信諾集團 (CI) 2024 Q3 法說會逐字稿

Ladies and gentlemen, thank you for standing by for the Cigna Group's Third 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 年第三季業績回顧。 （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 will begin by turning the conference over to Ralph Giacobbe. Please go ahead.

我們首先將會議交給拉爾夫·賈科布 (Ralph Giacobbe)。請繼續。

Thanks, operator. Good morning, everyone. Thank you for joining today's call. I'm Ralph Giacobbe, Senior Vice President of Investor Relations. With me on the line this morning are David Cordani, the Cigna Group's Chairman and Chief Executive Officer; Brian Evanko, Chief Financial Officer 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，接線生。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 third 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，包括我們第三季度的財務業績和 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.

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

A reconciliation of these measures to the most directly comparable GAAP measures, shareholders net income and total revenues, respectively, is contained in today's earnings release, which is posted in the Investor Relations section of the cignagroup.com. 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. A description of these risks and uncertainties is contained in the cautionary note to today's earnings release and in our most recent reports filed with the SEC.

在今天的演講中，我們將做出一些前瞻性聲明，包括有關我們對 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。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 couple of items pertaining to our GAAP financial results. In the third quarter, we recorded shareholders' net income of $739 million or $2.63 per share. This is driven by a noncash, after-tax net realized investment loss of $1 billion or $3.69 per share related to VillageMD. This includes both the write-down of the remaining carrying value of the asset as well as the impairment of the dividend, which is recognized as a special item in the quarter. This is excluded from adjusted income from operations and adjusted earnings per share in our discussion of financial results.

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。第三季度，我們的股東淨利潤為 7.39 億美元，即每股 2.63 美元。這是由與 VillageMD 相關的 10 億美元或每股 3.69 美元的非現金稅後淨實現投資損失所推動的。這包括資產剩餘帳面價值的減記以及股利減損，股利被確認為本季的特殊項目。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。

In the third quarter, we also recorded other after-tax net special item charges of $162 million or $0.58 per share. Details of the special items are included in our quarterly financial supplement. Additionally, please note that when we make prospective comments regarding financial performance, including our full year 2024 outlook, we'll do so on a basis that includes the potential impact of future share repurchases and anticipated 2024 dividends.

第三季度，我們也記錄了其他稅後淨特殊項目費用 1.62 億美元或每股 0.58 美元。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，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 today's call. Today, I'll spend a few minutes talking about our strong results in the third quarter and how we're advancing our growth strategy. I'll also provide some initial perspective relative to 2025, including some of the expected tailwinds and headwinds. Then Brian will share more detail about our results and our outlook for the rest of the year and then we'll take your questions. So let's get started.

謝謝，拉爾夫。大家早安，感謝您參加今天的電話會議。今天，我將花幾分鐘討論我們第三季的強勁業績以及我們如何推進我們的成長策略。我還將提供一些相對於 2025 年的初步看法，包括一些預期的有利因素和不利因素。然後布萊恩將分享更多關於我們的業績和今年剩餘時間的展望的細節，然後我們將回答你們的問題。那麼就讓我們開始吧。

Building on a track record of competitively differentiated performance, I'm pleased to report that in the third quarter, the Cigna Group delivered total revenue of $63.7 billion and adjusted earnings per share of $7.51. Our results are a testament to the collective depth and strength of our people and commitment, hard work, and focus they bring to everything we do.

基於具有競爭優勢的業績記錄，我很高興地報告，第三季度，Cigna Group 的總收入為 637 億美元，調整後每股收益為 7.51 美元。我們的成果證明了員工的集體深度和力量，以及他們為我們所做的一切所做的承諾、辛勤工作和專注。

We have deep continuity and the most experienced leadership team in the industry with more than 16 years average tenure across our growth platforms. And we continue to infuse new talent into the company to across many sectors and industries to round out our enterprise perspective.

我們擁有深厚的連續性和業內最有經驗的領導團隊，在我們的成長平台上平均任期超過 16 年。我們不斷向公司注入跨領域和行業的新人才，以完善我們的企業願景。

Our third quarter performance demonstrates how we harness the complementary capabilities of our two growth platforms, Evernorth Health Services and Cigna Healthcare to drive attractive growth.

我們第三季的業績展示了我們如何利用 Evernorth Health Services 和 Cigna Healthcare 兩個成長平台的互補能力來推動有吸引力的成長。

This quarter, Evernorth anchored our results by delivering strong top and bottom line contributions generated by market-leading innovation and affordability initiatives, particularly within our specialty and care services folio as well as our pharmacy benefit services business. Evernorth's strong overall growth reflects the continued demand for our services as we continue investing in broadening our offerings and expanding our reach.

本季度，Evernorth 透過市場領先的創新和可負擔性計劃產生的強勁頂線和底線貢獻來支撐我們的業績，特別是在我們的專業和護理服務組合以及我們的藥品福利服務業務中。 Evernorth 強勁的整體成長反映了對我們服務的持續需求，因為我們繼續投資擴大我們的產品和範圍。

Cigna Healthcare was also continuing their momentum in the quarter. US employer business draws on enterprise capabilities to deliver greater affordability and support healthy outcomes for the benefit of our clients, and their employees and families. Of note, we are driving continued solid growth in our select customer segment. Our results demonstrate focus execution and momentum during our peak selling season and continued opportunity for growth in the years ahead.

Cigna Healthcare 在本季也持續維持成長動能。美國雇主企業利用企業能力提供更大的負擔能力並支持健康的結果，以造福我們的客戶及其員工和家庭。值得注意的是，我們正在推動特定客戶群的持續穩健成長。我們的業績證明了銷售旺季期間的專注執行力和勢頭，以及未來幾年的持續成長機會。

Touching on our Medicare Advantage business, we remain on track to close on our sale of our Medicare business to HCSC in the first quarter of 2025. We continue to expect to use the majority of the proceeds for share repurchase. I would note that our Medicare business is performing in line with expectations, and we're pleased with the overall value of our offerings, including our nationwide enrollment weighted average will again be 4 stars for 2025.

談到我們的 Medicare Advantage 業務，我們仍有望在 2025 年第一季完成將 Medicare 業務出售給 HCSC。我要指出的是，我們的醫療保險業務的表現符合預期，我們對我們產品的整體價值感到滿意，包括我們的全國註冊加權平均數將在 2025 年再次達到 4 顆星。

Going forward, our focus will be on further growing our Evernorth chassis to continue to serve Medicare lives. Overall, our quarterly results reflect clear strategy and strong execution, resulting in attractive results.

展望未來，我們的重點將是進一步發展 Evernorth 底盤，以繼續為醫療保險生活服務。總體而言，我們的季度業績反映了明確的策略和強大的執行力，從而產生了有吸引力的結果。

Now stepping back, I want to take a moment to comment on recent headlines and speculation around our company. And while we don't comment on media rumors, we believe that it is important to provide additional context during these unprecedented times.

現在退一步，我想花點時間評論一下最近的頭條新聞和圍繞我們公司的猜測。雖然我們不對媒體謠言發表評論，但我們認為在這個前所未有的時期提供更多背景資訊非常重要。

First, there is no question that the industry is highly disrupted. For example, the Medicare event market is particularly challenged given a number of factors, including elevated medical cost, a significant change in stars ratings for many, and the reset of the risk-adjusted revenue streams. These and other forces are contributing to operational disruption for some as well.

首先，毫無疑問，這個行業受到了高度幹擾。例如，考慮到許多因素，包括醫療成本上升、許多人的星級評級發生重大變化以及風險調整後收入流的重置等，醫療保險活動市場尤其面臨挑戰。這些因素和其他因素也導致了一些企業的營運中斷。

As I noted, we don't comment on numbers, but what I will do is be very clear on the actions we are pursuing. We continue to deploy our excess free cash flow for share repurchase, with repurchases totaling $5.7 billion year-to-date, including over $715 million in October. Looking forward, we expect to continue to actively repurchase our shares in the fourth quarter, further leveraging our remaining repurchase capacity, which stands at [$5.6 billion].

正如我所指出的，我們不會對數字發表評論，但我會非常清楚地說明我們正在採取的行動。我們繼續將多餘的自由現金流用於股票回購，今年迄今的回購總額為 57 億美元，其中 10 月的回購總額超過 7.15 億美元。展望未來，我們預計將在第四季繼續積極回購股票，進一步利用我們剩餘的回購能力（56 億美元）。

Now I want to transition and cover several actions we are driving in the third quarter and throughout 2024 that address the forces of change to the reshaping the face of health care. While we continue to position our company for growth for the benefit of clients, our customers and our patients. The first is the pace and rate of pharmacological innovation and it continues to surge. Many of the treatments coming to market are meaningful in extending and improved quality of lives, for example, through new gene therapies and breakthrough treatments, but they are pressuring affordability given the high list price for manufacturers.

現在，我想過渡並介紹我們在第三季和 2024 年全年推動的幾項行動，這些行動旨在應對重塑醫療保健面貌的變革力量。同時，我們將繼續推動公司發展，為客戶、我們的客戶和患者帶來利益。首先是藥理學創新的步伐和速度，並且持續激增。許多即將上市的治療方法對於延長和改善生活品質具有重要意義，例如透過新的基因療法和突破性治療，但鑑於製造商的高標價，它們對承受能力造成了壓力。

Evernorth Specialty Pharmacy business, Accredo, is continuing its strong growth trajectory, given both the secular tailwinds and our differentiated strengths, which make us the market leader in the space. The opportunity in biosimilars is a good example of how we are leading the way and providing more value.

鑑於長期順風和我們的差異化優勢，Evernorth 專業藥房業務 Accredo 正在繼續其強勁的成長軌跡，這使我們成為該領域的市場領導者。生物相似藥的機會是我們如何引領潮流並提供更多價值的一個很好的例子。

At the end of June, we began dispensing our interchangeable biosimilar for HUMIRA. And we're pleased that biosimilar penetration was approximately one-third among eligible accretive patients in the quarter. Building on that success several weeks ago, we announced that we will begin offering an interchangeable to STELARA biosimilar in 2025.

六月底，我們開始分發 HUMIRA 的可互換生物相似藥。我們很高興看到本季符合條件的成長患者中生物相似藥的滲透率約為三分之一。基於幾週前的成功，我們宣布將於 2025 年開始提供 STELARA 生物相似藥的可互換產品。

Like HUMIRA biosimilar, it will be available for a $0 out-of-pocket for eligible accretive patients, which drives savings for individuals as well as clients. Another example of our leadership is the GLP-1 drug class, which is on pace to be the Number 1 drug trend driver for plant this year. Another expensive with manufacturers list price of approximately $15,000 a year

與 HUMIRA 生物相似藥一樣，符合條件的增值患者可以自付費用 0 美元，這為個人和客戶節省了開支。我們領先地位的另一個例子是 GLP-1 藥物類別，該類別有望成為今年植物的第一大藥物趨勢驅動因素。另一種價格昂貴，製造商標價約為每年 15,000 美元

Express Scripts, our Pharmacy Benefit Service business, the EnCircleRx solution provides a clinical program wrapper around the medication to help to support sustainable and positive lifestyle changes for patients as well as improve affordability and access for clients.

Express Scripts 是我們的藥房福利服務業務，EnCircleRx 解決方案提供了圍繞藥物的臨床計劃包裝，以幫助支持患者可持續和積極的生活方式改變，並提高客戶的負擔能力和可及性。

I'm pleased to share that in the quarter, EnCircleRx has already grown to almost 8 million lives now enrolled. The pace of change in pharmacological industry is also why we continue to proactively address misconceptions in this information around the pharmacy benefits industry. This is vital to ensure that patients and individuals continue to maintain access to affordable high-quality prescriptions.

我很高興地告訴大家，在本季度，EnCircleRx 的註冊人數已增至近 800 萬人。藥理學行業的變化速度也是我們繼續積極消除有關藥品福利行業資訊的誤解的原因。這對於確保患者和個人繼續獲得負擔得起的高品質處方至關重要。

Earlier this month, Dr. Dennis Carlton, Professor of Economics Americas from the University of Chicago and former DOJ economists released a comprehensive review of the PBM industry. Dr. Carlton's research was conducted over 16 months and drew from multiple sources, including analysis of approximately 20 billion 30-day equivalent prescriptions.

本月早些時候，芝加哥大學美洲經濟學教授丹尼斯·卡爾頓博士和前司法部經濟學家發布了對 PBM 行業的全面回顧。 Carlton 博士的研究歷時 16 個月，採用多種來源，包括約 200 億個 30 天等效處方的分析。

The finding of Dr. Carlton's research in direct contradiction with the FTC's report concludes that PBM's lower high drug prices by fostering competition among tribal drug manufacturers and pharmacies. PBMs facilitate broader access to generic medications in addition to name brand alternatives with lower costs.

卡爾頓博士的研究結果與聯邦貿易委員會的報告直接矛盾，得出的結論是，PBM 透過促進部落藥品製造商和藥房之間的競爭來降低高藥價。除了成本較低的名牌替代藥物之外，PBM 還有助於更廣泛地獲得仿製藥。

And importantly, PBM support independent pharmacies with higher reimbursement rates than chains, and the number of independent pharmacies is increasing. We will leverage Dr. Carlton's study as we continue to engage in fact-based discussions about these critical issues.

而且重要的是，PBM 支持獨立藥局的報銷率高於連鎖店，而且獨立藥局的數量正在增加。當我們繼續就這些關鍵問題進行基於事實的討論時，我們將利用卡爾頓博士的研究。

Moving to the second rapidly changing trend, the increased need for quality behavioral services, which is in part driven by geopolitical, economic, social dynamic tensions that are unfolding around the globe. For context, in the past five years, we've seen overhaul behavioral therapy utilization nearly doubled.

第二個快速變化的趨勢是對優質行為服務的需求不斷增加，這在一定程度上是由全球各地不斷出現的地緣政治、經濟、社會動態緊張局勢所推動的。就背景而言，在過去五年中，我們看到徹底改變的行為療法的使用率幾乎翻了一番。

Now in the same period, we worked to increase services and access, for example, adding almost 270,000 providers to our network, assessing the needs of those with lower complexity issues and offering new coaching programs, and implementing online scheduling and access with appointments guaranteed within 72 hours, which millions of Cigna Healthcare customers can now pursue.

現在，在同一時期，我們努力增加服務和訪問，例如，在我們的網絡中添加了近270,000 個提供商，評估問題複雜性較低的人的需求並提供新的輔導計劃，並實施在線安排和訪問，並保證預約72 小時，數百萬 Cigna Healthcare 客戶現在可以追求。

This is another example of how our businesses have complementary capabilities as we leverage behavioral health innovations and services from Evernorth and embed them into Cigna Healthcare solutions.

這是我們利用 Evernorth 的行為健康創新和服務並將其嵌入 Cigna Healthcare 解決方案時，我們的業務如何實現能力互補的另一個例子。

The final trend I will touch on is technology-enabled innovations. We're only beginning to see the start of profound changes as emerging technologies such as AI powered diagnostics and treatments will drive vast improvements, including more personalized care. Another example is the ongoing adoption of virtual services, which is rapidly rising with about 25% of patients accessing care through telehealth services last year in the US. This far exceeds the 5% of viewer who access care this way part of the pandemic.

我要談的最後一個趨勢是科技驅動的創新。我們才剛開始看到深刻變革的開始，因為人工智慧診斷和治療等新興技術將推動巨大的進步，包括更個人化的照護。另一個例子是虛擬服務的持續採用，這種服務正在迅速增長，去年美國約有 25% 的患者透過遠距醫療服務獲得照護。這遠遠超過了在大流行期間透過這種方式獲得護理的觀眾的 5%。

We continue to advance in this area with our telehealth platform, MDLIVE. We have offered MDLIVE for our customers since its acquisition in 2021. And last month, we took another step forward with patients that have lower health risk issues, enabling them to get fast flexible care without a phone call or a video call, whenever and wherever they want with MDLIVE physicians via an online portal. The patients typically are able to receive treatment within one out. At the Cigna Group, we are built to create and capture value from these forces of change for the benefit of those we serve.

我們透過遠距醫療平台 MDLIVE 繼續在這一領域取得進展。自2021 年收購MDLIVE 以來，我們一直為客戶提供MDLIVE。通話他們希望透過線上入口網站與 MDLIVE 醫生聯繫。患者通常能夠在一時間內接受治療。在 Cigna 集團，我們致力於從這些變革力量中創造和獲取價值，以造福我們所服務的人。

Next, I'll transition to provide some context relative to the tailwinds and headwinds we anticipate for 2025. Now we'll provide detailed guidance as we always do during our fourth quarter call. With the strength of our Evernorth and Cigna Healthcare platforms, we expect to both finish 2024 strong and for 2025 to have another year of competitively attractive performance.

接下來，我將提供一些與我們預計 2025 年的順風和逆風相關的背景資訊。憑藉我們的 Evernorth 和 Cigna Healthcare 平台的優勢，我們預計 2024 年將實現強勁增長，並在 2025 年將迎來另一個具有競爭力的業績表現。

Some notable tailwinds include our continued ramp-up of biosimilar offerings, continued advancement of new client relationships, and EPS accretion from the divestiture of our Medicare business, specifically the impact of share repurchase from the sales proceeds.

一些值得注意的有利因素包括我們生物相似藥產品的持續增加、新客戶關係的持續發展以及醫療保險業務剝離帶來的每股收益增加，特別是銷售收入回購股票的影響。

Now turning to headwinds. We expect lower net investment income as we will no longer recognize the dividend from our VillageMD investment. We anticipate constrained overhead from the sale of our Medicare Advantage business, which we will mitigate over time. And we will make continued strategic investments across our portfolio to drive sustained innovation and position ourselves for long-term growth.

現在轉向逆風。我們預計淨投資收入將會下降，因為我們將不再確認 VillageMD 投資的股利。我們預計出售 Medicare Advantage 業務的管理費用將受到限制，隨著時間的推移，我們將減少這種費用。我們將在我們的投資組合中進行持續的策略性投資，以推動持續創新並為長期成長做好準備。

Considering all the puts and takes, we expect another strong year of growth in 2025 with EPS growth of at least 10%, which is consistent with our historical approach where we start the year with appropriate prudence.

考慮到所有看跌期權和看跌期權，我們預計 2025 年將是另一個強勁增長年，每股收益增長至少 10%，這與我們以適當謹慎的方式開始新年的歷史方法一致。

Now I'll briefly summarize our performance for the quarter. Building on our momentum, our focus and disciplined third quarter execution positions us to meet our full year 2024 and long-term growth targets. The Cigna Group has earned a reputation for delivering differentiated value for those we serve and driving new innovation in ways that lead the industry.

現在我將簡要總結我們本季的業績。憑藉我們的勢頭、我們的專注和嚴格的第三季執行力，我們能夠實現 2024 年全年和長期成長目標。 Cigna 集團因為我們服務的客戶提供差異化價值並以引領行業的方式推動新創新而贏得了聲譽。

Our ability to consistently do this year after year is directly attributable to the strength of our leadership team and the passion and commitment of our 70,000 colleagues worldwide. And the deliberate structure of our company, which is designed with growth platforms capable of navigating even the most dynamic environments.

我們能夠年復一年地始終如一地做到這一點，直接歸功於我們領導團隊的實力以及全球 70,000 名同事的熱情和承諾。我們公司的結構經過深思熟慮，設計有能適應最動態環境的成長平台。

As a result in the third quarter, we delivered on our financial commitments with adjusted EPS of $7.51 and we remain on track to deliver full year adjusted earnings per share of at least $28.40 in 2024. Our company has attractive and sustainable growth opportunities over the long term, and we remain confident in delivering our continued average annual EPS growth rate of 10% to 14% on average, building on our track record of achieving 13% adjusted EPS on a compounded growth rate over the past decade.

因此，在第三季度，我們兌現了財務承諾，調整後每股收益為7.51 美元，並且我們仍有望在2024 年實現至少28.40 美元的全年調整後每股收益。在可持續成長機會的短期內，我們仍有信心實現每股盈餘年平均成長率為 10% 至 14%，以過去 10 年複合成長率實現 13% 調整後每股盈餘的記錄為基礎。

With that, I'll turn it over to Brian to share additional perspective on our performance for the quarter and our outlook for the rest of the year.

接下來，我將把它交給布萊恩，分享我們對本季業績和今年剩餘時間前景的更多看法。

Thank you, David. Good morning, everyone. Today, I'll review Cigna's third quarter 2024 results and discuss our outlook for the full year. During a year where the environment has been highly disrupted and dynamic. We're pleased with another quarter of strong results, highlighting our consistent execution and delivering against our prior commitments.

謝謝你，大衛。大家早安。今天，我將回顧 Cigna 2024 年第三季的業績，並討論我們對全年的展望。在環境高度混亂且充滿活力的一年。我們對又一個季度的強勁業績感到滿意，這突顯了我們一貫的執行力和兌現了我們先前的承諾。

Key consolidated financial highlights for the third quarter include revenue of $63.7 million and adjusted earnings per share of $7.51. These results, combined with our breadth of capabilities and diverse portfolio of businesses reinforce our confidence in our full year 2024 adjusted earnings per share outlook of at least $28.40, representing more than 13% year-over-year growth.

第三季的主要綜合財務亮點包括 6,370 萬美元的收入和 7.51 美元的調整後每股收益。這些結果，加上我們廣泛的能力和多元化的業務組合，增強了我們對 2024 年全年調整後每股收益前景至少 28.40 美元的信心，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 consistent execution across our businesses, with particularly significant growth within our specialty and care services business in the third quarter. Total Evernorth revenues for third quarter 2024 grew to $52.5 billion and pretax adjusted earnings grew 9% to $1.9 billion, slightly ahead of expectations. This growth came despite a $33 million headwind to net investment income related to the absence of the VillageMD dividend.

現在轉向我們的細分結果，我將首先評論 Evernorth。在我們各業務一致執行的推動下，Evernorth 持續取得強勁業績，第三季我們的專業和護理服務業務成長尤為顯著。 Evernorth 2024 年第三季總營收成長至 525 億美元，稅前調整後盈餘成長 9% 至 19 億美元，略高於預期。儘管由於沒有 VillageMD 股息而導致淨投資收入面臨 3300 萬美元的阻力，但這一增長還是實現了。

Our strong Evernorth results reflect our continued execution amidst the ongoing long-term trend of pharmacological innovation. With rising clinical needs, the introduction of new therapies to the market and more availability of biosimilars, Evernorth is well positioned to assist patients and clients in navigating these trends.

我們強勁的 Evernorth 業績反映了我們在持續的藥理創新長期趨勢中的持續執行。隨著臨床需求的不斷增長、新療法的引入以及生物相似藥的供應增加，Evernorth 已準備好幫助患者和客戶應對這些趨勢。

Moving to our businesses within Evernorth, specialty and care services revenue of $23.8 billion and adjusted earnings of $825 million, both grew 23% in the quarter, a significant acceleration in year-over-year growth when compared to the first half of 2024. While we had expected strong contributions in the quarter, this performance was above expectations, reflecting growth across our specialty businesses driven by more rapid uptake of specialty medications.

轉向 Evernorth 內的業務，本季專業和護理服務收入為 238 億美元，調整後收益為 8.25 億美元，均增長 23%，與 2024 年上半年相比，同比增長顯著加速。將會有強勁的貢獻，但這一業績超出了預期，反映出我們的專業業務在特殊藥物更快採用的推動下實現了成長。

Additionally, the quarter also benefited from increased adoption of HUMIRA biosimilars. The increased adoption benefits both patients through lower out-of-pocket costs as well as clients through lower net costs. And in the quarter, we saw approximately one-third of eligible HUMIRA Scripts transition to biosimilars.

此外，本季也受惠於 HUMIRA 生物相似藥採用的增加。採用率的增加使自付費用降低，使患者受益，也透過降低淨成本使客戶受益。在本季度，我們看到大約三分之一符合條件的 HUMIRA Scripts 轉向生物相似藥。

As we have highlighted, we are the leader in the specialty market, and we are confident in delivering long-term profitable growth given the pipeline of new drug innovation and our decades of experience in the space. As we've established a differentiated business model with proven superior clinical outcomes for complex high-cost conditions.

正如我們所強調的，我們是專業市場的領導者，鑑於新藥創新的管道和我們在該領域數十年的經驗，我們有信心實現長期的盈利增長。因為我們已經建立了差異化的商業模式，並在複雜的高成本條件下證明了卓越的臨床效果。

Pharmacy benefit services also posted robust revenue growth driven by the addition of new business wins, expansion of existing relationships, and continued demand for new drugs through our innovative products and solutions. Pretax adjusted earnings increased to $1 billion, as our differentiated capabilities continue to drive affordability and value to our patients, customers and clients.

由於新業務的增加、現有關係的擴大以及透過我們的創新產品和解決方案對新藥的持續需求，藥品福利服務也實現了強勁的收入成長。由於我們的差異化能力持續提高病患、顧客和客戶的負擔能力和價值，稅前調整後收益增加至 10 億美元。

Overall, Evernorth delivered results slightly above expectations even while absorbing the aforementioned net investment income headwind, and we continue to expect accelerating growth in the fourth quarter.

總體而言，即使吸收了上述淨投資收入逆風，Evernorth 的業績仍略高於預期，我們繼續預期第四季將加速成長。

Regarding Cigna Healthcare, third quarter 2024 revenues were $13.3 billion. Pretax adjusted earnings were $1.2 billion, and the medical care ratio was 82.8%. The medical care ratio was in line with expectations. As we have discussed, we planned and priced for elevated trend coming into the year.

至於 Cigna Healthcare，2024 年第三季營收為 133 億美元。稅前調整後收益為12億美元，醫療保健比例為82.8%。醫療配比符合預期。正如我們所討論的，我們針對今年的上升趨勢進行了規劃和定價。

During the quarter, we did observe elevated trends in specialty medications in our Cigna Healthcare book. This is consistent with the higher volumes we saw in our specialty and care business within Evernorth, and speaks to the balance of our well-diversified portfolio, which we intentionally created to position our company for some of the highest growth secular tailwinds in health care. Overall, Cigna Healthcare delivered solid results this quarter, demonstrating consistent steady execution in a dynamic environment.

在本季度，我們確實在 Cigna Healthcare 書中觀察到特殊藥物的上升趨勢。這與我們在Evernorth 的專業和護理業務中看到的較高銷售是一致的，並說明了我們多元化投資組合的平衡，我們有意創建該投資組合，以使我們的公司在醫療保健領域處於一些成長最快的長期順風車。總體而言，Cigna Healthcare 本季取得了穩健的業績，展現了在動態環境中始終如一的穩定執行力。

Now turning to our outlook for full year 2024. Given the strength and diversity of our portfolio, we have the confidence to reaffirm our full year 2024 expectation for consolidated adjusted earnings per share of at least $28.40.

現在轉向我們對 2024 年全年的展望。

Moving 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 a continued acceleration of earnings in the fourth quarter, driven by strength in specialty volumes and increasing adoption of HUMIRA biosimilars as well as the continued advancement of new client relationships. This is partially offset by lower expected net investment income.

接下來是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。這反映了第四季度利潤持續加速，這是由於專業銷售的強勁、HUMIRA 生物相似藥的採用不斷增加以及新客戶關係的持續發展所推動。這被較低的預期淨投資收入部分抵消。

For Cigna Healthcare, we continue to expect full year 2024 pretax adjusted earnings of at least $4.775 billion. And we are maintaining our full year medical care ratio outlook of 81.7% to 82.5% although we now expect to be toward the high end of the range due to the aforementioned increase in specialty medication utilization, which we expect to continue through the fourth quarter. We expect the impact of the higher fourth quarter MCR to be offset by other levers within Cigna Healthcare, such as operating efficiency.

對於 Cigna Healthcare，我們繼續預期 2024 年全年稅前調整後盈餘至少為 47.75 億美元。我們維持全年醫療保健比率預期為 81.7% 至 82.5%，但由於上述特殊藥物利用率的增加（我們預計這種情況將持續到第四季度），我們現在預計該比率將接近該範圍的高端。我們預計第四季度 MCR 較高的影響將被 Cigna Healthcare 內的其他槓桿（例如營運效率）所抵消。

Turning to our 2024 capital management position. We remain confident in our strong balance sheet and cash flow generation due to our efficient asset-light strategy that delivers attractive returns on capital. I would note that timing-related items impacted third quarter cash flow from operations. We are anticipating a meaningful step up in cash flow in the fourth quarter, and our capital deployment priorities remain consistent with our long-term framework.

轉向我們 2024 年的資本管理狀況。由於我們高效的輕資產策略能夠帶來有吸引力的資本回報，我們對強勁的資產負債表和現金流產生仍然充滿信心。我要指出的是，與時間相關的項目影響了第三季的營運現金流。我們預計第四季度現金流將出現有意義的成長，並且我們的資本部署優先事項與我們的長期框架保持一致。

Regarding share repurchase, year-to-date through October 30, 2024, we have repurchased approximately 16.9 million shares of our common stock for approximately $5.7 billion, including a repurchase of $715 million in the month of October alone. We continue to expect additional share repurchase in the fourth quarter, demonstrating our confidence in the strength and sustainable growth of our business.

關於股票回購，今年迄今截至 2024 年 10 月 30 日，我們已回購約 1,690 萬股普通股，價值約 57 億美元，其中僅 10 月就回購了 7.15 億美元。我們繼續預計第四季度將進行更多股票回購，這表明我們對業務的實力和可持續成長充滿信心。

Now to recap. Strong results through the first three quarters of the year give us confidence to deliver on our full year 2024 adjusted earnings per share outlook of at least $28.40, representing over 13% year-over-year growth toward the higher end of our long-term average adjusted EPS growth target range.

現在回顧一下。今年前三個季度的強勁業績使我們有信心實現 2024 年全年調整後每股收益至少 28.40 美元的前景，同比增長超過 13%，接近長期平均水平的高端調整後的每股收益增長目標範圍。

As David mentioned, we look forward to providing our 2025 outlook on our fourth quarter earnings call. We are confident in delivering another year of competitively differentiated EPS growth of at least 10%, consistent with our historical approach where we start the year with appropriate prudence.

正如 David 所提到的，我們期待在第四季財報電話會議上提供 2025 年展望。我們有信心在新的一年裡實現至少 10% 的具有競爭力的差異化每股收益增長，這與我們以適當謹慎的方式開始新年的歷史方法一致。

The ability to consistently meet our financial commitments is a testament to our team, executing to drive value for our clients and customers and our portfolio of complementary businesses that we've strategically positioned for strong stable and sustainable long-term growth.

持續履行財務承諾的能力證明了我們的團隊致力於為我們的客戶和客戶以及我們的互補業務組合創造價值，我們對這些業務組合進行了戰略定位，以實現強勁、穩定和可持續的長期增長。

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)

（操作員說明）

A.J. Rice, UBS.

A.J.賴斯，瑞銀。

Thanks. Hi, everybody. Maybe I'll just ask about two things here. One, you obviously had a little bit of elevated commercial trend this year, but you said all year long that you were able to price for it and anticipate it. I wonder at this early date, as you look out to '25, are you assuming more of the same? Are you getting any pushback from employers on taking that approach if you are, again?

謝謝。大家好。也許我會在這裡問兩件事。第一，今年你的商業趨勢顯然有一點上升，但你全年都表示你能夠為其定價並進行預測。我想知道，在這麼早的日期，當你展望 25 年時，你是否會假設更多相同的事情？如果您再次採取這種方法，您是否會受到雇主的反對？

And then on the VillageMD, I know you laid out a strategy for working with them is one of the ways that Evernorth could address the primary care market. Obviously, that situation is in flux. I wonder if there's any pivots the company is considering and how important putting something in place with respect to physician groups, particularly primary care it is for the overall Evernorth strategy.

然後在 VillageMD 上，我知道您制定了與他們合作的策略，這是 Evernorth 解決初級保健市場問題的方法之一。顯然，這種情況正在不斷變化。我想知道該公司是否正在考慮任何重點，以及在醫生群體方面落實一些措施，特別是初級保健對於 Evernorth 的整體策略有多重要。

Good morning AJ, it's David. Let me ask Brian to take your first question relative to trend '24 and '25, and then I'll provide a little color on Village and specifically our value-based care strategy and where we go from here. Brian?

早安，AJ，我是大衛。讓我請 Brian 回答你關於 24 和 25 趨勢的第一個問題，然後我將提供一些有關 Village 的信息，特別是我們基於價值的護理策略以及我們今後的發展方向。布萊恩？

Good morning, AJ So first off, we're very pleased with the strength of our US employer business within Cigna Healthcare. That business continues to perform well for us. And as a reminder, our US employer book is nearly 85% ASO or self-funded, which includes earning levers that go well beyond the peer risk-based MCR. That said, our US employer book is currently operating from a position of strength as we've been performing within our target margin ranges here in 2024.

早安，AJ 首先，我們對 Cigna Healthcare 的美國雇主業務實力感到非常滿意。該業務對我們來說繼續表現良好。提醒一下，我們的美國雇主手冊中近 85% 是 ASO 或自籌資金，其中包括遠遠超出基於同業風險的 MCR 的收入槓桿。也就是說，我們的美國雇主目前的營運狀況良好，因為我們的表現一直在 2024 年的目標利潤範圍內。

As it relates to the external market, to your point on employers, we characterize the environment as competitive but rational, and we remain disciplined with our own pricing strategy in this environment. As it relates to 2025, we do expect cost trends to remain elevated above historical levels, and we're pricing for 2025 rate increases that are greater than what we achieved in 2024. Given that continued elevated cost trend expectation, the firm competitive environment as well as our desire to preserve our margin levels.

由於它與外部市場有關，就您對雇主的觀點而言，我們將環境描述為競爭性但理性的，並且我們在這種環境中仍然遵守我們自己的定價策略。就 2025 年而言，我們確實預計成本趨勢將繼續高於歷史水平，並且我們對 2025 年利率漲幅的定價將高於我們在 2024 年實現的水平。維持利潤水準的願望。

So David, I'll turn it over to you to talk about the Village piece.

大衛，我將把它交給你來談論鄉村部分。

Sure. AJ, so relative to Village, you brought a part of your question talks about the strategy. So stepping up first and foremost. VBC, value-based care from our point of view is how do we align incentives, leverage information and then leverage clinical resources and extenders to deliver improved overall quality and ultimately value. Within our Cigna Healthcare platform, that's done day in, day out for collaborative accountable care relationships, and those relationships continue to evolve. Those are partnered relationships, leverage relationships that we drive forward Increasingly, some of Evernorth's capabilities are in support of that.

當然。 AJ，所以相對於 Village，你提出了部分關於策略的問題。所以首先要加強。從我們的角度來看，VBC，基於價值的護理是我們如何調整激勵措施、利用訊息，然後利用臨床資源和擴展來提高整體品質和最終價值。在我們的 Cigna Healthcare 平台中，我們日復一日地致力於建立協作式責任護理關係，並且這些關係不斷發展。這些是我們推動的合作關係、槓桿關係，Evernorth 的一些能力越來越多地支持這一點。

Second, specific to the VillageMD relationship, we sought to accelerate that through our Evernorth accountable care relationship for lives and patients outside of those that were within our program in chassis on the benefit side of the equation. And in hindsight, the timing of that, given the disruption to the marketplace, including the risk adjuster disruption and some of the cash flow disruption from some of the underlying investors proved to be poorly timed.

其次，具體到 VillageMD 關係，我們力求透過 Evernorth 負責任的護理關係來加速這一進程，為那些不在我們計劃範圍內的生命和患者提供服務，以實現等式的受益方。事後看來，考慮到市場受到的干擾，包括風險調節器的干擾和一些基礎投資者的現金流幹擾，事實證明，這一時機的選擇並不恰當。

Moving forward from an Evernorth standpoint, even though the accountable care relationships will continue to probe and identify where and how we can expand relationships I would note that we do continue to make very good progress on deepening relationships with health care professionals out of Evernorth, specifically off of our CuraScript capabilities that continues to grow meaningfully, but we will continue to take a paced path with the Evernorth accountable care relationships currently, given the disruption, again, meaningfully caused by the change in the risk adjuster environment.

從Evernorth 的角度來看，儘管負責任的醫療關係將繼續探索和確定我們可以在何處以及如何擴大關係，但我要指出的是，我們在深化與Evernorth 醫療保健專業人員的關係方面確實繼續取得了非常好的進展，特別是我們的 CuraScript 能力繼續有意義地增長，但鑑於風險調整者環境的變化再次造成有意義的中斷，我們將繼續與目前的 Evernorth 責任護理關係保持同步發展。

Thanks.

謝謝。

Justin Lake, Wolfe Research.

賈斯汀·萊克，沃爾夫研究中心。

Thanks, good morning. First, I want to follow up on, David, your comments around capital deployment and some of the rumors out there in the market. Just to be clear, do you -- you talked a lot about the share repurchase in 2024, which has been significant. The fourth quarter, the proceeds -- the last time we had this discussion, you also talked about a forward year and where you kind of saw the predominance of capital going as well. Are you also saying -- or did I miss that you were going to talk about that you are going to deploy capital to share repurchase or the vast majority of the share repurchase in 2025 as well?

謝謝，早安。首先，大衛，我想跟進您對資本部署的評論以及市場上的一些謠言。需要明確的是，您談論了很多關於 2024 年股票回購的問題，這意義重大。第四季的收益－上次我們進行討論時，您也談到了未來一年，您也看到了資本的主導地位。您是否還說過——或者我是否錯過了您將要談論的您將在 2025 年部署資本進行股票回購或絕大多數股票回購？

And then just on the business, can you give us some more color on what's going on in specialty? There have been a few companies talking about that. What do you think is driving that? And any other specifics you can give us, we'd appreciate. Thanks.

然後就業務而言，您能給我們更多關於專業領域正在發生的事情嗎？已經有幾家公司在談論這個問題。您認為是什麼推動了這個趨勢？如果您可以向我們提供任何其他具體信息，我們將不勝感激。謝謝。

Justin. Good morning, it's David. Let me take your first question, and then I'll ask Eric to give you, I think your broader second question is relative to what's transpired in the Specialty space. So first, to the specific part of your question, you didn't miss anything I communicated. We've not provided detailed guidance for 2025. We'll provide more comprehensive guidance as we always do on our fourth quarter call and we look forward to doing so.

賈斯汀.早上好，我是大衛。讓我回答你的第一個問題，然後我會請艾瑞克給你，我認為你更廣泛的第二個問題與專業領域發生的事情有關。首先，對於你問題的具體部分，你沒有錯過我傳達的任何內容。我們尚未提供 2025 年的詳細指導。

Second, stepping back, as I noted in my prepared remarks, given the disruption in the space, we wanted to ensure that we had as much information out there and the clarity of put forth.

其次，退後一步，正如我在準備好的發言中指出的那樣，考慮到該領域的混亂，我們希望確保我們擁有盡可能多的信息並提供清晰的信息。

I'd ask maybe to step back and reflect for a moment. If you think about to the core of your question, what we've done, our actions that both Brian and I reinforced meaningful share repurchase in 2024, which has been on a repurchasing through the month of October and expect it to continue to repurchase in the fourth quarter.

我想請您退後一步，反思一下。如果你思考問題的核心，我們做了什麼，我們的行動，布賴恩和我都加強了2024 年有意義的股票回購，該回購一直持續到10 月份，並預計將在2024 年繼續回購。

If you reflect back on the last four years, we've repurchased about $24 billion of our stock, right? That was strategically guided as we were harnessing the benefit of the combination. We did have some divestitures within the context of that and as we leverage the broad cash flow generation of our asset-light portfolio and capabilities.

如果你回顧過去四年，我們已經回購了大約 240 億美元的股票，對嗎？當我們利用合併的好處時，這是策略性的指導。在此背景下，我們確實進行了一些資產剝離，因為我們利用了輕資產投資組合和能力產生的廣泛現金流。

So I would ask you to stay tuned for more comprehensive 2025 guidance but reflect on our disciplined track record of being a good steward of capital and demonstrating the ability to create real sustained shareholder value in the way we deploy capital. Eric, I'll ask you to talk about the specialty space.

因此，我請您繼續關注更全面的 2025 年指導，但請反思我們作為良好資本管理者的紀律記錄，並展示我們透過部署資本的方式創造真正持續的股東價值的能力。艾瑞克，我想請你談談專業領域。

Great. Thanks, David. Good morning, Justin, it's Eric. As we find at our Investor Day earlier this year, the specialty market is a $400 billion market and growing. And we're leaders in this space, driven by our focused condition-specific model, our clinical expertise and our overall geographic reach. And this positions us well to be helpful to our clients across the board, whether it's health plans, employers, health systems, and the like.

偉大的。謝謝，大衛。早安，賈斯汀，我是艾瑞克。正如我們在今年稍早的投資者日上發現的那樣，專業市場是一個價值 4000 億美元的市場，並且還在不斷增長。在我們專注的特定條件模型、臨床專業知識和整體地理覆蓋範圍的推動下，我們是這一領域的領導者。這使我們能夠為我們的客戶提供全面的幫助，無論是健康計劃、雇主、衛生系統等等。

Now specific to this quarter, this was the first full quarter where we dispensed our biosimilar HUMIRA. And additionally, we had some expansion with existing clients choosing to move more business to Accredo. And we had broad-based volume strength as well. And I'd call out therapies for inflammatory conditions, for oncology and neurology as areas with particularly strong growth in the quarter.

具體到本季度，這是我們分發生物相似藥 HUMIRA 的第一個完整季度。此外，我們也進行了一些擴張，現有客戶選擇將更多業務轉移到 Accredo。我們也擁有廣泛的銷售優勢。我認為發炎性疾病、腫瘤學和神經病學的治療是本季成長特別強勁的領域。

Now, with respect to the 23% growth in the quarter, we've noted in the past that the results in any given quarter is going to depend on the timing of new volumes, new customers, new therapies being available and so on. But over time, we expect this market to be a meaningful part of the growth of our enterprise. We've talked about our specialty and care Solutions space growing at 8% to 12% on a sustained annual basis. And all of these factors are built into our assessment there.

現在，關於本季 23% 的成長，我們過去曾指出，任何特定季度的業績將取決於新銷量、新客戶、新療法的推出時間等。但隨著時間的推移，我們預期這個市場將成為我們企業發展的一個有意義的部分。我們已經談到我們的專業和護理解決方案領域每年持續成長 8% 至 12%。所有這些因素都納入我們的評估中。

So we continue to be well positioned in this market and quite excited about the opportunities to serve the market to grow and to serve our patients.

因此，我們繼續在這個市場中佔據有利地位，並且對服務市場成長和服務患者的機會感到非常興奮。

Ryan Langston, TD Cowen.

瑞安·蘭斯頓，TD·考恩。

Hi, thank you. I think in the prepared remarks, you said you had 8 million lives now on the EnCircleRx program. My understanding is that was only -- I say only about 3 million to 5 million only just a couple of months ago. That seems like incredibly strong growth and demand. I guess, what's driving that? And I guess, where do we see that pick up moving over the next couple of years, just given it seems in the past couple of months, that's risen pretty dramatically? Thanks.

你好，謝謝。我想在準備好的發言中，您說過 EnCircleRx 專案現在有 800 萬人的生命。我的理解是，就在幾個月前，我說大約只有 300 萬到 500 萬。這似乎是令人難以置信的強勁成長和需求。我想，是什麼推動了這一點？我想，考慮到過去幾個月的成長速度相當驚人，我們認為未來幾年的成長會在哪裡？謝謝。

Ryan, it's Eric. Thanks the question. As you can imagine, there's real interest in need from our clients is they're looking for help with managing the affordability of GLP-1s and these conditions overall. We're really excited about the opportunity to bring this first of its kind solution to the market. And as David noted, I think you said we're almost at 8 million lives. So not quite there yet but approaching it rapidly.

瑞安，我是埃里克。謝謝提問。正如您可以想像的那樣，我們的客戶真正感興趣的是他們正在尋求幫助來管理 GLP-1 的負擔能力和整體條件。我們非常高興有機會將這一同類解決方案推向市場。正如 David 指出的，我想你說過我們的生命已經接近 800 萬人了。所以還沒有完全實現，但正在迅速接近。

We launched this program just a handful of months ago. And as we've talked about previously, it targets the right patient population, working to bring the relevant clinical markers and engage patients with the support they need to help make changes that make the impact last, provides a guaranteed clinical comes to our clients and provides a strong overall return for the investment in the program.

我們幾個月前才啟動了這個計畫。正如我們之前討論過的，它針對正確的患者群體，致力於帶來相關的臨床標誌物，並為患者提供他們所需的支持，以幫助做出使影響持久的改變，為我們的客戶提供有保證的臨床結果，為該計劃的投資提供了強勁的整體回報。

Performance so far is that the solution is working well. The early results, our clients are enrolled. They're seeing significant savings and reductions in trends compared to those who are not enrolled as we mature the process or mature the data, we'll have more to report here.

到目前為止，該解決方案運作良好。早期結果顯示，我們的客戶已註冊。隨著我們成熟的流程或成熟的數據，與那些未註冊的人相比，他們看到了顯著的節省和趨勢的減少，我們將在這裡報告更多內容。

David, maybe any other perspective you want to share?

大衛，也許您還想分享其他觀點？

Sure. Thanks. I'll just amplify 2 points. As we all spend a significant amount of time in the market, we're a field-based organization. This is typically a top 1, 2 or 3 topic with clients, with brokers, with consultants and with others in the market. So as we noted, GLP-1s remain front and center.

當然。謝謝。我只強調2點。由於我們都在市場上花費了大量時間，因此我們是一個基於現場的組織。這通常是客戶、經紀人、顧問和市場上其他人最關心的 1、2 或 3 個主題。正如我們所指出的，GLP-1 仍然處於前沿和中心位置。

The specific piece I would add, though, is as the market continues to absorb the challenges of affordability, the market also is observing and clients are observing and physicians are observing the start and stop dynamic that is transpiring for some patients, which also doesn't generate the desired or intended outcome if a patient starts on a regimen and stops in eight months and then maybe starts up and then maybe stops as well.

不過，我要補充的具體內容是，隨著市場持續吸收負擔能力的挑戰，市場也在觀察，客戶也在觀察，醫生也在觀察某些患者正在發生的開始和停止動態，這也沒有改變。如果患者開始接受治療並在八個月內停止，然後可能開始，然後也可能停止，就不會產生期望的或預期的結果。

So folks are really -- the value proposition really resonates relative to the clinical wrappers, the care wrappers, the coaching wrappers, the behavioral support wrappers that exist in the value-based care nature of the underlying program. So I appreciate you calling out the growth because it is significant and it underscores the need for innovation that we lead as these new treatments come to market.

所以人們真的——價值主張確實與臨床包裝、護理包裝、指導包裝、行為支持包裝產生共鳴，這些包裝存在於基礎項目的基於價值的護理性質中。因此，我感謝您指出這種成長，因為它意義重大，並且強調了隨著這些新療法進入市場，我們需要引領創新。

All right, thank you.

好的，謝謝。

Lisa Gill, JPMorgan.

麗莎·吉爾，摩根大通。

Thanks very much. Good morning. Can you maybe talk about the 2025 selling season on the PBM side? I'm just really curious around a few things. One, as we have more biosimilars, are we seeing a change in the economics of how contracts are formulated going into 2025? And then just as a follow-up, David, you highlighted the FTC report and the report that the University of Chicago professors looked at. Is there any update on potential legislation or anything you're seeing from a state perspective that potentially is using some of this information when they're thinking about legislation?

非常感謝。早安.您能否談談 PBM 方面的 2025 年銷售季？我只是對一些事情很好奇。第一，隨著我們擁有更多的生物相似藥，我們是否會看到 2025 年合約制定方式的經濟學發生變化？大衛，作為後續行動，你強調了聯邦貿易委員會的報告和芝加哥大學教授研究的報告。是否有關於潛在立法的任何更新，或者您從州的角度看到的任何在他們考慮立法時可能會使用這些資訊的資訊？

Lisa, it's David. Let me ask Eric to start with the Evernorth selling season, including the PBM dynamic and what's transpiring and then I'll address your FTC question.

麗莎，是大衛。讓我請 Eric 從 Evernorth 銷售季節開始，包括 PBM 動態和正在發生的事情，然後我將回答您的 FTC 問題。

Thanks, David. Lisa, fundamentally, we start with a portfolio that's equipped to offer choice and flexibility in how we work to support our clients. We work to make the pharmacy benefit accessible for the patient and more affordable, and we continue to innovate to bring new ways to the market to do that. And stepping back, Evernorth is well positioned to continue to grow. The strength of those innovations and our solutions continue to resonate. And just as we talked about the growth EnCircleRx, we continue to have growth in our various innovative programs.

謝謝，大衛。麗莎，從根本上說，我們從一個產品組合開始，為我們支援客戶的工作方式提供選擇和靈活性。我們致力於讓患者能夠以更實惠的價格獲得藥品福利，並且我們不斷創新，為市場帶來新的方法來實現這一目標。退一步來說，Evenorth 已做好繼續發展的準備。這些創新的力量和我們的解決方案不斷產生共鳴。正如我們談論 EnCircleRx 的成長一樣，我們的各種創新項目也持續成長。

Now specifically with respect to the pharmacy benefit services business for 2025, we had a good 2025 selling season, and our retention rate continues to be consistent with recent years in the mid- to high 90s percent range. We're driving meaningful innovations, whether it's EnCircleRx, our oncology benefit services are just recent examples. And we're positioned for another good year in 2025.

現在，特別是在 2025 年的藥品福利服務業務方面，我們在 2025 年的銷售季節表現良好，並且我們的保留率繼續與近年來保持一致，處於 90% 的中高水平。我們正在推動有意義的創新，無論是 EnCircleRx，還是我們的腫瘤福利服務都只是最近的例子。我們將在 2025 年迎來另一個美好的一年。

As far as change, again, I'd say there's good interest in discussing what services, what financing arrangements are going to best align with our clients' needs, but I wouldn't call out any wholesale or substantial change in terms of what our customers and clients are actually purchasing from us. David?

至於改變，我想說，討論哪些服務、哪些融資安排將最符合客戶的需求是很有興趣的，但我不會在我們的服務方面提出任何大規模或實質性的改變。是從我們這裡購買的。大衛？

This is relative to the FTC, I think the end of your question really pointed toward legislation, but let me just pull back for a moment. First and foremost, and you know the space extremely well, right? PBM and pharmacy benefit service industry exists to create real, sustained differentiated value through improved affordability, through expanding access to services that are more affordable like generics, through patient coordination and clinical coordination programs, which are especially critical for the chronic and polychronic population.

這是相對於聯邦貿易委員會而言的，我認為你問題的結尾確實指向了立法，但讓我先退一步。首先，您非常了解這個空間，對吧？ PBM 和藥品福利服務行業的存在是為了透過提高負擔能力、擴大獲得更實惠的服務（如仿製藥）的機會、透過患者協調和臨床協調計劃（這對於慢性和多慢性人群尤其重要）來創造真正、持續的差異化價值。

And as a validation of the value we deliver, our client retention levels reinforce that with historic client retention levels in the 95% plus range. And as we look to the year ahead in 2025, it being even at the higher end of that range.

作為對我們所提供價值的驗證，我們的客戶保留水準進一步強化了這一點，歷史上的客戶保留水準高達 95% 以上。當我們展望 2025 年時，它甚至處於該範圍的高端。

And secondly, as we've talked about, whether it's through EnCircleRx, through the biosimilars, our ability to continue to lead the market with innovations that deliver more value especially with new treatments coming to market is mission-critical. Specific to the FTC report, let me be really clear. We disagree on the unfounded assertions that were put forth.

其次，正如我們所討論的，無論是透過 EnCircleRx 還是透過生物相似藥，我們繼續透過創新引領市場的能力至關重要，這些創新能夠提供更多價值，尤其是在新療法上市的情況下。具體到聯邦貿易委員會的報告，讓我說得更清楚。我們不同意所提出的毫無根據的斷言。

Second, the clear direction that was put forth by Dr. Carlton's report is in direct contrast to that. And going forward, we will engage in fact-based conversations. As it relates specifically to legislation, we do not see any specific fully mature proposed legislation right now that looks like it will be put forward. Obviously, there's a bit more time left in the year. There's no doubt relative to that. We remain actively engaged.

其次，卡爾頓博士的報告所提出的明確方向與此形成鮮明對比。展望未來，我們將進行基於事實的對話。由於它具體涉及立法，我們目前沒有看到任何具體的、完全成熟的擬議立法，看起來會被提出。顯然，今年還剩下一些時間。與此相關是毫無疑問的。我們仍然積極參與。

I was in Washington on Monday of this week on a variety of topics. We remain actively engaged. But I think most importantly, at capping it off, we're confident in the durability of our model, our proven ability to partner, our proven ability to drive ongoing innovation to make sure we are able to continue to grow and deliver the value, both in the pharmacy benefit service space as well as in the specialty space.

這週星期一我在華盛頓討論了各種話題。我們仍然積極參與。但我認為最重要的是，最終，我們對我們模型的耐用性、我們經過驗證的合作能力、我們經過驗證的推動持續創新的能力充滿信心，以確保我們能夠繼續成長並提供價值，無論是在藥局福利服務領域還是在專業領域。

Great. Thanks for the comments, David.

偉大的。感謝您的評論，大衛。

Andrew Mok, Barclays.

安德魯·莫克，巴克萊銀行。

Hi, good morning. You called out planned investments across both core PBM and specialty in the release, and it sounds like that will continue into 2025. Can you give us a little bit more detail on the nature and magnitude of those investments? Thanks.

嗨，早安。您在發布的版本中提到了核心 PBM 和專業領域的計劃投資，聽起來這將持續到 2025 年。謝謝。

Good morning, Andrew, it's Brian. So as we intend to do in any year, we have a fair amount of our discretionary capital that goes back into internal reinvestments. So when we talk about the continued investment in the business, not just in the Evernorth platform, but also in Cigna Healthcare, that's a core part of our capital deployment framework before we start talking about capital being returned to shareholders.

早安，安德魯，我是布萊恩。因此，正如我們打算在任何一年所做的那樣，我們都有相當數量的可自由支配資本用於內部再投資。因此，當我們談論對業務的持續投資時，不僅是對 Evernorth 平台，還有對 Cigna Healthcare 的投資，這是我們資本部署框架的核心部分，然後我們才開始談論向股東返還資本。

So this year, we're tracking to, call it, $1.5 billion or so of discretionary CapEx, and that's kind of over and above the core administrative expenses, which are round numbers about $20 billion that we spend in the year. So most of that will go toward technology going forward, so that some of that customer patient-facing technology. Some of that is provider-facing technology, and some of that is a broker or field-facing technology as well.

因此，今年，我們追蹤的可自由支配資本支出約為 15 億美元，這超出了核心管理費用，我們今年的支出約為 200 億美元。因此，其中大部分將用於未來的技術發展，以便一些面向客戶的患者技術。其中一些是面向提供者的技術，其中一些也是經紀人或面向現場的技術。

So the majority of when you think about our discretionary CapEx is headed in that direction. And as we think about the long-term growth opportunity we have, for example, in the specialty space, which is already a $400 billion addressable market growing at the secular high single-digit type rate. We see opportunities to continue strengthening our capabilities there to make ourselves even more relevant. So think of it as primarily technology, and we gear that up or down in any given year.

因此，當您考慮我們的可自由支配資本支出時，大多數情況都是朝著這個方向發展。當我們思考我們擁有的長期成長機會時，例如，在專業領域，該領域已經是一個 4000 億美元的潛在市場，並且以長期高個位數成長率成長。我們看到了繼續加強我們的能力的機會，使我們變得更加重要。因此，我們主要將其視為技術，並且我們在任何特定年份都會對其進行調整。

Erin Wright, Morgan Stanley.

艾琳·賴特，摩根士丹利。

Great. Thanks so much. I wanted to dig into specialty a bit more. It just sounds like you're seeing the traction with the HUMIRA biosimilar strategy. Just how would you compare that to the strategy around products like STELARA and the ramp you expect with STELARA relative to what you saw with HUMIRA and other biosimilars that are coming down the pipe? I guess, how do you think about the cadence of that opportunity over the next several years but also just in terms of 2025 from an LOE perspective. Thanks.

偉大的。非常感謝。我想進一步深入研究專業。聽起來您似乎看到了 HUMIRA 生物相似藥策略的吸引力。您如何將其與 STELARA 等產品的策略以及您對 STELARA 的預期與 HUMIRA 和其他即將推出的生物相似藥的預期進行比較？我想，您如何看待未來幾年該機會的節奏，以及從 LOE 角度來看 2025 年的機會。謝謝。

Erin, it's Eric. I appreciate the question. Stepping back, I think the model that we've built here and that we've deployed around our biosimilar HUMIRA has provided another good choice in the market, and it's one that we think we're well positioned to replicate in the appropriate situations going forward. As David mentioned in his prepared remarks, we will be launching a no out-of-pocket cost alternative to STELARA in 2025. And I could envision us using this playbook and approach for additional biosimilars as we look ahead into the coming years.

艾琳，我是埃里克。我很欣賞這個問題。退一步說，我認為我們在這裡建立的模型以及我們圍繞生物仿製藥 HUMIRA 部署的模型為市場提供了另一個不錯的選擇，我們認為我們有能力在適當的情況下複製這個模型。正如David 在他準備好的演講中提到的那樣，我們將在2025 年推出一種無需自付費用的STELARA 替代品。多的生物相似藥。

We've noted at our Investor Day earlier this year that we see nearly half of the specialty market having biosimilar alternatives choice available in terms of bringing new affordability to the market. And this is one example of a strategy that will help to improve the affordability and the accessibility of these medicines for the patients that need them and for the plan sponsors that are funding them.

我們在今年稍早的投資者日指出，我們看到近一半的專業市場有生物相似藥替代品可供選擇，為市場帶來新的負擔能力。這是一項策略的一個例子，該策略將有助於提高需要這些藥物的患者和為其提供資金的計劃贊助商的可負擔性和可及性。

So every different therapy will have a different alternatives, they will have different kind of adoption of paths based off of the clinical needs of the patients being served based off of the break and pace of availability of products and such.

因此，每種不同的療法都會有不同的替代方案，他們將根據所服務患者的臨床需求、產品可用性的中斷和速度等，採用不同的路徑。

But at a macro level, we're really well positioned to continue to lead in this market and bring new solutions to market just like we did with the biosimilar HUMIRA, like we are in the process of doing with STELARA and like we'll do with other drugs coming after that. David?

但從宏觀層面來看，我們確實處於有利地位，可以繼續在這個市場保持領先地位，並向市場推出新的解決方案，就像我們對生物相似藥HUMIRA 所做的那樣，就像我們正在對STELARA所做的那樣，就像我們將要做的那樣之後還有其他藥物。大衛？

Erin, just one point I want to add to Eric's comment relative to the specialty market specifically, and maybe it's a statement of the obvious, but when we operate in an environment of elevated medical cost pressure which the industry is seeing in a broader sense, you could also think about the high-performing nature in this case, of our specialty capabilities, both through Accredo as well as through CuraScript, in some ways, provides us a natural or structured hedge against the medical cost pressure that is natural to manifest itself on the benefit side of the equation.

艾琳，我想在埃里克關於專業市場的評論中補充一點，也許這是一個顯而易見的陳述，但是當我們在醫療成本壓力升高的環境中運營時，業界在更廣泛的意義上看到了這一點，您也可以考慮在這種情況下，我們的專業能力的高性能本質，無論是透過Accredo 還是透過CuraScript，在某種程度上，為我們提供了一種自然或結構化的對沖手段，以因應自然顯現出來的醫療成本壓力在等式的受益方。

So when we talk about the conscious way we've structured the corporation, we've structured it, obviously, with different addressable markets. We've structured it with an asset-light framework. But in this case, also highlighting the structure provides some natural hedge when inflationary pressure or utilization pressure manifests on one side, it also provides growth opportunity and value capture opportunities on the other side of our very diverse portfolio. So I just wanted to punctuate that.

因此，當我們談論我們有意識地建立公司的方式時，顯然，我們是針對不同的目標市場來建立它的。我們用輕資產框架建構了它。但在這種情況下，當通貨膨脹壓力或利用壓力一方面顯現出來時，強調結構也提供了一些自然對沖，它也為我們非常多樣化的投資組合的另一方面提供了成長機會和價值捕獲機會。所以我只是想強調一下。

Scott Fidel, Stephens.

斯科特·菲德爾，史蒂芬斯。

Hi, thanks, good morning. Question if I could try to do a two-parter would be one, just on the cost trend side, maybe if you could just drill in a little bit, give us an update on the inpatient side as well in terms of what you've been seeing there relative to expectations recently.

嗨，謝謝，早安。問題是我是否可以嘗試做一個由兩部分組成的項目，只是在成本趨勢方面，也許您可以稍微深入一下，向我們提供住院方面的最新情況以及您所了解的情況最近看到那里相對於預期。

And then I did want to get your perspective just on the competitive environment for the exchanges in 2025. It looks like from our analysis of the CMS landscape data for the federal exchange is that we do see a number of the major carriers with actually negative rates in their same-store plans for 2025. So it does seem like the competitive framework has intensified quite a bit. And so I'm certainly interested in your perspective right now on that market category as well. Thanks.

然後我確實想了解您對 2025 年交易所競爭環境的看法。同店計畫中。因此，我當然也對您現在對該市場類別的看法感興趣。謝謝。

Good morning, Scott, it's Brian. I'll take both of your questions here. So first off, we're pleased to have delivered another solid quarter of MCR performance within Cigna Healthcare with the overall performance in line with expectations, as I noted earlier. And just as a reminder, we had planned and price for the overall elevated utilization levels that began in 2023 to continue throughout 2024.

早安，史考特，我是布萊恩。我將在這裡回答你的兩個問題。首先，我們很高興 Cigna Healthcare 再次實現了穩健的 MCR 業績季度，整體業績符合預期，正如我之前指出的。提醒一下，我們已對從 2023 年開始持續到 2024 年整體提高的利用率水準進行了規劃和定價。

And within the quarter specifically, we had a range of affordability initiatives that proved to be beneficial to the MCR, and it had some offset to the uptick I mentioned in specialty drug utilization in the quarter. And where we saw that most notably was we saw some deceleration in cost trends in surgical activity in particular. You asked about inpatient. Inpatient was broadly in line with our expectations in the quarter. So I wouldn't flag that as a particular hotspot or an area of favorability.

具體而言，在本季度內，我們採取了一系列可負擔性舉措，事實證明對 MCR 有利，並且它在一定程度上抵消了我提到的本季度特種藥物利用率的上升。我們看到最值得注意的是，我們看到手術活動的成本趨勢有所放緩。你問的是住院的情況。本季住院患者基本上符合我們的預期。因此，我不會將其標記為特定的熱點或有利區域。

And as David said, we're fortunate to have the natural hedge at the enterprise level where the elevated customer demand for specialty drugs resulted in the favorable performance we saw in our Evernorth business, specifically within the specialty and care services platform.

正如 David 所說，我們很幸運能夠在企業層面擁有自然對沖，客戶對特種藥物的需求增加導致我們在 Evernorth 業務中看到了良好的業績，特別是在特種和護理服務平台內。

As it relates to the individual exchanges, so we continue to see this market as being an important subsegment of the US health care system for those who don't have access to employer or government-sponsored coverages. We've been a consistent player in this market over the past decade since the ACA went into effect.

由於它與個人交換有關，因此我們繼續認為這個市場是美國醫療保健系統中那些無法獲得雇主或政府資助的保險的人的重要組成部分。自《平價醫療法案》生效以來，我們在過去十年中一直是該市場的堅定參與者。

And for us, 2024 has been a year focused on margin expansion in our individual exchange business. And that approach is playing out largely as we expected here with fewer customers in 2024, but carrying a higher profit margin profile compared to our 2023 experience. As it relates to 2025, specifically, as you noted, the weighted average rate increase for our customer base is in the low double digits, which based on the publicly available information is on the higher end of the competitive set.

對我們來說，2024 年是我們個人交易所業務利潤率擴張的一年。這種方法的效果基本上符合我們的預期，2024 年客戶數量會減少，但與我們 2023 年的經驗相比，利潤率會更高。就 2025 年而言，具體而言，正如您所指出的，我們客戶群的加權平均增長率為低兩位數，根據公開信息，該增長率處於競爭中的高端。

That said, there's a considerable variation by geography when you dig into that. And for us, the exact margin profile and customer volumes will be a function of geographic mix and competitor behavior in each of those different geographies. But taken all together, we continue to invest in this business, see it as a growth engine for the company and over time, look forward to 10% to 15% annualized growth here.

也就是說，當你深入研究時，不同地理位置之間有相當大的差異。對我們來說，確切的利潤狀況和客戶量將取決於地理組合和每個不同地區的競爭對手行為。但總的來說，我們繼續投資這項業務，將其視為公司的成長引擎，隨著時間的推移，預計年化成長率將達到 10% 至 15%。

[Adam Ron], Bank of America

[亞當羅恩]，美國銀行

Hey, thanks for the question. I also wanted to dig into the specialty comments. But from the managed care side, you mentioned that it was the reason that you're increasing your MLR guidance. And I know that you still do currently own the Medicare Advantage company. That also has the Part D business. And so wondering if you could delineate like the pressure that you're seeing in specialty between the Medicare side and the commercial side. And on the Medicare side, if you think it's being driven by the IRA at all? Thanks.

嘿，謝謝你的提問。我還想深入研究專業評論。但從管理醫療方面來看，您提到這是您增加 MLR 指導的原因。我知道您目前仍然擁有 Medicare Advantage 公司。其中還有 D 部分業務。因此，想知道您是否可以描述醫療保險方面和商業方面之間的專業壓力。在醫療保險方面，您是否認為它完全是由愛爾蘭共和軍推動的？謝謝。

Good morning Adam, it's Brian. I'll start. If you my colleagues want to pile on, you're welcome to. So as it relates to what we saw in Cigna Healthcare on the Specialty drug side, really, the uptick in the utilization was broad-based across most of our Accredo therapeutic resource centers in the third quarter. In particular, we saw it in inflammatory conditions, oncology and neurology.

早安，亞當，我是布萊恩。我開始吧。如果我的同事想加點的話，歡迎你們。因此，與我們在 Cigna Healthcare 的特殊藥物方面看到的情況相關，實際上，第三季度我們大多數 Accredo 治療資源中心的利用率都有廣泛的上升。特別是，我們在發炎性疾病、腫瘤學和神經病學中看到了它。

And really this transpired across all the Cigna Healthcare product lines, Commercial Employer, Medicare and the individual exchanges. The Medicare volumes were slightly more elevated than commercial, but not enough that we would flag it as having a different root cause, and we do not see the IRA is having driven a meaningful amount of the third quarter experience. And as I said earlier, I'm pleased to have the natural hedge with the Evernorth Specialty business benefiting from those increased volumes in the quarter.

事實上，這在所有 Cigna Healthcare 產品線、商業雇主、醫療保險和個人交易所中都發生了。醫療保險數量比商業保險數量略高，但還不足以讓我們將其標記為具有不同的根本原因，而且我們認為 IRA 並沒有對第三季度的經歷產生有意義的推動。正如我之前所說，我很高興 Evernorth Specialty 業務的自然對沖受益於本季銷售的增加。

And Brian, the only thing I would add is, Adam, to your broader question, as noted in our opening comments, but by and large, the Medicare Advantage portfolio of our business is performing in line with our expectations as we build the plan out for the course of the year. So Brian's reference is on the margin in terms of the elevation there.

布萊恩，我唯一要補充的是，亞當，對於你更廣泛的問題，正如我們在開場評論中指出的那樣，但總的來說，我們業務的醫療保險優勢投資組合在我們制定計劃時表現符合我們的預期在這一年。因此，布萊恩的參考資料就那裡的海拔而言是處於邊緣的。

George Hill, Deutsche Bank.

喬治·希爾，德意志銀行。

Yeah. Good morning guys. David, I kind of want to come back to the -- your comments on the Medicare Advantage market that you opened up the call with, which is in the past, you kind of said that MA is a strategically important market with a lot of long-term value. And on this call, you're saying it's a challenged market. So first, I guess, number one is kind of can you help me bridge the gap between those two lines of thoughts?

是的。早安，夥計們。大衛，我有點想回到你對醫療保險優勢市場的評論，你在過去的電話會議中談到了這一點，你說 MA 是一個具有重要戰略意義的市場，有很多長期的市場。 。在這次電話會議上，您說這是一個充滿挑戰的市場。首先，我想，第一個問題是你能幫我彌補這兩個想法之間的差距嗎？

And then as you look at the market from where you sit, given that you guys still participate, do you see its challenges as cyclical or structural?

然後，當你從你所在的位置觀察市場時，考慮到你們仍然參與其中，你認為它的挑戰是週期性的還是結構性的？

Good morning, George. My comments relative to the marketplace are our view, a statement of fact, given the current environment, drawing back to your broader point of view, we see from a societal standpoint, MA as currently and in the future, an important part of the offering to the marketplace. So it would be very clear. Secondly, as we've discussed before, within our Evernorth portfolio today, fully approaching a third of all of our product programs and services face off against government-sponsored programs, very inclusive of MA and the supporting programs are on MA and we will continue to invest in and grow those programs, products and services.

早上好，喬治。我對市場的評論是我們的觀點，是事實的陳述，考慮到當前的環境，回到您更廣泛的觀點，我們從社會的角度來看，MA 當前和未來是產品的重要組成部分到市場。所以這就非常清楚了。其次，正如我們之前討論的，在我們今天的Evernorth 產品組合中，完全接近我們所有產品計劃和服務的三分之一與政府資助的計劃相對立，這些計劃非常包容MA，並且支持計劃都在MA上，我們將繼續投資和發展這些計劃、產品和服務。

What I was seeking to draw back to was, again, given the disruption in the marketplace and the headline that we were drawn into great clarity that the marketplace is disrupted and our actions and our behaviors are consistent with what we said they were going to be specifically using our discretionary free cash flow for share repurchase.

我想再次強調的是，考慮到市場的混亂以及我們被吸引到非常清楚的標題，即市場已被破壞，我們的行動和我們的行為與我們所說的一致。的自由現金流來回購股票。

Looking forward, I would expect to see the MA marketplace find its footing again, albeit it's going to go through a choppy phase right now for the forces I talked about before, elevated medical costs. Significant reset the stars. So if you look back, there was a time when the marketplace had almost 90% of all lives in 4-star plus plans that gets reset down to 60%-plus of lives. That's a large resetting for the marketplace. The risk adjuster part of the program coming through is also quite meaningful.

展望未來，我預計 MA 市場將再次站穩腳跟，儘管由於我之前談到的醫療費用上漲的因素，它現在將經歷一個動蕩的階段。重大重置星星。因此，如果你回顧過去，曾經有一段時間，市場上幾乎 90% 的生命都處於 4 星級以上計劃，而這些計劃被重置為 60% 以上。這是市場的重大重置。該計劃中的風險調整部分也很有意義。

So I deem it to be transitional for the marketplace. The leaders in the marketplace will find a way to lead through this. And importantly, MA serves a very important value prop from a societal standpoint. On average, an MA life as lower income on average in MA life is supportive of better clinical coordination, clinical efficacy and an average in MA life is getting better overall value and affordability. The space is just going through a choppy time right now, and that's what we're trying to call attention to.

所以我認為它對於市場來說是過渡性的。市場領導者將找到解決這個問題的方法。重要的是，從社會角度來看，MA 有非常重要的價值支撐。平均而言，MA 壽命的平均收入較低，支持更好的臨床協調、臨床療效，且平均 MA 壽命的整體價值和負擔能力變得更好。這個空間現在正經歷一段動盪的時期，這就是我們試圖引起人們注意的地方。

I appreciate the color. Thank you.

我很欣賞它的顏色。謝謝。

Josh Raskin, Nephron Research.

喬許·拉斯金，腎單位研究。

So I'll harp on those. I'll sort of keep on the topic here. But just in terms of the cadence of buybacks, I want to understand you guys were relatively strong in the first quarter, particularly strong in the second quarter. A noticeable pause in 3Q, and I heard David, your response to Justin's question around this disruption in the space and wanting to get as much clarity as possible.

所以我會反覆討論這些。我會繼續討論這個話題。但就回購節奏而言，我想了解你們在第一季相對強勁，尤其在第二季強勁。第三季有一個明顯的停頓，我聽到大衛，你對賈斯汀關於空間中斷的問題的回答，並希望得到盡可能多的澄清。

Should we assume that you now have the clarity that you need to understand the Medicare Advantage business and that is what's leading to this reacceleration in the buybacks and into 2025? And then just a smaller one, just on favorable development, it was a little larger in 3Q. Could you talk were there any specific drivers of that or areas where development came in better?

我們是否應該假設您現在清楚知道您需要了解 Medicare Advantage 業務，而這正是導致回購加速並持續到 2025 年的原因？然後只是一個較小的，只是在良好的發展情況下，第三季的規模稍大一些。您能否談談是否有任何具體的驅動因素或發展得更好的領域？

Josh, it's David. Let me take your first question and then ask Brian to take the second part of your questions. No. If the specific answer to your question, the call -- the cadence of our buybacks is driven by cash flow timing. So you'll note that our cash flow, and we've highlighted this in the past, doesn't happen ratably throughout the course of the year.

喬什，我是大衛。讓我回答你的第一個問題，然後請布萊恩回答你問題的第二部分。不。因此，您會注意到，我們過去強調的現金流量在全年中並沒有大幅增加。

So early part of the year, we expected to have significant deployment of capital and toward the latter part of the year, we expect to have significant deployment of capital. So specific to your question, the timing and cadence of deployment of free cash flow is tied to the timing of the cash flow generation in the fourth quarter will be a high cash flow generation quarter for us. And we highlighted the fact that we are quite active in the marketplace, noting the share repurchase through the month of October thus far.

因此，在今年年初，我們預計將有大量的資本部署，而在今年下半年，我們預計將有大量的資本部署。因此，具體到你的問題，自由現金流部署的時機和節奏與第四季度現金流產生的時間有關，這對我們來說將是一個高現金流生成季度。我們強調了這樣一個事實，即我們在市場上相當活躍，並注意到迄今為止 10 月的股票回購。

Brian, can I ask you to take the second part of the question?

布萊恩，我可以請你回答問題的第二部分嗎？

Sure, David, good morning. So as it relates to the prior year development that we saw in the third quarter, it was a little bit higher than we typically would see in the third quarter. But Important to keep in mind that, that's gross prior year development, which doesn't translate [one for one] to a net P&L impact, just given the variety of factors like client sharing, MLR rebate impacts and other items.

當然，大衛，早安。因此，由於它與我們在第三季度看到的去年發展有關，因此它比我們通常在第三季度看到的要高一些。但重要的是要記住，這是去年的總發展，僅考慮到客戶共享、MLR 回扣影響和其他項目等各種因素，並不能[一對一]轉化為淨損益影響。

And in any given period, we tend to see a fluctuation as you can appreciate, in reserve development from year-to-year, quarter-to-quarter. And overall, the net P&L effect of prior period reserve development was not a significant driver of the Cigna Healthcare MCO or the Cigna Healthcare income in the third quarter. So I appreciate the questions. .

在任何特定時期，我們往往會看到每年、每季的儲備開發出現波動，正如您所看到的那樣。整體而言，前期準備金發展的淨損益效應並不是 Cigna Healthcare MCO 或 Cigna Healthcare 第三季營收的重要推手。所以我很感激這些問題。 。

Lance Wilkes, Bernstein.

蘭斯威爾克斯，伯恩斯坦。

Thanks so much. Just a couple of cleanup questions and one broad strategic question. On the strategic level, as you're looking at deployment of capital as you're thinking about inorganic moves, how do you look at things from a management and board level with respect to management stability, stability and volatility of a business model, et cetera? And are there other important criterias we should be aware of?

非常感謝。只是幾個清理問題和一個廣泛的戰略問題。在策略層面上，當你在考慮無機舉措時考慮資本部署時，你如何從管理層和董事會層面看待管理穩定性、業務模式的穩定性和波動性等問題諸如此類？還有其他我們應該注意的重要標準嗎？

And the little items are just over in the employer market, given high premium inflation, are you seeing different behaviors from employers whether that's faster shift to ASO or certain types of cost containment features that they're looking for? Thanks.

考慮到高保費通膨，雇主市場上的小專案剛剛結束，您是否看到雇主有不同的行為，無論是更快地轉向 ASO 還是他們正在尋找的某些類型的成本控制功能？謝謝。

Lance, good morning, it's David. Let me take your strategic question specific to M&A criteria and then ask Brian to take your follow-up. You painted a miscleanup. I find that interesting. But specific to your strategic question, if you step back and think about our M&A criteria, which is the core of your question, our criteria has not changed. And to remind you, first is strategic alignment. Then second is financial attractiveness. I'll come back to that in a moment. And then third is our need to see a clear path to close.

蘭斯，早上好，我是大衛。讓我回答您針對併購標準的策略問題，然後請布萊恩回答您的後續問題。你畫了一個錯誤的清理。我覺得這很有趣。但具體到你的策略問題，如果你退一步思考我們的併購標準，這是你問題的核心，我們的標準沒有改變。提醒您，首先是策略調整。其次是財務吸引力。我稍後會回來討論這一點。第三是我們需要找到一條明確的結束路徑。

As it relates to financial attractiveness, we take into consideration EPS accretion. So the level of, the timing of, the visibility of, the durability of. We also look at capital efficiency, return on invested capital on a relative basis in terms of assessing it. So to the core of your question, if I heard you correctly, a more disruptive environment or a less stable asset would increase the beta. Increasing the beta requires a higher visibility to highly durable synergies, value capture and the durability of that.

由於它與財務吸引力相關，我們考慮了每股收益的增加。所以，它的水平、時機、可見度、持久性。在評估時，我們也會在相對基礎上檢視資本效率、投資資本報酬率。因此，對於你問題的核心，如果我沒聽錯的話，更具破壞性的環境或不太穩定的資產會增加貝塔值。增加貝塔值需要對高度持久的協同效應、價值捕獲及其持久性有更高的可見度。

So to the core of your question is, of course, we have to consider that because you're looking for strategic value creation and strategic value capture. And adjacency versus further adjacency and the more stable and predictable versus the more volatile has to be taken into consideration. And I'll end with, I believe we have a very clear, good track record of applying these criteria and creating shareholder value over a long period of time.

因此，您問題的核心當然是我們必須考慮這一點，因為您正在尋求策略價值創造和策略價值獲取。必須考慮相鄰性與進一步相鄰性以及更穩定和可預測性與更不穩定的因素。最後，我相信我們在長期應用這些標準和創造股東價值方面有著非常清晰、良好的記錄。

Brian, I'll transition you?

布萊恩，我會轉移你嗎？

Yes. Lance, on the second question in terms of how employers are reacting to a higher cost trend environment, a few things highlight there from our US employer portfolio. Affordability is generally the number 1 topic when we talk to employer clients. And historically, they look at benefit buy-downs, changes to deductibles and out-of-pocket maximums maybe premium contribution changes.

是的。蘭斯，關於雇主如何應對成本上升趨勢環境的第二個問題，我們美國雇主投資組合中強調了一些事情。當我們與雇主客戶交談時，負擔能力通常是排在第一位的話題。從歷史上看，他們會考慮福利購買、免賠額變化和自付費用最高限額可能是保費繳款變化。

But the strategies are becoming more precise and more granular now. So as an example, we're seeing more and more interest in our specialty pharmacy capabilities, programs like the EnCircleRx to help mitigate GLP-1 spending and ensure clinical appropriateness of all those programs. So we're seeing interest in more precise affordability programs.

但現在這些策略變得更加精確和細化。舉例來說，我們看到越來越多的人對我們的專業藥學能力、EnCircleRx 等項目感興趣，以幫助減少 GLP-1 支出並確保所有這些項目的臨床適用性。因此，我們看到了人們對更精確的負擔能力計劃的興趣。

We're also seeing a lot of interest in our mental health and substance of these capabilities. Since the pandemic started, this has been a higher cost trend category. And even this year, it's contributing about 1% to employer cost trends just in the year. So there's interest in what programs and services we have available to address that as well as the link between mental and physical health, which has been shown, metal health utilization deflects physical health needs down the line.

我們也看到人們對我們的心理健康和這些能力的實質內容很感興趣。自大流行開始以來，這是一個成本較高的趨勢類別。即使今年，它對當年雇主成本趨勢的貢獻也約為 1%。因此，人們對我們可以提供哪些計劃和服務來解決這個問題以及心理和身體健康之間的聯繫感興趣，事實證明，金屬健康的利用會轉移身體健康的需求。

And then finally, there's interest in more precise provider network configurations that help to optimize cost, quality incentive alignment. So things like our Pathwell Specialty offerings, things like our Pathway Bone & Joint program, so all those things are of increased interest to employers in a high trend environment. And taken all together, our Cigna Healthcare offerings are well positioned to address those themes.

最後，人們對更精確的提供者網路配置感興趣，這有助於優化成本、品質激勵協調。像我們的 Pathwell Specialty 產品、Pathway Bone & Joint 計劃這樣的東西，在高趨勢環境下，所有這些東西都引起了雇主越來越多的興趣。總而言之，我們的 Cigna Healthcare 產品能夠很好地解決這些主題。

Great.

偉大的。

[Michael Hop, Baird].

[邁克爾·霍普，貝爾德]。

Alright, thank you. Firstly, on '25 headwinds and tailwinds, thank you for providing that list in your prepared remarks. I was just wondering if you could maybe flesh that out a bit more specifically, which of those building blocks perhaps are you most confident about in terms of helping you on your path to 10% or at least 10% EPS growth next year?

好的，謝謝。首先，關於 25 年的逆風和順風，感謝您在準備好的發言中提供了該清單。我只是想知道您是否可以更具體地闡述一下，您對哪些建置模組最有信心能夠幫助您實現明年 10% 或至少 10% 的 EPS 成長？

And then following up on Erin's question, maybe a different approach to it. I know biosimilar quickly rose to 20% share of your specialty book last quarter. Where has that trended in third quarter? Where do you see both HUMIRA biosimilar adoption, which I believe is now one third of eligible and that biosimilars share, especially by trending into year-end and over the next year.

然後跟進艾琳的問題，也許有不同的方法。我知道上個季度生物相似藥在你們的專業書籍中所佔的份額迅速上升到 20%。第三季的趨勢在哪裡？您在哪裡看到 HUMIRA 生物相似藥的採用率，我認為現在有三分之一符合資格，生物仿製藥所佔份額，特別是從年底和明年的趨勢來看。

And then as I think about Evernorth's earnings growth, I think you mentioned last quarter that biosimilars is going to help drive it to high single-digit growth in third quarter, which you did. So I wanted to get your thoughts on how are we now in a spot where it can sustainably grow high single digits going forward, are we officially now in that sort of new paradigm of earnings contribution Evernorth from biosimilars? Thank you.

然後，當我想到 Evernorth 的盈利增長時，我認為您在上個季度提到生物仿製藥將有助於推動其在第三季度實現高個位數增長，您確實做到了。因此，我想了解您對我們現在如何能夠持續實現高個位數成長的想法，我們現在是否正式處於生物相似藥收益貢獻 Evernorth 的新範式中？謝謝。

Hi, good morning. It's David. Michael, it's David. You packed a lot in there for us to begin to bring our call to a close in short order, but important topics. So first, let me just frame a little bit of the headwind tailwind framework and then ask Brian to peel it back, although it will give you a bit more specificity. And then we'll transition to Eric, who will talk about the trends in direction, et cetera. I don't think we're declaring a new normal as opposed to the growth trajectory we see relative to that business in the 8% to 12% compounded over time, which is above the secular trends.

嗨，早安。是大衛。邁克爾，是大衛。您為我們準備了很多內容，以便我們開始在短時間內結束我們的通話，但主題很重要。因此，首先，讓我先框架一下逆風順風框架，然後請布萊恩將其剝離出來，儘管這會給你更多的具體性。然後我們將轉向艾瑞克（Eric），他將談論趨勢方向等。我認為我們並不是宣布新常態，而是與我們看到的相對於該業務隨時間複合的 8% 至 12% 的成長軌跡相反，這高於長期趨勢。

But let me shift back to the headwind tailwind. As I noted in my prepared remarks, we'll provide much more detail in our fourth quarter call as we provide the 2025 outlook and guidance as we always do. Importantly, and we want to stress, this will come off of 2024, which is going to be another strong year and competitively differentiated year. And our outlook for 2025 will be a strong year and competitively differentiated year.

但讓我回到逆風順風。正如我在準備好的發言中指出的那樣，我們將在第四季度電話會議中提供更多詳細信息，因為我們將一如既往地提供 2025 年展望和指導。重要的是，我們想強調，這將在 2024 年結束，這將是另一個強勁的一年和競爭差異化的一年。我們對 2025 年的展望將是強勁的一年和競爭差異化的一年。

And we highlighted several of the headwinds and tailwinds as you put them all together, even at this point, we're confident to step forward and say that our growth algorithm will be intact for 2025, yet we would expect to guide at the lower end of our algorithm range with taking a posture prudence.

當你把它們放在一起時，我們強調了一些逆風和順風，即使在這一點上，我們也有信心向前邁出一步，並表示我們的增長算法將在2025 年保持完整，但我們預計會在低端進行指導我們的演算法範圍，並採取謹慎的姿勢。

So Brian, could I ask you to give a little bit more color on some of the drivers within the headwinds and tailwinds and some dimensioning?

那麼布萊恩，我可以請你對一些車手的逆風和順風以及一些尺寸提供更多的資訊嗎？

Sure, David. Michael, I'll give you maybe a little bit more detail on the 3 tailwinds and 3 headwinds that David outlined earlier on the call. So in terms of the 3 tailwinds we see for 2025, continued biosimilar adoption is one. Obviously, that's been a theme throughout the morning here, and we do have a high degree of confidence in that being delivered in 2025.

當然，大衛。邁克爾，我可能會向您提供有關大衛早些時候在電話會議中概述的 3 個順風和 3 個逆風的更多詳細信息。因此，就我們在 2025 年看到的 3 個有利因素而言，生物相似藥的持續採用就是其中之一。顯然，這是整個上午的主題，我們對 2025 年實現這一目標充滿信心。

Secondly, we expect advancements in our large PBS client relationships. Obviously, we had a very sizable new client in '24. We also have others that we've onboard in recent years. And then the third tailwind is EPS accretion from the deployment of the Medicare sale proceeds.

其次，我們預期 PBS 的大型客戶關係將取得進展。顯然，我們在 24 年有了一個非常大的新客戶。近年來我們還加入了其他人。第三個推動因素是醫療保險銷售收益的部署帶來的每股盈餘增加。

And given we know the magnitude of this, we would expect this to be a low single-digit percent impact on 2025 EPS when you think about the deployment of those proceeds. That's offset by three primary headwinds that we see at this juncture. The first is the absence of the 2025 VillageMD dividend recognition. So as I made reference to earlier, that was $33 million in the third quarter. You annualize that out. It's about $130 million of a headwind for 2025 to the Evernorth segment income as well as, obviously, the enterprise.

鑑於我們知道這一影響的嚴重程度，當您考慮這些收益的部署時，我們預計這對 2025 年每股收益的影響將是低個位數百分比。我們目前看到的三個主要阻力抵消了這一點。首先是沒有2025年VillageMD股利的認可。正如我之前提到的，第三季為 3300 萬美元。你將其年化。到 2025 年，這對 Evernorth 部門的收入以及企業來說將帶來約 1.3 億美元的阻力。

Secondly, we'll have some stranded overhead from the Medicare divestiture, which is currently at about $150 million for the year. And you can think of that as split roughly half and half between Cigna Healthcare and Evernorth. And obviously, our teams will work to whittle that down over time, but we see that as about $150 million headwind for '25.

其次，我們將從醫療保險剝離中獲得一些滯留的管理費用，目前今年的管理費用約為 1.5 億美元。你可以認為 Cigna Healthcare 和 Evernorth 之間大約各佔一半。顯然，隨著時間的推移，我們的團隊將努力減少這種情況，但我們認為這對 25 年來說是大約 1.5 億美元的阻力。

And then finally, continued investments for long-term growth, as I made reference to an earlier question, that will gear up or gear down depending on the market opportunities that we see as we balance short-term and long-term needs for the company. So Eric, you can pile on here on the biosimilars part of the question?

最後，正如我所提到的一個早期問題，持續投資以實現長期成長，這將根據我們在平衡公司的短期和長期需求時看到的市場機會而加速或減速。艾瑞克（Eric），您可以在這裡繼續討論問題的生物相似藥部分嗎？

Thanks, Brian, and thanks for the question, Michael. With respect to HUMIRA, a couple of notes I wanted just to be clear on, we began to spend in a biosimilar HUMIRA at the end of June. We noted in our second quarter call that throughout the month of July, had achieved about 20% -- or about 20% of our customers had elected to use the biosimilar HUMIRA.

謝謝布萊恩，也謝謝麥可的提問。關於 HUMIRA，我想澄清幾點，我們從 6 月底開始購買生物相似藥 HUMIRA。我們在第二季電話會議中指出，整個 7 月份，大約有 20% 的客戶選擇使用生物相似藥 HUMIRA。

And that's grown throughout the quarter. The number we provided today was that across the third quarter in its entirety now about 33% of the eligible patients had adopted. So really nice growth throughout the quarter. We would expect that to continue to grow over the balance of the year.

這一數字在整個季度都在增長。我們今天提供的數字是，整個第三季度，大約 33% 的符合條件的患者已經採用了該技術。整個季度的成長非常好。我們預計這一數字將在今年餘下時間繼續增長。

And to your more macro question, just I'll step back for a minute. We're well positioned to bring value to the benefit of our customers and clients overall. And as we've noted for several years now, we see and have worked to deliberately position ourselves to be lined up to capture the forces associated with pharmacological innovation and we've positioned our company to play a leading role in connecting patients with the medicines that they need there.

對於你更宏觀的問題，我先退後一步。我們有能力為我們的客戶和客戶的整體利益帶來價值。正如我們多年來所指出的那樣，我們看到並努力將自己定位為抓住與藥理創新相關的力量，並且我們將公司定位為在連接患者與藥物方面發揮主導作用他們在那裡需要的。

At our Investor Day back in March, we again increased the top end of our long-term growth range for Evernorth up to 5% to 8% growth, and that reflects all of these dynamics. And so that's the I think the fourth time we increased the growth trajectory of Evernorth since Evernorth was launched just a few years ago, and we're excited about the opportunity to continue to grow in this space are the same, the positive forces that we've just talked about and the ability to have a meaningful positive influence on affordability of health care and the patients that we serve overall. So we're excited about the opportunity and well positioned to play a leading role here.

在三月的投資者日，我們再次將 Evernorth 的長期成長區間上限提高至 5% 至 8%，這反映了所有這些動態。因此，我認為自從幾年前 Evernorth 推出以來，我們第四次提高了 Evernorth 的成長軌跡，我們對有機會在這個領域繼續成長感到興奮，這是我們所帶來的積極力量。保健的負擔能力和我們所服務的患者產生有意義的積極影響的能力。因此，我們對這個機會感到很興奮，並且有能力在這裡發揮主導作用。

Thank you. I'd like to turn the call back to David Cordani for closing remarks.

謝謝。我想將電話轉回給大衛·科達尼 (David Cordani)，讓其致閉幕詞。

I just want to briefly wrap up. Most importantly, thanks for your questions, your time and your engagement on our call today.

我只想簡單總結一下。最重要的是，感謝您提出問題、抽出時間參加我們今天的電話會議。

Just to highlight a few headlines. Cigna Group once again, given our business momentum and complementary growth platforms delivered a strong third quarter, and we remain on track to deliver our 2024 EPS outlook of at least $20.40, and we're on track for another competitively differentiated year in 2025.

只是為了突出幾個標題。鑑於我們的業務勢頭和互補的成長平台，Cigna Group 再次實現了強勁的第三季業績，我們仍有望實現2024 年每股收益至少20.40 美元的預期，並且我們預計在2025 年迎來又一個具有競爭優勢的一年。

Before I close, I want to thank our 70,000 colleagues around the world and a fantastic senior leadership team. It's their focus, caring orientation, and commitment that allows us to do what we do day in, day out for those we have the privilege to serve. We're proud of what we've accomplished in the third quarter and the trajectory that we have for the full year, and we look forward to talking you in the future. Have a great day.

在結束之前，我要感謝我們世界各地的 70,000 名同事以及優秀的高階領導團隊。正是他們的關注、關懷和承諾使我們能夠日復一日地為那些我們有幸服務的人做我們所做的事情。我們對第三季所取得的成就以及全年的發展軌跡感到自豪，我們期待著將來與您交談。祝你有美好的一天。

Ladies and gentlemen, this concludes the Cigna Group's Third 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 888-282-0035 or 203-369-3602. There is no passcode required for this replay.

女士們、先生們，信諾集團 2024 年第三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 888-282-0035 或 203-369-3602 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。