CVS Health Corp (CVS) 2023 Q3 法說會逐字稿

Good morning or good afternoon, and welcome to today's Third Quarter 2023 CVS Health Earnings Call. My name is Adam, and I'll be your operator for today. (Operator Instructions)

早上好或下午好，歡迎參加今天的 2023 年第三季 CVS Health 收益電話會議。我叫 Adam，今天我將擔任您的接線生。 （操作員說明）

I will now hand the floor to Larry McGrath to begin. So Larry, please go ahead when you are ready.

我現在請拉里·麥格拉思開始。所以拉里，請在你準備好後繼續。

Good morning, and welcome to the CVS Health Third Quarter 2023 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 Tom Cowhey, Interim Chief Financial Officer.

早安，歡迎參加 CVS Health 2023 年第三季財報電話會議和網路廣播。我是 CVS Health 業務開發和投資者關係高級副總裁 Larry McGrath。今天上午，總裁兼執行長凱倫·林奇 (Karen Lynch) 也加入了我的行列。臨時財務長 Tom Cowhey。

Following our prepared remarks, we'll host a question-and-answer session that will include additional members of our leadership team. Our press release and slide presentation are being posted to our website, along with our Form 10-Q that we filed this morning with the SEC. Today's call is also being broadcast on our website, where it will be archived for 1 year.

在我們準備好的發言之後，我們將舉辦問答會議，其中包括我們領導團隊的其他成員。我們的新聞稿和幻燈片演示以及我們今天早上向 SEC 提交的 10-Q 表格已發佈到我們的網站上。今天的電話會議也在我們的網站上播出，並將存檔一年。

During this call, we will make certain forward-looking statements. Our forward-looking statements are subject to significant risks and uncertainties that could cause actual results to differ materially from currently projected results. We strongly encourage you to review the reports we file with the SEC regarding these risks and uncertainties, in particular, those that are described in the cautionary statement concerning forward-looking statements and risk factors in our most recent annual report filed on Form 10-K, our quarterly reports on Form 10-Q, the most recent of which was filed this morning, and our recent filings on Form 8-K, including this morning's earnings press release.

在本次電話會議中，我們將做出某些前瞻性陳述。我們的前瞻性陳述面臨重大風險和不確定性，可能導致實際結果與目前預測結果有重大差異。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，特別是我們在 10-K 表格上提交的最新年度報告中有關前瞻性陳述和風險因素的警告聲明中描述的報告、我們的10-Q 表格季度報告（最新的一份於今天早上提交）以及我們最近提交的8-K 表格（包括今天早上的收益新聞稿）。

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

在本次電話會議中，我們將在談論公司的財務業績和財務狀況時使用非公認會計準則衡量標準，您可以在今天上午的新聞稿以及發佈在我們的投資者關係部分的對帳文件中找到這些非公認會計準則衡量標準的調節表我們網站的。

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

說到這裡，我想把電話轉給凱倫。凱倫？

Thank you, Larry. Good morning, everyone, and thanks for joining our call. Today, we reported strong third quarter results, highlighting the power of our diversified business model. We delivered adjusted EPS of $2.21 and adjusted operating income of nearly $4.5 billion. Our consolidated revenues for the quarter of almost $90 billion reflect an increase of nearly 11% over the prior year. And once again, we generated outstanding operating cash flows, bringing our year-to-date total to $16.1 billion. We are reconfirming our guidance range for 2023 adjusted EPS of $8.50 to $8.70. This reflects execution against our strategy with strong performance in our Pharmacy & Consumer Wellness segment and continued momentum in our Health Services segment, offsetting incremental Medicare Advantage medical cost pressures in our Health Care Benefits segment.

謝謝你，拉里。大家早安，感謝您加入我們的通話。今天，我們公佈了強勁的第三季業績，凸顯了我們多元化業務模式的力量。我們的調整後每股收益為 2.21 美元，調整後營業收入接近 45 億美元。我們本季的綜合收入接近 900 億美元，比前一年增長了近 11%。我們再次產生了出色的營運現金流，使年初至今的現金流總額達到 161 億美元。我們再次確認 2023 年調整後每股收益的指導範圍為 8.50 美元至 8.70 美元。這反映了我們策略的執行情況，我們的製藥和消費者健康部門表現強勁，健康服務部門持續成長，抵消了醫療保健福利部門日益增加的 Medicare Advantage 醫療成本壓力。

The power of our integrated model is clear. We demonstrated this with the significant progress made in restoring our Medicare Advantage Star rating. Our 2024 rating show that we will have 87% of our Medicare Advantage members and plans rated 4 stars or better. We accomplished this in a very short period of time by utilizing the full breadth of CVS Health touch point with our members. We improved cap stores by an average of 2/3 of a point by driving powerful consumer insight to design experiences that address the unique needs of our members.

我們的整合模型的力量是顯而易見的。我們在恢復 Medicare Advantage 星級評級方面取得的重大進展證明了這一點。我們 2024 年的評級顯示，我們將有 87% 的 Medicare Advantage 會員和計劃獲得 4 星或更高評級。透過充分利用 CVS Health 與會員的接觸點，我們在很短的時間內實現了這一目標。透過推動強大的消費者洞察力來設計滿足會員獨特需求的體驗，我們將上限平均提高了 2/3 個百分點。

We also made improvements beyond cap. For example, to address HEDIS and patient safety measures, our Medicare Advantage team worked closely with CVS Pharmacy and Caremark to help members improve medication adherence, remove costs and transportation barriers and ensure members completed critical tests, screenings and preventive services. As a result of these efforts, among many others, Aetna was the top performer in both the Part D patient safety and HEDIS domain. Our 2024 Star rating will improve our position in the 2025 plan year and will enhance our position well into the future.

我們也進行了超出上限的改進。例如，為了解決 HEDIS 和病患安全措施，我們的 Medicare Advantage 團隊與 CVS Pharmacy 和 Caremark 密切合作，幫助會員提高用藥依從性，消除成本和運輸障礙，並確保會員完成關鍵的測試、篩選和預防服務。由於這些努力以及其他許多努力，Aetna 在 D 部分患者安全和 HEDIS 領域均名列前茅。我們的 2024 年星級評級將提高我們在 2025 計畫年的地位，並將增強我們在未來的地位。

Medicare Advantage is a key strategic growth area for our business. While it's still early in the 2024 annual enrollment period, we are confident that our competitive offering and attractive benefit design will meet consumer expectations. Aetna continues to be a leader in zero-dollar premium product and approximately 84% of Medicare eligibles will have access to Aetna plans in this category in 2024. We are also expanding the breadth of our D-SNP footprint and now cover more than 2/3 of Medicare eligibles, up 6% from last year. Our D-SNP strategy focuses on offering the coordinated medical management these members need to live healthier lives, including introducing them to care delivery options such as Oak Street Health, where appropriate. Our ability to offer access to convenient sites of care and the integrated benefits that seniors value most will position us to grow at or above the market in 2024.

Medicare Advantage 是我們業務的關鍵策略成長領域。雖然現在還處於 2024 年年度招生期的早期，但我們相信我們有競爭力的產品和有吸引力的福利設計將滿足消費者的期望。 Aetna 繼續成為零美元優質產品的領導者，到 2024 年，大約 84% 的 Medicare 合格者將可以享受此類別的 Aetna 計劃。我們還在擴大 D-SNP 覆蓋範圍，目前已覆蓋超過 2/ 3 名符合醫療保險資格的人，比去年增加了6%。我們的 D-SNP 策略專注於為這些成員提供他們過上更健康生活所需的協調醫療管理，包括在適當的情況下向他們介紹 Oak Street Health 等護理服務選項。我們有能力提供便利的照護場所以及老年人最重視的綜合福利，這將使我們能夠在 2024 年達到或高於市場水平。

Turning now to how we are unlocking new sources of value in health care. This quarter, we announced the creation of Cordavis, a wholly owned subsidiary of CVS Health. We have an established history of innovating to find ways to lower drug spend and to ensure that people we serve have access to the medications they need to stay healthy. Cordavis continues that history of innovation. The biosimilar market in the U.S. is expected to be a $100 billion opportunity by 2029. It represents one of the biggest sources of drug cost savings for consumers and the U.S. health care system. Through Cordavis, we are working directly with manufacturers to bring a portfolio of biosimilar products to the market, driving our growth and ensuring that our customers and clients will realize the significant savings potential available through biosimilars for years to come.

現在談談我們如何釋放醫療保健領域的新價值來源。本季度，我們宣布成立 CVS Health 的全資子公司 Cordavis。我們有著悠久的創新歷史，致力於尋找降低藥品支出的方法，並確保我們服務的人們能夠獲得保持健康所需的藥物。 Cordavis 延續了創新的歷史。預計到 2029 年，美國的生物相似藥市場將帶來 1000 億美元的機會。它是消費者和美國醫療保健系統節省藥品成本的最大來源之一。透過 Cordavis，我們直接與製造商合作，將生物相似藥產品組合推向市場，推動我們的成長，並確保我們的客戶和客戶在未來幾年將認識到透過生物相似藥可實現的巨大節省潛力。

Let's turn to our performance in the quarter. In our Health Care Benefits segment, we grew revenues to more than $26 billion, an increase of nearly 17% and delivered adjusted operating income of $1.5 billion. Medical membership in the third quarter grew to 25.7 million, an increase of 1.4 million members versus the prior year reflecting growth across multiple product lines, including individual exchange, Medicare and commercial.

讓我們看看本季的業績。在我們的醫療保健福利部門，我們的收入成長了近 17%，超過 260 億美元，調整後的營業收入達到 15 億美元。第三季的醫療會員人數增至 2,570 萬，較上年增加 140 萬，反映出個人交換、醫療保險和商業等多個產品線的成長。

We continue to experience elevated utilization trends in our Medicare Advantage business, primarily in outpatient and supplemental benefits such as dental, behavioral health, OTC and flex card. Given the elevated cost trends that have emerged this year, we are executing on plans to unlock additional revenue, clinical and network opportunities to help alleviate these pressures.

我們的 Medicare Advantage 業務的使用率持續呈上升趨勢，主要是門診和補充福利，如牙科、行為健康、OTC 和彈性卡。鑑於今年出現的成本上升趨勢，我們正在執行計劃以釋放額外的收入、臨床和網路機會，以幫助緩解這些壓力。

In our Health Services segment, revenues grew to near $47 billion, an increase of more than 8%. Adjusted operating income grew nearly 11% to $1.9 billion. These results once again reflect impressive performance in our Pharmacy Services business, where our commitment to lower drug costs and deliver innovative clinical solutions drive value for our consumers and our clients.

在我們的健康服務部門，營收成長至近 470 億美元，增幅超過 8%。調整後營業收入成長近 11%，達到 19 億美元。這些結果再次反映出我們的藥房服務業務的令人印象深刻的業績，我們致力於降低藥品成本並提供創新的臨床解決方案，為我們的消費者和客戶帶來價值。

In the 2024 selling season, our renewals are substantially complete and our retention remains strong in the high 90s, excluding the Centene contract. Our sales strategy for new business has been successful capturing over 60% of national employers that moved PBM.

在 2024 年銷售季，我們的續約已基本完成，並且我們的保留率仍保持在 90 多歲的高水準（不包括 Centene 合約）。我們的新業務銷售策略已成功吸引了超過 60% 的推行 PBM 的全國雇主。

Turning to our care delivery assets. We are scaling capabilities to accelerate growth at both Signify and Oak Street. We are progressing on our initiatives to create integrated health experiences across multiple channels, including Aetna, Signify, CVS Retail Health and CVS Pharmacy.

轉向我們的護理服務資產。我們正在擴展能力以加速 Signify 和 Oak Street 的成長。我們正在推動跨多個管道（包括 Aetna、Signify、CVS Retail Health 和 CVS Pharmacy）打造全面健康體驗的措施。

For Oak Street Health, we are using these channels to educate Medicare-eligible adults about the health services they need and can receive in our primary care clinic. While it's still early, the results of these initiatives are encouraging, and we are excited to share more details at our Investor Day in December.

對於 Oak Street Health，我們正在利用這些管道向符合 Medicare 資格的成年人宣傳他們需要並可以在我們的初級保健診所獲得的健康服務。雖然現在還為時過早，但這些措施的結果令人鼓舞，我們很高興能在 12 月的投資者日分享更多細節。

For Signify Health, we are connecting more CVS Pharmacy patients to Signify for in-home evaluation and other services in the home. Our trusted relationship with 90 million patients at the pharmacy counter is a powerful connection and the most frequent engagement in health care. By utilizing our pharmacist connection, we have been able to reach more than 50% of Aetna members that Signify was previously unable to reach, enhancing the opportunity to more effectively engage these members in their care. This initiative has surpassed our initial conversion rate goals, and we are excited by the prospects of scaling our capabilities in 2024 and beyond.

對於 Signify Health，我們正在將更多 CVS Pharmacy 患者連接到 Signify，以提供家庭評估和其他家庭服務。我們與藥房櫃檯 9000 萬患者的信任關係是一種強大的聯繫，也是醫療保健領域最頻繁的參與。透過利用我們的藥劑師聯繫，我們已經能夠接觸到 Signify 以前無法接觸到的 50% 以上的 Aetna 會員，從而增加了更有效地讓這些會員參與護理的機會。這項措施已經超越了我們最初的轉換率目標，我們對 2024 年及以後擴展我們的能力的前景感到興奮。

Turning to our Pharmacy & Consumer Wellness segment. Revenues grew to nearly $29 billion, up 6% versus the prior year. We generated $1.4 billion of adjusted operating income in the quarter, in line with our results in the prior year. Performance in our retail pharmacy business was strong. Same-store pharmacy sales increased nearly 12% versus the prior year, primarily driven by pharmacy drug mix and brand inflation. Same-store prescription growth when excluding the impact of COVID, grew by 3.5%.

轉向我們的藥房和消費者健康部門。營收成長至近 290 億美元，較上年成長 6%。本季我們產生了 14 億美元的調整後營業收入，與前一年的業績一致。我們的零售藥局業務表現強勁。同店藥局銷售額較上年增長近 12%，這主要是由藥房藥品組合和品牌膨脹所推動的。排除新冠疫情的影響，同店處方增加了 3.5%。

Turning to our consumer engagement strategy. Our digital platform is helping consumers navigate and simplify their health journey. Our digital reach continues to grow with now over 55 million unique customers, an increase of nearly 20% versus last year. This strong growth has been powered by our focus on innovating and delivering on experiences that matter most for our customers. We have been removing barriers to digital adoption and making it easier for customers to access the services they seek, such as pharmacy refill and advanced scheduling for immunizations online. Our strong digital engagement and enhanced capabilities will strengthen our ability to drive seasonal flu, COVID and RSV immunization awareness and connect patients to our CVS locations for these important health services.

轉向我們的消費者參與策略。我們的數位平台正在幫助消費者導航並簡化他們的健康之旅。我們的數位覆蓋範圍持續成長，目前擁有超過 5,500 萬獨立客戶，比去年增加了近 20%。這種強勁的成長得益於我們專注於創新和提供對客戶最重要的體驗。我們一直在消除數位化採用的障礙，讓客戶更容易獲得他們想要的服務，例如藥房補充和線上免疫接種的高級安排。我們強大的數位參與和增強的能力將增強我們提高季節性流感、新冠肺炎和呼吸道合胞病毒免疫意識的能力，並將患者連接到我們的 CVS 地點以獲得這些重要的醫療服務。

Before I turn it over to Tom to discuss our financial results, I'd like to highlight some recent changes to our leadership team. As we previously announced, I would like to welcome Brian Kane as our new President of Aetna. Brian's extensive industry experience will be critical as he and his team work to deliver consumer-centric, holistic health care to the more than 35 million members served by Aetna.

在我把它交給湯姆討論我們的財務表現之前，我想強調一下我們領導團隊最近的一些變化。正如我們之前宣布的，我熱烈歡迎 Brian Kane 擔任 Aetna 的新總裁。 Brian 豐富的行業經驗至關重要，因為他和他的團隊致力於為 Aetna 服務的超過 3500 萬名會員提供以消費者為中心的整體醫療保健服務。

In mid-October, we also announced that Shawn Guertin, our Chief Financial Officer and President of the Health Services business, is taking a leave of absence due to unforeseen family health reasons. Tom Cowhey has been appointed to the role of Interim CFO and Mike Pykosz has assumed the role Interim President of Health Services. Both Tom and Mike are well positioned to continue to seamlessly execute on our strategy.

10 月中旬，我們也宣布，我們的財務長兼健康服務業務總裁 Shawn Guertin 由於不可預見的家庭健康原因而休假。 Tom Cowhey 被任命為臨時財務官，Mike Pykosz 被任命為衛生服務部臨時總裁。湯姆和麥克都處於有利位置，可以繼續無縫執行我們的策略。

Finally, I would like to thank our colleagues for the commitment and dedication they show every day to support our customers, our clients and our patients.

最後，我要感謝我們的同事每天為支持我們的客戶、客戶和患者所表現出的承諾和奉獻精神。

I will now turn the call over to Tom to provide more details on our results and our guidance. Tom?

我現在將把電話轉給湯姆，以提供有關我們的結果和指導的更多詳細資訊。湯姆？

Thank you, Karen, and good morning, everyone. Our third quarter results continue to demonstrate the power of our execution and the value of our diversified enterprise. This quarter, we saw strength across key metrics such as revenue, adjusted earnings per share and cash flow from operations.

謝謝你，凱倫，大家早安。我們第三季的業績繼續證明了我們的執行力和多元化企業的價值。本季度，我們看到了營收、調整後每股盈餘和營運現金流等關鍵指標的強勁表現。

A few total company highlights. Third quarter revenues of nearly $90 billion increased by double-digit percentages over the prior year quarter, reflecting strong growth across each of our businesses. We delivered adjusted operating income of nearly $4.5 billion and adjusted EPS of $2.21, representing growth of approximately 2% versus the prior year. These increases were primarily due to continued strong execution in our pharmacy services operations, partially offset by pressure in Health Care Benefits and the inclusion of Oak Street Health results.

公司的一些整體亮點。第三季營收近 900 億美元，比去年同期成長兩位數，反映出我們各項業務的強勁成長。我們實現調整後營業收入近 45 億美元，調整後每股收益為 2.21 美元，比上年增長約 2%。這些成長主要是由於我們的藥房服務業務持續強勁的執行力，部分被醫療保健福利的壓力和橡樹街健康結果的納入所抵消。

Our ability to generate cash remains outstanding with year-to-date cash flow from operations of $16.1 billion. Cash flows benefited from the timing of CMS payments that are expected to normalize in the fourth quarter. Excluding this impact, our year-to-date cash flows from operations remained strong at approximately $11 billion.

我們產生現金的能力依然出色，今年迄今的營運現金流量為 161 億美元。現金流受益於 CMS 付款時間，預計第四季將正常化。排除這項影響，我們年初至今的營運現金流仍然強勁，約 110 億美元。

Shifting to the details for our Health Care Benefits segment. We delivered strong revenue growth versus the prior year. Third quarter revenue of $26.3 billion increased nearly 17% year-over-year, reflecting growth across all product lines, but primarily attributable to Medicare and our individual exchange products. Membership grew to 25.7 million, an increase of 54,000 members sequentially, reflecting growth in our individual exchange and Medicare businesses, partially offset by the impact of Medicaid redeterminations.

轉向我們的醫療保健福利部分的詳細資訊。與前一年相比，我們實現了強勁的收入成長。第三季營收為 263 億美元，年成長近 17%，反映了所有產品線的成長，但主要歸功於 Medicare 和我們的個人交換產品。會員數量增至 2,570 萬，比上一季增加 54,000 名，反映了我們個人交易所和醫療保險業務的增長，但部分被醫療補助重新確定的影響所抵消。

Adjusted operating income of $1.5 billion in the quarter declined approximately 6% versus the prior year. This decline was driven by a higher medical benefit ratio, partially offset by higher net investment income.

本季調整後營業收入為 15 億美元，較上年同期下降約 6%。這一下降是由較高的醫療福利比率推動的，但部分被較高的淨投資收入所抵消。

Our medical benefit ratio of 85.7% increased 230 basis points from the prior year quarter, primarily reflecting lower prior period development as well as higher Medicare Advantage utilization inside the quarter. Utilization pressure was primarily attributable to the categories Karen highlighted earlier, including outpatient and supplemental benefits such as dental, behavioral health, OTC and flex cards.

我們的醫療福利比率為 85.7%，比去年同期增加了 230 個基點，主要反映了前期發展的下降以及本季內 Medicare Advantage 利用率的提高。使用壓力主要歸因於凱倫先前強調的類別，包括門診和補充福利，例如牙科、行為健康、非處方藥和彈性卡。

Further, we also experienced individual exchange growth in the special enrollment period that exceeded our expectations. These members, particularly when added late in the year, will drive a higher MBR. As a result, our higher individual exchange growth is also contributing to our updated MBR guidance for the full year. We continue to closely watch utilization trends in our other lines of business, but at this stage, we have not observed any other trends that we would consider inconsistent with our total expectations.

此外，我們在特殊招生期間也經歷了超出我們預期的個人交流成長。這些成員，尤其是在今年稍後添加的成員，將推動更高的 MBR。因此，我們較高的個人交易成長也有助於我們更新全年的 MBR 指導。我們繼續密切關注其他業務線的利用率趨勢，但在現階段，我們尚未觀察到任何我們認為與我們整體預期不一致的其他趨勢。

Days claims payable at the end of the quarter was 50.3, up 3.4 days sequentially and reserve growth exceeded premium growth sequentially. Overall, we remain confident in the adequacy of our reserves.

本季末應付理賠天數為 50.3 天，較上季增加 3.4 天，準備金成長超過保費成長。整體而言，我們對儲備充足性仍然充滿信心。

Our Health Services segment, which includes our Pharmacy Services business and our Health Services operations, generated revenue of approximately $47 billion, an increase of more than 8% year-over-year. This increase was driven by pharmacy drug mix, growth in specialty pharmacy, brand inflation and the addition of Signify and Oak Street. These increases were partially offset by the impact of continued client price improvements.

我們的健康服務部門，包括我們的藥房服務業務和健康服務業務，創造了約 470 億美元的收入，比去年同期成長超過 8%。這一增長是由藥房藥物組合、專業藥房的增長、品牌擴張以及 Signify 和 Oak Street 的增加所推動的。這些成長被客戶價格持續上漲的影響部分抵消。

Adjusted operating income of nearly $1.9 billion grew approximately 11% year-over-year, primarily driven by strong execution and improved purchasing economics, partially offset by ongoing client price improvements. Total pharmacy claims processed in the quarter declined by less than 1% versus the prior year, and were only down 40 basis points when excluding COVID-19 vaccinations. This decline was primarily attributable to the New York Medicaid carve-out and lower COVID-19 vaccinations, partially offset by net new business. Total pharmacy membership remains steady at approximately 110 million members.

調整後營業收入接近 19 億美元，年增約 11%，這主要是由強勁的執行力和採購經濟性的改善所推動的，但部分被持續的客戶價格上漲所抵消。本季處理的藥品索賠總額與前一年相比下降了不到 1%，如果不包括 COVID-19 疫苗接種，僅下降了 40 個基點。這一下降主要歸因於紐約醫療補助計劃的取消和 COVID-19 疫苗接種量的減少，但部分被淨新業務所抵消。藥房會員總數穩定在約 1.1 億會員。

We continue to be encouraged by the performance and growth of our Health Services assets. Signify completed 655,000 in-home evaluations in the quarter, an increase of 7% versus the same period last year and generated revenue growth of 21%. Oak Street ended the quarter with 192 centers and 191,000 at-risk lives. We've grown by 31 centers versus the prior year quarter and are on track to open a total of 35 new centers this year, ramping to 50 to 60 centers in 2024.

我們的健康服務資產的表現和成長繼續令我們感到鼓舞。 Signify 在本季度完成了 655,000 次家庭評估，比去年同期增長了 7%，收入增長了 21%。截至本季末，Oak Street 共有 192 個中心和 191,000 人處於危險之中。與去年同期相比，我們增加了 31 個中心，今年預計將開設 35 個新中心，到 2024 年將增至 50 至 60 個。

Oak Street also significantly increased revenue in the quarter, growing 44% compared to the same quarter last year. Oak Street's clinical model continues to demonstrate exceptional performance. Last week, CMS released the 2022 savings performance of all ACO REACH participants. Oak Street was among the top 5% of program participants, generating a meaningful gross savings rate of 21%.

Oak Street 本季的營收也大幅成長，與去年同期相比成長了 44%。 Oak Street 的臨床模型持續展現出卓越的性能。上週，CMS 發布了所有 ACO REACH 參與者的 2022 年節省績效。 Oak Street 躋身前 5% 的計畫參與者之列，產生了 21% 的有意義的總儲蓄率。

Moving to our Pharmacy & Consumer Wellness segment. We generated revenue of nearly $29 billion, up 6% versus the prior year, nearly 9% on a same-store basis, reflecting the impact of pharmacy drug mix, increased prescriptions and brand inflation. These revenue increases were partially offset by continued reimbursement pressure, the impact of recent generic introductions, a decrease in store count and decreased COVID-19 related volume. Adjusted operating income of $1.4 billion was in line with the prior year, driven by continued reimbursement pressure and lower COVID contributions, largely offset by improved drug purchasing, increased prescription volumes and lower expenses. Same-store pharmacy sales were up nearly 12%, driven by drug mix, a 2.7% increase in same-store prescription volumes and brand inflation. The increase in same-store prescription volumes, excluding the impact of COVID-19 vaccinations, was 3.5%.

轉向我們的藥房和消費者健康部門。我們的收入接近 290 億美元，比上年增長 6%，同店增長近 9%，反映了藥房藥品組合、處方增加和品牌膨脹的影響。這些收入成長部分被持續的報銷壓力、最近推出的仿製藥的影響、商店數量的減少和 COVID-19 相關銷售的減少所抵消。調整後營業收入為 14 億美元，與上年持平，原因是持續的報銷壓力和新冠疫情捐款減少，但很大程度上被藥品採購改善、處方量增加和費用降低所抵消。受藥物組合、同店處方量成長 2.7% 和品牌膨脹的推動，同店藥局銷售額成長了近 12%。排除 COVID-19 疫苗接種的影響，同店處方量增加了 3.5%。

As we continue to execute on our store closure initiative, having closed 564 out of 900 planned stores, we encourage investors to focus on same-store metrics to understand underlying growth.

隨著我們繼續執行門市關閉計劃，已關閉 900 家計劃門市中的 564 家，我們鼓勵投資者關注同店指標，以了解潛在成長。

Our front store business continues to exhibit resiliency in the face of industry challenges, underscoring the value we offer consumers. Same-store sales for the front store were down 2.2%, primarily due to declines in cough, cold and flu and OTC test kits. Excluding the impact of OTC test kits, same-store front sales were in line with the prior year.

面對產業挑戰，我們的前店業務持續展現彈性，凸顯了我們為消費者提供的價值。前店同店銷售額下降 2.2%，主要是因為咳嗽、感冒和流感以及 OTC 檢測試劑盒的下降。排除OTC檢測試劑盒的影響，同店前台銷售額與上年持平。

Shifting to the balance sheet. Our liquidity and capital position remains excellent. Our ability to generate cash flow remains a core strength of our organization and the enterprise continues to identify new opportunities to further optimize our balance sheet. Through the third quarter, we generated cash flow from operations of $16.1 billion, including the CMS prepayment I discussed earlier. We ended the quarter with approximately $2.7 billion of cash at the parent and unrestricted subsidiaries.

轉向資產負債表。我們的流動性和資本狀況仍然良好。我們產生現金流的能力仍然是我們組織的核心優勢，企業繼續尋找新的機會來進一步優化我們的資產負債表。在整個第三季度，我們從營運中產生了 161 億美元的現金流，其中包括我之前討論過的 CMS 預付款。截至本季末，我們的母公司和不受限制的子公司擁有約 27 億美元的現金。

This quarter, we returned $779 million to shareholders through our quarterly dividend. We remain committed to maintaining our current investment-grade ratings while preserving flexibility to deploy capital strategically.

本季度，我們透過季度股息向股東返還 7.79 億美元。我們仍然致力於維持目前的投資等級評級，同時保持策略性部署資本的靈活性。

Turning now to our full year outlook for 2023. We are reaffirming our adjusted EPS of $8.50 to $8.70. This primarily reflects our performance through the third quarter and the continuation of higher Medicare Advantage medical cost trend for the remainder of 2023, offset by strength in our Pharmacy & Consumer Wellness and Health Services segments.

現在轉向我們對 2023 年的全年展望。我們重申調整後的每股收益為 8.50 美元至 8.70 美元。這主要反映了我們第三季的業績以及 Medicare Advantage 醫療成本在 2023 年剩餘時間內持續較高的趨勢，但被我們的藥房和消費者健康及健康服務領域的實力所抵消。

In the Health Care Benefits segment, we now expect our 2023 medical benefit ratio to be approximately 86%, primarily driven by the previously mentioned impact of higher Medicare Advantage utilization as well as the impact of higher-than-expected individual exchange growth during the special enrollment period. As a result, we now expect adjusted operating income for the segment to be in a range of $5.63 billion to $5.76 billion.

在醫療保健福利領域，我們目前預計 2023 年的醫療福利比率約為 86%，這主要是受到前面提到的 Medicare Advantage 利用率較高的影響以及特殊時期個人兌換增長高於預期的影響推動的。報名期間。因此，我們現在預計該部門調整後的營業收入將在 56.3 億美元至 57.6 億美元之間。

Our individual exchange business is expected to reduce adjusted operating earnings in 2023, largely a function of late year growth. However, this business is now poised to reach an annualized run rate of more than $6 billion of revenue, and we are well positioned to earn a positive margin in this business in 2024 based on specific actions our teams are implementing including pricing adjustments.

我們的個人兌換業務預計將在 2023 年減少調整後的營業利潤，這主要是由於年末成長所致。然而，該業務目前預計將達到超過 60 億美元的年化運行率，並且根據我們團隊正在實施的具體行動（包括定價調整），我們完全有能力在 2024 年在該業務中獲得正利潤率。

In our Health Services segment, we are updating our adjusted operating income guidance to a range of $7.18 billion to $7.31 billion, reflecting the strong execution year-to-date in our Pharmacy Services business and our expectation of continued strength for the remainder of the year.

在我們的健康服務部門，我們將調整後的營業收入指引更新至 71.8 億美元至 73.1 億美元的範圍，反映了我們的藥房服務業務今年迄今的強勁執行力以及我們對今年剩餘時間持續強勁的預期。

In our Pharmacy & Consumer wellness segment, we now expect adjusted operating income in the range of $5.76 billion to $5.86 billion, primarily driven by higher contributions from seasonal immunizations, partially offset by lower-than-expected script volume, primarily attributable to Medicaid redeterminations.

在我們的製藥和消費者健康部門，我們現在預計調整後的營業收入在57.6 億美元至58.6 億美元之間，這主要是由於季節性免疫接種的貢獻增加，部分被低於預期的腳本量所抵消，主要歸因於醫療補助的重新確定。

Shifting to our cash flow. Given our strong performance year-to-date, we now anticipate full year 2023 cash flow from operations to be at the upper end of our range of $12.5 billion to $13.5 billion. Our expectation for capital expenditures is now $2.5 billion to $2.7 billion. We are also updating our adjusted effective tax rate to 24.9% and our share count to 1.291 billion. You can find additional details on the components of our updated 2023 guidance on our Investor Relations web page.

轉向我們的現金流。鑑於我們今年迄今的強勁表現，我們現在預計 2023 年全年營運現金流將處於 125 億美元至 135 億美元區間的上限。我們目前對資本支出的預期為 25 億至 27 億美元。我們也將調整後的有效稅率更新為 24.9%，並將股票數量更新為 12.91 億股。您可以在我們的投資者關係網頁上找到有關我們更新的 2023 年指南組成部分的更多詳細資訊。

Before I conclude my prepared remarks, I want to give you an update on the headwinds and tailwinds for 2024, starting with the headwinds. As we previously discussed, the decline in our Star ratings for benefit year 2024 will pressure our Medicare Advantage margins. We now expect the impact to be closer to the low end of our previously communicated range of $800 million to $1 billion. We continue to expect the current level of elevated utilization in our Medicare Advantage book to persist and, at an abundance of caution, are maintaining a provision for further utilization pressure in 2024.

在結束準備好的演講之前，我想向您介紹 2024 年逆風和順風的最新情況，首先從逆風開始。正如我們之前討論的，2024 年福利年度星級評級的下降將為我們的 Medicare Advantage 利潤率帶來壓力。我們現在預計影響將接近我們先前通報的 8 億至 10 億美元範圍的下限。我們繼續預期 Medicare Advantage 帳簿中目前較高的利用率水準將持續下去，並謹慎地維持 2024 年進一步利用率壓力的撥備。

As previously discussed, contributions from Centene will decline as the contract ends on January 1, 2024. We expect a lower contribution in our PCW segment related to COVID, consumer softness and incremental labor investments, and we expect the 340B headwind from 2023 to annualize in 2024.

如前所述，隨著合約於2024 年1 月1 日結束，Centene 的貢獻將下降。我們預計與新冠疫情、消費者疲軟和增量勞動力投資相關的PCW 部門的貢獻將下降，並且我們預計2023年的340B 逆風將在2024 年。

Shifting to the tailwinds for 2024. We expect underlying growth in our core businesses. We now expect the savings from our previously announced actions and cost initiatives coming at the higher end of our guidance. We expect a positive contribution from the pricing of our individual exchange business as well as commercial pricing actions. We believe we have the opportunity to capture value from our newly created Cordavis business. And we expect incremental contributions from our Health Services businesses, net of the impact from previously discussed clinic expansion.

轉向 2024 年的順風車。我們預計核心業務將實現潛在成長。我們現在預計，我們先前宣布的行動和成本措施所帶來的節省將達到我們指導的上限。我們預計我們個人交易所業務的定價以及商業定價行為將做出積極貢獻。我們相信我們有機會從新創建的 Cordavis 業務中獲取價值。我們預計我們的健康服務業務將做出增量貢獻，扣除先前討論的診所擴張的影響。

At this distance, based on the sum total of these headwinds and tailwinds, including the uncertainty created by our recent utilization trends, we believe it is prudent for investors to ground their expectations for 2024 adjusted EPS at the low end of our previously communicated preliminary guidance range of $8.50 to $8.70. At our Investor Day in December, we will provide detailed 2024 guidance and updated views on our long-term growth outlook.

在此距離上，根據這些逆風和順風的總和，包括我們最近的利用率趨勢造成的不確定性，我們認為投資者將2024 年調整後每股收益的預期維持在我們之前傳達的初步指導的低端是明智的範圍為 8.50 美元至 8.70 美元。在 12 月的投資者日，我們將提供詳細的 2024 年指引以及對長期成長前景的最新看法。

To conclude, we remain focused on operational execution and sustainable growth as we advance our goal of becoming the leading health solutions company for consumers. We look forward to providing more detailed updates on our progress against our strategy in December.

總而言之，在我們推進成為消費者領先的健康解決方案公司的目標的過程中，我們仍然專注於營運執行和永續成長。我們期待在 12 月提供有關我們戰略進展的更詳細的最新資訊。

With that, we'll now open the call to your questions. Operator?

現在，我們將開始回答您的問題。操作員？

(Operator Instructions) And the first question today comes from Justin Lake from Wolfe Research.

（操作員說明）今天的第一個問題來自 Wolfe Research 的 Justin Lake。

Wanted to see if we can get some more color on Medicare Advantage cost brands, specifically, what did you see through the quarter? What did you assume for these value cards versus what kind of was expected? And then can you talk about how you think the business is going to perform in 2024, right? It looks like you invested in benefits there. So maybe you could just tell us where you think margins are this year? Where you think they're going to be next year? And then hopefully, walk us through where -- how investors should think about improvement in 2025 and beyond as you reprice this business, get your Stars back, et cetera?

想看看我們是否可以對 Medicare Advantage 成本品牌有更多了解，具體來說，您在本季看到了什麼？您對這些超值卡的假設與預期的類型有何不同？然後您能談談您認為該業務在 2024 年的表現如何嗎？看起來你在那裡投資了福利。那麼也許您可以告訴我們您認為今年的利潤率是多少？你認為他們明年會在哪裡？然後希望能引導我們了解——當你重新定價這項業務、收回你的星星等等時，投資者應該如何考慮 2025 年及以後的改進？

Justin, thanks for the question. Bear with me. There's a lot to go through here. So maybe I'd walk you through a couple of ways that we'd like you to think about 2024, really make sure that you understand what's happened in '23. And then I'll turn it over to Brian to talk about some of your other questions.

賈斯汀，謝謝你的提問。耐心聽我說。這裡有很多事情要經歷。因此，也許我會引導您透過幾種方式來思考 2024 年，真正確保您了解 23 年發生的事情。然後我會把它交給布萊恩來討論你的其他一些問題。

So you remember on our second quarter call, we discussed that we were seeing 100 to 110 bps of Medicare pressure in the first half, and that was driven by higher-than-expected utilization in outpatient and some supplemental benefits such as dental and behavioral health. We carried forward that pressure into the second half, resulting in an increase for the total company of about 50 bps to the total year MBR guide. We further indicated that we had captured a portion of the outpatient trend pressure in our bids in 2024, and that the remaining pressure we did not incorporate was reflected in the 2024 guide. We also put a placeholder in for additional utilization in our 2024 preliminary guidance range.

所以你還記得在我們第二季度的電話會議上，我們討論過上半年醫療保險壓力為 100 至 110 個基點，這是由門診利用率高於預期以及牙科和行為健康等一些補充福利推動的。我們將這種壓力延續到了下半年，導致整個公司的 MBR 全年指導值增加了約 50 個基點。我們進一步表示，我們在 2024 年的投標中捕捉了部分門診趨勢壓力，而我們未納入的剩餘壓力已反映在 2024 年指南中。我們還在 2024 年初步指導範圍中放置了一個佔位符，以供額外使用。

So as you look into the third quarter, we're experiencing higher utilization than we anticipated. The main driver of this pressure continues to be Medicare Advantage, but a less impactful notable driver is continued strong growth in the individual exchange product through the SEP. So this SEP membership, particularly when it's added late in the year, carries a higher-than-average MBR.

因此，當您展望第三季時，我們的使用率高於我們的預期。這種壓力的主要驅動因素仍然是 Medicare Advantage，但影響力較小的顯著驅動因素是透過 SEP 實現的個人交換產品的持續強勁成長。因此，這個 SEP 成員資格，尤其是在今年稍後添加的成員，其 MBR 高於平均水平。

So if you look specifically then at Medicare, we've continued to see elevated utilization in outpatient, including additional pressure in the second quarter. We've also seen incremental pressure and supplemental benefits in the third quarter, particularly dental, behavioral health and OTC and flex cards. So OTC and flex cards is a differentiator for our 2023 plan design, but it's also an important part of how we were planning to grow in 2024 and part of our bid strategy. The cards allot members a fixed amount of cash, typically on a quarterly basis, that they can use for OTC as well as food among other purchases. To date, we've seen meaningfully higher levels of utilization in the use of these cards than we had anticipated in our 2023 pricing and in our initial outlook.

因此，如果您具體關注醫療保險，我們將繼續看到門診利用率的提高，包括第二季的額外壓力。我們在第三季也看到了增量壓力和補充福利，特別是牙科、行為健康、非處方藥和彈性卡。因此，OTC 和靈活卡是我們 2023 年計畫設計的差異化因素，但它也是我們計畫在 2024 年實現成長的重要組成部分，也是我們競標策略的一部分。這些卡通常按季度向會員分配固定金額的現金，他們可以用這些現金進行非處方藥以及食品等購買。迄今為止，我們發現這些卡的使用率明顯高於我們在 2023 年定價和最初展望的預期。

If you roll that forward to the full year guide, we've raised the MBR by 75 to 80 basis points. 10 to 15 basis points is primarily related to the exchange product growth in the SEP and its impact on our MBR. The remaining 65 bps is related to Medicare Advantage, where we've presumed that the elevated level of trend we observed in the third quarter persists into the fourth quarter. Net of some revenue offsets, that represents about $550 million of pressure in Medicare.

如果您將其滾動到全年指南，我們已將 MBR 提高了 75 至 80 個基點。 10到15個基點主要與SEP中交易所產品的成長及其對我們MBR的影響有關。剩下的 65 個基點與 Medicare Advantage 有關，我們假設我們在第三季觀察到的趨勢水準上升將持續到第四季。扣除一些收入抵銷後，這意味著醫療保險面臨約 5.5 億美元的壓力。

It's important to note, though, as you look at our full year guidance reduction in HCB, there are about $250 million of favorable non-MBR items, which include things like net investment income, fees and also expenses. And a portion of these tailwinds are expected to persist into 2024.

不過，值得注意的是，當您查看我們全年 HCB 指導削減時，您會發現大約有 2.5 億美元的有利非 MBR 項目，其中包括淨投資收入、費用和支出等。這些有利因素的一部分預計將持續到 2024 年。

So as we think about how the MBR pressure in '23 then impacts '24, as I mentioned, our '24 MA bid completed higher MA utilization for outpatient and supplemental benefits although the current experience exceeds the pricing provision. As it specifically relates to OTC and flex cards, we recognized how customers value this benefit that it would be an important part of how we were going to market in 2024 in the sale of our products. And therefore, we proactively assumed higher utilization in those cards, which is much more consistent with how 2023 has actually played out. Consequently, 25 bps of the incremental 65 bps of the pressure this quarter was contemplated in pricing on account of the OTC and flex cards, while the remaining 40 bps was not.

因此，當我們思考23 年的MBR 壓力如何影響24 年時，正如我所提到的，我們的24 年MA 出價完成了門診和補充福利的更高MA 使用率，儘管當前的經驗超出了定價規定。由於它特別涉及 OTC 和靈活卡，我們認識到客戶如何重視這一優勢，這將成為我們 2024 年產品銷售方式的重要組成部分。因此，我們主動假設這些卡的利用率更高，這與 2023 年的實際情況更加一致。因此，本季增量 65 個基點壓力中的 25 個基點考慮在定價中考慮 OTC 和彈性卡，而其餘 40 個基點則沒有考慮。

So as you think then about that 40 bps of exposure, there's a couple of things that we think are offsets. First, as we progress our Stars mitigation and contract diversification efforts, we're now projecting that 2024 Stars will be at the low -- the impact will be at the low end of our expectations or about $800 million versus the prior midpoint expectation of $900 million.

因此，當您考慮 40 個基點的曝光時，我們認為有幾件事是抵消的。首先，隨著我們推進Stars 緩解措施和合約多元化工作，我們現在預測2024 年Stars 將處於較低水平- 影響將處於我們預期的低端，即約8 億美元，而之前的中點預期為900美元百萬。

Second, we've repriced our individual exchange members as we get to move forward towards our target margins in 2024. The incremental individual exchange membership coming through SEP actually provides upside opportunity in '24 as these members get properly documented for risk adjustment.

其次，隨著我們向2024 年的目標利潤邁進，我們對個人交易所會員重新定價。透過SEP 增加的個人交易所會員實際上在24 年提供了上行機會，因為這些會員得到了適當的風險調整記錄。

Third, the net investment income tailwinds that we've seen will almost certainly persist in light of the current macro environment, which was not previously contemplated.

第三，鑑於當前的宏觀環境，我們所看到的淨投資收益的順風幾乎肯定會持續下去，這是之前沒有想到的。

And finally, we expect to achieve the high end of our enterprise cost reduction initiatives, which we've previously talked about being $700 million to $800 million next year.

最後，我們期望實現企業成本削減計畫的高端，我們之前談到明年將達到 7 億至 8 億美元。

Altogether, we believe these tailwinds can offset a meaningful portion of the incremental 2024 Medicare headwind but we're encouraging investors to focus on the lower half of our '24 guidance range until we understand where trends are going to stabilize. It's worth noting, out of an abundance of caution, we've preserved the excess 2024 Medicare utilization provision that we talked about in the second quarter inside our updated guidance range for 2024. Brian?

總而言之，我們認為這些有利因素可以抵消 2024 年醫療保險增量逆風的很大一部分，但我們鼓勵投資者關注我們 24 年指導範圍的下半部分，直到我們了解趨勢將穩定在哪裡。值得注意的是，出於高度謹慎的考慮，我們在 2024 年更新的指導範圍內保留了我們在第二季度討論的 2024 年超額醫療保險利用條款。布萊恩？

Thanks, Tom. Let me talk a little bit about the utilization just to build on what Tom was saying, and then we can talk about the benefit design and, Justin, your question on margins.

謝謝，湯姆。讓我在湯姆所說的基礎上談談利用率，然後我們可以討論效益設計，賈斯汀，你關於利潤的問題。

With respect to utilization, just to echo what Tom said, obviously have been through the bids in detail, really to understand all the detailed utilization assumptions, and I would just say after all -- everything is fully baked in, including the utilization breakage that Tom discussed, the guide, I believe, fully reflects what's in our pricing as well as utilization break. So I feel good about where we are for the 2024 guide that Tom laid out.

關於利用率，只是為了呼應湯姆所說的，顯然已經詳細地進行了投標，真正了解了所有詳細的利用率假設，我只想說，畢竟一切都已完全成熟，包括利用率破損湯姆說，我相信該指南充分反映了我們的定價和利用率中斷的內容。因此，我對 Tom 制定的 2024 年指南的進展感到滿意。

Just with respect to some other categories, I think it's important to say that none of the other service categories besides the outpatient and some of the supplemental benefits that Tom went through are showing any pressure in patient is well controlled, for example, as well as other service categories.

就其他一些類別而言，我認為重要的是要說，除了門診和湯姆經歷的一些補充福利之外，其他服務類別都沒有顯示出患者的壓力得到了很好的控制，例如，其他服務類別。

On the individual side, I think it's important to mention what Tom did, which is to say, we did get more members in the SEP period than we anticipated which actually, I think, is a good thing for 2024. And so while it's creating some pressure in 2023 because they come in late in the year and you don't have the opportunity to document their conditions, between the pricing increases that we put through as well as our risk adjustment processes that will really ramp up for 2024, it's actually a nice tailwind for 2024.

就我個人而言，我認為有必要提及 Tom 所做的事情，也就是說，我們在 SEP 期間確實獲得了比我們預期更多的成員，我認為這實際上對 2024 年來說是一件好事。 2023 年會面臨一些壓力，因為它們在今年稍後到來，你沒有機會記錄它們的情況，在我們進行的定價上漲以及我們將在2024 年真正加強的風險調整流程之間，實際上2024 年的良好順風車。

Our commercial business also is doing well, our group commercial business at our Medicaid business. So there's no other pressures there. This is really a Medicare story. And as I said, I think we're fully covered with our 2024 guide.

我們的商業業務也表現良好，我們的醫療補助業務中的集團商業業務。所以沒有其他壓力。這確實是一個醫療保險的故事。正如我所說，我認為 2024 年指南已完全涵蓋了這一點。

Justin, with respect to your benefits question, it was important for us coming into 2024 to maintain benefit stability for our members in light of obviously the Stars pressure that we faced. This is an important strategic priority for Medicare. It not only impacts our business on the Aetna side but also has wide-ranging impacts across the enterprise. And so this was a business that we are committed to maintaining benefits stability and being thoughtful in some of the investments that we made.

賈斯汀，關於您的福利問題，鑑於我們顯然面臨星星壓力，進入 2024 年，保持會員福利的穩定性非常重要。這是 Medicare 的重要策略重點。它不僅影響我們安泰方面的業務，而且對整個企業產生廣泛的影響。因此，我們致力於保持福利穩定性，並在我們所做的一些投資中深思熟慮。

So for example, on the D-SNP side, that's clearly an area where we leaned in. Our focus was on the flex cards. And as Tom said, these are cards that our members can use for food, OTC, utilities, et cetera. We believe this was an attractive benefit, but importantly, the assumptions we use for 2024 effectively assume full utilization. And so there's just not a lot of incremental breakage that can occur in 2024 relative to the D-SNP population.

例如，在 D-SNP 方面，這顯然是我們重點關注的領域。我們的重點是靈活卡。正如湯姆所說，我們的會員可以使用這些卡購買食品、非處方藥、公用事業等。我們相信這是一個有吸引力的好處，但重要的是，我們對 2024 年使用的假設實際上假設了充分利用。因此，相對於 D-SNP 群體而言，2024 年不會發生太多增量破壞。

I'd also remind you that our D-SNP population is largely HMO, and so they weren't impacted by the Stars challenges that we've had for 2024. So as you think about marginal contribution and where our benefit design is and our anticipation to grow that book, actually, we expect marginal profit contribution on new members for D-SNP. And so I actually view that as a positive.

我還想提醒您，我們的 D-SNP 人群主要是 HMO，因此他們沒有受到 2024 年星星挑戰的影響。因此，當您考慮邊際貢獻以及我們的福利設計和我們的福利設計時期望增加這本書，實際上，我們預期D-SNP 新成員的邊際利潤貢獻。所以我實際上認為這是積極的。

And on the general enrollment side, we are very targeted in our investments and the investments we made tended to be in new plans as opposed to existing plans, which actually was a thoughtful way of really driving opportunities for growth without burning the entire book with incremental costs. So again, I feel good about 2024, where we're positioned. And I would say, as Karen said in her opening remarks, feel very good about our ability to achieve at or above market growth on the Medicare side.

在一般招生方面，我們的投資非常有針對性，我們所做的投資往往是新計劃而不是現有計劃，這實際上是一種真正推動增長機會的深思熟慮的方式，而不用增量來燒毀整本書。成本。再說一次，我對 2024 年我們的定位感覺良好。我想說，正如凱倫在開場白中所說，我們對我們在醫療保險方面實現等於或高於市場增長的能力感到非常滿意。

And then finally, on your margin question, clearly, we're way below where we need to be on 2024 margins. We understand that. Our expectation for 2025 is that we'll take significant ground against our margin targets. Obviously, we need to see where the rate notice comes out, what the competitive dynamic is, but you should expect 2025 for us to see incremental margin improvement and hopefully material improvement in that regard.

最後，關於您的利潤率問題，顯然，我們遠低於 2024 年利潤率所需的水平。我們明白這一點。我們對 2025 年的預期是，我們將在利潤率目標上取得重大進展。顯然，我們需要看看利率通知在哪裡發布，競爭動態如何，但你應該預期 2025 年我們會看到利潤率逐步改善，並希望在這方面出現實質改善。

The next question comes from Lisa Gill from JPMorgan.

下一個問題來自摩根大通的麗莎吉爾。

I want to focus on the health care services side of the business and really had a few questions here. One, when I think about Cordavis and I think about the opportunity around biosimilars, is there a way for you to maybe frame how big that opportunity is? Secondly, when we think about things like GLP-1s, I would think of that as being a positive for this business. Can you help us to understand that? And then thirdly, there is some expectation that there'll be some level of PBM, maybe a bill this year when we think about the reconciliation. Can you talk about what you're seeing right now? And is that built into any of your expectations around your business for 2024?

我想專注於醫療保健服務方面的業務，並且確實有幾個問題。第一，當我想到 Cordavis 並想到圍繞生物相似藥的機會時，您是否有辦法確定這個機會有多大？其次，當我們考慮像 GLP-1 之類的事情時，我認為這對這項業務是積極的。你能幫助我們理解這一點嗎？第三，人們期望會有某種程度的 PBM，也許今年我們考慮對帳時會提出一項法案。你能談談你現在所看到的嗎？這是否包含在您對 2024 年業務的期望中？

Lisa, let me take a couple and then I'm going to ask Prem to talk about Cordavis and I'll ask the team to talk about GLP-1s. But just generally on the PBM bill, obviously, there's a lot of unrest going on in the legislative body of the U.S. We don't -- we may see something at the end of the year and the end of the -- in that reconciliation bill. Our best thinking now is that is transparency, which we are fully aware of and have contemplated in our business. So -- but it remains to be seen what really will happen in that year-end reconciliation package. I think there's a lot going on in Washington. So it's unclear what will happen.

Lisa，讓我舉幾個例子，然後我會請 Prem 談談 Cordavis，我會請團隊談談 GLP-1。但總的來說，就 PBM 法案而言，顯然，美國立法機構中存在許多動盪。我們可能會在今年年底和年底看到一些和解的情況帳單。我們現在最好的想法是透明度，我們充分意識到這一點，並在我們的業務中考慮這一點。所以，但年終和解計畫中到底會發生什麼事還有待觀察。我認為華盛頓發生了很多事情。所以目前還不清楚會發生什麼事。

Relative to Cordavis, we view that as a significant opportunity, as I mentioned in my prepared remarks. This is an opportunity for us to bring a healthy biosimilar market to the U.S. so that we can really bring lower drug costs to our customers. Prem has been doing a lot on this opportunity, and I'll ask him to talk about kind of the magnitude of it. But we are excited and we are in a position to really have an impact. It is a $100 billion opportunity by 2029. So we have the opportunity over the next few years to really make significant improvement in lowering drug cost and obviously, in the performance of our company.

正如我在準備好的演講中提到的，相對於 Cordavis，我們認為這是一個重要的機會。這是我們為美國帶來一個健康的生物相似藥市場的機會，這樣我們才能真正為我們的客戶帶來更低的藥品成本。普雷姆利用這個機會做了很多事情，我會請他談談這個機會的重要性。但我們很興奮，並且我們能夠真正產生影響力。到 2029 年，這是一個價值 1000 億美元的機會。因此，我們有機會在未來幾年內真正在降低藥品成本方面取得重大改進，顯然，在我們公司的業績方面也有重大改進。

And then relative to GLP-1s, what I would say is that this is an area that has demonstrated and proven that we can see significant weight loss and improvement in health, but it comes at a very hefty price tag. And it is the reason why a PBM exists, to really have the opportunity to reduce overall cost for GLP-1s. That's what we are very focused on doing by creating competitive environment. It is -- it could cost U.S. $1 trillion if every American that is considered obese, and that's about 70 million Americans, were prescribed these GLP-1s. That would put significant pressure on the U.S. health care system. So it is imperative for us as a PBM to really reduce the overall cost of those drugs, and we're working very closely with our customers to do that. As you can imagine, our customers' top priority is really understanding the cost of GLP-1s, and David will talk about that.

然後相對於 GLP-1，我想說的是，這是一個已經證明並證明我們可以看到體重顯著減輕和健康改善的領域，但它的價格非常高。這就是 PBM 存在的原因，真正有機會降低 GLP-1 的整體成本。這就是我們非常注重創造競爭環境的事情。如果每個被認為肥胖的美國人（即大約 7,000 萬美國人）都服用這些 GLP-1，可能會花費 1 兆美元。這將給美國醫療保健系統帶來巨大壓力。因此，作為 PBM，我們必須真正降低這些藥物的整體成本，為此我們正在與客戶密切合作。正如您可以想像的那樣，我們客戶的首要任務是真正了解 GLP-1 的成本，David 將談論這一點。

But let me turn it over to Prem to talk about Cordavis.

但讓我把它交給 Prem 來談談 Cordavis。

Yes. And just to add to what Karen said, Cordavis is an extremely exciting opportunity for us. And Lisa, you've been around the PBM industry for a long time. And if you think about the competition that was created in the early part of the 2010s, as it relates to the generic pipeline, we view the biosimilar pipeline as the competition for the specialty drugs. And if you think about the amount of pharmacy spend that's in specialty drugs, it's greater than 50% at this point. So it's really important for us to be able to create that competition in biosimilars.

是的。補充一下 Karen 所說的，Cordavis 對我們來說是一個非常令人興奮的機會。 Lisa，您已經在 PBM 行業工作了很長時間。如果你考慮一下 2010 年代初期產生的與仿製藥管道相關的競爭，我們將生物相似藥管道視為特種藥物的競爭。如果您考慮特殊藥品的藥局支出，此時比例已超過 50%。因此，能夠在生物相似藥領域創造競爭對我們來說非常重要。

And as I think about what Cordavis is really intended to do, it's going to work with manufacturers to bring these products into the U.S. pharmaceutical marketplace. One of the big pieces that we need to ensure is what I'd say is continuity of supply of these products in the marketplace. And that's one of the things that Cordavis will work for. So our first product that we'll launch, as we mentioned earlier in the year is going to be a contract with Sandoz to co-manufacture and commercialize Hyrimoz and is a biosimilar product for HUMIRA. And we'll be launching that in the first quarter of 2024. And recall, we mentioned that we were going to launch it at a list price that's greater than 80% lower than the current list price for HUMIRA. So again, it creates lower cost for consumers, better access and affordability across the board.

當我思考 Cordavis 的真正意圖時，它將與製造商合作，將這些產品帶入美國製藥市場。我想說的是，我們需要確保的重要事項之一是這些產品在市場上的供應連續性。這就是 Cordavis 將致力於的事情之一。因此，正如我們在今年早些時候提到的，我們將推出的第一個產品將是與 Sandoz 簽訂的合同，共同製造和商業化 Hyrimoz，並且是 HUMIRA 的生物仿製藥產品。我們將在 2024 年第一季推出該產品。回想一下，我們提到我們將以比 HUMIRA 目前標價低 80% 以上的標價推出它。因此，它再次為消費者創造了更低的成本、更好的取得和全面的負擔能力。

As we look out into 2024 with Cordavis, we intend to have a full portfolio of products as we see other biosimilar competition coming in the specialty marketplace to facilitate the broader access of these products in the U.S.

當我們展望 2024 年 Cordavis 時，我們打算擁有完整的產品組合，因為我們看到其他生物相似藥競爭進入專業市場，以促進這些產品在美國更廣泛的使用。

And I'll hand it over to Tom to talk about some of the questions on the financial.

我將把它交給湯姆來討論一些有關財務的問題。

Lisa, you asked about kind of the GLP-1 impact, but I think it's important to just talk about what the enterprise impact is there, and then David can talk some more about some of the specifics on how the PBM helps here and some of the challenges that our self-insured customers are facing.

Lisa，您詢問了 GLP-1 的影響，但我認為重要的是只討論對企業的影響，然後 David 可以更多地討論 PBM 如何提供幫助的一些具體細節以及一些我們的自我保險客戶面臨的挑戰。

In Pharmacy Services, the GLP-1s are a class of drugs that are uniquely suited to the value of the services that a PBM provides. And so we do have a positive margin contribution from the GLP-1s in that segment. On the Aetna side, it's really about whether or not we capture utilization in our pricing. But most of that pricing is really capturing indications for diabetes, not for weight loss. For weight loss, that's really something that our self-insured customers make an individualized decision on or it's a buyout for our insured book and we believe that for 2023, we've appropriately priced that and we're taking our latest thinking into our pricing for '24.

在藥局服務中，GLP-1 是一類特別適合 PBM 提供的服務價值的藥物。因此，我們確實從該細分市場的 GLP-1 中獲得了積極的利潤貢獻。在 Aetna 方面，真正重要的是我們是否在定價中考慮到利用率。但大部分定價其實是針對糖尿病的適應症，而不是減肥。對於減肥，這確實是我們的自保客戶做出個性化決定的事情，或者是對我們投保書籍的買斷，我們相信，到2023 年，我們已經對其進行了適當的定價，並且我們正在將最新的想法納入我們的定價中'24。

On the flip side, branded products pressure margins in the PCW business. So the GLP-1s are generally a headwind to that business.

另一方面，品牌產品對 PCW 業務的利潤率構成壓力。因此，GLP-1 通常對該業務構成阻礙。

Maybe, David, you could provide a little more context on kind of the PBM impacts?

David，也許您可以提供更多有關 PBM 影響的背景資訊？

Sure. Thanks, Tom. So as Karen mentioned, the GLP-1s are certainly at the top of every client's list in terms of areas that they're concerned about going into '24 and beyond. Good news is that PBM actually plays a critically important role in managing this category of drugs. So we really have 3 different ways in which we're trying to drive savings for our customers. The first is formulary, so we create competition. And obviously, as new entrants come into the market, it serves as an opportunity for us to continue to reduce the cost for our customers. Secondly is utilization management, so focusing on the appropriate use of the medications, including off-label utilization. And then lastly, and there's a significant investment being made in our advanced care management solutions, which is looking at the holistic view of the conditions of which we're treating. And it's essentially complementing the drug therapy and it's giving us an opportunity to focus on the underlying causes of the conditions.

當然。謝謝，湯姆。正如 Karen 所提到的，就每位客戶關心的進入 24 世紀及以後的領域而言，GLP-1 無疑是他們最關心的問題。好消息是，PBM 實際上在管理此類藥物方面發揮著至關重要的作用。因此，我們確實有 3 種不同的方式來努力為客戶節省開支。第一個是規定性的，所以我們創造競爭。顯然，隨著新進業者進入市場，這為我們提供了繼續降低客戶成本的機會。其次是使用管理，因此重點關注藥物的適當使用，包括超說明書使用。最後，我們對高級護理管理解決方案進行了大量投資，該解決方案著眼於我們正在治療的病症的整體觀點。它本質上是對藥物治療的補充，讓我們有機會關注疾病的根本原因。

So as we look at the results, at least year-to-date, you look at the combination of our formulary management in addition to the utilization management, we're saving nearly 70% of costs for our commercial clients. So again, it's a great proof point that we've been able to take cost out of the system as we're looking obviously at this growing cost of medications.

因此，當我們查看結果時，至少今年迄今為止，您會看到我們的處方管理與使用率管理相結合，我們為商業客戶節省了近 70% 的成本。再說一遍，這是一個很好的證據，表明我們已經能夠從系統中降低成本，因為我們顯然正在關注不斷增長的藥物成本。

The area that I would say we're focused on in '24 is there's still a sizable percentage of our customers that have included obesity or weight loss. And it's an area that's probably growing 6x what the non -- or the diabetic utilization is. And so there's a big focus right now on both the ROI as well as making sure as new competitors come into the market that we're using these opportunities to focus on reducing the unit pricing of the product and then more specifically, focusing on the overall ROI for the services that is delivering.

我想說的是，我們在 24 年關注的領域是，我們的客戶仍有相當大比例有肥胖或減肥問題。這一領域的成長速度可能是非糖尿病患者或糖尿病患者的 6 倍。因此，現在的重點是投資報酬率，以及確保新競爭對手進入市場，我們利用這些機會專注於降低產品的單位定價，然後更具體地說，專注於整體所提供服務的投資報酬率。

So maybe if I could just pivot 1 minute on the Cordavis because I just -- and it was a 3-part question, Lisa, and I know we're trying to answer it in a variety of different ways. But I think Cordavis is a really important unique opportunity for us in the market. So as Prem said, Cordavis has brought to market a low list price product. As the PBM, we have a formulary that looks at both clinical efficacy as well as driving low net cost for our customers. The good news is, is that we -- when we have influence, we actually are moving to a product with the low list prices, as Prem mentioned, 80% below the current list price of the brand HUMIRA.

所以也許我可以在 Cordavis 上花一分鐘時間，因為我只是 - 這是一個由 3 部分組成的問題，麗莎，我知道我們正在嘗試以各種不同的方式回答它。但我認為 Cordavis 對於我們在市場上來說是一個非常重要的獨特機會。正如 Prem 所說，Cordavis 向市場推出了一款低價產品。作為 PBM，我們有一個處方集，既考慮臨床療效，又為客戶降低淨成本。好消息是，當我們有影響力時，我們實際上正在轉向標價較低的產品，正如 Prem 所提到的，比 HUMIRA 品牌目前標價低 80%。

So it does require changing the market. So if you look at our -- how we're looking at the opportunity going into '24, it's can we move enough share in order to create value for our customers? In our models, we believe we can take 50% of the 2022 cost out for this category by moving aggressively to a low list price product. So then we have to then look at what gives us confidence that we can actually move the share.

所以它確實需要改變市場。因此，如果你看看我們如何看待進入 24 年的機會，我們是否可以轉移足夠的份額，以便為我們的客戶創造價值？在我們的模型中，我們相信透過積極轉向低標價產品，我們可以將該類別的 2022 年成本削減 50%。因此，我們必須看看是什麼讓我們有信心能夠真正移動份額。

So we've mentioned, obviously, in previous calls that we've had success with moving Lantus to BASAGLAR. We had 97-plus percent conversion for that product back many years ago. And if you look at one example, which is a client in Medicaid that has chosen to exclude the coverage of branded HUMIRA, we've been able to move upwards of 90% of the product by -- within the last 30 days. So I think it's become a proof point that, one, we can actually move the low-cost biosimilars. We can actually reduce the cost of the category for our customers and ultimately make sure we're preserving the experience for the members.

因此，我們顯然在先前的電話會議中提到，我們已經成功地將來得時轉移到 BASAGLAR。許多年前，我們對該產品的轉換率高達 97% 以上。如果你看一個例子，即醫療補助計劃中的一位客戶選擇排除品牌 HUMIRA 的承保範圍，我們已經能夠在過去 30 天內提高 90% 的產品。所以我認為這已經成為一個證據，第一，我們實際上可以轉移低成本的生物相似藥。我們實際上可以為客戶降低該類別的成本，並最終確保我們保留會員的體驗。

So I think, again, we're pretty bullish on our opportunity of changing the marketplace and capitalizing on bringing new innovative therapies to market.

因此，我再次認為，我們非常看好改變市場的機會，並利用將新的創新療法推向市場的機會。

The next question comes from Nathan Rich from Goldman Sachs.

下一個問題來自高盛的內森·里奇。

It sounds like Oak Street is kind of scaling in line to maybe a bit better than your expectations. I guess, could you maybe just update us on how you're thinking about the incremental platform contribution next year? And what you see as the kind of biggest opportunities for practices in terms of how they need to adapt just given the tougher rate environment that we're going to be in for Medicare next year?

聽起來橡樹街的規模正在擴大，可能比您的預期要好一些。我想，您能否向我們介紹一下您對明年增量平台貢獻的最新看法？鑑於明年我們將面臨醫療保險更嚴格的費率環境，您認為在如何適應方面最大的實踐機會是什麼？

And from a capital deployment standpoint, can you talk about your appetite for additional M&A from a care delivery standpoint? Is that something that you're looking at currently? Or do you need to kind of allow the existing kind of assets to mature more before you look to build further?

從資本部署的角度來看，您能否從護理服務的角度談談您對額外併購的興趣？這是您目前正在關注的事情嗎？或者，在尋求進一步建設之前，您是否需要讓現有資產更加成熟？

Yes. Maybe I'll start on the operational priorities and then turn it over to Tom on the financials. The biggest thing for us is keep focusing on what we do best, which is keep our patients healthy and out of the hospital. We know if we apply our care model, we'll do that. And we have the proof points, whether it's the Medicare shared savings program a couple of years ago where we were a top 1% performer, whether it's the ACO REACH program which has risk score caps or whether it's an MA that we can create a lot of value by keeping our patients healthy and then capturing that savings.

是的。也許我會從營運優先事項開始，然後將其交給湯姆處理財務問題。對我們來說最重要的是繼續專注於我們最擅長的事情，即保持患者健康並遠離醫院。我們知道，如果我們應用我們的照護模式，我們就會做到這一點。我們有證據，無論是幾年前我們排名前 1% 的醫療保險共享儲蓄計劃，還是具有風險評分上限的 ACO REACH 計劃，還是我們可以創造很多的 MA通過保持患者健康並節省費用來實現價值。

And so that's the biggest focus at Oak Street is running our care model, running it well, running every day, running at every center and keeping that culture intact. And if we do that, we'll be in great shape. And I actually think that if you think about the medium or longer term, I think the changes in how they're doing risk adjustment will be a tailwind for us because it's going to make sure that you're doing the right things to care for patients, and that's what's driving your business. And if it's harder for others, I think that will just further differentiate the Oak Street platform. So that's our focus.

因此，橡樹街最大的重點是運行我們的護理模式，運作良好，每天運行，在每個中心運行並保持文化完整。如果我們這樣做，我們就會處於良好狀態。事實上，我認為，如果你考慮中期或長期，我認為他們進行風險調整的方式的變化對我們來說將是順風，因為它將確保你做正確的事情來照顧患者，這就是您業務的推動力。如果對其他人來說更困難，我認為這將進一步使橡樹街平台脫穎而出。這就是我們的重點。

Thanks, David. As you think about the financial impact, and I think you're specifically referring to v28 on the risk model, which is something that we spent a tremendous amount of time thinking through in diligence. We think that there's a lot of opportunity here over the long term as we think about the ability of Oak Street, their people, their process, their technology to really adapt to a changing regulatory environment. And so we have a lot of confidence in their model. We have a lot of confidence in their ability to execute this.

謝謝，大衛。當您考慮財務影響時，我認為您具體指的是 v28 的風險模型，這是我們花了大量時間進行盡職思考的內容。我們認為，從長遠來看，當我們考慮橡樹街及其人員、流程和技術真正適應不斷變化的監管環境的能力時，這裡有很多機會。所以我們對他們的模型很有信心。我們對他們執行此任務的能力充滿信心。

The issue that you think about this is really going to be what's the timing impact of this? They've eliminated a lot of more generic codes and they've added a lot of HCC indexes to more complicated codes where they think there's a higher correlation with costs. And so we've got to both set the systems up to ensure that we're capturing the appropriate data to help not just think about what the gross impact is but what the net impact is. And then we need to have the encounters happen to actually capture that data. And there's lots of other mitigants.

您考慮的問題實際上是這對時間的影響是什麼？他們消除了許多更通用的程式碼，並在更複雜的程式碼中添加了大量 HCC 索引，他們認為這些程式碼與成本具有更高的相關性。因此，我們必須設定係統，以確保我們捕獲適當的數據，以幫助我們不僅思考整體影響是什麼，而且思考淨影響是什麼。然後我們需要讓相遇真正捕捉這些數據。還有很多其他緩解措施。

I think, as we look at Oak Street, we're pretty comfortable that they're in better shape than a lot of other participants in the industry. But because of kind of the timing of the implementation of these changes, it is only 1/3 phased in next year, but we think it will probably have about a 2% revenue impact. But we actually think that, that gap will shrink over time even as v28 is more fully implemented. And so -- and all of that is captured within our preliminary guidance range.

我認為，當我們觀察橡樹街時，我們很高興他們的狀況比業內許多其他參與者更好。但由於這些變更實施的時間安排，明年只分階段實施了 1/3，但我們認為這可能會對收入產生約 2% 的影響。但我們實際上認為，即使 v28 得到更全面的實施，這種差距也會隨著時間的推移而縮小。所以——所有這些都在我們初步的指導範圍內。

Overall, we actually feel really good about Oak Street's model, its ability to deliver exceptional care. I think the ACO REACH results is just another great example of how their model is differentiated versus what else is out in the marketplace. And so we feel really great about the long-term prospects, which is why we've actually doubled down and we're going to grow 50 to 60 centers next year and probably accelerate after that as we look to expand that footprint more aggressively.

總的來說，我們實際上對橡樹街的模式及其提供卓越護理的能力感到非常滿意。我認為 ACO REACH 結果只是另一個很好的例子，說明了他們的模型與市場上其他模型的差異化。因此，我們對長期前景感到非常滿意，這就是為什麼我們實際上加倍努力，明年我們將增加 50 到 60 個中心，之後可能會加速，因為我們希望更積極地擴大足跡。

You asked also about capital and M&A. I think we've done a lot of acquisitions this year and our focus in the near term is really on execution, execution in growing those businesses, which are well on track for '23 and execution and continuing to drive synergies and growth.

您也問到了資本和併購的問題。我認為我們今年已經進行了很多收購，短期內我們的重點實際上是執行，執行成長這些業務，這些業務在 23 年和執行方面進展順利，並繼續推動協同效應和成長。

The next question comes from Kevin Caliendo from UBS.

下一個問題來自瑞銀集團的 Kevin Caliendo。

If I go on to the retail segment a little bit. The pharmacy growth still remains elevated. Love to hear the competitive dynamics driving that, if there's anything in particular. And then also exactly how much the increased vaccine is contributing to the change in retail this year and what you expect for next year? I think you called out a couple of the headwinds and tailwinds broadly, but specifically, just for the retail segment, how should we think about any micro headwinds and tailwinds within that segment for '24?

如果我繼續涉足零售領域。藥品成長仍維持在高水準。喜歡聽到競爭動態推動這一點，如果有什麼特別的話。那麼，增加的疫苗對今年零售業的變化到底有多大貢獻以及您對明年的預期呢？我認為您廣泛地指出了一些逆風和順風，但具體而言，僅針對零售領域，我們應該如何考慮 24 年該領域內的任何微觀逆風和順風？

Sure. Why don't I start and then Prem can give you a little bit more color on kind of the competitive environment. You asked specifically about some of the tailwinds in that segment. I think there's 2 things that I'd call out. The first is just strengthen our immunization franchise and the second is I think that as you think of -- as you look at where the consensus was for that business, I don't think that we're getting enough credit there for some of the actions that we took to restructure quorum last year and some of the benefits that, that would provide.

當然。為什麼我不開始，然後 Prem 可以給你更多關於競爭環境的資訊。您特別詢問了該領域的一些有利因素。我想我要指出兩件事。第一個是加強我們的免疫特許經營權，第二個是我認為，正如你所想到的，當你看到對該業務的共識時，我認為我們在某些​​方面沒有獲得足夠的信任。我們去年為重組法定人數而採取的行動以及由此帶來的一些好處。

Some of the store closures, which continue to ramp and some of the benefits that you're starting to see from that, particularly as we've exceeded all of our goals on employee retention, but importantly, on script retention and also front store retention. So we've done really well and kudos to that team on the execution there.

一些商店的關閉數量繼續增加，您也開始從中看到一些好處，特別是因為我們已經超出了員工保留的所有目標，但重要的是，腳本保留和前台商店保留。所以我們做得非常好，並且對那個團隊的執行表示讚賞。

But as you think maybe about the immunization franchise, we did just under 8 million vaccines in the quarter. Flu represented probably about half of that total with COVID probably about a quarter and the remainder is a variety of different vaccines, but also included the new RSV vaccine, which we saw a strong growth in. Performance across that book was quite good, and a lot of that actually has to do with some of the efforts of our trade team, which helped to really drive some of the strength in the quarter. We project that vaccines are probably going to peak early in the fourth quarter before declining in 2024, and that's primarily due to COVID softening versus part of the early part of '23 when the public health emergency was still in effect. As COVID moves into the endemic phase, our plan is that we're going to talk about the vaccine franchise more holistically, but we do think that there's going to be pressure there because COVID is going to wane.

但當你想到免疫接種特許經營權時，我們在本季度生產了不到 800 萬劑疫苗。流感可能佔總數的大約一半，新冠病毒可能約佔四分之一，其餘的是各種不同的疫苗，但也包括新的RSV 疫苗，我們看到了這種疫苗的強勁增長。該書的表現相當不錯，而且這很大程度上與我們貿易團隊的一些努力有關，這有助於真正推動本季的一些實力。我們預計疫苗可能會在第四季初達到頂峰，然後在 2024 年下降，這主要是由於新冠疫情的疲軟，而 23 年初公共衛生緊急狀態仍然有效。隨著新冠病毒進入流行階段，我們的計劃是我們將更全面地討論疫苗系列，但我們確實認為這方面將會面臨壓力，因為新冠病毒將會減弱。

And I think as you think about next year, we've anticipated that the current level of performance is not going to persist, partially because of COVID, partially because of the typical dynamics of just rate and reimbursement pressure, but also about a little bit of a provision for consumer softness.

我認為，當你考慮明年時，我們預計當前的績效水準不會持續下去，部分原因是新冠疫情，部分原因是利率和報銷壓力的典型動態，但也有一點消費者軟性的規定。

Prem, maybe you could talk a little bit about -- more about kind of the script growth and underlying dynamics in the market.

Prem，也許你可以多談談劇本的成長和市場的潛在動態。

Yes, sure. Sure thing. So our retail pharmacy business continues to be execute and deliver strong results across scripts service and our transformational initiatives. If you think about our same-store scripts, we grew 2.7%. And if you exclude COVID, we grew 3.5%. So continued strong momentum on script growth.

是的，當然。當然可以。因此，我們的零售藥局業務繼續執行，並透過腳本服務和我們的轉型計劃取得了強勁的成果。如果你考慮我們的同店腳本，我們的成長率為 2.7%。如果排除新冠疫情，我們的成長率為 3.5%。因此，劇本成長動能持續強勁。

On the service front, we continue to measure NPS, and our NPS year-to-date is about 40 basis points higher than prior year. So continue to have strong service. And we know that service is a primary reason to retain and grow scripts.

在服務方面，我們繼續衡量 NPS，年初至今我們的 NPS 比去年高出約 40 個基點。因此，繼續提供強而有力的服務。我們知道服務是保留和成長腳本的主要原因。

And then lastly, I think the transformational initiatives that we're focused on, first and foremost, how do we lower our cost of goods and then also continue to think about our engagement with consumers through our innovative omnichannel strategies. And we continue to think about ways in which we can make the consumer experience easier.

最後，我認為我們關注的轉型措施首先是如何降低商品成本，然後繼續考慮透過創新的全通路策略與消費者互動。我們繼續思考如何讓消費者體驗更輕鬆。

One of the things that we did during COVID was we did group scheduling as well as multi vaccine scheduling this year that had very good results for our consumers in the marketplace. Lastly, we continue to look at our operating model. We have to continue to invest in our colleagues and working to really scale innovative technology solutions that can make the pharmacy easier for our colleagues in our stores, and we continue to do that with some of the things that we're doing around sharing work across stores as well as some of the other model changes that we're doing in 2024.

我們在新冠疫情期間所做的一件事是，我們今年進行了團體調度和多種疫苗調度，這為市場上的消費者帶來了非常好的結果。最後，我們持續審視我們的營運模式。我們必須繼續對我們的同事進行投資，並努力真正擴大創新技術解決方案的規模，使我們商店裡的同事能夠更輕鬆地進行藥房工作，我們將繼續透過我們圍繞共享工作所做的一些事情來做到這一點商店以及我們在 2024 年進行的一些其他模型更改。

And lastly, it's incredibly important for us to continue to deliver payer value in terms of our clinical and value-based programs for consumers, focused on things like our Stars rating. So we work very closely with our MA partners, including Aetna, on that to drive adherence and patient outcomes and be the #1 national chain really across those measures.

最後，對我們來說，繼續透過我們的臨床和基於價值的計劃為消費者提供付款人價值非常重要，重點是我們的星級評級等。因此，我們與包括 Aetna 在內的 MA 合作夥伴密切合作，以提高依從性和患者治療效果，並在這些措施中真正成為排名第一的全國連鎖店。

And really, what's really important is also leveraging our engagement in these stores to connect into our other businesses, whether that's into our payer businesses or into Oak Street or into Signify to really streamline and make those consumer experiences better.

事實上，真正重要的是利用我們在這些商店的參與來連接到我們的其他業務，無論是我們的付款業務、Oak Street 還是 Signify，以真正簡化並改善消費者體驗。

As it relates to front store, we continue to grow share and help consumers, what I would say is navigate the challenging market conditions through convenience and value in health and wellness products, and we've continued to see that business perform really well. If you exclude COVID OTC test kits, our front store same-store sales are about -- are flat, and we continue to grow drug share about 41 basis points even despite the softening traffic that we're seeing.

就前店而言，我們繼續增加份額並幫助消費者，我想說的是透過健康和保健產品的便利性和價值來應對充滿挑戰的市場條件，而且我們繼續看到業務表現非常好。如果排除新冠 OTC 檢測試劑盒，我們的前店同店銷售額大約持平，儘管我們看到客流量疲軟，但我們的藥品份額繼續增長約 41 個基點。

Yes. I just want to take this opportunity. Kevin, you talked about the competitive dynamics, and there's a lot of discussion around the labor market. And what I would say is that, as a company, we are committed to providing the best place to work for all of our colleagues, including our pharmacists and our pharmacy techs. Over the last year or so, we've made a number of investments for our labor. By the end of the year, we'll have wage investments of over $1 billion.

是的。我只是想利用這個機會。凱文，你談到了競爭動態，圍繞勞動市場有很多討論。我想說的是，作為一家公司，我們致力於為所有同事提供最好的工作場所，包括我們的藥劑師和藥劑技術人員。在過去一年左右的時間裡，我們對勞動力進行了多項投資。到今年年底，我們的薪資投資將超過 10 億美元。

We continue to invest in our technology to support our teams in the field so that they can have streamlined workflows and smoother operations. We are committed and continue to hire. It's a tight labor market, but we've been having very good success in hiring. Our attrition numbers are stable. And we are actively developing new training programs as well for the ongoing development of our colleagues. But as I said at the top of the -- top here, we are committed to making sure that this is a powerful and -- we are an employer of choice.

我們繼續投資我們的技術來支援我們的現場團隊，以便他們能夠簡化工作流程和更順暢的操作。我們承諾並繼續招募。這是一個緊張的勞動力市場，但我們在招聘方面取得了非常好的成功。我們的員工流動率穩定。我們也積極制定新的培訓計劃，以促進同事的持續發展。但正如我在頂部所說，我們致力於確保這是一個強大的，並且我們是首選雇主。

The next question comes from Eric Percher from Nephron Research.

下一個問題來自 Nephron Research 的 Eric Percher。

I want to come back to the headwinds and tailwinds for Health Services in 2024. For '23 after we've seen pretty significant outperformance after that 340B headwind early in the year, and you've attributed this to sourcing, specialty and drug mix, and I'm reading the latter as rebate outperformance on GLP-1 and biosimilar. Question 1 is were sourcing benefits outsized in '23 versus '22 or the outlook for '24? And then question 2 is, do you expect that drug mix or rebates will be on par or better in '24 versus '23, given what we saw on biosimilar introduction this year? And is Cordavis really a tailwind in '24 itself? Or is it as share shifts over time?

我想回到 2024 年醫療服務的逆風和順風。對於 23 年，我們在年初的 340B 逆風之後看到了相當顯著的優異表現，你將其歸因於採購、專業和藥物組合，我將後者視為GLP-1 和生物相似藥的折扣表現。問題 1 是「23 年」與「22 年」或「24 年的前景」相比，採購效益是否過大？然後問題 2 是，考慮到我們今年推出的生物相似藥，您是否預計 24 年的藥物組合或回扣將與 23 年持平或更好？ Cordavis 真的是 24 世紀的順風車嗎？還是隨著時間的推移份額而改變？

A couple of things in there, Eric, so let me start, and David can add any color commentary. Sourcing benefits, our trade teams are exceptional. They continue to execute every year. Some of the strength that we saw in the vaccine franchise is part of their efforts and some of -- applying some of their strategies to what we do more broadly. So I wouldn't say that there's anything exceptional except for the fact that, that team is exceptional every day.

艾瑞克，其中有幾件事，讓我開始，大衛可以添加任何色彩評論。在獲取利益方面，我們的貿易團隊非常出色。他們每年都繼續執行。我們在疫苗專營權中看到的一些優勢是他們努力的一部分，並將他們的一些策略應用到我們更廣泛的工作中。所以我不會說有什麼特別之處，除了這個團隊每天都很特別之外。

Your point on drug mix and rebates I think is spot on. GLP-1s are a category that particularly with enhanced competition is going to present an excellent opportunity for us to continue to drive lowest net cost. But the way that, that's developed this year has made some of our guarantees less onerous to hit.

我認為你關於藥物組合和回扣的觀點是正確的。 GLP-1 是一個類別，特別是隨著競爭的加劇，將為我們提供一個絕佳的機會，繼續推動最低的淨成本。但今年的發展方式使得我們的一些保證變得不那麼難以實現。

And as we think about Cordavis in 2024, we absolutely believe that there will be a benefit as we drive volume through that organization.

當我們考慮 2024 年的 Cordavis 時，我們絕對相信，當我們透過該組織推動銷售時，將會帶來好處。

Final question we have time for today is from Elizabeth Anderson from Evercore ISI.

今天我們要回答的最後一個問題來自 Evercore ISI 的 Elizabeth Anderson。

I also wanted to return to some of the headwinds and tailwinds you talked about. I think previously for the HSS segment, I think you talked about sort of the poor AOI growth being like mid-single digits for 2024 in the assumptions that you put through. So I was wondering if you still -- like given all those headwinds to tell us that you're saying that, that would be sort of how you would still position that business? And then secondarily, I hear what you're saying about some of the labor investment. How do we think about that on more of a like quantitative level in terms of '24 versus obviously some of the cost savings that you mentioned on the more corporate level?

我還想回到你談到的一些逆風和順風。我認為之前對於 HSS 細分市場，我認為您談到了在您提出的假設中 2024 年 AOI 增長不佳的情況，就像中個位數一樣。所以我想知道你是否仍然——就像考慮到所有這些逆風告訴我們你所說的那樣，這將是你仍然會如何定位該業務的方式？其次，我聽到你所說的一些勞動力投資。與您提到的在企業層面上明顯節省的一些成本相比，我們如何在 24 年的類似數量層面上考慮這一點？

Yes. There's -- thanks, Elizabeth. So I think that as you think about core growth, I think that's probably the best way to start to think about this. So we do think that you should see mid-single-digit core growth out of the business. But then you've got some very specific items that kind of are pluses and minuses against that. So the first would be the loss of the Centene contract and that we've sized that for folks in the past or implicitly. But I think as you think about how well that business has performed this year, that number has become a little bit larger.

是的。有——謝謝，伊麗莎白。所以我認為，當你考慮核心成長時，我認為這可能是開始考慮這個問題的最佳方式。因此，我們確實認為您應該會看到該業務實現中個位數的核心成長。但是你會得到一些非常具體的項目，這些項目是相對的優點和缺點。因此，首先是 Centene 合約的損失，我們已經為過去或隱含的人們確定了這一點。但我認為，當你考慮今年這項業務的表現如何時，這個數字已經變得更大了。

We also -- as we talked about, we have the annualization of 340B. And so both of those will help the pressure that -- and offset some of that core growth. Offsetting that, you are going to see incremental value from Cordavis and you'll also see some of our overall cost savings that will be in the Pharmacy Services segment that will help to offset that. But I think you're probably looking at a low single-digit growth as you think about the AOI there. I mean we'll provide a lot more details on that as we get to Investor Day.

正如我們所討論的，我們還有 340B 的年化收益。因此，這兩者都將有助於緩解壓力，並抵消部分核心成長。抵消這一點，您將看到 Cordavis 的增量價值，您還將看到我們在藥房服務領域的一些總體成本節省，這將有助於抵消這一點。但我認為，當您考慮 AOI 時，您可能會看到較低的個位數成長。我的意思是，當投資者日到來時，我們將提供更多相關細節。

As we think about the labor investments, I think there are other places that we can look to try to offset those. It's clear based on the environment that this is the right thing to do, and we're committed to doing that.

當我們考慮勞動力投資時，我認為我們可以在其他地方嘗試抵消這些投資。從目前的環境來看，很明顯這是正確的做法，我們也致力於這樣做。

I would also note that over the last few years through next year, we'll have made over $1 billion investment in wages. And so we're committed to continuing that strength and making sure that we're a destination for employees.

我還要指出的是，從過去幾年到明年，我們將在薪資方面進行超過 10 億美元的投資。因此，我們致力於繼續保持這一優勢，並確保我們成為員工的目的地。

This concludes today's Q&A session. So I'll hand the call back to Karen Lynch for any concluding remarks.

今天的問答環節到此結束。因此，我會將電話轉回給凱倫·林奇 (Karen Lynch)，讓其發表結論性意見。

Yes. Thank you for joining the call. We'll see you in December in Boston. Thanks.

是的。感謝您加入通話。我們十二月在波士頓見。謝謝。

This concludes today's call. Thank you very much for you attendance. You may now disconnect your lines.

今天的電話會議到此結束。非常感謝您的出席。現在您可以斷開線路。