三方獨立分析來分析我們的行業所做的事情，特別是我們以基於事實的令人難以置信的方式代表我們所服務的人所做的事情。因此，您應該期望看到我們更加完整和積極，以確保我們能夠擴大這一點。但毫無疑問，我們還需要繼續創新，我們將繼續創新，以造福我們所服務的人。

A.J. Rice, UBS.

A.J.賴斯，瑞銀。

I might just flip over and ask you about the any distinctive you're seeing in the health benefit selling season across your book, and a large group and select, et cetera. And then also, you called out for quite a while now, fatigue on point solutions. I wonder, I understand how you're addressing affordability and understand how you addressing behavioral health integration.

我可能會翻轉並詢問您在健康福利銷售季節在您的書中看到的任何特色，以及一大群和精選等等。而且，您已經呼籲了很長一段時間，對單點解決方案感到疲勞。我想知道，我了解您如何解決負擔能力問題，也了解您如何解決行為健康整合問題。

But on the point solution question, is there anything that is or do you think you'll consider buying some of these point solutions and then offering them as part of your integrated offering? Do you sort of see yourself getting in the middle of helping employers choose between the myriad of point solutions? How are you addressing that?

但關於單點解決方案問題，您是否認為您會考慮購買其中一些單點解決方案，然後將它們作為整合產品的一部分提供？您是否認為自己正在幫助雇主在無數的單點解決方案中進行選擇？你是如何解決這個問題的？

A.J., it's Brian. I'll start on the Cigna Healthcare selling season and buying pattern dynamic. And then I think David will pick up on the second part of your question relative to point solutions and some of our inorganic activities.

A.J.，是布萊恩。我將從 Cigna Healthcare 的銷售季節和購買模式動態開始。然後我認為大衛會回答你問題的第二部分，涉及點解決方案和我們的一些無機活動。

So as it relates to the Cigna Healthcare selling season, I'll concentrate my comments on the larger end of the US employer market just given the time of the year. We're seeing a relatively consistent number of RFPs this year in comparison to last year at this time. And similarly, in terms of our existing clients, we have a similar amount out to bid as we did last year at this time. So, just for some context on the numbers.

因此，由於它與 Cigna Healthcare 的銷售季節有關，因此我將在一年中的這個時候將我的評論集中在美國雇主市場的較大端。與去年同期相比，今年的 RFP 數量相對穩定。同樣，就我們現有的客戶而言，我們的投標金額與去年同期相似。因此，僅了解一些有關數字的背景資訊。

Now each of these larger employer clients tend to have unique needs. There's a few areas that thematically I'd call out in terms of what our teams are seeing out in the market. One, as David made reference to earlier, affordability continues to be a key area of focus particularly with the wave of drug innovation, including GLP-1s and gene therapy hitting the market.

現在，每個較大的雇主客戶往往都有獨特的需求。根據我們的團隊在市場上看到的情況，我會從主題上指出幾個領域。第一，正如 David 之前提到的，負擔能力仍然是一個關鍵的關注領域，特別是隨著藥物創新浪潮，包括 GLP-1 和基因療法進入市場。

Secondly, to your point, some of the larger employers are seeking to consolidate vendors or point solutions with those who can supply more integrated offerings. Third, we're seeing mental health and substance of these benefits and programs becoming more and more important each year, particularly given some of the downstream effects of the pandemic.

其次，就您的觀點而言，一些較大的雇主正在尋求將供應商或單點解決方案與那些能夠提供更整合產品的供應商進行整合。第三，我們看到心理健康以及這些福利和計劃的實質內容每年變得越來越重要，特別是考慮到大流行的一些下游影響。

And finally, many of these larger clients are interested in digitally enabled care navigation capabilities to drive either further study care optimization or consumer empowerment. So taken all together, our Cigna Healthcare offerings are well positioned to address these themes and demands from large employers.

最後，許多大客戶對數位化護理導航功能感興趣，以推動進一步的研究護理優化或消費者賦權。總而言之，我們的 Cigna Healthcare 產品能夠很好地滿足大型雇主的這些主題和需求。

And importantly, we also continue to see strong traction in net growth in our under 500 Select segment as you'll see in the statistical supplement, 7% year-over-year growth in customers within our Cigna Healthcare Select segment specifically. David, maybe you want to pick up on the point solution question?

重要的是，我們還繼續看到 500 名以下精選細分市場的淨增長強勁，正如您在統計補充中看到的那樣，我們的 Cigna Healthcare Select 細分市場的客戶同比增長了 7%。大衛，也許你想了解點解問題？

Sure. So first, if you think about some of the solutions we identified both in today's call and in prior conversations, you can think about our digital health formulary, as a way that we connect capabilities and work to connect them seamlessly. You can think about the way the Encircle program is designed.

當然。因此，首先，如果您考慮我們在今天的電話會議和之前的對話中確定的一些解決方案，您可以考慮我們的數位健康處方集，這是我們連接功能並努力將它們無縫連接的一種方式。大家可以思考一下Encircle程式的設計方式。

It's designed to have actually coordination and continuity that is patient-centric the oncology program that we will roll out in 2025 is another example of taking specific care need or episode of care and redesigning the pathway to care in a much more coordinated basis, staying focused on the patient and the health care professional.

它的設計目的是具有實際的協調性和連續性，以患者為中心，我們將於2025 年推出的腫瘤學計劃是考慮特定護理需求或護理事件並以更加協調的方式重新設計護理途徑的另一個例子，保持專注關於病人和醫療保健專業人員。

The Cigna Behavioral Group offering that I referenced has much more continuity and coordination of the care experience, starting from the access to the medical professional, the matching and the coordination and there'll be new offerings.

我提到的 Cigna Behavioural Group 的產品在護理體驗方面具有更多的連續性和協調性，從接觸醫療專業人員、匹配和協調開始，並且將會有新的產品。

You can think about all those as largely having been built organically as we continue to invest back in the organization. To the core question through acquisition, you could think about that as well, you never roll it out largely not fueled through acquisition, although there could be episodic coordination of point solutions.

您可以認為所有這些在很大程度上都是隨著我們繼續對組織進行投資而有機構建的。對於透過收購的核心問題，您也可以考慮這一點，儘管可能存在點解決方案的間歇性協調，但在很大程度上不是透過收購推動的，您永遠不會推出它。

And then I would graph in the middle, I'd remind you that we operate the Cigna Ventures organization where we have a now meaningful track record of partnering with organizations where they are, by definition, almost point solutions and helping collaboratively to co-innovate with them as we go forward.

然後我會在中間畫出圖表，我想提醒您，我們運營 Cigna Ventures 組織，我們現在擁有與組織合作的有意義的記錄，根據定義，這些組織幾乎是點解決方案，並幫助協作共同創新與他們一起前進。

So stepping back, largely organically driven proven track record and the acceleration of new innovations that are coming to market for the benefit of those we serve to meet that demand.

因此，退一步來說，很大程度上是有機驅動的、經過驗證的記錄和新創新的加速，這些創新即將進入市場，以造福我們服務的人們，以滿足這一需求。

Andrew Mok, Barclays.

安德魯·莫克，巴克萊銀行。

Hi, good morning. With all the changes coming to Part D, there could be significant changes, not only to membership, but also formulary managing for next year. How does the shifting risk to Part D sponsors impact Evernorth more broadly? And how are you helping clients navigate these changes?

早安.隨著 D 部分的所有變化，可能會發生重大變化，不僅是會員資格，而且明年的規定管理也可能發生重大變化。 D 部分贊助商的風險轉移對 Evernorth 有何更廣泛的影響？您如何幫助客戶應對這些變化？

Andrew, it's David. Let me comment briefly on the PDP macro environment and then ask Eric to walk through our capabilities and our proven track record of supporting our clients relative to their PDP offerings. As you step back, it was clear that the Inflation Reduction Act as it was designed and the ultimate implementation of it was going to cause PDP premiums to rise meaningfully. And most likely, that was going to create some meaningful disruption for seniors.

安德魯，是大衛。讓我簡要評論一下 PDP 宏觀環境，然後請 Eric 介紹一下我們的能力以及我們在支援客戶的 PDP 產品方面的良好記錄。退一步來看，很明顯《通膨削減法案》的設計和最終實施將導致 PDP 保費大幅上漲。最有可能的是，這會給老年人帶來一些有意義的干擾。

Now as the bids have gone in, CMS has assessed those bids and has drawn apparently some of the similar conclusions relative to the acceleration of the bids and the acceleration of the premiums required given the design features. And after reviewing those has created a short-term window for some bid adjustments that we and like others are going through that on an accelerated basis.

現在，隨著投標的進行，CMS 對這些投標進行了評估，並顯然得出了一些與投標加速和考慮到設計特徵所需保費加速相關的類似結論。在審查這些內容後，我們和其他人一樣正在加速進行一些出價調整，這為一些出價調整創造了一個短期窗口。

So that disruption was designed from the Inflation Reduction Act in the marketplace is reacting to that. Mok Eric to talk more specifically to our capabilities and how we work and supportive in many cases, our health plan clients in their PDP book of business to ensure we deliver great quality and overall affordability. Eric?

因此，市場上根據《通貨膨脹減少法案》設計的顛覆正在對此做出反應。 Mok Eric 更具體地談論我們的能力以及我們如何工作，並在許多情況下為我們的健康計劃客戶提供 PDP 業務手冊中的支持，以確保我們提供卓越的品質和整體負擔能力。艾瑞克？

Evernorth and Express Scripts specifically has a long history of supporting health plans to offer Medicare Part D plans. We've got a great track record of a treatment and strong stars outcomes for them and supporting our plans and their offerings and helping them with the tools to manage formularies and model the impacts of changes for example.

Evernorth 和 Express Scripts 在支援健康計劃以提供 Medicare D 部分計劃方面有著悠久的歷史。我們為他們提供了良好的治療記錄和強星級結果，並支持我們的計劃和他們的產品，並幫助他們使用管理處方集和模擬變化影響的工具。

We're continuing to make investments to help ensure our plans are well positioned with the continued evolution of Part D coverage. We even with the most recent round of changes from the IRA like the administrative requirements associated with the copay smoothing just as one example. This continues to be an important part of the Evernorth and Express Scripts business that we're positioned to continue to help our plans succeed and thrive as they work through these changes.

我們將繼續進行投資，以幫助確保我們的計劃能夠隨著 D 部分覆蓋範圍的不斷發展而處於有利位置。我們甚至以愛爾蘭共和軍最近一輪的變化為例，例如與共付額平滑相關的管理要求。這仍然是 Evernorth 和 Express Scripts 業務的重要組成部分，我們將繼續幫助我們的計劃在這些變化中取得成功和蓬勃發展。

Scott Fidel, Stephens.

斯科特·菲德爾，史蒂芬斯。

Hi, thanks and good morning. I was hoping to maybe just touch on the marketplace and a couple of things there. One, just with the Hips 2023 risk adjustment true-up, if you can tell us what the net impact was to earnings if there was any relative to how you had accrued for that?

你好，謝謝，早安。我希望也許能接觸市場和那裡的一些事情。第一，就 Hips 2023 風險調整調整而言，您能否告訴我們，如果與您的累積收益有任何關係，那麼這對收益的淨影響是什麼？

And then also, just when thinking about the commentary on cost trends. Maybe if you could overlay that into the marketplace in terms of if you're seeing a similar trend there and how that's influencing your view on exchange margins for the full year. I think that prior view had been probably still a bit below long-term target there for marketplace margins this year, just interested in an updated view on margins for the year.

然後，就在考慮對成本趨勢的評論時。也許您可以將其疊加到市場中，看看您是否看到了類似的趨勢，以及這如何影響您對全年交易所利潤率的看法。我認為先前的觀點可能仍略低於今年市場利潤率的長期目標，只是對今年利潤率的最新觀點感興趣。

Morning, Scott. It's Brian. Maybe I'll try to just take a big picture view of the individual exchange business in aggregate and hit your risk adjustment question as part of that. So the headline I'd ask you to take away broadly speaking, our individual exchange book is performing as we expected in 2024.

早安，史考特。是布萊恩。也許我會嘗試從整體上全面了解個人交易所業務，並作為其中的一部分解決您的風險調整問題。因此，我想請您注意的標題是，從廣義上講，我們的個人交換簿在 2024 年的表現符合我們的預期。

As it relates to the final 2023 individual exchange risk-adjusted true-up, we had already been accrued for a sizable risk adjustment payable. And in the second quarter results, we did have a small unfavorable true-up that was recorded in the Cigna Healthcare P&L. But overall, this was not a meaningful performance driver in the second quarter for us.

由於它涉及最終的 2023 年個人交易所風險調整調整，我們已經提列了相當大的應付風險調整。在第二季的業績中，我們確實有一個小的不利的調整，記錄在 Cigna Healthcare 損益表中。但總體而言，這對我們來說並不是第二季有意義的業績驅動因素。

And then as it relates to the 2024 performance year, we did receive our first look at the industry-wide risk adjustment data for the specific states we participate, as we closed up the second quarter books and the preliminary industry data confirmed that our previous 2024 risk adjustment assumptions were reasonable.

然後，由於與2024 年業績年度相關，我們確實收到了我們參與的特定州的全行業風險調整數據的第一次查看，因為我們關閉了第二季度賬目，初步行業數據證實了我們之前的2024 年業績風險調整假設合理。

My earlier commentary on cost trends was broadly applicable to the individual exchange business as well. So when you put all the pieces together, we are tracking toward the improved 2024 margin profile we outlined during our first quarter call. And therefore, we'd expect to land the year slightly below our long-term target margin range of 4% to 6% for the individual exchange business.

我之前對成本趨勢的評論也廣泛適用於個人交易所業務。因此，當你把所有因素放在一起時，我們正在追蹤我們在第一季電話會議中概述的改善的 2024 年利潤狀況。因此，我們預計今年個人交易所業務的利潤率將略低於我們 4% 至 6% 的長期目標利潤範圍。

Ryan Langston, TD Cowen.

瑞安·蘭斯頓，TD·考恩。

Hey, good morning. Just looks like the exchange business was down maybe 99,000 to 100,000 members sequentially. I certainly understand why it was down versus '23 year-end, but wasn't exactly expecting that sequential move anything to call out there? And maybe a little early, but I'll ask just any expectations on 2025 in terms of growth trajectory and perhaps even margin profile?

嗨，早安。看起來交易所業務的會員數量連續下降了 99,000 至 100,000 名。我當然理解為什麼它比 23 年底有所下降，但我並沒有完全預料到這種連續的變化有什麼值得指出的嗎？也許有點早，但我會問對 2025 年成長軌跡甚至利潤狀況有何期望？

Thanks. Morning, Ryan, it's Brian. Congratulations on your new role. As it relates to the individual exchange lives intra year, maybe I'll just step back and give you kind of a year-to-date perspective, and then I'll get into the sequential component of your question.

謝謝。早安，瑞安，我是布萊恩。恭喜您擔任新角色。由於它與一年內的個人交換生活有關，也許我會退後一步，給您今年迄今為止的觀點，然後我將進入您問題的連續部分。

So as we discussed during our first quarter results call, the primary driver of the year-to-date change in Cigna Healthcare customer volumes is our individual exchange book. You'll recall that we repositioned this business in 2024, including taking some needed pricing actions in certain geographies in order to improve profitability and we expected to see a reduction in customer volumes as we have witnessed. And sequentially, the individual exchange business drove the majority of the modest decline in the second quarter customer volumes.

因此，正如我們在第一季業績電話會議中討論的那樣，今年迄今為止 Cigna Healthcare 客戶量變化的主要驅動力是我們的個人交換簿。您可能還記得，我們​​在 2024 年重新定位了這項業務，包括在某些地區採取了一些必要的定價行動，以提高盈利能力，並且我們預計客戶數量會減少，正如我們所看到的那樣。其次，個人交易所業務是第二季客戶量小幅下降的主要原因。

Now you should think of the primary driver of that being non-payment of premiums as a result of some of the pricing actions we took in a couple of the larger geographies. So it's essentially the delayed effect of those grace periods kicking in. It was an immaterial impact to our financial results in the quarter. Over the course of the balance of this year, we would expect to see continued strong growth within our US employer under 500 Select segment, which should result in sequential growth in US employer and Cigna Healthcare lives for the balance of the year.

現在您應該想到造成這種情況的主要驅動因素是由於我們在幾個較大的地區採取的一些定價行動而導致未支付保費。因此，這本質上是寬限期開始產生的延遲效應。在今年剩餘的時間裡，我們預計 500 強精選細分市場中的美國雇主將持續強勁增長，這將導緻美國雇主和 Cigna Healthcare 壽險在今年餘下的時間裡連續增長。

So taken all together, we're pleased with the overall balance in the Cigna Healthcare portfolio. As it relates to 2025 in the picture there, we've just recently completed all the pricing and rate filings network design. And until we really see all the competitive dynamics, it's hard to know how that will shake through we would expect our margins to be similar or potentially a little bit better next year in the individual exchange book as we look forward. But too early to know exactly how we'll shake out from a membership standpoint.

總而言之，我們對 Cigna Healthcare 產品組合的整體平衡感到滿意。由於圖中涉及的是 2025 年，我們最近剛完成了所有定價和費率備案網路設計。在我們真正看到所有競爭動態之前，很難知道這將如何改變，我們預計明年在個人交換簿中的利潤率會相似或可能會更好一點，正如我們所期望的那樣。但從會員的角度來看，現在確切知道我們將如何擺脫困境還為時過早。

Josh Raskin, Nephron Research.

喬許·拉斯金，腎單位研究。

Hi, thanks. Good morning. I'd be curious to get your views on the potential for ICRA and specifically how that could impact the small group or select market? And maybe how does stop-loss fit into that equation?

你好謝謝。早安.我很想知道您對 ICRA 潛力的看法，特別是這會如何影響小團體或特定市場？也許停損是如何融入這個等式的？

Josh, it's Brian. I'll take that one as well. So we see the ICRA market in its current form is likely being a niche market, but one that we're monitoring closely. So more specifically, we see the ICRA market as something that could be in a feeling option for smaller employers who tend to be more commoditized buyers. And we expect this is most likely to be an attractive option for employers with less than 50 employees, which is a market segment that is financially immaterial for us today. And within the under 50 market, the average employer there has fewer than 10 employees, so very small employers typically.

喬什，這是布萊恩。我也拿那個。因此，我們認為當前形式的 ICRA 市場可能是一個利基市場，但我們正在密切關注這個市場。因此，更具體地說，我們認為 ICRA 市場對於往往是商品化程度較高的買家的小型雇主來說可能是個明智的選擇。我們預計，對於員工人數少於 50 人的雇主來說，這很可能是一個有吸引力的選擇，而這個細分市場對於我們今天來說在財務上並不重要。在 50 歲以下市場中，雇主的平均員工人數不到 10 人，因此雇主通常規模很小。

Now all that said, our individual exchange business represents an opportunity for us to participate in the ICRA space, should it gain more momentum? Again, I didn't know where I started and that we see this most likely being a niche market our stop-loss offerings, to your question, are fully integrated with our Select segment business. So you should not think of that as something that is a net threat to us in the select market provided that the under 50 concentration transpires the way that I described earlier.

話雖如此，我們的個人交易所業務為我們提供了參與 ICRA 領域的機會，它是否應該獲得更多動力？再說一次，我不知道我從哪裡開始，我們認為這很可能是一個利基市場，對於你的問題，我們的停損產品與我們的精選細分市場業務完全整合。因此，如果 50 歲以下人群的集中度按照我之前描述的方式發生，您不應將其視為對我們精選市場的淨威脅。

George Hill, Deutsche Bank.

喬治·希爾，德意志銀行。

Yes. Good morning, guys. I thought I'd just ask a question on what I consider to be your cost of goods sold line, which is there continues to be a lot of discussion from the retail pharmacy side of the business around trying to negotiate new payment models or changes in terms. I don't know if there's any update that you can provide on how those conversations are progressing?

是的。早上好傢伙。我想我只想問一個關於我認為你們的商品銷售成本是多少的問題，零售藥房業務方面仍然有很多討論圍繞嘗試協商新的支付模式或改變條款。不知道能否介紹一下這些對話的進展？

Good morning, George, it's Eric. First, I'm going to comment on any specific negotiations with any pharmacies or things along those lines. But as you know, we've got a wide array of choices and options for our clients. That extends to how we've constructed our network as we look to balance access and affordability that best meets the needs of our clients and their patients.

早安，喬治，我是艾瑞克。首先，我將對與任何藥房或類似事項的任何具體談判發表評論。但如您所知，我們為客戶提供了廣泛的選擇和選擇。這延伸到了我們如何建立我們的網絡，因為我們希望平衡可及性和負擔能力，以最好地滿足我們的客戶及其患者的需求。

So we work to assemble a range of different network options under a range of different reimbursement types that match up with the needs for cost access and the associated trade-offs and touch there for our clients. So overall, that approach has served us well.

因此，我們致力於在一系列不同的報銷類型下組裝一系列不同的網路選項，以滿足成本獲取和相關權衡的需求，並為我們的客戶提供協助。總的來說，這種方法對我們很有幫助。

We work to continue to innovate to bring new solutions to market. An example of a new solution there would be like late last year, we announced our ClearNetwork Solution. ClearNetwork provides a comprehensive simple solution in that, the pricing is based off of independent, externally created index and then it's got a simple margin that's shared between us and the pharmacy.

我們致力於持續創新，將新的解決方案推向市場。新解決方案的一個例子是去年年底，我們發布了 ClearNetwork 解決方案。 ClearNetwork 提供了一個全面的簡單解決方案，其中定價基於獨立的外部創建的指數，然後由我們和藥房共享簡單的利潤。

So it's a new offering we put in the market last year that's generating interest. But again, overall, the portfolio of offerings that we continue to pull together resonates with our buyers and is part of the reason we've continued to grow the pharmacy benefits services, chassis nicely over the last few years.

因此，這是我們去年推出市場的新產品，引起了人們的興趣。但總的來說，我們繼續整合的產品組合與我們的買家產生了共鳴，這也是我們在過去幾年中繼續發展藥品福利服務和框架的部分原因。

Kevin Fischbeck, Bank of America.

凱文‧菲施貝克，美國銀行。

Hey. This is Adam on for Kevin. So you raised guidance in Q1 on what seems like a smaller beat at least for street expectations, but you didn't raise guidance this quarter. Can you give a little more color on why maybe you wouldn't raise and how things came in versus your expectations? And if there's anything to read into on the PYD or maybe on DCPs being down. Any color would be helpful.

嘿。這是凱文的亞當。因此，您在第一季提出了指導意見，至少對於街頭預期來說，這看起來似乎較小，但本季您沒有提出指導意見。您能否詳細說明為什麼您可能不加註以及事情的進展與您的預期有何不同？如果有任何關於 PYD 或 DCP 宕機的資訊需要了解。任何顏色都會有幫助。

Morning, Adam, it's Brian. So first off, we're pleased to have delivered another strong quarter of results on both the top and bottom lines with overall results slightly ahead of our expectations in the second quarter. Now within the quarter, we did have some timing-related benefits, including tax items that contributed to the strength in the EPS line, and we're pleased to reaffirm our full year guidance as well as all key supporting metrics considering this dynamic environment.

早安，亞當，我是布萊恩。首先，我們很高興在營收和利潤方面又取得了強勁的季度業績，第二季的整體業績略高於我們的預期。現在，在本季度內，我們確實獲得了一些與時間相關的收益，包括有助於增強每股收益的稅收項目，我們很高興重申我們的全年指導以及考慮到這種動態環境的所有關鍵支持指標。

And importantly, both Evernorth and Cigna Healthcare are delivering against their respective commitments. Taking into account the environment, we're being prudent with this attractive full year EPS outlook of at least $2.40, representing over 13% growth near the high end of our long-term average annual EPS growth rate range of 10% to 14%.

重要的是，Evernorth 和 Cigna Healthcare 都在履行各自的承諾。考慮到環境，我們對這一有吸引力的全年每股收益前景持謹慎態度，該前景至少為2.40 美元，相當於超過13% 的增長，接近我們長期平均年每股收益增長率範圍10%至14% 的上限。

Erin Wright, Morgan Stanley.

艾琳·賴特，摩根士丹利。

So you called out the strength across specialty and services at Evernorth. I guess, how do we think about the Humira strategy contributing to the results now? And then how does that influence sort of the quarterly progression across Evernorth in the back half of the year? And just the strategy around Humira, and how that's playing out relative to your expectations? Have you, for instance, in-sourced? Humira similar across your CuraScript business. Does it make sense to in-source more than the 50%, for instance, that you're targeting on that front?

所以你稱讚了 Evernorth 在專業和服務方面的優勢。我想，我們現在如何看待 Humira 策略對結果的貢獻？那麼這對今年下半年 Evernorth 的季度進展有何影響？圍繞 Humira 的策略，以及相對於您的期望而言，其效果如何？例如，您有內源嗎？ Humira 與您的 CuraScript 業務類似。例如，在這方面內源化超過 50% 的目標是否有意義？

Okay. Thanks. Good morning. It's David. Let me start. You have a lot in your question and appreciate it, given the importance of the space. First, just to reiterate, the Specialty and Care part of the portfolio represents really 30% of our enterprise today. And we're quite excited about the growth potential for that business. We see the product business portfolio as a provision of care business that leverages in many cases, and we're talking about the specialty services.

好的。謝謝。早安.是大衛。讓我開始吧。考慮到這個空間的重要性，你的問題有很多，並且很欣賞。首先，重申一下，產品組合中的專業和護理部分實際上占我們當今企業的 30%。我們對該業務的成長潛力感到非常興奮。我們將產品業務組合視為在許多情況下發揮作用的護理業務的提供，我們正在談論專業服務。

As noted, we had strong growth in the second quarter of 12% and as we discussed for quite some time, the breadth of our capabilities position us well relative to changes in the marketplace, more specifically the biosimilar opportunity. Now you have multiple questions here that I'll ask Eric to peel back a little bit relative to the more specific opportunities we see both in terms of our core business through Accredo as well as through CuraScript as we're expanding our capabilities in our portfolio. Eric?

如前所述，我們在第二季度實現了12% 的強勁增長，正如我們討論了相當長一段時間的那樣，我們能力的廣度使我們能夠很好地應對市場的變化，更具體地說是生物仿製藥的機會。現在您有多個問題，我將請 Eric 稍微討論一下我們在透過 Accredo 以及透過 CuraScript 擴展我們的產品組合能力時在核心業務方面看到的更具體的機會。艾瑞克？

Thanks, David. So, just stepping back a little bit again as well. Biosimilars are really important opportunity to improve the affordability of these high-cost specialty medicines. And we're really well positioned to help to connect our clients and their customers with these therapies. Our approach here has been consistent in that we offer choice and value to best align with our clients' needs.

謝謝，大衛。所以，也只是再退一步。生物相似藥確實是提高這些高成本特殊藥物的可負擔性的重要機會。我們確實有能力幫助我們的客戶及其客戶與這些療法建立聯繫。我們的做法始終如一，即提供最符合客戶需求的選擇和價值。

And we're focused on getting to low net cost fuel and competition and aligning incentives for everyone involved. The patients, our clients, our plan sponsors and the pharma supply chain. As you've made reference to in your question through Quallent Pharmaceuticals, our private label distributor we contracted with multiple manufacturers for interchangeable biosimilar Humira, and this is available at no cost to patients and attractive cost to plan sponsors began shipping this product at the very end of June.

我們專注於實現低淨成本燃料和競爭，並為每位參與者制定激勵措施。患者、我們的客戶、我們的計畫贊助商和藥品供應鏈。正如您在問題中提到的那樣，Quallent Pharmaceuticals 是我們的自有品牌分銷商，我們與多家製造商簽訂了可互換生物仿製藥Humira 的合同，患者可以免費獲得該產品，並且對計劃贊助商來說價格有吸引力，開始在六月底。

So just a few weeks ago, we've already seen meaningful uptake in the last few weeks, consistent with our expectations. We expect the customer adoption to continue to grow over the balance of the year. And it's early, five weeks in, really or so, but we see biosimilars having about a 20% share of our book at this point after just shipping this product for the last five weeks. I've said to overall continue to see that this is a real opportunity for us to improve the affordability of health care for the benefit of our clients and our plan sponsors.

因此，就在幾週前，我們已經看到了過去幾週的有意義的吸收，這與我們的預期一致。我們預計客戶採用率將在今年餘下時間持續成長。現在還為時過早，大約五週後，但我們看到生物相似藥在過去五週內剛剛發貨後，目前在我們的書籍中所佔的份額約為 20%。我說過，總體而言，我們將繼續看到這對我們來說是一個真正的機會，可以提高醫療保健的負擔能力，從而造福我們的客戶和計劃發起人。

Stephen Baxter, Wells Fargo.

史蒂芬‧巴克斯特，富國銀行。

Yes, hi. Thanks. One of the questions has been asked, but I wanted to ask about in-group membership trends. It does seem we're starting to see more mixed data on the job front. Could you spike out a little bit what you're seeing in the in group trends? And do you think your sequential membership changes are generally a good reflection of that?

是的，嗨。謝謝。其中一個問題已被問到，但我想問團體內成員的趨勢。我們似乎確實開始在工作方面看到更多混合數據。您能否指出一些您在群體趨勢中看到的情況？您認為您的連續會員資格變更通常很好地反映了這一點嗎？

Steve, good morning. It's David. As we discussed back in 2023, as the year was unfolding, just by way of context, we were very mindful of the potential for some softening of the employer marketplace. And then to your point, in group trends softening a little bit. And when we state of quite close to monitoring it, it didn't really manifests itself in any material way, given employers we're still working to get to a full level of employment.

史蒂夫，早安。是大衛。正如我們在 2023 年討論的那樣，隨著這一年的展開，僅從背景來看，我們非常關注雇主市場可能出現的疲軟情況。然後就你的觀點而言，團體趨勢有所軟化。當我們非常接近監控它時，它並沒有真正以任何實質方式表現出來，因為我們仍在努力實現充分就業水平的雇主。

For 2024, we've taken a similar cautious curious monitoring approach and built a little bit of consideration relative to softening. And by and large, we have not seen that to date. So the membership headlines that we've delivered represent good fundamental strength as Brian noted previously, the change in our membership is largely driven by our as expected, dampening of the marketplace, as you would call it, our individual exchange business. But we remain closely monitoring any dampening tied to the economy and thus far haven't seen anything material to call out there.

對於 2024 年，我們採取了類似的謹慎好奇的監控方法，並針對軟化進行了一些考慮。總的來說，到目前為止我們還沒有看到這種情況。因此，我們發布的會員資格標題代表了良好的基本實力，正如布萊恩之前指出的那樣，我們會員資格的變化很大程度上是由我們預期的市場抑制所驅動的，正如您所說的那樣，我們的個人交易所業務。但我們仍在密切關注與經濟相關的任何抑制因素，到目前為止還沒有看到任何值得指出的重大消息。

Dave Windley, Jefferies.

戴夫·溫德利，杰弗里斯。

Hi, good morning. Thanks for taking my question. Brian, in your comments, I think I heard you say that the excess reserves from 1Q have basically developed in line with your expectations. I think I also heard you say that you didn't see any, say, intra quarter trends or a particular month in the quarter that stood out as an anomaly.

早安.感謝您提出我的問題。 Brian，在您的評論中，我想我聽到您說第一季超額準備金的發展基本上符合您的預期。我想我還聽到您說您沒有看到任何季度內趨勢或該季度中的某個特定月份作為異常現象。

And I think in looking at your progression looks like MLR implied for the second half is maybe in the neighborhood of 200 basis points above the first half historical normal, maybe about half of that. So just wanted to understand if the higher MLR expectation for the second half is kind of cautious posture or if you're expecting certain things to accelerate in the second half that would drive that.

我認為，從你的進展來看，MLR 暗示的下半年可能比上半年歷史正常水平高出 200 個基點左右，也許大約是一半。因此，我只是想了解國土資源部對下半年的較高預期是否是一種謹慎的態度，或者您是否預計下半年某些事情會加速，從而推動這一趨勢。

And maybe a last question would be relative to pricing, would you view yourselves as pricing to forward view of trend as you head into next year? Or would you be pricing to expand margin? Another long question.

也許最後一個問題與定價有關，當你進入明年時，你是否認為自己的定價是為了展望趨勢？或者您會定價以擴大利潤嗎？又是一個很長的問題。

No problem, Dave. So as it relates to the second half MCR guidance, I think your question was in a year-over-year context. Really, three factors that I'd highlight, if you're looking at it relative to the back half of '23, you may recall from our first quarter earnings release, we discussed that the 2024 seasonality would be more similar to pre-pandemic norms with the MCR increasing as the year unfolded, in part driven by our individual exchange business metal tier mix, which is skewed more bronze this year.

沒問題，戴夫。因此，由於它與下半年 MCR 指導相關，我認為你的問題是在同比背景下提出的。事實上，我要強調的三個因素，如果你相對於 23 年下半年來看，你可能還記得我們第一季的收益發布，我們討論過 2024 年的季節性將更類似於大流行前隨著今年的展開，MCR 的規範不斷增加，部分原因是我們個人交易所業務的金屬層組合，今年銅牌的比重更大。

Additionally, we had some favorable stop loss utilization in the fourth quarter of 2023 that we are anticipating will normalize in 2024 and our year-to-date experience is consistent with that expectation. And then finally, there is one additional business day in the third quarter of this year, which has some elevation in the MCR in the third quarter specifically for that.

此外，我們在 2023 年第四季有一些有利的停損利用率，我們預計這些停損利用率將在 2024 年正常化，而我們今年迄今的經驗與這一預期一致。最後，今年第三季增加了一個工作日，這使得第三季的 MCR 專門為此而有所上升。

So all those factors combined to generate a higher second half MCR year-over-year. But again, we remain comfortable and confident with the full year MCR guidance range that we provided here.

因此，所有這些因素結合在一起，產生了同比更高的下半年 MCR。但我們再次對我們在此提供的全年 MCR 指導範圍保持放心和信心。

As it relates to the pricing environment, and I'll comment specifically on our US employer business, as a reminder, this is a book that's nearly 85% ASO or self-funded. So therefore, we have earnings levers that go well beyond a pure risk-based MCR, but that said, our US employer book is currently operating from a position of strength as we've been performing within target margin ranges.

因為它涉及定價環境，我將專門評論我們的美國雇主業務，提醒一下，這是一本近 85% ASO 或自籌資金的書。因此，我們的獲利槓桿遠遠超出了純粹基於風險的 MCR，但話雖如此，我們的美國雇主帳目目前處於強勢地位，因為我們一直在目標利潤範圍內表現。

And we remain disciplined with our own pricing strategy in the current environment. We continue to price to our best estimate of forward-looking cost trends. To your point, I don't need additional margin recapture at the book level. We are seeing the impact of inflation work its way through our provider contracts. As these contracts renew, we continue to expect elevated levels of utilization through 2024.

在當前環境下，我們仍然遵守自己的定價策略。我們繼續根據前瞻性成本趨勢的最佳估計來定價。就您的觀點而言，我不需要在帳面層級收回額外的保證金。我們看到通貨膨脹的影響透過我們的供應商合約發揮作用。隨著這些合約的續簽，我們預計到 2024 年利用率將會提高。

So when you put all those pieces together, our all-in pricing trend for 2024, slightly higher than what we had assumed a year ago for the corresponding 2023 pricing cycle. And we're confident in our ability to secure appropriate pricing for 2025 and beyond. So a long answer to your long question.

因此，當你把所有這些部分放在一起時，我們 2024 年的整體定價趨勢略高於我們一年前對相應 2023 年定價週期的假設。我們對確保 2025 年及以後的適當定價的能力充滿信心。這是對你的長問題的長答案。

Jessica Tassan, Piper Sandler.

傑西卡·塔桑，派珀·桑德勒。

Hi, thank you so much for taking the question. I'm curious how you're thinking about the possibility that Skyrizi and Rinvoq substitutions could maybe foreclose the Humira biosimilar opportunity? And I guess just what recourse do you have to ensure that the biosimilar products that you've got in the market succeed, I think you've given us plenty of evidence that they're the best for the patients. So just yes, how are you thinking about the possibility of foreclosure and what can you do to kind of prevent or mitigate that? Thank you.

您好，非常感謝您提出問題。我很好奇您如何看待 Skyrizi 和 Rinvoq 替代品可能會排除 Humira 生物相似藥機會的可能性？我想你有什麼辦法來確保你在市場上獲得的生物相似藥產品取得成功，我認為你已經給了我們足夠的證據表明它們對患者來說是最好的。那麼，您如何看待取消抵押品贖回權的可能性以及您可以採取哪些措施來防止或減輕這種情況？謝謝。

Jessica, it's Eric. So I guess stepping back, our approach is focused on offering choice and value and getting to the lowest cost and best available solution from a patient perspective. So a couple of things I would note. First of all, our biosimilar offering is interchangeable. And so that facilitates an easier election if a patient chooses to choose a biosimilar, it's an easier process by being interchangeable, so that would be one thing I would note as a differentiator for us.

潔西卡，這是艾瑞克。因此，我想退一步來說，我們的方法專注於提供選擇和價值，並從患者的角度獲得最低成本和最佳可用的解決方案。所以我要注意一些事情。首先，我們的生物相似藥產品是可以互換的。因此，如果患者選擇生物相似藥，這會促進更容易的選擇，因為可互換，這是一個更容易的過程，所以這將是我要指出的一件事，作為我們的差異化因素。

More broadly, we're here to facilitate and ensure patients have access to the medicines that they need. So if the Skyrizi or Rinvoq will be in a position to fulfill that as well. But overall, we're working to make sure that we've got the right access to all of the medication. As we look ahead, ensuring we've got on a fully developed portfolio of all of the available biosimilar offerings will be important, and we'll continue to be in a position to lead here.

更廣泛地說，我們來這裡是為了促進並確保患者能夠獲得他們需要的藥物。因此，如果 Skyrizi 或 Rinvoq 也能夠實現這一目標。但總的來說，我們正在努力確保我們能夠正確獲得所有藥物。展望未來，確保我們擁有所有可用生物相似藥產品的全面開發的產品組合將非常重要，並且我們將繼續處於領先地位。

Lance Wilkes, Bernstein.

蘭斯威爾克斯，伯恩斯坦。

Great. Thanks, guys. Could you just give me a little more color on some of the faster growth areas in Evernorth, in particular, if you could talk a little bit about GLP-1 coverage outlook for -- during the selling season for next year, so fee growth has been really strong. How much of that is coming from traditional PBM versus care services growth? And are you seeing any of that in Accredo? Thanks.

偉大的。多謝你們。您能否給我更多關於 Evernorth 一些增長較快的地區的信息，特別是如果您可以談談明年銷售季節期間的 GLP-1 覆蓋前景，因此費用增長已經真的很堅強。其中有多少來自傳統的 PBM 與護理服務的成長？您在 Accredo 中看過這樣的情況嗎？謝謝。

Lance. Good morning. It's Eric. So let me start and just talk a little bit about the Encircle and then I'll ask Brian to talk a little bit more about the numerical dimensions of things. So within the Encircle program, we've got over 2 million covered lives at this point. So that's growing nicely. Stepping back a little bit in terms of just looking at the coverage for GLP-1s for weight loss indications overall in the Express Scripts business, we've now got essentially 50% or so of plan sponsors covering for weight loss indications. So we've seen continued incremental growth there. The underlying utilization levels also continue to grow nicely. We've seen growth there, consistent with what you might have seen from an industry growth perspective or things along those lines.

槊。早安.是埃里克。因此，讓我開始談談包圍圈，然後我會請布萊恩多談談事物的數字尺寸。因此，在 Encircle 計畫中，目前我們已經涵蓋了超過 200 萬條生命。所以它生長得很好。退後一步，僅查看 Express Scripts 業務中整體減肥適應症的 GLP-1 承保範圍，我們現在基本上有 50% 左右的計劃發起人承保減肥適應症。因此，我們看到了那裡的持續增量成長。基礎利用率水準也持續良好成長。我們已經看到了那裡的成長，這與您從行業成長角度或類似情況所看到的一致。

Looking ahead, we expect the use of these medications to continue to grow. And that is part of the growth algorithm for Evernorth overall. Stepping away from GLP-1 specifically, we see broader growth opportunity in specialty with continued growth, both through new therapies through biosimilars coming to market as well as us continuing to expand our relationships whether that's through our CuraScript, specialty distributor or through other direct opportunities. So overall, growth across a number of different fronts within Evernorth that we're pleased to be in a position to deliver. Brian, do you want to pick up the second part of Lance's question?

展望未來，我們預計這些藥物的使用將持續成長。這是 Evernorth 整體成長演算法的一部分。具體來說，遠離GLP-1，我們看到了專業領域更廣泛的成長機會，並且持續成長，無論是透過進入市場的生物相似藥的新療法，還是我們繼續擴大我們的關係，無論是透過我們的CuraScript、專業經銷商還是透過其他直接機會。總的來說，我們很高興能夠實現 Evernorth 內部多個不同領域的成長。布萊恩，你想回答蘭斯問題的第二部分嗎？

Sure. So as it relates to the fees and other revenue line in Evernorth, which is up 14% quarter-over-quarter, I think about a number of different areas contributing to the strong performance. contributions from our Evernorth Care businesses are reflected here. So think of EviCore, MDLIVE, our behavioral health business.

當然。因此，由於它與 Evernorth 的費用和其他收入線相關（季度環比增長 14%），我認為許多不同的領域促成了強勁的業績。我們 Evernorth Care 業務的貢獻都體現在這裡。想想我們的行為健康業務 EviCore、MDLIVE。

And then additionally, to the core of your question, we are seeing continued growth in service-based solutions within the pharmacy benefit services business where clients are electing more fee-based orientations with us.

此外，對於您問題的核心，我們看到藥品福利服務業務中基於服務的解決方案持續成長，客戶在我們這裡選擇更多基於收費的方向。

So finally, the other contributor to this is the cross enterprise leverage that we're driving with Cigna Healthcare results in revenue from Cigna Healthcare showing up in fees and other revenue in Evernorth and then being eliminated at the corporate level. So all of those contribute to that strong growth in the fees and other revenue line.

最後，另一個因素是我們與 Cigna Healthcare 推動的跨企業槓桿作用，導致 Cigna Healthcare 的收入顯示在 Evernorth 的費用和其他收入中，然後在公司層面被消除。因此，所有這些都有助於費用和其他收入的強勁增長。

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

偉大的。謝謝。我將把電話轉回給大衛·科達尼 (David Cordani) 進行總結發言。

First, let me thank you all for your engagement today, your time and your questions. I just want to highlight a few headline points. With our momentum, we are confident that we will deliver on our EPS outlook of at least $28.40 for 2024, which represents over a 13% growth rate from 2023.

首先，讓我感謝大家今天的參與、時間和問題。我只想強調幾個標題要點。憑藉我們的勢頭，我們有信心實現 2024 年每股收益至少 28.40 美元的預期，這意味著自 2023 年以來增長率將超過 13%。

Additionally, before we close, I want to recognize and express appreciation to our 70,000 co-workers across the globe. It's their continued focus, dedication and commitment to support our clients, our customers, our patients and our partners that enable us to deliver on our commitments, including those to you, our shareholders.

此外，在結束之前，我想向我們全球 70,000 名同事表示認可和感謝。正是他們對支持我們的客戶、顧客、患者和合作夥伴的持續關注、奉獻和承諾，使我們能夠兌現我們的承諾，包括對您、我們的股東的承諾。

We're proud of what we've achieved, and we're excited about the opportunities that stand as we look ahead. And as always, we look forward to our future discussions. Have a great day. Thanks.

我們為我們所取得的成就感到自豪，我們對展望未來的機會感到興奮。一如既往，我們期待未來的討論。祝你有美好的一天。謝謝。

Ladies and gentlemen, this concludes the Cigna Group's second 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. You may access the recorded conference by dialing (800) 839-1190 or (203) 369-3031. There is no passcode required for this replay. Thank you for participating. We will now disconnect.

女士們先生們，信諾集團 2024 年第二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。您可以撥打 (800) 839-1190 或 (203) 369-3031 存取錄製的會議。此重播不需要密碼。感謝您的參與。我們現在將斷開連接。