CVS Health Corp (CVS) 2018 Q4 法說會逐字稿

Good morning, everyone, and thank you for standing by.

大家早上好，謝謝你們的支持。

Welcome to the conference call to discuss CVS Health's fourth quarter 2018 results and 2019 outlook.

歡迎參加電話會議，討論 CVS Health 2018 年第四季度業績和 2019 年展望。

As a reminder, this call is being recorded on Wednesday, February 20, 2019.

提醒一下，本次通話的錄音時間為 2019 年 2 月 20 日，星期三。

I'm Mike McGuire, Senior Vice President of Investor Relations for CVS Health.

我是 CVS Health 投資者關係高級副總裁 Mike McGuire。

I'm joined this morning by Larry Merlo, President and CEO; and Eva Boratto, Executive Vice President and CFO.

今天早上，總裁兼首席執行官拉里·梅洛 (Larry Merlo) 加入了我的行列；和 Eva Boratto，執行副總裁兼首席財務官。

Following our prepared remarks, we'll host a question-and-answer session.

在我們準備好的評論之後，我們將舉辦問答環節。

(Operator Instructions)

（操作員說明）

In addition to this call and our press release, we have posted a slide presentation on our website that summarizes the information in our prepared remarks as well as some additional facts and figures regarding our operating performance and guidance.

除了本次電話會議和我們的新聞稿外，我們還在我們的網站上發布了幻燈片演示文稿，其中總結了我們準備好的評論中的信息以及一些關於我們的經營業績和指導的額外事實和數據。

Our 10-K will be filed later this month, and that, too, will be available on our website once filed.

我們的 10-K 將於本月晚些時候提交，提交後也將在我們的網站上提供。

I have one announcement this morning.

今天早上我有一個公告。

Our annual Investor Day has been scheduled for Tuesday, June 4, in New York City.

我們的年度投資者日定於 6 月 4 日星期二在紐約市舉行。

You will have the opportunity to hear from our senior management team, who will provide a comprehensive update of the execution of our strategic vision and an in-depth review of our strategies for driving long-term growth and creating shareholder value.

您將有機會聽取我們高級管理團隊的意見，他們將全面更新我們戰略願景的執行情況，並深入審查我們推動長期增長和創造股東價值的戰略。

We plan to send invitations via e-mail with more specific details in the spring, but please save the date.

我們計劃在春季通過電子郵件發送包含更具體細節的邀請，但請保留日期。

Again, that's Tuesday, June 4.

同樣，那是 6 月 4 日，星期二。

Please note that during this call, we will make certain forward-looking statements that reflect our current views related to our future financial performance, future events and industry and market conditions and forward-looking statements related to the integration of the Aetna acquisition, including the expected consumer benefits, financial projections and synergies.

請注意，在本次電話會議期間，我們將作出某些前瞻性陳述，以反映我們當前對我們未來財務業績、未來事件以及行業和市場狀況的看法，以及與 Aetna 收購整合相關的前瞻性陳述，包括預期的消費者利益、財務預測和協同效應。

These forward-looking statements are subject to risks and uncertainties that could cause actual results to differ materially from what may be indicated in the forward-looking statements.

這些前瞻性陳述受到風險和不確定性的影響，這些風險和不確定性可能導致實際結果與前瞻性陳述中可能表明的結果存在重大差異。

We strongly encourage you to review the information in the reports we file with the SEC regarding these specific risks and uncertainties, in particular, those that are described in the Risk Factors section of our annual report on Form 10-K and the cautionary statement disclosures in our quarterly report on Form 10-Q.

我們強烈建議您查看我們向美國證券交易委員會提交的報告中有關這些特定風險和不確定性的信息，特別是我們年度報告的 10-K 表風險因素部分和中的警告聲明披露中描述的那些信息我們關於 10-Q 表格的季度報告。

You should also review the section entitled Forward-Looking Statements in our earnings press release.

您還應該查看我們的收益新聞稿中標題為“前瞻性陳述”的部分。

During this call, we will use non-GAAP financial measures when talking about our company's performance and financial condition.

在這次電話會議中，我們將在談論我們公司的業績和財務狀況時使用非 GAAP 財務指標。

In accordance with SEC regulations, you can find a discussion of these non-GAAP measures and the comparable GAAP measures in the associated reconciliation document we posted on the Investor Relations portion of our website.

根據美國證券交易委員會的規定，您可以在我們網站投資者關係部分發布的相關調節文件中找到對這些非 GAAP 措施和類似 GAAP 措施的討論。

And as always, today's call is being webcast on our website, where it will be archived for 1 year following today's call.

與往常一樣，今天的電話會在我們的網站上進行網絡直播，並在今天的電話會議後存檔 1 年。

Now I'll turn this over to Larry Merlo.

現在我將把這個交給 Larry Merlo。

Thanks, Mike.

謝謝，邁克。

Good morning, everyone, and thanks for joining us today.

大家早上好，感謝今天加入我們。

We achieved strong performance in the fourth quarter and in full year 2018.

我們在第四季度和 2018 年全年取得了強勁的業績。

And importantly, with the completion of our merger with Aetna, we have positioned CVS Health to excel in a market that is undergoing profound and rapid transformation.

重要的是，隨著我們與 Aetna 的合併完成，我們已將 CVS Health 定位為在正在經歷深刻而快速轉型的市場中脫穎而出。

In recent years, it has become increasingly evident that the path to long-term growth and value creation lies in the establishment of new integrated health care models that provide consumers better care and convenience at a lower cost.

近年來，越來越明顯的是，長期增長和價值創造的途徑在於建立新的綜合醫療保健模式，以更低的成本為消費者提供更好的護理和便利。

And since closing the Aetna merger, we are increasingly confident in the synergistic potential of this powerful combination to build and deliver shareholder value.

自從完成與 Aetna 的合併以來，我們對這一強大組合在建立和實現股東價值方面的協同潛力越來越有信心。

CVS Health is in a superior position to lead the change needed in a fragmented U.S. health care system with our compelling fully integrated health care offerings, our unmatched local community assets, proven pharmacy care leadership and a commitment to collaborating with health care providers to achieve the very best outcomes for the patients and clients we serve.

CVS Health 處於優勢地位，可以通過我們引人注目的完全整合的醫療保健產品、我們無與倫比的當地社區資產、久經考驗的藥房護理領導力以及與醫療保健提供者合作的承諾來引領支離破碎的美國醫療保健系統所需的變革，以實現為我們服務的患者和客戶帶來最好的結果。

In 2018, we delivered on our financial expectations as did Aetna, laying a strong foundation for a successful combination.

2018 年，我們與 Aetna 一樣實現了財務預期，為成功合併奠定了堅實的基礎。

We generated significant cash flows with nearly $7 billion of free cash for full year '18, consistent with our expectations.

18 年全年，我們產生了可觀的現金流，自由現金接近 70 億美元，符合我們的預期。

And we returned $2 billion back to shareholders through dividends and later deployed the cash we raised in early '18 to fund the Aetna merger.

我們通過股息向股東返還了 20 億美元，後來又動用了我們在 18 年初籌集的現金，為 Aetna 的合併提供資金。

So in short, 2018 was a milestone year both tactically and strategically as we successfully completed our transformational merger with Aetna.

因此，簡而言之，2018 年在戰術和戰略上都是具有里程碑意義的一年，因為我們成功完成了與 Aetna 的轉型合併。

Now we also delivered our key foundational steps for growth in health care services.

現在，我們還實施了促進醫療保健服務增長的關鍵基礎步驟。

This includes making more than 80% of primary care services available to consumers at MinuteClinic, while also increasing home visits by Coram for infusion services by more than 15%.

這包括在 MinuteClinic 向消費者提供超過 80% 的初級保健服務，同時還將 Coram 輸液服務的家訪次數增加 15% 以上。

Importantly, we began effective implementation of our integration strategy and took important steps toward building the integrated health care model that will bring substantial value to our various stakeholders.

重要的是，我們開始有效實施我們的整合戰略，並採取重要步驟建立整合醫療保健模式，這將為我們的各個利益相關者帶來巨大價值。

Now we expect 2019 to be a year of transition as we integrate Aetna and focus on key pillars of our growth strategy, creating a more consumer-centric health care experience.

現在，我們預計 2019 年將是轉型的一年，因為我們整合了 Aetna 並專注於我們增長戰略的關鍵支柱，創造更加以消費者為中心的醫療保健體驗。

As an example, our first 3 concept stores were unveiled earlier this month.

例如，我們的前 3 家概念店於本月早些時候亮相。

And you probably saw the press coverage last week, and there's a lot of excitement around the consumer engagement and response.

你可能上週看到了媒體報導，消費者的參與和反應令人興奮。

Now it's still early as we're in the learning phase and working to define a hub-and-spoke approach, but it's an example of the work underway, and I'll share additional progress on achieving our vision in just a few minutes.

現在還為時過早，因為我們正處於學習階段並正在努力定義中心輻射型方法，但這是正在進行的工作的一個例子，我將在短短幾分鐘內分享實現我們願景的其他進展。

Now that said, we're also fully aware of the need to address the impact of certain headwinds that are having a disproportionate impact in '19 when compared to prior years.

話雖如此，我們也充分意識到有必要解決某些逆風的影響，這些逆風在 19 年與往年相比產生了不成比例的影響。

Many of these issues we've talked about previously, and most significant is the ongoing pharmacy reimbursement pressures in our businesses and the reduction in offsets to those pressures.

其中許多問題我們之前已經討論過，最重要的是我們業務中持續存在的藥房報銷壓力以及對這些壓力的抵消減少。

What we're experiencing in '19 is a declining benefit from new generics, lower brand inflation and the ongoing questions around rebates, along with some structural and CVS-specific challenges in the long-term care space.

我們在 19 年經歷的是新仿製藥帶來的收益下降、品牌通脹下降以及圍繞回扣的持續問題，以及長期護理領域的一些結構性和 CVS 特定挑戰。

And while these factors will negatively affect the business in the short term, I want to outline the comprehensive actions we have taken in response.

雖然這些因素會在短期內對業務產生負面影響，但我想概述一下我們已採取的綜合應對措施。

In our Retail business, we are continuing to develop product and service initiatives that will accelerate top line revenue and profitability.

在我們的零售業務中，我們將繼續開發產品和服務計劃，以加快收入和盈利能力。

We are winning from a growth perspective, and we expect to continue on those positive trends.

從增長的角度來看，我們正在取得成功，我們希望繼續保持這些積極趨勢。

In the front store, this includes introducing new product lines in the health and beauty areas, along with the expansion of higher-margin service offerings.

在前店，這包括在健康和美容領域引入新的產品線，以及擴大利潤率更高的服務產品。

In the pharmacy, we will continue to deliver market-leading top line growth through our network relationships and clinical care programs.

在藥房，我們將繼續通過我們的網絡關係和臨床護理計劃實現市場領先的收入增長。

Additionally, we are developing a new retail contracting strategy that better aligns reimbursement to the value our clinical products provide, enabling adherence improvements and store enhancements while saving patients money, to name just a few.

此外，我們正在開發一種新的零售合同策略，以更好地使報銷與我們的臨床產品提供的價值保持一致，從而在為患者節省金錢的同時實現依從性改進和商店增強，僅舉幾例。

Second in the PBM, we've created a new contracting model that provides for more transparency, simplicity for and alignment with our clients.

其次，在 PBM 中，我們創建了一個新的合同模型，為我們的客戶提供更高的透明度、簡單性和一致性。

The Guaranteed Net Cost pricing model is an innovative way to approach the market by allowing us to maximize all cost control tools at our disposal.

保證淨成本定價模型是一種進入市場的創新方式，它使我們能夠最大限度地利用所有可用的成本控制工具。

In this model, clients will receive 100% of rebates while we leverage our core strengths of contracting expertise and utilization management to drive lower net costs for our clients and members without compromising on the quality of care.

在這種模式下，客戶將獲得 100% 的回扣，同時我們利用我們在合同專業知識和使用管理方面的核心優勢，在不影響護理質量的情況下為我們的客戶和會員降低淨成本。

Now this is a win-win.

現在這是一個雙贏的局面。

Clients will benefit from the simplicity of one guaranteed price per claim that's focused on lower net costs and not discounts and rebates.

客戶將受益於每次索賠的一個保證價格的簡單性，該價格專注於降低淨成本而不是折扣和回扣。

Now we've introduced this approach to clients and benefit consultants, and we will have a small number of clients adopting the model this year.

現在我們已經向客戶和福利顧問介紹了這種方法，今年我們將有少量客戶採用這種模式。

We expect a more rapid adoption in '20 and beyond.

我們預計在 20 世紀及以後會得到更快的採用。

Third, back in August, we outlined a 4-point plan to get the Long-Term Care business back on track.

第三，早在 8 月份，我們就制定了一項 4 點計劃，以使長期護理業務重回正軌。

And while progress is being made in the identified areas, the benefits are being offset by the external factors impacting the Skilled Nursing business.

雖然在確定的領域取得了進展，但影響熟練護理業務的外部因素正在抵消收益。

And work is underway to accelerate the action plan time line to achieve the benefits more quickly.

並且正在努力加快行動計劃的時間表，以更快地實現收益。

And we've already begun to see some progress, realizing nearly $80 million in process improvement savings with more to come.

我們已經開始看到一些進展，在流程改進方面實現了近 8000 萬美元的節省，未來還會有更多。

Fourth, in early January, we began planning a new cost-reduction effort across the enterprise, going beyond the previously announced productivity initiatives of the legacy companies and targeting opportunities that neither company would be able to accomplish as a stand-alone.

第四，在 1 月初，我們開始計劃在整個企業範圍內開展新的成本削減工作，超越先前宣布的傳統公司的生產力計劃，並瞄準兩家公司都無法獨立完成的機會。

This effort is in addition to the near-term synergy work tied to the $750 million target, which we are on track to exceed.

這項工作是對與 7.5 億美元目標相關的近期協同工作的補充，我們有望超過該目標。

As we look across the new combined enterprise, there are significant streamlining opportunities in member enrollment, clients processing and customer service as well as through the use of robotics and advanced analytics.

當我們審視新的合併企業時，在會員註冊、客戶處理和客戶服務以及通過使用機器人技術和高級分析方面存在顯著的精簡機會。

Additionally, we are focused on aggressively managing working capital, especially through the reduction of inventory and improvement of terms within our payables.

此外，我們專注於積極管理營運資金，尤其是通過減少庫存和改善應付賬款條款。

And we'll have more details for you on our May earnings call.

我們將在 5 月份的財報電話會議上為您提供更多詳細信息。

And finally, we continue to evaluate our assets and the roles they play in enabling the core strategies of our new company.

最後，我們繼續評估我們的資產以及它們在實現我們新公司的核心戰略方面發揮的作用。

So we'll provide updates to the actions we have underway as we execute our vision in a strategic and innovative, yet practical, realistic and carefully prioritized way.

因此，我們將更新我們正在採取的行動，以一種戰略性和創新性、務實、現實和仔細確定優先次序的方式執行我們的願景。

We understand acutely the importance of balancing near-term execution with longer-term vision, and we are confident that these actions will position us well in 2020 and beyond.

我們敏銳地理解平衡近期執行與長期願景的重要性，我們相信這些行動將使我們在 2020 年及以後處於有利地位。

Now several key pillars that we are executing on today will drive above-market growth going forward in this rapidly changing health care environment.

現在，我們今天正在執行的幾個關鍵支柱將在這個瞬息萬變的醫療保健環境中推動高於市場的增長。

And a few key initiatives that underlie the ongoing execution of our strategy are as follows.

以下是我們持續執行戰略的一些關鍵舉措。

First, we are growing membership.

首先，我們正在增加成員。

We are working to expand the reach of our government business with Medicare positioned to lead the way.

我們正在努力擴大政府業務的範圍，而 Medicare 處於領先地位。

Medicare Advantage top line growth is being driven by the addition of new membership in existing markets and continued geographic expansion.

Medicare Advantage 的收入增長受到現有市場新成員的增加和持續的地域擴張的推動。

Driving excellence in STAR ratings continues to be a primary focus for our business.

推動卓越的 STAR 評級仍然是我們業務的主要重點。

And by enhancing our clinical model, products and capabilities, we are expanding our offering to take care of higher-acuity and complex members, including dual-eligibles, a critically important set of beneficiaries, when bending the cost curve.

通過增強我們的臨床模型、產品和能力，我們正在擴大我們的產品範圍，以在彎曲成本曲線時照顧更敏銳和復雜的成員，包括雙重資格，一組至關重要的受益人。

Our success in building the largest Medicare Part D plan, SilverScript, while simultaneously becoming the partner of choice for more than 40 health plan Part D clients, gives us the confidence that we can further expand upon the success of both organizations.

我們成功構建了最大的醫療保險 D 部分計劃 SilverScript，同時成為 40 多個健康計劃 D 部分客戶的首選合作夥伴，這讓我們有信心進一步擴大這兩個組織的成功。

Looking ahead, we see a strong and growing pipeline of new business opportunity within Group Medicare for 2020.

展望未來，我們看到 2020 年 Group Medicare 內的新商機數量不斷增加。

And we see opportunity as well within Medicaid, building upon the success we've had with recent wins in Kansas and Florida.

我們在醫療補助計劃中也看到了機會，建立在我們最近在堪薩斯州和佛羅里達州取得成功的基礎上。

And of course, we are actively working to strengthen our commercial offerings.

當然，我們正在積極努力加強我們的商業產品。

Now success in all of these areas requires the use of our full breadth of capabilities: comprehensive data, predictive analytics and our unparalleled intervention points with consumers to drive behavior change and improve health outcomes.

現在，要在所有這些領域取得成功，都需要利用我們全面的能力：全面的數據、預測分析和我們無與倫比的消費者乾預點，以推動行為改變並改善健康結果。

And both Aetna and CVS Caremark have very successful employer businesses, and we're working on opportunities to create new products and services to meet the needs of these payers.

Aetna 和 CVS Caremark 都有非常成功的雇主業務，我們正在努力創造新產品和服務的機會來滿足這些付款人的需求。

Second, we are creating differentiated products and services at the community level, driving meaningful value for both consumers and payers while improving the bottom line.

其次，我們正在社區層面創造差異化的產品和服務，為消費者和付款人帶來有意義的價值，同時提高底線。

Now this reflects our broad base of consumer-facing assets that is highlighted by our nearly 10,000 CVS pharmacies.

現在，這反映了我們面向消費者的廣泛資產基礎，我們近 10,000 家 CVS 藥店突出了這一點。

And I touched on the first concept stores earlier, but importantly, our assets extend well beyond our pharmacies when you think about the role and the value that MinuteClinic, Coram, Accordant and other ancillary businesses can play.

我早些時候談到了第一家概念店，但重要的是，當你考慮 MinuteClinic、Coram、Accordant 和其他輔助業務可以發揮的作用和價值時，我們的資產遠遠超出了我們的藥店。

And while our community assets have the power to improve outcomes and reduce costs, they also contribute to enterprise revenue and earnings growth.

雖然我們的社區資產有能力改善成果和降低成本，但它們也有助於企業收入和收益增長。

Third is the role of partnerships in accelerating innovation.

第三是夥伴關係在加速創新方面的作用。

And our recent announcement with Apple on the development and springtime rollout of Attain by Aetna is just one example.

我們最近與 Apple 就 Aetna 的 Attain 的開發和春季推出發表的聲明只是一個例子。

Applying new technologies will be a component of our consumer-centric approach to improving health.

應用新技術將成為我們以消費者為中心的改善健康方法的組成部分。

And finally, we are establishing the optimal structure and go-to-market strategy for our health services offerings.

最後，我們正在為我們的醫療服務產品建立最佳結構和上市戰略。

We've been very clear about our vision of creating an open platform model that will serve the needs of all payers.

我們一直非常清楚我們創建一個開放平台模型以滿足所有付款人需求的願景。

And to support this goal, we are integrating existing capabilities with new products and services that will benefit all Aetna and Caremark clients and their members, and we are on track to have this in the market for the 2021 selling season.

為了支持這一目標，我們正在將現有能力與新產品和服務相結合，這將使 Aetna 和 Caremark 的所有客戶及其成員受益，我們有望在 2021 年銷售季將其推向市場。

So we're more excited than ever about our progress and the opportunities that lie ahead.

因此，我們對我們的進步和未來的機遇比以往任何時候都更加興奮。

We also have a good understanding of the factors that impact our business in the near term and are actively working to address them.

我們也非常了解影響我們業務的短期因素，並正在積極努力解決這些問題。

We view 2019 as a bridge to the future, and we expect our businesses to strengthen meaningfully from the integration of CVS and Aetna's core capabilities.

我們將 2019 年視為通向未來的橋樑，我們希望我們的業務能夠通過 CVS 和 Aetna 核心能力的整合而顯著增強。

Now I'm also pleased to introduce the leaders of our businesses: Jon Roberts, Chief Operating Officer; Kevin Hourican, President of CVS Pharmacy; Karen Lynch, President of Aetna; and Derica Rice, President of CVS Caremark.

現在我也很高興介紹我們業務的領導者：Jon Roberts，首席運營官； CVS 藥房總裁 Kevin Hourican； Aetna 總裁 Karen Lynch；和 CVS Caremark 總裁 Derica Rice。

They'll be joining us for the Q&A after our prepared remarks.

在我們準備好發言後，他們將加入我們的問答環節。

And our senior leadership team is energized by the prospects of our new company.

我們的高級領導團隊對新公司的前景充滿活力。

And together with all of our colleagues across the enterprise, we are laser-focused and fully committed to delivering on the vast potential of this combination.

我們與整個企業的所有同事一起，專注於激光並完全致力於實現這種組合的巨大潛力。

So let me turn the call over to Eva to walk through the key items from '18 and the details of our '19 financial outlook.

因此，讓我將電話轉給 Eva，讓她了解 18 年的關鍵項目以及我們 19 年財務展望的詳細信息。

Thanks, Larry, and good morning, everyone.

謝謝，拉里，大家早上好。

Before I get into the details of our results and guidance, please note there is a significant amount of information in the presentation we posted to our website this morning to help you understand the changes to our financials for both 2018 and 2019.

在我詳細介紹我們的結果和指導之前，請注意我們今天早上在我們網站上發布的演示文稿中包含大量信息，以幫助您了解我們 2018 年和 2019 年財務狀況的變化。

Regarding 2018, while the face of the P&L is different, definitions of non-GAAP are consistent with legacy CVS.

關於 2018 年，雖然損益表有所不同，但非 GAAP 的定義與舊版 CVS 一致。

However, interest income is shifting from net interest expense to revenue to conform to insurance company presentation.

然而，利息收入正從淨利息支出轉為收入，以符合保險公司的陳述。

With that, I'll provide some key highlights for 2018.

有了這個，我將提供 2018 年的一些主要亮點。

As Larry stated, CVS Health generated significant free cash of nearly $7 billion for the full year '18.

正如拉里所說， CVS Health 在 18 年全年產生了近 70 億美元的大量自由現金。

And we used it in addition to the cash on hand to repay $5.5 billion in debt, of which $3.5 billion were scheduled maturities and $2 billion was a voluntary early repayment of a 5-year term loan.

除了手頭現金外，我們還用它償還了 55 億美元的債務，其中 35 億美元是定期到期的，20 億美元是自願提前償還的 5 年期貸款。

We also delivered $2 billion to shareholders through our dividend.

我們還通過股息向股東交付了 20 億美元。

We delivered adjusted EPS of $7.08, at the high end of our guidance range, reflecting the addition of Aetna, with all of our businesses performing at our expectations.

我們交付的調整後每股收益為 7.08 美元，處於我們指導範圍的高端，反映了 Aetna 的加入，我們所有業務的表現都達到了我們的預期。

On a stand-alone basis, CVS Health adjusted revenue grew 2.3% in 2018, at the top end of our full year guidance range.

單獨來看，CVS Health 調整後的收入在 2018 年增長了 2.3%，處於我們全年指導範圍的頂端。

With the addition of 34 days of Aetna's operations, which are now embedded in our new Health Care Benefits segment, adjusted revenues grew 5% to $194 billion, with HCB contributing an additional $5.1 billion after considering eliminations.

隨著 Aetna 運營的 34 天增加（現在已納入我們新的醫療保健福利部門），調整後的收入增長了 5% 至 1,940 億美元，HCB 在考慮消除後貢獻了額外的 51 億美元。

In 2018, the Retail/Long-Term Care segment delivered adjusted script growth of 8.8%, driven by our pharmacy clinical programs, comprised of increased adoption of 90-day program as well as the successful partnering with PBMs and health plans via network relationships, including additional preferred positions in a number of Med D networks.

2018 年，零售/長期護理部門在我們的藥房臨床項目的推動下實現了 8.8% 的調整後腳本增長，包括增加採用 90 天計劃以及通過網絡關係與 PBM 和健康計劃成功合作，包括在許多 Med D 網絡中的其他首選職位。

Adjusted operating income declined by 1.2%, driven by our decision to invest a portion of the benefits we've realized from tax reform into wages and benefits.

調整後的營業收入下降了 1.2%，這是由於我們決定將我們從稅制改革中獲得的部分收益投資於工資和福利。

Additionally, we continued to experience underperformance in the Long-Term Care Pharmacy business.

此外，我們的長期護理藥房業務繼續表現不佳。

Excluding those 2 items, stand-alone Retail Pharmacy adjusted operating income grew solidly by about 5% over full year 2017.

不包括這兩項，獨立零售藥房調整後的營業收入比 2017 年全年穩步增長約 5%。

Notably, our market-leading script growth increased our Pharmacy market share to a record 26% in December.

值得注意的是，我們市場領先的腳本增長在 12 月將我們的藥房市場份額提高到創紀錄的 26%。

In the PBM, adjusted claims increased 6.1% over full year 2017, driven by net new business wins and continued adoption of Maintenance Choice.

在 PBM 中，調整後的索賠比 2017 年全年增長了 6.1%，這主要受新業務淨贏和繼續採用 Maintenance Choice 的推動。

PBM operating income was up nearly 1%, as expected.

正如預期的那樣，PBM 營業收入增長了近 1%。

The formulary and cost-management strategies Caremark has developed effectively mitigated drug cost increases in 2018.

Caremark 開發的處方集和成本管理策略有效地緩解了 2018 年的藥物成本增長。

Prices for non-specialty medications decreased 4.2% for commercial clients, while we also held price growth on specialty products to just 1.7%, despite even higher list price increases.

商業客戶的非專業藥物價格下降了 4.2%，而我們也將專業產品的價格漲幅保持在 1.7%，儘管標價漲幅更高。

We also worked to improve health outcomes and reduce member costs, successfully driving the average cost per script for plan members down for a third year in a row.

我們還努力改善健康結果並降低會員成本，成功地連續第三年降低計劃會員的每個腳本的平均成本。

And finally, the Health Care Benefits' medical membership was 22.1 million.

最後，醫療保健福利的醫療會員人數為 2210 萬。

Government programs represented approximately half of HCB's insured membership at year-end '18, positioning the segment to drive future growth.

截至 18 年底，政府計劃約佔 HCB 投保會員的一半，定位該細分市場以推動未來增長。

Overall HCB operations performed as we expected.

HCB 的整體運營表現符合我們的預期。

Medicare Advantage membership growth materially outpaced the market, fueled in part by our strong Star's performance.

Medicare Advantage 會員的增長速度大大超過市場，部分原因是我們強勁的 Star 業績。

Our clinical care and service programs expanded their reach in 2018, resonating in the marketplace and strengthening the value proposition of our commercial offerings.

我們的臨床護理和服務計劃在 2018 年擴大了範圍，在市場上引起共鳴並加強了我們商業產品的價值主張。

Adjusted gross margin for legacy CVS Health was 15.6%, up 20 basis points compared to full year 2017.

傳統 CVS Health 的調整後毛利率為 15.6%，與 2017 年全年相比上升了 20 個基點。

This was due to mix given that the higher-margin Retail business grew faster than the PBM.

這是由於利潤率較高的零售業務增長快於 PBM 的混合。

Total adjusted operating expense dollars increased 12%, largely driven by the addition of Aetna's business as well as investments from a portion of the tax reform benefits into the Retail business and costs to support Pharmacy growth.

調整後的總運營費用美元增長了 12%，這主要是由於 Aetna 業務的增加以及部分稅收改革收益對零售業務的投資以及支持藥房增長的成本。

As noted in our press release this morning, due to continued industry-wide and operational challenges in Q4, we recorded a $2.2 billion goodwill impairment charge on the Long-Term Care business.

正如我們在今天上午的新聞稿中指出的那樣，由於第四季度持續存在的全行業和運營挑戰，我們對長期護理業務記錄了 22 億美元的商譽減值費用。

Transitioning to our 2019 guidance, there are a few key changes to note.

過渡到我們的 2019 年指南，需要注意一些關鍵變化。

Beginning in '19, we are realigning our segments for changes to our operating model that I'll detail shortly.

從 19 年開始，我們正在重新調整我們的細分市場以改變我們的運營模式，我將在稍後詳細介紹。

And our adjusted operating income guidance reflects the adoption of Aetna's legacy definition, which excludes intangible amortization.

我們調整後的營業收入指引反映了 Aetna 遺留定義的採用，該定義不包括無形攤銷。

We maintain the same definition for adjusted EPS, which excludes intangible amortization and transaction and integration costs, which were consistent across both companies.

我們對調整後的每股收益保持相同的定義，不包括無形攤銷以及交易和整合成本，這在兩家公司都是一致的。

A summary of the changes is included in the slides we posted to our website, along with a full GAAP to non-GAAP reconciliation.

我們在網站上發布的幻燈片中包含變更摘要，以及完整的 GAAP 與非 GAAP 對賬。

2018 has been adjusted for comparability as appropriate.

2018 年已根據可比性進行了適當調整。

As stated in our press release, consolidated full year adjusted EPS is expected to be in the range of $6.68 to $6.88, down from the $7.08 we reported in 2018.

正如我們在新聞稿中所述，合併的全年調整後每股收益預計在 6.68 美元至 6.88 美元之間，低於我們在 2018 年報告的 7.08 美元。

We expect consolidated full year 2019 adjusted operating income between $14.8 billion to $15.2 billion, with consolidated revenue in the range of $249.9 billion to $254.3 billion.

我們預計 2019 年全年調整後綜合營業收入在 148 億美元至 152 億美元之間，綜合收入在 2499 億美元至 2543 億美元之間。

For the segments, we expect operating income in the Retail/Long-Term Care segment to be in the range of $6.6 billion to $6.7 billion and Pharmacy Services segment in the range of $4.8 billion to $4.9 billion.

對於這些部門，我們預計零售/長期護理部門的營業收入將在 66 億美元至 67 億美元之間，藥房服務部門的營業收入將在 48 億美元至 49 億美元之間。

We expect the HCB segment operating income to be in the range of $5.1 billion to $5.2 billion.

我們預計 HCB 部門的營業收入將在 51 億美元至 52 億美元之間。

Significant synergies will be generated by the combined business this year, stemming from elimination of duplicative corporate and operational functions, purchasing efficiencies and some medical cost savings, including formulary alignment.

今年合併後的業務將產生顯著的協同效應，這源於重複的公司和運營職能的消除、採購效率的提高和一些醫療成本的節省，包括處方集的調整。

These synergies are expected to be between $300 million and $350 million in 2019, and we are on track to exceed our goal of $750 million in 2020.

這些協同效應預計在 2019 年將達到 3 億至 3.5 億美元，我們有望在 2020 年超過 7.5 億美元的目標。

Additionally, there will be investments in initiatives designed to set the foundation for future new product offerings.

此外，還將對旨在為未來新產品提供奠定基礎的計劃進行投資。

Investments are being made to further our analytics and digital capabilities, develop new programs such as chronic kidney care and enhance Aetna's clinical platform.

正在投資以進一步提高我們的分析和數字能力，開發慢性腎臟護理等新項目，並增強 Aetna 的臨床平台。

We expect our incremental investments spending to be between $325 million and $350 million in 2019.

我們預計 2019 年的增量投資支出將在 3.25 億美元至 3.5 億美元之間。

Integration costs of approximately $550 million are excluded from our non-GAAP guidance.

我們的非 GAAP 指南不包括大約 5.5 億美元的整合成本。

We expect to deliver between $9.8 billion to $10.3 billion of cash flow from operations.

我們預計將從運營中產生 98 億至 103 億美元的現金流。

We remain committed to our capital allocation priority.

我們仍然致力於我們的資本配置優先事項。

After the payment of our shareholder dividend, capital retention to support our insurance operation and gross capital expenditures of $2.3 billion to $2.6 billion, we will use the remaining cash available to continue to pay down debt.

在支付了股東股息、支持保險業務的資本保留和 23 億至 26 億美元的資本支出總額後，我們將使用剩餘的可用現金繼續償還債務。

As we stated when we announced the Aetna acquisition, while we intend to maintain our shareholder dividend, we will not restart share repurchases or engage in large M&A transactions until we achieve our leverage target.

正如我們在宣布收購 Aetna 時所說，雖然我們打算維持股東分紅，但在實現槓桿目標之前，我們不會重啟股票回購或進行大型併購交易。

We expect to pay down our maturities this year as they come due and have other sources of prepayable debt available to us.

我們希望在今年到期時償還我們的到期債務，並為我們提供其他可提前償還的債務來源。

We expect leverage to modestly improve, and we will pay down debt in line with previous expectations.

我們預計槓桿率將適度改善，我們將按照之前的預期償還債務。

Moving on to the segments.

繼續細分。

For the year, we expect Retail/Long-Term Care revenue to be between $85.3 billion and $86.8 billion, with adjusted operating income down about 10%.

今年，我們預計零售/長期護理收入在 853 億美元至 868 億美元之間，調整後的營業收入下降約 10%。

Retail is expected to continue to deliver strong adjusted script growth in the range of 4.5% and 6.8% due to continued successful execution of our pharmacy clinical care programs that drive improved adherence and patient retention.

由於繼續成功執行我們的藥房臨床護理計劃，推動提高依從性和患者保留率，預計零售將繼續實現 4.5% 和 6.8% 的強勁調整後腳本增長。

Additionally, we will experience growth in the Medicare partnerships we formed in 2018 as well as a few new regional preferred relationships in 2019.

此外，我們將在 2018 年建立的 Medicare 合作夥伴關係以及 2019 年一些新的區域首選關係中實現增長。

The contraction in adjusted operating income reflects the annualization of tax reform investments and expected performance of Long-Term Care.

調整後營業收入的收縮反映了稅收改革投資的年化和長期護理的預期表現。

These factors are expected to contribute nearly half of the contraction.

這些因素預計將貢獻近一半的收縮。

Continued reimbursement pressure without the full benefits of traditional offsets is also causing contraction.

沒有傳統抵消的全部好處的持續報銷壓力也導致收縮。

Historically, reimbursement pressure has been primarily offset by growth in generics as well as inflation on branded pharmaceuticals.

從歷史上看，報銷壓力主要被仿製藥的增長以及品牌藥的通貨膨脹所抵消。

We will experience a larger year-over-year headwind from a lower contribution from break-open generics and a diminished return on generic-dispensing increases.

由於突破性仿製藥的貢獻減少以及仿製藥配藥增長的回報減少，我們將經歷更大的同比逆風。

The front of the store is expected to drive margins with a focus on winning in our health and beauty businesses through improved customer personalization and consumer engagement.

商店的正面預計將通過提高客戶個性化和消費者參與度來提高利潤率，重點是在我們的健康和美容業務中獲勝。

Front store margin rate in dollars are expected to expand year-over-year.

以美元計算的前台店利潤率預計將同比擴大。

As we look to the future, we believe CVS Retail is best positioned in the market to deal with the challenges we see.

展望未來，我們相信 CVS Retail 在市場上處於最佳地位，可以應對我們所看到的挑戰。

Our best-in-class clinical programs will allow us to continue to gain market share.

我們一流的臨床項目將使我們能夠繼續獲得市場份額。

We have strong partnerships with payers, including incentives to drive dispensing into our CVS channel.

我們與付款人建立了牢固的合作夥伴關係，包括推動分配進入我們的 CVS 渠道的激勵措施。

And finally, we will continue to drive efficiencies in our pharmacies through the use of technology and productivity improvement.

最後，我們將繼續通過使用技術和提高生產力來提高我們藥房的效率。

Now let me turn to the PBM.

現在讓我轉向 PBM。

This segment's 2019 reported figures will be affected by 2 important reporting changes.

該部門 2019 年報告的數字將受到 2 項重要報告變更的影響。

First, our individual SilverScript PDP will move from the PBM segment to the Health Care Benefits segment, enabling us to rapidly create the best products for seniors in advance of the 2020 bid season in this important part of our business.

首先，我們個人的 SilverScript PDP 將從 PBM 部分轉移到醫療保健福利部分，使我們能夠在 2020 年投標季之前為我們這一重要業務部分的老年人快速創造最好的產品。

We have restated 2018 results for comparability, and this information is also available on our website.

為了便於比較，我們重述了 2018 年的結果，這些信息也可以在我們的網站上找到。

Second, we will consolidate the pharmacy operations of Aetna into the PBM to enable us to rapidly drive efficiencies.

其次，我們將把 Aetna 的藥房業務整合到 PBM 中，使我們能夠快速提高效率。

For the PBM segment in 2019, we expect revenue to be in the range of $136.5 billion to $139 billion, with adjusted operating income down low single digits.

對於 2019 年 PBM 部分，我們預計收入將在 1365 億美元至 1390 億美元之間，調整後的營業收入將下降到低個位數。

There are a few key elements driving 2019 PBM performance to note.

有幾個推動 2019 年 PBM 績效的關鍵因素需要注意。

As we have stated previously, price compression continues to be a factor in the marketplace.

正如我們之前所說，價格壓縮仍然是市場的一個因素。

Exacerbating the impact is the cumulative effect on rebate guarantees due to lower branded inflation.

加劇影響的是較低的品牌通貨膨脹對回扣保證的累積影響。

Second, the net benefits from the 2019 selling season are expected to be modest.

其次，預計 2019 年銷售旺季的淨收益不大。

And we expect Anthem to remain as strong a headwind, given the investments required to onboard the business on its accelerated time line.

考慮到在加速的時間線上開展業務所需的投資，我們預計 Anthem 仍將是一個強勁的逆風。

The onboarding is expected to begin in the second quarter of this year.

入職預計將於今年第二季度開始。

As a reminder, the revenue for this contract will be recorded on a net basis.

提醒一下，該合同的收入將按淨額記錄。

Our retention rate stands at a strong 98% for 2019.

2019 年，我們的保留率高達 98%。

In addition, Centene has notified us of their intent to move their business to their PBM partner, RxAdvance.

此外，Centene 已通知我們他們打算將業務轉移到他們的 PBM 合作夥伴 RxAdvance。

It is expected to begin in 2019, although the exact timing is not clear at this point.

預計將於 2019 年開始，但目前尚不清楚確切時間。

The retention rate I mentioned excludes any impact from this transition.

我提到的保留率不包括這種轉變的任何影響。

Additionally, the PBM will benefit from the segment shift.

此外，PBM 將受益於細分市場的轉變。

On the like-for-like basis, operating income will be down mid-single digits versus 2018.

在同類基礎上，營業收入與 2018 年相比將下降中個位數。

It is clear that the PBM industry is in the middle of an environmental change given the dialogue around rebates.

鑑於圍繞回扣的對話，很明顯 PBM 行業正處於環境變化之中。

However, it is also clear that the PBM brings tremendous savings and value to the clients we serve.

然而，同樣明顯的是，PBM 為我們服務的客戶帶來了巨大的節省和價值。

The importance of size, scale and customer relationship will continue to be paramount, and we remain focused on delivering the value our clients expect.

規模、規模和客戶關係的重要性將繼續至關重要，我們將繼續專注於提供客戶期望的價值。

Finally, in the Health Care Benefits segment, we expect revenue between $67.7 billion and $68.7 billion in 2019.

最後，在醫療保健福利領域，我們預計 2019 年的收入將在 677 億美元至 687 億美元之間。

We expect continued strength in our government programs with top line increases driven by industry-leading Medicare growth as well as the key Medicaid wins in Kansas and Florida.

我們預計我們的政府計劃將繼續走強，在行業領先的醫療保險增長以及堪薩斯州和佛羅里達州的關鍵醫療補助計劃的推動下，我們的收入將有所增長。

We expect to end the year between 22.7 million and 23 million medical members as we expect strong commercial ASC membership gains to complement our government program growth.

我們預計今年年底將有 2270 萬至 2300 萬醫療會員，因為我們預計 ASC 商業會員的強勁增長將補充我們政府計劃的增長。

A handful of other dynamics will impact HCB results, including: year 1 deal synergies will disproportionately benefit the HCB segment.

少數其他動態將影響 HCB 結果，包括：第一年的交易協同效應將不成比例地有利於 HCB 部門。

Second, incremental investments will be deployed in 2019 to accelerate growth, enhance infrastructure and drive market differentiation.

其次，2019年將部署增量投資，以加速增長、加強基礎設施和推動市場差異化。

Third, the suspension of the health insurer fee in 2019 will impact certain operating ratios, while the after-tax impact of this suspension versus 2018 is immaterial.

第三，2019 年暫停收取醫療保險費用將影響某些運營比率，而此次暫停收取的稅後費用與 2018 年相比並不重要。

And finally, certain onetime benefits realized by Aetna in 2018 are not expected to repeat in 2019, and the HCB segment will be negatively affected by the segment movements discussed earlier.

最後，Aetna 在 2018 年實現的某些一次性收益預計不會在 2019 年重現，並且 HCB 部門將受到前面討論的部門變動的負面影響。

Excluding the segment move, the incremental investments we're making in 2019 to accelerate growth and the impact of the HIF suspension, HCB operating income is expected to grow modestly.

排除部門變動、我們在 2019 年為加速增長而進行的增量投資以及 HIF 暫停的影響，預計 HCB 營業收入將適度增長。

Turning to operating efficiencies, both CVS and Aetna have had a strong history of successful cost-productivity initiatives.

談到運營效率，CVS 和 Aetna 都有成功的成本生產率舉措的悠久歷史。

And as we begin integrating the 2 companies, we are seeing the opportunity to accelerate our cost savings across the enterprise even further than originally expected.

隨著我們開始整合這兩家公司，我們看到了在整個企業範圍內加速成本節約的機會，甚至比最初預期的還要多。

As Larry stated, we are embarking upon an aggressive cost-reduction initiative.

正如拉里所說，我們正在著手實施一項積極的成本削減計劃。

The savings this will generate will help offset the competitive dynamics we have experienced, drive the creation of more affordable products for our customers and provide capacity that will help us achieve our financial targets as we continue to invest in our strategic and transformational initiative.

這將產生的節省將有助於抵消我們所經歷的競爭動態，推動為我們的客戶創造更多負擔得起的產品，並提供能力來幫助我們在我們繼續投資於我們的戰略和轉型計劃時實現我們的財務目標。

We are confident that these initiatives will help drive longer-term growth in the combined business beyond 2019.

我們相信，這些舉措將有助於推動合併後業務在 2019 年以後的長期增長。

Before I wrap up, I want to touch on expectations for the first quarter and the remainder of the year.

在結束之前，我想談談對第一季度和今年剩餘時間的預期。

In Q1, we expect to deliver adjusted EPS of $1.49 to $1.53 and GAAP EPS of $1.04 to $1.08.

在第一季度，我們預計調整後每股收益為 1.49 美元至 1.53 美元，GAAP 每股收益為 1.04 美元至 1.08 美元。

As you look at the spreads for the remainder of the year, you can assume that the seasonality of our expected results this year will closely resemble that of our reported results in 2018.

當您查看今年剩餘時間的利差時，您可以假設我們今年預期結果的季節性將與我們 2018 年報告的結果非常相似。

Year-over-year growth of consolidated adjusted operating income will be highest through the first 3 quarters as we wrap the addition of Aetna.

隨著 Aetna 的加入，前三個季度綜合調整後營業收入的同比增長將達到最高水平。

In the legacy CVS business, Retail, Long-Term Care and PBM, we expect to see our greatest level of year-over-year deterioration in Q1, with operating income growth in those segments improving as we move throughout the year.

在傳統的 CVS 業務、零售、長期護理和 PBM 中，我們預計第一季度將出現最大程度的同比惡化，隨著我們全年的發展，這些領域的營業收入增長將有所改善。

Adjusted operating income within HCB is expected to be greatest in Q1 and lowest in Q4.

HCB 調整後的營業收入預計在第一季度最高，第四季度最低。

At our Investor Day in June, we will provide you a more detailed road map to long-term growth.

在 6 月的投資者日，我們將為您提供更詳細的長期增長路線圖。

We will provide you with our long-term targets, including more specifics around the innovative products and services we plan to bring to market.

我們將為您提供我們的長期目標，包括有關我們計劃推向市場的創新產品和服務的更多細節。

We'll also lay out our capital structure and allocation plan to provide you with more visibility into the time line for returning more capital to shareholders while also continuing to invest in the business.

我們還將製定我們的資本結構和分配計劃，讓您更清楚地了解向股東返還更多資本的時間表，同時繼續投資於業務。

With that, I'll turn the call back to Larry.

有了這個，我會把電話轉回給拉里。

All right.

好的。

Thanks, Eva.

謝謝，伊娃。

Well, CVS is much better positioned to provide value to our customers and the broader community through our new enterprise model.

那麼，CVS 可以更好地通過我們的新企業模型為我們的客戶和更廣泛的社區提供價值。

And our diversified company is providing our stakeholders with a highly effective ability to make health care more local, more simple and less costly, while reducing our dependencies on dispensing revenue and maximizing the benefits from value-added services.

我們多元化的公司正在為我們的利益相關者提供高效的能力，使醫療保健更加本地化、更簡單、成本更低，同時減少我們對分配收入的依賴，並最大限度地從增值服務中獲益。

We have a number of unique offerings being piloted or launched in the coming months.

我們將在未來幾個月內試行或推出許多獨特的產品。

And those capabilities utilize enterprise assets in a differentiated way, with the goal of increasing consumer engagement while improving health outcomes and lowering costs.

這些功能以差異化的方式利用企業資產，目標是提高消費者參與度，同時改善健康結果並降低成本。

As an example, expanding MinuteClinic services and incorporating CVS community assets in conjunction with Aetna analytics around a member's Next Best Action will allow us to help individuals achieve a better health outcome.

例如，擴展 MinuteClinic 服務並將 CVS 社區資產與圍繞會員的下一步最佳行動的 Aetna 分析相結合，將使我們能夠幫助個人獲得更好的健康結果。

And we see tremendous opportunities ahead, whether it's improving adherence, closing gaps in care, engaging high-risk members through care managers or providing new approaches to complex disease management.

我們看到了巨大的機遇，無論是提高依從性、縮小護理差距、通過護理經理吸引高風險成員，還是提供複雜疾病管理的新方法。

Just take the mitigation of hospital readmissions.

只需減輕再入院率即可。

We understand the contributing factors to readmission, and we can now bring solutions to those factors.

我們了解重新入院的影響因素，現在我們可以為這些因素提供解決方案。

Aetna had about 470,000 hospital discharges in 2017, and about 47,000 of those were readmitted at an average cost of $14,000.

2017 年，Aetna 約有 470,000 人出院，其中約 47,000 人再次入院，平均費用為 14,000 美元。

If we're successful cutting that number in half, we'll remove more than $300 million of costs while creating a better patient experience.

如果我們成功地將這個數字減半，我們將減少超過 3 億美元的成本，同時創造更好的患者體驗。

Again, the list of opportunities goes well beyond the few examples mentioned.

同樣，機會列表遠遠超出了所提到的幾個例子。

Importantly, many of these unique service offerings will ultimately be available to our health plan clients, creating value across the health care system.

重要的是，許多這些獨特的服務產品最終將提供給我們的健康計劃客戶，從而在整個醫療保健系統中創造價值。

And it's this combination of assets and capabilities that will ultimately drive enterprise growth and create significant shareholder value.

正是這種資產和能力的結合最終將推動企業發展並創造可觀的股東價值。

So with that, let's go ahead and open it up for your questions.

因此，讓我們繼續並打開它來回答您的問題。

(Operator Instructions) Our first question comes from Michael Cherny from Bank of America Merrill Lynch.

（操作員說明）我們的第一個問題來自美銀美林的邁克爾切爾尼。

Larry, Eva, if we think about all of the headwinds in particular that you outlined going back to your conference presentation last month, I guess relative to them, what was bigger than you expected?

拉里、伊娃，如果我們特別考慮你在上個月的會議演講中概述的所有不利因素，我想相對於它們，有什麼比你預期的要大？

And I guess, most importantly, as you think about all of the big ones, whether it's Omnicare, Anthem, Centene transition, et cetera, what do you view as the most transitory?

我想，最重要的是，當你考慮所有大公司時，無論是 Omnicare 、 Anthem 、 Centene transition 等等，你認為什麼是最短暫的？

In particular, where do you have the most confidence in the transitory that will be able to reverse itself or at least improve in '20 and beyond?

特別是，您對能夠自我逆轉或至少在 20 世紀及以後有所改善的暫時性最有信心？

Yes, Mike, it's Larry.

是的，邁克，是拉里。

Thanks for the question.

謝謝你的問題。

Mike, as you look at the transitory nature of the headwinds, you think about the impact of the investments and tax reform.

邁克，當你看到逆風的暫時性時，你會想到投資和稅收改革的影響。

That rolls off midyear of this year.

這將在今年年中結束。

You look at the inflation impact on our rebate guarantees, that peaks in 2019 and rolls off at the end of 2020.

你看看通貨膨脹對我們退稅保證的影響，它在 2019 年達到頂峰，並在 2020 年底下降。

We certainly expect the Omnicare performance to stabilize and improve.

我們當然希望 Omnicare 的性能能夠穩定和改善。

And as you think about the contribution of generics, as we've talked many times, there are going to be peaks and valleys that can occur in any given year.

當你考慮仿製藥的貢獻時，正如我們已經多次討論過的那樣，任何一年都會出現高峰和低谷。

As we sit here today and look at what that looks like for 2020, we expect that to improve.

當我們今天坐在這裡審視 2020 年的情況時，我們預計情況會有所改善。

So many of these headwinds are transitory in nature.

許多不利因素本質上都是暫時的。

Also, keep in mind that there are parts of the business that have momentum: growth in Medicare, growth in the commercial business.

此外，請記住，業務的某些部分具有發展勢頭：醫療保險的增長、商業業務的增長。

We've got momentum at Retail as much as in front store growth but Pharmacy growth as well.

我們在零售業和前店增長方面都有動力，但在藥房方面也有增長。

And we're really pleased with the speed with which we're executing the integration activities.

我們對執行集成活動的速度感到非常滿意。

And Larry, the only thing that I would add there, as Larry outlined, we also see additional opportunities to continue to manage our cost base and reduce our core to help mitigate these headwinds as we go forward.

拉里，我唯一要補充的是，正如拉里所概述的那樣，我們還看到了更多的機會來繼續管理我們的成本基礎並減少我們的核心業務，以幫助減輕我們前進的這些不利因素。

Our next question comes from Lisa Gill from JPMorgan.

我們的下一個問題來自摩根大通的 Lisa Gill。

Let me just, first, just go back to the guidance again.

首先，讓我再次回到指導。

And just looking at the different segments versus our numbers and The Street, it looks like the biggest headwind year-over-year is clearly on the Retail side.

看看不同的細分市場與我們的數字和 The Street，看起來最大的逆風顯然是在零售方面。

Larry, when you talked about things that were transitory, not -- obviously, Omnicare being one of them.

拉里，當你談到暫時的事情時，顯然，Omnicare 是其中之一。

Is that the biggest driver, one, within Retail?

這是零售業最大的驅動力之一嗎？

You talked about a new type of model around reimbursement.

你談到了一種圍繞報銷的新型模式。

Is that something that you believe will take hold in 2020 and reimbursement will start looking better?

您是否認為這會在 2020 年站穩腳跟，報銷情況會開始好轉？

I just really want to understand how we think about how Retail really turns around.

我真的很想了解我們如何看待零售業如何真正扭轉局面。

That would be the first part of my question.

那將是我問題的第一部分。

And then secondly, how do we think about that $3 billion cost-cutting initiative that you talked about a couple of years ago?

其次，我們如何看待您幾年前談到的 30 億美元的成本削減計劃？

Where do we see that in the numbers?

我們在數字中哪裡看到了這一點？

And how is that coming along?

那是怎麼回事？

Lisa, this is Eva.

麗莎，這是伊娃。

I'll start, okay?

我開始，好嗎？

As you think about the performance in Retail contracting about 10%, the impact of Omnicare as well as the tax reform investment, that represents about half of the contraction.

正如你所考慮的零售業收縮約 10% 的表現，Omnicare 的影響以及稅改投資約佔收縮的一半。

And clearly, the next most significant driver is what Larry described around lower benefit from generics in 2019.

顯然，下一個最重要的驅動因素是 Larry 描述的 2019 年仿製藥帶來的較低收益。

In terms of the streamlining effort, that is on track, and we're delivering in line with our expectations.

就精簡工作而言，這是按計劃進行的，我們的交付符合我們的預期。

It's reflected in both the PBM and the Retail segments.

它反映在 PBM 和零售領域。

Lisa, this is Kevin.

麗莎，這是凱文。

I can also talk about the longer-term component.

我還可以談談長期部分。

Our plan to improve profit outlook in Retail is focused on 3 very important things.

我們改善零售業利潤前景的計劃集中在三件非常重要的事情上。

First is to grow the top line.

首先是增加頂線。

Increasing script volumes enables us to leverage the highly fixed cost nature of retail pharmacy fulfillment, that's the first.

增加腳本量使我們能夠利用零售藥店履行的高度固定成本性質，這是第一個。

The second is to lower our fixed and variable costs, as Eva just spoke to, through significant productivity improvement, namely automation within the pharmacy fulfillment process as well as continued reduction in cost of goods sold through Red Oak.

第二是降低我們的固定和可變成本，正如 Eva 剛才所說，通過顯著提高生產力，即藥房履行流程的自動化以及通過 Red Oak 銷售的商品成本的持續降低。

The third, and Larry mentioned this in his prepared remarks, is the migration to a new and improved third-party payer contracting model.

第三，拉里在他準備好的發言中提到了這一點，是遷移到一個新的和改進的第三方付款人合同模型。

We will align incentives with payers to lower overall health care costs and begin to reduce the pressure over time on the actual core pharmacy reimbursement rate.

我們將使激勵措施與付款人保持一致，以降低整體醫療保健成本，並隨著時間的推移開始減輕實際核心藥房報銷率的壓力。

And then just as a follow-up to that, is Omnicare strategic to the company going forward?

然後作為後續行動，Omnicare 是否對公司未來具有戰略意義？

I mean, if I listen to you, Omnicare has been a headwind last year.

我的意思是，如果我聽你的話，去年 Omnicare 一直是逆風。

Eva, you just talked about it being half of the headwinds for 2019.

伊娃，你剛剛談到它是 2019 年的一半逆風。

Is this a strategic asset for CVS going forward?

這是 CVS 未來的戰略資產嗎？

So Lisa, it's Larry.

麗莎，是拉里。

The growth opportunity with Omnicare was always focused on the independent and assisted living spaces.

Omnicare 的增長機會始終集中在獨立和輔助的生活空間上。

And those opportunities still exist, and they're consistent with our strategy of putting the customer at the nucleus of transforming care.

這些機會仍然存在，它們與我們將客戶置於轉變護理核心的戰略相一致。

The challenges that we have in that business are really around the skilled nursing facilities, which have been worse than we originally expected.

我們在該業務中面臨的挑戰實際上是圍繞熟練的護理設施，這比我們原先預期的還要糟糕。

Our next question comes from Ralph Giacobbe from Citi.

我們的下一個問題來自花旗銀行的 Ralph Giacobbe。

Just going back, I was hoping -- and I could certainly understand the directional commentary, but are you guys willing to actually sort of quantify the drag within -- in each of the buckets?

回到過去，我希望——我當然能理解方向性評論，但你們願意真正量化每個桶中的阻力嗎？

As you've sort of laid out the headwinds, it just gives more clarity on kind of the numbers and the size of each of the drags.

當您列出逆風時，它只會更清楚地說明數字的種類和每個阻力的大小。

Yes, Ralph, this is Eva.

是的，拉爾夫，這是伊娃。

In terms of -- I tried to quantify pieces of it.

就-我試圖量化它的一部分。

As you look at Retail, which has the most significant impact, the impact of Omnicare as well as the annualized impact of the tax reform investment is driving nearly half of the contraction on the Retail business.

當您查看影響最大的零售業時，Omnicare 的影響以及稅改投資的年化影響正在推動近一半的零售業務收縮。

And think about the remainder, clearly, the lack of generics as the biggest driver there.

想想剩下的，顯然，缺乏仿製藥是最大的驅動因素。

Certainly, on the PBM side, the impact of the cumulative nature of the rebate guarantees affected by the lower inflation is a pretty significant driver on the PBM business.

當然，在 PBM 方面，受較低通脹影響的回扣擔保的累積性質的影響是 PBM 業務的一個相當重要的驅動力。

Additionally, we said it will peak in '19.

此外，我們說它將在 19 年達到頂峰。

We had some impact in '18.

我們在 18 年產生了一些影響。

It's what moved -- it was a key element moving us to the lower end of our guidance range.

這就是移動的原因——它是將我們推向指導範圍低端的關鍵因素。

And we do expect that to move through 2020.

我們確實希望這種情況會持續到 2020 年。

Okay.

好的。

All right.

好的。

That's helpful.

這很有幫助。

And then just maybe one quick follow-up, you've had a little more time to digest the HHS rebate proposal.

然後也許只是一個快速的跟進，你有更多的時間來消化 HHS 退稅提案。

Any updated thoughts there and particularly, if it gets implemented for 1/1/20?

那裡有任何更新的想法，特別是它是否在 20 年 1 月 1 日實施？

And then more broadly, you mentioned the new PBM sort of net pricing model.

然後更廣泛地說，你提到了新的 PBM 類型的淨定價模型。

You expect, I think, to see a small number initially and more rapid adoption beyond 2020.

我認為，您希望在 2020 年之後看到最初採用的數量較少，並且採用速度更快。

I guess, how do you drive that change, particularly if employers like the legacy model?

我想，你如何推動這種變化，特別是如果雇主喜歡傳統模式？

And do you see yourselves perhaps moving to just that net pricing model and just moving away from rebates altogether?

你是否認為自己可能會轉向淨定價模式並完全擺脫回扣？

Yes, Ralph, it's Larry.

是的，拉爾夫，是拉里。

I'll take the first part, then flip it over to Derica to talk about the new pricing model.

我先講第一部分，然後交給 Derica 談談新的定價模式。

As you look at the rebate rule, we fully support the administration's objectives to lower drug prices and out-of-pocket costs for consumers.

當您查看回扣規則時，我們完全支持政府降低藥品價格和消費者自付費用的目標。

And CVS has pioneered a number of innovative solutions that have delivered against that goal.

CVS 率先推出了許多實現該目標的創新解決方案。

Unfortunately, we see the rebate rule taking us backwards, not forwards.

不幸的是，我們看到回扣規則讓我們倒退，而不是前進。

And we've been very public about the fact that 100% of rebates are turned over in the Medicare business and had been utilized to buy down premiums.

我們一直非常公開的事實是，100% 的回扣都在 Medicare 業務中上交，並被用來購買保費。

You look at that dynamic, premiums will increase.

你看那個動態，保費會增加。

And some actuarial reports have it growing as much as 52%.

一些精算報告顯示它增長了 52%。

We actually took a step back and looked at today's Part D program.

我們實際上退後一步，看看今天的 D 部分計劃。

We went back to 2009.

我們回到了2009年。

We looked at monthly premiums.

我們查看了每月保費。

10 years ago, they were $29.

10 年前，它們是 29 美元。

10 years later, they're $32.

10 年後，它們是 32 美元。

At the same time, you look at generics.

同時，你看看泛型。

They represent about 90% of all Part D scripts that are dispensed.

它們佔分配的所有 D 部分腳本的大約 90%。

So those are 2 important data points that absolutely point to premiums increasing for everyone.

所以這是兩個重要的數據點，絕對錶明每個人的保費都在增加。

And the reality that yes, a small percentage of seniors may net out favorably, but again, the actuaries are estimating as many as 70% of beneficiaries are going to be worse off.

事實上，一小部分老年人可能會獲得有利的淨收益，但精算師再次估計，多達 70% 的受益人的境況將變得更糟。

So one of the concerns that we have is that fewer beneficiaries sign up for Part D. And then you look at the estimated cost of $200 billion over 10 years, and it puts taxpayers on the hook and branded pharma ends up with a profit windfall.

因此，我們擔心的一個問題是，參加 D 部分的受益人越來越少。然後你看看 10 年內 2000 億美元的估計成本，它讓納稅人陷入困境，而品牌製藥公司最終獲得了暴利。

There are certainly readily available solutions in the commercial space that can be applied to Medicare, and you look at what those potentially could be.

在商業領域肯定有現成的解決方案可以應用於醫療保險，你看看這些可能是什麼。

We work with commercial clients today to reduce out-of-pocket costs with point-of-sale rebates and the utilization of a preventive drug list.

今天，我們與商業客戶合作，通過銷售點回扣和使用預防藥物清單來減少自付費用。

We think programs like that are far better solutions than the proposed rule.

我們認為這樣的計劃是比擬議規則更好的解決方案。

And we also have -- we've talked about the realtime benefits tool in Caremark.

我們也有——我們已經討論了 Caremark 中的實時福利工具。

Kevin's got a similar program in our Retail pharmacies.

凱文在我們的零售藥店也有類似的計劃。

And both of those tools have reduced out-of-pocket costs for consumers.

這兩種工具都降低了消費者的自付費用。

So we're certainly weighing in during the comment period with our concerns with the rebate rule, but more importantly, what we believe the appropriate solutions are to address the root cause of what we're trying to solve for.

因此，我們當然會在評論期間考慮我們對回扣規則的擔憂，但更重要的是，我們認為適當的解決方案是解決我們正在努力解決的問題的根本原因。

Derica?

德里卡？

Ralph, this is Derica.

拉爾夫，這是德麗卡。

In regards to our new pricing model, what we're calling the Guaranteed Net Cost model, we've had 2 clients who adopted for 2019.

關於我們的新定價模型，我們稱之為保證淨成本模型，我們有 2 位客戶在 2019 年採用了這種模型。

In addition to that, we've already provided to all of the benefit consultants draft contract language.

除此之外，我們已經向所有福利顧問提供了合同草案。

So they've been able to walk through and see all of the elements in terms of the fine print in the details.

因此，他們已經能夠根據細節中的細則瀏覽並查看所有元素。

The feedback, thus far, has been very positive.

到目前為止，反饋非常積極。

So we will look to continue to drive a more rapid adoption through the remainder of '19 and, more specifically, for the 2020 period.

因此，我們將尋求在 19 年剩餘時間，更具體地說，在 2020 年期間繼續推動更快速的採用。

In terms of rebates, whether we have rebates or discounts, what we really want is still the opportunity, and this is kind of piggybacking on the HHS roll question, our ability to execute formulary management, which is the methodology we've been able -- and the tool we've been able to use historically to be able to create rebate or discounts from manufacturers to create value for our clients and their members.

在回扣方面，無論我們有回扣還是折扣，我們真正想要的仍然是機會，這有點像 HHS 滾動問題，我們執行處方管理的能力，這是我們能夠使用的方法 - - 以及我們過去一直能夠使用的工具，能夠從製造商那裡獲得回扣或折扣，從而為我們的客戶及其成員創造價值。

So as long as we have access to that wherewithal to be able to do that with the manufacturers, we will be able to execute the GNC model.

因此，只要我們能夠獲得能夠與製造商合作的資金，我們就能夠執行 GNC 模型。

And really, what this means is getting to the lowest net cost.

實際上，這意味著達到最低的淨成本。

It is not a focus on aggregate rebate value.

它不關注總回扣值。

Our next question comes from Justin Lake from Wolfe Research.

我們的下一個問題來自 Wolfe Research 的 Justin Lake。

First one of two, discuss rebate guarantees and the break-open generics, I'm just trying to understand '19 to 2020.

兩個中的第一個，討論回扣保證和突破性仿製藥，我只是想了解 19 到 2020 年。

So it sounded like, Larry, you said break-open generics get better in 2020 versus 2019.

所以聽起來，拉里，你說突破性仿製藥在 2020 年比 2019 年會更好。

Can you give us an order of magnitude there?

你能給我們一個數量級嗎？

And then same thing on rebate guarantees.

然後在回扣保證上也是如此。

It sounds like it peaks in '19, but it gets better in 2020 in your mind?

聽起來它在 19 年達到頂峰，但在您看來它會在 2020 年變得更好？

And maybe you could tell us about some of the remediation that you've assumed in these -- in your guidance around rebate guarantees.

也許你可以告訴我們你在這些方面假設的一些補救措施——在你關於回扣保證的指導中。

Yes, Justin, this is Jon.

是的，賈斯汀，這是喬恩。

I'll take the generic question first.

我先回答一般性問題。

So the overall dollar amount of generic launches in '19 is similar to what we saw in '18, but there are some key differences.

因此，19 年仿製藥上市的總金額與我們在 18 年看到的相似，但存在一些關鍵差異。

So you heard us talk about less value from break-open generics in '19 compared to '18.

所以你聽到我們談論與 18 年相比，19 年突破性仿製藥的價值更低。

And that's primarily due to the timing of the launches, leading to slower progress in '19 to the break-open status.

這主要是由於發佈時間的原因，導致 19 年進入突破狀態的進展較慢。

But there are also more generics launching in '19 compared to '18 that are single-sourced generics, where we're unable to optimize our profitability during that exclusivity period.

但是，與 18 年的單一來源仿製藥相比，19 年推出的仿製藥更多，我們無法在排他性期間優化我們的盈利能力。

And as a result, these generics for the most part are headwinds in '19.

因此，這些仿製藥在很大程度上是 19 年的不利因素。

And finally, in '19, we're seeing generics that launch with limited competition, stay with limited competition even after the exclusivity period expires.

最後，在 19 年，我們看到仿製藥在有限競爭中推出，即使在獨占期到期後仍保持有限競爭。

And this is driven by many factors, including manufacturing complexity and regulatory approval time lines.

這是由許多因素驅動的，包括製造複雜性和監管批准時間線。

But as we look forward into 2020, based on what we know today, we see 2020 improving from where we were in '19.

但是，當我們展望 2020 年時，根據我們今天所知道的情況，我們看到 2020 年比 19 年有所改善。

And Justin, this is Derica.

賈斯汀，這是德里卡。

In regards to the rebate guarantees and exposure, just recall from both Eva and Larry's remarks that we anticipate that the rebate exposure peaks in 2019, and we anticipate that it will dissipate over the '20 and 2021 period.

關於回扣保證和風險，回想一下 Eva 和 Larry 的評論，我們預計回扣風險將在 2019 年達到頂峰，我們預計它將在 20 年和 2021 年期間消散。

And we've also been able to go back and adjust our underwriting models to now we're assuming a mid-single-digit inflation rate.

而且我們還能夠回過頭來調整我們的承保模型，現在我們假設通脹率為中個位數。

So much (inaudible) working with current trends.

這麼多（聽不清）與當前趨勢合作。

Okay.

好的。

And if I could just sneak a follow-up, the last number you gave us on rebates' retention was $300 million, I believe.

如果我能偷偷跟進一下，我相信你給我們的最後一個關於回扣保留的數字是 3 億美元。

And that's net of payouts for rebate guarantees.

這是扣除退款保證的支出。

Given that rebate guarantees have gone up, can you give us an updated number there?

鑑於回扣保證已經上升，你能給我們一個更新的數字嗎？

Justin, this is Eva.

賈斯汀，這是伊娃。

That was a stand-alone legacy CVS PBM.

那是一個獨立的遺留 CVS PBM。

And I would say, it's in the same ZIP code, if you will, in terms of that overall 2 to 3 percentage points.

我會說，它在相同的郵政編碼中，如果你願意的話，就總體而言 2 到 3 個百分點。

Our next question comes from Ana Gupte from SVB Leerink.

我們的下一個問題來自 SVB Leerink 的 Ana Gupte。

My question was about on the health benefits side.

我的問題是關於健康益處方面的。

The medical loss ratio, you had said that the experience-rated book would create a reset.

醫療損失率，你說經驗等級書會重置。

It's a bit more than we had anticipated.

這比我們預期的要多一些。

I wanted to know if this is kind of a onetime thing.

我想知道這是否是一次性的事情。

And can you talk about on the commercial side, what the implications were there for membership on either retention and/or new growth?

您能否談談商業方面，對會員保留和/或新增長有何影響？

And also, if you -- when you're planning to go to market with Aetna and the Caremark book together?

而且，如果你 - 什麼時候你計劃與 Aetna 和 Caremark 一起上市？

Is it going to be midyear this year, in 1/1/20, maybe later?

是今年年中，20 年 1 月 1 日，也許更晚？

Ana, this is Eva.

安娜，這是伊娃。

I'll start.

我會開始。

As you look at our guidance for the MBR, it's about 84%.

當您查看我們對 MBR 的指導時，它大約是 84%。

There are a couple of things that I would call out.

我要指出幾件事。

First, obviously the mechanics of the HIF as well as if you look at the mix of our business, we have very material growth in the government services business, which obviously also increases that MBR.

首先，顯然 HIF 的機制以及如果你看一下我們的業務組合，我們在政府服務業務方面有非常實質性的增長，這顯然也增加了 MBR。

And it's early in the year, and we feel it's important to be prudent as we look at these estimates.

現在是今年年初，我們認為在審視這些估計時保持謹慎很重要。

Yes, Ana, just to answer your question on when we'll go to market with the Caremark book, obviously, we're in the process of evaluating where we have opportunities.

是的，安娜，只是為了回答你關於我們何時將 Caremark 書推向市場的問題，顯然，我們正在評估我們有機會的地方。

We are rapidly looking at where we have medical and not pharmacy and vice versa, working very closely with Derica.

我們正在迅速尋找我們擁有醫療而非藥房的地方，反之亦然，與 Derica 密切合作。

We are building products and service capabilities, so that we can go to market.

我們正在構建產品和服務能力，以便我們能夠進入市場。

And you should expect us to see -- go to market later this year, early in '20.

你應該期待我們看到——今年晚些時候，20 年初上市。

If I could just sneak in a follow-up on that, so also on the tax reform, Aetna had seen some pressure on MLR rebates.

如果我能就此採取後續行動，那麼在稅收改革方面，Aetna 已經看到了 MLR 退稅的一些壓力。

Will this combination help you on that?

這種組合會幫助你嗎？

Might that start in 2020?

這可能從 2020 年開始嗎？

And I think you also had talked about enterprise value in your last communication post-close.

我想你在最後一次交割後的溝通中也談到了企業價值。

And is that going to impact how you price your Aetna book?

這會影響您為 Aetna 書籍定價的方式嗎？

Because you do have value that's created now from the PBM and Retail that wasn't there earlier?

因為您確實擁有現在從 PBM 和零售中創造的價值，而以前沒有？

Yes, relative to pricing, we will factor all that and consider that in our pricing.

是的，相對於定價，我們會考慮所有這些因素並在我們的定價中加以考慮。

But Ana, what I would tell you is we'll continue to maintain pricing discipline on our commercial book.

但是安娜，我要告訴你的是，我們將繼續在我們的商業書籍上保持定價紀律。

But we'll take the value of a combined organization or the value that we expect to capture from additional services in consideration when we do price our book.

但是，當我們為我們的書定價時，我們會考慮合併後的組織的價值或我們期望從附加服務中獲得的價值。

Our next question comes from Steven Valiquette from Barclays.

我們的下一個問題來自巴克萊銀行的 Steven Valiquette。

So for the HCB segment, the slides include a comment that excluding segment shift impacts, incremental investments and the impact of the HIF, the operating income is expected to grow modestly over 2018.

因此，對於 HCB 細分市場，幻燈片中包含一條評論，即排除細分市場轉移影響、增量投資和 HIF 的影響，營業收入預計將在 2018 年溫和增長。

I think some investors might have been expecting that profit growth to be a little bit stronger in '19, just given the robust Medicare Advantage membership growth for Aetna, actually both last year and this year.

我認為一些投資者可能一直期望 19 年的利潤增長會更強勁一些，因為 Aetna 的 Medicare Advantage 會員增長強勁，實際上在去年和今年都是如此。

I know it's a general notion that new MA lives aren't that profitable in year 1. But maybe you could just give a little more color, high level around the Medicare Advantage membership growth in 2019, maybe just frame it in terms of top line growth versus profit growth within HCB.

我知道人們普遍認為新的 MA 生活在第一年沒有那麼有利可圖。但也許你可以在 2019 年的 Medicare Advantage 會員增長方面提供更多顏色，高水平，也許只是根據頂線來構建它HCB 內部的增長與利潤增長。

Yes, Steve, this is Eva.

是的，史蒂夫，這是伊娃。

I think a key aspect is we noted in our prepared remarks that we're making significant investments in terms of transformation.

我認為一個關鍵方面是我們在準備好的評論中指出，我們在轉型方面進行了大量投資。

There are some of that affecting the HCB segment, so the modest growth is obviously taking into account that impact.

其中一些影響了 HCB 部分，因此溫和的增長顯然是考慮到了這種影響。

So let me just comment on just general Medicare growth in '19 and '20.

因此，讓我只評論 19 年和 20 年的一般醫療保險增長。

Both years, we are above-industry growth.

這兩年，我們的增長都高於行業。

You have to consider when you look at our Medicare business, the split -- the mix between individual and group, obviously, there are different margin profiles on those books.

當您查看我們的醫療保險業務時，您必須考慮拆分——個人和團體之間的組合，顯然，這些賬簿上有不同的利潤率概況。

If you think about 2020, we are exceptionally pleased with the growth that we have for 1/1.

如果您考慮 2020 年，我們對 1/1 的增長感到非常高興。

As you can -- as you've seen, we're above-industry growth.

如您所見——正如您所見，我們的增長速度高於行業。

That is really, truly reflecting the number of years that we've been investing in Medicare.

這確實、真實地反映了我們在 Medicare 上投資的年數。

It's reflecting our Star's performance.

它反映了我們明星的表現。

It's reflecting our expansion into different geographic counties and really tight management of our benefit product.

這反映了我們向不同地理縣的擴張以及對我們福利產品的嚴格管理。

What I would also say to you is that the way to think about our growth for 1/1, think about it half group and half individual.

我還要告訴你的是，考慮我們 1/1 增長的方式，一半是團隊，一半是個人。

Our next question comes from Ricky Goldwasser from Morgan Stanley.

我們的下一個問題來自摩根士丹利的 Ricky Goldwasser。

Larry, going back to the HHS rebate rule, I understand the questions that you raised.

拉里，回到 HHS 退稅規則，我理解你提出的問題。

But if -- assuming that the rule is finalized effective 1/1/20, it seems that there's going to be a change to the business model as we know it today.

但是，如果 - 假設該規則於 20 年 1 月 1 日最終確定生效，那麼我們今天所知道的商業模式似乎將會發生變化。

So one, can you fully offset with premium increase an impact on the PDP business?

那麼，您能否通過保費增長完全抵消對 PDP 業務的影響？

Two, what would be the implications for your commercial business?

第二，這對您的商業業務有何影響？

I.e., based on past experience, how long does it take before we see the spillover effect to commercial changes?

即，根據過去的經驗，我們需要多長時間才能看到商業變化的溢出效應？

And three, you're in the hole on the commercial book on rebate guarantees.

第三，你在關於回扣保證的商業賬簿上陷入困境。

Is the new rule a material enough change that will allow you to go back to your commercial customers and trigger a change in current contractual terms that can help offset that?

新規則是否足以讓您回到商業客戶並觸發當前合同條款的變化以幫助抵消這種變化？

Yes, Ricky, it's Larry.

是的，瑞奇，是拉里。

In terms of your first question around the offsets, yes, we would underwrite that with a different set of assumptions, Ricky.

關於你關於抵消的第一個問題，是的，我們會用一組不同的假設來保證它，Ricky。

And some of that goes back to my earlier comments.

其中一些可以追溯到我之前的評論。

The concern would be will people deselect from a Part D program because of the increase in monthly premiums.

問題是人們會不會因為每月保費的增加而取消選擇 D 部分計劃。

We know that from all the research we've done over the years that beneficiaries, that's the first thing they look at.

我們知道，從我們多年來對受益人所做的所有研究中，這是他們首先要看的東西。

And SilverScript has been successful growing with holding down that monthly premium level for the reasons that I touched on earlier.

由於我之前提到的原因，SilverScript 一直成功地保持著每月的保費水平。

Your second point, Ricky, around commercial.

Ricky，你的第二點是關於商業的。

Listen, our sense is what is it that our clients want and value?

聽著，我們的感覺是我們的客戶想要和看重的是什麼？

And I would sit here today and say, "Broadly, our commercial clients value the same elements, that the Medicare Part D program works, that they want to use the rebates and discounts to buy down the monthly premium." So I'm not sure that I see a rapid adoption in the commercial space for that reason.

我今天會坐在這裡說，“從廣義上講，我們的商業客戶重視相同的要素，即 Medicare D 部分計劃的有效性，他們希望使用回扣和折扣來購買每月的保費。”因此，我不確定是否會因此在商業領域迅速採用。

And Ricky, the other thing that I would point out is, I think, many people are aware that Caremark introduced a new plan this year.

Ricky，我想指出的另一件事是，我認為很多人都知道 Caremark 今年推出了一項新計劃。

It was called Allure, where it priced -- it took the rebates and applied point of sale.

它被稱為 Allure，它定價的地方——它接受了回扣並應用了銷售點。

We had a very, I would say, small number of seniors enroll in that program.

我想說，我們有非常少的老年人參加了該計劃。

It was around 20,000.

大約有 20,000 人。

And we think one of the barriers to that was the increase that we saw in the monthly premium.

我們認為實現這一目標的障礙之一是我們在每月保費中看到的增加。

Okay.

好的。

So a follow-up question here.

所以這裡有一個後續問題。

One, just if you can refer to -- if the change happens, can you go back and change some contractual terms?

第一，如果你可以參考——如果發生變化，你能否返回並更改一些合同條款？

And then a second follow-up is, obviously, 2019 is a transition year, and you're going to give long-term guidance on your Analyst Day.

然後第二個後續行動顯然是，2019 年是過渡年，您將在分析師日提供長期指導。

But it's been over a year since you gave us year 2 accretion goal.

但是你給我們第二年的增生目標已經一年多了。

So can you give us any update there?

那麼你能給我們任何更新嗎？

What type of growth should we expect next year?

明年我們應該期待什麼樣的增長？

Yes, Ricky.

是的，瑞奇。

In terms of the other question on can we go back to clients should there be a material change in how the programs are written, the answer to that question is yes, okay?

關於另一個問題，如果程序的編寫方式發生重大變化，我們能否回到客戶那裡，這個問題的答案是肯定的，好嗎？

And in terms, Ricky, for a 2020 outlook, we're not going to provide that today.

就 2020 年的展望而言，瑞奇，我們今天不會提供。

It's -- we're working diligently, recognizing that we have made great progress on the integration work that was tied to the synergy goals that we've talked about.

這是 - 我們正在努力工作，認識到我們在與我們談到的協同目標相關的整合工作方面取得了很大進展。

And as you think about the regulatory pathway, quite frankly, it was very late in that process that we were able to begin the transformation work in earnest.

當你考慮監管途徑時，坦率地說，在這個過程中我們能夠認真開始轉型工作已經很晚了。

So we're pretty pleased that we've got concept stores up and running.

所以我們很高興我們已經開始運營概念店。

We've got a number of pilots in the market and a whole another series ready to go to market to learn and understand.

我們已經在市場上進行了一些試點，並且還有一個完整的系列準備進入市場學習和理解。

And that is our primary objective, to complete more of that work.

這是我們的主要目標，即完成更多的工作。

So when we get to June, we will be able to provide more of a long-term outlook.

因此，當我們到達 6 月時，我們將能夠提供更多的長期展望。

Our next question comes from Ann Hynes from Mizuho Securities.

我們的下一個問題來自瑞穗證券的 Ann Hynes。

I actually just want to follow up on Ricky's question because I do think 2020 is important.

實際上，我只想跟進 Ricky 的問題，因為我確實認為 2020 年很重要。

Because when you closed the deal, you did give some directional guidance that's mid-single digits.

因為當你完成交易時，你確實給出了一些中個位數的方向指導。

And if you adjust for tax reform, it would suggest a mid-$8 range.

如果您針對稅制改革進行調整，則建議在 8 美元左右的範圍內。

And the reason I bring it up is because that's where consensus estimate is now.

我之所以提出來，是因為這就是現在的共識估計。

So I know you don't want to comment on it.

所以我知道你不想對此發表評論。

But what do you think that we should consider in our models as the biggest change to your business model since you gave that guidance in December of 2017, I believe?

但是你認為我們應該在我們的模型中考慮什麼是自你在 2017 年 12 月給出該指導以來你的商業模式的最大變化，我相信？

So that's one.

這就是一個。

And secondly, on the Retail operating profit decline, if you ex the Omnicare and I think you said the tax reform investment is down 5%.

其次，關於零售營業利潤下降，如果你不考慮 Omnicare，我想你說過稅改投資下降了 5%。

And I know you say it's because break-open generics is less of an offset, but I still feel like that's very low.

我知道你說這是因為突破性仿製藥的抵消較少，但我仍然覺得這很低。

Can you give us more detail on what's happening there, so we put it on our models going forward?

你能給我們更多關於那裡發生的事情的細節，所以我們把它放在我們未來的模型上嗎？

Because it just seems a bigger decline than I would think.

因為這似乎比我想像的要大。

Yes, Ann, this is Kevin.

是的，安，這是凱文。

I'll take the Retail question, and then Eva will talk about 2020.

我將回答零售問題，然後伊娃將談論 2020 年。

The primary headwind in the Retail profitability excluding Long-Term Care and the tax investment is in pharmacy reimbursement.

不包括長期護理和稅收投資在內的零售盈利能力的主要阻力在於藥房報銷。

It's impacting small operators and big operators.

它正在影響小型運營商和大型運營商。

It's a secular headwind impacting everyone.

這是影響每個人的長期逆風。

What we talked about is a tailwind that, typically, is utilized to help us blunt that reduction is the generic wave.

我們談論的是一種順風，通常用於幫助我們減弱減少是通用浪潮。

And Jon covered it well that, that value year-over-year is down.

喬恩很好地說明了這一點，即價值同比下降。

Eva also mentioned in her prepared remarks that there has been effect from branded inflation that helps that blunting as well, and that number is down year-over-year.

伊娃在她準備好的發言中還提到，品牌通貨膨脹的影響也有助於減緩，而且這個數字同比下降。

So we're seeing a consistent headwind.

所以我們看到了持續的逆風。

It's the 2 tailwinds themselves that reduced in value year-over-year.

這是 2 個順風本身的價值同比下降。

And as I mentioned a few moments ago, our plan to address that for 2020 and beyond is to accelerate our top line growth.

正如我剛才提到的，我們在 2020 年及以後解決這個問題的計劃是加速我們的收入增長。

The good news in our Retail business is we are winning in the top line.

我們零售業務的好消息是我們贏得了收入。

We're taking market share in both the front and Pharmacy business.

我們正在前線和藥房業務中佔據市場份額。

We're resonating with consumers, growing share of wallet with consumers and taking market share.

我們正在與消費者產生共鳴，增加消費者的錢包份額並佔據市場份額。

What we need to do more for 2020 and beyond is increase the year-over-year value of productivity improvement.

我們需要為 2020 年及以後做更多的事情是增加生產率提高的同比價值。

We have some compelling innovations coming in technology improvement that can help automate things that are currently done manually within the pharmacies.

我們在技術改進方面有一些引人注目的創新，可以幫助自動化目前在藥房內手動完成的事情。

And I'll just repeat, the most important thing we need to do is to make a pivot in our third-party payor contracting.

我再說一遍，我們需要做的最重要的事情是在我們的第三方付款人合同中做出調整。

We are going to lead to change there to migrate to a new method of doing pharmacy contracting.

我們將在那裡進行變革，以遷移到一種新的藥房承包方法。

We're going to start with ourselves.

我們將從我們自己開始。

So by owning a large insurer and owning the largest PBM, we can lead that change by structuring a contracting relationship, that if we can lower overall health care costs, we can take some of the burden off of the annual reimbursement reform.

因此，通過擁有一家大型保險公司和最大的 PBM，我們可以通過構建合同關係來引領變革，如果我們能夠降低整體醫療保健成本，我們就可以減輕年度報銷改革的一些負擔。

And where that will come from is the last thing I'll say is we can prove through technology and clinical care programs that we can improve medication adherence.

我要說的最後一件事是我們可以通過技術和臨床護理計劃證明我們可以提高藥物依從性。

We can maximize the formulary compliance that Derica spoke to in his remarks.

我們可以最大限度地遵守 Derica 在他的評論中提到的處方集。

We can do things that are net new like reduced hospitalization through our clinical outreach program, saving Aetna money, and then we can share in the benefit of that from the Retail segment.

我們可以做一些全新的事情，比如通過我們的臨床推廣計劃減少住院率，節省 Aetna 的錢，然後我們可以分享零售部門的好處。

We intend to bring that model to the other payers, and 2 of the other payers also own an insurance company.

我們打算將該模型帶給其他付款人，而其他付款人中有 2 家也擁有一家保險公司。

And I just want to emphasize the last point that Kevin just mentioned, because I've come to appreciate when you look at the Aetna business today, more than 50% of their claims have some type of outcomes-based reimbursement tied to that.

我只想強調凱文剛才提到的最後一點，因為當你今天看 Aetna 業務時，我開始意識到，他們超過 50% 的索賠都與某種類型的基於結果的報銷相關。

And it's all on the medical side with providers, okay?

這一切都與提供者有關，好嗎？

Yet, we have -- Pharmacy has not penetrated that.

然而，我們已經 - 藥房還沒有滲透。

And this new model is going to demonstrate the role that Pharmacy can play in terms of affecting and improving outcomes.

這種新模式將展示藥房在影響和改善結果方面可以發揮的作用。

And I think it's one of the big unlocks as you think about an open platform concept that we could make elements of broadly available in the market.

我認為這是一個大的解鎖，因為你考慮一個開放平台概念，我們可以在市場上廣泛提供元素。

So Ann, this is Eva, I'll go back to your 2020 question.

安，這是伊娃，我將回到你的 2020 年問題。

And as Larry said, it's still really early to give 2020 guidance or expectation, but let me try to provide you some color.

正如拉里所說，現在給出 2020 年的指導或期望還為時過早，但讓我試著為你提供一些色彩。

In terms of the accretion numbers that were provided back when the deal was announced, it's really difficult at this point in time to speak to those.

就交易宣佈時提供的增生數字而言，目前很難及時與這些人交談。

Given the timing of the deal close, you'd have to mix and match periods as well as the changes related to tax reform.

考慮到交易完成的時間，您必須混合和匹配期間以及與稅收改革相關的變化。

But what is 100% clear is that Aetna is performing at or better than our expectations.

但 100% 清楚的是，Aetna 的表現達到或優於我們的預期。

We absolutely stand behind the estimates of the value being created by the deal.

我們絕對支持對交易所創造價值的估計。

And as we've said, we're tracking ahead of our synergy number, year 2 synergy number of 2020.

正如我們所說，我們正在追踪我們的協同效應數字，即 2020 年的第 2 年協同效應數字。

The factors affecting, what I'll say, the legacy CVS businesses, as you think about 2020, all of those factors will either improve or phase out.

我要說的是，影響傳統 CVS 業務的因素，正如您對 2020 年的看法，所有這些因素都將得到改善或逐步淘汰。

The tax reform investment obviously is complete.

稅改投資顯然已經完成。

The impact of the rebate guarantee peaks in '19 and is reduced in 2020.

回扣保證的影響在 19 年達到頂峰，並在 2020 年減少。

And we expect both Omnicare and generics to improve in 2020.

我們預計 Omnicare 和仿製藥都將在 2020 年有所改善。

Our next question comes from Robert Jones from Goldman Sachs.

我們的下一個問題來自高盛的羅伯特瓊斯。

I guess just to follow up there on the synergies.

我想只是為了跟進協同效應。

It clearly sounds like you're still on track.

聽起來您似乎仍在軌道上。

I mean, maybe one of the other sides of it that was a little bit larger than I think we would have expected was the incremental spending in order to achieve those synergies.

我的意思是，也許它的另一面比我認為我們預期的要大一點，那就是為了實現這些協同效應而增加的支出。

So just on the numbers that you provided for this year, could you talk a little bit about what that spend is exactly?

那麼就您今年提供的數字而言，您能否談談這筆支出到底是多少？

And I know you said, Eva, that HCB would disproportionately benefit from the synergies this year.

我知道你說過，Eva，HCB 將從今年的協同效應中受益匪淺。

Is that safe to assume where the incremental spend would also come?

可以安全地假設增量支出也會來自哪裡嗎？

Yes, Bob, thanks for the question.

是的，鮑勃，謝謝你的提問。

So as we think about the additional investment spending, it's in the $325 million to $350 million range.

因此，當我們考慮額外的投資支出時，它在 3.25 億美元到 3.5 億美元之間。

I would put that spending into 2 large buckets, right?

我會把這筆支出分成兩個大桶，對嗎？

Supporting transformation and includes investments in our clinical platform to more effectively engage members, our chronic care initiative and other initiatives aimed at improving outcomes and lowering cost.

支持轉型，包括投資我們的臨床平台以更有效地吸引會員、我們的長期護理計劃和其他旨在改善結果和降低成本的計劃。

The other area that we're continuing to invest in and expand our investment is digital and improving the digital and mobile experience for members and customers across all of our businesses.

我們繼續投資和擴大投資的另一個領域是數字化，並改善我們所有業務的會員和客戶的數字和移動體驗。

And we're making investments in our health cloud software platform.

我們正在投資我們的健康雲軟件平台。

So a large amount of these investments do affect the Aetna business as there was 0 in 2019, if you will, in the denominator for which we're comparing.

因此，這些投資中有很大一部分確實影響了 Aetna 的業務，因為如果你願意的話，在我們比較的分母中，2019 年為 0。

Okay.

好的。

And then safe to assume that as we roll beyond '19, these costs should reduce would just be the quick follow-up.

然後可以安全地假設，隨著我們超越 19 年，這些成本應該會減少，這只是快速跟進。

And then the other question I had, more housekeeping, was just as we look at the guide for HCB housekeeping, is prior period development included or excluded from that guidance?

然後我遇到的另一個問題，更多的內務管理，就像我們查看 HCB 內務管理指南一樣，該指南是否包含或排除前期開發？

So Bob, I'll take your last question first.

鮑勃，我先回答你的最後一個問題。

There is no -- consistent with Aetna's legacy practices, there is no prior period development included in our guidance.

沒有——與 Aetna 的傳統做法一致，我們的指南中沒有包含前期開發。

In terms of investments in the business, yes, I do think as the investments will step down over time, but we will continue to invest in our business as we're evolving to our new model with the consumer at the center.

就業務投資而言，是的，我確實認為隨著時間的推移投資會減少，但隨著我們向以消費者為中心的新模式發展，我們將繼續投資我們的業務。

And Bob also, just keep in mind to that point that as you've heard us talk on the Retail side, more on the CapEx side, we have the opportunity to repurpose capital that we would have spent in the areas that can be dedicated to our activity here.

還有鮑勃，請記住這一點，正如你聽到我們在零售方面的談話，更多的是在資本支出方面，我們有機會重新利用我們本可以投入的領域的資本我們在這裡的活動。

So that's one of the reasons why you don't hear us talking about it in that regard.

所以這就是為什麼你沒有聽到我們在這方面談論它的原因之一。

Our next question comes from Charles Rhyee from Cowen.

我們的下一個問題來自 Cowen 的 Charles Rhyee。

I just want to go back to Omnicare real quickly here.

我只想在這裡快速回到 Omnicare。

You've kind of written off maybe upwards of half of the value of what you've kind of put into it initially when you consider the debt you took on as well.

當你考慮你承擔的債務時，你可能已經註銷了你最初投入其中的價值的一半以上。

It sounds like there's 2 pieces you're talking about, right?

聽起來你說的是 2 件作品，對吧？

The piece that you're interested in, which was the independent and assisted living market versus the SNF market.

您感興趣的部分是獨立和輔助生活市場與 SNF 市場。

When you talk about the turnaround here, is it that you expect initiatives to grow the business in assisted living, that's going to take off?

當您在這裡談論轉機時，您是否期望發展輔助生活業務的舉措會起飛？

Or is it that you think the declines in the SNF business are going to slow?

還是您認為 SNF 業務的下滑會放緩？

And you've been talking about this for a little bit.

你一直在談論這個。

What's kind of giving you the confidence -- what gives you the confidence here that you would expect that to turn as you get into '20?

是什麼給了你信心——是什麼給了你信心，讓你相信當你進入 20 歲時這種情況會發生變化？

Yes, Charles, it's Larry.

是的，查爾斯，是拉里。

And just one quick comment on that, and then I want to flip it over to Jon.

對此只有一個簡短的評論，然後我想把它交給喬恩。

As you look at the Omnicare business, don't lose sight of there was a specialty component of that business, which has been fully integrated and quite successful for the business.

當您審視 Omnicare 業務時，請不要忽視該業務的專業組成部分，該部分已完全整合併且對業務非常成功。

So I don't want to lose that element of the acquisition.

所以我不想失去收購的那個要素。

Yes.

是的。

And Charles, this is Jon.

查爾斯，這是喬恩。

So what gives us the confidence that we can stabilize the Long-Term Care, that's the SNF.

那麼，是什麼讓我們有信心穩定長期護理，那就是 SNF。

We have to think about stabilizing that.

我們必須考慮穩定它。

We've invested in account management personnel, so that they're providing higher levels of service to the facilities.

我們投資了客戶管理人員，以便他們為設施提供更高水平的服務。

We've seen significant improvements in our service levels, and our retention rates are improving pretty significantly.

我們已經看到我們的服務水平有了顯著提高，我們的保留率也在顯著提高。

And we're putting technology in that assist these facilities in communicating with the pharmacies.

我們正在使用技術來幫助這些設施與藥店進行溝通。

So we think service ties directly to retention, and we've made significant improvements there.

因此，我們認為服務與保留率直接相關，並且我們在這方面做出了重大改進。

And then we still are very bullish on our ability to grow in assisted living.

然後我們仍然非常看好我們在輔助生活中成長的能力。

So we've implemented a new service model, we call them community care centers.

所以我們實施了一種新的服務模式，我們稱之為社區護理中心。

So that there's a single point of contact with that community staff for senior living.

這樣就可以與社區工作人員建立一個單一的聯繫點，以解決老年生活問題。

That was not the case prior to this past year.

在過去的一年之前情況並非如此。

And then we've introduced some tools that we think are going to be very attractive to these facilities, like multidose packaging that is better than what's available generally in the market with barcode scanning.

然後我們介紹了一些我們認為對這些設施非常有吸引力的工具，比如多劑量包裝，它比市場上通常使用條形碼掃描的包裝更好。

And then we're also leveraging our CVS retail pharmacies for stat deliveries to these facilities.

然後我們還利用我們的 CVS 零售藥店向這些設施進行統計交付。

So these pharmacies are closer than the Omnicare pharmacies.

所以這些藥店比 Omnicare 藥店更近。

They can respond more rapidly and actually develop a relationship, a local relationship with those facilities, along with the Omnicare pharmacy.

他們可以更快地做出反應，並與這些設施以及 Omnicare 藥房建立關係，建立當地關係。

So we think we'll be able to not only grow our penetration rate in these assisted living facilities, but we're seeing existing clients, where we didn't have all of the assisted living facilities, actually give us more of their facilities because of these services and changes and enhancements that we've made.

所以我們認為我們不僅能夠提高這些輔助生活設施的滲透率，而且我們看到現有客戶，我們沒有所有的輔助生活設施，實際上給了我們更多的設施，因為這些服務以及我們所做的更改和增強。

My understanding -- just to follow up on that, my understanding is in assisted living, the part of the problem with that market was that the facilities themselves didn't think of themselves really as health care providers, really more as residential communities.

我的理解——只是為了跟進這一點，我的理解是在輔助生活方面，該市場的部分問題在於設施本身並不真正將自己視為醫療保健提供者，實際上更像是住宅社區。

Is that behavior starting to change?

這種行為開始改變了嗎？

Because it seems like a lot of the issues that you're discussing here are actually issues probably that Omnicare dealt with years ago as well.

因為看起來你在這裡討論的很多問題實際上可能也是 Omnicare 多年前處理的問題。

And so it kind of points to more of a structural issue, particularly in the SNF market, I guess.

因此，我猜這更多地指向了一個結構性問題，尤其是在 SNF 市場。

Any kind of structural changes you're either seeing that you think can be a positive as you kind of move forward here?

當你在這裡向前邁進時，你看到任何你認為可能是積極的結構變化嗎？

I think the structural change we're seeing in senior living or independent living, they're trying to be able to provide continuity of care as people progress through the different phases of aging and they move from independent living to assisted living.

我認為我們在老年生活或獨立生活中看到的結構性變化，他們正試圖在人們經歷不同的衰老階段並從獨立生活轉向輔助生活時提供持續的護理。

And so we think our value proposition will resonate even more based on these changing dynamics and what we've seen historically.

因此，我們認為我們的價值主張將根據這些不斷變化的動態和我們在歷史上看到的情況產生更多共鳴。

Our final question comes from Kevin Caliendo from UBS.

我們的最後一個問題來自瑞銀的 Kevin Caliendo。

One question I had just on the Aetna business, the health benefits business.

我剛剛提出一個關於 Aetna 業務的問題，即健康福利業務。

If you could just tell us on an apples-to-apples basis without any of the shifts between the segments and the like, what Aetna would have looked like, excluding any cost shifts that you may have done into that segment or the like.

如果你能在蘋果對蘋果的基礎上告訴我們，沒有任何細分市場之間的變化等，那麼 Aetna 會是什麼樣子，不包括你可能對該細分市場等所做的任何成本轉移。

What are we -- what would we be looking at?

我們是什麼——我們會看到什麼？

That's the first question.

這是第一個問題。

And the second question, can you talk about the magnitude of the Centene loss?

第二個問題，你能談談 Centene 損失的幅度嗎？

Should we expect to see that revenue loss?

我們應該期望看到收入損失嗎？

And how would it roll and impact the PBM margins positively or negatively and -- going forward?

它將如何滾動並積極或消極地影響 PBM 利潤率以及 - 向前發展？

So Kevin, this is Eva.

凱文，這是伊娃。

I'll take the first question regarding Aetna's performance without the shift.

我將回答有關 Aetna 在沒有轉變的情況下的表現的第一個問題。

What we're seeing, the most clarity I can give you here is without the shift and some of the things we've called out, we expect to see modest growth.

我們所看到的，我能在這裡給你的最清晰的是沒有轉變和我們已經提出的一些事情，我們預計會看到適度的增長。

The business has tailwinds behind it with the growth on membership in both commercial and government space, benefiting nicely from the synergies, but we're also making investments.

隨著商業和政府領域會員人數的增長，該業務在其背後有順風，從協同效應中受益匪淺，但我們也在進行投資。

So the best on a same-same basis, some modest growth on the bottom line.

因此，最好在相同的基礎上，在底線上有一些適度的增長。

Obviously, normalizing for the health insurance fee impact.

顯然，歸一化對於醫保費用的影響。

Right.

正確的。

Okay.

好的。

And then on Centene?

然後在 Centene 上？

Kevin, this is Derica.

凱文，這是德里卡。

In regards to Centene, just keep in mind that it will be a multiyear migration.

關於 Centene，請記住這將是一個多年的遷移。

We anticipate it will start in 2019, likely to peak in 2020, and there's probably a residual in 2021.

我們預計它將在 2019 年開始，可能在 2020 年達到頂峰，並且可能在 2021 年有殘留。

And as Centene is migrating, they're looking to move to their own PBM platform, RxAdvance.

隨著 Centene 的遷移，他們希望遷移到自己的 PBM 平台 RxAdvance。

And Kevin, just to add one thing to Derica's point, while the exact timing with these large changes, you don't know exactly how the rollout will go, in our guidance range, we had made estimates within the range around our expected migration.

凱文，只是為 Derica 的觀點添加一件事，雖然這些大變化的確切時間，你不知道推出將如何進行，在我們的指導範圍內，我們已經在預期遷移的範圍內進行了估計。

Got it.

知道了。

And just, I guess, one more on the WellCare, the PDP business that you sold to WellCare, how is that incorporated into the numbers now?

而且，我想，還有一個關於 WellCare，您出售給 WellCare 的 PDP 業務，現在如何將其納入數字？

Is it?

是嗎？

And what was the magnitude?

幅度有多大？

So WellCare, it's a transition year.

所以 WellCare，這是一個過渡年。

The economics still continue to benefit Aetna.

經濟學仍然繼續有利於 Aetna。

Yes, they benefit Aetna.

是的，它們使 Aetna 受益。

They're still in the Aetna results as we're transitioning it out.

當我們將其轉換時，它們仍在 Aetna 結果中。

Okay.

好的。

Great.

偉大的。

I just wanted to make sure that they were still included in there.

我只是想確保它們仍然包含在其中。

All right.

好的。

So listen, we know this was a long call.

所以聽著，我們知道這是一個漫長的電話。

We know there's a lot of information, a lot of questions.

我們知道有很多信息，很多問題。

And as is always the case, Mike will be -- Mike and his team will be available for any follow-ups.

與往常一樣，Mike 將——Mike 和他的團隊將隨時準備好進行任何跟進。

And I'm sure we'll see many of you soon.

我相信我們很快就會見到你們中的許多人。

Thanks.

謝謝。

This concludes today's conference.

今天的會議到此結束。

You may now disconnect.

您現在可以斷開連接。