信諾集團 (CI) 2025 Q1 法說會逐字稿

Ladies and gentlemen, thank you for standing by for The Cigna Group's first-quarter 2025 results preview. (Operator Instructions) As a reminder, ladies and gentlemen, this conference, including the Q&A session, is being recorded. We'll begin by turning the conference over to Ralph Giacobbe. Please go ahead.

女士們、先生們，感謝您關注信諾集團 2025 年第一季業績預測。（操作員指示）女士們、先生們，提醒一下，本次會議（包括問答環節）正在錄製。首先，我們把會議交給 Ralph Giacobbe。請繼續。

Great. Thank you, 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, President and Chief Operating Officer; and Ann Dennison, Chief Financial Officer.

偉大的。謝謝您，接線生。大家早安。感謝您參加今天的電話會議。我是投資者關係資深副總裁 Ralph Giacobbe。今天早上與我一起接電話的還有 Cigna 集團董事長兼執行長 David Cordani、總裁兼營運長 Brian Evanko 和財務長 Ann Dennison。

In our remarks today, David, Brian, and Ann will cover a number of topics, including our first quarter 2025 financial results and our financial outlook for 2025. Following their prepared remarks, David, Brian, and Ann will be available for Q&A.

在今天的演講中，David、Brian 和 Ann 將討論許多主題，包括我們的 2025 年第一季財務表現和 2025 年財務展望。在準備好的演講之後，David、Brian 和 Ann 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（也稱為 GAAP）確定的。

A reconciliation of these measures to the most directly comparable GAAP measures, shareholders net income and total revenues, respectively, is contained in today's earnings release, which is posted in the Investor Relations section of 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.

今日的收益報告已將這些指標與最直接可比較的 GAAP 指標（股東淨利潤和總收入）進行了對賬，該報告發佈於 thecignagroup.com 的「投資者關係」版塊。我們使用「調整後營業收入」和「調整後每股盈餘」這兩個術語，其基準與我們衡量財務表現的主要指標相同。

In our remarks today, we will be making some forward-looking statements, including statements regarding our outlook for 2025 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的陳述，包括有關 2025 年和未來業績展望的陳述。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。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 first quarter, we recorded net after-tax special item charges of $229 million or $0.84 per share. This included an after-tax special item charge of $163 million or $0.63 per share related to a strategic optimization program to further leverage the company's ongoing operational efficiency initiatives.

關於我們第一季的業績，我們記錄的淨稅後特殊項目費用為 2.29 億美元，即每股 0.84 美元。其中包括與策略優化計畫相關的 1.63 億美元或每股 0.63 美元的稅後特殊專案費用，旨在進一步利用公司正在進行的營運效率措施。

Additional 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 2025 outlook, we will do so on a basis that includes the potential impact of future share repurchases and anticipated 2025 dividends. With that, I'll turn the call over to David.

有關特殊項目的更多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 2025 年全年展望）做出前瞻性評論時，我們將以未來股票回購和預期 2025 年股息的潛在影響為基礎。說完這些，我會把電話轉給大衛。

Thanks Ralph. Good morning, everyone, and thank you for joining today's call. We begin 2025 with momentum, and I'm pleased to report that in the first quarter, The Cigna Group posted strong results while we continue to focus on delivering on our commitments to build a better, more sustainable health care model.

謝謝拉爾夫。大家早安，感謝大家參加今天的電話會議。我們以強勁的勢頭開啟了 2025 年，我很高興地報告，在第一季度，信諾集團取得了強勁的業績，同時我們繼續專注於履行建立更好、更可持續的醫療保健模式的承諾。

Joining me on the call is Brian Evanko, our President and Chief Operating Officer, and I also want to welcome Ann Dennison, our Chief Financial Officer. As you likely saw, Brian and Ann were named to these new roles in March.

與我一起參加電話會議的還有我們的總裁兼營運長 Brian Evanko，我也想歡迎我們的財務長 Ann Dennison。正如您可能看到的，Brian 和 Ann 在三月被任命擔任這些新職位。

With the announcement, we'll be following a new format for our call this morning. I'll share some brief comments and focus on our performance and how we're leading to address all the stakeholder needs. Then Brian will discuss the key business drivers fueling our growth, and Ann will provide more detail on our financial results, and then we'll take your questions.

隨著這項公告的發布，我們將採用新的形式召開今天上午的電話會議。我將分享一些簡短的評論，並重點介紹我們的表現以及我們如何滿足所有利害關係人的需求。然後，布萊恩將討論推動我們成長的關鍵業務驅動因素，安將提供有關我們財務業績的更多細節，然後我們將回答您的問題。

To start today, I'm pleased to report that we delivered $65.5 billion in total revenue, and we grew adjusted earnings per share to $6.74 this quarter. And we are also raising our full-year EPS guidance estimate to at least $29.60.

今天首先，我很高興地報告，本季我們的總收入為 655 億美元，調整後每股收益成長至 6.74 美元。我們還將全年每股收益預期上調至至少 29.60 美元。

We delivered this performance in a dynamic environment with forces of change going beyond tariffs and trade, significant geopolitical and evolving social impacts. At The Cigna Group, our market-leading capabilities and flexible model have fueled our consistent track record of delivering differentiated value, innovating, and smartly expanding our addressable markets, driving sustained long-term growth even in the most disruptive environments.

我們在一個充滿活力的環境中實現了這一業績，變革的力量超越了關稅和貿易，還有重大的地緣政治和不斷演變的社會影響。在信諾集團，我們市場領先的能力和靈活的模式推動了我們持續提供差異化價值、創新和智慧擴展目標市場的良好記錄，即使在最具顛覆性的環境中也能推動持續的長期成長。

Whether measured over the last 3, 5 or 10 years, we've performed and delivered on our EPS growth algorithm. We've been able to deliver these competitively attractive results through a relentless approach to position our company to lead through the forces of change in health care.

無論以過去 3 年、5 年或 10 年來衡量，我們都已執行並實現了我們的 EPS 成長演算法。我們透過不懈努力，使我們的公司在醫療保健領域的變革力量中處於領先地位，從而取得了具有競爭力的成果。

We all know the health care system is on an unsustainable trajectory. Annual US health care expenditures now exceed $4.5 trillion, and society's growing needs are overwhelming the current system, which remains primarily oriented to providing interventions after someone becomes ill.

我們都知道醫療保健系統正處於不可持續的軌道上。目前，美國每年的醫療保健支出超過 4.5 兆美元，社會日益增長的需求使現行體係不堪重負，而現行體系仍主要專注於在患者患病後提供幹預措施。

All of these dynamics, particularly when matched against the current economic, geopolitical, and social environment, are driving strong demand for strategic partners that could help individuals, employers, governmental agencies, health plans, and integrated health care delivery systems to achieve both their short- and long-term goals.

所有這些動態，特別是在與當前的經濟、地緣政治和社會環境相結合時，都推動了對戰略合作夥伴的強烈需求，這些合作夥伴可以幫助個人、雇主、政府機構、健康計劃和綜合醫療保健系統實現其短期和長期目標。

The engines for converting these opportunities into differentiated results are our two growth platforms. Evernorth, our health services portfolio, and Cigna Healthcare, our integrated benefits portfolio. Together, the businesses across these platforms are leveraging the breadth of our core strengths and the power of our capabilities to create and capture more value than any one business could achieve alone.

將這些機會轉化為差異化成果的引擎是我們的兩個成長平台。Evernorth 是我們的健康服務組合，而 Cigna Healthcare 是我們的綜合福利組合。這些平台上的業務共同利用我們的核心優勢和強大的能力來創造和獲得比任何企業單獨實現的更多價值。

Importantly, we also continue to shape our portfolio with strategic acquisitions, partnerships and divestitures. The recently completed sale of our Medicare businesses to HCSC this past quarter is the most recent example that demonstrates our disciplined execution of our capital management strategy.

重要的是，我們也繼續透過策略性收購、合作和資產剝離來塑造我們的投資組合。我們上個季度剛完成將醫療保險業務出售給 HCSC，這是最新的例子，證明了我們嚴格執行資本管理策略。

Now while we've long been on the path to evolve and drive continuous improvement as we stepped into 2025, the forces of change in health care further strengthened our urgency and resolve and in part fueled customer-focused commitments and series of actions we announced earlier this year to address some of the most pressing challenges in health care in five key areas.

現在，雖然我們早已走在發展和推動持續改進的道路上，但當我們邁入2025年時，醫療保健領域的變革力量進一步增強了我們的緊迫感和決心，並在一定程度上推動了我們今年早些時候宣布的以客戶為中心的承諾和一系列行動，以應對醫療保健領域五個關鍵領域的一些最緊迫的挑戰。

First, access. We are addressing the challenges customers and patients face in getting care and making our processes simpler and faster. Second is support. Helping our customers and patients with enhanced resources to navigate the health care system with greater ease and peace of mind.

第一，訪問。我們正在解決客戶和患者在獲得護理方面面臨的挑戰，並使我們的流程更簡單、更快捷。二是支持。幫助我們的客戶和病患利用增強的資源更輕鬆、更安心地駕馭醫療保健系統。

Next is value, working to further lower cost for our customers and patients.

接下來是價值，努力進一步降低我們的客戶和患者的成本。

Fourth is accountability. Our promise to stand behind our commitments, specifically by tying our leadership compensation to improving customer and patient satisfaction.

四是問責。我們承諾信守承諾，特別是將領導階層的薪酬與提高客戶和病患的滿意度掛鉤。

And finally, transparency. We will publicly share our progress and improvements to serve our customers and patients as we go forward. These actions represent yet another significant commitment from The Cigna Group to build a better future, and I'm pleased we are already making good progress.

最後，透明度。我們將公開分享我們的進展和改進，以便為我們的客戶和患者提供服務。這些行動代表了信諾集團對建立更美好未來的另一個重大承諾，我很高興我們已經取得了良好的進展。

Now to wrap up my comments. Against the backdrop that is dynamic and challenging, we are well positioned for a strong 2025. Our first quarter results underscore the momentum we're building and our resilience as we continue to drive growth and invest for the long term. And we are confident in our ability to sustainably deliver 10% to 14% compounded EPS growth over the strategic horizon, along with providing an attractive dividend.

現在總結一下我的評論。在充滿活力和挑戰的背景下，我們已為強勁的2025年做好了準備。我們第一季的業績凸顯了我們在繼續推動成長和進行長期投資的過程中所累積的勢頭和韌性。我們有信心在策略範圍內持續實現 10% 至 14% 的複合每股收益成長，並提供有吸引力的股息。

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. Before getting into our business performance, I'd like to share a few thoughts on the new roles that were announced in March for Ann and myself. I'm humbled and grateful to be named as President and COO of The Cigna Group.

謝謝你，大衛。在介紹我們的業務表現之前，我想先分享一些關於 3 月宣布的安和我的新職位的想法。我很榮幸也很感激被任命為 Cigna 集團總裁兼營運長。

My new team's primary focus will be on driving profitable growth for the company, while making health care better for our primary stakeholders, most notably customers, patients, clients, and health care professional partners. I'm also thrilled to pass the reins of our finance function over to Ann, who is an accomplished and strategic financial leader.

我的新團隊的主要工作重點是推動公司的獲利成長，同時為我們的主要利害關係人（尤其是客戶、病患、客戶和醫療保健專業合作夥伴）提供更好的醫療保健服務。我也很高興將我們的財務職能交給安，她是一位成就卓著、具有策略眼光的財務領導者。

Over the past several weeks, as I've transitioned to the new role, I have spent meaningful time meeting with a number of our clients and partners and some key insights were reinforced through these engagements. First, our clients and partners consistently point to the attractive breadth and depth of our services and expertise across our Evernorth Health Services and Cigna Healthcare portfolio to solve their most pressing health care needs.

在過去的幾周里，隨著我過渡到新的角色，我花了很多時間與我們的一些客戶和合作夥伴會面，並透過這些會面強化了一些關鍵的見解。首先，我們的客戶和合作夥伴一致認為，我們的 Evernorth Health Services 和 Cigna Healthcare 產品組合所提供的服務和專業知識具有極強的廣度和深度，能夠解決他們最迫切的醫療保健需求。

For example, in Evernorth Specialty and Care Services businesses, representing about 30% of the company's income today, we have unique capabilities in this fast-growing sector that others can't match. Last year, we delivered more than 8 million prescriptions to over 1 million patients through our owned operational assets and capabilities, including safely mixing and preparing medications in sterile environments that take years to build and fully license.

例如，Evernorth 專業和護理服務業務目前占公司收入的 30% 左右，我們在這個快速成長的領域擁有其他公司無法比擬的獨特能力。去年，我們透過自有營運資產和能力向 100 多萬名患者提供了 800 多萬張處方，包括在耗時數年建立並獲得完全許可的無菌環境中安全地混合和準備藥物。

This business represents one of the company's top growth opportunities going forward in a space with high secular growth rates. Specialty drugs are clinically intensive, serving a relatively small number of patients who rely on them. Our patients clearly value the experience enabled by our clinicians, pharmacists, and nurses, both in their home and over the phone. As we see 97% patient satisfaction rates on interactions with our Accredo nurses.

該業務代表了該公司在長期高成長率領域未來最大的成長機會之一。特種藥物屬於臨床密集型藥物，僅服務相對較少的依賴該藥物的患者。我們的患者非常重視我們的臨床醫生、藥劑師和護士在家中和透過電話提供的體驗。我們發現病患與 Accredo 護理師互動的滿意度高達 97%。

In Express Scripts, our Pharmacy Benefit Services business, which also represents about 30% of the company's income, we are working tirelessly to lower prescription drug prices for more than 100 million Americans, and we saved about $38 billion for our clients last year.

在快速藥方（Express Scripts）中，我們的藥局福利服務業務也占公司收入的 30% 左右，我們孜孜不倦地致力於降低超過 1 億美國人的處方藥價格，去年我們為客戶節省了約 380 億美元。

Unlike our lower-volume clinically-intensive specialty pharmacy business, our PBS business features much higher prescription volumes, including low-cost generics alongside the lower prices we negotiate for high list price branded drugs.

與我們較低容量的臨床密集型專業藥房業務不同，我們的 PBS 業務具有更高的處方量，包括低成本仿製藥以及我們協商的高價品牌藥品的較低價格。

For example, we will process over 2 billion prescriptions in Express Scripts this year with around 90% of these being cost-effective generics. And finally, in Cigna Healthcare, where we generate about 40% of The Cigna Group's income, my recent engagements with some of our US employer clients have underscored the value of our consultative client partnership model.

例如，今年我們將在快捷藥方 (Express Scripts) 處理超過 20 億張處方，其中約 90% 是具有成本效益的仿製藥。最後，在信諾醫療保健 (Cigna Healthcare)，我們為信諾集團創造了約 40% 的收入，我最近與一些美國雇主客戶的合作凸顯了我們的諮詢式客戶合作模式的價值。

This has been further advanced by improving customer outcomes through better unit costs, site of care optimization and personalized clinical programs. And we continue to generate net growth rates that are well above the market in our under 500 Select segment, where we have now reached more than 3 million customers.

透過更好的單位成本、護理地點優化和個人化臨床計劃來改善客戶結果，這一目標得到了進一步推進。我們在 500 強以下精選客戶群中持續維持遠高於市場的淨成長率，目前該領域的客戶數量已超過 300 萬。

Finally, I'm proud of the way all of my colleagues at The Cigna Group care deeply about those we serve. Our clients and partners appreciate the expertise of our team and the passion that they bring to our work to improve health care for all. As I look to the future, I'm very excited about the growth opportunities we see across our businesses, while we remain focused on building a more sustainable model for health care.

最後，我為信諾集團全體同事對我們服務對象的深切關懷感到自豪。我們的客戶和合作夥伴欣賞我們團隊的專業知識以及他們為改善全民健保的工作所付出的熱情。展望未來，我對我們在整個業務中看到的成長機會感到非常興奮，同時我們仍然專注於建立更永續的醫療保健模式。

Now let me turn to the quarter in our business performance. Evernorth earnings were in line with expectations and revenues grew by double digits, led by our strong pharmacy benefit services and specialty pharmacy capabilities. Within Cigna Healthcare, we achieved strong revenue performance across our US employer and international health businesses, driven by growth in our Select segment customers and strong rate execution.

現在讓我來談談我們本季的業務表現。Evernorth 的收益符合預期，收入成長了兩位數，這得益於我們強大的藥房福利服務和專業藥房能力。在信諾醫療集團 (Cigna Healthcare) 內部，得益於精選客戶群的成長和強勁的利率執行，我們在美國雇主和國際健康業務中取得了強勁的收入表現。

We are also confident in our action plan to improve margins on our stop loss products, and we are pleased to see that the early indicators on 2025 stop loss performance are tracking to expectations. Let me unpack these headlines more fully. Evernorth Specialty and Care Services businesses drove very strong growth in the first quarter with double-digit growth rates in both revenue and normalized earnings. And this space continues to represent one of the fastest-growing sectors in the industry.

我們對提高停損產品利潤率的行動計畫也充滿信心，我們很高興看到2025年停損表現的早期指標正在追蹤預期。讓我更全面地解釋一下這些標題。Evernorth 專業和護理服務業務在第一季實現了非常強勁的成長，收入和正常收益均實現了兩位數的成長率。這一領域仍然是該行業成長最快的領域之一。

The specialty pharmacy market continues to grow at an attractive pace -- as new specialty drugs are introduced, existing medications are authorized for expanded indications and biosimilars become more prevalent. We are pleased with the further increased adoption of our interchangeable HUMIRA biosimilar. And this month, we are taking another step forward with an interchangeable STELARA biosimilar, which will also be available to eligible patients for $0 out of pocket.

專業藥房市場繼續以驚人的速度增長——隨著新型專業藥物的推出、現有藥物的適應症擴大以及生物相似藥的日益普及。我們很高興看到可互換的 HUMIRA 生物相似藥的採用率進一步提高。本月，我們又邁出了一步，推出了可互換的 STELARA 生物仿製藥，符合條件的患者也可以以 0 美元的自付費用購買該藥物。

Turning to our Pharmacy Benefit Services business. We drove attractive revenue growth of 14%, while balancing the need to continue investments for the long term. And while it's early into the 2026 selling season, we continue to see strong demand among existing and new clients. And we further increased investments in the pharmacy benefits business to drive even greater transparency and savings and to make the health care system work better for customers and patients.

轉向我們的藥房福利服務業務。我們實現了 14% 的可觀收入成長，同時平衡了長期持續投資的需要。儘管現在正處於 2026 年銷售旺季的初期，但我們仍然看到現有客戶和新客戶的需求強勁。我們進一步增加了對藥品福利業務的投資，以提高透明度和節省成本，使醫療保健系統更好地為客戶和患者服務。

We will soon be announcing enhancements to the patient experience with new flexible and personalized digital tools and capabilities. In Cigna Healthcare, our earnings exceeded expectations in the quarter, along with 9% revenue growth, powered by strong rate execution. We generated strong growth in our under 500 Select segment with customers growing 9% year-over-year, well above industry growth.

我們很快就會宣布透過新的靈活和個人化的數位工具和功能來改善患者體驗。在 Cigna Healthcare，我們本季的收益超出了預期，在強勁的利率執行的推動下，營收成長了 9%。我們在 500 強以下精選客戶群中實現了強勁增長，客戶數量同比增長 9%，遠高於行業增長率。

And we continue to see further headroom for future customer growth given our market share is just 7% in this segment. And as David mentioned, we are laser-focused on the actions we announced earlier this year to improve the customer experience within Cigna Healthcare. The response to our proactive commitments has been very positive, with stakeholders appreciating the associated transparency and accountability.

鑑於我們在該領域的市佔率僅為 7%，我們仍然認為未來客戶成長還有進一步的空間。正如大衛所提到的，我們正專注於今年早些時候宣布的行動，以改善 Cigna Healthcare 的客戶體驗。我們的積極承諾得到了非常積極的回應，利益相關者對相關的透明度和問責表示讚賞。

To bring it all together, I'd like to share one specific example of how we continue to lead through the rapidly changing environment, with new innovations, leveraging our differentiated capabilities. The GLP-1 drug class is on pace to be the number one drug trend driver for plans this year. In fact, for the average employer who provides access to GLP-1s for weight management, GLP-1s now represent about 3% of their total health care costs.

總而言之，我想分享一個具體的例子，說明我們如何利用新的創新和差異化的能力，繼續在快速變化的環境中保持領先地位。GLP-1 類藥物有望成為今年計畫中第一大藥物趨勢驅動因素。事實上，對於提供 GLP-1 用於體重管理的普通雇主而言，GLP-1 目前約佔其總醫療保健成本的 3%。

And GLP-1s are now being prescribed beyond their original application for diabetes to include use for obesity and weight management and more recently for sleep apnea, with additional indications on the horizon. These treatments have been called once in a generation, and we all know they're changing lives and changing health care. By 2030, we expect the market size to exceed $100 billion in the US alone. And 1 in 10 Americans is expected to be on a GLP-1 medication.

GLP-1 目前的用途已超出了其最初的糖尿病治療範圍，包括肥胖症和體重管理，最近也用於治療睡眠呼吸暫停，並且即將出現更多適應症。這些治療方法每代都會出現一次，我們都知道它們正在改變生活和醫療保健。到 2030 年，我們預計僅在美國市場規模就將超過 1,000 億美元。預計每 10 個美國人中就有 1 個將服用 GLP-1 藥物。

But the challenge of affordability, access and clinical coordination for GLP-1s in the US remains. Clients are looking for ways to manage the high cost of these medicines while ensuring appropriate use and patients want to access these medications at an affordable price point and have a positive experience with the clinical support they need to achieve durable and impactful results.

但美國 GLP-1 的可負擔性、可近性和臨床協調性的挑戰依然存在。客戶正在尋找方法來管理這些藥物的高成本，同時確保適當使用，患者希望以可負擔的價格獲得這些藥物，並獲得持久和有影響力的結果所需的臨床支持的積極體驗。

Our EncircleRx solution provides a clinical program wrapper around the medication to help support sustainable and positive lifestyle changes for patients as well as improve affordability and access for clients. EncircleRx now has approximately 9 million members enrolled.

我們的 EncircleRx 解決方案提供了圍繞藥物的臨床程序包裝，以幫助支持患者可持續和積極的生活方式改變，並提高客戶的可負擔性和可及性。EncircleRx 目前約有 900 萬名會員。

Now we're building on that success with the launch of additional innovations around GLP-1 access and affordability including our new EnReachRx solution, a high-touch patient support clinical model enabled by pharmacies committed to enhance clinical care for dispensing GLP-1 medicines.

現在，我們在此基礎上繼續取得成功，推出了有關 GLP-1 可及性和可負擔性的更多創新，包括我們的新 EnReachRx 解決方案，這是一種由致力於加強 GLP-1 藥物配發臨床護理的藥房支持的高接觸患者支持臨床模式。

We also will offer a new specialized GLP-1 pharmacy called EnGuide, which will go live for patients and clients next month. The combination of our pharmacy solutions further strengthens our position as a leader and innovator in this space by solving pharmacy, client and patient challenges.

我們還將提供一種名為 EnGuide 的新型專業 GLP-1 藥房，該藥房將於下個月向患者和客戶投入使用。透過解決藥房、客戶和患者的挑戰，我們的藥房解決方案組合進一步加強了我們作為該領域的領導者和創新者的地位。

As I wrap up my remarks, I'd like to reiterate a few points. We had a strong start to the year across both Evernorth and Cigna Healthcare. Some of the notable headlines from the quarter's performance include favorable MCR performance in Cigna Healthcare, leading to better-than-expected earnings. Strong growth in Cigna Healthcare Select segment customers, up 9% year-over-year.

在結束發言之前，我想重申幾點。今年，我們在 Evernorth 和 Cigna Healthcare 兩方面都取得了強勁的開局。本季業績的一些引人注目的頭條新聞包括 Cigna Healthcare 良好的 MCR 表現，從而帶來好於預期的盈利。Cigna Healthcare Select 細分客戶成長強勁，較去年同期成長 9%。

Within Evernorth, we posted double-digit percentage growth in both revenue and normalized earnings within our high-growth specialty and care services operating segment and we had a strong start to the year in our pharmacy benefit services business, including double-digit revenue growth.

在 Evernorth，我們的高成長專業和護理服務營運部門的收入和正常化收益均實現了兩位數的百分比增長，我們的藥房福利服務業務今年開局強勁，包括兩位數的收入增長。

We delivered these strong results alongside making strategic investments for the longer term, including the customer provider-facing enhancements we committed to earlier this year. I'm excited by the numerous growth opportunities we have in the future and the enhancements we are making in order to improve the health care system for all.

我們在取得這些強勁業績的同時，也進行了長期策略投資，包括我們今年稍早承諾的面向客戶供應商的改進。我對我們未來擁有的眾多發展機會以及我們為改善全民健保系統所做的改進感到非常興奮。

Now I'll turn it over to Ann to cover our financial performance and outlook in more detail.

現在我將讓安更詳細地介紹我們的財務表現和前景。

Thank you, Brian, and good morning, everyone. I'm excited to join you for my first earnings call as the CFO of The Cigna Group. Since joining over a year ago, I have been inspired by the dedication and talent of our employees, which gives me confidence in our ability to deliver value for our patients and customers and to achieve attractive long-term growth. I look forward to engaging with many of you over the coming months.

謝謝你，布萊恩，大家早安。我很高興能作為 Cigna 集團財務長參加我的第一次財報電話會議。加入公司一年多來，我一直受到員工的奉獻精神和才華的鼓舞，這讓我對我們為患者和客戶提供價值以及實現有吸引力的長期增長的能力充滿信心。我期待在接下來的幾個月與你們中的許多人進行交流。

As Brian mentioned, we started the year with a strong first-quarter performance ahead of expectations. Key consolidated financial highlights for the first quarter include revenue of $65.5 billion and adjusted earnings per share of $6.74.

正如布萊恩所提到的，我們今年第一季的業績表現強勁，超出了預期。第一季的主要合併財務亮點包括 655 億美元的營收和 6.74 美元的調整後每股盈餘。

With the first quarter results, we are raising our full year 2025 adjusted earnings per share outlook to at least $29.60. This outlook reflects confidence in our businesses while maintaining a prudent view of the current environment.

根據第一季業績，我們將2025年全年調整後每股盈餘預期上調至至少29.60美元。這項預期體現了我們對業務的信心，同時也體現了對當前環境的審慎看法。

Now turning to our segment results. I will first comment on Evernorth. Evernorth continues to deliver strong results. First quarter 2025 revenues grew to $53.7 billion, while pretax adjusted earnings grew 5% to $1.4 billion, in line with expectations.

現在談談我們的分部表現。我首先對 Evernorth 進行評論。Evernorth 繼續取得強勁業績。2025 年第一季營收成長至 537 億美元，稅前調整後收益成長 5% 至 14 億美元，符合預期。

Specialty and Care services showed strong growth with revenue up 19% to $23.9 billion. Normalizing for the impact of lower net investment income due to the absence of the VillageMD dividend, pretax adjusted earnings were up 11% year-over-year. This performance reflects the continued demand for specialty drugs as well as increased adoption of biosimilars.

專業和護理服務表現強勁，營收成長 19%，達到 239 億美元。由於沒有 VillageMD 股息導致淨投資收入較低，因此將其影響正常化後，稅前調整後收益同比增長 11%。這一表現反映了對特種藥物的持續需求以及生物相似藥的採用率的提高。

Pharmacy Benefit Services also posted solid growth, reflecting strong client retention expansion of existing relationships and new business wins. Pretax adjusted earnings were up 4% to $544 million as our innovative capabilities continue to drive value and savings for our patients, customers, and clients.

藥房福利服務也實現了穩健成長，體現出強勁的客戶保留、現有關係的擴大以及新業務的贏得。由於我們的創新能力持續為我們的患者、顧客和客戶創造價值並節省開支，稅前調整後收益增加 4% 至 5.44 億美元。

Overall, we're pleased with Evernorth's first quarter results and confident about the long-term growth outlook for the underlying businesses.

總體而言，我們對 Evernorth 第一季的業績感到滿意，並對其基礎業務的長期成長前景充滿信心。

Turning to Cigna Healthcare. First quarter 2025 revenues were $14.5 billion, and pretax adjusted earnings were $1.3 billion. The medical care ratio for the first quarter was 82.2%. On March 19, we completed the divestiture of our Medicare businesses to HCSC. This transaction closed about a month later than our financial planning assumptions. The timing of the closing modestly benefited our first-quarter earnings but had a greater impact on our medical care ratio as the Medicare businesses operate at a higher MCR compared to the rest of our portfolio.

轉向 Cigna Healthcare。2025 年第一季營收為 145 億美元，稅前調整後收益為 13 億美元。第一季醫療保健率為82.2%。3 月 19 日，我們完成了將醫療保險業務剝離給 HCSC 的交易。這次交易比我們的財務規劃假設晚了一個月左右。此交易的完成時間略微有利於我們第一季的收益，但對我們的醫療保健比率產生了更大的影響，因為與我們投資組合中的其他部分相比，醫療保險業務的 MCR 更高。

An additional month equates to an increase of approximately 100 basis points to our MCR in the first quarter, which is included in our reported results. Excluding the impact of the later timing of the Medicare divestiture, the fundamental Cigna Healthcare adjusted earnings in MCR were both favorable to expectations.

額外的一個月相當於我們第一季的 MCR 增加約 100 個基點，這已包含在我們報告的結果中。排除醫療保險剝離時間較晚的影響，Cigna Healthcare 在 MCR 的基本調整效益均符合預期。

As previously noted, we anticipated medical cost trends in 2025 to remain elevated. Year-to-date, we have observed elevated trends consistent with our expectations in most categories, with some favorability in surgical activity and OB services.

如前所述，我們預計 2025 年醫療成本趨勢將保持在高位。今年迄今為止，我們觀察到大多數類別都呈現與我們的預期一致的上升趨勢，其中外科手術活動和婦產科服務表現出一定的有利趨勢。

And finally, our stop loss performance is tracking in line with expectations, and we continue to assume an elevated full year MCR for this business, consistent with our commentary on the fourth quarter earnings call. Overall, Cigna Healthcare delivered strong results in a dynamic operating environment.

最後，我們的停損表現符合預期，我們繼續假設該業務的全年 MCR 將會上升，這與我們在第四季度財報電話會議上的評論一致。整體而言，信諾醫療在充滿活力的營運環境中取得了強勁的業績。

Before I comment on our 2025 outlook, as Ralph mentioned, in the first quarter, we initiated a strategic optimization program to further advance the company's ongoing efficiency initiatives. These actions will continue to leverage our scale, technology, and innovation to position us for sustainable long-term growth.

在我評論我們的 2025 年展望之前，正如拉爾夫所提到的，在第一季度，我們啟動了一項戰略優化計劃，以進一步推進公司正在進行的效率舉措。這些舉措將繼續利用我們的規模、技術和創新，為我們實現可持續的長期成長做好準備。

Now turning to our outlook for the full year 2025. We are increasing our full year 2025 expectation for consolidated adjusted income from operations to at least $29.60 per share. This increase is primarily attributed to the incremental earnings contribution from our Medicare businesses, largely reflecting later timing of the divestiture.

現在來談談我們對 2025 年全年的展望。我們將 2025 年全年合併調整後營業收入預期上調至每股至少 29.60 美元。這一成長主要歸因於我們的醫療保險業務帶來的增量收益貢獻，這在很大程度上反映了資產剝離的後期時間。

Regarding the cadence of earnings, we expect the second quarter adjusted earnings per share to be slightly below 25% of the full-year outlook.

關於獲利節奏，我們預計第二季調整後每股盈餘將略低於全年預期的 25%。

Now turning to our 2025 outlook for each of our growth platforms. In Evernorth, we continue to expect full year 2025 pretax adjusted earnings of at least $7.2 billion, and we expect Evernorth's second quarter pretax adjusted earnings seasonality to be similar to 2024.

現在來談談我們對每個成長平台的 2025 年展望。在 Evernorth，我們繼續預計 2025 年全年稅前調整後收益至少為 72 億美元，並且我們預計 Evernorth 第二季度稅前調整後收益的季節性將與 2024 年相似。

For Cigna Healthcare, we are increasing our full year 2025 pretax adjusted earnings outlook by $25 million to at least $4.125 billion. We expect the second quarter Cigna Healthcare adjusted earnings to be slightly above 25% of the full year outlook. We continue to expect the full year medical care ratio within the range of 83.2% to 84.2%. Additionally, we expect our second quarter medical care ratio to be towards the low end of the full year range.

對於 Cigna Healthcare，我們將 2025 年全年稅前調整後獲利預期上調 2,500 萬美元，達到至少 41.25 億美元。我們預計 Cigna Healthcare 第二季的調整後盈餘將略高於全年預期的 25%。我們繼續預計全年醫療保健比率將在 83.2% 至 84.2% 之間。此外，我們預計第二季的醫療保健比例將接近全年範圍的低端。

Turning to our 2025 capital management position. Our debt-to-capitalization ratio was 43.1% as of March 31. We expect this ratio to be lower at year-end as we balance our capital management strategy, including debt pay down as we move through the year.

轉向我們的 2025 年資本管理狀況。截至 3 月 31 日，我們的負債資本比率為 43.1%。我們預計，隨著我們平衡資本管理策略（包括全年減少債務償還），這一比率在年底會降低。

As of May 1, we have repurchased 8.2 million shares of common stock for approximately $2.6 billion. And we remain confident in our strong balance sheet and cash flow generation and we will continue our disciplined capital management approach to drive sustainable long-term growth.

截至 5 月 1 日，我們已回購 820 萬股普通股，價值約 26 億美元。我們仍然對強勁的資產負債表和現金流產生充滿信心，並將繼續採取嚴謹的資本管理方法來推動可持續的長期成長。

Now to recap. Our first quarter 2025 results reflect strong contributions and disciplined execution from both Evernorth and Cigna Healthcare. Our 2025 outlook reflects the sustained momentum and solid fundamentals of our growth platforms, which gives us confidence to increase our full year 2025 adjusted earnings outlook to at least $29.60 per share. And with that, we'll turn it over to the operator for the Q&A portion of the call.

現在回顧一下。我們的 2025 年第一季業績反映了 Evernorth 和 Cigna Healthcare 的強大貢獻和嚴格的執行。我們對 2025 年的展望反映了我們成長平台的持續發展勢頭和穩固基本面，這使我們有信心將 2025 年全年調整後收益預期提高至每股至少 29.60 美元。接下來，我們將把電話會議的問答部分交給接線員。

(Operator Instructions) Lisa Gill, JPMorgan.

（操作員指示） 摩根大通的麗莎吉爾 (Lisa Gill)。

I wanted to start first with weight loss. We saw a competitor yesterday signed a deal with Novo. I'm just curious around what you're seeing on the opportunity to be able to negotiate a better price with either of the large GLP-1 players in the marketplace?

我想先從減肥開始。我們看到昨天一家競爭對手與 Novo 簽署了協議。我只是好奇，您認為有機會與市場上任何一家大型 GLP-1 廠商協商出一個更優惠的價格嗎？

And then two, you talked about 9 million people enrolled in the program, but can you talk about general coverage from an employer or ASO perspective, is there a big opportunity if we start to see materially better pricing?

第二，您提到有 900 萬人參加了該計劃，但是您能否從雇主或 ASO 的角度談談一般覆蓋範圍，如果我們開始看到實質上更好的定價，是否存在很大的機會？

And then just lastly, David, I have to sneak this one in here. I just really would love to hear your thoughts on Arkansas and the legislation. And I believe you have a large pharmacy benefit relationship with one of the large employers in that state. So if you could give some color around that as well.

最後，大衛，我必須偷偷地把這個放在這裡。我真的很想聽聽您對阿肯色州和立法的看法。我相信您與該州的一家大型雇主有著廣泛的藥房福利關係。所以如果你能對此給出一些解釋的話。

It's David. You sure packed a lot in there. So let me ask Brian to take the first tranche of your questions, which all focus around the GLP-1 space and talk about what we're seeing in the market. You asked questions around what's happening with coverage, but more specifically, what's happening with innovation in the marketplace, both in terms of the access and the affordability, then I'll come back on the Arkansas bill. Brian?

是戴維。你肯定在裡面裝了很多東西。因此，請容許我請 Brian 回答你們第一部分的問題，這些問題都集中在 GLP-1 領域，並談談我們在市場上看到的情況。您詢問了保險覆蓋範圍的情況，更具體地說，市場創新情況如何，包括可及性和可負擔性方面，然後我將回到阿肯色州的法案上。布賴恩？

Thanks, David, and Lisa too. I’ll step back and take a look at the GLP-1 space and our position, we're really proud of the comprehensive approach that we're taking towards this market. So that's represented by the combined suite of GLP-1 programs that I referenced in my earlier comments, specifically around EncircleRx and EnReachRx and EnGuide. And we developed these programs really in response to some of the clear needs that were emerging around the market. So most notably, access, affordability, clinical safety and longer-term lifestyle changes.

謝謝 David，還有 Lisa。我將退一步來看看 GLP-1 領域和我們的地位，我們對針對這個市場採取的全面方法感到非常自豪。這就是我在之前的評論中提到的 GLP-1 程式組合套件所代表的，特別是圍繞 EncircleRx、EnReachRx 和 EnGuide。我們開發這些項目其實是為了滿足市場上出現的一些明顯需求。因此最值得注意的是可近性、可負擔性、臨床安全性和長期生活方式的改變。

We don't necessarily see formulary replacement or choosing one drug over another in this class as being sufficient to generate the societal impact that these drugs can have. And it's important to keep in mind that we have multiple formularies, multiple network options available across our Evernorth platform today. And some of these solutions are narrower in nature, some of them are broader.

我們不一定認為處方替換或選擇此類藥物中的一種藥物足以產生這些藥物可能帶來的社會影響。重要的是要記住，我們今天在 Evernorth 平台上有多個處方集和多個網路選項可供選擇。其中一些解決方案本質上比較狹窄，而另一些則比較廣泛。

Now as it relates to specific drugs or manufacturers that we partner with, there are some principles that tend to guide us whether for GLP-1s or for other drugs. So one principle is that competition tends to improve affordability over time. So that competition can occur between manufacturers on a specific type of drug or between injectable versions and tablet versions.

現在，當它涉及到我們合作的特定藥物或製造商時，有一些原則傾向於指導我們，無論是對於 GLP-1 或其他藥物。因此，一個原則是，隨著時間的推移，競爭往往會提高可負擔性。這樣，特定類型藥物的製造商之間或註射劑和片劑之間就會發生競爭。

All those dynamics are a good thing over time. It allows us to negotiate lower net cost which benefits both clients and patients. Another principle is that choice is good, all else equal. And a final principle is to ensure that a resilient supply chain exists, such that there's adequate supply of any drug class. So these principles apply across most drug classes but are particularly important for GLP-1s.

從長遠來看，所有這些動態都是好事。它使我們能夠協商降低淨成本，從而使客戶和患者都受益。另一個原則是，在其他條件相同的情況下，選擇是好的。最後一項原則是確保存在有彈性的供應鏈，以確保任何類別的藥物都有足夠的供應。因此，這些原則適用於大多數藥物類別，但對於 GLP-1 尤其重要。

And we have a proven track record of being able to dynamically manage against this changing prescription drug landscape. So again, we're really proud of our comprehensive approach to the GLP-1 market and the solutions that we've introduced that address access affordability, clinical safety and longer-term lifestyle changes.

我們已經證明能夠動態地應對處方藥市場的變化。因此，我們再次對我們對 GLP-1 市場的全面方法以及我們推出的解決可負擔性、臨床安全性和長期生活方式改變的解決方案感到非常自豪。

In terms of coverage levels, what we're seeing in our Evernorth book of business is just north of 50% of our employers provide coverage for weight management. That's relatively stable from where it was in 2024.

就覆蓋範圍而言，我們在 Evernorth 業務記錄中看到，超過 50% 的雇主提供體重管理保險。與 2024 年相比，這一水準相對穩定。

In our Cigna Healthcare book of business, the percentage covering for weight management is lower. We're in the 15% to 20% range, and that's because we have a smaller average employer in our Cigna Healthcare book of business. and that percentage is also relatively stable from 2024 to 2025.

在我們的 Cigna Healthcare 業務中，體重管理的覆蓋率較低。我們的比例在 15% 到 20% 之間，這是因為我們的 Cigna Healthcare 業務中平均雇主規模較小。而且從 2024 年到 2025 年，這一比例也相對穩定。

So as net pricing comes down in this class, it should increase the percentage of employers who are interested in providing this benefit for their employees and their dependents.

因此，隨著這一階層的淨價格下降，有興趣為其員工及其家屬提供這種福利的雇主比例應該會增加。

David, do you want to pick up on the last part of Lisa's question?

大衛，你想繼續麗莎問題的最後一部分嗎？

Sure. And again, before I pivot over to Arkansas, just amplify two pieces. Lisa, first, as I think you very well know, back to coverage, that's part of your question, in the United States, Brian referenced the coverage levels. Broadly speaking, OECD countries outside the US do not cover GLP-1s for weight management.

當然。再次，在我轉向阿肯色州之前，我先強調兩點。麗莎，首先，我想你很清楚，回到覆蓋範圍，這是你問題的一部分，在美國，布萊恩提到了覆蓋範圍。廣義上講，美國以外的 OECD 國家不涵蓋用於體重管理的 GLP-1。

So our country is in a different posture and hence as employers at that stable coverage level are increasingly looking for more value out of the coverage, including continuity of care as there's a lot of fracturing in terms of use of the medication starts and stops and starts and stops. So I just wanted to amplify that. Back to the Arkansas bill. First, context wise for Arkansas. Arkansas for the broad Cigna Group portfolio is a smaller market for us. Now specific to the bill, two points before we get to the Arkansas bill. As an organization we have and will continue to operate in an active legislative regulatory environment. That's something we have a long track record of demonstrated engagement and participation and then evolving our business portfolio.

因此，我們的國家處於不同的狀態，因此，在穩定的覆蓋水平下，雇主越來越多地尋求從覆蓋範圍中獲得更多價值，包括護理的連續性，因為在藥物使用方面存在很多分歧，開始和停止，開始和停止。所以我只是想進一步強調這一點。回到阿肯色州的法案。首先，就阿肯色州的情況而言。對於信諾集團 (Cigna Group) 廣泛的投資組合而言，阿肯色州的市場對我們來說較小。現在具體談談該法案，在討論阿肯色州法案之前，我們有兩點要說。作為一個組織，我們已經並將繼續在積極的立法監管環境中運作。我們長期以來一直積極參與這一領域，並不斷改進我們的業務組合。

Second, in that environment, we aggressively support evolution of both legislation and regulation around, for example, transparency for transparency that's actionable, improving value and affordability and importantly, maintaining or expanding choice versus constricting choice.

其次，在這種環境下，我們積極支持立法和監管的演變，例如，提高透明度以實現可操作性，提高價值和可負擔性，更重要的是，維持或擴大選擇而不是限制選擇。

Specific to the Arkansas bill, we see it broadly speaking in opposition of these goals, where the posture of the bill picks and chooses winners in the state, uses inappropriately from our point of view, licensure capabilities to limit choice, commerce and free market and the result of which, importantly, is going to be a decrease in access, a reduction in choice, an erosion in quality and continuity of care and ultimately increase in cost for citizens. So we oppose both the construct and the intent of the bill. Having said that, I'd reinforce that Arkansas is a relatively small market for The Cigna Group.

具體到阿肯色州的法案，我們認為它總體上與這些目標相悖，該法案的立場是挑選州內的贏家，從我們的角度來看，它不恰當地使用許可權力來限制選擇、商業和自由市場，其結果是，嚴重的是，它將導致獲取醫療服務的機會減少、選擇的減少、醫療質量和連續性的下降，並最終增加公民的成本。因此，我們反對該法案的結構和意圖。話雖如此，我還是要強調，阿肯色州對於信諾集團來說是一個相對較小的市場。

Lisa, thank you for your question.

麗莎，謝謝你的提問。

A.J. Rice, UBS.

瑞銀的 A.J. Rice。

Thanks for the comments about GLP-1s. I wonder if I could broaden it out a little bit. Obviously, there's a little bit more of an unsettled economic environment. I guess there's always some variability every time this year.

感謝您對 GLP-1 的評論。我想知道我是否可以將它稍微擴大一點。顯然，經濟環境更加不穩定。我想今年每次都會有一些變化。

But as you start to have discussions, obviously, you're well into the PBM selling season and you're gearing up to talk about benefit design with your commercial clients and the broader health care coverage, what are you seeing in terms of where they're focused and things that they're asking you about?

但是當您開始進行討論時，顯然您已經進入了 PBM 銷售季節，並且您正準備與您的商業客戶討論福利設計和更廣泛的醫療保險範圍，您看到他們關注的重點和他們向您詢問的事情是什麼？

And I wondered in an unsettled in the economic environment, does that tend to drive more of that Select market toward your product? Or does it make them pause on making a change like that?

我想知道，在經濟環境不穩定的情況下，這是否會吸引更多的精選市場購買您的產品？或者這會讓他們暫停做出這樣的改變嗎？

A.J., it's Brian. I'll take the question about the selling season, and then I'll try to address your point about the smaller employers and some of the uncertainty in the economic environment right now. So maybe I'll start with the net results that we're expecting at this point in time for 2026. And then I'll unpack some of the market dynamics underneath.

A.J.，我是布萊恩。我將回答有關銷售季節的問題，然後嘗試解答您關於小型雇主和當前經濟環境中的一些不確定性的問題。因此，也許我將從我們目前預期的 2026 年淨結果開始。然後我將解析下面的一些市場動態。

So within our Express Scripts Pharmacy Benefit Services business, we're currently tracking towards mid-90s or better retention. And that's a strong retention level consistent with what we've seen in prior years. Within The Cigna Healthcare portfolio, still pretty early in the season for smaller employers, but we do have some good insights on the larger end of the market, specifically our national accounts business.

因此，在我們的 Express Scripts Pharmacy Benefit Services 業務中，我們目前正在追蹤 90 年代中期或更好的保留率。這與前幾年我們看到的保留率相當高。在 Cigna Healthcare 投資組合中，對於小型雇主來說，仍處於初期階段，但我們對較大的市場，特別是我們的全國帳戶業務，確實有一些很好的見解。

And here, we continue to view this market segment as one that will be a flat to shrinking market overall. Over time, and our strategy in the national account space is to maintain our current share.

在這裡，我們繼續認為這個細分市場總體上將保持平穩甚至萎縮。隨著時間的推移，我們在國家帳戶領域的策略是保持我們目前的份額。

And at this point, we're not seeing anything unique for 2026 that would cause us to deviate from that general pattern. So maybe I'll spend just a minute or two on some of the dynamics transpiring in the selling season to your question.

目前，我們還沒有看到 2026 年出現任何特殊情況，導致我們偏離整體模式。因此，也許我會花一兩分鐘的時間來回答你的問題，談談銷售季節發生的一些動態。

So I'd characterize this as an active season, both as we compete for potential 2026 new business, but also amongst our existing client base who are exploring the market. So in terms of some common themes, a few things I'd highlight, as we've discussed in prior calls, affordability continues to be a key area of focus for employers, particularly with the higher cost trend environment that we're experiencing.

因此，我認為這是一個活躍的季節，因為我們不僅在爭奪潛在的 2026 年新業務，而且我們的現有客戶群也在探索市場。因此，就一些共同主題而言，我想強調幾點，正如我們在之前的電話會議中討論過的，可負擔性仍然是雇主關注的重點領域，特別是在我們正在經歷的成本趨勢較高的環境下。

Now this is driven in part by the wave of drug innovation including specialty drugs and GLP-1s, along with continued growth in mental health spending. Now fortunately, the significant strides we've taken in improving our own unit cost position in the Cigna Healthcare business has positioned us well to compete effectively on the unit cost dimension. And you can see that manifesting itself in the strong growth that we're posting in the under 500 Select segment.

現在，這在一定程度上受到包括特種藥物和 GLP-1 在內的藥物創新浪潮以及精神衛生支出的持續增長的推動。幸運的是，我們在改善 Cigna Healthcare 業務自身單位成本地位方面取得了重大進展，這使我們能夠在單位成本層面上進行有效競爭。您可以看到，我們在 500 以下精選細分市場的強勁成長中體現了這一點。

And of course, in the Express Scripts Pharmacy Benefit Services business, we continue to drive superior net cost outcomes for our clients, which allows us to retain and win not only employer but also health plan and government clients in this business.

當然，在快速藥方藥局福利服務業務中，我們繼續為客戶實現卓越的淨成本結果，這使我們能夠不僅留住和贏得雇主，而且還能留住和贏得健康計劃和政府客戶。

And as we look at the composition of cost for an average employer, about 20% of the average employer health care spend is now in specialty when you combine what's covered under the prescription and the medical benefits. And our Accredo Specialty Pharmacy Business is very well positioned to address this need and to deliver strong cost and clinical outcomes.

當我們查看普通雇主的成本組成時，如果將處方和醫療福利所涵蓋的費用加在一起，則大約有 20% 的普通雇主醫療保健支出用於專科治療。我們的 Accredo 專業藥局業務非常適合滿足這項需求，並提供強大的成本和臨床結果。

And finally, we continue to see interest in more precise and personalized solutions, both in the form of network configurations as well as clinical programs. So some of our solutions to address this need on the network side include the Pathwell Specialty offering as well as our Pathwell Bone and Joint program.

最後，我們繼續看到人們對更精確和個人化解決方案的興趣，包括網路配置和臨床計劃的形式。因此，我們在網路方面滿足這一需求的一些解決方案包括 Pathwell Specialty 產品以及 Pathwell Bone and Joint 計劃。

And on the clinical side, personalized programs are increasingly being demanded. And we're meeting that need with programs like the EnReach GLP-1 clinical support program that I described earlier.

在臨床方面，對個人化治療方案的需求日益增加。我們透過我之前描述的 EnReach GLP-1 臨床支援計劃等項目來滿足這項需求。

And finally, while we don't really typically talk about our Accredo specialty pharmacy in the context of the selling season, our patient base within Accredo continues to grow through a combination of Accredo being added as a network option and other companies' PBMs. Growth in our Express Scripts business, which leads to more Accredo patients and more existing Cigna Healthcare patients being prescribed specialty drugs.

最後，雖然我們通常不會在銷售季節的背景下談論我們的 Accredo 專業藥房，但透過結合添加 Accredo 作為網路選項和其他公司的 PBM，Accredo 內的患者群仍在繼續增長。我們的 Express Scripts 業務成長，為更多的 Accredo 患者和更多的現有 Cigna Healthcare 患者開出專科藥物。

The second part of your question was more around the Select segment under 500, the strong growth we have posted year-to-date of 9% customer growth year-over-year. I would say our solutions broadly are attractive to those employers because we have a funding agnostic approach that we use in terms of how we go to market, meaning if a client wants a fully insured offering, we'll offer them to fully insured offering.

您問題的第二部分更多地涉及 500 人以下的 Select 細分市場，今年迄今為止，我們的客戶數量同比增長了 9%，增長勢頭強勁。我想說我們的解決方案對這些雇主來說具有廣泛的吸引力，因為我們在進入市場方面採用了一種與資金無關的方法，這意味著如果客戶想要完全保險的產品，我們就會向他們提供完全保險的產品。

If they would prefer a self-funded or what we call level-funded where ASO with stop loss. That's also on the table for any employer that engages with us. So I think the consultative model has allowed us to be a net share taker in addition to the affordability improvements that we've made over time, independent of the economic environment, that go-to-market strategy has proven beneficial to us.

如果他們更喜歡自籌資金或我們所說的水平資助，其中 ASO 具有止損功能。任何與我們合作的雇主都可以享受這項福利。因此，我認為，除了我們隨著時間的推移而實現的可負擔性改進之外，諮詢模式還使我們成為淨市場份額的獲取者，不受經濟環境的影響，這種市場進入策略已被證明對我們有利。

So I don't necessarily correlate the current economic uncertainty with the growth we've experienced, but we're pleased with the results we put up. Thanks for the question.

因此，我並不一定將當前的經濟不確定性與我們所經歷的成長聯繫起來，但我們對所取得的成果感到滿意。謝謝你的提問。

Justin Lake, Wolfe Research.

賈斯汀·萊克，沃爾夫研究公司。

I wanted to follow up on the stop loss discussion. I was hoping you might be able to give us a little more detail in terms of what you're seeing in terms of cost trend in your commercial book, but specifically in the stop loss business relative to what you saw kind of pressure you in the fourth quarter?

我想跟進有關止損的討論。我希望您能向我們提供更多細節，說明您在商業帳簿上看到的成本趨勢，特別是止損業務相對於您在第四季度看到的壓力如何？

And then any early kind of feedback from the customer community as you're starting to work on getting that book reprice for 2026? I know you're trying to target getting it fully back in terms of the margin that you lost last year, but you guide it to something a little bit less than that. Curious how you're seeing that kind of run through.

那麼，當您開始著手為 2026 年的書籍重新定價時，客戶社群是否提供了任何早期回饋？我知道您的目標是完全收回去年損失的利潤，但您設定的目標比這個少一些。好奇你是如何看到這種情況的。

Justin, good morning. It's David. Let me ask Brian to start with the marketplace. Our rate execution, continue working with our clients, et cetera. And Ann will pick up from the talk about the performance we saw in the first quarter to bridge a part of your -- latter part of your comment, our plan and expectations to recoup the margin through the '25 and '26 season.

賈斯汀，早安。是戴維。讓我請布萊恩先從市場開始。我們的費率執行，繼續與我們的客戶合作等等。安將從我們在第一季看到的表現開始，來銜接您評論的後半部分，以及我們在 25 和 26 賽季收回利潤的計劃和期望。

So over the two-year horizon, profitable book of business, less profitable than it's historically been, we'll recoup throughout the course of this year, largely in the second half. and then recoup further in 2026.

因此，在兩年的時間裡，雖然獲利情況比歷史上要低，但我們將在今年全年收回成本，主要是在下半年，然後在 2026 年進一步收回成本。

Brian, can I ask you talk about the selling season and the clients' reactions?

布萊恩，我可以請您談談銷售季節和客戶的反應嗎？

Sure, David. Good morning. Justin. So the headline I'd ask you to take away is that we're tracking to the stop loss margin improvement plan that we outlined during the fourth quarter call. Now kind of stepping back from that, our stop loss offerings are an important part of our US Employer portfolio within Cigna Healthcare.

當然，大衛。早安.賈斯汀。因此，我想請大家記住的是，我們正在追蹤我們在第四季度電話會議上概述的止損保證金改善計劃。現在退一步來說，我們的停損產品是我們 Cigna Healthcare 旗下美國雇主投資組合的重要組成部分。

They work in complement with our other products and solutions for the employers who choose to employ a self-funding or ASO style relationship with us. And the stop loss products provide employers with budgetary protection against unexpected large claim activity or aggregate cost levels being unexpectedly high.

對於選擇與我們建立自籌資金或 ASO 式關係的雇主來說，它們與我們的其他產品和解決方案相輔相成。止損產品為雇主提供了預算保護，以防意外的大額索賠活動或總成本水準意外升高。

And all of the stop loss business that we write is through an integrated offering with the employer where we also administer their overall medical benefits, and we continue to see very strong market demand for these solutions. And we are the industry leader in this space.

我們開展的所有停損業務都是透過與雇主的綜合服務實現的，我們也管理他們的整體醫療福利，並且我們繼續看到市場對這些解決方案的強勁需求。我們是該領域的行業領導者。

Now as we noted in our fourth quarter call, we are working to improve the margin profile in this business over the course of the next two renewal cycles, as David indicated, and we're confident in our ability to deliver against this.

正如我們在第四季度電話會議上指出的那樣，正如大衛所指出的，我們正在努力在接下來的兩個更新周期內改善該業務的利潤率狀況，我們有信心實現這一目標。

Now over the past few months, we've been able to make progress on this plan, specifically by incorporating the revised cost structure in our later 2025 client renewals, and we've been able to execute this while preserving our typical client retention levels. So overall, the year-to-date ‘25 performance is tracking to the expectations that we had outlined for you during the fourth quarter call.

在過去的幾個月裡，我們已經能夠在該計劃上取得進展，特別是透過將修改後的成本結構納入我們 2025 年後期的客戶續約中，並且我們能夠在保持我們典型的客戶保留水平的同時執行該計劃。因此總體而言，今年迄今的 25 年業績符合我們在第四季度電話會議上為您概述的預期。

Ann, I'll turn it over to you if you want to elaborate on what we're seeing in the first-quarter financials and the outlook specifically.

安，如果您想詳細說明我們在第一季的財務狀況和前景中看到的情況，我會把它交給您。

Sure. Thanks, Brian. So we'll start maybe first with trend utilization, what we're seeing more broadly. And then talk about stop loss, specifically how the first quarter has played out. So heading into 2025, we expected the trend to remain elevated. In the first quarter, trends remained elevated in most categories consistent with what we expected. So we continue to see elevation in the specialty and behavioral categories.

當然。謝謝，布萊恩。因此，我們首先會從趨勢利用率開始，也就是我們所看到的更廣泛的趨勢利用率。然後談談止損，特別是第一季的情況。因此，我們預計到 2025 年這一趨勢仍將保持在高位。第一季度，大多數類別的趨勢仍保持上升趨勢，與我們的預期一致。因此，我們繼續看到專業和行為類別的提升。

But as I mentioned in my prepared remarks, we did see some moderation in surgical activity and OB services. But given its early in the year, we've prudently maintained our MCR assumptions for the full year.

但正如我在準備好的發言中提到的那樣，我們確實看到外科手術活動和婦產科服務有所緩和。但考慮到今年還處於初期階段，我們謹慎地維持了全年的 MCR 假設。

Now specifically for stop loss. As a reminder, we've assumed a higher stop loss MCR for this year versus last year, consistent with what we said coming out of the fourth quarter. stop loss is a cumulative product, and we are still very early in the year.

現在專門針對停損。提醒一下，我們假設今年的停損 MCR 會比去年更高，這與我們在第四季所說的一致。停損是一種累積產品，而我們今年還處於初期階段。

The first quarter stop loss MCR reflects our expectation for the full year. So thus far, things are tracking to expectations based on the early indicators that we're monitoring that measure the performance of the business. So taken all together, as Brian said, performance is in line with our expectations for the stop loss book.

第一季的止損MCR反映了我們對全年的預期。到目前為止，根據我們監測的衡量業務績效的早期指標，事情正在按照預期進行。所以總的來說，正如布萊恩所說，業績符合我們對停損帳簿的預期。

Charles Rhyee, TD Cowen.

查爾斯·瑞伊（Charles Rhyee），考恩（Cowen）TD。

Just wanted to follow up maybe on Arkansas for a second. What is the recourse for companies like Cigna and other companies that operate both PBMs and pharmacies in this case maybe mail order specialty pharmacy because I think, obviously, the bigger question is perceptions of potential conflicts of interest of having these kind of entities joined together, and obviously there's a lot of different proposals, both in Congress and across many states, trying to address this through things like greater transparency.

我只是想稍微跟進一下阿肯色州的情況。對於像 Cigna 這樣的公司以及其他同時經營 PBM 和藥局的公司來說，在這種情況下，他們能採取什麼補救措施？也許是郵購專業藥局，因為我認為，顯然，更大的問題是人們對這類實體合併在一起可能產生的利益衝突的看法，而且顯然國會和許多州都提出了許多不同的提案，試圖透過提高透明度等方式來解決這個問題。

And I appreciate that you guys have been moving forward in trying to provide greater transparency, but what in your view are some of the more simple steps that could be done to maybe assuage some of these concerns about potential conflicts of interest that doesn't have to go all the way to what Arkansas has tried to do here? And then if I could just quickly add also if Quallent has launched biosimilar STELARA would be great. Thanks.

我很欣賞你們在努力提供更大透明度方面所取得的進展，但您認為可以採取哪些更簡單的措施來緩解對潛在利益衝突的擔憂，而不必像阿肯色州在這裡嘗試做的那樣？然後，如果我可以快速補充一下，如果 Quallent 推出了生物相似藥 STELARA，那就太好了。謝謝。

Good morning, Charles, it's David. I'm going to give you a directional tone to your question because I'm not trying to give you the specifics you may be looking for.

早安，查爾斯，我是大衛。我將對您的問題給出一個定向的語氣，因為我並不是試圖向您提供您可能正在尋找的具體資訊。

First, as I mentioned to Lisa's question, we fundamentally think the bill is a flawed posture. The value creation is indisputable of what is being able to be delivered and supported and actually bridged your last comment and work my way back. If you think about the biosimilar success in terms of the interchangeable that we've been able to launch and bring to market for HUMIRA, that is enabled by the breadth of our portfolio and the breadth of our capabilities.

首先，正如我在回答麗莎的問題時提到的那樣，我們從根本上認為該法案是一種有缺陷的姿態。價值創造是無可爭議的，它能夠被交付和支持，並且實際上彌合了你最後的評論並讓我回到正軌。如果您從我們能夠推出並推向市場的 HUMIRA 可互換性角度來考慮生物仿製藥的成功，那麼這是得益於我們廣泛的產品組合和廣泛的能力。

It's been able to harness those the result of which is significant savings for employers, health plans or government latency clients in $0 out-of-pocket for a consumer. It's indisputable.

它能夠利用這些優勢，為雇主、健康計劃或政府延遲客戶節省大量開支，消費者無需自掏腰包支付任何費用。這是無可爭辯的。

Secondly, as an example, the capabilities Brian walked through around our GLP-1 innovations, they are expressly enabled by harnessing the breadth of capabilities across our portfolio as opposed to dismantling those capabilities. So fundamentally, we disagree with the core tenant. Now to your point, what can be done?

其次，舉例來說，Brian 圍繞著我們的 GLP-1 創新所介紹的功能，是透過利用我們產品組合中的廣泛功能（而不是拆除這些功能）而明確實現的。所以從根本上來說，我們不同意核心觀點。現在回到你的觀點，我們可以做些什麼呢？

Fact-based engagement relative to what the problem statement is how the marketplace works and how ongoing innovation is being brought to market. Second, further amplifying and activating clients' voice relative to maintaining choice as opposed to structurally removing choice. Third, as you articulated, and I highlighted in my prior comments, embracing transparency; transparency is something that the marketplace has and further leans into.

與問題陳述相關的基於事實的參與是市場如何運作以及持續的創新如何被推向市場。其次，進一步擴大和啟動客戶的聲音，以保持選擇權，而不是從結構上消除選擇權。第三，正如您所闡述的，我在先前的評論中也強調過，要擁抱透明度；透明度是市場所擁有的，並且會進一步傾向的。

In fact, when we think about the pharmacy services space, you have the largest, most sophisticated buyers in the marketplace from Fortune 1,000 corporations to large diverse health plans through integrated health care delivery systems through governmental agencies themselves.

事實上，當我們考慮藥房服務領域時，你會發現市場上最大的、最成熟的買家，從財富 1,000 強企業到透過政府機構本身的綜合醫療保健提供系統的大型多元化健康計劃。

The last two comments I would make is continue to innovate -- continued innovation of our products, programs and services. And then finally, taking necessary steps from a regulatory or litigious standpoint, if we deem all else fails because we fundamentally disagree with this posture which again removes choice, arbitrarily picks winners and losers and erodes affordability, clinical quality and access for consumers.

我要說的最後兩條是繼續創新——繼續創新我們的產品、專案和服務。最後，如果我們認為所有其他方法都失敗了，因為我們從根本上不同意這種立場，這種立場再次剝奪了選擇權，任意挑選贏家和輸家，並削弱了消費者的負擔能力、臨床質量和可及性，那麼從監管或訴訟的角度採取必要的措施。

I think on the back end, you were asking a little bit about what the status of the STELARA biosimilar is. So I'll turn it to Brian and ask just him just highlight rate and pace of that other, again, very exciting evolution of our portfolio.

我認為在後端，您稍微詢問了 STELARA 生物相似藥的狀態。因此，我將把話題轉向布萊恩，請他重點介紹我們投資組合中另一個非常令人興奮的演變的速度和步伐。

Sure, David. Good morning, Charles. I don't think I have anything else to add on the Arkansas issue. But as it relates to STELARA biosimilar kind of stepping back from that, we're pleased to see the building momentum of biosimilars in the US, which really was powered forward by HUMIRA biosimilars becoming more prevalent.

當然，大衛。早上好，查爾斯。我認為關於阿肯色州問題我沒有什麼可補充的。但就 STELARA 生物相似藥而言，我們很高興看到美國生物相似藥的發展勢頭強勁，而 HUMIRA 生物相似藥的普及確實推動了這一進程。

And as a reminder, this is just the start of a multiyear wave that's coming here for US-based biosimilars. And beyond HUMIRA, we expect another $100 billion of specialty drug spend to be subject to competition for biosimilars and generics by 2030, which represents a tremendous opportunity to reduce net costs for patients and clients.

需要提醒的是，這只是美國生物相似藥多年熱潮的開始。除了 HUMIRA 之外，我們預計到 2030 年，另外 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，這為降低患者和客戶的淨成本提供了巨大的機會。

As I mentioned earlier, we'll have a $0 patient out-of-pocket biosimilar option available for STELARA starting this month, and that leverages the learnings that we had from the HUMIRA biosimilar that we launched last year.

正如我之前提到的，從本月開始，我們將為 STELARA 提供 0 美元的患者自付生物仿製藥選項，這利用了我們從去年推出的 HUMIRA 生物仿製藥中獲得的經驗。

Now importantly, each biosimilar will have different rates of adoption based upon factors such as interchangeability, dosage levels, branded alternatives and other dimensions. But that said, we do expect to see gradual growth in STELARA biosimilars over the balance of the year in our Evernorth outlook contemplates this, and we'd expect to further step up in 2026. Thanks for the question.

現在重要的是，每種生物相似藥的採用率都會有所不同，這取決於可互換性、劑量水平、品牌替代品和其他方面等因素。但話雖如此，我們確實預計 STELARA 生物仿製藥將在今年剩餘時間內逐步增長，我們的 Evernorth 展望也考慮到了這一點，並且我們預計 2026 年將進一步增長。謝謝你的提問。

Ann Hynes, Mizuho Securities.

瑞穗證券的安‧海因斯 (Ann Hynes)。

Just on the capital deployment front. I know you've said in the past that bolt-on M&A is your priority. Is that still the case? And on that front, is there any capability that you think you need either in the health insurance segment or Evernorth that you need to that you need to invest into organically or inorganically?

僅在資本部署方面。我知道您過去曾說過，附加併購是您的首要任務。現在還是這樣嗎？在這方面，您認為在健康保險領域或 Evernorth 方面您需要哪些能力，需要以有機或無機的方式進行投資嗎？

It's David. There's two dimensions to your question. One is our capital deployment strategy and specifically within the M&A dimension that comes along with it. Specific to our capital deployment strategy, that remains consistent.

是戴維。您的問題涉及兩個方面。一是我們的資本配置策略，特別是隨之而來的併購維度。具體到我們的資本配置策略，這一點保持一致。

Priority one, support the ongoing growth of the business; priority two, prudent deployment of capital for CapEx and innovation; priority three, return excess capital to shareholders and/or pursue attractive M&A, which I'll come back to in a moment relative to those criteria. As it relates to our actions, as you see, we've been meaningfully returning excess capital to shareholders through repurchase as well as an attractive dividend that we just recently raised again.

優先事項一，支持業務的持續成長；優先事項二，審慎部署資本支出和創新資金；優先事項三，將過剩資本返還給股東和/或進行有吸引力的併購，稍後我將結合這些標準再次討論這個問題。就我們的行動而言，如您所見，我們一直在透過回購以及最近再次提高的誘人股息向股東返還多餘的資本。

Now specific to M&A, our priorities remain consistent. We look for opportunities that are strategically attractive assets. Second, assets that are financially attractive. So within that, we see durable synergies that would inure back to us as we would be able to execute. And then certainty in terms of being able to close the asset.

現在具體到併購，我們的優先事項保持一致。我們尋找具有策略吸引力的資產機會。第二，具有財務吸引力的資產。因此，我們看到了持久的協同效應，當我們能夠執行時，它將為我們帶來回報。然後確定能夠關閉資產。

As an organization, we've been oriented around bolt-on acquisitions. We typically use that terminology with our size and scale to connote acquisitions up to single-digit billions of dollars. So that gives you an idea of size and scale. And we don't identify and we haven't highlighted any specific category or capability.

作為一個組織，我們一直致力於附加收購。我們通常使用該術語來表示我們的規模和範圍，即價值高達數十億美元的收購。這樣您就可以了解尺寸和規模。我們沒有確定也沒有強調任何特定的類別或能力。

I think the last piece may be inferred in your comment is do we believe we have to add on any capabilities. I would say relative to that, answer is no. We feel very good about our business portfolio and the positioning we've been quite deliberate to position our business portfolio.

我認為您評論中的最後一點可以推斷我們是否認為我們必須增加任何能力。我想說，相對於這一點，答案是否定的。我們對我們的業務組合和定位感到非常滿意，我們非常謹慎地定位我們的業務組合。

And as we stand today, we have a high-performing modular services portfolio through Evernorth and we have a high-performing integrated benefits portfolio that addresses both US and non-US opportunities through Cigna Healthcare, and our track record is quite clear relative to its ongoing growth.

就目前情況而言，我們透過 Evernorth 擁有高性能模組化服務組合，並透過 Cigna Healthcare 擁有高性能綜合福利組合，可滿足美國和非美國市場的需求，而且相對於其持續增長，我們的業績記錄非常清晰。

Final comment I would make is we've been quite deliberate in terms of ensuring that we're well positioned into a variety of addressable markets from the individual market through employers, health plans, governmental agencies and increasingly integrated delivery systems and multispecialty physician groups with our broad portfolio of services. So capital deployment strategy is consistent. M&A priority is consistent, focused on bolt-ons where they make strategic financial and clarity of closing. Thanks for your question.

我最後要說的是，我們一直非常謹慎地確保我們能夠在從個人市場到雇主、健康計劃、政府機構以及日益整合的服務交付系統和多專業醫生團體等各種可尋址市場中佔據有利地位，並提供廣泛的服務組合。所以資本配置策略是一致的。併購的重點是一致的，重點是附加項目，以實現策略財務和交易的明確性。謝謝你的提問。

Andrew Mok, Barclays.

巴克萊銀行的 Andrew Mok。

As the Part D market evolves alongside the IRA, curious to hear what your experience has been on the Evernorth side of the business. Can you comment on any manufacturer or member behavior changes that you're seeing in the market? And relatedly, are you seeing a pickup in specialty or high-cost brand scripts from the Part D program that were previously served directly through a patient assistance program?

隨著 D 部分市場與 IRA 一起發展，我很好奇想聽聽您在 Evernorth 業務方面的經歷。您能否評論一下您在市場上看到的任何製造商或會員行為變化？與此相關的是，您是否看到 D 部分計劃中的專科或高成本品牌處方有所增加，而這些處方以前是透過患者援助計劃直接提供的？

Morning, Andrew, it's Brian. So I'll try to take both parts of your question there. So as you know, we've spoken a number of times about drug innovation being an emerging trend in health care which is poised to continue to at least the end of the decade.

早安，安德魯，我是布萊恩。因此，我會嘗試回答您問題的兩個部分。如你所知，我們已經多次談到藥物創新是醫療保健領域的新興趨勢，而這種趨勢至少會持續到本世紀末。

In the specialty drug space, to the core of your question, this is already a $400 billion addressable market with high single-digit secular growth moving forward. And within that specialty drug space, we are the leader in this clinically intensive business, which positions us uniquely to create value for the patients that we serve.

在特種藥物領域，對於您問題的核心而言，這已經是一個價值 4000 億美元的潛在市場，並且未來將保持高個位數的長期成長率。在特種藥物領域，我們是臨床密集型業務的領導者，這使我們能夠為我們服務的患者創造價值。

Now those dynamics certainly transpired during the first quarter. So when you think about our 19% growth in the Specialty and Care Services business, that was powered by all of the themes I just made reference to.

這些動態確實在第一季發生了。因此，當您想到我們的專業和護理服務業務實現了 19% 的增長時，您就會明白這是由我剛才提到的所有主題推動的。

And in the quarter, our Evernorth specialty script volumes, they were up mid-teens. And the most notable growth within that was in our Medicare book of business, which showed a considerably higher rate of growth in comparison to the commercial employer or the Medicaid books of business.

本季度，我們的 Evernorth 專業劇本數量增加了十幾倍。其中最顯著的成長是我們的醫療保險業務，與商業雇主或醫療補助業務相比，其成長率相當高。

Now it's not 100% clear to us whether some of that Medicare growth was specifically induced by the IRA via the lower out-of-pocket maximums for the Medicare Part D plans or by pharmaceutical manufacturers ramping up their marketing to prescribers.

現在我們還不能完全確定，醫療保險的增長是否是由 IRA 通過降低醫療保險 D 部分計劃的自付費用最高限額而具體引起的，還是由製藥商加大對處方者的營銷而引起的。

But what is clear to us is that there's been a structural shift in the US health care space toward more complex clinically intensive specialty medications. In our Evernorth Specialty and Care Services business is a clear beneficiary of this substantial growth in specialty drug utilization. And you saw this again in the strong first quarter results, along with our long-term average annual income growth expectation of 8% to 12% for this high-growth part of the health care system. Thanks for the question.

但我們清楚的是，美國醫療保健領域已經發生了結構性轉變，轉向更複雜的臨床密集專科藥物。我們的 Evernorth 專業和護理服務業務顯然受益於專業藥物使用量的大幅成長。在第一季的強勁業績中，您再次看到了這一點，同時我們對醫療保健系統這一高成長部分的長期平均年收入成長預期為 8% 至 12%。謝謝你的提問。

Erin Wright, Morgan Stanley.

摩根士丹利的艾琳·賴特。

Could you describe a little bit more about EnReach as well as the EnGuide pharmacy rollout and what these initiatives entail and the economics for Cigna? And just on the GLP-1 strategy, the category is unique, but what are the tools -- or how are the tools different compared to what was deployed across historically PCSK9s, Hep C? I guess, how do you compare? Or how is this different in terms of the strategy to address drug cost and across your customer base?

您能否詳細介紹 EnReach 以及 EnGuide 藥局的推出情況，以及這些舉措的含義以及對 Cigna 的財務影響？就 GLP-1 策略而言，該類別是獨一無二的，但工具是什麼 - 或者與歷史上 PCSK9、丙型肝炎所部署的工具相比，這些工具有何不同？我猜，你怎麼比較？或者，從解決藥品成本的策略以及針對整個客戶群而言，這有何不同？

It's Brian. I'll try to take those different components here. So as I made reference to earlier, we're proud to take a leadership role here around GLP-1s, which is we all can appreciate. This is an impact that impacts many dimensions of our society and GLP-1s really are a microcosm of the broader wave of drug innovation that's transpiring that I just made reference to in Andrew's question.

我是布萊恩。我將嘗試在這裡採用這些不同的組件。正如我之前提到的，我們很自豪能夠在 GLP-1 領域發揮領導作用，這是我們所有人都非常感激的。這種影響會影響我們社會的方方面面，而 GLP-1 實際上是正在發生的更廣泛的藥物創新浪潮的縮影，正如我在安德魯的問題中提到的那樣。

So when we step back from this, we saw an opportunity to create new value in the GLP-1 space through the combination of addressing access, affordability, clinical safety, and longer-term lifestyle changes. And as it relates to our Encircle, EnReach, and EnGuide suite, maybe I'll just spend a moment talking about the market needs that are underneath those themes that I just made reference to.

因此，當我們退一步思考時，我們看到了透過解決可近性、可負擔性、臨床安全性和長期生活方式改變等問題，在 GLP-1 領域創造新價值的機會。由於它與我們的 Encircle、EnReach 和 EnGuide 套件相關，也許我會花一點時間談談我剛才提到的那些主題背後的市場需求。

So many of our employer clients, they've indicated the desire to offer GLP-1 coverage for weight management, but those employers are concerned about the cost and safety impact of unfettered access to the drugs. And as time unfolded, we also saw that adherence to the drug was mixed with people starting and stopping and many patients were concerned about access disruptions.

我們的許多雇主客戶都表示希望提供 GLP-1 覆蓋體重管理，但這些雇主擔心不受限制地獲取藥物的成本和安全影響。隨著時間的推移，我們也發現，人們開始和停止服藥的依從性參差不齊，許多患者擔心服藥中斷。

So those dynamics were leading to some patients stockpiling their GLP-1’s, some others were resorting to micro dosing. All of those things can distort the clinical effectiveness of the drugs and an additional market dynamic that we saw was pharmacies were reluctant to dispense the drugs because of their own economics, which exacerbated some of the concerns about access to the drugs.

因此，這些動態導致一些患者囤積 GLP-1，而另一些患者則採用微劑量給藥。所有這些因素都可能扭曲藥物的臨床效果，我們看到的另一個市場動態是藥局由於自身的經濟原因不願意配發藥物，這加劇了人們對獲得藥物的擔憂。

So we introduced EncircleRx in early 2024 as a mechanism to provide some budget certainty for employers along with addressing patient safety and supply concerns. And there's been really strong demand from our employer base here. We now have 9 million people eligible for the program.

因此，我們在 2024 年初推出了 EncircleRx，作為一種機制，為雇主提供一定的預算確定性，同時解決病人安全和供應問題。我們這裡的雇主群體的需求確實很強烈。目前我們有 900 萬人符合該計劃的資格。

And we built upon this year through the introduction of the EnReach solution that I made reference to. You can think about this as an enhanced clinical support and reimbursement stability model for participating pharmacies. So think about a curated network high-touch clinical support for patients. And importantly, the clinical support includes things like dose optimization, patient education, fraud waste and abuse monitoring.

今年，我們透過引入我提到的 EnReach 解決方案取得了進一步進展。您可以將其視為參與藥局的增強臨床支援和報銷穩定模型。因此，請考慮為患者提供精心策劃的網路高接觸臨床支援。重要的是，臨床支援包括劑量優化、病患教育、詐欺浪費和濫用監控等內容。

And in conjunction with that program is our EnGuide solution, which is our specialized home delivery GLP-1 pharmacy for those patients who prefer to have the drugs delivered directly to their homes. So taken all together, the suite of EncircleRx and EnReach, and EnGuide. It's meant to address these societal challenges of access, affordability, clinical safety as well as longer-term lifestyle changes.

與該計劃相結合的是我們的 EnGuide 解決方案，這是我們專門為那些喜歡將藥物直接送到家中的患者提供的送貨上門 GLP-1 藥房。總的來說，EncircleRx、EnReach 和 EnGuide 套件。其目的是解決醫療可近性、可負擔性、臨床安全以及長期生活方式改變等社會挑戰。

Now the financial contribution to that part of the question, you should think of this as certainly embedded in our Evernorth outlook for the year. One of many things that contributes to the overall P&L. But importantly, the steps we took here were meant to address those societal needs around this important drug class.

現在，對於該部分問題的財務貢獻，您應該認為這肯定已經融入了我們對 Evernorth 年度的展望中。影響整體損益的眾多因素之一。但重要的是，我們在此採取的措施是為了滿足圍繞這一重要藥物類別的社會需求。

Josh Raskin, Nephron Research.

Josh Raskin，Nephron Research。

Just quick clarification. What percentage of your Select segment actually takes stop loss with the ASO versus a full risk solution. And then my bigger question is just in the past, you've spoken about the disrupted environment for Medicare Advantage. And I'd be curious to get your thoughts on the segment currently and perhaps how the 2026 rate notice is impacting your forward view with an understanding, obviously, that you're no longer in the business as of 1.5 months ago.

只是快速澄清一下。與全風險解決方案相比，您的 Select 細分市場中有多少比例實際上會透過 ASO 來止損。然後我更大的問題是，就在過去，您談到了醫療保險優勢計劃 (Medicare Advantage) 的混亂環境。我很好奇地想了解您對目前該領域的看法，以及 2026 年利率通知將如何影響您的前瞻性觀點，顯然，您從 1.5 個月前就不再從事該業務了。

Hi, Josh. I'll take the first part of the question and David will take the second. So as it relates to the Select segment and the funding mix, as I made reference to an earlier question, we're agnostic, so employers can choose which model they like.

你好，喬希。我來回答問題的第一部分，大衛來回答第二部分。因此，就選擇部分和資金組合而言，正如我之前提到的問題，我們是不可知論者，因此雇主可以選擇他們喜歡的模式。

And amongst the 3 million or so clients that we have there, you can think of it as a little bit over half and fully insured and a little bit under half in an ASO and those that pick up ASO or self-funded, potentially 100% of them are buying a stop loss protection around that because given the size of their respective employee base, they need the budgetary protection and certainty that comes with our stop loss offerings, whether that be individual or aggregate.

在我們擁有的 300 萬左右的客戶中，您可以認為一半多一點的客戶已經完全投保，而一半以下的客戶則購買了 ASO，而那些選擇 ASO 或自籌資金的客戶，可能 100% 的客戶都在購買止損保護，因為考慮到他們各自的員工基礎規模，他們需要我們的止損產品帶來的集體保護和確定性，無論是止損性。

David, do you want to take the second part of Josh's question?

大衛，你想回答喬希問題的第二部分嗎？

Sure, Josh. Good morning. As you noted, we exited the space at the first quarter, I think broadly, you're asking our point of view relative to where the space is and where it's going. First and foremost, I said multiple times, we believe in the importance of strength of an overall value of the MA offering in the marketplace but you continue to expect? that. The growth there has been sizable?. Therefore, the value seniors see is quite significant.

當然，喬希。早安.正如您所說，我們在第一季就退出了該領域，我認為從廣義上講，您是在詢問我們對該領域的現狀和發展方向的看法。首先，我多次說過，我們相信 MA 產品在市場上的整體價值實力的重要性，但您仍然期望嗎？那。那裡的增長相當可觀。因此，老年人看到的價值是相當可觀的。

Secondly, on average, lower average income levels for individuals who are buying that, meaning price sensitivity, yet higher value and greater clinical coordination across the players that exist.

其次，平均而言，購買該產品的個人的平均收入水平較低，這意味著價格敏感度較高，但價值較高，現有參與者之間的臨床協調性也較好。

Now importantly, before I specifically comment on the rating environment you're asking about, we serve a meaningful number of Medicare Advantage customers, whether it's through MA, MA-PDP, stand-alone PDP duals or otherwise through our broad portfolio of Evernorth services in direct service of other health plans as well as Brian referenced, the breadth of what Accredo provides day and day out.

現在重要的是，在我具體評論您所詢問的評級環境之前，我們為大量的 Medicare Advantage 客戶提供服務，無論是透過 MA、MA-PDP、獨立 PDP 雙保險，還是透過我們廣泛的 Evernorth 服務組合直接為其他健康計劃提供服務，以及 Brian 提到的 Accredo 每天提供的廣泛服務。

So now bridging back to the last part of your question, the overall rate environment obviously is strained. The V-28 phase-in environment is causing strain to some of the ecosystems to try to get the right symmetry between benefit offering and pricing.

現在回到你問題的最後一部分，整體利率環境顯然緊張。V-28 的逐步實施環境給一些生態系統帶來了壓力，迫使它們試圖在福利提供和定價之間取得正確的對稱性。

What we see in that, my last comment would be those that are in the marketplace are even pressing more for value and affordability and some of the innovations we bring are directly responsive in support of our health planning clients of today to help them have the value of the clinical continuity in support of STARS as well as the overall affordability and value that's going to be necessary on a go-forward basis.

我們看到，我最後的評論是，市場上的人們更加追求價值和可負擔性，我們帶來的一些創新直接響應了我們今天的健康計劃客戶，幫助他們獲得支持 STARS 的臨床連續性的價值以及未來所必需的整體可負擔性和價值。

Josh, thanks for the question.

喬希，謝謝你的提問。

George Hill, Deutsche Bank.

德意志銀行的喬治·希爾。

Kind of just two housekeeping questions. Ann, on the 100 basis points, it was the -- in MLR that was the contribution from the M&A business. I guess can you say whether that carrying of that business a net drag on earnings in the quarter?

這只是兩個普通問題。安，以 100 個基點計算，MLR 中的貢獻來自於併購業務。我想您能否說一下這項業務是否會對本季的收益造成淨拖累？

And can you kind of quantify what the net drag or the net contribution was in the quarter? And then I also thought for the guidance for fiscal '25 that you guys had some degree of what I'll call a recession assumption in the numbers. And I'd like to just -- like kind of your updated comments around how you're thinking about that.

您能否量化本季的淨拖累或淨貢獻是多少？然後，我還認為，對於 25 財年的指導，你們在數字中存在一定程度的我稱之為衰退假設的情況。我只是想——聽聽您關於如何看待這個問題的最新評論。

Great. Thanks for the question. I'll take the first part of the question and turn it over to David for the second part. On the Medicare business, as I said in my prepared remarks, that extra month increased our MCR by 100 bps as the Medicare business ran at a higher medical care ratio. The impact on earnings was marginal, I think, less than $20 million. The favorability really came from our ongoing businesses. And we saw favorability both in earnings and embedded in the MCR for the ongoing businesses.

偉大的。謝謝你的提問。我將回答問題的第一部分，然後交給大衛回答第二部分。關於醫療保險業務，正如我在準備好的發言中所說，由於醫療保險業務的醫療保健比率更高，額外的一個月使我們的 MCR 增加了 100 個基點。我認為，對收益的影響很小，不到 2000 萬美元。這種好感確實來自於我們正在進行的業務。我們看到，對於正在運營的業務而言，其盈利和 MCR 都表現良好。

So picking up before we go to the economy, the net effect of that would be the ongoing businesses in Cigna Healthcare. Think about the MCR at about 80, absent the impact of the Medicare Advantage component and the approximately $20 million or a little less than $20 million is the result of having that business for about a month longer than we had anticipated, as Ann referenced in the planning assumption.

因此，在我們進入經濟之前，其淨效應將是 Cigna Healthcare 的持續業務。想像 MCR 約為 80，沒有醫療保險優勢部分的影響，大約 2000 萬美元或略低於 2000 萬美元是由於該業務比我們預期的時間長了大約一個月，正如 Ann 在規劃假設中提到的那樣。

I think to the last part of your question was oriented around the guide, what it assumes in the economy. Broadly speaking, as we stepped into the year, we recognized the fact that the year was going to be another dynamic year. The economy is a bit uncertain and a bit less stable. Stepping back in the current environment, we do not see dislocation in terms of our broader client portfolio, the overall enrollment levels remain relatively consistent employment levels.

我認為你問題的最後一部分是圍繞著指南展開的，它對經濟做了什麼假設。總體而言，當我們步入新的一年時，我們認識到這一年將是充滿活力的一年。經濟有點不確定，也不太穩定。回顧當前環境，我們並未看到更廣泛的客戶組合出現錯位，整體入學水準保持相對穩定的就業水準。

There's ebbs and flows, of course, in terms of some of the headlines. But point one is, thus far through Q1, we see the economy holding up in terms of the nature in which it supports our portfolio. Two, we believe our full year outlook contemplates and the ranges, importantly, contemplate the dynamism of the market.

當然，就一些頭條新聞而言，存在著起伏。但第一點是，到目前為止，透過第一季度，我們看到經濟在支持我們投資組合的性質方面保持穩定。其次，我們相信，我們的全年展望考慮到了市場活力，更重要的是，考慮到了市場範圍。

And as Ann mentioned both in our prepared remarks and previously, we believe that it's prudent to maintain our planning assumptions. Even though we had strength across the board in the first quarter of the year.

正如安在我們準備好的發言和之前提到的那樣，我們認為維持我們的規劃假設是謹慎的。儘管我們今年第一季全面表現強勁。

So some are us relative to the economy for sure, not seeing the impact in the first quarter. We believe it's prudent at this point in time to maintain our planning assumptions. Thanks for your question.

因此，對我們來說，相對於經濟而言，肯定在第一季看不到影響。我們認為，目前維持我們的規劃假設是謹慎的。謝謝你的提問。

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

謝謝。現在，我將把電話轉給 David Cordani 做結束語。

Thank you again for joining our call. Let me just reinforce a few points. One, we're confident in our ability to deliver our increased outlook for the full year. And to do that, we remain focused on those we serve and executing with discipline while we continue to innovate.

再次感謝您參加我們的電話會議。我僅強調幾點。首先，我們有信心實現全年業績的成長。為了做到這一點，我們始終專注於我們服務的對象，嚴格執行紀律，同時不斷創新。

Second, we will continue our leadership in improving health care, including delivering on the commitments we made earlier this quarter and the five that I highlighted in my prepared remarks. And third, I want to underscore that the progress we continue to make starts with and is fueled by the dedication, passion and commitment of our coworkers around the world.

第二，我們將繼續發揮領導作用，改善醫療保健，包括履行我們本季早些時候所做的承諾以及我在準備好的發言中強調的五項承諾。第三，我想強調的是，我們不斷的進步始於並得益於世界各地同事的奉獻、熱情和承諾。

We're proud of what we've achieved, and we're excited about the opportunities in front of us. Again, thanks for joining our call today.

我們為所取得的成就感到自豪，並對我們面前的機會感到興奮。再次感謝您今天參加我們的電話會議。

Ladies and gentlemen, this concludes The Cigna Group's first-quarter 2025 results review. Cigna Investor Relations will be available to respond to additional questions shortly. A recording of this conference will be available for 10 business days following this call. You may access the recorded conference by dialing (800) 835-8067 or (203) 369-3354. There is no pass code required for this replay. Thank you for participating. We will now disconnect.

女士們、先生們，信諾集團 2025 年第一季業績回顧到此結束。Cigna 投資者關係部將很快回答您的其他問題。本次會議的錄音將在會議結束後 10 個工作天內提供。您可以撥打 (800) 835-8067 或 (203) 369-3354 存取錄製的會議。這次重播不需要密碼。感謝您的參與。我們現在將斷開連接。