CVS Health Corp (CVS) 2019 Q3 法說會逐字稿

Ladies and gentlemen, thank you for standing by, and welcome to the CVS Health Q3 2019 Earnings Call.

女士們、先生們，感謝大家的支持，歡迎參加 CVS Health 2019 年第三季度財報電話會議。

(Operator Instructions)

（操作員說明）

I would now like to hand the conference over to your speaker today, Valerie Haertel, Senior Vice President of Investor Relations.

我現在想將會議交給今天的發言人，投資者關係高級副總裁瓦萊麗·哈特爾 (Valerie Haertel)。

Thank you.

謝謝。

Please go ahead.

請繼續。

Thank you, and good morning, everyone.

謝謝大家，大家早上好。

Welcome to the CVS Health Third Quarter 2019 Earnings Call.

歡迎參加 CVS Health 2019 年第三季度收益電話會議。

As a reminder, this call is being recorded.

提醒一下，此通話正在錄音。

I'm Valerie Haertel, Senior Vice President of Investor Relations for CVS Health.

我是 Valerie Haertel，CVS Health 投資者關係高級副總裁。

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

今天上午，總裁兼首席執行官拉里·梅洛 (Larry Merlo) 也加入了我的行列。伊娃·博拉托 (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 when Jon Roberts, Chief Operating Officer; Karen Lynch, President of Aetna; Derica Rice, President of Caremark; and Kevin Hourican, President of CVS Pharmacy, will also join us.

在我們準備好的發言之後，我們將舉辦問答環節，首席運營官喬恩·羅伯茨 (Jon Roberts)凱倫·林奇 (Karen Lynch)，Aetna 總裁；德麗卡·賴斯 (Derica Rice)，Caremark 總裁； CVS Pharmacy 總裁 Kevin Hourican 也將加入我們。

(Operator Instructions)

（操作員說明）

In addition to this call and our press release, consistent with our practice, we have posted a slide presentation on our website.

除了本次電話會議和我們的新聞稿之外，根據我們的慣例，我們還在我們的網站上發布了幻燈片演示。

Our Form 10-Q was filed this morning and is available.

我們的 10-Q 表格已於今天早上提交並可供使用。

Please note, 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，在本次電話會議中，我們將做出某些前瞻性陳述，反映我們對未來財務業績、未來事件以及行業和市場狀況的當前看法，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.

這些前瞻性陳述存在風險和不確定性，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 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 concerning forward-looking statements disclosures in our quarterly report on Form 10-Q.

我們強烈建議您查看我們向 SEC 提交的有關這些風險和不確定性的報告中的信息，特別是我們 10-K 表格年度報告的風險因素部分中描述的信息以及有關前瞻性聲明的警示性聲明。查看我們10-Q 表季度報告中的報表披露內容。

You should also review the section entitled Cautionary Statement Concerning Forward-looking Statements in this morning's earnings press release.

您還應該查看今天上午的收益新聞稿中標題為“有關前瞻性陳述的警示聲明”的部分。

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

在本次電話會議中，我們在談論公司的業績和財務狀況時將使用非公認會計準則財務指標。

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

根據 SEC 規定，您可以在收益新聞稿和我們網站投資者關係部分發布的對賬文件中找到對這些非 GAAP 衡量標準和可比 GAAP 衡量標準的討論。

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

與往常一樣，今天的電話會議將在我們的網站上播出，並將在電話會議後存檔一年。

Now I'll turn the call over to Larry.

現在我將把電話轉給拉里。

Well, thanks, Valerie.

嗯，謝謝，瓦萊麗。

Good morning, everyone, and thanks for joining us.

大家早上好，感謝您加入我們。

In the third quarter, we continued building on our positive business momentum, delivering adjusted earnings per share of $1.84, exceeding the high end of our guidance range.

第三季度，我們繼續保持積極的業務勢頭，實現調整後每股收益 1.84 美元，超出了我們指導範圍的上限。

Importantly, this performance was driven by strong operational execution across our enterprise, with all 3 segments performing in line with or above our expectations.

重要的是，這一業績是由我們整個企業強大的運營執行力推動的，所有三個部門的表現均符合或高於我們的預期。

And I'll note that $0.04 of our Q3 performance was the result of net realized capital gains and favorable prior year development.

我要指出的是，我們第三季度業績的 0.04 美元是淨實現資本收益和上一年有利發展的結果。

We generated strong cash flow from operations, which enabled us to continue to make progress on deleveraging, all while investing in our core businesses and return capital to our shareholders through dividends.

我們的運營產生了強勁的現金流，這使我們能夠在去槓桿方面繼續取得進展，同時投資於我們的核心業務並通過股息向股東返還資本。

Given our year-to-date success in executing against our strategic plan, we are raising and narrowing our adjusted earnings per share guidance range to $6.97 to $7.05.

鑑於我們今年迄今在執行戰略計劃方面取得的成功，我們將調整後每股收益指導範圍上調並縮小至 6.97 美元至 7.05 美元。

And Eva will provide a more in-depth review of our results and increased guidance in her remarks.

伊娃將在她的講話中對我們的結果進行更深入的審查並提供更多指導。

Now as we continue to transform CVS into the country's leading consumer health company, we are successfully executing on our long-term growth strategy across the 4 key enterprise-wide priorities we shared at our June Investor Day.

現在，隨著我們繼續將 CVS 轉型為全國領先的消費者健康公司，我們正在成功執行我們在 6 月投資者日分享的 4 個關鍵企業優先事項的長期增長戰略。

Importantly, our teams are working together across the enterprise to maximize value to our members, consumers, patients and shareholders.

重要的是，我們的團隊在整個企業內共同努力，為我們的會員、消費者、患者和股東創造最大價值。

And our operational and financial performance this year reflects their efforts.

我們今年的運營和財務業績反映了他們的努力。

We continued to use our unmatched combination of assets by enhancing and creating products and services to further grow and differentiate our businesses, our first strategic priority.

我們繼續利用我們無與倫比的資產組合，通過增強和創造產品和服務來進一步發展和差異化我們的業務，這是我們的首要戰略重點。

In our Retail/Long-Term Care segment, we continued to drive strong prescription growth using our data and analytics capabilities through targeted, proactive member communication.

在我們的零售/長期護理部門，我們通過有針對性的、主動的會員溝通，利用我們的數據和分析能力，繼續推動處方藥的強勁增長。

A key differentiator of our retail stores is our ability to meet members and consumers where they are to deliver local, personalized care through our MinuteClinics and now our HealthHUBs, making health care more accessible and affordable.

我們零售店的一個關鍵區別在於我們能夠滿足會員和消費者的需求，他們通過我們的 MinuteClinics 和現在的 HealthHUB 提供本地個性化護理，使醫療保健變得更容易獲得和負擔得起。

And our approach is clearly resonating in the marketplace and is exemplified both by our continued share gains at retail and the early success of the HealthHUBs.

我們的方法顯然在市場上引起了共鳴，我們在零售領域的持續份額增長和 HealthHUB 的早期成功就證明了這一點。

Now in terms of early impact, our HealthHUBs in Houston, which now have about 8 months of performance, have continued to outperform their control group with higher script volume in MinuteClinic visits along with higher front store sales, traffic and store margin.

現在就早期影響而言，我們位於休斯敦的HealthHUB 目前已有約8 個月的業績，其表現繼續優於對照組，MinuteClinic 訪問中的腳本量更高，而且前台店銷售額、流量和店面利潤也更高。

This favorable performance and the incremental value we expect will be derived from the expanded utilization of the hubs gives us further confidence in our planned rapid rollout, and we are on track with 3 additional metro areas with approximately 50 hubs operational by year-end, along with our plan to have 1,500 hubs by the end of 2021.

這種良好的表現和我們期望的增量價值將來自於樞紐的擴大利用，這讓我們對計劃中的快速部署更加充滿信心，我們正計劃在年底前增加3 個都市區，運營約50 個樞紐，我們計劃到 2021 年底擁有 1,500 個樞紐。

The value we expect our HealthHUBs to deliver stems from various sources: first, increased earning contributions from the greater use of our new and enhanced products and services; second, improved medical cost savings in Aetna's book of business as we deploy our capabilities to address the unique needs of the member populations we serve, driving value to our Health Care Benefits segment.

我們期望 HealthHUB 提供的價值來自多種來源：首先，通過更多地使用我們的新產品和增強型產品和服務來增加收入貢獻；其次，隨著我們部署我們的能力來滿足我們所服務的會員群體的獨特需求，從而提高我們的醫療保健福利部門的價值，Aetna 業務中的醫療成本節省得到了改善。

Our plan design innovations aim to incentivize members to utilize more cost-effective settings, and providing our pharmacies with integrated medical and pharmacy data allows for improving the delivery of a member's next best health action to impact behavior changes and improved health outcomes.

我們的計劃設計創新旨在激勵會員利用更具成本效益的環境，並為我們的藥房提供綜合的醫療和藥房數據，以便改善會員下一個最佳健康行動的實施，以影響行為改變和改善健康結果。

Third is our unmatched capability through our open-source approach in extending consumer-centric offerings to our health plan relationships across the CVS Health enterprise.

第三，我們通過開源方法將以消費者為中心的產品擴展到整個 CVS Health 企業的健康計劃關係，從而擁有無與倫比的能力。

And our new product and service offerings have a direct impact on the overall health care costs of the clients and partners serviced by CVS Caremark and CVS Pharmacy, and they're making a difference in our market positioning with these clients and partners.

我們的新產品和服務對 CVS Caremark 和 CVS Pharmacy 服務的客戶和合作夥伴的整體醫療保健成本產生直接影響，並且它們正在改變我們與這些客戶和合作夥伴的市場定位。

And all of this leads to a fourth driver of value, and that's the resultant benefit of increased customer satisfaction and retention.

所有這些都帶來了第四個價值驅動因素，那就是提高客戶滿意度和保留率所帶來的好處。

Now our opportunity to differentiate our offerings at the community level received another boost with a recent designation earned by our MinuteClinics.

現在，我們在社區層面提供差異化​​服務的機會再次得到提升，我們的 MinuteClinics 最近獲得了這一稱號。

CVS Health professionals who staff our clinics, which, again, are foundational to our HealthHUB expansion, have earned a Pathway to Excellence designation from the American Nurses Credentialing Center for the quality services they provide.

我們診所的 CVS Health 專業人員是我們 HealthHUB 擴張的基礎，他們因其提供的優質服務而獲得了美國護士資格認證中心授予的“卓越之路”稱號。

And MinuteClinic is the first and only retail clinic to receive this elite designation.

MinuteClinic 是第一家也是唯一一家獲得這一精英稱號的零售診所。

So as more hubs come online toward our goal of 1,500, we will continue to update you on our performance and the benefits of our integrated health care approach for consumers.

因此，隨著越來越多的中心上線以實現我們 1,500 個的目標，我們將繼續向您通報我們的績效以及我們的綜合醫療保健方法為消費者帶來的好處。

For our Pharmacy Services segment, we continued to deliver solid performance, driven by growth in specialty, strong volume in our Maintenance Choice program and continued improvement in purchasing economics.

對於我們的藥房服務部門，在專業增長、維護選擇計劃的強勁銷量以及採購經濟性的持續改善的推動下，我們繼續提供穩健的業績。

As for the 2020 selling season, it's nearly complete, with gross new business increasing $1.1 billion and net new business improving by approximately $1 billion since our second quarter update in August.

至於 2020 年銷售季，它已接近尾聲，自 8 月份更新第二季度以來，新業務總額增加了 11 億美元，新業務淨額增加了約 10 億美元。

The 2021 selling season is now underway, and we are well positioned with our product offerings, and our sales teams are engaging in productive conversations, identifying innovative ways to serve both new and existing clients.

2021 年銷售季節現已到來，我們的產品已做好充分準備，我們的銷售團隊正在進行富有成效的對話，確定為新客戶和現有客戶提供服務的創新方法。

To that end, in the quarter, we successfully renewed our relationship with the Federal Employees Health Benefits Program through December 2021.

為此，我們在本季度成功將與聯邦僱員健康福利計劃的關係續簽至 2021 年 12 月。

And this renewal includes both our mail and retail contracts and represents an opportunity to continue to strengthen our client relationship.

此次續約包括我們的郵件和零售合同，是繼續加強我們客戶關係的機會。

Our Health Care Benefits segment is also well positioned for growth heading into '20, and we are building momentum with our new enterprise offerings, which will differentiate us in the marketplace.

我們的醫療保健福利部門也為進入 20 世紀的增長做好了準備，我們正在通過新的企業產品打造動力，這將使我們在市場上脫穎而出。

Our customer value proposition has been further reinforced by the most recent Medicare Advantage Star Ratings data released by CMS last month.

CMS 上個月發布的最新 Medicare Advantage 星級評級數據進一步強化了我們的客戶價值主張。

And Aetna's Medicare Advantage plans earned an overall weighted average of 4.3 out of 5 stars for 2020, with 76% of our Medicare Advantage members enrolled in plans rated at least 4.5 stars, and that's based on our September 2019 membership, and that's also the highest percentage among publicly traded companies with over 250,000 Medicare Advantage enrollees.

Aetna 的Medicare Advantage 計劃2020 年的總體加權平均得分為4.3 星（滿分5 星），我們76% 的Medicare Advantage 會員加入的計劃評分至少為4.5 星，這是基於我們2019 年9 月的會員資格，這也是最高的Medicare Advantage 參保人數超過 250,000 名的上市公司中的百分比。

Our 2020 Star Ratings drive more favorable bonus payments and bid rebates, enabling enhanced product offerings in 2021.

我們的 2020 年星級評級推動了更優惠的獎金支付和投標回扣，從而增強了 2021 年的產品供應。

And this year's Star Ratings demonstrate the success of Aetna's approach to growing our Medicare business across the country while maintaining best-in-class quality.

今年的星級評級表明 Aetna 在保持一流質量的同時在全國范圍內發展醫療保險業務的方法取得了成功。

Turning to Medicaid.

轉向醫療補助。

We were recently awarded Medicaid lives in the Texas STAR+

我們最近獲得了德克薩斯州 STAR+ 的醫療補助生活

PLUS program and the West Virginia children and youth program.

PLUS 計劃和西弗吉尼亞州兒童和青少年計劃。

And these wins reinforce our commitment to Medicaid and speak to the strength of our Medicaid services and capabilities, allowing us to build upon existing relationships with 2 very important state partners.

這些勝利強化了我們對醫療補助的承諾，並證明了我們醫療補助服務和能力的實力，使我們能夠與兩個非常重要的州合作夥伴建立現有關係。

Now we're also encouraged by the strong client interest in our new integrated capabilities, including our HealthHUBs, and these capabilities will be a core component of our value proposition for the '21 selling season.

現在，客戶對我們的新集成功能（包括我們的 HealthHUB）的強烈興趣也讓我們深受鼓舞，這些功能將成為我們 21 銷售季價值主張的核心組成部分。

We're also excited about our recently launched Healing Better program, a transitions-of-care program intended to improve the recovery process from joint replacement procedures.

我們還對最近推出的“Healing Better”計劃感到興奮，這是一項護理過渡計劃，旨在改善關節置換手術的恢復過程。

Healing Better is another example of the power of our combination to provide enterprise solutions to improve patient experiences.

Healing Better 是我們強強聯手提供企業解決方案以改善患者體驗的另一個例子。

And we're excited to incorporate this offering into Medicare Advantage plans in select geographies in 2020.

我們很高興能在 2020 年將這一產品納入特定地區的 Medicare Advantage 計劃。

Moving to our second strategic priority, delivering transformational products and services, we are continuing to advance innovative pilot programs and introduce new and innovative offerings.

轉向我們的第二個戰略重點，即提供變革性產品和服務，我們將繼續推進創新試點計劃並推出新的創新產品。

In the third quarter, our oncology pilot continued to roll out across selected geographies.

第三季度，我們的腫瘤學試點繼續在選定的地區推出。

We also rolled out the first phase of our chronic kidney care management program to Aetna and Caremark clients for early disease detection and care management development.

我們還向 Aetna 和 Caremark 客戶推出了第一階段的慢性腎臟護理管理計劃，以實現早期疾病檢測和護理管理髮展。

And with several hundred members under management, we are moving on to the second phase of the program, which is the face-to-face counseling around different dialysis modalities.

在管理著數百名會員的情況下，我們正在進入該計劃的第二階段，即圍繞不同透析方式的面對面諮詢。

And I should also mention that our home hemodialysis clinical trial is progressing as expected, with our first 2 sites active.

我還應該提到，我們的家庭血液透析臨床試驗正在按預期進展，我們的前兩個站點正在活躍中。

And we are confident that we will complete the trial on our previously discussed time line.

我們有信心按照之前討論的時間表完成試驗。

With our third strategic priority, we are developing and enhancing programs that encompass our consumer-centric technology infrastructure.

在我們的第三個戰略重點中，我們正在開發和加強包含以消費者為中心的技術基礎設施的計劃。

And as previously announced, our CarePass subscription service went live nationally in the third quarter.

正如之前宣布的那樣，我們的 CarePass 訂閱服務於第三季度在全國范圍內上線。

And we have already enrolled more than 1 million members in less than 2 months, which has exceeded our expectations for this recently launched membership program.

而我們在不到兩個月的時間裡已經註冊了超過100萬會員，這超出了我們對最近推出的會員計劃的預期。

In our Health Care Benefits segment, we have expanded the use of our proprietary Novologix technology for prior authorization and claims management in our commercial population.

在我們的醫療保健福利領域，我們擴大了專有 Novologix 技術的使用，以在商業人群中進行事先授權和索賠管理。

And given the proven success of our Novologix capabilities, we are confident in our ability to drive cost savings and efficiencies for our clients who participate in those programs.

鑑於我們的 Novologix 能力已取得了成功，我們對為參與這些計劃的客戶節省成本和提高效率的能力充滿信心。

Additionally, we now have more than 82 million consumers and members engaging with our enterprise through text messaging, and that's an increase of 7% from last quarter.

此外，我們現在有超過 8200 萬消費者和會員通過短信與我們的企業互動，比上季度增加了 7%。

And we're encouraged by the increased engagement we experienced across our digital programs.

我們對數字項目中參與度的提高感到鼓舞。

Moving to our fourth strategic priority, modernizing our enterprise functions and capabilities.

轉向我們的第四個戰略重點，實現企業職能和能力的現代化。

Again, we're making progress and are on track to see the initial benefits beginning in 2020.

同樣，我們正在取得進展，並有望在 2020 年開始看到初步效益。

We have aligned teams around simplifying our service operations, embedding intelligent automation to streamline routine processes and further advance our digital footprint.

我們讓團隊圍繞簡化服務運營、嵌入智能自動化來簡化日常流程並進一步推進我們的數字化足跡。

These initiatives are expected to further enhance our self-service capabilities by eliminating unnecessary member and patient mailings as well as reduce incoming call volume across our businesses.

這些舉措預計將通過消除不必要的會員和患者郵件以及減少整個企業的來電量來進一步增強我們的自助服務能力。

And we continue to expect to generate $1.5 billion to $2 billion in run rate net savings in 2022 for enterprise modernization.

我們仍然預計 2022 年企業現代化將產生 15 億至 20 億美元的運行率淨節省。

And I should also note this is in addition to the $900 million run rate of projected integration synergies in 2021 that we have previously discussed.

我還應該指出，這還不包括我們之前討論過的 2021 年預計整合協同效應 9 億美元的運行率。

Another exciting accomplishment related to our investments on the CSR front is CVS Health being named to the prestigious Dow Jones Sustainability Index for the seventh consecutive year and for the first time added to their World index.

與我們在企業社會責任方面的投資相關的另一項令人興奮的成就是 CVS Health 連續第七年入選著名的道瓊斯可持續發展指數，並首次加入其世界指數。

And we are proud of this recognition, which is a true indication of our industry leadership in the area of corporate sustainability and our commitment to improving the health care system.

我們對此認可感到自豪，這真正表明了我們在企業可持續發展領域的行業領先地位以及我們對改善醫療保健系統的承諾。

And with that, I'll turn the call over to Eva to walk through our financial results and guidance.

接下來，我會將電話轉給伊娃，讓她詳細介紹我們的財務業績和指導。

Thanks, Larry, and good morning, everyone.

謝謝拉里，大家早上好。

As Larry said, strong performance across the enterprise drove our third quarter results.

正如拉里所說，整個企業的強勁表現推動了我們第三季度的業績。

Adjusted earnings per share of $1.84 was above the high end of our guidance, including $0.04 attributable to nonrecurring items generated by net realized capital gains and prior year's development.

調整後每股收益為 1.84 美元，高於我們指導的上限，其中包括由已實現淨資本收益和上一年發展產生的非經常性項目產生的 0.04 美元。

Health Care Benefits exceeded our expectations while Pharmacy Services and Retail/Long-Term Care were in line.

醫療保健福利超出了我們的預期，而藥房服務和零售/長期護理則符合預期。

The quarter also benefited from lower interest expense.

該季度還受益於利息支出的下降。

Consolidated adjusted revenues grew 37.1% in Q3 of '19, also exceeding our expectations.

2019 年第三季度合併調整後收入增長了 37.1%，也超出了我們的預期。

This year-over-year increase was largely driven by the addition of Aetna as well as higher volume in both the PBM and Retail/Long-Term Care segment.

這一同比增長主要是由於 Aetna 的加入以及 PBM 和零售/長期護理領域銷量的增加推動的。

The Health Care Benefits segment, which includes our SilverScript PDP business, contributed $17.2 billion of revenues for the quarter.

醫療保健福利部門（包括我們的 SilverScript PDP 業務）為本季度貢獻了 172 億美元的收入。

Adjusted consolidated operating income grew 48.9% compared to last year, primarily due to the addition of the Aetna business.

調整後綜合營業收入較去年增長 48.9%，主要是由於 Aetna 業務的增加。

Health Care Benefits contributed $1.4 billion, and we experienced growth in the PBM, which was partially offset by a decline in Retail/Long-Term Care.

醫療保健福利貢獻了 14 億美元，我們經歷了 PBM 的增長，但部分被零售/長期護理的下降所抵消。

Looking at our results by segment and starting with Pharmacy Services.

按細分市場查看我們的業績，從藥房服務開始。

Total revenues increased 6.4%, with adjusted claims volume up 9.3% year-over-year.

總收入增長 6.4%，調整後的索賠量同比增長 9.3%。

Drivers included net new business, particularly in specialty related to the IngenioRx onboarding and the continued adoption of our Maintenance Choice offerings.

驅動因素包括淨新業務，特別是與 IngenioRx 入門相關的專業業務以及我們的維護選擇產品的持續採用。

PBM adjusted operating income increased 5.7% versus Q3 of '18 due to increased claims volume, the shift of Aetna mail order and specialty operations into our Pharmacy Services segment and improved purchasing economics.

由於索賠量增加、Aetna 郵購和專業業務轉移到我們的藥房服務部門以及採購經濟性的改善，PBM 調整後的營業收入比 18 年第三季度增長了 5.7%。

We continue to mitigate our rebate guarantee exposure through formulary compliance and have experienced a larger-than-expected benefit from generic launches, primarily in specialty.

我們繼續通過處方合規來減輕我們的回扣保證風險，並從仿製藥（主要是特種藥物）的推出中獲得了超出預期的好處。

These improvements are partially offset by continued price compression.

這些改進被持續的價格壓縮部分抵消。

Brand drug inflation remains consistent with our previous expectations.

品牌藥品通脹與我們之前的預期保持一致。

Moving to Retail/Long-Term Care.

轉向零售/長期護理。

The segment performed in line with our expectations, with total revenues up 2.9%, driven by higher prescription volume.

該部門的表現符合我們的預期，在處方量增加的推動下，總收入增長了 2.9%。

We delivered strong adjusted script growth of 6.4%, with comp scripts up 7.8%, primarily driven by the continued adoption of our patient care programs.

我們的調整後腳本增長了 6.4%，補償腳本增長了 7.8%，這主要是由於我們的患者護理計劃的持續採用。

Our share of retail scripts increased approximately 110 basis points to 26.6% in Q3 versus the same period last year.

第三季度，我們的零售腳本份額與去年同期相比增加了約 110 個基點，達到 26.6%。

Additionally, front store comp sales increased 60 basis points, driven primarily by continued growth in health and beauty sales, including cough and cold.

此外，前店銷售額增長了 60 個基點，這主要是受到健康和美容產品（包括咳嗽和感冒）銷售持續增長的推動。

Retail/Long-Term Care third quarter adjusted operating income declined 6.5% year-over-year, primarily driven by continued reimbursement pressure, partially offsetting the decline with continued script growth and front store margin improvement as well as the benefit of generics, where we have seen some improvement.

零售/長期護理第三季度調整後營業收入同比下降 6.5%，主要是由於持續的報銷壓力，部分抵消了持續的腳本增長和前台利潤率改善以及仿製藥的好處所帶來的下降，其中我們已經看到一些改善。

As part of our ongoing review of our asset portfolio and focus on driving greater returns, in the quarter, we made the decision to close approximately 75 retail pharmacy stores during 2020, the majority of which are nearing the end of their lease term.

作為我們持續審查資產組合併專注於推動更大回報的一部分，本季度我們決定在 2020 年期間關閉約 75 家零售藥店，其中大部分已接近租賃期結束。

This resulted in a $96 million GAAP charge in the Retail/Long-Term Care segment.

這導致零售/長期護理部門的 GAAP 費用為 9600 萬美元。

We believe these decision will generate enhanced longer-term performance.

我們相信這些決定將產生增強的長期業績。

Our real estate footprint remains very productive, and we will continue to look for opportunities to further improve the performance in our portfolio.

我們的房地產業務仍然非常富有成效，我們將繼續尋找機會進一步提高我們投資組合的業績。

Lastly, our Health Care Benefits segment delivered better-than-expected results for the quarter due to prior year's development and net realized capital gains.

最後，由於上一年的發展和淨實現資本收益，我們的醫療保健福利部門本季度的業績好於預期。

Total revenues of $17.2 billion continued to benefit from strong growth in Government business.

172 億美元的總收入繼續受益於政府業務的強勁增長。

Total health MBR of 83.3% benefited from favorable prior period development across all our core products.

83.3% 的總體健康 MBR 受益於我們所有核心產品前期的良好發展。

Last quarter, we highlighted modest pressure in a specific portion of the lower end of our middle market commercial book.

上個季度，我們強調了中端市場商業書籍低端特定部分的適度壓力。

During this quarter, we saw modest improvement in this business, and we continue to expect our MBR for the full year to be above the midpoint of our guidance range of 84%, plus or minus 50 basis points.

在本季度，我們看到該業務略有改善，我們繼續預計全年的 MBR 將高於我們指導範圍 84% 的中點，上下浮動 50 個基點。

Our days claims payable was 51 days for Q3.

第三季度的索賠應付天數為 51 天。

Compared to Q2, days claims payable increased by 3 days due to the seasonality that is typical of our PDP business.

與第二季度相比，由於我們 PDP 業務的典型季節性，應付索賠天數增加了 3 天。

We remain confident in the adequacy of our reserves and our ongoing reserving process.

我們對我們的儲備充足性和正在進行的儲備過程仍然充滿信心。

Within our corporate segment, we realized $32 million of net realized capital gains in the quarter.

在我們的企業部門中，本季度我們實現了 3200 萬美元的淨已實現資本收益。

Corporate segment expenses increased sequentially and year-over-year primarily due to investments in our transformation and modernization programs.

企業部門支出環比和同比增長主要是由於我們對轉型和現代化計劃的投資。

Moving to capital management.

轉向資本管理。

During the third quarter, we continued to make progress on our deleveraging efforts, which resulted in a net debt reduction of approximately $2.9 billion.

第三季度，我們的去槓桿工作繼續取得進展，淨債務減少約29億美元。

In addition to paying off over $1.5 billion term loan, $850 million of scheduled maturities, we completed a $4 billion tender offer for our outstanding senior debt and issued $3.5 billion of senior debt at favorable rates during the quarter.

除了償還超過 15 億美元的定期貸款和 8.5 億美元的預定期限外，我們還完成了對未償高級債務的 40 億美元要約收購，並在本季度以優惠利率發行了 35 億美元的高級債務。

We have now repaid approximately $8 billion of net debt since the close of the Aetna transaction.

自 Aetna 交易結束以來，我們現已償還了約 80 億美元的淨債務。

And we remain focused on deleveraging and achieving our leverage target of below 3x in 2022.

我們仍然專注於去槓桿化，並在 2022 年實現槓桿率低於 3 倍的目標。

Turning to cash flows and dividends.

轉向現金流和股息。

This quarter, we generated strong cash from operations of $2.9 billion from improved working capital and earnings performance.

本季度，由於營運資本和盈利業績的改善，我們從運營中產生了 29 億美元的強勁現金。

We also returned more than $600 million to shareholders through dividends.

我們還通過股息向股東返還超過 6 億美元。

With that, let me turn to our revised guidance for 2019.

接下來，讓我談談我們修訂後的 2019 年指引。

As Larry mentioned, in light of our third quarter performance, we are narrowing and raising our consolidated full year adjusted earnings per share guidance range to $6.97 to $7.05 million, compared to prior guidance of $6.89 to $7.

正如拉里提到的，鑑於我們第三季度的業績，我們正在縮小並提高全年綜合調整後每股收益指導範圍至 6.97 至 705 萬美元，而之前的指導範圍為 6.89 至 7 美元。

Our full year guidance reflects an aggregate of approximately $0.20 of prior year's development and net realized capital gain that we have recorded in the first 9 months of this year.

我們的全年指導反映了我們在今年前 9 個月記錄的上一年開發和已實現淨資本收益總計約 0.20 美元。

We are also raising our consolidated full year total revenues expectations to $251.6 billion to $254.2 billion and raising and narrowing our adjusted operating income expectations to $15.22 billion to $15.4 billion.

我們還將全年綜合總收入預期上調至 2516 億美元至 2542 億美元，並將調整後營業收入預期上調至 152.2 億美元至 154 億美元。

Additionally, we're on track to deliver at least $400 million of integration synergies this year.

此外，我們今年有望實現至少 4 億美元的整合協同效應。

Now a few highlights on our segments.

現在我們的細分市場有一些亮點。

There is additional detail in the slide presentation we posted on our website.

我們在網站上發布的幻燈片演示文稿中有更多詳細信息。

We are increasing our expectations for the Pharmacy Services segment, with adjusted operating income now in the range of $5.1 billion to $5.16 billion, reflecting the momentum in the business.

我們提高了對藥房服務部門的預期，調整後的營業收入目前在 51 億美元至 51.6 億美元之間，反映了該業務的發展勢頭。

We're maintaining our full year adjusted operating income range for the Health Care Benefits segment of $5.18 billion to $5.24 billion, reflecting year-to-date performance, including favorable prior year's development and net realized capital gains as well as our latest projection of investments required to onboard 2020 new business.

我們將醫療保健福利部門的全年調整後營業收入範圍維持在51.8 億美元至52.4 億美元之間，反映了年初至今的業績，包括上一年有利的發展和已實現的淨資本收益以及我們最新的投資預測開展 2020 年新業務所需的。

We are narrowing our full year adjusted operating income range for our Retail/Long-Term Care segment to $6.68 billion to $6.74 billion.

我們將零售/長期護理部門的全年調整後營業收入範圍縮小至 66.8 億美元至 67.4 億美元。

And we are lowering our interest expense estimates due our strong cash flow and the impact from the net paydown of debt.

由於我們強勁的現金流和債務淨償還的影響，我們正在降低利息支出估計。

Our updated full year 2019 GAAP EPS guidance range is $4.90 to $4.98, reflecting our year-to-date performance, the negative impact of store closures and the loss on the early extinguishment of debt.

我們更新後的 2019 年全年 GAAP 每股收益指導範圍為 4.90 美元至 4.98 美元，反映了我們今年迄今的業績、商店關閉的負面影響以及提前清償債務的損失。

We're maintaining our full year 2019 cash flow guidance, expecting to deliver strong cash from operations between $10.1 billion and $10.6 billion and have increased our projected cash available to pay down debt to $4.7 billion to $5.1 billion, of which $4.7 billion has been used to pay down debt year-to-date.

我們維持 2019 年全年現金流指引，預計運營業務帶來 101 億至 106 億美元的強勁現金，並將可用於償還債務的預計現金增加至 47 億至 51 億美元，其中 47 億美元已使用償還年初至今的債務。

Our cash flow projections include the improvements to our underlying business performance as well as early benefit from our initiative to reduce pharmacy inventory in our retail stores by $1.5 billion in 2022.

我們的現金流預測包括我們基本業務績效的改善，以及我們到 2022 年將零售店藥品庫存減少 15 億美元的計劃的早期收益。

We continue to expect 2019 net capital expenditures of $2.3 billion to $2.6 billion.

我們繼續預計 2019 年淨資本支出為 23 億美元至 26 億美元。

In terms of the fourth quarter, there are a few things to keep in mind.

就第四季度而言，有幾件事需要牢記。

For Health Care Benefits, the last quarter of the year is the typically lowest adjusted operating income quarter due to the seasonality of the business including spending to support January 1 readiness for our Medicare business.

對於醫療保健福利，由於業務的季節性，包括支持 1 月 1 日醫療保險業務準備就緒的支出，一年中的最後一個季度通常是調整後營業收入最低的季度。

Fourth quarter will also include higher sequential spending for our transformation programs.

第四季度我們的轉型計劃的連續支出也將增加。

Finally, given the timing of the close of the Aetna transaction, prior year fourth quarter does not include the full impact of share dilution and interest expense resulting from the transaction.

最後，考慮到 Aetna 交易的結束時間，去年第四季度並未包括交易造成的股票稀釋和利息支出的全部影響。

These differences affect the year-over-year adjusted EPS comparability.

這些差異影響了同比調整後每股收益的可比性。

As we look ahead to 2020, we feel very good about the momentum in our business, and we are even more confident in generating at least $7 of adjusted earnings per share, with low single-digit growth off our 2019 baseline, which excludes the nonrecurring items of approximately $0.20 I mentioned earlier.

展望 2020 年，我們對業務勢頭感到非常滿意，並且更有信心實現至少 7 美元的調整後每股收益，較 2019 年基線（不包括非經常性損益）實現低個位數增長。我之前提到過的大約0.20 美元的物品。

These items will not be included in our 2020 guidance, consistent with the legacy Aetna practice.

這些項目將不會包含在我們的 2020 年指南中，這與 Aetna 的傳統做法一致。

As we have stated previously, we will provide full 2020 guidance on our fourth quarter earnings call.

正如我們之前所說，我們將在第四季度財報電話會議上提供完整的 2020 年指引。

In summary, we continue to execute against our plan, and we are confident that we will be able to achieve our financial and operating goal for the full year and over the longer term.

總而言之，我們將繼續執行我們的計劃，我們有信心能夠實現全年和長期的財務和運營目標。

We remain focused on strengthening our business to deliver sustainable long-term growth and create value for all stakeholders through our transformation into the most consumer-centric health company.

我們仍然專注於加強我們的業務，以實現可持續的長期增長，並通過轉型為最以消費者為中心的健康公司為所有利益相關者創造價值。

With that, I would like to open it up for your questions.

說到這裡，我想打開它來回答你們的問題。

(Operator Instructions) Your first question comes from the line of Lisa Gill with JPMorgan.

（操作員說明）您的第一個問題來自摩根大通的 Lisa Gill。

Great.

偉大的。

Larry, I want to start with your comments around the HealthHUBs.

Larry，我想從您對 HealthHUB 的評論開始。

You talked about the outperformance versus the control group.

您談到了與對照組相比的優異表現。

I really have 3 questions here.

我真的有3個問題。

One, any numbers that you can share around that?

第一，您可以分享一些相關的數字嗎？

Two, as we think about the impact of rolling out another 50 this year and as we get into 2020, will it have any impact on your 2020 numbers?

第二，當我們考慮今年推出另外 50 個計劃的影響時，以及當我們進入 2020 年時，這會對你們 2020 年的數字產生任何影響嗎？

And then thirdly, as we think about additional services that will go into those HealthHUBs, have you thought more about primary care versus episodic care?

第三，當我們考慮將進入這些 HealthHUB 的額外服務時，您是否更多地考慮了初級護理與臨時護理？

And as you think about that integrated model with the medical side, are you learning anything from those Aetna members of incremental services that you think you need to bring to the HealthHUB?

當您考慮與醫療方面的集成模型時，您是否從增量服務的 Aetna 成員那裡學到了您認為需要帶到 HealthHUB 的任何內容？

Yes, Lisa.

是的，麗莎。

And I'll start, and then I'll flip it over to Kevin.

我先開始，然後將其交給凱文。

Yes, Lisa, in terms of the numbers themselves, as you know, we have been qualitative in our definition of performance.

是的，麗莎，就數字本身而言，正如你所知，我們對績效的定義是定性的。

And we've done that.

我們已經做到了。

It's a very small subset of stores at this point.

目前，這只是商店的一小部分。

But as you've heard us say countless times, it absolutely has given us the confidence and the belief in our strategy and the need for a rapid rollout.

但正如您無數次聽到我們所說的那樣，這絕對給了我們對我們的戰略以及快速推出的必要性的信心和信念。

So as we get more of a critical mass of stores, you will see us move from qualitative definition to more quantitative definition.

因此，當我們擁有更多的臨界數量的商店時，您會看到我們從定性定義轉向更定量的定義。

And you can think about that sometime in the -- probably in the second quarter time frame, in the spring time frame, where we think we'll have enough of a critical mass and multiple geographies across the country.

你可以考慮一下——可能是在第二季度的時間框架內，在春季的時間框架內，我們認為我們將在全國范圍內擁有足夠的臨界質量和多個地理位置。

Lisa, in terms of 2020 impact, as we've talked, the rollout will go through 2020 as well as 2021.

Lisa，就 2020 年的影響而言，正如我們所說，推出將持續到 2020 年和 2021 年。

And you really have 2 dynamics in play here: You've got gaining that critical mass of HealthHUBs as well as the opportunities for client adoption.

這裡確實有兩個動力在發揮作用：您已經獲得了足夠數量的 HealthHUB 以及客戶採用的機會。

So I do believe that, that will take some time.

所以我確實相信，這需要一些時間。

I wouldn't expect that we'll see a material impact in 2020.

我預計我們不會在 2020 年看到實質性影響。

I think it's more 2021 that we'll see that happening.

我認為 2021 年左右我們就會看到這種情況發生。

But again, we're extremely excited in terms of what we have seen, what we've learned in Houston.

但是，我們對在休斯頓所看到的、學到的東西感到非常興奮。

And I'll flip it over to Kevin to pick up on that third question.

我將把它轉給凱文來回答第三個問題。

Thanks, Larry.

謝謝，拉里。

Thanks for the question.

謝謝你的提問。

I'll just build on the second part of your question, which was the services provided.

我將僅以您問題的第二部分為基礎，即提供的服務。

The new wellness product that we've added to the front store continues to do well, including the products that we're selling in the sleep apnea space, helping fill white space and an unmet consumer demand.

我們在前店添加的新健康產品繼續表現良好，包括我們在睡眠呼吸暫停領域銷售的產品，有助於填補空白區域和未滿足的消費者需求。

We're bullish on the MinuteClinic expanded services, getting into chronic disease management in a more coordinated way.

我們看好 MinuteClinic 擴大服務範圍，以更加協調的方式進入慢性病管理領域。

We believe it's in collaboration with primary care, to answer your question, not in replacement of primary care.

我們相信它是與初級保健合作來回答您的問題，而不是取代初級保健。

In the pharmacy space, we're excited about what our pharmacists are doing in partnership with data coming to us from the Aetna business unit on which patients need our greatest help on a longitudinal way.

在製藥領域，我們對藥劑師與 Aetna 業務部門提供的數據合作所做的工作感到興奮，患者需要我們縱向提供最大的幫助。

So it's not one phone call and one specific day.

所以這不是一個電話和某一天的事情。

It's over a course of time working with those patients to help introduce them to care coordination services that are available through Aetna and also working with the PBM sales team on what the members of our Caremark business unit are looking for.

我們需要與這些患者合作一段時間，幫助他們了解 Aetna 提供的護理協調服務，並與 PBM 銷售團隊合作，了解我們 Caremark 業務部門成員所尋求的服務。

And just an important point to note as it relates to your provider question, 80% of the services that can be provided by a primary care physician can, in fact, be provided by our nurse practitioners in our pharmacies -- excuse me, in our MinuteClinics.

需要注意的重要一點是，因為它與您的提供者問題有關，初級保健醫生可以提供的 80% 的服務實際上可以由我們藥房的執業護士提供 - 對不起，在我們的藥房分鐘診所。

And again, we view it as complementary to primary care.

我們再次將其視為初級保健的補充。

And then just as a follow-up, you brought up Caremark.

然後作為後續行動，您提出了 Caremark。

Are you seeing, either Jon or Karen, are you seeing anything as far as this selling season those having an impact.

喬恩或凱倫，您是否看到任何對本銷售季產生影響的事情？

I know, Larry, it's still a small market.

我知道，拉里，這仍然是一個小市場。

But as we think about the number of MinuteClinics you have today, the services that you're providing, any impact at all in the 2020 selling season around having these offerings?

但當我們考慮一下您今天擁有的 MinuteClinics 數量、您提供的服務時，這些產品對 2020 年銷售季有何影響？

Or again, is that more of 2021?

或者再說一遍，這是 2021 年的情況嗎？

And I'll stop there.

我就到此為止。

It's Karen.

是凱倫。

Yes, we've been -- a couple of things on this topic.

是的，我們已經就這個主題做了一些事情。

We've been talking to our clients throughout the 2020 selling season about how we can deliver that more personal, integrated, cost-effective and holistic care approach

在整個 2020 年銷售季，我們一直在與客戶討論如何提供更加個性化、綜合性、成本效益高和全面的護理方法

(technical difficulty)

（技術難度）

Response from our customers have been very positive to date.

迄今為止，我們客戶的反應非常積極。

And I think we're seeing a fair amount of activity and pipeline build for 2021.

我認為 2021 年我們將看到大量的活動和管道建設。

And as we talked about previously, our focus for 2020 was to go to market with a more integrated medical pharmacy offering.

正如我們之前談到的，我們 2020 年的重點是向市場提供更加綜合的醫療藥房產品。

And what we've done for the 2020 selling season, I'm very pleased to tell you that we are seeing increased traction in overall pharmacy penetration for our employer sponsor business, particularly where Aetna had the medical business, and we're now winning significantly greater percentage of pharmacy business.

我們在 2020 年銷售季所做的工作，我很高興地告訴您，我們看到我們的雇主擔保業務的整體藥房滲透率有所增加，特別是在 Aetna 擁有醫療業務的地方，我們現在正在獲勝藥品業務的比例顯著提高。

So there's a lot going on, and we're -- I can talk later relative to the -- some of the pilots that we have, but I'll let Jon cover where we're headed.

因此，正在發生很多事情，我們 - 我可以稍後談論我們擁有的一些飛行員，但我會讓喬恩介紹我們的前進方向。

Lisa, this is Derica.

麗莎，這是德麗卡。

In regards to -- on the Caremark side, we've had the opportunity to introduce the HealthHUBs to a number of our clients both on the health plan side as well as on the employer side.

就 Caremark 而言，我們有機會向健康計劃方面和雇主方面的許多客戶介紹 HealthHUB。

And we've had a great deal of excitement and interest, and it's clearly playing out in not only in our selling season as we look to wrap that up, but also to 2021.

我們對此充滿了興奮和興趣，顯然，這不僅在我們希望結束的銷售季節中發揮作用，而且在 2021 年也同樣如此。

And I know there was always -- with the announcement of the deal between CVS and Aetna, there was some concern amongst investors about potential for channel conflict.

我知道，隨著 CVS 和 Aetna 之間交易的宣布，投資者一直擔心渠道沖突的可能性。

We -- with the interest that we've had from some of the health plan clients, we've actually now enlisted 2 that are actually performing some pilots with us.

我們——由於一些健康計劃客戶對我們感興趣，我們現在實際上已經招募了 2 家，他們實際上正在與我們一起進行一些試點。

That was related to the HealthHUBs itself.

這與 HealthHUB 本身有關。

So that gives you some idea to the type of traction we're getting in that space.

因此，這讓您對我們在該領域獲得的吸引力類型有所了解。

And then Lisa, this is Jon.

然後麗莎，這是喬恩。

If you remember, back when Caremark rolled out Maintenance Choice and the excitement in the market and the momentum that gave us, we're seeing a similar reaction in the market to HealthHUBs from the clients.

如果您還記得，當 Caremark 推出 Maintenance Choice 時，市場上的興奮和給我們帶來的動力，我們在市場上看到了客戶對 HealthHUB 的類似反應。

Your next question comes from the line of Lance Wilkes with Sanford Bernstein.

你的下一個問題來自蘭斯·威爾克斯和桑福德·伯恩斯坦的對話。

My question is on the PBM, and it looks like a strong performance.

我的問題是關於 PBM 的，看起來表現很強勁。

I was wondering, in 2019, how much cross-sale you're seeing in the Aetna book of business for this year, as contrasted with maybe some sort of metric related to how much progress you're going to see for the beginning of 2020, given the selling season that Karen just mentioned.

我想知道，在 2019 年，您在今年的 Aetna 商業手冊中看到了多少交叉銷售，與 2020 年初您將看到多少進展相關的某種指標形成鮮明對比，考慮到凱倫剛才提到的銷售季節。

And then what do you see as sort of the upside possibility with that?

那麼您認為這有什麼好處呢？

And I guess related to the PBM also is, for those additional wins you've got over the last quarter, what segments are those in?

我想與 PBM 相關的是，對於上個季度取得的額外勝利，這些勝利屬於哪些細分市場？

Is that in health plan or employer business?

這是健康計劃還是雇主業務？

Lance, it's Karen.

蘭斯，是凱倫。

Let me just talk about where I see the opportunities on PBM.

我簡單說一下我在PBM上看到的機會在哪裡。

As I mentioned, we're having a good 2020 selling season.

正如我所提到的，我們 2020 年的銷售旺季表現良好。

And what we're measuring is really penetration of the book.

我們衡量的是這本書的真正滲透率。

So we're looking at a number of ways.

所以我們正在尋找多種方法。

We're looking at where we have medical, and we want to drive pharmacy integration.

我們正在研究哪裡有醫療服務，我們希望推動藥房整合。

We're looking at the -- Derica and I are jointly looking at the pharmacy book and looking at where we want to potentially sell medical opportunities.

我們正在研究——德麗卡和我正在共同研究藥學書籍，並研究我們希望在哪裡銷售醫療機會。

And then we're looking together holistically to say, "Hey, where are the opportunities that neither one of us have business?" And that's where I think we're starting to see that growing pipeline in 2021 and bringing all the capabilities of the company together.

然後我們一起整體審視並說：“嘿，我們雙方都沒有業務的機會在哪裡？”我認為這就是我們在 2021 年開始看到不斷增長的渠道並將公司所有能力整合在一起的地方。

And we've just recently had a lot of customer interactions.

我們最近剛剛進行了很多客戶互動。

We've been out in the market with our brokers talking about this integrated story, and we are seeing very positive response.

我們已經在市場上與我們的經紀人談論這個綜合故事，我們看到了非常積極的反應。

And Lance, just to build upon Karen's comments.

蘭斯，只是以凱倫的評論為基礎。

In regards to the impact on the PBM, you've seen here of late that we -- at least since the Q2 call, that we've improved our net wins by $1 billion.

關於對 PBM 的影響，您最近在這裡看到，至少自第二季度電話會議以來，我們已經將淨盈利提高了 10 億美元。

The vast majority of that came in the employer segment in the, call it, kind of the middle market.

其中絕大多數來自所謂的中間市場的雇主部門。

And that plays very well with the integration efforts that Karen laid out also.

這也與凱倫所做出的整合工作配合得很好。

And then as you can think about what I talked about earlier about being able to introduce the HealthHUBs and some of the broad array of services to that client group, that's -- they've been very receptive to that and absolutely is playing into the outlook and the expectations we're establishing in the marketplace.

然後，您可以想一想我之前談到的關於能夠向該客戶群引入 HealthHUB 和一些廣泛的服務的內容，他們對此非常樂於接受，並且絕對正在考慮前景以及我們在市場上建立的期望。

Great.

偉大的。

And just a quick follow-up.

只是快速跟進。

Karen, previously, you'd talked stand-alone Aetna about efforts in the kind of downmarket employer segment to do more cross-selling, more bundled sales and kind of go after that self-insured market more.

凱倫，之前，您曾談到獨立的安泰保險在低端市場雇主細分市場中所做的努力，以進行更多的交叉銷售、更多的捆綁銷售以及更多地追求自我保險市場。

I'm just wondering what was the status of progress on that for you guys looking at 2020.

我只是想知道 2020 年這方面的進展情況如何。

Yes.

是的。

It's obviously early for 2020 for that end of the market.

對於這一端市場來說，2020 年顯然還為時過早。

We've been very focused on national account, higher end or middle.

我們一直非常關注國民賬戶，無論是高端還是中端。

So it's a bit early, but we have the teams out talking about our new capabilities relative to the HealthHUBs, which people are excited about.

所以現在還為時過早，但我們的團隊正在討論我們相對於 HealthHUB 的新功能，人們對此感到興奮。

We've introduced our Novologix capabilities that people are introduced about and then we're -- people are excited about our new digital capabilities.

我們已經向人們介紹了我們的 Novologix 功能，然後人們對我們新的數字功能感到興奮。

So we are pushing our integrated message throughout all of our segments.

因此，我們正在所有細分市場中推廣我們的綜合信息。

And we are seeing some good interest, but it's really too early to tell you about 2020 at this point.

我們看到了一些良好的興趣，但現在告訴您 2020 年的情況還為時過早。

Your next question comes from the line of Charles Rhyee with Cowen.

你的下一個問題來自 Charles Rhyee 和 Cowen 的對話。

Yes.

是的。

When I look at the full year guidance for the rest of this year, you kind of talk about year-to-date product development and net realized capital gains of $0.20.

當我查看今年剩餘時間的全年指導時，您談到了年初至今的產品開發和 0.20 美元的淨實現資本收益。

When we're thinking about next year and 2020 and sort of like when you initially kind of had said better than $7 a share, should we be looking at this number, including the capital -- this kind of number assuming that we probably have similar types next year?

當我們考慮明年和 2020 年時，就像你最初說每股好於 7 美元時，我們是否應該考慮這個數字，包括資本——這種數字假設我們可能有類似的股票明年的類型？

Or should we be thinking about it without?

或者我們應該考慮一下沒有？

Yes, Charles, this is Eva.

是的，查爾斯，這是伊娃。

Thanks for the question.

謝謝你的提問。

I think, as I outlined in my prepared remarks, right, where we're sitting today versus where we sat back in June, we're even more confident with our low single-digit growth.

我認為，正如我在準備好的發言中概述的那樣，我們今天所處的位置與 6 月份時的位置相比，我們對較低的個位數增長更加充滿信心。

We provided the transparency and the color around the $0.20.

我們提供的透明度和顏色大約為 0.20 美元。

As we've said consistently, we don't guide to that.

正如我們一直所說的那樣，我們不會對此進行指導。

So think about that growth off -- after you remove that from your baseline. .

因此，在將其從基線中刪除之後，請考慮一下這種增長。 。

Okay.

好的。

And is there any kind of -- as we think about the fourth quarter, is there -- I think, typically, prior-period development is really more of a second or third quarter kind of impact typically.

當我們考慮第四季度時，是否有任何類型的影響？我認為，通常情況下，前期發展實際上更多的是第二或第三季度的影響。

Is that -- would you expect more -- anything in the fourth quarter?

您對第四季度有更多期待嗎？

Typically, Charles, as you think about the fourth quarter, there's de minimis prior year development if you look at historical -- if you look at historical patterns.

查爾斯，通常情況下，當你想到第四季度時，如果你看看歷史——如果你看看歷史模式，就會發現去年的發展微乎其微。

We'll continue to provide the transparency on this and the realized capital gains as we go forward.

隨著我們的前進，我們將繼續提供這方面的透明度以及已實現的資本收益。

Okay.

好的。

That's helpful.

這很有幫助。

If I could just sneak another in on the HealthHUB, going back to Lisa's question.

如果我能偷偷地在 HealthHUB 上再講一次，回到麗莎的問題。

You talked about 50 stores by year-end, 1,500 stores by 2021.

您談到到年底將開設 50 家商店，到 2021 年將開設 1,500 家商店。

Is there a good interim target as we think about 2020 number of stores?

對於2020年的門店數量，是否有一個好的中期目標？

Yes.

是的。

Charles, it's Larry.

查爾斯，是拉里。

You can think about that we'll probably be in the zip code next year of 600 to 650 stores by year-end.

你可以想像一下，明年年底我們可能會擁有 600 到 650 家商店。

Your next question comes from the line of Ricky Goldwasser with Morgan Stanley.

您的下一個問題來自摩根士丹利的 Ricky Goldwasser。

So firstly, just to clarify on the EPS guidance question.

首先，澄清 EPS 指導問題。

So Eva, if we think about the new 2019 base of $6.97 to $7.05, and we excluded $0.20, and we grow it by low single digit, we get to a range of $6.84 to $7.12.

因此，伊娃，如果我們考慮 2019 年新的 6.97 美元至 7.05 美元的基數，並排除 0.20 美元，然後以較低的個位數增長，我們就會得到 6.84 美元至 7.12 美元的範圍。

I know that you said before above $7.

我知道你之前說過 7 美元以上。

So should we think about -- would you say that you're comfortable with kind of like that high-low single-digit range?

那麼我們是否應該考慮一下 - 您是否認為您對這種高低個位數範圍感到滿意？

Yes, Ricky, as we said, we'll provide our more fulsome guidance in February, but we reiterate that we're comfortable with at least $7 and the low single-digit growth, and we'll have more to provide.

是的，Ricky，正如我們所說，我們將在 2 月份提供更全面的指導，但我們重申，我們對至少 7 美元和低個位數增長感到滿意，並且我們將提供更多。

Okay.

好的。

That's helpful.

這很有幫助。

And then my question is focused on specialty.

然後我的問題集中在專業上。

And Karen, maybe this one is for you.

凱倫，也許這個適合你。

When we think about the opportunity in specialty, what's the specialty penetration within the Aetna book of business?

當我們思考專業領域的機會時，Aetna 業務中的專業滲透率是多少？

And how do you think that kind of like growing over time?

您如何看待隨著時間的推移而成長？

Ricky, let me just ask a point of clarification.

瑞奇，讓我澄清一點。

When you're talking specialty, are you talking about specialty pharmacy or just the specialty businesses within Aetna that includes pharmacy and others?

當您談論專業時，您是在談論專業藥房還是僅 Aetna 內的專業業務（包括藥房和其他業務）？

So specialty pharmacy.

所以專業藥房。

So Ricky, as you know, that's one of the highest-trending medical cost categories that we have.

所以，瑞奇，如您所知，這是我們趨勢最高的醫療費用類別之一。

And we've been working very closely with Derica's team on managing those specialty drugs and that -- the specialty costs.

我們一直與 Derica 的團隊密切合作，管理這些特殊藥物以及特殊成本。

And we are introducing some new capabilities into the market relative to 2020.

我們正在向市場推出一些相對 2020 年的新功能。

It is a critically important concern for our customers, particularly with the new drugs that are coming out that are very high cost.

對於我們的客戶來說，這是一個至關重要的問題，特別是對於即將推出的成本非常高的新藥。

So we are looking at innovative capabilities around stop-loss potentially.

因此，我們正在研究圍繞潛在止損的創新能力。

And again, we've introduced our Novologix capabilities across our portfolio, which I think will bring those costs -- we're hoping to bring those costs down and in line.

再次，我們在我們的產品組合中引入了 Novologix 功能，我認為這將帶來這些成本 - 我們希望將這些成本降低並保持一致。

So we're really excited.

所以我們真的很興奮。

And as we've been talking to our customers, they're excited about the possibilities there as well.

當我們與客戶交談時，他們也對那裡的可能性感到興奮。

And Ricky, just to emphasize the point that Karen was alluding to.

還有瑞奇，只是為了強調凱倫所暗示的觀點。

We would sit here today and say that there is a large portion of specialty that flows through the medical benefit that has been largely unmanaged, and that becomes a big opportunity here.

今天我們坐在這裡說，有很大一部分專業通過醫療福利流動，而這些福利基本上不受管理，這成為了一個巨大的機會。

Yes.

是的。

And that's really where the question was.

這確實是問題所在。

What's that incremental opportunity where you're currently not managing.

您目前沒有管理的增量機會是什麼？

And then if I may, just one follow-up because you talked about long-term care in Omnicare.

如果可以的話，請進行一次後續行動，因為您談到了 Omnicare 的長期護理。

How do you think about the progression of Omnicare first half versus second half?

您如何看待 Omnicare 上半年和下半年的進展？

And how is it performing against your targets and kind of like that opportunity to have Omnicare being a positive -- contributing positively to next year?

它對您的目標的表現如何，有點像讓 Omnicare 為明年做出積極貢獻的機會？

Yes, Ricky, this is Jon.

是的，瑞奇，這是喬恩。

So long-term care is performing slightly better than expected in 2019, and we've started to see improvement in our new sales and retention, given our service improvements.

因此，長期護理在 2019 年的表現略好於預期，而且隨著我們服務的改進，我們已經開始看到新銷售和保留率的改善。

And at the same time, we also continue to improve our cost structure.

同時，我們也不斷改善我們的成本結構。

I will say this market continues to be challenging as our clients have continued to divest facilities in 2019.

我想說的是，隨著我們的客戶在 2019 年繼續剝離設施，這個市場仍然充滿挑戰。

And we'll have more to say about it on our fourth quarter call.

我們將在第四季度的電話會議上對此進行更多討論。

Your next question comes from the line of Michael Cherny with Bank of America.

您的下一個問題來自美國銀行的邁克爾·切爾尼 (Michael Cherny)。

I want to dive a little bit into the Retail/LTC segment, particularly profit growth, in particular.

我想深入了解零售/長期護理領域，尤其是利潤增長。

You pointed to a lot of the moving pieces in the quarter and where things shook out on the positive versus negative side.

您指出了本季度的許多變化，以及積極與消極方面的變化。

Also, I know at the Investor Day you did talk about that segment being up, at least some preliminary expectations, low single-digit on EBIT.

另外，我知道在投資者日您確實談到了該細分市場的增長，至少有一些初步預期，息稅前利潤為低個位數。

I guess, based on what you've seen so far year-to-date, having just obviously addressed the long-term care question, how is everything tracking relative to the moving pieces within retail that will allow you to drive towards EBIT growth of that low single-digit rate into next year?

我想，根據您今年迄今為止所看到的情況，在明確解決了長期護理問題之後，相對於零售業中的移動部分，一切的跟踪情況如何，這將使您能夠推動息稅前利潤的增長明年的低個位數利率會怎樣？

Michael, this is Eva.

邁克爾，這是伊娃。

I'll start, and perhaps Kevin will jump in.

我先開始，也許凱文也會加入。

As we look at Q3, Q3 performed right in line with our expectations.

當我們看第三季度時，第三季度的表現完全符合我們的預期。

Q2 performed above our expectations.

第二季度的表現超出了我們的預期。

So we're pleased with how the business is performing and the initiatives which are underway to enable us to return to growth in the segment.

因此，我們對業務的表現以及正在採取的舉措感到滿意，這些舉措使我們能夠恢復該領域的增長。

Thanks, Eva.

謝謝，伊娃。

And I'll just build on that.

我將以此為基礎。

Your second part was our confidence in our being able to hit the guidance that we provided back on Investor Day for 2020.

第二部分是我們對能夠達到 2020 年投資者日提供的指導的信心。

As Eva just said, we're on track to be able to deliver against that guidance.

正如伊娃剛才所說，我們有望兌現這一指導方針。

In fact, we're more confident now than we were then.

事實上，我們現在比以前更有信心。

The key tenets of that strategy to enable that growth, we will grow our pharmacy business faster than the industry, continue to take market share and grow organically, which we've been doing this year, and that will continue.

為了實現這一增長，該戰略的關鍵原則是，我們將比行業更快地發展我們的製藥業務，繼續佔據市場份額並實現有機增長，這是我們今年一直在做的，而且還將繼續下去。

We will continue to grow both the top line and bottom line within our pharmacy -- excuse me, front store business, specific focus on health and beauty.

我們將繼續增加我們藥房的營收和利潤——對不起，前台業務，特別關注健康和美容。

The biggest year-over-year difference is a meaningful cost takeout through the modernization efforts that Jon Roberts covered back in June.

最大的同比差異是喬恩·羅伯茨 (Jon Roberts) 在 6 月份報導的現代化工作中實現的有意義的成本削減。

Those efforts are on track.

這些努力正在步入正軌。

We will take a significant amount of cost out of both our pharmacy and front store businesses.

我們將從藥房和前台業務中削減大量成本。

Those 3 things working in concert will enable that low single-digit growth that we guided back in June.

這三件事協同作用將實現我們在 6 月份指導的低個位數增長。

Great.

偉大的。

And then just one quick point of clarification to make sure we got this.

然後快速澄清一點以確保我們明白這一點。

Based on keeping the guide for the MBR, it seems like there's a pretty implied high number for 4Q.

根據保留 MBR 的指南，第四季度似乎有一個相當高的隱含數字。

Aside from seasonality, is there anything else that we should think about in there that drives that number higher than where it's been trending over the course of the year?

除了季節性之外，還有什麼我們應該考慮的因素導致這一數字高於全年趨勢？

No, there's -- Michael, this is Eva again.

不，這是——邁克爾，這又是伊娃。

There's nothing that we would call out.

沒有什麼值得我們指出的。

Your next question comes from the line of George Hill with Deutsche Bank.

你的下一個問題來自喬治·希爾與德意志銀行的電話。

Yes.

是的。

I kind of want to dovetail right off of Mike's question which is, I guess, are you able to quantify maybe the cost takeout that you're looking for in retail pharmacy next year?

我想直接回答邁克的問題，我想，你是否能夠量化明年你在零售藥房尋找的成本支出？

And I guess, just given -- looking at the pharmacy results for this year.

我想，剛剛給出的——看看今年的藥房業績。

And I don't think there's any reason to think that reimbursement next year is going to meaningfully improve.

而且我認為沒有任何理由認為明年的報銷將會顯著改善。

I'm also just trying to bridge the gap between kind of footing the retail pharmacy results this year and how we get that low single-digit EBIT growth in the segment next year.

我還試圖彌合今年零售藥房業績的基礎與明年該領域如何實現低個位數息稅前利潤增長之間的差距。

So a quantification on the cost takeouts and maybe the outlook for reimbursement or the year-over-year change in reimbursement and how it impacts results would be helpful.

因此，對成本支出、報銷前景或報銷的同比變化及其對結果的影響進行量化將會有所幫助。

Yes, George, it's Larry.

是的，喬治，是拉里。

Maybe just a couple of things to be reminded of.

也許只是需要提醒幾件事。

As we went through the first half of this year, keep in mind we had the additional investments that we made back in 2018 that cycled through the first half.

在我們度過今年上半年時，請記住，我們在 2018 年進行的額外投資在上半年循環進行。

Largely, the investments in tax reform as it rolled back into our retail business for our colleagues.

很大程度上，稅收改革的投資重新回到了我們同事的零售業務中。

And then, George, I would take us back to the Analyst Day in terms of -- we provided the headwinds/tailwinds as we looked at next year.

然後，喬治，我想帶我們回到分析師日，我們提供了明年的逆風/順風。

And there's nothing different that we see today from what we had talked about back in June.

我們今天看到的情況與我們六月份討論的情況沒有什麼不同。

And as you pointed out, we don't see reimbursement pressure abating, but the offsets to that reimbursement pressure, we have some dynamics in 2020 that we did not face in '19, when you look at the contribution of generics as one example.

正如您所指出的，我們並沒有看到報銷壓力減輕，但為了抵消報銷壓力，我們在 2020 年出現了一些我們在 19 年沒有遇到的動態，當您以仿製藥的貢獻為例時。

Okay.

好的。

And maybe just a quick follow-up for Eva.

也許只是對伊娃的快速跟進。

On the [PPD] in the quarter, was that -- and you kind of related that it was -- was it -- I guess was the positive PPD in the quarter, was it in response to the cost pressure that you saw in Q2?

關於本季度的 [PPD]，是——你有點認為是——是嗎——我想這是本季度積極的 PPD，是為了應對你在第二季度看到的成本壓力嗎？ ？

Or is it separate from the cost pressure you saw in Q2?

還是與您在第二季度看到的成本壓力無關？

No.

不。

I would say, overall, we had about $0.04 of PYD, prior year development, as well as net realized capital gains in totality.

我想說，總的來說，我們的 PYD、去年的開發以及淨實現資本收益總計約為 0.04 美元。

And the development that we saw was across -- was across all of our core businesses.

我們看到的發展是跨越我們所有核心業務的。

Your next question comes from the line of Ann Hynes with Mizuho Securities.

您的下一個問題來自瑞穗證券的 Ann Hynes。

Just going to the PBM, I know there was a lot of discussion earlier this year about the future of rebates, and that has become more quiet since the White House pulled the rebate rule.

剛談到 PBM，我知道今年早些時候有很多關於回扣未來的討論，自從白宮取消回扣規則以來，討論變得更加安靜。

But so could we assume, when it comes to rebates, it's business as usual going forward?

但我們是否可以假設，在回扣方面，未來一切照常進行？

That would be my first question.

這是我的第一個問題。

And my second question is with the Federal Employees contract, it looks like you extended it another year.

我的第二個問題是關於聯邦僱員合同，看來您又將其延長了一年。

Do you ever anticipate that going to full RFP?

您是否預計會進行完整的 RFP？

I guess what was the decision behind them, I guess, they keep on renewing it.

我想他們背後的決定是什麼，我想他們會不斷更新它。

So how do you view that contract going forward?

那麼您如何看待這份合同的未來呢？

I'll take your first question and then flip it over to Derica.

我將回答你的第一個問題，然後將其轉給德麗卡。

But Ann, your first question on rebates, look, if you go back, what, the last year, 1.5 years, the debate was the role of the PBMs, what happens to the rebate dollars.

但是，安，你關於回扣的第一個問題，如果你回頭看，去年，1.5 年，爭論的焦點是 PBM 的作用，回扣美元會發生什麼。

And as we sit here today, I think the debate has now shifted, not on the PBMs, but to the manufacturers in terms of why are the list prices what they are.

當我們今天坐在這裡時，我認為現在爭論的焦點不是 PBM，而是製造商，為什麼標價是這樣的。

And the data has proven the value that PBMs have brought to the marketplace in terms of reducing the net price of pharmaceuticals through formulary management, et cetera.

數據證明了 PBM 在通過處方管理等降低藥品淨價格方面為市場帶來的價值。

So we don't see that dynamic changing.

所以我們沒有看到這種動態變化。

And as a matter of fact, some of the various bills that are currently in committees today broaden the tools that have been proven to be successful for the PBMs in terms of introducing more competition across therapeutic classes to include biosimilars and some of the things that have delayed competition from entering the marketplace.

事實上，目前委員會正在審議的一些法案擴大了已被證明對 PBM 有效的工具，在治療類別之間引入更多競爭，包括生物仿製藥和一些已經被證明是成功的藥物。延遲競爭進入市場。

Ann, this is Derica.

安，這是德麗卡。

We've been able to take advantage of that.

我們已經能夠利用這一點。

And as we also shared back in June, that we would be able to manage or rebate exposure very efficiently.

正如我們在 6 月份分享的那樣，我們將能夠非常有效地管理或回扣風險。

And we've seen the peak this year.

今年我們已經看到了頂峰。

And in fact, we're doing slightly better than anticipated, and that will mitigate over time and continue to dissipate as we think about 2020.

事實上，我們的表現略好於預期，隨著時間的推移，這種情況會有所緩解，並在我們考慮 2020 年時繼續消散。

And then to your second question regarding FEP, along those lines, we're very pleased that we were able to extend our relationship with them.

關於您關於 FEP 的第二個問題，按照這些思路，我們非常高興能夠擴展與他們的關係。

We have a very strong partnership and history with FEP.

我們與 FEP 有著非常牢固的合作夥伴關係和歷史。

I would anticipate at some point, it will go to RFP, but the fact that we've been able to continue that relationship, I think, bodes very well for us and speaks very strongly to how we've been able to create a partnership that's lasted for a number of years.

我預計在某個時候，它將提交給 RFP，但我認為，我們能夠繼續這種關係的事實對我們來說是一個非常好的兆頭，並且非常有力地說明了我們如何能夠建立合作夥伴關係這種情況持續了好幾年。

Your next question comes from the line of Robert Jones with Goldman Sachs.

你的下一個問題來自高盛的羅伯特·瓊斯。

Great.

偉大的。

I guess just a couple of more detailed follow-ups.

我想只是一些更詳細的後續行動。

I mean, one, Eva, I think you mentioned a larger-than-expected benefit from generic launches, particularly in specialty.

我的意思是，第一，伊娃，我認為您提到了仿製藥上市帶來的好處超出預期，特別是在特種藥物方面。

So I was just wondering if you could expand on that dynamic a little bit.

所以我只是想知道你是否可以稍微擴展一下這種動態。

And was this an area that you guys were expecting?

這是你們所期待的領域嗎？

Or is this actually something that could be trending more meaningfully in your favor as far as follow-on biologics or generic biologics?

或者，就後續生物製劑或仿製藥而言，這實際上是一種對您更有利的趨勢嗎？

So Bob, I'll take the first part, and I think Jon will provide some more color.

所以鮑勃，我將承擔第一部分，我認為喬恩會提供更多的色彩。

Overall, the timing of the launches and when they come to market can vary.

總體而言，發佈時間和上市時間可能會有所不同。

So this was something we were expecting, albeit it came early for us.

所以這是我們所期待的，儘管對我們來說來得早。

And as we continue to focus to execute and deliver value and savings, right, driving the penetration of generics is an important priority for us.

隨著我們繼續專注於執行和提供價值和節省，推動仿製藥的滲透是我們的一個重要優先事項。

And Bob, this is Jon.

鮑勃，這是喬恩。

So for 2019, we continue to improve our purchasing economics on mature products.

因此，2019年，我們繼續提高成熟產品的採購經濟性。

And then when they -- we looked at some of the new generic launches that were coming to market, we actually were able to get more favorable rates than what we historically had.

然後，當我們查看一些即將上市的新仿製藥時，我們實際上能夠獲得比歷史上更優惠的價格。

So that was a positive.

所以這是積極的。

And then we had some new generic launches that we did not expect that were favorable.

然後我們推出了一些新的仿製藥，但我們沒想到會受到歡迎。

And then as we look forward onto 2020 and beyond, we still see significant generic launches and launches of biosimilars.

然後，當我們展望 2020 年及以後時，我們仍然會看到大量的仿製藥和生物仿製藥的上市。

And between 2020 and 2023, there'll be $41 billion of generics and biosimilars that will come to the market.

2020 年至 2023 年間，將有價值 410 億美元的仿製藥和生物仿製藥進入市場。

And in addition to that, we see opportunities to improve how we purchase complex generics, generics where there's only one manufacturer and also, again, a great opportunity around biosimilars.

除此之外，我們還看到了改進複雜仿製藥採購方式的機會，這些仿製藥只有一家製造商，而且生物仿製藥也是一個巨大的機會。

So we still see this as a very attractive area for us.

所以我們仍然認為這對我們來說是一個非常有吸引力的領域。

Got it.

知道了。

And I have just one quick follow-up maybe for Karen.

我可能只想對凱倫進行一次快速跟進。

We've gotten some questions on some disclosure from WellCare related to Aetna's PDP.

我們收到了一些關於 WellCare 披露的與 Aetna PDP 相關的信息的問題。

I think it generated around $300 million in gross profit through the first 3 quarters of this year.

我認為今年前三個季度它的毛利潤約為 3 億美元。

Is that the right way we should think about the impact to Aetna CVS when that PDP business eventually rolls off next year?

當 PDP 業務最終於明年推出時，我們應該以這種方式思考對 Aetna CVS 的影響嗎？

So Bob, we haven't provided that level of detail on specific parts of the business.

鮑勃，我們還沒有提供有關業務特定部分的詳細信息。

Obviously, there will be an earnings hit related to the roll-off of the business as well as our need to work through some stranded costs that Karen's team is focused on.

顯然，由於業務下滑以及我們需要解決凱倫團隊關注的一些擱淺成本，盈利將會受到影響。

And when we give guidance in February, we'll try to provide some more color.

當我們在二月份提供指導時，我們將嘗試提供更多色彩。

Your next question comes from the line of Ralph Giacobbe with Citi.

您的下一個問題來自花旗集團的拉爾夫·賈科布 (Ralph Giacobbe)。

Great.

偉大的。

Just want to go to the health benefits segment.

只是想進入健康福利部分。

Obviously, last quarter, you had noted the pressure in Commercial and middle markets in the specific geography.

顯然，上個季度，您已經註意到特定地區商業和中間市場的壓力。

It sounds like you've made some improvements there.

聽起來你在那裡做了一些改進。

So if you can help with sort of the details on what sort of got better.

因此，如果您能提供有關哪些方面變得更好的詳細信息，請提供幫助。

But at the same time, you're still expecting MLR above midpoint.

但與此同時，您仍然期望 MLR 高於中點。

So maybe just help on that more broadly.

所以也許只是在更廣泛的方面提供幫助。

And then if you could just help us with cost trend by segment, just Commercial, Medicare and Medicaid.

然後，如果您能幫助我們了解按細分市場（僅商業、醫療保險和醫療補助）的成本趨勢。

And within Medicaid specifically, there's been a lot around reverification issues we've heard from some of your peers.

特別是在醫療補助計劃中，我們從一些同行那裡聽到了很多關於重新驗證的問題。

Is that hampering your margins in the segment?

這是否會影響您在該領域的利潤率？

And is that driving up the MLR as well?

這是否也會推高MLR？

So a lot of questions there.

所以有很多問題。

I'll start with the Commercial and medical cost question.

我將從商業和醫療費用問題開始。

Yes, we mentioned in the second quarter that we had some pressure in utilization in our lower end of the middle market.

是的，我們在第二季度提到，我們在中低端市場的利用率方面面臨一些壓力。

During the second quarter, we noted that we took appropriate actions to address those elevated medical costs.

在第二季度，我們注意到我們採取了適當的行動來解決醫療費用上漲的問題。

And I would tell you, with an additional 3 months of claims experience, we feel comfortable that the actions that we took have mitigated the elevated pressures that we thought we saw in the second quarter.

我想告訴您，憑藉額外 3 個月的索賠經驗，我們感到放心的是，我們採取的行動減輕了我們認為在第二季度看到的高壓。

Specifically, what we did was we had intensified our medical management in those geographies, the claims activity that we now have seen, we believe that we've identified the right products, the right segments and the right geographies where that business had what we thought was elevated utilization, we feel that we've effectively addressed it.

具體來說，我們所做的是加強了這些地區的醫療管理，我們現在看到的索賠活動，我們相信我們已經確定了正確的產品、正確的細分市場和正確的地區，該業務在這些地區擁有我們所認為的利用率提高了，我們認為我們已經有效地解決了這個問題。

Relative to medical cost by segment, we have not disclosed that.

相對於各細分市場的醫療費用，我們尚未披露。

So I'll let Eva take that question.

所以我會讓伊娃回答這個問題。

Yes.

是的。

I think as you look -- listen, we've indicated all of our businesses are performing well.

我想，正如你所看到的——聽著，我們已經表明我們所有的業務都表現良好。

As you look at the mix of our business and as Government has really grown, we look at the overall MBR as an indicator around the health of our business.

當你觀察我們的業務組合以及政府的真正發展時，我們將整體 MBR 視為我們業務健康狀況的指標。

The other thing that I would highlight is, just recall, SilverScript is now part of the MBR related to the Health Care Benefits segment, which is larger than the legacy Aetna PDP, and it performs differently within the MBR on essentially reverse of the typical managed care.

我要強調的另一件事是，請記住，SilverScript 現在是與醫療保健福利細分市場相關的MBR 的一部分，該細分市場比傳統的Aetna PDP 更大，並且它在MBR 中的表現有所不同，與典型的託管模式本質上相反。關心。

Yes.

是的。

And just to follow-up, I think you were asking a question on Medicaid redetermination.

作為後續行動，我認為您是在問有關醫療補助重新確定的問題。

They've always been and continue to be something that we monitor very closely.

我們一直並將繼續密切關注它們。

There's really 2 impacts on redeterminations, the first and most obvious one is enrollment.

重新決定實際上有兩個影響，第一個也是最明顯的一個是入學。

The second one is on experience.

第二個是經驗。

Both impacts have been and continue to be immaterial for us.

這兩種影響對於我們來說一直都是無關緊要的。

But as I said, we closely monitor it.

但正如我所說，我們密切監視它。

But it isn't having any material impact on our Medicaid business.

但這對我們的醫療補助業務沒有任何實質性影響。

Okay.

好的。

So thanks, Ralph.

謝謝，拉爾夫。

Your next question comes from the line of A.J. Rice with Crédit Suisse.

你的下一個問題來自 A.J.瑞士信貸的大米。

First of all, just maybe get you guys.

首先，也許可以得到你們。

At this point, we've got more information about the lay of the land going into 2020 around the Medicare Advantage product offering.

目前，我們已經獲得了有關 2020 年 Medicare Advantage 產品供應情況的更多信息。

Competitive offerings are visible to you where they were in the early stages of the open enrollment period.

您可以看到處於開放註冊期早期階段的競爭性產品。

I know at the Investor Day, you guys had said you thought you could grow above market even.

我知道在投資者日，你們曾說過你們認為自己的增長甚至可以高於市場水平。

Obviously, with the HIF and other things coming back, any updated thoughts on how that looks, how much geographic expansion, things like that will drive your performance next year?

顯然，隨著 HIF 和其他事情的回歸，關於它的外觀、地理擴張程度等任何更新的想法將推動您明年的業績嗎？

And what might be a general range on growth and enrollment in the business?

該業務的增長和入學人數的一般範圍是多少？

A.J., it's Karen.

A.J.，是凱倫。

Let me just comment on the competitive landscape and what our go-to-market strategy is.

讓我簡單評論一下競爭格局以及我們的市場戰略。

As you know, and as you've seen, the competitive landscape appears to be competitive in 2020.

如您所知，也如您所見，2020 年的競爭格局似乎非常激烈。

However, as you have seen, CMS is estimating market growth to be about 10%.

然而，正如您所見，CMS 預計市場增長率約為 10%。

We think it will be a little bit lower than that, but we are still optimistic that we can outpace our industry growth despite the HIF headwinds.

我們認為會比這個數字低一點，但我們仍然樂觀地認為，儘管存在 HIF 的不利因素，我們仍能超越行業增長。

And we -- there's a couple of reasons why we're optimistic.

我們持樂觀態度有幾個原因。

One, I would just say, we continue our efforts around geographic expansion.

第一，我只想說，我們將繼續努力進行地域擴張。

We're at 81% of Medicare eligibles.

我們有 81% 的人符合 Medicare 資格。

We continue to make investments in our growth and retention of our existing service areas.

我們繼續投資於現有服務領域的發展和保留。

Our stars performance is incredibly helpful to helping us -- in our optimism relative to Medicare growth.

我們的明星表現對幫助我們非常有幫助——我們對醫療保險增長持樂觀態度。

We have -- we maintained our 0 premium plans, and we're the top health plan with respect to 0 premium plans.

我們維持了 0 保費計劃，並且我們是 0 保費計劃方面頂級的健康計劃。

We also had expansion of our D-SNP markets.

我們還擴大了 D-SNP 市場。

And we are also focused, as I've mentioned at Investor Day, of converting our PDP business as well as our commercial business as our Commercial business ages into retirement age.

正如我在投資者日提到的，隨著我們的商業業務進入退休年齡，我們還致力於轉變我們的 PDP 業務以及商業業務。

And we believe that we can be successful relative to all those factors.

我們相信，相對於所有這些因素，我們能夠取得成功。

I also would comment, A.J., that we have incorporated some of our new and differentiated capabilities as a combined company.

A.J.，我還想說，作為一家合併後的公司，我們已經整合了一些新的、差異化的能力。

So we are offering the HealthHUB in our Houston market.

因此，我們在休斯頓市場提供 HealthHUB。

We have zero cost share benefit coverage in our MinuteClinics.

我們的 MinuteClinics 提供零成本分享福利。

We introduced our Healing Better program in select markets.

我們在特定市場推出了“Healing Better”計劃。

We also offered a fall prevention benefit that provides members with an annual allowance for fall safety items that is curated by CVS.

我們還提供跌倒預防福利，為會員提供由 CVS 策劃的跌倒安全項目的年度津貼。

And then our over-the-counter benefit provide members with an allowance at our CVS retail stores.

然後，我們的非處方優惠為會員在 CVS 零售店提供津貼。

So all those factors give us optimism that we will have above-industry growth.

因此，所有這些因素都讓我們樂觀地認為我們將實現高於行業的增長。

All right.

好的。

And maybe one quick follow-up on the Pharmacy Services.

也許還可以對藥房服務進行快速跟進。

I know throughout this year you've talked about the investment you're making to helping Anthem stand up its IngenioRx.

我知道今年以來您一直在談論您為幫助 Anthem 推出 IngenioRx 所做的投資。

It sounds like perhaps there is a -- that, that may swing to the positive.

聽起來也許有一種可能會轉向積極的方向。

Is there any way to talk about the order of magnitude of that headwind that now becomes, hopefully, a little bit of a tailwind heading into 2020?

有什麼辦法可以談論現在進入 2020 年時希望成為一點順風的逆風的數量級嗎？

This is Derica.

這是德麗卡。

We haven't quantified in terms of putting the specifics.

我們還沒有量化具體細節。

What we've stated is that clearly, 2019, at least the first half, was an investment year for us as we were looking to stand up that business.

我們已經明確表示，2019 年，至少是上半年，對我們來說是投資年，因為我們希望維持這項業務。

Now that we are far into the implementation of Ingenio, which has gone really, really very well.

現在我們已經進入 Ingenio 的實施階段，進展非常非常順利。

We obviously now have transitioned to operating costs many of those expenses.

顯然，我們現在已經將其中許多費用轉為運營成本。

We do expect that it will -- while it will be investment this year, we would turn profitable in 2020.

我們確實預計，雖然今年將進行投資，但我們將在 2020 年實現盈利。

And that's what we've stated.

這就是我們所說的。

Your final question comes from the line of Steven Valiquette with Barclays.

你的最後一個問題來自巴克萊銀行的 Steven Valiquette。

So a lot of the juicy topics have been covered already.

所以很多有趣的話題已經被涵蓋了。

So I guess for us, just for Medicaid, obviously, the Texas STAR+

所以我想對於我們來說，對於醫療補助來說，顯然，德克薩斯州 STAR+

PLUS award was pretty positive for the company.

PLUS 獎項對該公司來說非常積極。

Is there any additional color you can provide on what you think drove some of your success there, either qualitatively or quantitatively, just in terms of your ability to analyze the full outcomes for yourself relative to the other players?

您是否可以提供任何額外的信息來說明您認為推動您取得成功的因素，無論是定性還是定量，僅就您相對於其他玩家分析完整結果的能力而言？

Yes.

是的。

So thank you.

所以謝謝。

We're really excited about being awarded the Texas program.

我們對獲得德克薩斯州計劃感到非常興奮。

We believe that some of the reasons why we won, we really believe we had a compelling RFP response.

我們相信，我們獲勝的一些原因是我們確實相信我們收到了令人信服的 RFP 回复。

We have very strong existing value-based provider contracts in Texas.

我們在德克薩斯州擁有非常強大的現有基於價值的供應商合同。

We had a very unique partnership with texi healthy home area aging agencies.

我們與德克薩斯健康家居區老齡化機構建立了非常獨特的合作關係。

We made a commitment to the D-SNP plan.

我們對 D-SNP 計劃做出了承諾。

We offered our Texas HealthHUB in -- that we believe helped us, and we believe that our NCQA ratings helped us as well.

我們在德克薩斯州提供了 HealthHUB，我們相信這對我們有幫助，我們相信我們的 NCQA 評級也對我們有幫助。

Thanks, Steve.

謝謝，史蒂夫。

So look, let me just wrap up.

那麼，讓我總結一下。

It's really hard to believe that, at the end of the month, we're going to celebrate our first anniversary as one company.

真的很難相信，在這個月底，我們將慶祝我們作為一家公司的一周年紀念日。

And I could not be more pleased and proud of the commitment and engagement of our nearly 300,000 colleagues all across the country.

我對全國近 300,000 名同事的承諾和參與感到無比高興和自豪。

And as you've heard us talk this morning, our integrated model is designed to drive higher engagement, enhancing access to high-quality health care and reduce costs and create better health outcomes.

正如您今天早上聽到的那樣，我們的綜合模型旨在推動更高的參與度，增強獲得高質量醫療保健的機會，降低成本並創造更好的健康結果。

And ultimately, that's going to feel and accelerate our revenue and EPS growth over the long term.

最終，從長遠來看，這將加速我們的收入和每股收益的增長。

And I think, again, as you heard this morning, our entire organization is laser-focused on executing the plan that brings that strategy to life.

我再次認為，正如您今天早上聽到的那樣，我們整個組織都高度專注於執行將這一戰略變為現實的計劃。

So let me thank everyone for their time this morning, and we'll talk to all of you soon.

因此，請允許我感謝大家今天早上抽出寶貴的時間，我們很快就會與大家交談。

Ladies and gentlemen, this concludes today's conference call.

女士們、先生們，今天的電話會議到此結束。

Thank you for participating.

感謝您的參與。

You may now disconnect.

您現在可以斷開連接。