信諾集團 (CI) 2024 Q4 法說會逐字稿

Ladies, and gentlemen, thank you for standing by for The Cigna Group Fourth Quarter 2024 Results Review.

女士們、先生們，感謝您關注 Cigna Group 2024 年第四季業績評估。

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

（操作員指示）提醒一下，女士們，先生們，本次會議，包括問答環節，正在錄音。

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

我們先將會議交給 Ralph Giacobbe。

Please go ahead.

請繼續。

Thank you.

謝謝。

Good morning, everyone.

大家早安。

Thanks for joining today's call.

感謝您參加今天的電話會議。

I'm Ralph Giacobbe, Senior Vice President of Investor Relations.

我是投資者關係資深副總裁 Ralph Giacobbe。

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 Health Care; and Eric Palmer, President and Chief Executive Officer of Evernorth Health Services.

今天早上與我一起通話的還有 Cigna 集團董事長兼執行長 David Cordani； Brian Evanko，信諾集團財務長兼信諾醫療保健總裁兼執行長；以及 Evernorth Health Services 總裁兼執行長 Eric Palmer。

In our remarks today, David and Brian will cover a number of topics, including our fourth quarter and full-year 2024 financial results and our financial outlook for 2025.

在今天的演講中，David 和 Brian 將討論許多主題，包括我們的 2024 年第四季度和全年財務業績以及我們對 2025 年的財務展望。

Following their prepared remarks, David, Brian and Eric will be available for Q&A.

在發表準備好的演講後，David、Brian 和 Eric 將參加問答環節。

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.

正如我們的收益報告中所述，在描述我們的財務表現時，我們使用了某些財務指標，包括調整後的營業收入和調整後的收入，這些指標不是按照美國普遍接受的會計原則（即 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 thecignagroup.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.

今天的收益報告中包含了這些指標與最直接可比較的 GAAP 指標、股東淨收入和總收入的對賬，該報告已發佈在 thecignagroup.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」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 2025 and future performance.

在今天的演講中，我們將做出一些前瞻性的陳述，包括有關我們對 2025 年和未來業績的展望的陳述。

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

這些聲明受風險和不確定性的影響，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.

這些風險和不確定性的描述包含在今天的收益報告的警告說明中以及我們向美國證券交易委員會提交的最新報告中。

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

關於我們第四季度的業績，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.

特殊項目的詳細資訊包含在我們的季度財務補充報告中。

Additionally, please note that when we make prospective comments regarding financial performance, including our full-year 2025 outlook, we'll do so on a basis that includes the potential impact of future share repurchases and anticipated 2025 dividends.

此外，請注意，當我們對財務業績（包括 2025 年全年展望）做出前瞻性評論時，我們會考慮到未來股票回購和預期 2025 年股息的潛在影響。

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

說完這些，我會把電話轉給大衛。

Thanks, Ralph.

謝謝，拉爾夫。

Good morning, everyone, and thank you for joining our call.

大家早安，感謝大家參加我們的電話會議。

Today, I'll discuss key headlines from the quarter and our full-year 2024 performance.

今天，我將討論本季的主要新聞以及我們 2024 年全年的業績。

I'll also share more on the actions we are accelerating to build a better and more sustainable health care model.

我還將分享更多我們為建立更好、更永續的醫療保健模式而正在加快採取的行動。

And then Brian will provide additional details on our financial results and our 2025 outlook, and we'll take your questions.

然後，布萊恩將提供有關我們的財務業績和 2025 年展望的更多詳細信息，我們將回答您的問題。

Before I get into our earnings, I want to start by sharing a few comments on the current environment.

在談論我們的收益之前，我想先就當前環境分享一些評論。

During my tenure as the leader of The Cigna Group, there have been a number of periods in our industry where we faced unique challenges, whether the financial crisis, the introduction of the ACA to global pandemic or several significant shifts in political, regulatory and societal landscape.

在我擔任信諾集團領導人期間，我們產業經歷了多個時期面臨獨特的挑戰，無論是金融危機、ACA 的推出、全球疫情，還是政治、監管和社會格局的幾次重大轉變。

At The Cigna Group, our resilience and the durability of our business model have allowed us not only to overcome obstacles, but to lead through change while focusing on achieving our long-term objectives for sustainable growth.

在信諾集團，我們的韌性和商業模式的持久性不僅使我們能夠克服障礙，而且能夠引領變革，同時專注於實現可持續成長的長期目標。

In early December, we were all witnesses to the tragic murder of Brian Thompson, a leader at the UnitedHealth Group.

12月初，我們見證了聯合健康集團領導人布萊恩湯普森慘遭殺害。

The past several weeks have further challenged us to even more intensely listen to the public narrative about our industry.

過去幾週給我們帶來了進一步的挑戰，讓我們更認真地傾聽大眾對我們產業的評價。

At the Cigna Group, we are further accelerating improvements in innovations to increase transparency, expand support and drive even greater accountability.

在 Cigna 集團，我們正在進一步加快創新改進，以提高透明度、擴大支援並推動更大的責任感。

I'll come back to this important topic in a few moments.

稍後我將回到這個重要主題。

With that, let me start with a summary of our 2024 results.

首先，讓我總結一下我們的 2024 年業績。

We delivered full-year revenue growth of 27% to approximately $247 billion. Full-year

我們全年營收成長 27%，達到約 2,470 億美元。全年

adjusted earnings per share of $27.33 representing an increase of 9% year over year, but short of our expectations.

調整後每股收益為 27.33 美元，年增 9%，但低於我們的預期。

We returned $8.6 billion to shareholders through dividends and share repurchase.

我們透過股利和股票回購向股東返還了 86 億美元。

And our Board of Directors declared an 8% increase to our quarterly dividend to $1.51 per share and increased our share repurchase authority to $10.3 billion.

我們的董事會宣布將季度股息增加 8% 至每股 1.51 美元，並將我們的股票回購權增加至 103 億美元。

The Cigna Group also maintained a strong capital position in 2024.

信諾集團在 2024 年也維持了強勁的資本狀況。

We're also nearly complete with the sale of our Cigna Healthcare Medicare business to HCSC, and we continue to expect to close in the first quarter and plan to use the majority of the proceeds for share repurchase.

我們也已接近完成將 Cigna Healthcare Medicare 業務出售給 HCSC 的交易，我們預計該交易將在第一季完成，併計劃將大部分收益用於股票回購。

Now turning to our business results and actions, I want to cover just a few headlines.

現在談談我們的業務成果和行動，我只想談幾個要點。

First, our fourth quarter results were below expectations due to higher-than-expected medical costs in our stop loss product within Cigna Healthcare.

首先，由於 Cigna Healthcare 的停損產品的醫療成本高於預期，我們第四季的業績低於預期。

We are taking corrective actions on this near-term pressure and expect to recapture margin over the next two years.

我們正在對這一短期壓力採取糾正措施，並期望在未來兩年內重新獲得利潤。

This is a specific issue we identified and are mitigating and I'll reinforce that we believe our US Employer and Cigna Healthcare businesses are strong and remain well positioned, and we're confident in our long-term growth strategy.

這是我們發現並正在緩解的一個具體問題，我要強調的是，我們相信我們的美國雇主和 Cigna Healthcare 業務強勁且保持良好地位，我們對我們的長期成長策略充滿信心。

Brian will discuss this in greater detail in his remarks.

布萊恩將在他的演講中更詳細地討論這一點。

The second headline for the quarter is that Evernorth continues to drive strong results in line with our expectations, primarily driven by our Specialty and Care Services segment.

本季的第二個標題是，Evernorth 繼續按照我們的預期實現強勁業績，這主要得益於我們的專業和護理服務部門。

Our continued leadership with biosimilars is a good example of how we are addressing some of the biggest challenges facing clients and patients today.

我們在生物相似藥領域持續的領導地位就是一個很好的例子，說明了我們如何應對當今客戶和患者面臨的一些最大挑戰。

We began dispensing our HUMIRA interchangeable biosimilar last summer to eligible Accredo patients with $0 cost to our patients.

去年夏天，我們開始向符合條件的 Accredo 患者提供 HUMIRA 可互換生物相似藥，患者無需支付任何費用。

We are pleased that biosimilar use for eligible HUMIRA scripts reached nearly 50% by year-end 2024.

我們很高興，到 2024 年底，符合條件的 HUMIRA 處方的生物相似藥使用率將達到近 50%。

We took another step forward as we announced that we will be an offering an interchangeable STELARA biosimilar, again, for a $0 cost to our patients.

我們又向前邁進了一步，我們宣布將再次以 0 美元的價格向我們的患者提供可互換的 STELARA 生物仿製藥。

Looking forward, we expect approximately $100 billion of specialty drug spend in the US will be subject to biosimilar and generic competition over the next five years.

展望未來，我們預計未來五年美國約有 1000 億美元的特種藥物支出將受到生物相似藥和仿製藥的競爭。

Our HUMIRA and STELARA biosimilar offerings are just the start of this opportunity, and Accredo is well positioned to lead and continue to deliver real savings for our clients, customers and patients.

我們的 HUMIRA 和 STELARA 生物相似藥產品只是這一機會的開始，Accredo 已準備好引領並繼續為我們的客戶、顧客和患者帶來真正的節省。

Now stepping back, prescription drug coverage is the most frequently used health care benefit.

現在回想起來，處方藥保險是最常用的醫療保健福利。

On average, it's used about 15 times per year per person.

平均每人每年使用約15次。

And how our nation and industry captures the full promise of prescription drug innovation while addressing affordability has been subject to continued debate.

而我們國家和產業如何充分發揮處方藥創新的潛力並解決藥價昂貴問題一直是人們爭論的焦點。

Pharmacy benefit managers are essential in helping patients access medications at fair and affordable prices.

藥房福利管理人員對於幫助患者以公平合理的價格獲得藥物至關重要。

In fact, approximately 80% of Express Scripts patients spend less than $100 out of pocket per year for their prescriptions.

事實上，大約 80% 的 Express Scripts 患者每年自付的處方藥費用不到 100 美元。

Yet, we recognize for those Express Scripts patients who pay more than $100, for some, it's too high.

然而，我們意識到，對於一些支付超過 100 美元的 Express Scripts 患者來說，這個費用太高了。

For example, consider the increased use of GLP-1s in the United States, it is the number one driver of drug trend across employers of all sizes in 2024.

例如，考慮到美國 GLP-1 的使用增加，它將成為 2024 年各種規模雇主中藥物趨勢的頭號驅動因素。

Despite these medications being relatively cheap to produce, Americans are paying prices that are multiples higher for GLP-1s compared to other countries, even with full pass-through of rebates.

儘管這些藥物的生產成本相對較低，但即使全額回饋，美國人為 GLP-1 支付的價格仍比其他國家高出數倍。

Said otherwise, even including all discounts and rebates, the end result is that the US costs are multiples higher than other OECD countries.

換句話說，即使包括所有的折扣和回扣，最終結果也是美國的成本比其他經合組織國家高出數倍。

This is not acceptable, nor sustainable.

這是不可接受的，也不可持續的。

As for innovations, led by Evernorth and Express Scripts, we are proud that last year our EncircleRx solution grew to approximately 8 million lives enrolled, where we are supporting the best possible patient outcomes by providing those on GLP-1s additional lifestyle support and tools to help sustain long-term improvement.

至於由 Evernorth 和 Express Scripts 引領的創新，我們感到自豪的是，去年我們的 EncircleRx 解決方案已覆蓋約 800 萬人，我們透過為 GLP-1 患者提供額外的生活方式支持和工具來幫助維持長期改善，從而支持盡可能最佳的患者治療結果。

Now the next headline I want to touch on a bit more is the current environment.

現在我想要進一步談的下一個標題是目前的環境。

We have long been on a path to evolve and drive continuous improvement.

我們長期以來一直在不斷發展和推動持續改善的道路上。

As we step into 2025, we have further strengthened our urgency and resolve on this path.

當我們邁入2025年時，我們更加堅定了在這條道路上前進的緊迫感和決心。

That means we are accelerating investments that will positively impact the way our customers and patients experience health care.

這意味著我們正在加快投資，這將對我們的客戶和患者的醫療保健體驗產生積極影響。

To that end, this week, we announced actions we were taking in Express Scripts, our pharmacy benefit service business within Evernorth.

為此，本週我們宣布了對 Evernorth 旗下藥房福利服務業務 Express Scripts 的行動。

Our commitment will help patients directly benefit further from the negotiations we drive to lower out-of-pocket costs as well as work to further enhance transparency.

我們的承諾將幫助患者從我們推動的降低自付費用的談判中直接受益，並進一步提高透明度。

Let me briefly recap the announcements.

讓我簡單回顧一下這些公告。

Going forward, our standard products will provide patients lower prices at the pharmacy counter, protecting them from paying full list prices for drugs, and they will fully benefit from our lower net negotiated prices.

展望未來，我們的標準產品將為患者提供更低的藥房櫃檯價格，使他們無需支付藥品的全價，並且他們將充分受益於我們更低的淨協商價格。

Next, patients will also have improved predictability, especially and importantly, in their deductible phase by receiving the benefit of Express Scripts negotiated savings like their employer does.

其次，患者也將獲得更高的可預測性，尤其重要的是，在他們的免賠額階段，他們可以像他們的雇主一樣獲得 Express Scripts 協商節省的優惠。

We will also expand the benefit summaries and disclosures we provide.

我們也將擴大我們提供的福利摘要和揭露。

Patients will receive a personalized summary that details their annual total prescription drug costs, plan paid amounts and the savings we deliver.

患者將收到一份個人化摘要，詳細說明其年度處方藥總費用、計劃支付金額以及我們提供的節省金額。

And plan sponsors will also receive an enhanced report beyond what Express Scripts already provides, including additional transparency on costs and pharmacy claim level insights.

計劃發起人還將收到一份比 Express Scripts 現有更豐富的報告，其中包括額外的成本透明度和藥房索賠水平見解。

We know that more can be done within our health plan offering as well, for customers and patients as well as clinical partners to further ease access to care timeliness and expand support programs.

我們知道，我們可以在健康計劃中為客戶、患者以及臨床合作夥伴提供更多服務，以進一步方便及時獲得醫療服務並擴大支援計劃。

More specifically, Cigna Healthcare will soon be announcing steps to improve value and address patient points of friction.

更具體地說，Cigna Healthcare 將很快宣布採取措施提高價值並解決患者的摩擦點。

Our focus is on making prior authorizations faster and simpler and expanding access to advocates for those facing complex health conditions to help them navigate every stage of their care journey.

我們的重點是讓事先授權更快、更簡單，並擴大那些面臨複雜健康狀況的人獲得倡議的機會，以幫助他們度過護理旅程的每個階段。

These initiatives will require that we incur additional costs, but we firmly believe these are critical actions for the benefit of customers and patients.

這些措施將需要我們承擔額外的成本，但我們堅信，這些對客戶和患者的利益來說都是至關重要的措施。

We will continue to take a prudent approach to these and future Cigna Healthcare and Evernorth actions in the weeks and months ahead as we are determined to continue to evolve for the benefit of those we serve and build a more sustainable health care model.

在未來幾週和幾個月內，我們將繼續對這些以及未來的 Cigna Healthcare 和 Evernorth 行動採取審慎態度，因為我們決心繼續發展以造福我們服務的對象並建立更可持續的醫療保健模式。

Now let me briefly summarize.

現在我簡單總結一下。

Against the backdrop of a dynamic and challenging environment in 2024, we delivered full-year adjusted earnings per share of $27.33 and we returned $8.6 billion to shareholders through dividends and share repurchase.

在 2024 年充滿活力和挑戰的環境下，我們實現全年調整後每股收益 27.33 美元，並透過股息和股票回購向股東返還 86 億美元。

Looking ahead to 2025, our EPS outlook of at least $29.50 reinforces the sustained growth and strength of our company, and we are focused on taking the prudent steps necessary to ensure our company is well positioned for future growth.

展望 2025 年，我們的每股盈餘預期至少為 29.50 美元，這增強了公司的持續成長和實力，並且我們專注於採取必要的審慎措施，確保公司為未來成長做好準備。

And we remain confident in our long-term 10% to 14% growth target fueled by our differentiated capabilities and portfolio of businesses.

憑藉我們差異化的能力和業務組合，我們對 10% 至 14% 的長期成長目標仍然充滿信心。

Finally, we recognize the need for accelerated positive change in our health care system to make it simpler and more affordable for everyone.

最後，我們認識到需要加速醫療保健系統的積極變革，以使其對每個人都更加簡單、更實惠。

And The Cigna Group is committed to continuing to take actions to drive further accountability and transparency as well.

信諾集團致力於繼續採取行動，進一步提高問責制和透明度。

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

說完這些，我將把電話轉給布萊恩。

Thank you, David.

謝謝你，大衛。

Good morning, everyone.

大家早安。

Today, I'll review Cigna's fourth-quarter and full-year 2024 results, and I'll provide our outlook for 2025.

今天，我將回顧 Cigna 2024 年第四季和全年的業績，並提供 2025 年的展望。

For full-year 2024, we reported consolidated adjusted revenues of $247.1 billion, adjusted after-tax earnings of $7.7 billion, and adjusted earnings per share of $27.33. Our performance within the Evernorth Health Services segment ended the year strong with particular momentum in Specialty and Care Services.

我們報告 2024 年全年綜合調整後收入為 2471 億美元，調整後稅後收益為 77 億美元，調整後每股收益為 27.33 美元。 Evernorth 健康服務部門以強勁的表現結束了這一年度，尤其在專科和護理服務方面表現強勁。

Despite this, our enterprise earnings results fell short of our expectations, driven by higher-than-expected medical costs in our stop loss products within the Cigna Healthcare segment.

儘管如此，由於 Cigna Healthcare 部門的停損產品醫療成本高於預期，我們的企業獲利結果仍未達到預期。

This resulted in a full-year medical care ratio of 83.2%, which was above our guidance range.

這使得全年醫療保健比率達到83.2％，高於我們的指導範圍。

We are taking corrective action to recapture margin, and we remain confident in the long-term strength of our business despite the short-term pressure.

我們正在採取糾正措施重新獲得利潤，儘管面臨短期壓力，但我們對業務的長期實力仍然充滿信心。

Now more specific to Cigna Healthcare's fourth-quarter results.

現在更具體地了解 Cigna Healthcare 的第四季業績。

Fourth-quarter 2024 revenues were $13.3 billion. Pre-tax

2024 年第四季營收為 133 億美元。稅前

adjusted earnings were $511 million, and the medical care ratio was 87.9%.

調整後獲利為5.11億美元，醫療保健比例為87.9%。

As I noted, fourth-quarter earnings fell below our expectations as we observed elevated medical costs in stop loss.

正如我所指出的，由於我們觀察到停損醫療成本上升，第四季度的收益低於我們的預期。

Results of our other products were in line with expectations, exhibiting a continuation of elevated trends that we had seen throughout the year.

我們其他產品的結果符合預期，延續了我們全年看到的上升趨勢。

Taking a step back, it's important to note that stop loss is a unique product within our portfolio where employers limit their risk from unexpected high-cost claims by transferring that risk for medical costs above a specific individual or aggregate employer dollar amount.

退一步來說，值得注意的是停損是我們投資組合中的一個獨特產品，雇主可以透過將醫療費用風險轉移到特定個人或雇主總金額之上來限制意外高成本索賠帶來的風險。

We can see variability in this product at times, but we've generated and continue to expect attractive margins over the long term.

我們有時會看到該產品的變化，但我們已經產生並繼續預期在長期內具有吸引力利潤率。

This year, variability was more pronounced in the fourth quarter as we had an increase in the number of high-cost claimants related to cost pressures from the continued acceleration in the prescribing and use of specialty medications as well as elevated high acuity surgical activity.

今年，第四季度的波動性更加明顯，因為由於專科藥物處方和使用的持續加速以及高敏銳度手術活動的增加而導致的成本壓力導致高成本索賠人數增加。

The fourth quarter also tends to be when more client settlements transpire, including true-ups for the full calendar year of activity.

第四季也往往是更多客戶結算發生的時候，包括全年活動的結算。

We had seen some of these trends emerge in the third quarter and began pricing for higher trend on high dollar claims.

我們已經看到第三季出現了一些這樣的趨勢，並開始根據高額索賠的更高趨勢進行定價。

But did not capture the full extent of this trend acceleration that materialized in the fourth quarter.

但並未充分體現出第四季出現的這種趨勢加速的程度。

And as a result, we expect a slightly higher MCR for stop loss in 2025.

因此，我們預計 2025 年的停損 MCR 將略高。

While this negatively impacts near-term margin, we expect to recapture approximately 100 basis points of margin in the overall Cigna Healthcare segment over the next two years, with the majority in 2026 and the remaining in 2027.

雖然這對短期利潤率產生負面影響，但我們預計未來兩年內 Cigna Healthcare 整體部門的利潤率將恢復約 100 個基點，其中大部分將在 2026 年恢復，剩餘的將在 2027 年恢復。

We will do this by balancing pricing action, affordability initiatives, operating cost efficiency, and continued investments.

我們將透過平衡定價行動、可負擔性措施、營運成本效率和持續投資來實現這一目標。

Now turning to Evernorth. 2024 highlighted another year of sustained growth, particularly within the Specialty and Care segment, highlighting the attractiveness of our market-leading clinical capabilities and innovative solutions that create affordability for customers and patients, amidst the growing trend of pharmacological innovation.

現在轉向 Evernorth。 2024 年是另一個持續成長的一年，尤其是在專科和護理領域，在藥理創新日益增長的趨勢中，我們市場領先的臨床能力和創新解決方案的吸引力更加凸顯，這些解決方案為客戶和患者帶來了可負擔的價格。

Adjusted revenues for fourth-quarter 2024 grew 33% to $53.7 billion, and pretax adjusted earnings grew 14% to $2.1 billion, in line with expectations.

2024年第四季調整後營收成長33%至537億美元，稅前調整後收益成長14%至21億美元，符合預期。

Moving to our businesses within Evernorth, Specialty and Care Services adjusted revenue grew 18% to $23.5 billion and adjusted earnings grew 27% to $948 million.

轉向 Evernorth 內部的業務，專業和護理服務調整後收入增長 18%，至 235 億美元，調整後收益增長 27%，至 9.48 億美元。

This continues the pattern observed from last quarter, which reflects growth across our specialty businesses driven by higher utilization of specialty medications as well as a continued increase in the adoption of HUMIRA biosimilars.

這延續了上個季度的模式，反映了我們專科業務的成長，這得益於專科藥物的利用率提高以及 HUMIRA 生物相似藥的採用率持續增加。

By the end of the fourth quarter, we saw almost half of eligible HUMIRA scripts transition to biosimilars.

截至第四季末，我們看到幾乎一半符合資格的 HUMIRA 處方已轉變為生物相似藥。

Pharmacy Benefit Services also posted robust growth, reflecting client wins and the continued demand for new drugs through our innovative products and solutions.

藥房福利服務也實現了強勁增長，反映出客戶透過我們的創新產品和解決方案獲得的成功以及對新藥的持續需求。

Pretax adjusted earnings increased to $1.2 billion as our differentiated capabilities continue to drive affordability and value to our patients, customers, and clients.

由於我們的差異化能力持續為患者、顧客和客戶帶來可負擔性和價值，稅前調整後收益增加至 12 億美元。

Overall, the fourth quarter capped another strong year for Evernorth, with full-year pretax adjusted earnings growing 9% for the year.

總體而言，第四季度為 Evernorth 又一個強勁的一年畫上了句號，全年稅前調整後利潤增長了 9%。

We are the industry leader in pharmacy benefit services and in specialty pharmacy.

我們是藥房福利服務和專業藥房領域的行業領導者。

And our strong 2024 performance gives us confidence for sustained attractive growth over the long term.

我們 2024 年的強勁表現使我們對長期持續的可觀成長充滿信心。

Now turning to our 2025 outlook.

現在來談談 2025 年的展望。

First, I'd note that the divestiture of our Medicare businesses to HCSC remains on track to close in the first quarter, and this is contemplated in our outlook.

首先，我要指出的是，我們將醫療保險業務剝離給 HCSC 的工作仍將在第一季完成，這已在我們的展望中考慮。

We expect full year 2025 consolidated adjusted revenues of at least $252 billion.

我們預計 2025 年全年綜合調整後營收至少為 2,520 億美元。

And we expect full-year 2025 consolidated adjusted income from operations to be at least $7.9 billion or at least $29.50 per share.

我們預計 2025 年全年綜合調整後營業收入至少為 79 億美元，或每股至少 29.50 美元。

As David mentioned, we are accelerating investments that will positively impact the way our customers and patients experience health care.

正如戴維所說，我們正在加快投資，這將對我們的客戶和患者的醫療保健體驗產生積極影響。

Our outlook reflects up to $150 million in costs for these initiatives, split between Evernorth and Cigna Healthcare.

我們的預測顯示這些措施的成本高達 1.5 億美元，由 Evernorth 和 Cigna Healthcare 分攤。

When considering earnings seasonality, 2024 is not representative of typical patterns given the dynamics I referenced with our stop loss products.

考慮到收益季節性，鑑於我參考的止損產品動態，2024 年並不代表典型模式。

As such, we would expect the adjusted earnings per share pattern for 2025 to be more similar to 2023's pattern.

因此，我們預期 2025 年的調整後每股盈餘模式將與 2023 年的模式更加相似。

Now turning to our 2025 outlook for each of our segments.

現在來談談我們對各部門 2025 年的展望。

In Evernorth, we expect full-year 2025 adjusted earnings of at least $7.2 billion.

在 Evernorth，我們預計 2025 年全年調整後收益至少為 72 億美元。

This represents year-over-year growth within our long-term growth target range on a normalized basis.

這代表著我們在正常基礎上實現的長期成長目標範圍內的年成長。

Within Evernorth, we expect first quarter earnings to contribute slightly below 20% of full-year Evernorth earnings.

在 Evernorth 內部，我們預計第一季的收益將佔 Evernorth 全年收益的略低於 20%。

For Cigna Healthcare, we expect full-year 2025 adjusted earnings of at least $4.1 billion.

對於 Cigna Healthcare，我們預計 2025 年全年調整後收益至少為 41 億美元。

This represents mid-single-digit year-over-year growth on a normalized basis.

以正常化計算，這代表著同比成長率達到中個位數。

Within Cigna Healthcare, we expect approximately 55% of full-year earnings to be in the first half of the year, slightly more weighted to the first quarter.

對於 Cigna Healthcare 而言，我們預計約 55% 的全年收益將來自上半年，第一季的收益佔比略高。

Assumptions in our Cigna Healthcare outlook for 2025 include our medical care ratio to be in the range of 83.2% to 84.2%.

我們對 2025 年 Cigna Healthcare 前景的假設包括我們的醫療保健比例在 83.2% 至 84.2% 之間。

This reflects the expectation that our stop loss MCR continues to be above target levels for full-year 2025.

這反映了我們對 2025 年全年止損 MCR 持續高於目標水準的預期。

We expect the first-quarter 2025 medical care ratio to be below the low end of the full-year guidance range to reflect typical seasonal patterns.

我們預計 2025 年第一季的醫療保健比率將低於全年指引範圍的低端，以反映典型的季節性模式。

We expect approximately 18.1 million total medical customers at year-end, reflecting the divestiture of our Medicare businesses to HCSC, a reduction in individual exchange customers, and growth within our US Employer select and middle market segments.

我們預計年底的醫療客戶總數將達到約 1,810 萬，這反映了我們的醫療保險業務剝離給 HCSC、個人交換客戶的減少以及美國雇主精選和中端市場領域的成長。

For the enterprise, we project an adjusted SG&A ratio of approximately 5.4% for 2025.

對企業而言，我們預期 2025 年調整後的銷售、一般及行政開支比率約為 5.4%。

This percentage is lower in 2025, largely reflecting mix due to the absence of our Medicare businesses, which carried a higher SG&A ratio compared to the consolidated average.

2025 年，這一百分比將會降低，主要是由於我們不再擁有醫療保險業務，而該業務的銷售、一般及行政開支比率 (SG&A) 高於合併平均水平。

And we expect the consolidated adjusted tax rate to be approximately 19%.

我們預計合併調整後的稅率約為19%。

Now moving to our 2024 capital management position and 2025 capital outlook.

現在轉向我們的 2024 年資本管理狀況和 2025 年資本展望。

Our fourth-quarter cash flow is quite strong, and we finished full year by delivering $10.4 billion of cash flow from operations.

我們第四季的現金流非常強勁，全年我們的營運現金流達到 104 億美元。

In 2024, we repurchased 20.9 million shares of common stock for approximately $7 billion.

2024 年，我們以約 70 億美元回購了 2,090 萬股普通股。

In addition, the Board of Directors recently approved an increase of $6 billion in incremental share repurchase authorization, bringing the company's total share repurchase authorization to $10.3 billion as of December 31, 2024.

此外，董事會近期批准增加 60 億美元的增量股票回購授權，使截至 2024 年 12 月 31 日公司的總股票回購授權達到 103 億美元。

Finally, we returned $1.6 billion to shareholders via dividends in 2024.

最後，我們在 2024 年透過股利向股東返還了 16 億美元。

Now framing our 2025 capital outlook.

現在我們正在製定 2025 年資本展望。

We expect to deliver approximately $10 billion of cash flow from operations with the strength of our efficient service-based model.

憑藉我們高效的服務模式，我們預計營運現金流將達到約 100 億美元。

We expect to deploy approximately $1.4 billion to capital expenditures, and we expect to deploy approximately $1.6 billion to shareholder dividends, reflecting our quarterly dividend of $1.51 per share, an 8% increase on a per share basis.

我們預計將部署約 14 億美元用於資本支出，並預計將部署約 16 億美元用於股東分紅，這反映出我們的季度股息為每股 1.51 美元，每股增長 8%。

Our guidance assumes full-year weighted average shares outstanding to be in the range of 266 million to 270 million shares.

我們的預期是，全年加權平均流通股數將在 2.66 億股至 2.7 億股之間。

Our capital deployment priorities remain consistent with our long-term framework.

我們的資本部署重點與我們的長期框架保持一致。

We expect some debt paydown in 2025 as we look to bring our leverage ratio closer to our 40% target.

我們預計 2025 年將償還部分債務，因為我們希望將槓桿率提高到更接近 40% 的目標。

As it relates to the sale of our Medicare business, we continue to expect a majority of proceeds will go towards share repurchase.

由於這涉及出售我們的醫療保險業務，我們繼續預期大部分收益將用於股票回購。

Now to close, as we look to 2025 and beyond, we remain confident in our long-term strategy and our ability to deliver sustainable growth through our differentiated portfolio of businesses.

最後，展望 2025 年及以後，我們仍然對我們的長期策略和透過差異化業務組合實現永續成長的能力充滿信心。

As David mentioned, we're operating in a highly dynamic environment.

正如大衛所提到的，我們在一個高度動態的環境中運作。

But as we've demonstrated in the past, we have a proven track record of meeting challenges and taking the actions to deliver affordable and innovative solutions for our customers and patients.

但正如我們過去所展示的那樣，我們在應對挑戰和採取行動為我們的客戶和患者提供經濟實惠的創新解決方案方面有著良好的記錄。

We're confident in our ability to deliver full-year 2025 adjusted earnings of at least $29.50 per share, which we believe is prudent at this time, given the dynamic environment.

我們有信心實現 2025 年全年調整後每股收益至少 29.50 美元，考慮到當前的動態環境，我們認為這是謹慎的。

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

接下來，我們將把電話轉給接線員，進行通話的問答部分。

(Operator Instructions) Justin Lake, Wolfe Research.

（操作員指示）賈斯汀·萊克（Justin Lake），沃爾夫研究（Wolfe Research）。

I wanted to ask a couple of things on the stop loss business.

我想問一些有關停損業務的問題。

First, on the $7 billion of premium.

首先，關於70億美元的保費。

I was hoping you can give us some split between the aggregate versus specific stop loss premiums and then maybe tell us if there was any more margin pressure in one segment versus the other in the fourth quarter.

我希望您能為我們提供整體停損溢價與特定停損溢價之間的差異，然後告訴我們第四季度某個部門相對於其他部門的利潤壓力是否更大。

And then I wanted to just make sure I'm understanding the magnitude of the miss correctly here.

然後我想確保我正確理解了這次失誤的嚴重程度。

You talked about the fourth quarter miss being all stop loss.

您談到第四季的失利都是停損。

So I'm getting to like 1,500 basis points in the fourth quarter.

因此，我在第四季的預期是 1,500 個基點。

Is that in the ballpark?

那大致是如此嗎？

And then I think you said your margins overall are 100 basis points higher because of this or lower that you'll recapture which would seem to indicate stop loss is off by about 5% given the percentage of revenue.

然後我想您說過，由於這個原因，您的整體利潤率會高出 100 個基點，或者會低於這個數字，這似乎表明，考慮到收入的百分比，止損減少了約 5％。

Just making sure I understand all of that correctly.

只是想確保我正確理解了所有這些。

Any help, appreciate it.

任何幫助，不勝感激。

It's Brian, a number of components to your question so I'll do my best to capture as much of that as possible.

布萊恩，您的問題包含多個部分，我會盡力盡可能多地捕捉這些部分。

Let me just start with a little bit of context on the stop loss business.

讓我先簡單介紹一下停損業務的背景。

I'll try to get to your very specific questions there, on my way through here.

我將在途中盡力解答您提出的非常具體的問題。

So obviously, we're disappointed by the shortfall that we reported in the fourth quarter.

顯然，我們對第四季報告的缺口感到失望。

As I mentioned in my prepared comments earlier, the vast majority of the shortfall was driven by our stop loss products within Cigna Healthcare and the rest of the Company performed broadly as we expected.

正如我之前在準備好的評論中提到的那樣，絕大部分的缺口是由 Cigna Healthcare 內部的止損產品造成的，而公司其餘部分的表現大致符合我們的預期。

Now it's important to keep in mind that our stop loss product performance in the quarter is really more representative of the full-year impact.

現在要記住的是，我們本季的停損產品表現實際上更能代表全年的影響。

It's an accumulation product reflecting 12 months of health care activity for a given individual or an employer.

它是反映特定個人或雇主 12 個月醫療保健活動的累積產品。

And we continue to feel very good about the long-term fundamentals of our US Employer portfolio and the stop loss products specifically.

我們繼續對美國雇主投資組合和停損產品的長期基本面感到非常滿意。

And the shortfall that we're currently experiencing represents an embedded earnings opportunity for the future.

我們當前經歷的短缺意味著未來的獲利機會。

As we look back to 2024, the aggregate health care costs within the Cigna Healthcare portfolio were broadly in line with our expectations, reflecting the persistently elevated cost trend environment that I referenced.

回顧 2024 年，Cigna Healthcare 投資組合中的整體醫療保健成本基本上符合我們的預期，反映了我提到的持續上升的成本趨勢環境。

But the mix of those costs shifted more toward high-cost claimants than we had expected, which has a disproportionate impact on the stop loss products.

但這些成本的組合比我們預期的更多地轉向高成本索賠人，這對止損產品產生了不成比例的影響。

And given when we identified the magnitude of the 2024 stop loss pressure, we were not able to fully recognize this in our January 2025 renewal pricing as much of that pricing work was completed in the fall.

鑑於我們確定了 2024 年止損壓力的大小，我們無法在 2025 年 1 月的續約定價中完全認識到這一點，因為大部分的定價工作是在秋季完成。

Now some of the later 2025 renewals will reflect the updated estimates, with the majority of the 2025 stop loss pricing will not capture that elevated cost structure.

現在，2025 年的部分後續續約將反映更新後的估算，其中大部分 2025 年停損定價將不會反映出這一高昂的成本結構。

So when you put all those pieces together, we would expect to see 100 basis points of margin improvement across the Cigna Healthcare portfolio by 2027 with the majority of that to be captured in 2026.

因此，將所有這些部分放在一起時，我們預計到 2027 年，Cigna Healthcare 投資組合的利潤率將提高 100 個基點，其中大部分將在 2026 年實現。

Now more specifically to your questions.

現在更具體地回答您的問題。

When you think about the $6.7 billion of premium in our stop loss book of business, there's a mix of individual and aggregate stop loss in there.

當您考慮到我們的停損業務帳簿中的 67 億美元保費時，您會發現其中包含了單獨停損和整體停損。

And there are a variety of attachment points and different client choices embedded in there.

其中嵌入了多種連接點和不同的客戶端選擇。

You can think of it as more tilted toward the individual versus the aggregate, but we have a wide range of stop loss offerings that are out there.

您可以認為它更傾向於個體而非總體，但我們提供了各種各樣的止損產品。

And for full-year 2024, the overall stop loss MCR ran in the low 90s in terms of the percentage, which you can think of as being a mid-single-digit percentage amount worse than our expectations had been in 2024.

就 2024 年全年而言，整體止損 MCR 的百分比在 90% 以下，您可以認為這比我們對 2024 年的預期要低一個中等個位數的百分比。

So again, that $6.7 billion of premium multiplied by a mid-single-digit percentage miss gets you about the earnings impact that we're seeking to recover over time on the stop loss portion of the portfolio.

因此，再說一遍，67 億美元的溢價乘以中等個位數百分比的差距，就可以計算出我們希望隨著時間的推移在投資組合的止損部分中恢復的收益影響。

But importantly, the balance of the Cigna Healthcare portfolio ran broadly in line with expectations.

但重要的是，Cigna Healthcare 投資組合的平衡基本上符合預期。

Thanks for the question.

謝謝你的提問。

Stephen Baxter, Wells Fargo.

富國銀行的史蒂芬‧巴克斯特。

I'll ask another one on stop loss.

我會再問一個有關停損的問題。

I guess, when you've gone through these cycles in the past, can you talk a little bit about how it's impacted retention and membership for the impacted accounts that have seen these kind of larger above-trend increases for stop loss?

我想，當您過去經歷過這些週期時，您能否談談它是如何影響受影響帳戶的保留率和會員資格的，這些帳戶的止損額是否出現了高於趨勢的大幅增長？

And I can definitely appreciate why it takes until at least 2026 to get meaningful improvement.

我完全可以理解為什麼至少要到 2026 年才能有有意義的進步。

But when you're talking about some of this improvement leaking out into 2027 potentially, could you just help us understand a little bit why it could become even that far extended?

但是，當您談到這種改進可能會延續到 2027 年時，您能否幫助我們理解為什麼這種改進可能會延續到這麼久？

Stephen, it's Brian again.

史蒂芬，又是布萊恩。

So one thing that's critical to keep in mind as it relates to our stop loss portfolio is that we don't write standalone stop loss coverage.

因此，在與我們的停損組合相關時，需要牢記的關鍵一點是，我們不會寫獨立的停損保險。

So our entire book of business reflects an integrated employer offering where we're providing the first dollar coverage alongside.

因此，我們的整個業務範圍反映了雇主提供的綜合服務，同時我們也提供第一美元的保障。

So as a result, our overall relationship with the employer is multifaceted in nature and involves many products and solutions, which ends up creating numerous opportunities for value creation and the associated value capture.

因此，我們與雇主的整體關係本質上是多方面的，涉及許多產品和解決方案，最終為創造價值和相關價值獲取創造了無數機會。

And even with the stop loss claims pressure that we experienced in our 2024 results, our overall client level relationships are profitable for those employers who choose our stop loss offerings.

即使我們在 2024 年業績中經歷了止損索賠壓力，對於選擇我們的停損產品的雇主來說，我們的整體客戶層面關係仍然是有利可圖的。

When we look back historically over many years, decades, in fact, we've been able to overcome the short-term ups and downs of our stop loss portfolio and generate attractive long-term returns.

當我們回顧多年、幾十年的歷史時，事實上，我們已經能夠克服停損投資組合的短期起伏，並產生可觀的長期回報。

And our clients value these long-term relationships and the associated budget certainty that our offerings can provide to them, which really is evidenced by the fact that well over 50% of our employer clients who choose our stop loss products have been clients of Cigna Healthcare for five years or more.

我們的客戶重視這些長期合作關係以及我們的服務能夠為他們提供的相關預算確定性，事實確實如此：選擇我們的停損產品的雇主客戶中，超過 50% 的人已經成為 Cigna Healthcare 的客戶五年或更長時間。

So the shortfall in our 2024 results offers a substantial embedded earnings opportunity for the company, and we're confident in our ability to execute against this, balancing the timing of margin recovery with client persistency.

因此，我們 2024 年業績的缺口為公司提供了巨大的內含獲利機會，我們有信心能夠實現這一目標，平衡利潤率恢復的時機和客戶的堅持。

Charles Rhyee, TD Cowen.

查爾斯·瑞（Charles Rhyee），TD Cowen。

Just related to sort of the stop loss again a little bit.

這與停損又有一點關係。

You called out specialty meds at the start contributing to that.

您一開始就指出特種藥物對此有所貢獻。

Is that related to GLP-1s at all?

這與 GLP-1 有關係嗎？

And related to that, as we think about the Evernorth guide going forward, you're starting at a 3% operating income growth starting point.

與此相關，當我們考慮 Evernorth 指南的未來發展時，您將從 3% 的營業收入成長起點開始。

But you finished '24 up 9%, which, if I remember correctly, right, including onboarding costs related to Centene in the first half of the year.

但你們 24 年的業績上漲了 9%，如果我沒記錯的話，這其中包括了上半年與 Centene 相關的入職成本。

Anything to call out relative to '25 because otherwise, it seems this part of the guidance seems pretty conservative, particularly given the growth you saw in specialty in the back half of '24.

任何與 25 年相比需要注意的事情，因為否則，這部分指導似乎相當保守，特別是考慮到您在 24 年下半年看到的專業增長。

Charles, it's Brian.

查爾斯，我是布萊恩。

So as it relates to the stop loss specific drivers, I think was the core of your first question, you can think of this as being a situation where we had a greater frequency of high-dollar claimants than we have been expecting, particularly driven by high cost specialty pharmaceuticals and by high acuity surgical activity.

因此，就止損特定驅動因素而言，我認為這是你第一個問題的核心，你可以認為這種情況是我們面臨的高額索賠的頻率比我們預期的要高，特別是受到高成本特種藥品和高敏銳度手術活動的推動。

Now within the specialty drugs, I would not point to GLP-1s as a driver of this.

現在，在專科藥物中，我不會將 GLP-1 視為這種現象的驅動因素。

Think of it as more specialty injectables, so when you look at the nature of that particularly for the stop loss books, it's drugs like KEYTRUDA or OCREVUS, those sorts of specialty injectables that drove some of the upward pressure.

把它想像成更多的專業注射劑，所以當你觀察它的性質，特別是止損賬簿的時候，正是像 KEYTRUDA 或 OCREVUS 這樣的藥物，這些專業注射劑推動了一些上行壓力。

And then on the high acuity surgical side, think of that as more tilted to inpatient procedures, for example, oncology and cardiac-oriented procedure.

然後在高敏銳度手術方面，認為它更傾向於住院手術，例如腫瘤學和心臟手術。

So that was really the core of the upward pressure on the stop loss products.

所以這確實是停損產品上行壓力的核心。

Now as it relates to Evernorth's 2025 income outlook, just again, I'd start by saying how pleased we are with the overall performance of that portion of the company.

現在，就 Evernorth 的 2025 年收入前景而言，我首先要說的是，我們對公司該部分的整體表現感到非常滿意。

We delivered a strong result in '24, as you noted in your question.

正如您在問題中提到的那樣，我們在 24 年取得了強勁的業績。

As it relates to 2025, specifically, our outlook for the income growth is within our long-term growth rate range of 5% to 8% when a few adjustments are made.

具體來說，就 2025 年而言，我們對營收成長的預期在進行一些調整後，仍處於 5% 至 8% 的長期成長率範圍內。

So specifically, the absence of VillageMD net investment income, which was recorded in 2024 as well as the Evernorth share of stranded overhead from the Medicare divestiture.

具體來說，VillageMD 淨投資收益的缺失（該收益記錄於 2024 年）以及 Evernorth 在 Medicare 剝離中所佔的擱淺間接費用份額。

And then as I noted in my prepared comments, we have earmarked up to $150 million across the company for incremental 2025 investments in patient and provider facing initiatives, and our guidance reflects a portion of that spending in the Evernorth segment.

然後，正如我在準備好的評論中所指出的那樣，我們已在全公司範圍內撥出高達 1.5 億美元的資金，用於 2025 年面向患者和提供商的計劃的增量投資，我們的指引反映了 Evernorth 部門的部分支出。

So adjusting for these factors, we look forward to Evernorth delivering income growth within our long-term average annual growth rate range.

因此，在調整這些因素後，我們期待 Evernorth 在我們的長期年均成長率範圍內實現收入成長。

So overall, Evernorth performing well.

因此總體而言，Evernorth 表現良好。

We're positioned for another good year.

我們已準備好迎接另一個豐收的一年。

Lisa Gill, JPMorgan.

摩根大通的麗莎吉爾 (Lisa Gill)。

David, I wanted to go back to the comments that you made around Express Scripts and some of the offerings that you now have, lowering the price at the counter, et cetera, and really tie that back to comments you've made in the past around roughly 20% of total profits coming from rebate retention.

大衛，我想回到你對 Express Scripts 所發表的評論以及你們現在提供的一些服務，降低櫃檯價格等等，並將其與你過去發表的大約 20% 的總利潤來自回扣保留的評論聯繫起來。

Can you talk about two things?

能談兩件事嗎？

One, are clients shifting more where they want more of the rebate retention?

第一，客戶是否更轉向希望獲得更多回扣保留的地方？

And if so, how do we think about that impact to profitability over time?

如果是這樣，我們如何看待這種現象對長期獲利能力的影響？

And then secondly, the programs that you talked about, are those more of an opt in, so you're selling those into the marketplace.

其次，您所談論的計劃更像是一種選擇，因此您會將其銷售到市場上。

And I'm just curious around what you're seeing on the uptake side.

我只是好奇您在吸收方面看到了什麼。

So really two questions here, how I think about the future.

所以這裡其實有兩個問題，我如何看待未來。

And if we have changes, what that could do to the profit of the model.

如果我們做出改變，這會對模型的利潤產生什麼影響？

And then secondly, the uptake around this.

其次，對此的接受度。

Lisa, it's David.

麗莎，我是大衛。

I'll start and I'm going to ask Eric to expand.

我先開始，然後我會請 Eric 進一步闡述。

I think your latter part of your commenting question was the summary you were seeking.

我認為您評論問題的後半部分就是您所尋求的總結。

At the enterprise level, we do not see this as a change to our profit model.

從企業層面來說，我們並不認為這會改變我們的獲利模式。

So I'll come back to that headline in a moment.

所以我稍後會回到這個標題。

We've worked for an elongated period of time through innovation, through ongoing efficiency to continue to deliver more value while maintaining an attractive margin and by maintaining a stable low single-digit margin, which we think is responsible given the nature of this book of business.

我們長期以來一直致力於創新、不斷提高效率，繼續創造更多價值，同時保持有吸引力的利潤率，並維持穩定的低個位數利潤率，我們認為，考慮到這項業務的性質，這是負責任的做法。

Coming back up to the top, I'd ask you to not think that your statement was 20% of the profit is correlated to rebate retention.

回到最初的話題，我想請你不要認為你的聲明中的 20% 的利潤與回饋保留相關。

The vast majority of rebates are passed through today.

絕大多數折扣都是今天發放的。

The model has evolved rather rapidly through the vast majority of all rebates being passed through.

透過絕大多數回扣的轉嫁，該模式得到了相當迅速的發展。

We continue to offer choice in the marketplace.

我們將繼續在市場上提供選擇。

There are instances where employers, large sophisticated employers or collective bargaining arrangement unions, want to continue to use rebates a little differently in their overall benefit program.

在某些情況下，雇主、大型成熟雇主或集體協商安排工會希望在其整體福利計劃中繼續以略有不同的方式使用回扣。

And then to the core of the second part of your question, we're really excited about, and I couldn't be more appreciative and proud of the innovation of our team, with the most recent innovations we announced this week, which take even more precision to identify those patients who due to deductible phases or otherwise have some financial dislocation.

然後回到你問題的第二部分的核心，我們真的很高興，我對我們團隊的創新感到非常欣賞和自豪，我們本周宣布了最新的創新，這些創新需要更精確地識別那些由於免賠額階段或其他原因而出現財務混亂的患者。

As I noted, 80% of all Express Scripts customers have less than $100 cumulative out-of-pocket through the course of the entire year.

正如我所指出的，80％的 Express Scripts 客戶全年累計自付費用不足 100 美元。

However, we recognize some have more, and we need to bring more precision there and that's where some of the new innovations are targeted.

然而，我們認識到有些人擁有更多，我們需要在那裡提高精確度，這就是一些新創新的目標。

So I'll ask Eric to expand a little bit more on those exciting innovations.

因此我想請艾瑞克進一步闡述這些令人興奮的創新。

Great.

偉大的。

Thanks, David, and good morning, Lisa.

謝謝，大衛，早安，麗莎。

As David noted, as you noted, we announced yesterday a couple of additional enhancements and just built on our track record of innovation to make medicines more affordable.

正如戴維和您所說，我們昨天宣布了幾項額外的改進，並在我們創新的基礎上使藥品更加便宜。

So first, we announced that customers will not have to pay a list price at the pharmacy counter.

因此首先，我們宣布顧客無需在藥局櫃檯支付標價。

And regardless of where they're at with deductible, our go-forward approach will be to ensure that they get the benefits of the discounts we negotiate.

無論他們的免賠額是多少，我們的未來方針就是確保他們能從我們協商好的折扣中獲益。

Second, for customers who are in a phase of a deductible or coinsurance plan, we work to ensure that they receive the same price as their underlying plan would pay.

其次，對於處於免賠額或共同保險計劃階段的客戶，我們努力確保他們獲得與其基礎計劃支付的相同的價格。

And we also announced an additional series of patient and plan sponsor level reporting enhancements building on the transparency we deliver.

我們還宣布了一系列額外的患者和計劃發起人級別的報告增強功能，以提高我們提供的透明度。

So taken together, those are just another set of examples in our track record and our history of continuing to bring innovations to market.

總的來說，這些只是我們業績和持續將創新推向市場的歷史上的另一組例子。

And the kind of last piece of your question, I'd expect this will be the default way that we bring these solutions to market for employers and like.

關於你問題的最後一部分，我希望這將是我們為雇主等市場提供這些解決方案的預設方式。

As David noted, our clients undertake significant work to structure their benefits in a deliberate way, and we offer them choice on how they wish to structure them.

正如戴維所說，我們的客戶花費了大量的工作來以謹慎的方式建構他們的福利，而我們也為他們提供如何建構福利的選擇。

But as the years passed, rebate value that we share with our clients is continuing to increase, and we're proud of the choices we're able to offer and the work that we do to bring improved affordability to medicines to the millions of people we serve.

但隨著時間的推移，我們與客戶分享的回扣價值不斷增加，我們為我們能夠提供的選擇以及我們為使我們服務的數百萬人能夠更負擔得起藥品而開展的工作感到自豪。

A.J. Rice, UBS.

A.J.賴斯、瑞銀。

Hi, everybody.

大家好。

Just to maybe get a little bit of clarification on a couple of points with respect to the 2025 guidance.

只是想對 2025 年指導的幾個要點進行一點澄清。

And when you gave some preliminary comments on third quarter, I don't think you had incorporated this, but now you're incorporating the sale of the MA book by the end of the first quarter in the outlook as well as presumably some redeployment of that capital.

當您對第三季發表一些初步評論時，我認為您並未將這一點納入其中，但現在您將第一季末的 MA 帳簿銷售納入了展望中，以及可能對該資本進行的一些重新部署。

I'm trying to figure out what is the underlying assumption around what that does to the earnings outlook of the company when you start to factor that in.

我試著弄清楚，當你開始考慮這一點時，會對公司的獲利前景產生什麼影響？

Also, I think the other aspect of the '25 outlook was -- there was some pressure on the Evernorth margin in '24 related to the big new contract wins that you are absorbing and that there was presumably going to be some favorable step-up in '25 as that contract -- that one big contract, in fact, matured a little bit.

此外，我認為 25 年前景的另一個方面是 - Evernorth 的利潤率在 24 年面臨一些壓力，這與您正在吸收的大型新合約勝利有關，而且隨著那份合約 - 那份大合約實際上已經成熟，25 年的利潤可能會有一些有利的提升。

Are you assuming some level of step-up on that?

您是否認為這方面會有一定程度的提升？

Or are you now sort of assuming it's sort of steady-state margin?

或者您現在是否假設它是穩定狀態裕度？

A.J., it's Brian.

A.J.，我是布萊恩。

So let me do my best with your questions here.

因此，我會盡力解答您的問題。

The former in terms of the Medicare divestiture, as I mentioned earlier, on track to close in the first quarter.

前者是指醫療保險剝離，正如我之前提到的，預計將在第一季完成。

We've reflected that in the revenue and the income guide as well as the capital deployment expectations here for the year.

我們已在今年的收入和收益指南以及資本配置預期中反映這一點。

And you can think of it as about $12 billion of revenue from 2024 that will be obviously removed with the divestiture.

你可以將其視為自 2024 年起約 120 億美元的收入，這些收入顯然會隨著資產剝離而消失。

We'll recognize a stub here with one month of January revenue and then whenever the closing date happens to be in February or March.

我們將在這裡識別一張存根，上面寫著一月份的收入，以及二月或三月的截止日期。

As it relates to capital deployment, as I mentioned earlier, we expect to use the majority of the proceeds for share repurchase.

至於資本部署，正如我之前提到的，我們預計將大部分收益用於股票回購。

That's reflected in our share count guide.

這反映在我們的股票數量指南中。

And then relative to the other contributions when you think about the Cigna Healthcare income guide, the removal of Medicare is reflected in that.

然後，當您考慮 Cigna Healthcare 收入指南時，相對於其他貢獻，醫療保險的取消就反映在其中。

So maybe just to put a finer point on that.

所以也許只是為了更詳細地闡述這一點。

If you look at our segment income guide for Cigna Healthcare this year and you compare it to 2024, if you look at 2024 as actual income and remove the contribution from the Medicare financials, remove the stranded overhead from the divestiture and remove the favorable prior year development that we saw in 2024, the normalized Cigna Healthcare earnings would have been slightly below $4 billion in 2024.

如果您查看我們今年的 Cigna Healthcare 分部收入指南並將其與 2024 年進行比較，如果您將 2024 年視為實際收入並去除來自 Medicare 財務的貢獻，去除資產剝離的擱淺間接費用並去除我們在 2024 年看到的有利的上一年發展，則 2024 年的收益略低於 Cigna 收益將略低於 40 億美元。

So that just gives you a basis to compare our 2025 outlook, reflecting the removal of Medicare and the removal of the prior year development.

因此，這只是為您提供了一個基礎來比較我們的 2025 年展望，反映了醫療保險的取消和前一年發展的取消。

We do not forecast future prior year development.

我們不預測未來前幾年的發展。

As it relates to the client contribution in Evernorth and the guide that I walked through to the earlier question that Charles asked me, the implied normalized growth rate that I referenced being within our 5% to 8% long-term growth rate range reflects the continued maturation of our large client contracts.

就 Evernorth 的客戶貢獻以及我之前回答查爾斯提出的問題時所提到的隱含標準化增長率而言，它在我們 5% 到 8% 的長期增長率範圍內，反映了我們大客戶合約的持續成熟。

So it's in there.

所以它就在那裡。

The relationship continues to be very strong across the teams, and we're pleased with the overall financial contribution of that relationship.

團隊之間關係一直非常牢固，我們對這種關係帶來的整體財務貢獻感到滿意。

Scott Fidel, Stephens.

史考特菲德爾、史蒂芬斯。

Just wanted to sort of put the stop loss repricing efforts into some context.

只是想將停損重新定價的努力放到某種背景下。

First, just curious around the fact that we know that the stop loss pressures were not unique to Cigna.

首先，我們很好奇，停損壓力並非 Cigna 獨有的。

We did see data points during the quarter from other large stop loss carriers also discussing very similar effects.

我們確實看到本季其他大型停損承運商的數據點也討論了非常類似的影響。

So the first piece would be, as you reprice the business in '25 and into '26, do you think that the persistency of the clients may benefit from the fact that others in the market will also be needing to take similar pricing actions?

因此，第一個問題是，當您在 25 年和 26 年重新定價業務時，您是否認為客戶的堅持可能會受益於市場上其他人也需要採取類似的定價行動？

And then when we think about the renewal cycle of the clients that typically takes stop loss for Cigna, which has always been a bit more weighted towards select and middle market, there's a different renewal cycle for those clients.

然後，當我們考慮通常為 Cigna 止損的客戶的續約週期時，Cigna 一直更專注於精選和中端市場，這些客戶的續約週期是不同的。

They're not as entirely weighted to sort of Jan 1, for example.

例如，它們並不完全受 1 月 1 日的影響。

So basically, also, if you could remind us for '25 basically, walk us through how much of the business you still have an opportunity to reprice on where you see these higher stop loss costs.

因此，基本上，如果您可以提醒我們 25 年的情況，請向我們介紹一下在您看到這些更高的停損成本的情況下，您仍有機會重新定價多少業務。

Scott, it's Brian.

史考特，我是布萊恩。

So as it relates to your first question in terms of the client relationships, the timing to recover, et cetera, and putting that into context.

因此，這與您的第一個問題有關，即客戶關係、恢復時間等等，並將其放在上下文中。

As I mentioned to the earlier question, I think Stephen had asked me, important to keep in mind, these are all integrated client relationships where we have both the first dollar and the stop loss coverage.

正如我之前提到的問題，我想史蒂芬問過我，重要的是要記住，這些都是綜合的客戶關係，我們既有第一美元的保障，也有停損的保障。

And if you look across the totality of the relationships, on average, about 20% of a given client's cost is stop loss oriented.

如果你縱觀所有關係，平均而言，特定客戶約 20% 的成本與停損有關。

In terms of the clients that choose to work with us on stop loss, about -- on average, 20% of it is stop loss.

就選擇與我們合作停損的客戶而言，平均約有 20% 是停損。

Some are higher, some are lower depending on how much risk appetite they have, how much risk they seek to transfer.

有些較高，有些較低，這取決於他們的風險偏好程度以及他們尋求轉移的風險程度。

So the point being a point of overall claim cost is only 20% of that on the stop loss.

因此，整體索賠成本僅為止損成本的 20%。

So there's a little bit more of a buffer here as it relates to repricing in terms of the overall client persistency, which in our estimation gives us an advantage being an integrated stop loss carrier compared to the standalone stop loss carriers who might be competing up against us.

因此，就整體客戶持久性而言，這裡有一個與重新定價相關的緩衝，我們估計，與可能與我們競爭的獨立止損承運商相比，這使我們作為綜合止損承運商具有優勢。

Now your question on the renewal cycles.

現在您的問題是關於更新周期。

The way that our stop loss products happen to work, it's actually a little bit more tilted toward the beginning of the year.

我們的停損產品的工作方式實際上更傾向於年初。

So we have about two-thirds of our stop loss premium that renews in the first quarter, given that we also have large clients who purchased stop loss from us.

因此，考慮到我們也有大客戶向我們購買止損，我們大約有三分之二的停損溢價會在第一季續簽。

So it's not quite as uniformly distributed throughout the calendar year as our select segment happens to be.

因此，它在整個日曆年的分佈並不像我們選擇的部分那樣均勻。

And as a result of that, that's one of the primary reasons why we're not able to recapture more in 2025.

因此，這也是為什麼我們無法在 2025 年奪回更多收益的主要原因之一。

But again, we have the confidence that we'll capture a majority of that 100 basis points of Cigna Healthcare margin expansion in 2026 with any residual in 2027.

但我們再次有信心，我們將在 2026 年獲得 Cigna Healthcare 利潤率成長的 100 個基點中的大部分，並在 2027 年獲得剩餘部分。

Erin Wright, Morgan Stanley.

摩根士丹利的艾琳·賴特。

Great.

偉大的。

So you spoke to the buyback authorization increase, but how are you thinking about, I guess, capital deployment from an acquisition standpoint?

所以你談到了回購授權的增加，但從收購的角度來看，你是如何考慮資本部署的？

And just any sort of change in your thought process around the regulatory environment on that front?

您對這方面的監管環境的思考過程有什麼改變嗎？

Or just your broader framework and thought process around acquisitions, I guess.

或者我猜只是您圍繞收購的更廣泛的框架和思維過程。

Has anything changed there?

那裡有什麼改變嗎？

It's David.

是大衛。

First, to frame the M&A question, our capital priorities remain intact and consistent in terms of how we deploy our capital, in terms of supporting ongoing growth of the business, including our CapEx.

首先，為了建構併購問題，就我們如何部署資本、支援業務的持續成長（包括我們的資本支出）而言，我們的資本優先事項保持不變且一致。

We have a disciplined process attached to that and then evaluating both strategic M&A and ongoing deployment of targeted M&A activities, which I'll come back to in a moment.

我們有一個與之相關的嚴謹的流程，然後評估策略併購和有針對性的併購活動的持續部署，稍後我會回顧這一點。

And as both Brian and I noted, an attractive dividend sits in there as a part of it that continues to grow.

正如布萊恩和我都指出的那樣，其中的富有吸引力的股息是其中的一部分，而且還在繼續增長。

Now specific to M&A, first, our three growth platforms continue to perform well.

現在具體到併購，首先，我們的三個成長平台持續表現良好。

And I would just highlight and amplify how pleased we are overall with the sustained performance there, and call out the specific significant growth opportunity we continue to see in the Specialty and Care platform.

我只想強調並進一步說明我們對該業務持續表現的整體滿意程度，並指出我們在專業和護理平台上繼續看到的具體顯著成長機會。

By way of just our actions and our words lining up as we noted, we deployed in excess of $8.5 billion in 2024, mostly for share repurchase as well as with dividend payments.

正如我們所指出的，僅透過我們的行動和言論，我們在 2024 年就部署了超過 85 億美元的資金，主要用於股票回購和股息支付。

And our capital outlook and our cash flow outlook of greater than 10% cash yield for 2025 remains attractive.

我們對資本前景和 2025 年現金收益率超過 10% 的現金流前景仍然具有吸引力。

So as we look forward, we will continue to evaluate strategic, what we consider, bolt-on acquisitions that will advance our portfolio, but our ongoing growth of our core platforms will be the underlying driver, and we will support that with ongoing share repurchase as we believe that is a prudent ongoing investment back into the organization, and we'll evaluate those targeted bolt-on acquisitions as they make good strategic sense for us.

因此，展望未來，我們將繼續評估策略性、我們認為可以推進我們投資組合的附加收購，但我們核心平台的持續成長將是根本驅動力，我們將透過持續的股票回購來支持這一點，因為我們相信這是對組織的審慎的持續投資，我們將評估這些有針對性的附加收購，因為它們對我們具有良好的策略意義。

Andrew Mok, Barclays.

巴克萊銀行的 Andrew Mok。

I understand the different mechanics of the stop loss business.

我了解停損業務的不同機制。

But if you're seeing pressure in that part of the business related to higher specialty cost trends, I'm a little confused why you're not seeing that pressure on the fully insured part of the business.

但如果你發現該部分業務因專業成本趨勢上升而面臨壓力，我有點困惑為什麼你沒有看到完全投保部分業務面臨這種壓力。

Maybe help clarify that.

也許有助於澄清這一點。

Andrew, it's Brian.

安德魯，我是布萊恩。

So as it relates to your question on the different pockets of the Cigna Healthcare portfolio, maybe I'll expand a little bit on the MCR performance for the different components.

因此，關於您關於 Cigna Healthcare 產品組合不同部分的問題，也許我會稍微擴展一下不同組成部分的 MCR 性能。

But again, I'd come back to something I said earlier, where the all-in cost structure that we saw in 2024 was comparable to what we expected it to be, an elevated cost structure, but comparable to what we had planned and priced for in totality, but the mix of those costs shifted more toward high-cost claimants than what we had been anticipating coming into the year.

但是，我再次回到之前說過的事情，我們在 2024 年看到的總成本結構與我們預期的相當，是一種高成本結構，但與我們總體計劃和定價的相當，但這些成本的組合更多地轉向高成本索賠者，而不是我們對今年的預期。

If you think about the Cigna Healthcare portfolio in aggregate, you can think of it as three broad components.

如果從總體上考慮 Cigna Healthcare 產品組合，您可以將其視為三大組成部分。

So the largest portion of Cigna Healthcare, which represents about 60% of the Cigna Healthcare premium, and it's unrelated to stop loss, unrelated to Medicare, so think of everything else, broadly in line with expectations, and we ended the 2024 full year with an MCR of around 80% on that block of business.

因此，Cigna Healthcare 的最大部分，約佔 Cigna Healthcare 保費的 60%，並且與停損無關，與醫療保險無關，因此考慮其他所有事情，大致符合預期，我們在 2024 年全年結束時，該業務板塊的 MCR 約為 80%。

So that 60% ran at about 80% MCR and we're projecting a roughly similar MCR performance in 2025 for that portion of the book as our pricing yields are expected to track cost trends on that portion.

因此，那 60% 的 MCR 約為 80%，我們預計 2025 年該部分的 MCR 表現將大致相似，因為我們的定價收益率預計將追蹤該部分的成本趨勢。

The second component is our Medicare business, which represents about 25% of the Cigna Healthcare premium and ran broadly in line with expectations in 2024.

第二部分是我們的醫療保險業務，約佔 Cigna Healthcare 保費的 25%，且運作情況與 2024 年的預期基本一致。

And then the final 15% is the stop loss products.

最後15%是停損產品。

So for 2024, as I mentioned in Justin's earlier question, the overall stop loss ran in the low 90s on that 15% portion of the book.

因此，對於 2024 年，正如我在賈斯汀之前的問題中提到的那樣，該 15% 部分的整體停損位在 90% 以下。

So we ended up seeing, within the total health care pie, a shift toward more high-cost individual claimants putting pressure on the stop loss line, but the all-in fully insured products ran broadly in line with expectations.

因此，我們最終看到，在整個醫療保健領域中，向更多高成本個人索賠者轉變，給止損線帶來壓力，但全包全保產品的運作基本上符合預期。

David, do you want to add anything?

大衛，你還有什麼要補充嗎？

Sure.

當然。

Thanks, Brian.

謝謝，布萊恩。

And Andrew, maybe just to give you an illustration to click that down a notch as you're rightfully thinking about the aggregate cost structure versus stop loss.

安德魯，也許只是為了給你一個例子，讓你把它降低一點，因為你正在正確地思考總成本結構與停損。

For example, if you take facility costs for 2024, we saw a bit more moderation in lower dollar inpatient events, but an acceleration of higher dollar inpatient events.

例如，如果您考慮 2024 年的設施成本，我們會看到較低金額的住院事件數量會稍微放緩，但較高金額的住院事件數量會加速增長。

And you can think about those as cardiac surgical events or oncological events; in the oncological events, aided by specialty pharmaceuticals as they correlate against oncological program.

你可以將其視為心臟手術事件或腫瘤事件；在腫瘤事件中，借助與腫瘤計劃相關的特種藥物進行治療。

So that's an example where the aggregate inpatient may be closer to what we thought it would be throughout the course of the year.

這是一個例子，顯示全年住院總人數可能更接近我們預期的水平。

Because of the deceleration or the less growth on the lower dollar inpatient costs versus the higher dollar, it aggregates more in the stop loss component.

由於低美元住院費用相對於高美元的減速或增長較少，其在止損部分聚集更多。

That's an illustration of what Brian was articulating.

這就是 Brian 所表達觀點的例子。

Josh Raskin, Nephron Research.

喬希‧拉斯金 (Josh Raskin)，腎元研究公司。

Just on the pending Medicare asset sale to Health Care Service Corp, are there any potential adjustments to the purchase price based on revenues, membership MLR, and maybe a comment on the strong membership to start 2025.

就即將向 Health Care Service Corp 出售的 Medicare 資產而言，是否會根據收入、會員 MLR 對購買價格進行任何潛在調整，以及是否可能對 2025 年初的強大會員規模進行評論。

And then any pending approvals or any sort of last-minute things you're looking for?

還有其他待批准的事情或您正在尋找的任何最後一刻的事情嗎？

Josh, it's Brian.

喬希，我是布萊恩。

So overall, I'd just start by saying the Medicare businesses performed broadly in line with expectations in 2024, and we're on track to close the divestiture in the first quarter, as I mentioned earlier.

因此，總的來說，我首先要說的是，醫療保險業務在 2024 年的表現基本上符合預期，正如我之前提到的，我們預計在第一季完成資產剝離。

We have a very collaborative, constructive relationship with HCSC.

我們與 HCSC 保持著非常合作、建設性的關係。

We've completed all federal antitrust approvals and nearly all state approvals, just one more state to get through.

我們已經完成了所有聯邦反壟斷審批和幾乎所有州的審批，只剩下一個州的批准了。

We have typical financial adjustments to the final purchase price in terms of subsidiary capitalization and things along those lines, but nothing else that I would note that's particularly relevant to the core of your question.

我們對最終購買價格進行了典型的財務調整，包括子公司資本化和類似事項，但我沒有註意到與您的問題核心特別相關的其他內容。

Now as we approach 2025, as we always do, we employed a local market county level bid approach.

現在，我們即將迎來 2025 年，一如既往，我們採用了當地市場縣級競標方式。

And based upon our final product positioning, we did see attractive growth in this business, specifically in the geographies and the products where we were targeting.

根據我們最終的產品定位，我們確實看到這項業務取得了可觀的成長，特別是在我們所針對的地區和產品方面。

In particular, we're pleased to see net growth coming primarily from HMO products in our more mature markets where we have years of experience and strong provider relationships.

特別是，我們很高興看到淨成長主要來自於我們更成熟市場的 HMO 產品，我們在這些市場中擁有多年的經驗和強大的供應商關係。

So the business is on a solid footing.

因此，業務基礎穩固。

We're tracking for attractive growth in 2025, and we're ready to hand it off to HCSC.

我們預計 2025 年將實現可觀的成長，並且我們已準備好將其移交給 HCSC。

Adam Ron, Bank of America.

美國銀行的亞當‧羅恩 (Adam Ron)。

I'd like to dig a little deeper into the Evernorth guidance.

我想更深入地了解 Evernorth 指導。

I know we somewhat touched on it already, but if you could distill it down into a couple of more specific items.

我知道我們已經在某種程度上談到了這一點，但如果你能夠將其提煉為幾個更具體的項目。

So just curious, like, this time last year, what gave you the confidence to raise the growth rate in the segment that is now coming worse than those higher expectations.

所以只是好奇，例如，去年這個時候，是什麼讓你有信心提高這個領域的成長率，而現在這個領域的成長率卻比更高的預期更差。

It sounds like specialty growth, in particular, is coming in better, if anything.

聽起來，特別是專業領域的成長正在變得更好。

So are there any specific items like VillageMD or on trend guarantees that you gave customers that are driving the underperformance for 2025 in the outlook?

那麼，您是否向客戶提供了像 VillageMD 這樣的特定項目或趨勢保證，而這些是導致 2025 年業績展望不佳的原因？

Adam, let me ask Eric just to talk about the strategic positioning of the business and the ongoing sustained growth of the components in the business with our sustained strong performance of our PBS and talk a little bit about the retention rates and the growth profile as well as the ongoing focus on the innovation within our specialty business.

亞當，請允許我請艾瑞克談談業務的策略定位，以及業務組成部分的持續成長以及 PBS 的持續強勁表現，並談談留存率和成長概況，以及我們對專業業務創新的持續關注。

And then Brian, if you can take it from Eric and just talk a little bit further around the number aspect of where Adam's question comes back to.

然後布萊恩，如果你能從艾瑞克那裡得到答案，並就亞當的問題所涉及的數字方面進一步談談。

Eric?

埃里克？

Adam, it's Eric.

亞當，我是埃里克。

I'd start at the headline.

我先從標題開始。

We're really proud of the growth rate and the track record that we've had here.

我們對我們在這裡的成長率和業績感到非常自豪。

In fact, we've increased the growth rate for Evernorth a number of times over the course of the last number of years and are committed to and excited about the long-term growth rate of 5% to 8% that we see for the Evernorth portfolio overall.

事實上，過去幾年來，我們多次提高了 Evernorth 的成長率，我們致力於並且對 Evernorth 投資組合整體 5% 至 8% 的長期成長率感到興奮。

And I wouldn't call out anything that's changed relative to that as the long-term growth rate for the segment.

我不會指出與該部門的長期成長率相關的任何變化。

We are continued and committed to delivering that.

我們將繼續並致力於實現這一目標。

Brian walked through a couple of the specific kind of tactical items that were incorporated as we built up our 2025 specific guidance, and I think about those in the short term, but the long-term tailwinds and our positioning for innovation across both the Pharmacy Benefit Services and the Specialty and Care Services portfolio continue to be set up really well and we're leaders in both of these spaces.

布萊恩介紹了我們在製定 2025 年具體指導方針時納入的幾種具體戰術項目，我認為這些只是短期措施，但長期的順風和我們在藥房福利服務以及專業和護理服務組合方面的創新定位繼續保持良好狀態，我們在這兩個領域都處於領先地位。

And we think they're real opportunities for us to continue to grow and thrive there.

我們認為這是我們在那裡繼續成長和繁榮的真正機會。

Thanks, Eric.

謝謝，埃里克。

And just to reiterate, there are three unique items as you look at the '25 over '24 Evernorth income growth rate.

需要重申的是，當你觀察 25 年與 24 年 Evernorth 的收入成長率時，有三個獨特的項目。

The VillageMD recognition of the dividend, that was in '24 will not be there in '25; stranded overhead from the Medicare divestiture, a portion of that.

VillageMD 在 1924 年確認的股利在 1925 年將不再存在；醫療保險剝離造成的擱淺開銷，是其中的一部分。

We'll see in the Evernorth P&L in 2025.

我們將在 2025 年的 Evernorth 損益表中看到。

And then finally, the investments that I made reference to that David covered earlier, we've earmarked at the enterprise level up to $150 million, split between the Evernorth and Cigna Healthcare segment that will hit the 2025 P&L.

最後，我提到的 David 之前介紹過的投資，我們在企業層面已撥出高達 1.5 億美元的資金，分配給 Evernorth 和 Cigna Healthcare 部門，這將達到 2025 年的損益。

So those three items are discrete, '25 over '24 items, but the long-term mega trends remain very intact, as Eric mentioned earlier.

因此，這三項是獨立的，'25 項相對於 '24 項，但長期大趨勢仍然保持完整，正如 Eric 之前提到的。

Ann Hynes, Mizuho Securities.

瑞穗證券的安‧海因斯 (Ann Hynes)。

I just want some more clarity on 2025 MLR.

我只是想更清楚地了解 2025 MLR。

So I think you said earlier that off a $6.7 billion base of stop loss was off mid-single digit.

所以我認為您之前說過，67 億美元的停損基數是中等個位數。

So if I do the calculation, that's maybe like around $335 million or $340 million hit versus expectation.

因此，如果我進行計算的話，與預期相比，這可能相當於 3.35 億美元或 3.4 億美元的損失。

But when I look at the 2025 healthcare EBITDA it's about $800 million below the Street.

但當我看 2025 年醫療保健 EBITDA 時，它比華爾街的預期低了約 8 億美元。

So I'm just trying to figure out what the difference is versus our expectations.

所以我只是想弄清楚與我們的期望相比有何差異。

It's Brian.

我是布萊恩。

So as it relates to the stop loss dynamic we were discussing earlier, that was a 2024 reference when I described the low 90s MCR on the stop loss book on the $6.7 billion of premium.

因此，就我們之前討論的止損動態而言，當我描述 67 億美元保費的止損賬簿上的 90 年代低 MCR 時，那是 2024 年的參考。

For '25, we're expecting a slightly higher MCR on the stop loss book because of the timing of repricing cycle.

對於'25，由於重新定價週期的時間安排，我們預計止損帳簿上的 MCR 會略高一些。

And as I made reference, we're unable to capture all of the elevated cost trend on the stop loss for 2025.

正如我所提到的，我們無法捕捉到 2025 年停損的所有成本上升趨勢。

So we expect a slightly higher MCR on stop loss in 2025, and that will be on a higher premium base because that $6.7 billion will grow at an attractive rate again.

因此，我們預計 2025 年停損的 MCR 將略高，而且這將建立在更高的保費基礎上，因為 67 億美元將再次以有吸引力的速度成長。

So that dollar amount will grow in '25.

因此，這個美元金額在25年將會成長。

In addition, as I made reference earlier, we do not forecast future prior year development, which was a benefit to 2024, and we have earmarked up to $150 million at the enterprise level for the provider and patient-facing initiatives that David described, and a portion of that will be reflected in the Cigna Healthcare P&L.

此外，正如我之前提到的，我們沒有預測未來前一年的發展，這對 2024 年有利，並且我們已經在企業層面為 David 描述的提供者和麵向患者的計劃撥款高達 1.5 億美元，其中一部分將反映在 Cigna Healthcare P&L 中。

So those dynamics help to bridge, I think where you were going with the 2025 prior expectations to our 2025 guidance we've initiated today.

所以，我認為這些動態有助於彌合 2025 年之前的預期與我們今天啟動的 2025 年指導之間的差距。

Sarah James, Cantor Fitzgerald.

莎拉詹姆斯 (Sarah James)，費茲傑拉領唱者。

Since you started seeing the stop loss claims pressure in 3Q, was some of that pressure already included in the 3Q guide of more than 10% growth and was any of the $150 million investment spend, including in that?

自從您在第三季開始看到停損索賠壓力以來，這種壓力是否已經包含在第三季 10% 以上的成長指南中，其中是否包括 1.5 億美元的投資支出？

Because I'm trying to run the math, bridging the 8% to the more than 10%, and I kind of feel like I'm missing a few good guys.

因為我正在嘗試進行計算，將 8% 擴展到 10% 以上，但我感覺好像我漏掉了一些好人。

I'm wondering if your outlook improved on some of your other businesses.

我想知道您對其他一些業務的展望是否有所改善。

Sarah, it's Brian.

莎拉，我是布萊恩。

So the third-quarter commentary that we made again was not meant to be formal guidance.

因此，我們再次對第三季的評論並非正式的指導。

It was meant to be just directional guidance.

這只是方向性的指導。

And at the time, we had said at least 10% which we felt was a prudent growth rate range at that point in time.

當時，我們說至少 10%，我們認為這是當時審慎的成長率範圍。

You may also recall, we had moved the MCR guide for the full year at that point in time toward the upper end of the range because we've started to see some indications of some pressure on the stop loss but not to the degree that ultimately manifested across the full year.

您可能還記得，我們​​當時已將全年的 MCR 指南移向範圍的上限，因為我們已開始看到一些跡象表明止損存在一些壓力，但程度尚未達到最終在全年體現的程度。

So as you think about trying to do that bridge, the couple of things that I call out would be we have now factored in the up to $150 million of investment spend for the provider and patient-facing initiatives that David walked through, that's net new.

因此，當您考慮嘗試搭建這座橋樑時，我要指出的幾件事是，我們現在已經考慮到了 David 所經歷的用於提供者和麵向患者的計劃的高達 1.5 億美元的投資支出，這是淨新增金額。

The degree of the stop loss pressure for the full-year '24 was greater than what we had anticipated three months ago, that's net new.

24年全年的停損壓力程度比我們三個月前的預期要大，這是淨新增。

And then to your point, are there other things going better than expected across the company?

那麼回到您剛才提到的問題，公司其他方面的進展是否比預期的還要好呢？

Directionally, you should think of the growth as strong yet again.

從方向上看，你應該認為成長再次強勁。

So if you remove the Medicare business, we expect top line for the Company will grow in the, call it, 6% range, so we expect to have another year of good growth across the enterprise.

因此，如果不考慮醫療保險業務，我們預計公司的營業收入將成長 6% 左右，因此我們預計整個企業也將迎來一年的良好成長。

So broadly speaking, I would think of it in those different buckets.

所以從廣義上講，我會從不同角度來考慮這個問題。

But again, the third-quarter commentary was not meant to be formal guidance; it's just trying to give you some directional sense.

但第三季的評論並非正式的指導；它只是試圖給你一些方向感。

Ben Hendrix, RBC Capital Markets.

加拿大皇家銀行資本市場 (RBC Capital Markets) 的 Ben Hendrix。

I just was hoping you could put a finer point on your 2025 earnings cadence comments.

我只是希望您能對 2025 年盈利節奏的評論做出更細緻的闡述。

I appreciate the commentary that you would expect earnings to look a little bit more like 2023 patterns versus 2024.

我很欣賞您的評論，您預計收益將更像 2023 年的模式，而不是 2024 年的模式。

But knowing that we're going to be recapturing the stop loss margins over a number of years, any reason not to expect elevated 4Q cost trend in 2025 as well?

但是，考慮到我們將在幾年內重新獲得止損保證金，有什麼理由不預期 2025 年第四季的成本趨勢也會上升呢？

Just any comments on that seasonality.

只是關於季節性的任何評論。

Ben, it's Brian.

本，我是布萊恩。

So just the nature of the stop loss products that I was referencing earlier are really full-year products.

所以，我之前提到的停損產品的性質其實是全年產品。

And so each quarter, we're making estimates of where the final full-year MCR will land for stop loss.

因此，每個季度，我們都會估算最終全年 MCR 的停損水準。

In 2024, when the pressure was identified, it was late in the year, which is why the earnings impact showed up predominantly in the fourth quarter.

2024年，當人們發現壓力時，已經是年底了，這就是為什麼獲利影響主要出現在第四季。

But you should take that earnings impact and kind of spread it over the course of the full-year 2024, which is why we're saying that '24 seasonality is not reflective of what a typical year should look like.

但你應該把這種獲利影響分攤到 2024 年全年，這就是為什麼我們說 24 年的季節性不能反映一個典型年份的情況。

So 2025, for that reason, you should think of it as more of a normal year, if you will, where typical cost-sharing seasonality will drive lower MCRs in the first half of the year and higher MCRs in the back half of the year.

因此，您應該將 2025 年視為更正常的一年，如果您願意的話，典型的成本分攤季節性將導致上半年的 MCR 較低，下半年的 MCR 較高。

And we would expect the stop loss MCRs to have more of a level cadence over the course of 2025.

我們預計，到 2025 年，止損 MCR 將具有更平穩的節奏。

In addition to that, there are some dynamics unique to Evernorth, for example, the VillageMD and the stranded overhead that I made reference to are more first half weighted.

除此之外，Evernorth 還具有一些獨特的動態，例如，我提到的 VillageMD 和擱淺開銷更多是上半部的權重。

So they serve to depress the Evernorth income a bit on a year-over-year basis compared to the 2024 pattern.

因此，與 2024 年的模式相比，它們會按年略微降低 Evernorth 的收入。

But again, the stop loss dynamic, I think, is the most important point as you reflect on the seasonality of our expected earnings.

但是，當您反思預期收益的季節性時，我認為止損動態是最重要的一點。

George Hill, Deutsche Bank.

德意志銀行的喬治·希爾。

Two more quick ones, I guess, to close it out on stop losses.

我想，再來兩次就可以停損了。

Number one, Brian, are there any other considerations on the stop loss margin recovery besides price (as it relates looking out to '26 or '27) that we should be meaningfully thinking about?

第一，布萊恩，除了價格（與 26 年或 27 年相關）之外，我們還應該認真考慮止損保證金恢復的其他因素嗎？

Like, are there benefit design or kind of breakpoint levers that get pulled here that get you guys back?

例如，是否有福利設計或某種斷點槓桿可以讓你們回來？

And then the second one is you talked about high acuity surgical activity.

第二個問題是您談到的高敏銳度手術活動。

I'd be interested if you could comment on whether this is elective versus nonelective and if there's any particular procedure types you would call out.

如果您能評論一下這是否是選擇性的還是非選擇性的，以及是否有任何特定的程式類型，我會很感興趣。

George, it's Brian.

喬治，我是布萊恩。

So on the first question in terms of the stop loss recovery and are there other factors, to the comment I made earlier, given these are integrated client offerings, the stop loss is just one component of the conversation that we have when we go and renew with clients.

因此，關於第一個問題，關於停損恢復，是否還有其他因素，對於我之前所做的評論，鑑於這些都是綜合客戶服務，止損只是我們與客戶續約時談話的一個組成部分。

And as a result of that, it is not just a price conversation, it's a total relationship conversation that we tend to have and it's not uncommon for a client to say, I want to move my pooling points or my attachment points up to reflect the cost inflation that's happened over time, which helps to mitigate the budget outlay for the employer clients.

因此，這不僅僅是一個價格對話，而是一個我們傾向於進行的全面關係對話，而且客戶經常會說，我想提高我的池點或附加點以反映隨著時間的推移而發生的成本通膨，這有助於減輕雇主客戶的預算支出。

So those types of dynamics often do work their way into the renewal conversations.

因此，這些類型的動態通常確實會對續約對話產生影響。

And I made reference to earlier, we have decades of experience with this business and have shown during times of both good and bad the ability to keep persistency at strong levels with the employer clients that choose our stop loss offerings.

我之前提到過，我們在這個行業有幾十年的經驗，無論是在順境還是逆境，我們都證明，我們有能力讓選擇我們停損服務的雇主客戶保持強勁的持久力。

On the high acuity surgical activity that we saw specifically was a little more tilted toward inpatient.

我們特別看到的高敏銳度手術活動更傾向於住院患者。

And as David and I both commented, a little bit more cancer-driven and cardiac-driven, which we don't necessarily see correlating with elective procedures.

正如大衛和我都評論的那樣，這更多的是由癌症和心臟驅動的，我們不一定認為它們與選擇性手術有關。

And broadly speaking, our planning assumptions for 2025 are for the high-cost claimant activity we saw in '24 to continue.

廣義上講，我們對 2025 年的規劃假設是，24 年看到的高成本索賠活動將繼續存在。

So we see it as more of a structural shift than something that's temporary.

因此，我們認為這更多的是一種結構性轉變，而非暫時性的轉變。

And in the scenario where that assumption is incorrect and it is temporary, then that will offer some upside to the outlook that we've provided here this morning, but we don't see it as heavily correlated to electives.

如果這種假設不正確而且是暫時的，那麼這將為我們今天早上提供的觀點帶來一些好處，但我們認為這與選修課並沒有太大的關係。

Thank you.

謝謝。

At this time, I'll turn the call back over to David Cordani for closing remarks.

現在，我將把電話轉回給 David Cordani 來做結束語。

Thanks.

謝謝。

I'll be brief.

我會簡短地講一下。

First and foremost, thanks for joining our call and, of course, for your questions today.

首先，感謝您參加我們的電話會議，當然也感謝您今天提出的問題。

A few headlines just to reinforce as we wrap up against the backdrop of what is indisputably a dynamic and challenging environment.

當我們在無可爭議的充滿活力和挑戰性的環境中總結時，以下幾個標題只是為了強化這一點。

We're confident in our ability to deliver EPS commitment for 2025 of at least $29.50 and remain convicted and committed to our long-term growth algorithm of 10% to 14%.

我們有信心實現 2025 年每股收益至少 29.50 美元的承諾，並堅定不移地致力於 10% 至 14% 的長期成長演算法。

We also continue to focus with our specific actions on further improving the health care ecosystem and delivery system and supporting our customers and patients with greater value, greater support and expanding transparency for the benefit of all that we serve.

我們也將繼續透過具體行動，進一步改善醫療保健生態系統和服務體系，為我們的客戶和患者提供更大的價值、更大的支援和更大的透明度，以造福所有服務對象。

And lastly, before I close, I want to express my personal appreciation and recognition to our colleagues across the globe.

最後，在結束之前，我想向我們全球的同事表達我個人的感謝和認可。

We have about 70,000 colleagues who wake up every day to make a positive difference in customers and patients' lives, and by and large, do that each and every day, and we're going to further strengthen our ability to make a difference for those who have yet even higher needs or at times we may fall short on.

我們擁有大約 70,000 名同事，他們每天醒來都致力於為客戶和患者的生活帶來積極的改變，總的來說，我們每天都在這樣做，我們將進一步增強我們的能力，為那些有更高需求或有時我們可能無法滿足的人帶來改變。

Sincere appreciation to our colleagues.

向我們的同事致以誠摯的謝意。

Thank you.

謝謝。

We look forward to furthering our conversation in the future.

我們期待未來進一步對話。

Ladies and gentlemen, this concludes The Cigna Group's fourth-quarter 2024 results review.

女士們、先生們，信諾集團 2024 年第四季業績審查到此結束。

Cigna Investor Relations will be available to respond to additional questions shortly.

Cigna 投資者關係部將很快回覆其他問題。

A recording of this conference will be available for 10 business days following this call.

本次會議的錄音將在會議結束後 10 個工作天內提供。

You may access the recorded conference by dialing 800-819-5739 or 203-369-3350.

您可以撥打 800-819-5739 或 203-369-3350 訪問錄音會議。

There is no pass code required for this replay.

這次重播不需要密碼。

Thank you for participating.

感謝您的參與。

We will now disconnect.

我們現在將斷開連接。