信諾集團 (CI) 2025 Q4 法說會逐字稿

Ladies and gentlemen, thank you for standing by for the Cigna Group's fourth quarter 2025 results review. (Operator Instructions)

女士們、先生們，感謝各位耐心等待，我們將進行信諾集團2025年第四季業績回顧。（操作說明）

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.

提醒各位，女士們、先生們，本次會議（包括問答環節）將進行錄影。首先，我們將把會議交給拉爾夫·賈科貝。請繼續。

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

謝謝。各位早安。感謝您參加今天的電話會議。我是投資者關係高級副總裁拉爾夫·賈科貝。今天早上和我一起連線的是信諾集團董事長兼首席執行官大衛·科爾達尼；總裁兼首席營運官布萊恩·埃萬科；以及首席財務官安·丹尼森。

In our remarks today, David, Brian and Ann will cover a number of topics, including our fourth quarter and full year 2025 financial results and our financial outlook for 2026. 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 將涵蓋多個主題，包括我們 2025 年第四季和全年的財務表現以及我們對 2026 年的財務展望。在發表事先準備好的演講後，David、Brian 和 Ann 將接受問答環節。

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

正如我們在獲利報告中所述，在描述我們的財務表現時，我們使用了一些財務指標，包括調整後的營業收入和調整後的收入，這些指標並非按照美國公認會計原則（即 GAAP）確定。這些指標與最直接可比較的GAAP指標（股東淨收入和總收入）的調節表已載於今日發布的盈利報告中，該報告已發佈在cignagroup.com網站的投資者關係欄位中。我們使用「調整後營業收入」和「調整後每股盈餘」這兩個術語，其基礎與我們衡量主要財務表現的指標相同。

In our remarks today, we will be making some forward-looking statements, including statements regarding our outlook for 2026 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，我們將發表一些前瞻性聲明，包括有關我們對 2026 年的展望和未來業績的聲明。這些聲明存在風險和不確定性，可能導致實際結果與我們目前的預期有重大差異。這些風險和不確定性的描述包含在今天發布的收益報告中的警示說明以及我們最近向美國證券交易委員會提交的報告中。

Regarding our results in the fourth quarter, we recorded after-tax special item charges of $483 million or $1.82 per share. Details of the special items are included in our quarterly financial supplement. Additionally, please note that when we make prospective comments regarding financial performance, including our full year 2026 outlook, we will do so on a basis that includes the potential impact of future share repurchases and anticipated 2026 dividends.

關於我們第四季度的業績，我們提列了稅後特殊項目費用 4.83 億美元，即每股 1.82 美元。特別項目的詳情已列入我們的季度財務增刊。此外，請注意，當我們對財務表現做出預期評論時，包括我們對 2026 年全年的展望，我們將以未來股票回購和預期 2026 年股息的潛在影響為基礎。

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

接下來，我將把電話交給大衛。

Thanks, Ralph. Good morning, everyone, and thanks for joining our call. 2025 was a pivotal year for our company as we delivered new innovations for the benefit of our customers, strengthen meaningful partnerships and extended strategic client relationships.

謝謝你，拉爾夫。各位早安，感謝各位參加本次電話會議。 2025年對我們公司來說是至關重要的一年，我們推出了多項創新產品以造福客戶，加強了重要的合作關係，並拓展了策略客戶關係。

Today, I'll briefly focus my comments on delivering our financial commitments for 2025, and how we are leading through a dynamic environment by evolving and advancing our business for the benefit of our customers, clients and partners. Then Brian will provide an update on our performance and our growth platforms and perspective on the year ahead. Then Ann will review additional details on our results and our 2016 outlook, and we'll take your questions.

今天，我將簡要地重點談談我們如何履行 2025 年的財務承諾，以及我們如何在瞬息萬變的環境中不斷發展和推進業務，從而造福我們的客戶、合作夥伴和合作夥伴。然後，布萊恩將介紹我們的業績、成長平台以及對未來一年的展望。然後，Ann 將詳細介紹我們的業績和 2016 年展望，我們也會回答大家的問題。

So let's get started. In 2025, I'm pleased to report that the Cigna Group delivered full year adjusted revenue of $275 billion or 11% growth. Full year adjusted earnings per share of $29.84, a 9% increase, building on our multiyear track record of sustained earnings growth. We also took steps forward in improving our customer experience as evidenced by the increase in our customer Net Promoter Score year-over-year in each of our largest businesses.

那麼，我們就開始吧。我很高興地宣布，2025 年，信諾集團全年調整後營收達到 2,750 億美元，成長 11%。全年調整後每股收益為 29.84 美元，成長 9%，延續了我們多年來持續獲利成長的良好記錄。我們也採取了措施來改善客戶體驗，這體現在我們每個最大業務部門的客戶淨推薦值 (NPS) 都逐年提高。

At the Cigna Group, we also continue to shape our portfolio in 2025, emphasizing businesses where we see clear opportunities to generate attractive sustainable growth. For example, we further expanded our specialty capabilities to serve hospitals and health systems in part with our new investment in Field Health Solutions. And we completed the sale of Sydney Healthcare's Medicare business earlier last year.

在信諾集團，我們也將繼續調整我們在 2025 年的投資組合，重點關注那些我們看到明顯機會產生有吸引力的可持續成長的業務。例如，我們進一步拓展了專業能力，為醫院和醫療系統提供服務，部分原因是我們對現場醫療解決方案進行了新的投資。去年年初，我們完成了雪梨醫療保健公司旗下 Medicare 業務的出售。

We are well positioned to continue leading and growing in a rapidly changing environment. To that end, I want to briefly comment on our global settlement with the Federal Trade Commission announced yesterday.

我們已做好充分準備，在快速變化的環境中繼續保持領先並實現成長。為此，我想簡要評論我們昨天宣布的與聯邦貿易委員會達成的全球和解協議。

The settlement is a comprehensive resolution of all matters brought by the FTC regarding pharmacy benefits business. It includes the industry-wide insulin lawsuit and ongoing investigations. To be clear here, the beneficiary of the settlement are our customers and patients. The settlement noted $7 billion in out-of-pocket cost relief over the next 10 years for the 100 million customers and patients we serve. The savings will be delivered through lower insulin prices and reduced cost for branded medications for consumers at the pharmacy counter.

和解協議全面解決了聯邦貿易委員會就藥品福利業務提出的所有問題。其中包括針對整個行業的胰島素訴訟和正在進行的調查。需要明確的是，這次和解的受益者是我們的客戶和病人。和解協議指出，在未來 10 年內，我們服務的 1 億客戶和患者將獲得 70 億美元的自付費用減免。節省的費用將透過降低胰島素價格和減少藥房櫃檯上品牌藥品的成本來實現。

The settlement will also increase transparency for our customers and clients and strengthen our relationship further with community pharmacists. We were well positioned to execute on the terms of this settlement because of the new pharmacy benefit model that we began developing in the beginning of 2025 and announced in the third quarter of 2025.

和解協議也將提高我們客戶和顧客的透明度，並進一步加強我們與社區藥劑師的關係。由於我們在 2025 年初開始開發新的藥房福利模式，並在 2025 年第三季宣布了該模式，因此我們能夠很好地執行這項和解協議的條款。

Our new model clearly positions us to achieve this comprehensive settlement. It enhances the value we provide to customers and clients, all while we continue to strengthen our position and deliver on our long-term shareholder commitments. With the FTC matter now resolved and the additional clarity from the federal PBM reform legislation that passed earlier this week, we are squarely focused on driving affordability improvements and value for those we serve.

我們的新模式使我們能夠更有效地達成這項全面和解。它提升了我們為客戶和顧客提供的價值，同時我們也持續鞏固自身地位，並履行對股東的長期承諾。隨著 FTC 事件的解決以及本週早些時候通過的聯邦 PBM 改革立法帶來的更多明確性，我們正全力以赴地提高我們所服務人群的負擔能力和價值。

We know healthcare affordability impacts everyone from individuals and families to employers and governmental organizations. At the Cigna Group, we are steadfast in our focus on leaning into lower healthcare costs and expanding access to quality care and medications, but doing so requires confronting the underlying cost drivers, including both the demand and the supply side.

我們知道，醫療保健的負擔能力會影響到每個人，從個人和家庭到雇主和政府組織。在信諾集團，我們始終致力於降低醫療保健成本，擴大優質照護和藥品的取得途徑，但要做到這一點，就需要解決根本的成本驅動因素，包括需求面和供應面。

Demand for healthcare in the United States is growing rapidly. Our population is aging and chronic conditions are increasing. Today, chronic disease and mental health conditions account for roughly 90% of total health care spending. Together, these forces drive heightened demand for health care services and as such increased costs.

美國對醫療保健的需求正在迅速增長。我們的人口正在老化，慢性病也日益增加。如今，慢性病和精神健康問題約佔醫療保健總支出的 90%。這些因素共同導致對醫療保健服務的需求增加，從而推高了醫療成本。

Now relative to supply, in most industries when additional supply comes online, costs go down. However, in health care, costs are rising even as additional supply becomes available. Consider that since 2000, the cost of a hospital stay has increased more than 220%. And according to 2024 data, the median price of a new drug launch was over $370,000 compared to only $2,000 just 20 years ago.

現在，相對於供應而言，在大多數行業中，當新增供應上線時，成本就會下降。然而，在醫療保健領域，即使醫療資源不斷增加，成本仍在上升。想想看，自 2000 年以來，住院費用已經上漲了 220% 以上。根據 2024 年的數據，新藥上市的平均價格超過 37 萬美元，而 20 年前僅為 2,000 美元。

The organizations and professionals that supply and deliver costs, be they hospitals, doctors, pharmaceutical manufacturers and medical device companies are advancing significant innovations, but they are coming at an elevated costs. At the Cigna Group, we're moving forward with purpose and conviction counter these focuses. Let me share a few ways of how we're doing that.

無論是醫院、醫生、製藥商或醫療器材公司，提供和交付醫療服務的機構和專業人士都在推動重大創新，但這些創新也帶來了高昂的成本。在信諾集團，我們正以目標和信念向前邁進，以回應這些關注。讓我來分享一下我們實現這一目標的一些方法。

First, our approach to investing in and shaping our portfolio guides us to collaborate rather than own physician practices or pursuing capital intensive care delivery infrastructure. This gives us more agility to offer new solutions and services that expand access, lower cost and focus on prevention and treatment adherence. Our transformative rebate-free pharmacy benefits model is one of those improved innovations for prescription drugs. Another example is our new clarity solution in Cigna Healthcare that Brian will talk about in a few moments.

首先，我們投資和建立投資組合的方法指導我們合作，而不是擁有醫生診所或追求資本密集的醫療服務基礎設施。這使我們能夠更靈活地提供新的解決方案和服務，從而擴大服務範圍、降低成本，並專注於預防和治療依從性。我們變革性的無回扣藥局福利模式是處方藥領域的創新改進。另一個例子是我們為 Cigna Healthcare 提供的全新 Clarity 解決方案，Brian 稍後會詳細介紹。

Secondly, we are addressing affordability is by informing decisions more clearly on the location where care is provided as locations could significantly impact patient affordability, whether in a hospital, freestanding facility or a physician's office.

其次，我們正在透過更清晰地告知醫療服務提供地點來解決可負擔性問題，因為地點可能會對患者的可負擔性產生重大影響，無論是在醫院、獨立機構還是醫生診所。

A third way is through meaningful partnerships and collaboration. For example, in the new Trump Rx site launches, Evernorth is the pharmacy partner to the site and will dispense EMD Serona treatment for fertility. This will make treatments more accessible for all Americans struggling to start or expand their families at the lowest available cash price.

第三種途徑是透過有意義的夥伴關係和合作。例如，在新推出的 Trump Rx 網站上，Evernorth 是該網站的藥房合作夥伴，將提供 EMD Serona 生育治療藥物。這將使所有努力組建或擴大家庭的美國人都能以最低的現金價格更容易獲得治療。

And we're helping providers focus on care by minimizing their administrative burden, for example, in prior authorization processes. Over the past year alone, we further reduced the number of prior authorizations by 15%, and going forward, we are partnering with the administration to further streamline the prior authorization process.

我們正在幫助醫療服務提供者專注於護理工作，例如，透過減少事先授權流程等行政負擔。光是過去一年，我們就進一步減少了 15% 的事先授權數量，展望未來，我們將與政府合作，進一步簡化事先授權流程。

In the fourth way, we are driving affordabilities by leveraging competition and incurring the use of the most cost-effective solutions. Generics and biosimilar medications are important opportunities here. Today, for example, in the United States, approximately 90% of all prescriptions filled are generic, and they make up only 10% of the total pharmacy spend. As a result, the US has some of the lowest generic prices in the world and highest uptake levels, reflecting what happens when robust competition is harnessed.

第四種方法是，我們透過利用競爭和採用最具成本效益的解決方案來提高可負擔性。仿製藥和生物類似藥是這裡的重要機會。例如，如今在美國，大約 90% 的處方藥都是通用名藥物，但它們只佔藥房總支出的 10%。因此，美國的仿製藥價格是世界上最低的，而仿製藥的普及率卻是最高的，這反映了充分發揮競爭優勢所帶來的結果。

We see similar promise with biosimilars, and our company is already saving Americans money on the widely used brand-name medications such as HUMIRA and SOLAR, where we offer access to zero-dollar out-of-pocket offerings for our patients, saving them thousands of dollars each year. Looking ahead in the coming years, there will be more than $100 billion of savings for the US in the biosimilar space alone. At the Cigna Group, we will continue to make advancements in each of these areas in addition to the work we do day in, day out to support our customers, patients and our clients every day.

我們看到生物相似藥也有類似的前景，我們公司已經幫助美國人節省了在 HUMIRA 和 SOLAR 等廣泛使用的品牌藥上的開支，我們為患者提供零自付費用，每年為他們節省數千美元。展望未來幾年，光是生物相似藥領域就能為美國節省超過 1,000 億美元。在信諾集團，除了我們日復一日為客戶、患者和顧客提供支援的工作之外，我們還將繼續在這些領域取得進步。

Now to summarize. Time and again, at the Cigna Group, we have demonstrated the ability to evolve to meet the needs of our stakeholders, something we've done over years and decades. Against the backdrop of a disrupted operating landscape in 2025, we delivered full year adjusted earnings per share of $29.84, and we returned over $5 billion to shareholders through dividends and share repurchase.

現在總結一下。在信諾集團，我們一次又一次地證明了我們有能力不斷發展以滿足利害關係人的需求，而我們也在過去幾年甚至幾十年中一直這樣做。在 2025 年充滿挑戰的營運環境下，我們實現了全年調整後每股收益 29.84 美元，並透過股利和股票回購向股東返還了超過 50 億美元。

Looking ahead to 2026, our adjusted EPS outlook of at least $30.25 reinforced the sustained growth and strength of our company. We will also continue to make strategic investments in strengthening our capabilities and broadening our total addressable market profile, while we remain focused on harnessing the breadth of our capabilities across our organization for the evolving needs of those we serve.

展望 2026 年，我們調整後的每股盈餘預期至少為 30.25 美元，這進一步鞏固了我們公司的持續成長和實力。我們將繼續進行策略性投資，以增強自身能力並擴大潛在市場範圍，同時我們將繼續專注於利用組織內的各種能力，以滿足我們所服務對像不斷變化的需求。

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

接下來，我將把電話交給布萊恩。

Thank you, David. Good morning, everyone. I'll start by outlining some highlights of our business performance in the fourth quarter and the full year. I will then highlight the key innovations we introduced in a dynamic environment and outline our view of the years ahead.

謝謝你，大衛。各位早安。首先，我將概述我們第四季和全年業務表現的一些亮點。接下來，我將重點介紹我們在動態環境中引入的關鍵創新，並概述我們對未來幾年的展望。

Our performance underscores the value we provide for those we serve through our three business platforms, providing multiple paths for sustainable growth, including our specialty and care services businesses within Evernorth, our pharmacy benefit services business also within Evernorth, and Cigna Healthcare, our health benefits business.

我們的績效凸顯了我們透過三大業務平台為服務對象提供的價值，為永續成長提供了多種途徑，包括 Evernorth 旗下的專科和護理服務業務、Evernorth 旗下的藥房福利服務業務以及我們的健康福利業務 Cigna Healthcare。

During the quarter, our Evernorth portfolio demonstrated continued performance. Starting in our Specialty & Care businesses, we delivered strong results with 14% adjusted revenue growth, reflecting the demand for our services, and we saw 13% year-over-year growth in the number of specialty scripts in 2025. This is supported by the shift to biosimilars and our industry-leading patient support in Accredo. Our portfolio shaping efforts have resulted in an expansion of our specialty capabilities to serve hospitals and health systems, in part through our investment in Shields Health Solutions that we announced in late 2025.

本季度，我們的 Evernorth 投資組合表現出持續的良好勢頭。從我們的專科和護理業務開始，我們取得了強勁的業績，調整後的收入增長了 14%，反映了對我們服務的需求，並且我們看到 2025 年專科處方數量同比增長了 13%。向生物相似藥的轉變以及我們在 Accredo 提供的行業領先的患者支持，都為此提供了支持。我們透過調整產品組合，擴大了我們服務於醫院和醫療系統的專業能力，部分原因是我們在 2025 年底宣布對 Shields Health Solutions 進行投資。

Next in Evernorth Pharmacy Benefit Services business, our fourth quarter and full year results reflect continued solid performance. We built on our track record of innovative pharmacy benefit solutions to meet market demands. This includes our suite of GLP-1 solutions.

接下來是 Evernorth Pharmacy Benefit Services 業務，我們第四季和全年的業績反映了持續穩健的表現。我們憑藉著以往在創新藥局福利解決方案的成功經驗，滿足了市場需求。這包括我們的一系列 GLP-1 解決方案。

In 2025, we added EnreachRx, a new patient support model designed for pharmacies dispensing GLP-1 drugs committed to providing enhanced clinical services. We also expanded our patient assurance program to include these GLP-1 medicines, which sets caps on member out-of-pocket costs to improve predictability and affordability. And we are proud of our continued focus on service. We delivered a seamless January 1, implementation for new and existing clients, ensuring customers and patients have access to care when they need it. Overall, we're pleased to deliver another year of solid results across our Evernorth portfolio.

2025 年，我們新增了 EnreachRx，這是一種新的病患支援模式，專為致力於提供增強型臨床服務的 GLP-1 藥物藥局而設計。我們還擴大了患者保障計劃，將這些 GLP-1 藥物納入其中，該計劃對會員的自付費用設定了上限，以提高可預測性和可負擔性。我們為我們始終專注於服務而感到自豪。我們為新舊客戶實現了1月1日的無縫實施，確保客戶和患者在需要時能夠獲得醫療服務。整體而言，我們很高興 Evernorth 旗下所有業務在過去一年都取得了穩健的表現。

Now turning to Cigna Healthcare, our consultative approach and focus on affordability are driving strong overall performance. We delivered financial results that were slightly ahead of expectations. We maintained disciplined pricing while driving affordability and introducing or expanding differentiated clinical offerings.

現在我們轉向信諾醫療保健，我們採取的諮詢式方法和對價格可負擔性的關注正在推動其整體業績強勁增長。我們的財務表現略高於預期。我們在保持嚴格定價的同時，努力提高價格可負擔性，並推出或擴大差異化的臨床服務。

We're doing this in a number of ways, including encouraging customers to utilize lower cost generic and biosimilar medicines; optimizing sites of care between hospital facilities and lower cost alternatives and improving administrative processes for providers. We also continue to maintain a disciplined pricing stance. For sold business in the first quarter of 2026, our price increases are in excess of what we achieved for the comparable period in 2025.

我們正在透過多種方式來實現這一目標，包括鼓勵客戶使用價格更低的仿製藥和生物相似藥；優化醫院設施與價格更低的替代方案之間的護理地點；以及改善醫療服務提供者的行政流程。我們將繼續保持穩健的定價策略。對於 2026 年第一季售出的業務，我們的價格漲幅超過了 2025 年同期的價格漲幅。

We expanded our suite of AI-powered digital tools to improve and personalized customer experiences. These include a provider matching tool to help customers find in-network providers based on their specific needs and preferences, and a real-time cost tracking tool to provide a simple breakdown of costs, both before and after clinician and specialist visits.

我們擴展了人工智慧驅動的數位工具套件，以改善和個人化客戶體驗。其中包括供應商配對工具，可協助客戶根據其具體需求和偏好找到網路內供應商；以及即時成本追蹤工具，可提供臨床醫生和專家就診前後成本的簡單明細。

We also launched new partnerships to expand our offerings. For example, we collaborated with Progeny and Karat to offer new coverage options for employers to support patients through their fertility journeys. And we announced an industry-first collaboration with Headspace to support the mental health of millions of Cigna Healthcare customers with exclusive digital features and content.

我們也建立了新的合作夥伴關係，以拓展我們的產品和服務。例如，我們與 Progeny 和 Karat 合作，為雇主提供新的保險方案，以支持患者完成生育之旅。我們宣布與 Headspace 開展業內首創的合作，透過獨家數位功能和內容來支持數百萬 Cigna Healthcare 客戶的心理健康。

We see partnerships like these as critical to building a more sustainable model for healthcare and further accelerating innovation for our customers. Our performance across Cigna Healthcare underscores our focus on driving innovation, improving personalization, thoughtfully shaping our product portfolio and our execution orientation.

我們認為，像這樣的合作關係對於建立更永續的醫療保健模式以及進一步加速為我們的客戶進行創新至關重要。信諾醫療保健的表現凸顯了我們對推動創新、提高個人化、精心打造產品組合和執行導向的重視。

As we look ahead over a multiyear horizon, we are focused on leading the changes needed in healthcare to better serve our customers and clients, resulting in improved affordability and access. To do this, we are taking bold actions, including investments in defining the future of health care. Let me outline a few of these.

展望未來多年，我們將致力於引領醫療保健領域所需的變革，以更好地服務我們的客戶和顧客，從而提高醫療保健的可負擔性和可及性。為此，我們正在採取大膽的行動，包括投資於定義醫療保健的未來。讓我簡單介紹其中幾個方面。

First, we're focused on putting the customer at the center of everything we do through new innovations that are data-driven and tech forward. To do this, we are focused on personalizing the health care experience by leveraging and growing our digital and analytics capabilities.

首先，我們致力於透過數據驅動和技術領先的創新，將客戶置於我們一切工作的中心。為此，我們致力於透過利用和發展我們的數位化和分析能力，實現醫療保健體驗的個人化。

Already this year, we have seen a significant increase in digital registrations for our US employer businesses and decreased call volumes. We are facilitating seamless interactions for customers based on their engagement preferences, whether that be mobile, web, text or phone, including chat options with AI virtual assistance and easy connectivity to our service agents for even more personalized support. Beyond this, we are finding new ways to utilize data and analytics, insights and digital tools to better identify patients who need help earlier, particularly those with complex and high-cost conditions.

今年以來，我們已經看到美國雇主企業的數位化註冊量顯著增加，而電話諮詢量則有所下降。我們根據客戶的互動偏好，無論是透過行動裝置、網頁、簡訊或電話，為客戶提供無縫互動體驗，包括具有 AI 虛擬助理的聊天選項，以及與我們的服務代理輕鬆連接，從而獲得更個人化的支援。除此之外，我們也正在探索利用數據和分析、洞察力和數位工具的新方法，以便更好地識別需要更早幫助的患者，特別是那些病情複雜且治療費用高昂的患者。

We continue to lead the way in transforming our models and capabilities for those we serve through meaningful innovations. In October of last year, we announced the transformation of our pharmacy benefits model to meet the demands of the market and improve both affordability and transparency for our customers and patients.

我們將繼續引領變革，透過有意義的創新，提升我們服務對象的模式和能力。去年十月，我們宣布對藥房福利模式進行改革，以滿足市場需求，並提高客戶和患者的負擔能力和透明度。

As David mentioned, our new rebate free model will help people stay healthy and get the medications they need by lowering costs and supporting local pharmacies, so care is always within reach. We have received positive feedback about our new model from our broker partners clients and other stakeholders. Moving ahead and following our recent settlement with the FTC, we are confident in the transformation of pharmacy benefits we are leading for the industry.

正如大衛所提到的，我們新的免回扣模式將透過降低成本和支持當地藥房，幫助人們保持健康並獲得所需的藥物，從而使醫療保健觸手可及。我們的經紀合作夥伴、客戶和其他利害關係人對我們的新模式給予了正面的回饋。展望未來，繼我們最近與聯邦貿易委員會達成和解之後，我們對我們正在引領的藥品福利產業變革充滿信心。

In Cigna Healthcare, we are similarly driving step changes in our product offerings to create patient-centered solutions that simplify health care and ensuring we're rewarding outcomes rather than volume. One example is Clarity, our newest offering that we introduced in November, which puts customers and patients in control so they can focus on getting the care they need, designed with cost transparency available to customers at the time they need it.

在信諾醫療保健公司，我們也積極推動產品供應的變革，以創造以患者為中心的解決方案，簡化醫療保健，並確保我們獎勵的是結果而不是數量。例如，我們在 11 月推出的最新產品 Clarity，讓客戶和患者掌握主動權，從而可以專注於獲得所需的護理，其設計理念是讓客戶在需要時能夠獲得成本透明度。

Clarity helps individuals manage their health with ease and saves clients up to 10% medical costs. And it has a simple co-pay-only structure. Clarity also has a single digital front door for all Cigna Healthcare customers integrating experiences for pharmacy, dental and supplemental health, and patients have access to our trusted national network without referrals, supported by clinically sound externally validated quality measures.

Clarity 幫助個人輕鬆管理健康，並為客戶節省高達 10% 的醫療費用。而且它採用簡單的自付比例支付模式。Clarity 還為所有 Cigna Healthcare 客戶提供了一個統一的數位入口，整合了藥房、牙科和補充醫療保健體驗，患者無需轉診即可訪問我們值得信賴的全國網絡，並有臨床上可靠的外部驗證品質措施支持。

Finally, in our Specialty and Care Services business, our expanded suite of offerings has helped grow these businesses from around 25% of the company three years ago to around 35% this year, driven by high secular growth and our deliberate portfolio shaping to increase exposure in this highly attractive growth sector, and we see significant runway for additional growth in our specialty platforms in the future. This includes leveraging competition and the shift to more biosimilars and specialty generics with expected launches and uptake across other drug classes such as oncology, (inaudible), autoimmune and inflammatory conditions. Guided by a clear mission and vision that prioritizes improving healthcare and keeping the customer at the center, paired with a partnership orientation and a portfolio intentionally shaped for sustained growth markets, we are leaning into the disruption necessary to drive industry transformation.

最後，在我們的專科和護理服務業務中，我們擴大的產品組合幫助這些業務從三年前占公司約 25% 的份額增長到今年約 35%，這得益於長期的高速增長以及我們為增加在這個極具吸引力的增長領域的投資而進行的精心投資組合調整，我們看到未來我們的專科平台還有很大的增長空間。這包括利用競爭，以及向更多生物相似藥和特藥仿製藥的轉變，預計這些藥物將在其他藥物類別（如腫瘤、自體免疫和發炎性疾病）中推出和推廣。在以改善醫療保健和以客戶為中心的明確使命和願景的指引下，我們秉持合作導向，並精心打造面向持續成長市場的產品組合，積極應對推動產業轉型所必需的變革。

As I wrap up, I'd like to reflect on some bright spots for the quarter and the full year. Throughout 2025, we delivered through a dynamic environment. Revenues for the full year increased 11%, driven by specialty pharmacy growth and client relationships. We had a strong selling season in pharmacy benefit services with the retention rate over 97% for 2026. And we grew customers in our Select segment in Cigna Healthcare by 7%.

最後，我想回顧一下本季和全年的一些亮點。2025年全年，我們在充滿活力的環境中實現了目標。全年營收成長 11%，主要得益於專科藥局業務成長和客戶關係改善。我們在藥局福利服務領域取得了強勁的銷售業績，2026 年的客戶留存率超過 97%。我們在 Cigna Healthcare 的精選客戶群中成長了 7%。

We are a leading change in our industry from our commitments to better that we announced early last year, to our partnership with the administration on improving prior authorization to our announcements of affordable fertility drugs available through Trump Rx to our transformative new model for pharmacy benefits and our introduction of Clarity in Cigna Healthcare. Our mission, coupled with our capabilities, deep expertise and diverse portfolio of businesses positions us well to continue our track record of delivering for all stakeholders.

從去年年初宣布的致力於做得更好，到與政府合作改進事先授權，再到宣布透過 Trump Rx 提供價格合理的生育藥物，以及我們變革性的全新藥房福利模式，以及在 Cigna Healthcare 中引入 Clarity，我們引領著行業的變革。我們的使命，加上我們的能力、深厚的專業知識和多元化的業務組合，使我們能夠繼續保持為所有利害關係人創造價值的良好記錄。

Now I'll turn it over to Ann.

現在我把麥克風交給安。

Thank you, Brian, and good morning, everyone. Today, I'll review Cigna's fourth quarter and full year 2025 results, and I'll provide an outlook for 2026.

謝謝你，布萊恩，大家早安。今天，我將回顧信諾保險公司 2025 年第四季和全年業績，並展望 2026 年。

We are pleased to deliver another strong year for the Cigna Group, reflecting focused execution across Evernorth and Cigna Healthcare with both segments achieving pretax adjusted earnings at or above the outlook we shared a year ago. For full year 2025, we delivered consolidated adjusted revenues of $275 billion, adjusted after-tax earnings of $8 billion and adjusted earnings per share of $29.84. Now turning to our segment results.

我們很高興地宣布，Cigna 集團又迎來了一個強勁的年份，這反映了 Evernorth 和 Cigna Healthcare 兩大業務板塊的專注執行，這兩個板塊的稅前調整後收益均達到或超過了我們一年前公佈的預期。2025 年全年，我們實現合併調整後收入 2,750 億美元，調整後稅後利潤 80 億美元，調整後每股收益 29.84 美元。現在來看我們各業務部門的業績。

I'll start with Evernorth. 2025 marked another year of growth in Evernorth and the introduction of an industry-leading innovation and pharmacy benefit services as we advance our more simple, predictable and transparent rebate remodel. We also advanced our Specialty and Care Services capabilities through a strategic investment in Shields Health solutions as we build on our market-leading position and enhance our offerings in one of the largest and fastest-growing areas in healthcare.

我先來說說Evernorth。 2025年標誌著Evernorth又一個成長之年，我們推出了業界領先的創新藥局福利服務，同時推動我們更簡單、更可預測、更透明的返利改革。我們也透過對 Shields Health 解決方案的策略性投資，提升了我們的專科和護理服務能力，鞏固了我們在醫療保健領域最大、成長最快的領域之一的市場領先地位，並增強了我們的產品和服務。

Fourth quarter revenues grew to $63.1 billion, and pretax adjusted earnings grew to $2.2 billion, in line with expectations. Our Specialty and Care Services business delivered strong growth, generating $26.7 billion in revenue, an increase of 14% year-over-year and $1 billion in adjusted earnings. This performance reflects sustained momentum in our fastest-growing business, driven by robust specialty volumes and rising biosimilar use, which continues to generate meaningful savings for our patients and clients.

第四季營收成長至 631 億美元，稅前調整後收益成長至 22 億美元，符合預期。我們的專業護理服務業務實現了強勁成長，創造了 267 億美元的收入，年增 14%，調整後收益為 10 億美元。這一業績反映了我們成長最快的業務持續保持強勁勢頭，這得益於強勁的特藥銷售和不斷增長的生物相似藥使用量，從而繼續為我們的患者和客戶節省大量資金。

Our pharmacy benefit services business delivered $36.3 billion in revenue and $1.2 billion in adjusted earnings reflecting the impact of our strategic investments, including initiatives to enhance patient experience. Overall, the fourth quarter capped another year of growth for Evernorth. The underlying strength across our Evernorth businesses reinforces our confidence in making deliberate near-term investments to transform our pharmacy benefit services model, positioning us well for sustained long-term value creation.

我們的藥房福利服務業務實現了 363 億美元的收入和 12 億美元的調整後收益，反映了我們戰略投資的影響，包括旨在提升患者體驗的各項舉措。總體而言，第四季為 Evernorth 又一年的成長畫上了圓滿的句號。Evernorth 旗下各業務的強勁實力增強了我們對近期進行審慎投資以轉變藥房福利服務模式的信心，使我們能夠更好地創造持續的長期價值。

Turning to Cigna Healthcare. In 2025, Cigna Healthcare delivered strong results above our original expectations in a dynamic environment. This performance underscores the strength and resilience of our purposely constructed portfolio, including the divestiture of our Medicare businesses, which positions us to navigate volatility and drive durable growth.

轉而選擇信諾醫療保健。2025年，信諾醫療保健在充滿活力的環境中取得了超越我們最初預期的強勁業績。這項業績凸顯了我們精心建構的投資組合的實力和韌性，包括剝離我們的醫療保險業務，這使我們能夠應對市場波動並實現永續成長。

For fourth quarter 2025, Cigna Healthcare delivered adjusted revenues of $11.2 billion and pretax adjusted earnings of $734 million. Adjusted earnings slightly exceeded expectations as favorable net investment income more than offset modestly higher medical costs. The higher medical costs equated to approximately 60 basis points of MCR or about $50 million without notable impact to any one part of the portfolio. Relative to our stop-loss products, the full year MCR was slightly higher in 2025 compared to 2024, consistent with what we expected and communicated at the beginning of the year, and we remain on track with our margin improvement plan.

2025 年第四季度，Cigna Healthcare 的調整後收入為 112 億美元，稅前調整後收益為 7.34 億美元。調整後的收益略高於預期，因為有利的淨投資收益足以抵銷略微上漲的醫療成本。較高的醫療成本相當於 MCR 約 60 個基點，或約 5,000 萬美元，但對投資組合的任何部分都沒有明顯影響。相對於我們的停損產品，2025 年全年 MCR 比 2024 年略高，這與我們年初的預期和溝通一致，我們仍按計劃推進利潤率提升計劃。

Overall, we're pleased with Cigna Healthcare's performance in 2025. Looking ahead, we remain focused on driving greater affordability and value for the patients and clients we serve while continuing to execute with discipline against our financial targets.

總體而言，我們對信諾醫療保健在 2025 年的表現感到滿意。展望未來，我們將繼續專注於為我們服務的患者和客戶提高醫療服務的可負擔性和價值，同時繼續嚴格執行我們的財務目標。

Now turning to our 2026 outlook. We expect full year 2026 consolidated adjusted revenues of approximately $280 billion, and we expect full year 2026 consolidated adjusted income from operations of at least $30.25 per share. Considering earnings seasonality, we expect first quarter EPS to be slightly above 25% of our full year guidance. Now turning to our 2026 outlook for each of our segments.

現在展望一下2026年。我們預計 2026 年全年合併調整後收入約為 2,800 億美元，2026 年全年合併調整後營業收入至少為每股 30.25 美元。考慮到獲利季節性因素，我們預計第一季每股收益將略高於全年預期值的 25%。現在讓我們來看看我們對各個業務板塊2026年的展望。

In Evernorth, we expect full year 2026 adjusted earnings of at least $6.9 billion. As we discussed previously, we expect investment spending to build the infrastructure required for our transformative rebate remodel to commence in 2026, with this spend more back half weighted. As a result, we expect Evernorth's first half earnings to be higher than the historical pattern with the first quarter representing over 20% of full year earnings.

我們預計 Evernorth 2026 年全年調整後收益至少為 69 億美元。正如我們之前討論的那樣，我們預計投資支出將用於建設必要的基礎設施，以便我們在 2026 年開始進行變革性的退稅改革，而這項支出將更多地集中在後半段。因此，我們預計 Evernorth 上半年的收益將高於歷史水平，第一季收益將佔全年收益的 20% 以上。

For Cigna Healthcare, we expect full year 2026 adjusted earnings of at least $4.5 billion. Within Cigna Healthcare, we expect earnings seasonality to be consistent with prior years with the first quarter representing over 30% of our full year adjusted earnings expectations for the business. Assumptions underlying our 2026 outlook for Cigna Healthcare include a medical care ratio in the range of 83.7% to 84.7%, incorporating the pricing actions taken across stop loss, and individual exchange businesses as well as the assumption of a cost trend environment that remained elevated.

我們預計 Cigna Healthcare 2026 年全年調整後收益至少為 45 億美元。在信諾醫療保健領域，我們預計獲利季節性將與往年一致，第一季將占我們全年調整後獲利預期的 30% 以上。我們對 Cigna Healthcare 2026 年的展望基於以下假設：醫療保健比率在 83.7% 至 84.7% 之間，其中包括在止損和個人交易所業務中採取的定價措施，以及成本趨勢環境保持高位的假設。

We expect the first quarter 2026 medical care ratio to be below 81%, reflecting typical seasonality. We expect approximately 18.1 million total medical customers at year-end, including growth in our middle select and international markets offset by lower membership in our national accounts and individual exchange business.

我們預計 2026 年第一季醫療保健比率將低於 81%，這反映了典型的季節性因素。我們預計到年底醫療客戶總數將達到約 1,810 萬，其中中端精選市場和國際市場的成長將被國家帳戶和個人交易業務會員數量的下降所抵消。

For the enterprise, we project an adjusted SG&A ratio of approximately 5% for 2026, consistent with the 2025 level, reflecting both the investments to advance our pharmacy benefit services model and continued improvements in operating efficiency. We expect the consolidated adjusted tax rate to be approximately 19%. Now moving to our 2025 capital management position and 2026 capital outlook.

對於企業而言，我們預計 2026 年調整後的銷售、一般及行政費用率約為 5%，與 2025 年的水平一致，這反映了我們為推進藥房福利服務模式而進行的投資以及營運效率的持續提高。我們預計綜合調整稅率約為 19%。現在讓我們來談談 2025 年的資本管理狀況和 2026 年的資本展望。

Our fourth quarter cash flow was strong, and we finished the full year by delivering $9.6 billion of cash flow from operations. In 2025, we repurchased 11.9 million shares of common stock for approximately $3.6 billion and returned $1.6 billion to shareholders via dividends. We also improved our debt to capitalization ratio to 43% during 2025, including an improvement of 190 basis points in the fourth quarter. Now framing our 2026 capital outlook.

我們第四季的現金流表現強勁，全年營運現金流達到 96 億美元。2025年，我們回購了1,190萬股普通股，耗資約36億美元，並透過股利向股東返還了16億美元。我們還計劃在 2025 年將負債資本比率提高到 43%，其中第四季提高了 190 個基點。現在，讓我們展望2026年的資本前景。

We expect to deliver approximately $9 billion of cash flow from operations. As previously noted and consistent with 2025, we expect the majority of operating cash flow to be realized in the second half. Our capital deployment priorities remain consistent with our long-term framework.

我們預計將從營運中獲得約90億美元的現金流。如前所述，與 2025 年的情況一致，我們預計大部分經營現金流將在下半年實現。我們的資本部署重點與我們的長期框架保持一致。

We expect to deploy approximately $1.3 billion to capital expenditures, and we expect to deploy approximately $1.6 billion to shareholder dividends, reflecting our increased quarterly dividend of $1.56 per share. Our guidance assumes full year weighted average shares outstanding to be in the range of 261 million to 265 million shares. And during 2026, we expect to continue progressing towards our long-term debt to capitalization ratio of approximately 40%.

我們預計將投入約 13 億美元用於資本支出，並預計將投入約 16 億美元用於股東分紅，這反映了我們每股季度分紅增加至 1.56 美元。我們的預期是全年加權平均流通股數在 2.61 億股至 2.65 億股之間。預計到 2026 年，我們將繼續朝著長期債務資本比率約 40% 的目標邁進。

Now to close. As we move into 2026 and beyond, we remain confident in the strength and the resilience of our enterprise. Our disciplined execution, balance portfolio and strategic investments to drive innovation, affordability and an enhanced customer and patient experience, all position us well to deliver differentiated value for our customers, clients and shareholders over the long term. We are confident in our ability to deliver full year 2026 adjusted earnings of at least $30.25 per share, and our ability to deliver attractive long-term EPS growth.

現在要結束了。展望 2026 年及以後，我們對企業的實力和韌性依然充滿信心。我們嚴謹的執行、平衡的投資組合和策略性投資，旨在推動創新、降低成本並提升客戶和患者的體驗，所有這些都使我們能夠長期為客戶、委託人和股東創造差異化的價值。我們有信心實現 2026 年全年調整後每股收益至少 30.25 美元，並實現具有吸引力的長期每股收益成長。

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

接下來，我們將把電話交給接線生進行問答環節。

(Operator Instructions) Lisa Gill, JPMorgan.

（操作說明）Lisa Gill，摩根大通。

Thank you very much. Good morning. David, I feel like we've been waiting for a long time for this PBM legislation to finally pass. It's finally passed. You've put behind you the FTC suit. Can we talk about a few things. The first -- the change in economics. You talked about this with the new plan in October. But now that everything is kind of settled in place, we've got legislation, et cetera. Can you spend a few minutes talking about the margin profile of what we would expect in the steady state for the PBM?

非常感謝。早安.戴維，我覺得我們已經等了很久，這項藥品福利管理機構（PBM）的立法終於通過了。終於通過了。你已經把聯邦貿易委員會的訴訟拋在腦後了。我們能談談幾件事嗎？第一點——經濟的變化。您在十月的新計劃中談到了這一點。但現在一切都基本上塵埃落定，我們有了法律等等。您能否花幾分鐘時間談談PBM在穩定狀態下的預期利潤率？

And then secondly, one of the things that stood out to me in the FTC settlement was the moving of the GPO back to the US from Switzerland. I want to understand what that means to the tax rate. My understanding is that the tax rate over in Switzerland is about 15%. So when I think about [SN] coming back, what's the financial implication for that as well?

其次，FTC 和解協議中讓我印象深刻的一點是，美國政府郵政總局從瑞士遷回了美國。我想了解這對稅率意味著什麼。據我了解，瑞士的稅率約為15%。所以，當我想到[SN]回歸時，這在經濟上又會產生什麼影響呢？

Good morning, Lisa. Thanks for your comments and your question. So first, pulling back up, we've been saying for some time that the pharmacy services space would go through a clearing event, be it driven by market innovation, legislation or regulation. And when you step back, many of those forces converge this week. And the clarity of direction that we established back in 2025 with the work we started in early 2025 and announced in the third quarter of 2025 with our new innovative model from our point of view, is directly aligned.

早安，麗莎。感謝您的評論和提問。首先，回到正題，我們之前一直認為，藥局服務領域將會經歷一次清算，無論是由市場創新、立法或監管驅動。當你退後一步，你會發現本週許多這樣的力量匯聚到了一起。從我們的角度來看，我們在 2025 年確立的明確方向，以及我們在 2025 年初開始的工作和在 2025 年第三季宣布的創新模式，是完全一致的。

So to the first part of your question, at a macro level, as we said in the third quarter of last year, we believe the margin profile will remain similar. We have significant experience with a variety of programs today with the diverse population we serve, be it fee-based full pass-through, the continued innovation we drive with our clinical programs and services that we are able to offer that from a big picture standpoint, we believe the margin profile will be similar and therefore, we believe the underlying growth algorithm for the pharmacy benefit services portion of our portfolio will remain intact to be similar as we get through this innovation.

所以，對於你問題的第一部分，從宏觀層面來看，正如我們在去年第三季所說，我們認為利潤率狀況將保持類似。我們目前在為不同人群提供服務的各種項目中積累了豐富的經驗，無論是基於費用的全額轉嫁模式，還是我們不斷推動臨床項目和服務創新，從宏觀角度來看，我們相信利潤率將保持相似，因此，我們相信，隨著我們完成這項創新，我們投資組合中藥房福利服務部分的基本增長算法將保持不變。

And importantly, before I come to your tax question, it's important to really underscore the underpinnings of our innovation. First and foremost, it starts with a customer-first orientation in its design. It's therefore built to ensure that we are capable of delivering the lowest out-of-pocket cost for the consumer each and every time they consume a pharmaceutical at the altar most likely through their benefit program in the vast majority of cases, that's the instance and the unique cases where it could be a cash pay program or a direct program, et cetera, we have the ability to be able to support that.

更重要的是，在我回答你的稅務問題之前，有必要先強調我們創新的基礎。首先，它的設計以客戶至上為核心。因此，我們的建造旨在確保我們能夠為消費者每次在藥房購買藥品時提供最低的自付費用。在絕大多數情況下，他們很可能透過福利計劃獲得藥品，而對於現金支付計劃或直接支付計劃等特殊情況，我們也能夠提供支援。

Additionally. meaningfully expanding the support programs for independent local world pharmacies. And then lastly, as we've discussed, it's built on a more modern, no rebate, no spread framework that gives all visibility to employers on a fee-based transparent environment and ultimately provide you shareholders more visibility of the sustainability relative to it. So big picture, no change in overall margin profile, and therefore, no change in the growth algorithm over time for pharmacy benefit services business.

此外，切實擴大對獨立地方藥局的支持計畫。最後，正如我們討論過的，它建立在一個更現代的、無回扣、無利差的框架之上，使雇主能夠在基於費用的透明環境中完全了解情況，並最終使股東更清楚地了解其可持續性。因此，從宏觀角度來看，整體利潤率狀況沒有變化，因此，藥房福利服務業務的成長演算法也不會隨著時間的推移而改變。

As it relates to the second part of your question, the Ascent GPO has been and continues to be an important tool to improving affordability for customers and patients. We will move capabilities to the United States, bringing them closer to our US operations. We remain confident in the -- as I said before, the growth algorithm of the business.

關於您問題的第二部分，Ascent GPO 一直是並將繼續是提高客戶和患者負擔能力的重要工具。我們將把部分能力轉移到美國，使其更貼近我們在美國的營運。正如我之前所說，我們對公司的成長演算法仍然充滿信心。

At the macro level, you could think about an outside impact to the effective tax rate of our organization of up to 1% over time because there's a phase in here if unmitigated. So if you want to put a box around that, you can think about a maximum impact of 1% in the future if mitigated, therefore, given the strong performance of our portfolio and our diverse enterprise, we see that as totally manageable even at the outside parameters of that against our long-term earnings growth algorithm of 10% to 14%. Thanks for your question.

從宏觀層面來看，如果不加以緩解，隨著時間的推移，外部因素可能會對我們組織的實際稅率產生高達 1% 的影響，因為這裡存在一個階段性問題。因此，如果你想給它一個限制，你可以考慮如果加以緩解，未來最大影響為 1%。因此，鑑於我們投資組合的強勁表現和我們多元化的企業，我們認為即使在超出我們 10% 至 14% 的長期盈利增長演算法的參數範圍之外，這也是完全可控的。謝謝你的提問。

Scott Fidel, Goldman Sachs.

Scott Fidel，高盛集團。

Thanks. Good morning. Just wanted to follow up on Lisa's and then ask a follow-up around Brian's comments on the new pricing model with the customer.

謝謝。早安.我只是想跟進一下 Lisa 的問題，然後再就 Brian 關於客戶新定價模式的評論詢問一下後續情況。

So the first question, just following up on Lisa's question is just, it really does feel like there's been a real sea change in collection and just the amount of activity and developments that actually occurred around sort of moving the premium pricing model forward. And just curious from your perspective is, do you feel like at this point now, you've largely fully aligned your PBM model with how the regulators, with how the policymakers have been really pushing the industry to adapt to, or are there still some sort of regulatory battles, residual battles still ahead?

所以第一個問題，只是接著 Lisa 的問題問，感覺收藏領域真的發生了翻天覆地的變化，圍繞著推進高端定價模式的活動和發展也確實層出不窮。我只是好奇，從你的角度來看，你是否覺得目前你的藥品福利管理模式已經基本與監管機構和政策制定者推動行業適應的方式完全一致，還是說未來仍然存在一些監管方面的挑戰或遺留問題？

And then I wanted to just ask Brian around the premium clients in terms of moving to the new pricing model, just the traction that you're seeing there in terms of sort of your updated view on the ramp that you're expecting in terms of 26 to 28 the percentage of clients that you expect to move on to the pricing model. Thanks.

然後，我想問布萊恩，關於高端客戶向新定價模式過渡的情況，以及你目前看到的進展情況，特別是你對過渡到新定價模式的客戶比例的最新看法，你預計會有 26% 到 28% 的客戶會過渡到新定價模式。謝謝。

Scott, it's David. Let me take the first part of your question, and I'll transition to Brian for the second part.

史考特，我是大衛。讓我來回答你問題的第一部分，第二部分將由布萊恩來回答。

First, just contextually, it's important to note we are proud of the significant value that has been over a long period of time to the people we have the privilege of serving, our customers across the United States. And by way of context there, fully 80% of the Express Scripts customers have less than $250 out of pocket over the course of a full year. I'm going to come back to that in a moment.

首先，就背景而言，值得一提的是，我們為長期以來為我們有幸服務的美國各地客戶創造的巨大價值感到自豪。順便提一下，Express Scripts 80% 的客戶一年下來自付費用不到 250 美元。我稍後會再談到這一點。

And as I noted, through the good work of the pharmacy benefit services industry over a long period of time, 90% of all drugs consumed in America are generic, and they make up just over 10% of the total cost equation but 10% of brand, which make up almost 90% of the cost equation. That's creating undue pressure in force on everybody in the model today, including out-of-pocket dislocation for consumers.

正如我之前提到的，透過藥品福利服務業長期以來的良好工作，美國消費的所有藥品中有 90% 是仿製藥，它們僅佔總成本的 10% 多一點，而品牌藥則佔總成本的近 90%。這給當今模式下的每個人都造成了不必要的壓力，包括給消費者帶來自付費用方面的損失。

So when you come back to our model, we are confident that our model is built. The new innovation is built through customer first, no rebate, no spread, fully transparent fee-based model, where we step into the advocacy role for the consumer at point of consumption of a pharmaceutical each and every time at the counter to dynamically shop and make sure they get the lowest out-of-pocket costs. So when you look at any of the legislation or regulation, it's been oriented around improving affordability and predictability, harnessing, ultimately, transparency and expanding value for ultimately the consumers, along with the clients. Our innovation squarely goes in that direction, and we are excited and confident to lead the way for the industry.

所以，當你回到我們的模型時，我們確信我們的模型已經建造完成。這項創新建立在以客戶為先、不回饋、不收取差價、完全透明的收費模式之上，我們每次在櫃檯購買藥品時都會扮演消費者的代言人角色，動態地進行比價，確保他們獲得最低的自付費用。因此，當你審視任何立法或監管規定時，你會發現它們都圍繞著提高可負擔性和可預測性，最終實現透明度，並為消費者和客戶創造更大的價值。我們的創新方向正是如此，我們感到興奮和自信，能夠引領產業發展。

I'll transition to Brian for the second part of your question.

您的問題第二部分將由布萊恩回答。

Thanks, David. Morning, Scott. As it relates to the adoption rates and the pricing model, et cetera, consistent with what we talked about in the third quarter call, the entire Cigna Healthcare fully insured book will be adopting this new model in 2027, and we expect at least 50% of our Evernorth business will adopt the model by year-end 2028. Early feedback from clients brokers and other external stakeholders have been positive to date.

謝謝你，大衛。早安，史考特。關於採用率和定價模式等，正如我們在第三季電話會議上所討論的那樣，Cigna Healthcare 的所有全額保險業務將在 2027 年採用這一新模式，我們預計到 2028 年底，我們 Evernorth 業務中至少 50% 將採用該模式。迄今為止，來自客戶、經紀人和其他外部利害關係人的早期回饋均為正面回饋。

And I think importantly, coming back to link Lisa's question and yours, the core value creators in both our legacy models, and our new rebate free model really remain the same. If you think about securing better unit pricing for prescription drugs, administering benefits for plan sponsors and supporting patients with clinical safety checks and advanced clinical programs. Those three core value creators are the same in the legacy model as they are in the new model that we've introduced.

我認為重要的是，回到 Lisa 的問題和你的問題，我們傳統模式和新的無返利模式的核心價值創造者實際上仍然相同。如果您考慮為處方藥爭取更優惠的單價，為計劃發起人管理福利，並透過臨床安全檢查和先進的臨床計畫為患者提供支援。這三個核心價值創造者在傳統模式和我們推出的新模式中是一樣的。

The primary difference is the way in which we're compensated. So there's two primary ways will be paid in the future in this model. The first is a core admin fee that will be per member per script, delinked from the price of the drug. That will grow inflation over time. And then the second category be for clinical programs and other innovations that we bring to market, and we expect to take risk on this portion of the compensation. But in aggregate, as David said earlier, we expect to achieve a comparable level of profitability between the legacy model and the new model, although the sources of profit will evolve that land.

主要差異在於我們的報酬方式。因此，在這種模式下，未來主要有兩種支付方式。第一項是核心管理費，以每位會員每張處方收取，與藥品價格無關。隨著時間的推移，這將加劇通貨膨脹。第二類是臨床專案以及我們推向市場的其他創新，我們預期這部分補償將承擔風險。但總的來說，正如大衛之前所說，我們預計傳統模式和新模式的獲利能力將達到相當的水平，儘管利潤來源會隨之變化。

Charles Rhyee, TD Cowen.

Charles Rhyee，TD Cowen。

Thanks for taking the question. First one, just on clarification is just -- I think, Brian, you kind of mentioned it. With the settlement -- the timing of the settlement requirements, is that aligned with the launch of the new rebate free model is the first just sort of clarification question.

感謝您回答這個問題。首先，澄清一下──我想，布萊恩，你好像已經提到過了。關於和解協議－和解要求的具體時間是否與新的無回扣模式的推出一致，這是第一個需要澄清的問題。

But the second -- my second question really is more, obviously, your -- all these settlement agreements are related to the standard -- to provide standard offering, right, which largely aligns it feels like with the new model that you're launching by 2028. I guess the question is, to the extent that clients don't take this new offering, what is the responsibility for Cigna or Evernorth in this case to push the new standard offers so that these requirements are met? And if clients don't choose to take the new offering, is there any sort of liability to Cigna down the road?

但第二個問題——我的第二個問題其實更確切地說是——所有這些和解協議都與標準有關——提供標準產品，對吧？這感覺很大程度上與您在 2028 年推出的新模式相一致。我想問的是，如果客戶不接受這項新服務，那麼在這種情況下，Cigna 或 Evernorth 的責任是什麼？他們應該如何推廣新的標準服務，以滿足這些要求？如果客戶不選擇接受新方案，Cigna 將來是否會承擔任何責任？

And in particular, I'm kind of looking at, for example, ensuring members out-of-pocket expenses are lowest net cost. But if an employer doesn't choose that new option or if the employer chooses to maybe increase a coinsurance amount or deductible, is there any kind of does any kind of responsibility fall by to Cigna? Thanks.

特別是，我正在研究如何確保會員的自付費用達到最低淨成本。但是，如果雇主不選擇該新方案，或者雇主選擇增加共同保險金額或免賠額，那麼信諾保險公司是否需要承擔任何責任？謝謝。

Charles, good morning. It's David. Let me take the second part of your question, and I'll tack team with Brian on that as well as the first part of your question to pick up on.

查爾斯，早安。是大衛。讓我來回答你問題的第二部分，我會和布萊恩一起合作，同時也會繼續回答你問題的第一部分。

So a few important points here. First, macro we have, and we continue to believe in offering choice to the marketplace. And we serve a diverse number of clients from governmental agencies to health plans, to employer clients, et cetera. Two, as Brian noted, we will adopt this innovation January 1, 2027, for the Cigna Healthcare guaranteed cost book of business, where Cigna is the purchaser. So we will leave in the accelerated adoption. And third, we expect to see significant adoption in 2028, as Brian mentioned before.

這裡有幾點要點。首先，從宏觀層面來看，我們一直相信應該為市場提供選擇。我們的客戶群十分廣泛，包括政府機構、健康計畫、雇主客戶等等。第二，正如布萊恩所指出的那樣，我們將於 2027 年 1 月 1 日在 Cigna Healthcare 的保證成本業務中採用這項創新，其中 Cigna 是購買者。因此，我們將繼續加速採用。第三，正如布萊恩之前提到的，我們預計 2028 年將會有大量用戶採用。

Second, it will be our standard offering. It will be our lead offering in 2028, and that is congruent with the settlement and the direction.

其次，這將是我們的標準產品。這將是我們 2028 年的主要產品，這與和解協議和發展方向相符。

Third, there is no liability that we assume if the adoption rate is above or below that, we will lead the market. We will support this with marketing dollars because we are convicted and believe that this is the future of pharmacy benefit services for the benefit of consumers as well as clients as well as community pharmacists.

第三，如果採用率高於或低於該水平，我們不會承擔任何責任，我們將引領市場。我們將投入行銷資金來支持這項舉措，因為我們堅信，這才是藥房福利服務的未來，對消費者、客戶以及社區藥劑師都有益處。

So our conviction we will lean in and support the aggressive adoption of this. But choice will still be in the marketplace. We will still be able to afford -- enable solutions and forge solutions be the rebate, rebate pass-through or otherwise as the market goes through its transitional process and ultimately this model on a go-forward basis.

因此，我們堅信我們將積極參與並支持大力推廣這項措施。但市場上仍會有選擇。我們仍然能夠負擔得起——提供解決方案並製定解決方案，無論是退款、退款轉嫁還是其他方式，因為市場正在經歷轉型過程，最終這種模式將持續下去。

Brian, anything to add to that or to the first part of...

布萊恩，你還有什麼要補充的嗎？或者關於第一部分…

That's a pretty comprehensive answer, David, but just a few additional comments, Charles. So our launch plan from the standpoint of our new rebate-free model is unchanged based upon the FTC agreement that we reached this week. So we'll continue with the same milestone, the same expectations.

戴維，你的回答已經很全面了，不過查爾斯，我還有幾點補充。因此，根據我們本週與聯邦貿易委員會達成的協議，從我們新的無返利模式的角度來看，我們的發布計劃保持不變。所以，我們將繼續朝著同樣的里程碑努力，保持同樣的預期。

And importantly, as David made reference to earlier, inherent in our new model is we call our price Assure technology, which guarantees patients the lowest possible price on the drug when they get it filled. So whether that's the price we've negotiated with drug manufacturers, whether it's a cash pay alternative, whether it's their co-pay, whatever the lowest possible prices, we're guaranteeing in the new model of the patient will get that. And so that enables us to meet the spirit of the FTC's goals as well to drive lower patient out-of-pocket and to the point of what else could be a little bit different.

更重要的是，正如大衛之前提到的，我們新模式的固有特點是我們稱之為價格保障技術，它保證患者在配藥時獲得盡可能低的藥品價格。所以，無論是我們與藥品生產商協商的價格，還是現金支付的替代方案，或是他們的共同支付，無論價格如何，我們都保證在新模式下，患者都能獲得最低的價格。這樣一來，我們就能實現聯邦貿易委員會的目標精神，降低病患的自付費用，以及還能有哪些不同之處。

Lisa's question earlier, the move of our GPO capabilities from Switzerland or the US unrelated to the new rebate-free model. So there's some elements of the FTC agreement that are unrelated to it, but the launch plan for our rebate-free model is unchanged as a result of the agreement.

Lisa 先前提出的問題，即我們 GPO 能力從瑞士或美國轉移與新的無回扣模式無關。因此，FTC 協議中的一些內容與此無關，但由於該協議，我們無回扣模式的推出計劃不會改變。

Kevin Fischbeck, Bank of America.

凱文‧菲施貝克，美國銀行。

Great. Thanks. I'm a little bit surprised that the MLR in 2026 isn't expected to make any progress given exchanges should be repriced and smaller and stop loss. It sounds like you're repricing that again, getting generally speaking about pricing this year than last year. Why is that? And then I guess if you could just maybe give us a sense on the current business mix, what the right MLR to think about is when the business is fully repriced in the future? Thanks.

偉大的。謝謝。考慮到交易所應該重新定價、規模縮小並設定止損，我對 2026 年 MLR 預計不會取得任何進展感到有些驚訝。聽起來你們又要重新定價了，總的來說，今年的定價比去年還要高。這是為什麼？那麼，如果您能為我們介紹當前的業務組合，以及未來業務完全重新定價時，應該考慮的正確MLR是多少，那就太好了？謝謝。

Hi, Kevin. So I'll start by just reminding you what I mentioned in my prepared remarks, our 2026 MCR outlook incorporates the pricing actions we've taken across stock loss and the individual exchange businesses as well as the assumption that the cost trend environment remains elevated. So when thinking about the walk -- the MCR walk from '25 to '26, I'd point to -- two things that reduce the MCR, and two things that increase it. With respect to the reductions within stop loss, pricing is tracking in line with expectations, and we've achieved rate increases consistent with our targets for improvement in 2026. And then the second is for our individual business, we've repriced for margin improvement. So those are the two things that will reduce MCR going into '26.

嗨，凱文。首先，我想提醒大家我在準備好的發言稿中提到的內容，我們對 2026 年 MCR 的展望包含了我們在庫存損失和各個交易所業務中採取的定價措施，以及成本趨勢環境仍然高企的假設。所以，在思考這段步行——從 25 年到 26 年的 MCR 步行——時，我會指出兩件事會減少 MCR，兩件事會增加 MCR。就停損範圍內的減損而言，定價符合預期，且我們實現了與 2026 年改善目標一致的利率成長。其次，針對我們各自的業務，我們重新定價以提高利潤率。所以，這兩件事將導致 MCR 在 2026 年的表現下滑。

Items that increase the MCR on a comparative basis. If you recall that the 2025 MCR benefited from several onetime items in our individual business, both of which impact the jump-off point for the year and tempers the year-over-year MCR improvement. And beyond those items, there are mix dynamics to consider as well. And lastly, I do sort of overall, our assumptions incorporate appropriate prudence given the continued elevated cost environment.

相對而言，增加MCR的項目。如果你還記得，2025 年的 MCR 受益於我們各自業務中的幾個一次性項目，這兩個項目都會影響當年的起點，並削弱 MCR 逐年改善的幅度。除了這些因素之外，還要考慮組合動態。最後，總的來說，考慮到持續高企的成本環境，我們的假設包含了適當的謹慎。

So summarized, our MCR outlook incorporates stop-loss and due to individual pricing actions, onetime impact to '25 as well mix considerations impact that year-over-year view. And we continue to assume an elevated cost environment and appropriate imprudent. And for your question around the MCR, I'd point you to the outlook that we provided in terms of the range of where we expect to end up for 2026.

綜上所述，我們的 MCR 展望包含了止損，並且由於個別定價行為、對 2025 年的一次性影響以及組合因素，都會影響到同比展望。我們繼續假設成本環境高企，並採取適當的不審慎措施。至於你提出的關於 MCR 的問題，我想指出的是，我們已經提供了 2026 年預期最終結果範圍的展望。

Justin Lake, Wolfe Research.

賈斯汀·萊克，沃爾夫研究公司。

Thanks. Good morning. I wanted to ask a couple of more PBM questions. As you look out to 2027, it certainly seems like you don't expect the business transitions associated with the FTC settlement, the legislation would be a headwind to earnings, but wanted to confirm that is the case, and you expect 2027 PBM's earnings growth at this business to be in line with your long-term algorithm.

謝謝。早安.我還想問幾個關於藥品福利管理（PBM）的問題。展望 2027 年，您似乎不認為與 FTC 和解相關的業務轉型會對盈利造成不利影響，但我想確認一下情況是否如此，以及您是否預期 2027 年 PBM 在該業務領域的盈利增長將與您的長期演算法保持一致。

And then just from an accounting perspective, is there any changes to PBM revenue recognition here from all these business model changes effectively the move away from spread pricing, rebate guarantees towards a fee-based model, will PBM still be able to book the total pharmacy spending as revenue? Or would it move to kind of booking fee revenues similar to ASO on the medical side? Thanks.

那麼，從會計角度來看，所有這些商業模式的改變，例如從價差定價、回扣保證轉向收費模式，是否會對藥品福利管理機構 (PBM) 的收入確認產生任何影響？ PBM 是否還能將藥局的總支出確認為收入？或者它會轉向類似醫療領域應用程式商店優化（ASO）那樣的預訂費收入模式嗎？謝謝。

Good morning, Justin. It's Brian. On the first part of your question. At this point in time, the FTC agreement will not impact our 2017 financial outlook. Many of the agreements and commitments are multiyear in nature. As we talked about earlier, and as David said, our long-term growth algorithm for EBS remains intact as we move through the transitional period here.

早安，賈斯汀。是布萊恩。關於你問題的第一部分。就目前而言，聯邦貿易委員會的協議不會影響我們2017年的財務前景。許多協議和承諾都是多年期的。正如我們之前討論過的，也正如大衛所說，在我們度過這段過渡時期之際，EBS 的長期成長演算法仍然保持不變。

As we talked about on the third quarter call, we do expect 2026 and 2027 to have investment-related costs as we build out technology and infrastructure to support our new rebate-free model. So that's really the only thing I'd have you think about as it relates to 2027 in terms of the PBS outlook.

正如我們在第三季電話會議上所討論的那樣，我們預計 2026 年和 2027 年將會出現與投資相關的成本，因為我們需要建造技術和基礎設施來支持我們新的無退稅模式。所以，就 2027 年 PBS 的前景而言，這就是我唯一想讓你們考慮的事情。

On the revenue recognition question, at this point in time, we do not expect there to be changes in the way that our revenue is being recognized in the PBS segment even with the transition to a fee-based model as opposed to spread or rebate-oriented model that we have today. So we'll refine that over time and certainly can take that offline with you. We did not expect a change in the denominator and the margin profile.

關於收入確認問題，目前我們預計，即使從目前的價差或回扣模式過渡到收費模式，PBS 部門的收入確認方式也不會改變。所以我們會隨著時間的推移不斷完善，當然也可以線下跟你討論。我們並未預料到分母和利潤率結構會改變。

Erin Wright, Morgan Stanley.

艾琳·賴特，摩根士丹利。

Great. Thanks. I know there's a lot of focus on the PBM. But can you talk about the specialty business. You mentioned some of the strong organic growth there. Can you unpack a little bit some of the key drivers there, what you're anticipating in 2026? Any other implications from some of the dynamics at the PBM side as well, but also biosimilar pipeline, and as we head into 2026, how you're thinking about that? Thanks.

偉大的。謝謝。我知道大家對藥品福利管理機構（PBM）的關注度很高。但您能談談專業業務嗎？你提到了那裡的一些強勁的自然增長。能否詳細闡述其中的一些關鍵驅動因素，以及您對 2026 年的預期？PBM 方面的一些動態變化還有其他影響嗎？還有生物相似藥的研發管線，展望 2026 年，您對此有何看法？謝謝。

Good morning, Erin. It's Brian. So as we mentioned in our prepared comments, really pleased with the momentum of the Specialty business, 14%, and top line growth and attractive earnings contributions alongside of that. And we've talked about before with you, this is already a $400 billion-plus addressable market growing at a high single-digit secular growth rate, and we're really well positioned to capitalize that on that over the longer run.

早安，艾琳。是布萊恩。正如我們在準備好的評論中提到的，我們對特種業務的成長勢頭非常滿意，成長了 14%，同時營收也實現了成長，獲利貢獻也很可觀。我們之前也跟你們談過，這已經是一個超過 4000 億美元的潛在市場，並且正以接近兩位數的長期增長率增長，從長遠來看，我們完全有能力從中獲利。

And we certainly saw the dynamics emerge throughout 2025. So the full year, we had 13% growth in prescriptions. Higher rate of growth in our Medicare book of business, but also strong growth in the commercial employer and the Medicaid portfolio. And our Evernorth business is really well positioned to capitalize on each of those different payer types. We continue to expect long-term average annual income growth of 8% to 12% in this business, benefiting from some of these strong secular tailwinds.

我們確實在 2025 年看到了這種動態的出現。所以全年來看，我們的處方量增加了13%。我們的聯邦醫療保險業務成長率較高，商業雇主保險和醫療補助業務組合也實現了強勁成長。我們的 Evernorth 業務已經做好充分準備，可以充分利用每種不同的付款人類型。我們繼續預期，在強勁的長期利好因素的推動下，該行業的長期平均年收入成長率將達到 8% 至 12%。

A few specific TRCs or cost categories, I'd highlight that were particularly strong growers, include inflammatory asthma and allergy, those were -- those generated a good bit of the year-over-year growth in the specialty space. And as it relates to biosimilars, we're really pleased to see the building momentum across the United States, really HUMIRA, the past two years, becoming mainstream was a great win for the market.

我要重點指出一些成長特別強勁的特定 TRC 或成本類別，包括發炎性氣喘和過敏，這些類別在專業領域實現了相當大比例的同比增長。至於生物相似藥，我們非常高興地看到它在美國的發展勢頭強勁，尤其是在過去兩年裡，HUMIRA 成為主流藥物，這對市場來說是一個巨大的勝利。

And as David said earlier, we expect another $100 billion of Specialty drug spend to be subject to competition from biosimilars and generics by 2030. Each of these biosimilars have a slightly different adoption rate based on factors such as interchangeability, dosage levels, branded alternatives and other dimensions. But we've, as you know, introduced a zero-dollar patient out-of-pocket for both HUMIRA and STELARA. And the HUMIRA penetration in 2025 ended up representing the vast majority of eligible scripts. So that's clearly been a success story for American Healthcare from the standpoint of patients getting significant savings finance years, whether those be employers or health plans getting the benefit of the savings on these biosimilars, and we look forward to continue driving savings for patients in the future in the biosimilar and specialty generics space.

正如大衛之前所說，我們預計到 2030 年，另有 1000 億美元的專科藥物支出將面臨生物相似藥和仿製藥的競爭。根據互換性、劑量水平、品牌替代品和其他因素等因素，每種生物相似藥的採用率略有不同。但如您所知，我們已經為 HUMIRA 和 STELARA 推出了零自付費用政策。到 2025 年，HUMIRA 的滲透率最終將佔符合條件的處方藥的絕大多數。因此，從患者獲得顯著節省的角度來看，這顯然是美國醫療保健領域的一個成功案例；無論是雇主還是健康計劃，都能從這些生物類似藥的節省中受益。我們期待未來繼續在生物相似藥和特藥領域為患者節省開支。

So to kind of wrap this up, the space we're really excited about, it's 35% of the company's income now. That percentage will continue to grow in the future as we execute.

最後總結一下，我們真正感到興奮的這個領域，目前占公司收入的 35%。隨著我們不斷推進項目，這個比例未來還會繼續成長。

AJ Rice, UBS.

AJ Rice，瑞銀集團。

Hi, everybody. Thanks for the question. First, just a point of clarification to the previous comments. You guys gave the outlook for the new rebate-free model. And with that I mean for growth when you talked about third quarter, you haven't really changed that today, but you've obviously had FTC settlement and other things, where those -- I know those don't happen overnight, were those largely contemplated when you made your comments about the outlook in the third quarter.

大家好。謝謝你的提問。首先，我想對之前的評論做一點澄清。你們展望了新的無返利模式。就成長而言，您剛才談到第三季時，今天您並沒有真正改變看法，但顯然您與聯邦貿易委員會達成了和解，以及其他一些事情，我知道這些事情不會在一夜之間發生，這些事情在您發表關於第三季度前景的評論時，很大程度上都考慮到了。

And then the other thing I was wondering on your deals with manufacturers on the pharmacy side, do those need to be significantly renegotiated? How much of an unknown is that over the next few years? And do you envision formulary changes, significant or any other things we should be thinking about from the cost side of the pharmacy business.

另外，我還想問一下，關於你們與製藥廠商達成的協議，是否需要大幅重新談判？未來幾年內，這其中究竟存在多大的未知數？您是否預見到藥品目錄會發生重大變化？或者從藥局業務的成本方面，我們還應該考慮哪些其他事項？

AJ, good morning. It's David. A few parts to your question there. First, on the -- your opening portion of your question. You're correct. Our outlook or the '26 time frame and our outlook for the direction of our new pharmacy benefit innovation remains consistent, both the adoption target for '27, the adoption target for '28, and the overall margin profile.

AJ，早安。是大衛。你的問題包含幾個部分。首先，關於你問題的開頭部分。你說得對。我們對 2026 年的展望以及我們對新的藥房福利創新方向的展望仍然保持一致，包括 2027 年的採用目標、2028 年的採用目標以及整體利潤率。

Two, as I noted earlier, we began working on that in early 2025, the architecture of it, the design of it, et cetera, and we announced it in October, as you recall, of $25 million and the architecture of what we've built is quite congruent with where the regulatory environment was heading and was likely to head. So when you step back, you can look at the legislative environment or the regulatory environment, and say, what is the focus? The focus here is on increased transparency. The focus is on an environment customer first and tries to optimize the customers out-of-pocket costs and improve the customers' affordability.

第二，正如我之前提到的，我們從 2025 年初就開始著手這項工作，包括它的架構、設計等等，正如你們記得的，我們在 10 月份宣布了這項投資 2500 萬美元的項目，我們所構建的架構與監管環境的發展方向以及未來可能的發展方向非常一致。所以，當你退後一步，你可以審視立法環境或監管環境，然後說，重點是什麼？重點在於提高透明度。重點在於以客戶為先的環境，努力優化客戶的自付費用，提升客戶的負擔能力。

It's one that is more performance-oriented in some examples, I'll focus on the critical role of independent pharmacists in rural locations, et cetera, all that was contemplated in our design that we began approximately a year ago. So therefore, no change in the direction as a result of the settlement. No change in our direction as a result of what we saw in the legislation in the past this week.

在某些例子中，它更注重績效，我將重點放在獨立藥劑師在農村地區的關鍵作用等等，所有這些都是我們大約一年前開始的設計中所考慮的。因此，和解協議並未改變方向。儘管本周立法方面出現了一些變化，但我們的方向不會因此而改變。

On the second part of your question, there's work that sits in front of us to do, as Brian talked about, in the third quarter call and we referenced briefly here in terms of the build-out of the capabilities. But it is very familiar work to us and for our organization in terms of whether it's the technology work that needs to be enhanced amplifying capabilities that we're already using for the benefit of consumer pricing at point of consumption today or the work directly back with the manufacturers in terms of the restructuring of the economic arrangements that are aligned with this more transparent model on a go-forward basis.

關於你問題的第二部分，正如布萊恩在第三季度電話會議上所談到的，我們面前還有一些工作要做，我們在這裡也簡要地提到了能力建設方面的問題。但就我們和我們組織而言，這項工作非常熟悉，無論是需要加強的技術工作，以增強我們目前在消費點為消費者定價所使用的能力，還是直接與製造商合作，重組經濟安排，使其與這種更加透明的模式相一致，從而在未來更好地發展。

And your final question is will there be formulary changes. The formulary is a bit fluid. It's governed by clinical efficacy and comparative effectiveness. So clinical advocacy around the notion of the clinical impact of like-for-like drugs when they're similar, that it moves on to comparative effectiveness, which is the economics to generate that, but always led from a clinical standpoint with independent oversight. And the fluid nature of that will transpire.

最後一個問題是，配方是否會有變化。配方略有變動。它受臨床療效和比較效果的限制。因此，當藥物相似時，臨床倡議會圍繞著「同類藥物的臨床影響」這個概念展開，進而轉向比較療效，也就是產生療效的經濟效益，但始終要從臨床角度出發，並接受獨立監督。而這種變化的本質將會逐漸顯現。

But my closing comment would be, I would not expect that the transitional model to the future, it will be a direct correlation to a formulary change the formulary who will continue to be guided by the proper governance of clinical efficacy first and then comparative effectiveness, optimizing the total cost structure. So taking it all in, again, we could not be more pleased with the direction that we have set for the industry around the transparent customer-centric, rebate-free fee-based model, and the ability to secure a broad closure of issues, both from a regulatory standpoint and clarity from a legislative standpoint. AJ, thanks for the question.

但我最後想說的是，我不認為過渡到未來的模式會與處方集的變化直接相關，處方集將繼續以臨床療效為先導，然後是比較療效，以優化總成本結構為目標。綜上所述，我們對我們為行業設定的方向感到無比滿意，即以透明、以客戶為中心、無回扣、基於費用的模式為基礎，並能夠從監管角度和立法角度確保廣泛解決問題。AJ，謝謝你的提問。

Stephen Baxter, Wells Fargo.

史蒂芬‧巴克斯特，富國銀行。

Thank you. I was hoping you could maybe expand a little bit more on the healthcare medical membership outlook that you gave. It seems like we're seeing a bit more of an outsized shift into ASO funding models based on some of the other reports series, maybe that's the higher cost environment. So I was hoping you could expand a little bit on what you're seeing there, whether you might see more outsized growth in select this year? And then just broadly, how you're thinking about in-group enrollment trends given some of the uncertainty in the macro right now? Thank you.

謝謝。希望您能就您提出的醫療保健會員前景再詳細闡述。根據其他一些報告系列來看，我們似乎看到 ASO 資助模式出現了更大的轉變，也許是因為成本環境較高。所以我希望您能詳細說說您觀察到的情況，例如今年精選產品是否會有更顯著的成長？那麼，從總體上看，考慮到目前宏觀經濟存在一些不確定性，您如何看待團體內部招生趨勢？謝謝。

Good morning, Stephen. Tt's Brian. So as it relates to the Cigna Healthcare membership outlook, as you saw in the press release, we expect flat year-over-year at about 18.1 million lives. And really, you can think of that big picture is we expect growth in our US employer and international health businesses, offset by a decline in individual exchange customers. Within the US employer portfolio, we expect to see growth in both our select and middle market subsegments, reflecting the continued strength of the consultative model along with our integrated medical, pharmacy and behavioral offerings, plus our focus on affordability for these employers.

早安，史蒂芬。是布萊恩。因此，就 Cigna Healthcare 的會員前景而言，正如您在新聞稿中看到的那樣，我們預計會員人數將與去年持平，約為 1810 萬人。實際上，從宏觀角度來看，我們預計美國雇主和國際健康業務將實現成長，但個人交易所客戶的減少將抵消這一成長。在美國雇主組合中，我們預計精選市場和中端市場區隔領域都將實現成長，這反映了諮詢模式的持續優勢，以及我們整合的醫療、藥局和行為健康服務，還有我們對這些雇主可負擔性的關注。

I would not expect an outsized year of growth to your question on select necessarily, but we do expect growth in that space in 2026. And that growth in selected middle market is partially offset by some decline in national accounts customers in 2026, similar to what we signaled to you previously.

對於您提出的關於精選產品的問題，我並不認為今年會有超乎尋常的增長，但我們確實預計 2026 年該領域會有增長。而2026年部分中端市場的成長將被全國性客戶數量的下降部分抵消，這與我們先前向您發出的訊號類似。

Within the individual exchange business, we expect to end 2026 with fewer than 300,000 customers, reflecting another year where we prioritized margin overgrowth. So again, the net effect of all of this is membership that's approximately flat, although we anticipate an attractive year of earnings growth within Cigna Healthcare.

在個人兌換業務方面，我們預計到 2026 年底客戶數量將少於 30 萬，這反映出我們又一年優先考慮利潤率超額成長。因此，所有這些因素的最終結果是會員人數基本持平，儘管我們預計信諾醫療保健公司今年的獲利成長將十分可觀。

As it relates to the funding mix, we expect our group risk business to be stable for 2026 compared to 2025. So think of around 2.2 million lives, which, again, reflects our disciplined pricing posture. And as we talked about in prior settings, our select segment mix today is roughly 2/3 self-funded, and our net growth in Select has been coming from ASO and level-funded style solutions in recent years. And as a reminder, we're not active in the under 50 regulated small group markets. So our commercial group risk business here is essentially all large group in nature.

就資金結構而言，我們預計2026年集團風險業務將與2025年相比保持穩定。所以想想大約 220 萬人的生命，這再次體現了我們嚴謹的定價策略。正如我們之前討論過的，我們目前的精選細分市場組合大約有 2/3 是自籌資金的，而近年來我們在精選細分市場的淨增長主要來自應用商店優化 (ASO) 和按比例付費的解決方案。再次提醒大家，我們不涉足 50 歲以下受監管的小團體市場。因此，我們這裡的商業團體風險業務基本上都是大型團體性質的。

In group enrollment trends, we are not seeing anything out of the ordinary. Obviously, we continue to monitor economic data unemployment data. But to date, we have not seen anything out of the ordinary. Our 2026 outlook reflects our current view of what the economy will do.

從團體報名趨勢來看，我們並沒有發現任何異常情況。顯然，我們會持續監測經濟數據和失業數據。但到目前為止，我們還沒有發現任何異常情況。我們對 2026 年的展望反映了我們目前對經濟走向的看法。

Jason Cassorla, Guggenheim.

傑森·卡索拉，古根漢美術館。

Great. Thanks. Good morning. I wanted to ask, especially in care for 2026. I just wanted to confirm, are you still anticipating AOI growth at the higher end of your 8% to 12% target offer '26? And then can you help spike out what the implied AOI growth would be when excluding the income attribution from the Shield investment? Just maybe like more core basis, growth would be helpful. Thanks.

偉大的。謝謝。早安.我想問一下，特別是關於 2026 年的護理問題。我只是想確認一下，您是否仍預期 2026 年 AOI 成長將達到您預期目標 8% 至 12% 的上限？那麼，您能否幫忙估算一下，如果排除 Shield 投資的收入貢獻，隱含的 AOI 成長率會是多少？或許，像核心基礎更紮實一些，成長會有所幫助。謝謝。

Sure. Good morning, Jason. So for Specialty and Care, we expect earnings to grow towards the high end of the long-term growth rate, reflecting both strong fundamentals and the contribution from the shales investment. We're really pleased with what we saw in 2025 overall for Specialty & Care.

當然。早上好，傑森。因此，對於專科護理業務，我們預期其收益將成長至長期成長率的高端，這不僅反映了強勁的基本面，也反映了頁岩氣投資的貢獻。我們對 2025 年專科護理的整體發展非常滿意。

Our expectations for 2026 remain consistent with what we shared coming out of the third quarter. We haven't shared the details specifically around Shield is built into our expectations, but that takes us to the high end of the range.

我們對 2026 年的預期與第三季末公佈的預期保持一致。我們還沒有具體透露有關 Shield 的細節，但這符合我們的預期，也意味著我們將產品線推向高端。

Andrew Mok, Barclays.

Andrew Mok，巴克萊銀行。

Good morning. The operating cash flow and CapEx guidance implies less than 80% free cash flow conversion on your pretax income, which is below recent history and lower sequentially. So can you walk us through the drivers of that pressure and comment on the expected impact of the new rebate-free model on working capital? Thanks.

早安.營運現金流和資本支出指引表明，稅前收入的自由現金流轉換率低於 80%，低於近期歷史水平，且季減。那麼，您能否為我們詳細介紹造成這種壓力的因素，並評論一下新的無退稅模式對營運資金的預期影響？謝謝。

I'll start with the cash flow expectation. So we were really pleased with $9.6 billion for this year coming out. And as I said in my prepared remarks, we do expect a dynamic of higher cash flow or more cash flow in the back half of the year next year.

我先從現金流預期說起。所以，我們對今年96億美元的收入非常滿意。正如我在準備好的演講稿中所說，我們預計明年下半年現金流將會增加。

When stepping back and looking at our 2026 cash flow expectations, that -- the decline to the $9 billion that we're guiding to next year is roughly $600 million less than what we thought in 2025. That primarily reflects the lower contribution from the PBS business from our pharmacy benefit services business. And really, that includes the impact of large client renewals and some of the investments that we're making in 2026.

當我們回顧 2026 年的現金流預期時，會發現——我們預計明年現金流將下降至 90 億美元，比我們 2025 年的預期減少了約 6 億美元。這主要反映了我們的藥房福利服務業務中，PBS業務的貢獻較低。這實際上包括大客戶續約的影響以及我們在 2026 年進行的一些投資。

And Andrew, the rebate-free model will not impact the '26 cash flow outlook. And as we get closer to '27 to '28, we can square that up for you a bit in terms of reconciling how that moves year-over-year.

安德魯，無返利模式不會影響 2026 年的現金流前景。隨著 2027 年到 2028 年的臨近，我們可以稍微幫您理清一下，看看它是如何逐年變化的。

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

現在我將把電話交給大衛·科爾達尼，請他作總結發言。

First and foremost, thank you for your questions and your time today. I just want to reiterate the items. First, with our momentum, we are confident we will deliver on our adjusted EPS outlook of at least $30.25 for 2026. Important to note in the context of a very dynamic environment in 2025, we delivered competitively attractive results, and I'm proud of how our team works tirelessly each and every day for the benefit of those we serve, where we work to know our customers help them by delivering personalized solutions and support programs for the unique needs and working every day to make it easier to access affordable care. We look forward to our future conversations. Thanks, and have a good day.

首先，非常感謝各位提出的問題以及今天抽出時間。我只想重申一下這些事項。首先，憑藉我們目前的勢頭，我們有信心實現 2026 年調整後每股收益至少 30.25 美元的目標。值得注意的是，在 2025 年這個瞬息萬變的環境中，我們取得了具有競爭力的優異成績。我為我們的團隊感到自豪，他們每天都在努力，為我們服務的對象謀福利。我們努力了解客戶，透過提供個人化的解決方案和支援計劃來幫助他們，以滿足他們獨特的需要，並且每天都在努力讓他們更容易獲得負擔得起的醫療保健服務。我們期待未來的對話。謝謝，祝您今天過得愉快。

Ladies and gentlemen, this concludes the Cigna Group's fourth 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 866-405-7290 or 203-369-0603. There is no pass code required for this replay.

女士們、先生們，信諾集團2025年第四季業績回顧到此結束。信諾投資者關係部門將盡快解答其他問題。本次會議的錄音將在會議結束後10個工作天內提供聆聽。您可以撥打 866-405-7290 或 203-369-0603 收聽錄音會議。本次回放無需密碼。

Thank you for participating. You will now disconnect.

感謝您的參與。您即將斷開連線。