CVS Health Corp (CVS) 2022 Q3 法說會逐字稿

Ladies and gentlemen, good morning, and welcome to the CVS Health Third Quarter 2022 Earnings Conference Call.

女士們先生們，早上好，歡迎參加 CVS Health 2022 年第三季度收益電話會議。

(Operator Instructions)

（操作員說明）

As a reminder, today's conference is being recorded. I would now like to turn the call over to Larry McGrath, Senior Vice President of Business Development and Investor Relations for CVS Health. Please go ahead.

提醒一下，今天的會議正在錄製中。我現在想將電話轉給 CVS Health 業務發展和投資者關係高級副總裁 Larry McGrath。請繼續。

Good morning, and welcome to the CVS Health Third Quarter 2022 Earnings Call and Webcast. I'm Larry McGrath, Senior Vice President of Business Development and Investor Relations for CVS Health. I'm joined this morning by Karen Lynch, President and Chief Executive Officer; and Shawn Guertin, Executive Vice President and Chief Financial Officer.

早上好，歡迎來到 CVS Health 2022 年第三季度財報電話會議和網絡直播。我是 CVS Health 業務發展和投資者關係高級副總裁 Larry McGrath。今天上午，總裁兼首席執行官凱倫·林奇 (Karen Lynch) 加入了我的行列；和執行副總裁兼首席財務官 Shawn Guertin。

Following our prepared remarks, we'll host a question-and-answer session that will include Dr. Alan Lotvin, President, Pharmacy Services; Daniel Finke, President Healthcare Benefits; Michelle Peluso, Chief Customer Officer and Retail Co-President; and Prem Shah, Chief Pharmacy Officer and Retail Co-President.

在我們準備好的發言之後，我們將主持一個問答環節，其中包括藥房服務總裁 Alan Lotvin 博士； Daniel Finke，醫療福利總裁； Michelle Peluso，首席客戶官兼零售聯席總裁；以及首席藥房官兼零售聯席總裁 Prem Shah。

Our press release and slide presentation have been posted to our website, along with our Form 10-Q that we filed this morning with the SEC. Today's call is being broadcast on our website, where it will be archived for 1 year. During this call, we will make certain forward-looking statements, reflecting current views related to our future financial performance, future events, industry and market conditions, including impacts related to the ongoing COVID-19 pandemic as well as the expected consumer benefits of our products and services and our financial projections and the benefits of the proposed acquisition of Signify Health, Inc. and the associated integration plan, expected synergies and revenue opportunities.

我們的新聞稿和幻燈片演示以及我們今天早上向美國證券交易委員會提交的 10-Q 表格已發佈到我們的網站上。今天的電話會議正在我們的網站上播出，並將在網站上保存 1 年。在本次電話會議中，我們將做出某些前瞻性陳述，反映與我們未來財務業績、未來事件、行業和市場狀況相關的當前觀點，包括與持續的 COVID-19 大流行相關的影響以及我們的預期消費者利益產品和服務以及我們的財務預測以及擬議收購 Signify Health, Inc. 的好處以及相關的整合計劃、預期的協同效應和收入機會。

Our forward-looking statements are subject to significant risks and uncertainties that could cause actual results to differ materially from currently projected results, including, with respect to the ongoing COVID-19 pandemic, and the proposed acquisition and the integration of Signify Health. We strongly encourage you to review the reports we file with the SEC, regarding these risks and uncertainties, including our most recent annual reports on Form 10-K, our recent current reports on Form 8-K, this morning's earnings press release and our Form 10-Q.

我們的前瞻性陳述受到重大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當前預測的結果存在重大差異，包括關於正在進行的 COVID-19 大流行，以及擬議的收購和整合 Signify Health。我們強烈建議您查看我們向 SEC 提交的關於這些風險和不確定性的報告，包括我們最近的 10-K 表格年度報告、我們最近的 8-K 表格報告、今天上午的收益新聞稿和我們的表格10-Q。

During this call, we will use non-GAAP measures when talking about the company's performance and financial conditions and you can find a reconciliation of these non-GAAP measures in this morning's press release and in the reconciliation document, posted to the Investor Relations portion of our website.

在本次電話會議中，我們將在談論公司業績和財務狀況時使用非 GAAP 指標，您可以在今天上午的新聞稿和發佈到投資者關係部分的對賬文件中找到這些非公認會計原則指標的對賬。我們的網站。

With that, I'd like to turn the call over to Karen. Karen?

有了這個，我想把電話轉給凱倫。凱倫？

Thank you, Larry. Good morning, everyone, and thanks for joining our call today. CVS Health delivered another outstanding quarter. Based on our strategic progress and confidence in our execution, we are raising our adjusted earnings per share guidance for the third consecutive time this year to a range of $8.55 to $8.65.

謝謝你，拉里。大家早上好，感謝您今天加入我們的電話會議。 CVS Health 又交付了一個出色的季度。基於我們的戰略進展和對執行的信心，我們今年連續第三次將調整後的每股收益指引上調至 8.55 美元至 8.65 美元之間。

During the third quarter, we grew revenue by 10% versus the prior year to over $81 billion and grew adjusted operating income by nearly 4% over the prior year to $4.2 billion. Adjusted earnings per share in the quarter was $2.09, an increase of over 6% from the prior year.

在第三季度，我們的收入與去年同期相比增長了 10%，超過 810 億美元，調整後的營業收入比去年同期增長了近 4%，達到 42 億美元。本季度調整後每股收益為 2.09 美元，比上年增長 6% 以上。

Our cash flow from operations was $9.1 billion in the third quarter and $18.1 billion, year-to-date. Throughout 2022, we've consistently executed on our strategy, centered around expanding our capabilities in health care delivery. We are increasingly delivering broader access to quality care, simpler journeys and better outcomes at lower costs across our channels.

我們第三季度的運營現金流為 91 億美元，年初至今為 181 億美元。在整個 2022 年，我們始終如一地執行我們的戰略，以擴大我們在醫療保健服務方面的能力為中心。我們越來越多地通過我們的渠道以更低的成本提供更廣泛的優質護理、更簡單的旅程和更好的結果。

With the announced acquisition of Signify Health, we will strengthen our engagement with consumers. We will add best-in-class capabilities that enable in-home services and care coordination as well as a platform to accelerate value-based physician enablement. Together, we will have a strong foundation for developing new product offerings, consistent with our payer-agnostic approach. We project that this transaction will close in the first half of 2023.

隨著宣布收購 Signify Health，我們將加強與消費者的互動。我們將添加一流的功能，以實現家庭服務和護理協調，以及加速基於價值的醫生支持的平台。我們將共同為開發新產品打下堅實的基礎，這與我們與付款人無關的方法相一致。我們預計這筆交易將在 2023 年上半年完成。

We continually evaluate our portfolio of assets for nonstrategic areas that do not fit our long-term priorities. In October, we reached an agreement to sell bswift, and are actively exploring strategic alternatives for Omnicare. As we divest assets, we will continue to invest in areas aligned with our strategy with a disciplined approach to capital allocation.

我們不斷評估不符合我們長期優先事項的非戰略領域的資產組合。 10 月，我們達成了出售 bswift 的協議，並正在積極探索 Omnicare 的戰略替代方案。隨著我們剝離資產，我們將繼續投資於符合我們戰略的領域，並採用嚴格的資本配置方法。

This morning, we made an important announcement on our ongoing opioid legal matter. In late October, we began a mediation to resolve substantially all opioid lawsuits and claims against CVS Health by state, political subdivisions and tribe. We reached an, agreement in principle, to pay approximately $5 billion over 10 years beginning in 2023, an outcome that is in the best interest of all parties and one that will help put a decades old issue behind us, as we continue to focus on delivering a superior health experience for the millions of consumers who rely on us.

今天早上，我們就我們正在進行的阿片類藥物法律問題發表了重要聲明。 10 月下旬，我們開始調解，以解決州、政治分區和部落對 CVS Health 的所有阿片類藥物訴訟和索賠。我們原則上達成了一項協議，從 2023 年開始，在 10 年內支付約 50 億美元，這一結果符合各方的最佳利益，也將有助於我們擺脫幾十年前的問題，因為我們將繼續專注於為依賴我們的數百萬消費者提供卓越的健康體驗。

Let's turn to each of our foundational businesses and discuss their strong results. The Health Care Benefits segment had another strong quarter. Revenues for this segment grew nearly 10% year-over-year with adjusted operating income of $1.5 billion. Our medical benefit ratio of 83.5% improved by 230 basis points versus the prior year, driven by a lower impact from COVID and medical cost trends that remained favorable.

讓我們轉向我們的每一項基礎業務，並討論它們的強勁成果。醫療保健福利部門又一個強勁的季度。該部門的收入同比增長近 10%，調整後的營業收入為 15 億美元。我們的醫療福利比率為 83.5%，與上一年相比提高了 230 個基點，這是由於 COVID 的影響較小以及醫療成本趨勢仍然有利。

Enrollment in our Medicare and Commercial businesses was strong this quarter with our individual Medicare Advantage and PDP portfolio, exceeding market growth once again. The 2023 Medicare annual enrollment period is underway and we are well positioned for another year of growth in our individual Medicare and dual-eligible products. We remain a leader in offering $0 premium plans with more than 73% of our plans in that category.

本季度我們的醫療保險和商業業務的註冊人數強勁，我們的個人醫療保險優勢和 PDP 組合再次超過市場增長。 2023 年 Medicare 年度註冊期正在進行中，我們已做好準備，在我們的個人 Medicare 和雙重資格產品方面再實現一年的增長。我們仍然是提供 0 美元保費計劃的領導者，我們 73% 以上的計劃屬於該類別。

We also continued our geographic expansion in the D-SNP market and now offer plans to 61% of D-SNP eligible population of more than 8%, year-over-year. We were disappointed that the star rating on our national PPO contracts fell to 3.5 star after nearly a decade-long track record of performing at 4 stars or better. We have a strong history of delivering affordable, high-quality plan benefits and a commitment to continuous improvement.

我們還繼續在 D-SNP 市場進行地域擴張，現在為 61% 的符合條件的 D-SNP 人口提供計劃，同比增長超過 8%。我們感到失望的是，我們的國家 PPO 合同的星級評級在近十年的 4 星或更好的業績記錄後降至 3.5 星。我們在提供負擔得起的高質量計劃福利和持續改進方面有著悠久的歷史。

Improving our star performance continues to be a top priority for the company. We have the right actions in place to improve our star ratings with our ongoing quality and experience efforts as we address the specific measures scored on the member surveys that contribute to star ratings.

提高我們的明星業績仍然是公司的首要任務。我們採取了正確的行動，通過我們持續的質量和經驗努力來提高我們的星級評分，因為我們解決了會員調查中有助於星級評分的具體措施。

We will continue to focus on our members and invest in programs and processes, specifically designed to simplify and improve their health care experience. This is an important priority for the company.

我們將繼續關注我們的會員，並投資於專為簡化和改善他們的醫療保健體驗而設計的計劃和流程。這是公司的一個重要優先事項。

In our commercial business, our growth is driven by the combination of our competitive cost structure, our integrated benefit designs and services that utilize CVS Health platforms and capabilities. We achieved a key milestone this quarter with more than 2 million members enrolled in our integrated Aetna and Caremark product. This important goal demonstrates the value we provide our customers through our combined CVS Health offerings, a strong proof point of our strategy.

在我們的商業業務中，我們的增長是由我們具有競爭力的成本結構、我們利用 CVS Health 平台和能力的綜合福利設計和服務組合推動的。本季度我們實現了一個重要的里程碑，超過 200 萬會員註冊了我們的集成 Aetna 和 Caremark 產品。這一重要目標展示了我們通過組合 CVS Health 產品為客戶提供的價值，這是我們戰略的有力證明。

Turning to our ACA individual exchange platform. We expanded our footprint and will be available in a total of 12 states, beginning in January of 2023, covering 5.5 million lives or nearly 40% of the individual exchange population. Our co-branded product offerings include instant access to providers with 24/7 virtual care and face-to-face access in our MinuteClinic locations.

轉向我們的 ACA 個人交流平台。我們擴大了足跡，從 2023 年 1 月開始，將在總共 12 個州提供服務，覆蓋 550 萬人的生命或近 40% 的個人交換人口。我們的聯合品牌產品包括即時訪問提供 24/7 虛擬護理和在我們的 MinuteClinic 地點進行面對面訪問的供應商。

We are committed to helping provide access to affordable care for all Americans. Finally, our Medicaid platform continues to be an important area for growth. We grew our Ohio-RISE program after a successful implementation and have been chosen by the State of Louisiana to serve a portion of their Medicaid-eligible children due to the deep expertise we've built to engage and support children, their caregivers and their families.

我們致力於幫助為所有美國人提供負擔得起的醫療服務。最後，我們的醫療補助平台仍然是一個重要的增長領域。在成功實施後，我們發展了俄亥俄州 RISE 計劃，並被路易斯安那州選中為他們的部分符合醫療補助條件的兒童提供服務，因為我們在吸引和支持兒童、他們的照顧者和他們的家庭方面積累了深厚的專業知識.

We've expanded our capabilities with a focus on quality and member engagement through our CVS Health community channels, as we enter a robust bid period. In Pharmacy Services, our revenue grew nearly 11% with adjusted operating income of $1.9 billion. Specialty Pharmacy revenue grew 22% year-over-year, driven by our industry-leading cost management and service excellence that continue to differentiate us in the marketplace. We closed out another successful selling season, driving $3.5 billion of gross new business for 2023 and a client retention rate of nearly 98%, evidence of the strength of our portfolio of capabilities.

隨著我們進入強勁的投標期，我們通過 CVS Health 社區渠道擴展了我們的能力，重點關注質量和成員參與。在藥房服務方面，我們的收入增長了近 11%，調整後的營業收入為 19 億美元。專業藥房收入同比增長 22%，這得益於我們行業領先的成本管理和卓越服務，這些優勢繼續使我們在市場上脫穎而出。我們結束了另一個成功的銷售季節，在 2023 年推動了 35 億美元的新業務總額和近 98% 的客戶保留率，這證明了我們的能力組合的實力。

Efforts are underway to support a successful welcome season for our members. Last week, we learned that Centene decided to move their business to a competitor in 2024. While we hope to continue our relationship with Centene and bid to do so, we also maintained our pricing discipline. For the remainder of the contract, we will work with Centene to facilitate a seamless transition for members.

我們正在努力為我們的會員提供一個成功的歡迎季。上週，我們了解到 Centene 決定在 2024 年將他們的業務轉移給競爭對手。雖然我們希望繼續與 Centene 的關係並競標這樣做，但我們也保持了我們的定價紀律。對於合同的剩餘部分，我們將與 Centene 合作，以促進成員的無縫過渡。

Even after moving this contract, our purchasing power and our ability to drive value for our customers will not be diminished. Our demonstrated success in growing lives under management and revenue is a testament to our high-quality service, compliance capabilities and specialty pharmacy excellence.

即使在轉移這份合同之後，我們的購買力和為客戶創造價值的能力也不會減弱。我們在管理和收入增長方面取得的成功證明了我們的高質量服務、合規能力和卓越的專業藥房。

Our Pharmacy Services segment will remain an important driver of growth within CDSL in the years to come. Our Retail/Long-Term Care segment also continues to outperform expectations. Revenues in the quarter grew nearly 7% versus the prior year with $1.4 billion in adjusted operating income. Performance in both the front store and pharmacy was strong. Front store sales were up approximately 4%, driven by growth across the majority of our categories. Demand for COVID vaccines and over-the-counter test as well as cough, cold and flu products remain high.

未來幾年，我們的藥房服務部門仍將是 CDSL 增長的重要推動力。我們的零售/長期護理部門也繼續超出預期。該季度的收入與去年同期相比增長了近 7%，調整後的營業收入為 14 億美元。前店和藥房的表現都很強勁。在我們大多數類別的增長的推動下，前店銷售額增長了約 4%。對 COVID 疫苗和非處方藥檢測以及咳嗽、感冒和流感產品的需求仍然很高。

In pharmacy, scripts grew 1.8% year-over-year in the third quarter or 3.6%, excluding COVID vaccines. This growth helped propel our retail pharmacy business to another quarter of year-over-year market share gains, extending a trend that started in the first quarter of 2020. Our community retail health destinations play a strengthening role in the overall well-being of the consumers we serve. As demand for health products and services continues to be elevated, we are implementing new digital capabilities that provide a seamless and convenient consumer experience.

在藥房中，不包括 COVID 疫苗在內，第三季度的處方藥同比增長 1.8% 或 3.6%。這一增長有助於推動我們的零售藥房業務實現另一個季度的市場份額同比增長，延續了從 2020 年第一季度開始的趨勢。我們的社區零售健康目的地在整體福祉中發揮著加強作用我們服務的消費者。隨著對健康產品和服務的需求不斷增加，我們正在實施新的數字功能，以提供無縫和便捷的消費者體驗。

Now, most of our pharmacists are empowered to prescribe tax -- COVID antiviral treatment. Our investments in omnichannel health are enhancing transparency and helping consumers better manage their overall health. While there is growing economic uncertainty and recession expectations in 2023, we are well positioned across our foundational businesses to manage through these potential headwinds. We are increasingly delivering connected experiences and health solutions that improve overall well-being.

現在，我們的大多數藥劑師都有權開稅——COVID 抗病毒治療。我們對全渠道健康的投資正在提高透明度並幫助消費者更好地管理他們的整體健康。儘管 2023 年的經濟不確定性和衰退預期越來越大，但我們在基礎業務方面處於有利地位，可以應對這些潛在的不利因素。我們越來越多地提供互聯體驗和健康解決方案，以改善整體福祉。

More and more, we are there for every meaningful moment of our consumers' health. Throughout 2022, we made significant progress advancing our strategy. building a strong foundation for health care delivery and expanding our health service offerings and developing new products.

我們越來越多地為消費者健康的每一個有意義的時刻而存在。在整個 2022 年，我們在推進戰略方面取得了重大進展。為醫療保健服務奠定堅實的基礎，擴大我們的醫療服務範圍和開發新產品。

In October, we announced that Dr. Amar Desai has joined CVS Health to lead our health care delivery strategy. Dr. Desai's experience in transforming the health care system and driving value-based care will accelerate our vision of becoming the leading health solutions company and our efforts to improve health care for consumers.

10 月，我們宣布 Amar Desai 博士已加入 CVS Health 領導我們的醫療保健提供戰略。 Desai 博士在改變醫療保健系統和推動基於價值的醫療保健方面的經驗將加速我們成為領先的健康解決方案公司的願景，以及我們為改善消費者醫療保健所做的努力。

2022 has also been an important year for growing our digital presence and capabilities. This quarter, we added another approximately 1 million digital customers. CVS Health now serves more than 46 million unique digital customers, an impressive 11 million more, since this time last year. Our digitally-led omnichannel health approach prioritizes experience that matter most for consumers. This includes advancing our digital tools for a seamless and convenient experience, leading to higher engagement and satisfaction.

2022 年也是我們發展數字業務和能力的重要一年。本季度，我們又增加了大約 100 萬數字客戶。自去年這個時候以來，CVS Health 現在為超過 4600 萬唯一數字客戶提供服務，令人印象深刻的是增加了 1100 萬。我們以數字為主導的全渠道健康方法優先考慮對消費者最重要的體驗。這包括推進我們的數字工具以獲得無縫和便捷的體驗，從而提高參與度和滿意度。

For example, we recently launched a new functionality that drives more choice and convenience for patients filling prescriptions. Patients can expedite urgent prescriptions have visibility into out-of-pocket costs and track their order status, all before even coming in to our pharmacy. We continue to make strong progress on ESG. For example, we are working to decrease disparities with our focus on women's health, as it relates to accessing quality and convenient health care.

例如，我們最近推出了一項新功能，為患者填寫處方提供了更多選擇和便利。患者可以加快緊急處方的速度，甚至可以在進入我們的藥房之前了解自付費用並跟踪他們的訂單狀態。我們在 ESG 方面繼續取得強勁進展。例如，我們正在努力減少對女性健康的關注，因為這與獲得優質和便捷的醫療保健有關。

As part of our Here for Her initiative, we are launching a variety of new MinuteClinic virtual care services to support women's health that will be available 24/7.

作為 Here for Her 倡議的一部分，我們將推出各種新的 MinuteClinic 虛擬護理服務，以支持女性的健康，這些服務將 24/7 全天候提供。

And finally, I want to take this opportunity to, again, thank our CVS Health colleagues, especially those in Florida and Puerto Rico, who faced natural disasters. Our teams pulled together to ensure care continuity for our customers and the communities that we serve.

最後，我想藉此機會再次感謝我們的 CVS Health 同事，特別是佛羅里達和波多黎各面臨自然災害的同事。我們的團隊齊心協力，確保為我們的客戶和我們所服務的社區提供持續的護理。

I will now turn it over to Shawn for a deeper look into our operational and financial results and outlook.

我現在將把它交給肖恩，以更深入地了解我們的運營和財務結果和前景。

Thank you, Karen, and good morning, everyone. Our third quarter results reflect the continuation of the strong performance observed in the first half of 2022 as we exceeded our expectations for revenue, cash flow generation and adjusted earnings per share. This momentum allows us to again raise our 2022 adjusted EPS guidance to a range of $8.55 to $8.65 per share.

謝謝你，凱倫，大家早上好。我們的第三季度業績反映了 2022 年上半年強勁表現的延續，因為我們超出了我們對收入、現金流產生和調整後每股收益的預期。這種勢頭使我們能夠再次將 2022 年調整後的每股收益指引提高到每股 8.55 美元至 8.65 美元的範圍。

A few highlights regarding overall company performance. Third quarter revenues of over $81 billion increased by 10% year-over-year, reflecting robust growth across each of our operating segments. We delivered adjusted operating income of $4.2 billion and adjusted EPS of $2.09, representing increases of 3.9% and 6.1% versus prior year, respectively.

關於公司整體業績的一些亮點。第三季度收入超過 810 億美元，同比增長 10%，反映了我們每個運營部門的強勁增長。我們實現了 42 億美元的調整後營業收入和 2.09 美元的調整後每股收益，分別比上年增長 3.9% 和 6.1%。

Our ability to generate cash remains strong. Our cash flow from operations was $9.1 billion in the third quarter and $18.1 billion year-to-date. Cash flows in the quarter benefited from the timing of CMS payments that are expected to normalize in the fourth quarter. Looking at performance by business segment. In Health Care Benefits, we delivered strong revenue and adjusted operating income growth versus the prior year. Third quarter revenue of $22.5 billion, increased by nearly 10% over the prior year quarter. Membership grew 2.5% year-over-year despite the divestiture of 283,000 lives from Aetna International earlier this year.

我們產生現金的能力仍然很強。我們第三季度的運營現金流為 91 億美元，年初至今為 181 億美元。本季度的現金流受益於預計在第四季度正常化的 CMS 付款時間。按業務部門查看業績。在醫療保健福利方面，與去年相比，我們實現了強勁的收入和調整後的營業收入增長。第三季度收入為 225 億美元，比去年同期增長近 10%。儘管今年早些時候從 Aetna International 剝離了 283,000 人的生命，但會員人數同比增長 2.5%。

Our Medicare franchise remains a strong growth opportunity for us, adding 75,000 members sequentially across our portfolio of solutions for individuals and employers. Underlying growth in our commercial business also remains strong.

我們的 Medicare 特許經營權對我們來說仍然是一個強大的增長機會，在我們為個人和雇主提供的解決方案組合中依次增加了 75,000 名成員。我們商業業務的潛在增長也保持強勁。

We are excited about the prospects of our individual exchange business, which now includes 12 states as of January 1, 2023. The sequential decline in Medicaid membership is driven by a previously disclosed contract loss, partially offset by the ongoing suspension of redeterminations.

我們對我們的個人交換業務的前景感到興奮，截至 2023 年 1 月 1 日，該業務現在包括 12 個州。醫療補助成員的連續下降是由先前披露的合同損失推動的，部分被持續暫停的重新裁決所抵消。

Adjusted operating income of $1.5 billion increased 39.6% year-over-year, primarily due to the impact of higher COVID costs in third quarter 2021. COVID pricing actions we took this year and strong underlying performance, partially offset by incremental investments to support growth in the business and net realized investment portfolio losses. Our medical benefit ratio of 83.5% improved 230 basis points year-over-year, reflecting lower impact from COVID and medical cost trends that remain modestly favorable to our pricing assumptions.

調整後的營業收入為 15 億美元，同比增長 39.6%，這主要是由於 2021 年第三季度 COVID 成本上升的影響。我們今年採取的 COVID 定價行動和強勁的基本業績，部分被支持增長的增量投資所抵消業務和淨實現的投資組合損失。我們 83.5% 的醫療福利比率同比提高 230 個基點，反映出 COVID 和醫療成本趨勢的影響較小，這些趨勢仍然適度有利於我們的定價假設。

Consistent with last quarter, medical cost trends in our commercial business remain generally in line with pre-pandemic-trended baselines and government remains slightly lower than the pre-pandemic-trended baselines. Consolidated days claims payable at the end of the quarter was 54.9, up 0.6 days sequentially as reserves grew at a modestly higher rate than premiums. Overall, we remain confident in the adequacy of our reserves.

與上一季度一致，我們商業業務的醫療成本趨勢總體上與大流行前趨勢基線保持一致，政府仍略低於大流行前趨勢基線。本季度末應付的綜合索賠天數為 54.9 天，環比增加 0.6 天，原因是準備金的增長速度略高於保費。總體而言，我們對我們的儲備充足充滿信心。

In the Pharmacy Services business, our ability to deliver industry-leading drug trend for our clients, our specialty management capabilities and outstanding customer service levels continue to drive growth. During the third quarter, revenue of over $43 billion increased by nearly 11% year-over-year, driven by pharmacy claims growth, specialty pharmacy and brand inflation, partially offset by the impact of continued client price improvements.

在藥房服務業務中，我們為客戶提供行業領先藥物趨勢的能力、我們的專業管理能力和出色的客戶服務水平繼續推動增長。第三季度，在藥房索賠增長、專業藥房和品牌通脹的推動下，收入超過 430 億美元，同比增長近 11%，部分被客戶價格持續改善的影響所抵消。

Total pharmacy claims processed increased by 3.6%, above prior year, and 4.5% when excluding COVID-19 vaccinations, primarily attributable to new business in 2022 and increased utilization. Total pharmacy membership remains steady, exceeding 110 million members as growth in commercial and government lives helped to offset significant membership losses from the California Medicaid carve-out that started this year.

處理的藥房索賠總額比上年增長 3.6%，不包括 COVID-19 疫苗接種後增長 4.5%，這主要歸因於 2022 年的新業務和利用率的提高。藥房會員總數保持穩定，超過 1.1 億會員，因為商業和政府生活的增長幫助抵消了今年開始的加州醫療補助計劃剝離造成的重大會員損失。

Adjusted operating income of $1.9 billion grew nearly 6% year-over-year, driven by improved purchasing economics, including increased contributions from the products and services of our group purchasing organization. This was partially tempered by ongoing client price improvements. Quarterly contribution from our 340B product lines improved in the third quarter, in line with our estimates, as covered entities addressed manufacturer conditions for program participation.

調整後的營業收入為 19 億美元，同比增長近 6%，這得益於採購經濟的改善，包括我們團購組織的產品和服務貢獻增加。持續的客戶價格改善部分緩和了這一點。我們的 340B 產品線的季度貢獻在第三季度有所改善，符合我們的估計，因為涵蓋的實體解決了製造商參與計劃的條件。

In our Retail/Long-Term Care segment, we delivered strong revenue growth and adjusted operating income above our expectations despite mixed COVID-related trends and continued economic uncertainty. Specifically, during the third quarter, revenue of $26.7 billion grew nearly 7%, reflecting increased prescription and front store volume, including the sale of COVID-19 over-the-counter test kits as well as pharmacy drug mix and brand inflation. These increases were partially offset by a decrease in COVID-19 diagnostic testing and vaccinations.

在我們的零售/長期護理部門，我們實現了強勁的收入增長，調整後的營業收入高於我們的預期，儘管與 COVID 相關的趨勢好壞參半，經濟不確定性持續存在。具體而言，在第三季度，267 億美元的收入增長了近 7%，這反映了處方藥和門店數量的增加，包括 COVID-19 非處方藥的銷售以及藥房藥物組合和品牌膨脹。這些增長被 COVID-19 診斷測試和疫苗接種的減少部分抵消。

The impact of recent generic introductions and continued pharmacy reimbursement pressure. Adjusted operating income of $1.4 billion declined 18.9% versus prior year, driven by decreased COVID-19 diagnostic testing in vaccinations, continued pharmacy reimbursement pressure as well as increased investments in the segment's operations and capabilities. These decreases were partially offset by the increased prescription and front store volume, improved generic drug purchasing and the favorable impact of business initiatives.

最近仿製藥推出的影響和持續的藥房報銷壓力。調整後的營業收入為 14 億美元，較上年下降 18.9%，原因是疫苗中 COVID-19 診斷測試減少、藥房報銷壓力持續以及對該部門運營和能力的投資增加。這些下降被處方和前店數量的增加、仿製藥採購的改善以及業務舉措的有利影響部分抵消。

Pharmacy prescription volume grew 1.8% year-over-year, reflecting increased utilization. Excluding the impact of COVID, pharmacy prescription volume increased by 3.6% year-over-year.

藥房處方量同比增長 1.8%，反映出利用率增加。排除 COVID 的影響，藥房處方量同比增長 3.6%。

Turning to the balance sheet. Our liquidity and capital position remained excellent. Year-to-date, we generated cash flow from operations of $18.1 billion, and ended the quarter with $7.9 billion of cash at the parent and unrestricted subsidiaries. Cash flows during the quarter were positively impacted by the early receipt of $3.2 billion of CMS payments which will normalize in the fourth quarter. During the quarter, we repaid $2.6 billion of long-term debt. Through our quarterly dividend, we returned $726 million to shareholders.

轉向資產負債表。我們的流動性和資本狀況保持良好。年初至今，我們從運營中產生了 181 億美元的現金流，並在本季度結束時在母公司和不受限制的子公司獲得了 79 億美元的現金。本季度的現金流受到提前收到 32 億美元的 CMS 付款的積極影響，這將在第四季度正常化。本季度，我們償還了 26 億美元的長期債務。通過我們的季度股息，我們向股東返還了 7.26 億美元。

We remain committed to maintaining our investment-grade ratings, while also having the flexibility to deploy capital strategically for capability-focused M&A. A few other items worth highlighting for investors. We continue to experience the impact of market volatility on our investment portfolio and recorded net realized capital losses of approximately $110 million in the quarter. These losses emerged predominantly in the HCB segment.

我們仍然致力於維持我們的投資級評級，同時還可以靈活地戰略性地部署資本以進行以能力為中心的併購。其他一些值得投資者強調的項目。我們繼續經歷市場波動對我們的投資組合的影響，並在本季度錄得約 1.1 億美元的已實現淨資本損失。這些損失主要出現在 HCB 領域。

We were not immune to the impacts of Hurricane Ian and recorded losses of approximately $40 million related to damages from the storm. We recorded a pretax loss on assets held for sale of $2.5 billion related to the write-down of our long-term care business, Omnicare, where we are in the process of exploring strategic alternatives.

我們也未能倖免於颶風伊恩的影響，並記錄了與風暴造成的損失有關的約 4000 萬美元的損失。我們記錄了 25 億美元的持有待售資產的稅前虧損，這與我們正在探索戰略替代方案的長期護理業務 Omnicare 的減記有關。

We also recorded pretax charges of $5.2 billion for legal settlements related to agreements in principle with certain states and governmental entities to resolve opioid claims. Consistent with past practice, these GAAP impacts have been excluded from our adjusted operating metrics.

我們還記錄了 52 億美元的稅前費用，用於與某些州和政府實體原則上與解決阿片類藥物索賠的協議相關的法律和解。與過去的做法一致，這些 GAAP 影響已被排除在我們調整後的運營指標之外。

Turning to our 2022 outlook. We are raising the midpoint of our adjusted earnings per share guidance by $0.10 to a range of $8.55 to $8.65. This increase reflects favorable underlying third quarter performance in retail and HCB, an improved Q4 outlook for the retail LTC segment and slight improvement in the full year outlook for tax rate and share count, partially offset by the anticipated impact of market volatility on net investment income for the HCB business.

轉向我們的 2022 年展望。我們將調整後每股收益指引的中點提高 0.10 美元，至 8.55 美元至 8.65 美元之間。這一增長反映了零售和 HCB 第三季度的良好基本表現、零售 LTC 部門第四季度前景的改善以及稅率和股票數量的全年前景略有改善，部分被市場波動對淨投資收入的預期影響所抵消用於 HCB 業務。

We are narrowing our full year adjusted operating income guidance in health care benefits to a range of $5.96 billion to $6.02 billion. This reflects the previously discussed strong underlying fundamental performance, offset by continued caution on our outlook for investment income given the volatile rate environment.

我們正在將醫療保健福利的全年調整後營業收入指導範圍縮小到 59.6 億美元至 60.2 億美元之間。這反映了之前討論的強勁的基本面表現，但在波動的利率環境下，我們對投資收入前景的持續謹慎抵消了這一點。

Our outlook also contemplates the extension of the public health emergency into the early part of the first quarter of 2023. For the retail LTC segment, we are raising and narrowing full year guidance as follows: revenue increases to a range of $102.7 billion to $104.0 billion; adjusted operating income guidance increases by $105 million at the midpoint to a range of $6.66 billion to $6.72 billion. We now forecast that we will administer 28 million COVID-19 vaccinations in 2022 with approximately 70% already administered through the third quarter of 2022. We expect full year diagnostic testing volumes of approximately 17 million, which is down from our prior outlook.

我們的展望還考慮將突發公共衛生事件延長至 2023 年第一季度初。對於零售 LTC 部門，我們正在上調和縮小全年指引如下：收入增至 1027 億美元至 1040 億美元;調整後的營業收入指引在中點增加 1.05 億美元至 66.6 億美元至 67.2 億美元之間。我們現在預測，我們將在 2022 年進行 2800 萬次 COVID-19 疫苗接種，其中大約 70% 已經到 2022 年第三季度進行。我們預計全年診斷檢測量約為 1700 萬次，低於我們之前的預測。

However, we now expect higher sales of over-the-counter test kits, exceeding 65 million units or nearly triple the number of kits sold last year. In aggregate, we expect these 3 categories of COVID-driven items to continue to produce over $3 billion of revenue in 2022, a decline of approximately 29% versus 2021, but reflective of the endemic tail of COVID on our retail business.

但是，我們現在預計非處方測試套件的銷量會增加，超過 6500 萬套，幾乎是去年售出套件數量的三倍。總的來說，我們預計這 3 類 COVID 驅動的商品將在 2022 年繼續產生超過 30 億美元的收入，與 2021 年相比下降約 29%，但反映了 COVID 對我們零售業務的普遍影響。

Our updated outlook also contemplates higher levels of investment spending in the fourth quarter as we continue to invest in our workforce and enhance our customer experience. In Pharmacy Services, we are narrowing our outlook range and now project full year adjusted operating income guidance to be between $7.31 billion to $7.40 billion.

隨著我們繼續投資於我們的員工隊伍並提升我們的客戶體驗，我們更新的展望還考慮到第四季度更高水平的投資支出。在藥房服務方面，我們正在縮小我們的展望範圍，現在預計全年調整後的營業收入指引將在 73.1 億美元至 74.0 億美元之間。

Looking at the enterprise as a whole, we anticipate continued strong cash flow from operations in 2022 and have raised our guidance accordingly to a range of $13.5 billion to $14.5 billion, with capital expenditures unchanged at a range of $2.8 billion to $3.0 billion. We are also updating our guidance on share count to a range of 1.325 billion to 1.33 billion shares and on our effective tax rate to 25.5%.

縱觀整個企業，我們預計 2022 年的運營現金流將持續強勁，並相應地將我們的指導上調至 135 億美元至 145 億美元的範圍，資本支出保持在 28 億美元至 30 億美元的範圍內。我們還將對股票數量的指導更新為 13.25 億股至 13.3 億股，並將我們的有效稅率更新為 25.5%。

As Karen noted earlier, we have reached an agreement, in principle, to resolve substantially all opioid lawsuits and claims against CVS Health, providing increased clarity regarding this long-standing issue. The agreement amount to be paid is approximately $5 billion and will be paid over 10 years, beginning in 2023. The timing of cash settlement payments spread over multiple years results in an annual impact to our cash flows that enables us to continue to invest in our strategic priorities.

正如 Karen 之前指出的，我們原則上已達成一項協議，以解決針對 CVS Health 的所有阿片類藥物訴訟和索賠，從而更加明確這一長期存在的問題。將支付的協議金額約為 50 億美元，將從 2023 年開始分 10 年支付。現金結算支付的時間分佈在多年內，這對我們的現金流產生了年度影響，使我們能夠繼續投資於我們的戰略重點。

While we will offer detailed 2023 guidance on our fourth quarter call in early February, I wanted to offer some high-level commentary as investors think through our potential financial performance in 2023. We need to consider several factors as we determine the 2022 baseline.

雖然我們將在 2 月初的第四季度電話會議上提供詳細的 2023 年指導，但我想在投資者考慮我們 2023 年的潛在財務表現時提供一些高水平的評論。在確定 2022 年的基線時，我們需要考慮幾個因素。

First, prior year reserve development improved our year-to-date 2022 adjusted operating income by over $217 million or approximately $0.12 of adjusted earnings per share, and we do not forecast prior year reserve development to recur in future periods. Second, due to the turbulent rate environment, we have experienced unanticipated headwinds in our net investment income in 2022.

首先，上一年的儲備開發使我們 2022 年迄今調整後的營業收入增加了超過 2.17 億美元或調整後每股收益約 0.12 美元，我們預計上一年的儲備開發不會在未來期間再次發生。其次，由於動蕩的利率環境，我們在 2022 年的淨投資收入遇到了意想不到的逆風。

As we look at the full year, these headwinds could exceed $350 million or over $0.20 in adjusted EPS. In 2023, we plan to use a reporting convention that excludes capital gains and losses from adjusted operating income, consistent with how Aetna, which bears the vast majority of these impacts, reported these items prior to the acquisition.

縱觀全年，這些不利因素可能超過 3.5 億美元或調整後每股收益超過 0.20 美元。 2023 年，我們計劃使用一種報告慣例，將資本收益和損失排除在調整後的營業收入之外，這與承受絕大多數這些影響的 Aetna 在收購前報告這些項目的方式一致。

Third, in the second quarter of 2022, we strengthened reserves in our legacy Aetna Long Term Care insurance business, which reduced adjusted operating income by $108 million or approximately $0.06 per share. This adjustment was the first time we significantly adjusted this reserve since the Aetna acquisition, and we do not currently project we will need to make additional adjustments to this reserve in 2023.

第三，在 2022 年第二季度，我們加強了傳統 Aetna 長期護理保險業務的準備金，這使調整後的營業收入減少了 1.08 億美元或每股約 0.06 美元。此次調整是我們自收購 Aetna 以來首次大幅調整該儲備金，我們目前預計不會在 2023 年對該儲備金進行額外調整。

Fourth, we have made great progress this year in rationalizing our portfolio to focus on those businesses that will drive the highest growth for our enterprise over the long term. While none of these divestitures, which include Payflex, bswift and portions of our Aetna International business are material on their own. Collectively, they present a 2023 headwind of approximately $0.04 in adjusted EPS.

第四，今年我們在合理化我們的投資組合方面取得了很大進展，以專注於那些能夠為我們的企業帶來長期最高增長的業務。儘管這些資產剝離（包括 Payflex、bswift 和我們的部分 Aetna International 業務）本身都不是實質性的。總的來說，他們提出了 2023 年調整後每股收益約為 0.04 美元的逆風。

In addition to those specific adjustments, we are projecting that our Retail LTC segment will have over $3 billion of revenues in 2022 from COVID, which have a robust margin profile. It is not prudent to anticipate a similar level of COVID-based revenues going forward. And we expect that the economics on vaccines and diagnostic testing will change, following expiration of the public health emergency which we project will happen in the early part of the first quarter of 2023.

除了這些具體調整之外，我們預計我們的零售 LTC 部門將在 2022 年從 COVID 獲得超過 30 億美元的收入，其利潤率狀況強勁。預計未來會有類似水平的基於 COVID 的收入是不謹慎的。我們預計，在我們預測的公共衛生緊急事件將在 2023 年第一季度初發生後，疫苗和診斷測試的經濟狀況將會發生變化。

As detailed in our third quarter slide presentation, starting with the midpoint of our updated adjusted EPS guidance range of $8.60 and adjusting for these items creates a 2022 baseline of approximately $8.20. Shifting to our view on 2023, there are a number of headwinds and tailwinds that we are contemplating, as we develop our outlook. In our retail business, we plan to continue to offset reimbursement pressure and wage improvements with continued script growth and purchasing improvements as well as front store growth and benefits from our store footprint optimization efforts.

正如我們在第三季度幻燈片演示中所詳述的那樣，從我們更新後的調整後每股收益指導範圍的中點 8.60 美元開始，對這些項目進行調整後，2022 年的基線約為 8.20 美元。轉向我們對 2023 年的看法，在我們制定展望的過程中，我們正在考慮一些不利因素和不利因素。在我們的零售業務中，我們計劃通過持續的腳本增長和採購改進以及門店增長和門店足跡優化工作帶來的好處，繼續抵消報銷壓力和工資改進。

We remain committed to generating at least $6 billion of adjusted operating income in this segment in 2023, consistent with the targets we outlined at our Investor Day in December of 2021.

我們仍然致力於在 2023 年在該部門產生至少 60 億美元的調整後營業收入，這與我們在 2021 年 12 月投資者日概述的目標一致。

In PSS, we are targeting mid-single-digit growth over our baseline. New sales wins and growth in specialty generic and biosimilar launches will help drive this result, combined with stabilization of 340B dynamic and a continued focus on efficiencies. In Health Care Benefits, we will continue to target mid- to high single-digit growth.

在 PSS 中，我們的目標是在我們的基線上實現中個位數的增長。新的銷售勝利和特殊仿製藥和生物仿製藥的推出將有助於推動這一結果，再加上 340B 動態的穩定和對效率的持續關注。在醫療保健福利方面，我們將繼續以中高個位數增長為目標。

The strength of our Medicare Advantage offering in 2023 and continued membership growth, including in individual and group Medicare will help to offset losses from Medicaid redeterminations and our divested assets to drive topline growth. Continued disciplined pricing and efficiencies will help to drive adjusted operating income growth.

我們在 2023 年提供的 Medicare Advantage 產品的實力和會員資格的持續增長，包括個人和團體 Medicare 將有助於抵消 Medicaid 重新確定和我們剝離資產以推動收入增長的損失。持續嚴格的定價和效率將有助於推動調整後的營業收入增長。

Capital deployment remains an important part of our growth equation, and we expect to repurchase shares in 2023 opportunistically to ensure we achieve our targets and to offset dilution. Our preliminary outlook does not include any impact from the announced acquisition of Signify Health, which we continued to project, will close in the first half of 2023 and be accretive to adjusted EPS.

資本部署仍然是我們增長等式的重要組成部分，我們預計將在 2023 年機會性地回購股票，以確保我們實現目標並抵消稀釋。我們的初步展望不包括宣布收購 Signify Health 的任何影響，我們繼續預計，該收購將在 2023 年上半年完成並增加調整後的每股收益。

Taking all these factors into consideration, our initial goal in 2023 is to grow our adjusted EPS to a range of $8.70 to $8.90. At the midpoint, this range is consistent with the high single-digit outlook we provided at our Investor Day last December. Before we conclude, I want to discuss the recent 2024 Medicare STARs updates. We are very disappointed with our Medicare STARs results for 2024, but remain dedicated to providing our Medicare Advantage members with the high quality and service that they have come to expect. We also remain committed to maintaining a competitive product and benefits offering in 2024 and to continue to grow Medicare Advantage membership throughout this period.

考慮到所有這些因素，我們在 2023 年的初始目標是將調整後的每股收益提高到 8.70 美元至 8.90 美元之間。在中點，這個範圍與我們在去年 12 月的投資者日提供的高個位數前景一致。在結束之前，我想討論一下最近的 2024 Medicare STARs 更新。我們對 2024 年的 Medicare STARs 結果感到非常失望，但仍致力於為我們的 Medicare Advantage 成員提供他們所期望的高質量和服務。我們還繼續致力於在 2024 年保持具有競爭力的產品和福利，並在此期間繼續增加 Medicare Advantage 會員。

The change in star ratings is not projected to impact our 2022 guidance, and we expect to be able to manage the impacts to 2023, including cost to improve our 2024 star ratings. Our intent is to mitigate some of the financial impact of lower STARs ratings in 2024 through our ongoing contract diversification efforts combined with a variety of operational initiatives as we work to find additional efficiencies.

預計星級的變化不會影響我們 2022 年的指導，我們預計能夠管理到 2023 年的影響，包括提高 2024 年星級的成本。我們的目的是在 2024 年通過我們正在進行的合同多元化工作以及各種運營計劃來減輕 2024 年較低 STAR 評級對財務的影響，同時我們努力尋找額外的效率。

Even if successful, given the magnitude of this headwind, it is appropriate to assume that these efforts alone, while potentially significant, will not close the entire GAAP. The recently announced loss of the Centene contract places further pressure on our 2024 outlook. Importantly, and to be absolutely clear, the powerful capital generation capabilities of our enterprise provide us with financial capacity to increase share repurchase in excess of the $8 billion of our remaining authorization and produce adjusted EPS, consistent with our 2021 Investor Day outlook, which had implied adjusted EPS in the range of $9.75 to $9.95 in 2024.

即使成功，考慮到這種逆風的規模，假設這些努力雖然可能很重要，但不會關閉整個公認會計原則。最近宣布的 Centene 合同損失給我們 2024 年的前景帶來了進一步的壓力。重要且絕對清楚的是，我們企業強大的資本生成能力為我們提供了財務能力，以增加超過我們剩餘授權的 80 億美元的股票回購併產生調整後的每股收益，這與我們的 2021 年投資者日展望一致，其中2024 年隱含調整後每股收益在 9.75 美元至 9.95 美元之間。

While this would achieve a 2024 EPS objective, repurchasing shares alone will not advance the strategic positioning of the company. Alternatively, strategic capital deployment may not yield the same adjusted EPS accretion in 2024 as share repurchases, but could further advance our care delivery strategy and help sustainably accelerate the adjusted EPS growth rate of CVS Health.

雖然這將實現 2024 年的每股收益目標，但僅回購股票並不能推進公司的戰略定位。或者，戰略資本部署可能不會在 2024 年產生與股票回購相同的調整後每股收益增長，但可以進一步推進我們的醫療服務戰略，並有助於可持續地加快 CVS Health 調整後的每股收益增長率。

Absent deploying capital towards further strategic acquisitions Investors should expect that we will deploy capital towards share repurchases to address our 2024 earnings headwinds. We remain committed to using our liquidity to help achieve both our long-term and near-term goals.

沒有將資金用於進一步的戰略收購投資者應該期望我們將資金用於股票回購，以應對我們 2024 年的盈利逆風。我們仍然致力於利用我們的流動性來幫助實現我們的長期和近期目標。

To conclude, our third quarter results reflect continued strength from all our core business segments, and we are pleased to raise our full year 2022 adjusted EPS guidance. Our focus on growth and operational execution persists and we continue to progress on our long-term strategy. We will now open the call to your questions. Operator?

總而言之，我們的第三季度業績反映了我們所有核心業務部門的持續實力，我們很高興上調 2022 年全年調整後的每股收益指引。我們持續關注增長和運營執行，並繼續推進我們的長期戰略。我們現在將打開您的問題的電話。操作員？

(Operator Instructions)

（操作員說明）

We'll take our first question from Lisa Gill with JPMorgan.

我們將向摩根大通的麗莎吉爾提出我們的第一個問題。

I just really want to go back the last comment that you made and just really understand how you and Karen are thinking about this. One, you talked about hiring Dr. Desai as Head of Health Care Delivery. And as we think about that strategy going forward, is it, one, you haven't found an acquisition that fits? Two, do you think that there's organic opportunities?

我真的很想回到您發表的最後一條評論，並真正了解您和凱倫是如何考慮這個問題的。一，您談到聘請德賽博士擔任醫療保健服務主管。當我們考慮未來的戰略時，是不是，你還沒有找到合適的收購？二，你認為有有機機會嗎？

And I do appreciate that if something doesn't come along, you're going to buy back shares. But I think as investors think about your story longer term, they want to see you really propelling the strategy that you and Karen laid out last year. So that would be my first question.

而且我很感激，如果沒有什麼事情發生，你會回購股票。但我認為，隨著投資者從長遠角度考慮你的故事，他們希望看到你真正推動你和凱倫去年制定的戰略。所以這將是我的第一個問題。

Yes, Lisa, it's Karen. So let me start. You're right. We laid out a strategy, and we said that we wanted to expand into health care services. We said that we wanted to have primary care. We thought we would need an acquisition to do that. We also said we want to extend into the home and have provider enablement through the Signify acquisition. That represents strong execution this year of our strategy. We will continue to evaluate our options on primary care. And as I said, we believe that we need to do M&A and we continue to evaluate those options in the marketplace.

是的，麗莎，是凱倫。那麼讓我開始吧。你是對的。我們制定了一項戰略，並表示我們希望擴展到醫療保健服務領域。我們說我們想要初級保健。我們認為我們需要收購才能做到這一點。我們還表示，我們希望通過收購 Signify 擴展到家庭並支持供應商。這代表了我們今年戰略的有力執行。我們將繼續評估我們在初級保健方面的選擇。正如我所說，我們認為我們需要進行併購，我們將繼續評估市場上的這些選擇。

Yes. And Lisa, I would just echo. I mean, obviously, I think with the 10 months since our Investor Day we've been at this, I think we've demonstrated and I've talked to you a lot about the discipline we have around value and capability assessment. And that will be something that we continue to embrace and we'll remain critical for the future. So that, I think, has not changed, but it's certainly something we've embraced. As it pertains to M&A and some of my closing comments, what I would say is keep in mind that the ultimate answer here is a byproduct of the specific attributes of any asset and where we are at a given time in terms of our cash and balance sheet capacity.

是的。還有麗莎，我只想附和。我的意思是，顯然，我認為自我們的投資者日以來的 10 個月裡，我們已經證明了，我已經和你談了很多關於我們圍繞價值和能力評估的紀律。這將是我們繼續接受的東西，我們將繼續對未來至關重要。所以，我認為，這並沒有改變，但它肯定是我們已經接受的東西。由於它與併購和我的一些結束評論有關，我想說的是，這裡的最終答案是任何資產特定屬性的副產品，以及我們在特定時間的現金和余額片材容量。

At our current valuation, an M&A deal is likely less accretive than share repurchase. Having said that, for the right strategic deal, we could opt to use the balance sheet capacity, we still have, even after these enhanced levels of share repurchase.

按照我們目前的估值，併購交易的增值可能不如股票回購。話雖如此，對於正確的戰略交易，我們可以選擇使用資產負債表能力，即使在這些提高的股票回購水平之後，我們仍然擁有。

Okay, great. And so just so I understand this, I know you're not giving any kind of guidance yet around cash flow. But is there anything that should be different when we think about cash flow for '23? Just to give us an idea of how much cash flow you'll have available for something in this area.

好，太棒了。所以我理解這一點，我知道你還沒有就現金流提供任何指導。但是，當我們考慮 23 年的現金流時，有什麼不同的地方嗎？只是為了讓我們了解您在該領域有多少可用的現金流。

I think in the broad strokes of the year, it's going to be a similar year. Obviously, I think, we think, CapEx will be in a comparable position and obviously, regulatory capital is a byproduct of the growth in the business, and we'll look at that as well. But our sort of baseline assumption that is behind my commentary today is a similar level of cash flow that we're talking about for this year in the same neighborhood. Again, we'll provide more detailed guidance on the Q4 call, but the '23 capacity, I think, is very sound and intact.

我認為在今年的大範圍內，這將是類似的一年。顯然，我認為，我們認為，資本支出將處於可比的位置，顯然，監管資本是業務增長的副產品，我們也會關注這一點。但是，在我今天的評論背後，我們的那種基線假設是我們今年在同一地區談論的類似水平的現金流量。同樣，我們將在第四季度電話會議上提供更詳細的指導，但我認為 23 年的容量非常合理和完整。

And we'll take our next question from Justin Lake with Wolfe Research.

我們將與 Wolfe Research 一起從 Justin Lake 那裡得到下一個問題。

I'll start with my follow-up to Lisa's question here. Shawn, during your prepared comments at the end there, you gave, at least me, the impression that there was kind of an if-then statements on this physician -- on the potential for a physician deal versus share repurchase and the ability to hit 2024. So I just want to clarify, are you saying that if you do a large physician group purchase, but obviously, that advances the strategy, but if you do that, you probably don't have enough capital to buy back shares and still hit the 2024 low double-digit EPS estimate. So you can hit the low double digits. If you don't do a physician deal, you -- that number becomes a risk if you do a physician deal?

我將從這裡對 Lisa 問題的後續跟進開始。肖恩，在你最後準備好的評論中，你至少給了我這樣一種印象，即對這位醫生有一種如果-那麼的陳述——關於醫生交易與股票回購的潛力以及打擊的能力2024.所以我想澄清一下，你是說如果你做一個大的醫生團購，但顯然，這會推進戰略，但如果你這樣做，你可能沒有足夠的資金回購股票，仍然達到 2024 年兩位數的低每股收益預期。所以你可以打低兩位數。如果你不做醫生交易，你 - 如果你做醫生交易，這個數字會變成風險嗎？

Yes. What I'm saying is it's hard for me to be completely definitive when we're talking about a hypothetical asset, right? And so what I will say to you is we have done modeling where we can achieve both objectives.

是的。我的意思是，當我們談論假設資產時，我很難完全確定，對吧？所以我要對你說的是，我們已經完成了建模，我們可以實現這兩個目標。

And obviously, we think it's the job of management to always try to achieve your near-term and your long-term objectives. Again, the ultimate answer around that will be dictated by the specific asset and the timing of when we have to fund for that asset. So in the absence of sort of having sort of an actual deal in hand where I could be more definitive. But let me be clear, our goal is to try to achieve both. We think there is a pathway to achieve both, but ultimately, the specifics of having a deal in hand.

顯然，我們認為管理層的工作是始終努力實現您的近期和長期目標。同樣，最終答案將取決於特定資產以及我們必須為該資產提供資金的時間。因此，在沒有手頭有某種實際交易的情況下，我可以更加確定。但讓我明確一點，我們的目標是努力實現兩者。我們認為有一條途徑可以實現兩者，但最終是達成交易的具體細節。

I'll also clarify, if we don't have the deal, I think I was pretty clear in my remarks, then we will continue to proceed with repurchase and as we march towards achieving those objectives. So that's, I think, again, in the absence of having sort of something specific to talk about, I think that's the framework I'd like you to understand.

我還要澄清一下，如果我們沒有達成協議，我想我在我的評論中已經很清楚了，那麼我們將繼續進行回購，並朝著實現這些目標前進。所以，我想，再一次，在沒有什麼具體的事情可以談論的情況下，我認為這就是我希望你理解的框架。

That's helpful. And then my question was just around, you mentioned a couple of headwinds to 2024, specifically the Centene loss in the STARs. I assume there's probably a little much to ask for exact potential impacts from that. But maybe you could just put it in the context of the long-term growth targets in those businesses over the PBM, I think it's mid-single digits and for the health care benefit, it's mid to high. Maybe you could talk about how to view the lens to view 2024 in those businesses with those specific headwinds?

這很有幫助。然後我的問題就在附近，您提到了 2024 年的一些不利因素，特別是 STAR 中的 Centene 損失。我認為可能有很多要求從中獲得確切的潛在影響。但也許你可以把它放在 PBM 那些業務的長期增長目標的背景下，我認為它是中個位數，而對於醫療保健來說，它是中高。也許你可以談談如何在那些有特定逆風的企業中看待 2024 年？

Yes. Let me talk about the '24 headwinds a little bit more specifically. We project the combined impact of STARs and Centene on 2024 to be approximately $2 billion on an unmitigated basis. My comments today regarding repurchases and achieving our Investor Day commitments, assume that we're successful in mitigating approximately half of this headwind. That work is in process and underway, but obviously not 100% certain at this stage. That would leave a headwind of about $1 billion or $0.55 a share for 2024.

是的。讓我更具體地談談 24 年的逆風。我們預計 STAR 和 Centene 對 2024 年的綜合影響將達到約 20 億美元。我今天關於回購和實現我們的投資者日承諾的評論假設我們成功地緩解了大約一半的逆風。這項工作正在進行中，但在現階段顯然不是 100% 確定的。這將在 2024 年留下約 10 億美元或每股 0.55 美元的逆風。

The amount of repurchases required to combat that headwind could be up to $10 billion. But obviously, the actual amount can vary based on assumed share price and the cost of any debt financing. And going to Lisa's question about capacity, this is an amount that we have the cash and balance sheet capacity to handle and stay within our leverage metrics for 2023.

應對這種逆風所需的回購金額可能高達 100 億美元。但顯然，實際金額可能會根據假設的股價和任何債務融資的成本而有所不同。對於麗莎關於產能的問題，這是我們擁有現金和資產負債表能力來處理並保持在 2023 年槓桿指標範圍內的金額。

We'll take our next question from Michael Cherny with Bank of America.

我們將向美國銀行的 Michael Cherny 提出下一個問題。

Maybe one just a clarification and then a separate question. With regards to the '23 bridge, can you just let us know in terms of what's preliminarily target on, a, what -- that $0.50 COVID net headwind, that does include some COVID contribution and then the health care benefits mid- to high single-digit growth. Any way to couch out or tease out what you have in there, relative to the investments around the STARs performance?

也許一個只是一個澄清，然後是一個單獨的問題。關於 '23 橋樑，您能否讓我們知道初步目標是什麼，a，什麼 - 0.50 美元的 COVID 淨逆風，其中包括一些 COVID 貢獻，然後是中高單的醫療保健福利- 數字增長。相對於圍繞 STAR 表現的投資，有什麼方法可以整理或梳理出你在那裡擁有的東西？

Yes. We've contemplated whatever SG&A investments that we need to make in that outlook for next year, and then we will make some, obviously, and that has been contemplated. I'm glad you asked about COVID and retail because I just want to make sure that everyone's grounded in that.

是的。我們已經考慮了我們需要在明年的前景中進行的任何 SG&A 投資，然後我們將進行一些，顯然，這是已經考慮過的。我很高興你問到 COVID 和零售，因為我只是想確保每個人都對此有基礎。

As we mentioned, we're still around $3 billion of revenue. We've talked about the margin profile and that business before. In that $0.50, there's an item or 2 that actually kind of goes the other way like the hurricane, for example. But you're talking about probably removing $900 million of operating income on COVID-related categories in retail, which if you went back through each quarter's guidance increase, that's about what we've raised the guidance sort of over the course of the year. So we're resetting back to a number there for comparison purposes to something that's closer to sort of how we kind of entered the year.

正如我們所提到的，我們仍然有大約 30 億美元的收入。我們之前已經討論過利潤率概況和該業務。例如，在那 0.50 美元中，有一個或 2 個項目實際上就像颶風一樣。但是你說的可能是在零售中與 COVID 相關的類別中減少 9 億美元的營業收入，如果你回顧每個季度的指導增長，這就是我們在一年中提高指導的程度。因此，為了比較的目的，我們將重置回一個數字，以便與我們進入這一年的方式更接近。

Again, I think this year is a good demonstration that there's an endemic tail to this business going forward. And so we are expecting some contribution, likely not as high as we thought coming into this year. But again, that's also baked into our outlook of getting to $6 billion on that business.

同樣，我認為今年是一個很好的證明，表明這項業務的發展存在特有的尾巴。因此，我們預計今年會有一些貢獻，可能沒有我們想像的那麼高。但同樣，這也體現在我們對該業務達到 60 億美元的預期中。

Got it. And then I don't mean to keep this completely hypothetical, but obviously, I'm not going to ask you about what could or could not happen with the primary care side on M&A. I'm going to ask on what you're doing on an organic basis? And how should we think about the build-out that you're going to be putting in place, investments you're going to be making, while you do wait for a deal to come or not to come to fruition?

知道了。然後我並不是要完全假設，但顯然，我不會問你在併購中初級保健方面可能發生或不可能發生的事情。我要問你在有機基礎上做什麼？我們應該如何考慮您將要進行的擴建，您將要進行的投資，而您確實在等待交易達成或不達成目標？

Michael, it's Karen. Yes. So first of all, obviously, we just hired Dr. Desai to help us really clarify our longer-term clinical care delivery strategy. We have been making investments across all of our businesses to support health care delivery. We've made investments in MinuteClinic to extend our services. We've been making investments in the front store to extend our health and wellness and we're really driving at our integrated products to drive growth of the topline. And we're having very strong progress around that.

邁克爾，我是凱倫。是的。因此，首先，顯然，我們剛剛聘請了 Desai 博士來幫助我們真正闡明我們的長期臨床護理提供策略。我們一直在對所有業務進行投資，以支持醫療保健服務。我們對 MinuteClinic 進行了投資以擴展我們的服務。我們一直在對前店進行投資以擴展我們的健康和保健，並且我們確實在推動我們的綜合產品以推動收入增長。我們在這方面取得了非常大的進展。

So we continue to invest in products and service capabilities to make sure that we are competitive in the marketplace. So all across the company, we've been making this investment to advance our strategy. And what I would say is that we are continuing to perform on our strategy. I think a good evidence of that is our Signify acquisition. I think that gives you a good sense that we're executing strongly. We said we wanted to be in the home. We'll make investments around that. And as I said, we expect to close in the first half of 2023.

因此，我們繼續投資於產品和服務能力，以確保我們在市場上具有競爭力。因此，在整個公司範圍內，我們一直在進行這項投資以推進我們的戰略。我想說的是，我們將繼續執行我們的戰略。我認為我們收購昕諾飛就是一個很好的證據。我認為這讓你很好地感覺到我們正在強有力地執行。我們說我們想待在家裡。我們將圍繞它進行投資。正如我所說，我們預計將在 2023 年上半年關閉。

We'll take our next question from A.J. Rice with Crédit Suisse.

我們將回答 A.J. 的下一個問題。瑞士信貸大米。

I guess I'm doing 2 quick cleanups, hopefully, here from previous questions. For the '23 outlook, you don't have Signify in there, but you think it's going to close in the first half of the year and you have this Omnicare sale you're pursuing. Any way to bracket what the range of potential accretion Signify might represent? And would an Omnicare sale be a positive or a negative to the outlook?

我想我正在從以前的問題中進行 2 次快速清理，希望如此。對於 23 年的展望，您沒有 Signify，但您認為它將在今年上半年結束，並且您正在進行 Omnicare 銷售。有什麼方法可以將 Signify 可能代表的潛在吸積範圍括起來嗎？ Omnicare 的銷售對前景是積極的還是消極的？

And then just maybe a little more on the mitigation efforts. It sounds like half of the mitigation for '24 or half of -- yes, you're offsetting, you said, about half of that headwind with mitigation. I'm specifically wondering with your national PPO, how you can move that. I know we used to be able to just collapse plans, but it's a little tougher these days to move members. Can you talk a little bit about what you're doing with all of that?

然後可能只是在緩解工作上多一點。這聽起來像是 '24 或一半的緩解措施的一半——是的，你說，你正在通過緩解措施抵消大約一半的逆風。我特別想知道您的國家 PPO，您如何移動它。我知道我們過去只能崩潰計劃，但現在移動成員有點困難。你能談談你在做什麼嗎？

A.J., I'll start and then Dan and Shawn will clean up. Relative, I just want to go back to your question on Omnicare. I think it's important for you all to recognize that we continue to evaluate our portfolio strategically and are making decisions around assets that don't fit into our portfolio strategically, Omnicare is a good example of that, bswift was a good example of that. And as Sean said earlier this year, we made divestitures as part of our international business and Payflex as well.

A.J.，我先開始，然後丹和肖恩來收拾東西。相對，我只想回到你關於 Omnicare 的問題。我認為對你們所有人來說，重要的是要認識到我們繼續從戰略上評估我們的投資組合，並圍繞戰略上不適合我們投資組合的資產做出決策，Omnicare 就是一個很好的例子，bswift 就是一個很好的例子。正如肖恩今年早些時候所說，我們將資產剝離作為我們國際業務和 Payflex 的一部分。

Regarding STARs, and I'll let Shawn talk about the financials in a second. Just a comment on STARs. I would just say kind of across the industry, everyone was challenged with STARs, and we were extremely disappointed in our 3.5 star rating plan. But as you know, we have been a very strong leader in STARs performance for a decade. And we continue to invest. We will continue to invest in our STARs performance.

關於 STAR，我將讓 Shawn 稍後談談財務狀況。只是對明星的評論。我只想說整個行業，每個人都受到 STAR 的挑戰，我們對 3.5 星評級計劃感到非常失望。但如您所知，十年來，我們一直是 STAR 表現的非常強大的領導者。我們繼續投資。我們將繼續投資於我們的 STAR 業績。

We have a number of actions relative to the CAP survey and member scores, which is really part of the driver. We do have a diversification effort. I'll ask Dan to talk about what we're specifically doing there. But I am confident that we have the activities, the investment and approach to mitigate STARs for 2024. And with that, let me turn it to Shawn to talk about the divestitures and then Dan will pick up on STARs.

我們有一些與 CAP 調查和會員評分相關的行動，這確實是驅動因素的一部分。我們確實有多元化的努力。我會請丹談談我們在那裡的具體工作。但我相信我們有活動、投資和方法來減輕 2024 年的 STARs。因此，讓我讓 Shawn 談談資產剝離，然後 Dan 將接聽 STARs。

Okay. Just on the -- so on the divestitures and obviously, this is -- the timing of all this is still to be determined. But I think, if successful, on Omnicare, there's probably another $0.02 or $0.03 potentially that I would add to that $0.04 that I described in the bridge for divested asset.

好的。就在 - 所以關於資產剝離，顯然，這是 - 所有這一切的時間仍有待確定。但我認為，如果在 Omnicare 上成功，我可能會再增加 0.02 美元或 0.03 美元，這可能是我在剝離資產橋中描述的 0.04 美元。

Again, not something that I think that would change our outlook on our range. But when you're thinking about the baseline, it would be a small -- sort of a small additional item. But again, one we think is navigable for 2023. And obviously, we think this is the right long-term thing strategically to do for the business. Signify, we will, when we get to the closing, we'll talk more specifically about the accretion. But you're right, we do not have anything in there right now. But when we get more definitive idea, on closing date, we can talk about the accretion on that.

同樣，我認為這不會改變我們對范圍的看法。但是當你考慮基線時，它會是一個很小的——一個小的附加項目。但同樣，我們認為它可以在 2023 年通航。顯然，我們認為這是從戰略上為企業做的正確的長期事情。表示，我們會，當我們接近尾聲時，我們將更具體地談論吸積。但你是對的，我們現在那裡沒有任何東西。但是當我們得到更明確的想法時，在截止日期，我們可以談論它的增加。

Yes. Let me give you a little bit of flavor of our mitigation strategy. I mean, the way I would think about it is we do have a broad mitigation strategy, but there are 2 very specific initiative and approaches that we're pushing. First of all, as Karen said, is our track record around STAR shows that we have a robust STARs and CAPS program. And it's through that program that we've already taken some actions and improved things like benefit improvements. An example of that is where we moved 200 drugs to a lower tier for about 650,000 members.

是的。讓我向您介紹一下我們的緩解策略。我的意思是，我認為我們確實有一個廣泛的緩解策略，但我們正在推動兩個非常具體的舉措和方法。首先，正如 Karen 所說，我們在 STAR 方面的記錄表明我們擁有強大的 STAR 和 CAPS 計劃。正是通過該計劃，我們已經採取了一些行動並改進了諸如福利改進之類的東西。這方面的一個例子是，我們將 200 種藥物轉移到了大約 650,000 名成員的較低級別。

We have enhancements to our medication adherence programs and continuous operational efficiencies. With that said, we also have a very intense focus across the enterprise on some targeted actions to drive some improved performance in some of those impactable domain measures. Those are the ones that give us the greatest opportunity to really move the score.

我們增強了我們的藥物依從性計劃和持續的運營效率。話雖如此，我們在整個企業中也非常關註一些有針對性的行動，以推動在一些有影響的領域措施中提高性能。那些給了我們最大的機會來真正改變比分的人。

So things like gaps in care, member incentives and experience improvements, so really intense program efforts there. On the contract diversification, we do recognize that we've had a concentration of members in one contract. That's largely a result of our own success in using that high-quality, popular contract for expansion efforts. And we've been working on this contract diversification. It's been in progress. And we have some additional tactics that we're taking to achieve that, and we'll update you as things progress.

因此，諸如護理方面的差距、會員激勵措施和體驗改進之類的事情，在那裡非常激烈的計劃工作。在合同多樣化方面，我們確實認識到我們已經將成員集中在一份合同中。這在很大程度上歸功於我們自己成功地使用了高質量、受歡迎的合同進行擴張。我們一直在努力實現合同多元化。它一直在進行中。我們正在採取一些額外的策略來實現這一目標，我們會隨著事情的進展向您更新。

We'll take our next question from Eric Percher with Nephron Research.

我們將向 Nephron Research 的 Eric Percher 提出下一個問題。

Question on the potential settlement of $5 billion. I'm interested in your view on state buy-in. Obviously, you want to ring-fence all liability, but where the distributors were national, pharmacy chains have very different state penetration. So what's your view on the likelihood that all states will sign on? And what's a reasonable goal for among the states and municipalities?

關於 50 億美元潛在和解的問題。我對你對國家支持的看法很感興趣。顯然，您想隔離所有責任，但在分銷商是全國性的情況下，藥房連鎖店的國家滲透率卻大不相同。那麼您對所有州都簽署的可能性有何看法？州和市之間的合理目標是什麼？

Yes, Eric, let me just give kind of a broad view of opioids. I'll give you our perspective on that. I just want to reiterate that in late October, we did begin our mediation discussions. And as we disclosed today, we have an agreement, in principle, to substantially close all of the opioid lawsuits and the claims against the company. As you mentioned, all conditions have to be satisfied, and that means the state still need to buy in.

是的，埃里克，讓我簡單介紹一下阿片類藥物。我會告訴你我們對此的看法。我只想重申，在 10 月下旬，我們確實開始了調解討論。正如我們今天披露的那樣，我們原則上達成了一項協議，將大幅結束所有阿片類藥物訴訟和針對公司的索賠。正如你所說，必須滿足所有條件，這意味著國家仍然需要購買。

We have experience in Florida, where we have demonstrated our ability to have those conversations. So we'll be monitoring it across the board. But as Shawn and I both said, this clearly provides us more certainty and it gives us -- puts a decade-long issue behind us so that we can clearly focus on our strategy of improving health quality and access to care for our customers.

我們在佛羅里達有經驗，在那裡我們展示了我們進行這些對話的能力。因此，我們將全面監控它。但正如肖恩和我都說的那樣，這顯然為我們提供了更多確定性，它給了我們——將一個長達十年的問題拋在腦後，這樣我們就可以清楚地專注於提高健康質量和為客戶提供護理的戰略。

I would also tell you that we recognize that the seriousness of the opioid abuse in this conduct has had on so many Americans. And I just would say that we have made significant investments over the years to combat the opioid crisis and continue to do so through our leadership and our behavioral health company. So we are working -- we'll work very closely with the states, Eric, and we're -- we'll keep you updated along the way.

我還要告訴你，我們認識到這種行為中阿片類藥物濫用的嚴重性已經影響了這麼多美國人。我只想說，多年來，我們為應對阿片類藥物危機進行了大量投資，並通過我們的領導層和我們的行為健康公司繼續這樣做。所以我們正在努力——我們將與各州密切合作，埃里克，而且我們——我們將在此過程中隨時為您提供最新信息。

I appreciate that. And is there any type of minimum we should think of as required to get this to the finish line?

我很感激。是否有任何我們應該考慮的最低要求才能達到終點線？

At this point, there's not necessarily a minimum. We need to kind of work through and have the states. But recognize that all the AGs were at the table, having these discussions over this mediation period. So we have a high degree of confidence.

在這一點上，不一定有最低限度。我們需要努力完成並擁有狀態。但要認識到，所有 AG 都在談判桌旁，在此調解期間進行了這些討論。所以我們有很高的信心。

And we'll take our next question from Elizabeth Anderson with Evercore ISI.

我們將向 Evercore ISI 的 Elizabeth Anderson 提出我們的下一個問題。

I had a question in regards to the 2023 preliminary outlook that you provided, maybe specifically on the pharmacy services business, which we haven't talked about as much. Can you sort of walk us through sort of the puts and takes of that mid-single-digit growth that you're outlining for 2023?

關於您提供的 2023 年初步展望，我有一個問題，可能特別是關於藥房服務業務，我們沒有談得太多。您能否向我們介紹一下您為 2023 年概述的中個位數增長的看跌期權和收益？

Yes, Elizabeth, I would say it's a fairly straightforward story as it pertains to next year. Obviously, we had another good sales season and good renewal season. We have the normal sort of volume and revenue drivers.

是的，伊麗莎白，我想說這是一個相當簡單的故事，因為它與明年有關。顯然，我們又迎來了一個不錯的銷售旺季和續訂旺季。我們有正常的數量和收入驅動因素。

We also have the normal headwinds around pricing and things like that, that we need to sort of solve for. So I think the big thing for us year-over-year is we'll have some stabilization now, I think, in 340B, whereas that was a drag, obviously, this year a little bit on growth, that should turn in the other direction. So that will also be helpful. Obviously, we're still -- we think the timing around biosimilars and specialty generics will be pushed out into the year a little bit in that effect. But Alan, anything you'd like to add to that?

我們在定價等方面也有正常的逆風，我們需要解決這些問題。所以我認為每年對我們來說最重要的是我們現在會有一些穩定，我認為，在 340B 中，而這顯然是一個拖累，今年有點增長，應該會在另一個方向。所以這也會有所幫助。顯然，我們仍然 - 我們認為圍繞生物仿製藥和特種仿製藥的時間將被推遲到今年。但是艾倫，你有什麼想補充的嗎？

No, I think the only thing I would add, Shawn, is continued focus on expense management, on optimizing or minimizing all guaranteed exposures. So it's, I would say, very much business as usual with sales growth and kind of 340B stabilization as the changes.

不，Shawn，我認為我唯一要補充的是繼續關注費用管理，優化或最小化所有保證風險。因此，我會說，隨著銷售增長和 340B 穩定性的變化，一切照舊。

And we'll take our last question from Ricky Goldwasser with Morgan Stanley.

我們將回答摩根士丹利的瑞奇·戈德瓦瑟的最後一個問題。

This is Erin Wright and Ricky here. But we did see that you signed a value-based care contract with the home health provider announced this week. How do you think about the trade-off between partnerships and owning home health assets? And can partners, such as this, help you to fill that gap as opposed to necessarily outright M&A? And then I have a quick follow-up.

這是 Erin Wright 和 Ricky。但我們確實看到您與本周宣布的家庭健康提供者簽署了基於價值的護理合同。您如何看待合作夥伴關係和擁有家庭健康資產之間的權衡？像這樣的合作夥伴能否幫助您填補這一空白，而不是直接進行併購？然後我有一個快速跟進。

Well, Erin, on the home services, as you know, we believe that our Signify Health will close some of the gaps that we have in home, and it will give us a platform to accelerate return to care and provider enablement. So we're -- we've made the decision, obviously, to do an acquisition in the home health space.

好吧，Erin，關於家庭服務，如您所知，我們相信我們的 Signify Health 將彌補我們在家庭中的一些差距，它將為我們提供一個平台來加速返回護理和提供者支持。所以我們 - 顯然，我們已經決定在家庭健康領域進行收購。

Obviously, the Aetna business continues to have a variety of different contracts, and we'll continue to look at their network to make sure that they have adequate coverage across the country. And I'll ask Dan if there's anything else he wants to add.

顯然，Aetna 業務繼續擁有各種不同的合同，我們將繼續關注他們的網絡，以確保他們在全國范圍內有足夠的覆蓋範圍。我會問丹是否還有什麼要補充的。

Yes. Karen, I would just add that value-based contracting has been a key portion of our strategy for a long time in HCB, and it continues to be. It's a way that we can provide value, not only to our providers, but also to our customers. As you think about the acquisition strategy, that only enhances our ability to provide a really strong network. And so I would think about those as sitting side by side and only strengthening the opportunity that we have to provide value to our customers.

是的。凱倫，我只想補充一點，長期以來，基於價值的合同一直是我們在 HCB 戰略的關鍵部分，而且仍然如此。這是一種我們可以為我們的供應商以及我們的客戶提供價值的方式。當您考慮收購策略時，這只會增強我們提供真正強大網絡的能力。因此，我認為這些人並肩而坐，只會加強我們必須為客戶提供價值的機會。

Okay. Great. And then the follow-up is when we think about your ability to achieve those near-term EPS targets as well as long-term strategic targets for you, will this involve taking on more debt? Or is this all based on cash?

好的。偉大的。然後後續是當我們考慮您實現這些近期每股收益目標以及您的長期戰略目標的能力時，這是否會涉及承擔更多債務？還是這一切都基於現金？

No, we would actually use some of our balance sheet capacity. We're well below sort of our leverage metrics now, and we'll continue to do that. So we have been building, both cash and balance sheet capacity. And to accomplish both of those objectives, we would need to take on more debt. But again, we remain committed to our investment-grade rating structure.

不，我們實際上會使用我們的一些資產負債表能力。我們現在遠低於我們的槓桿指標，我們將繼續這樣做。因此，我們一直在建設現金和資產負債表能力。為了實現這兩個目標，我們需要承擔更多的債務。但同樣，我們仍然致力於我們的投資級評級結構。

And I can, just as a rough rule of thumb, about 10 basis points on our debt-to-EBITDA is worth $2 billion of debt or thereabout. So they sound like small numbers, but they're actually significant in terms of capacity. So yes, we would do that, but we would remain committed to sort of our investment-grade ratings today.

而且我可以，根據粗略的經驗法則，我們的債務對 EBITDA 的大約 10 個基點價值 20 億美元左右的債務。因此，它們聽起來像是很小的數字，但就容量而言，它們實際上意義重大。所以是的，我們會這樣做，但我們將繼續致力於今天的投資級評級。

This concludes the Q&A.

問答環節到此結束。

Thank you for joining the call today. We appreciate your participation, and we'll talk to you next quarter.

感謝您今天加入電話會議。感謝您的參與，我們將在下個季度與您聯繫。

This concludes today's CVS Health Third Quarter 2022 Earnings Call and Webcast. You may disconnect your line at this time. Have a wonderful day.

今天的 CVS Health 2022 年第三季度財報電話會議和網絡直播到此結束。此時您可以斷開您的線路。有一個美好的一天。