CVS Health Corp (CVS) 2023 Q4 法說會逐字稿

Good morning or good afternoon all, and welcome to the CVS Health Q4 2023 Earnings Results Call. My name is Adam, and I'll be your operator today. (Operator Instructions)

大家早安，下午好，歡迎參加CVS Health 2023年第四季業績電話會議。我叫亞當，今天將為您主持電話會議。 （接線生指示）

I will now hand the call to Larry McGrath to begin. So Larry, please go ahead when you're ready.

現在我將把發言權交給拉里·麥格拉斯。拉里，準備好了就請開始。

Good morning, and welcome to the CVS Health Fourth Quarter and Full Year 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, Chief Financial Officer. Following our prepared remarks, we'll host a question-and-answer session that will include additional members of our leadership team.

早安，歡迎參加 CVS Health 2023 年第四季及全年財報電話會議及網路直播。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，我與總裁兼執行長 Karen Lynch 和財務長 Tom Cowhey 一同出席。在我們準備好的發言之後，我們將舉行問答環節，其他領導團隊成員也將參與其中。

Our press release and slide presentation have been posted to our website, along with our Form 10-K filed this morning with the SEC. Today's call is also being broadcast on our website, where it will be archived for 1 year.

我們的新聞稿和幻燈片簡報已發佈到我們的網站，以及我們今天早上向美國證券交易委員會提交的10-K表格。今天的電話會議也將在我們的網站上播出，並將存檔一年。

During this call, we'll 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 Form 10-K we filed this morning.

在本次電話會議中，我們將做出一些前瞻性陳述。這些前瞻性陳述受重大風險和不確定性的影響，可能導致實際結果與目前預測結果有重大差異。我們強烈建議您查閱我們向美國證券交易委員會 (SEC) 提交的有關這些風險和不確定性的報告，特別是我們今天上午提交的 10-K 表格中關於前瞻性陳述和風險因素的警示聲明中所述的內容。

During this call, we'll 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，我們將使用非公認會計準則 (Non-GAAP) 指標來討論本公司的財務表現和財務狀況。您可以在今天早上的新聞稿以及我們網站投資者關係板塊發布的對帳文件中找到這些非公認會計準則 (Non-GAAP) 指標的對帳表。

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

說完這些，我想把電話轉給凱倫。凱倫？

Thank you, Larry. Good morning, everyone, and thanks for joining our call today. In 2023, we made strong progress on our journey, bringing together integrated health solutions that meets the needs of consumers where and when they want health care. We successfully navigated a challenging environment and delivered on our financial commitments, a powerful testament to the strength of our diversified company. We are building America's health platform, enabling access to high-quality, convenient and affordable care that supports individuals and building healthier lives.

謝謝，拉里。大家早安，感謝大家今天參加我們的電話會議。 2023年，我們在發展道路上取得了長足的進步，整合了綜合健康解決方案，滿足了消費者隨時隨地的醫療保健需求。我們成功應對了充滿挑戰的環境，並兌現了財務承諾，這有力地證明了我們多元化公司的實力。我們正在建立美國的健康平台，使人們能夠獲得高品質、便利且負擔得起的醫療服務，從而支持個人並建立更健康的生活。

In the fourth quarter of 2023, we delivered adjusted operating income of $4.2 billion and adjusted EPS of $2.12. For the full year, our total revenues were $358 billion, an increase of 11% versus the prior year. We delivered adjusted operating income of $17.5 billion and adjusted EPS of $8.74. We generated $13.4 billion of operating cash flow, demonstrating the power of our business model and supporting our strategy. This morning, we revised our full year 2024 guidance for adjusted EPS to at least $8.30 and cash flow from operations to at least $12 billion.

2023年第四季，我們實現調整後營業利潤42億美元，調整後每股收益2.12美元。全年總營收3,580億美元，較上年成長11%。調整後營業利潤175億美元，調整後每股收益8.74美元。我們創造了134億美元的營運現金流，彰顯了我們商業模式的強大，並支持了我們的策略。今天上午，我們將2024年全年調整後每股盈餘指引至少調整至8.30美元，營運現金流指引至少調整至120億美元。

While utilization pressure in Medicare Advantage continues to be attributable to the same categories we have previously highlighted, a part of which was contemplated in our 2024 guidance, we are taking a cautious stance on our outlook for Medicare Advantage utilization until we have further clarity of these industry-wide trends. Tom will provide additional details on the components of our guidance.

雖然醫療保險優勢計劃 (Medicare Advantage) 的利用率壓力仍然源於我們先前強調的相同類別，其中一部分已在我們的 2024 年指引中進行了考慮，但我們對醫療保險優勢計劃的利用率前景持謹慎態度，直到我們進一步明確這些行業趨勢。 Tom 將提供有關我們指引各組成部分的更多詳細資訊。

While the Medicare Advantage market has been challenged recently, our view of the long-term opportunity offered by this business remains unchanged. As we discussed in December, we are committed to achieving our targeted 4% to 5% margin in Medicare Advantage over time, and we will begin that journey in 2025.

儘管醫療保險優勢計劃 (Medicare Advantage) 市場近期面臨挑戰，但我們對該業務提供的長期機會的看法始終如一。正如我們去年12月討論的那樣，我們致力於逐步實現醫療保險優勢計劃 4% 至 5% 的利潤率目標，並將於 2025 年開啟這一征程。

At CVS Health, we have built the scale to transform how health care is delivered and the ability to personalize care and coverage for each individual we serve. By bringing together the powerful capabilities of our brands, including Aetna, CVS Pharmacy, CVS Healthspire and Caremark, we can deliver significant value to the customers and communities we serve and unlock tremendous potential for our shareholders.

在CVS Health，我們已建立起規模效應，從而革新了醫療保健的提供方式，並能夠為每位服務對象提供個人化的照護和保障。透過整合其品牌（包括Aetna、CVS Pharmacy、CVS Healthspire和Caremark）的強大實力，我們能夠為客戶和社群創造巨大價值，並為股東釋放巨大的潛力。

When all of our assets work together, we are able to lower the total cost of care, improve health outcome, deepen patient engagement and increase loyalty. We are able to unlock up to 3 to 4x more enterprise value when we engage members in more than one CVS Health business. Today, we have more than 55 million CVS Health customers that engage with at least two of our offerings. We see tremendous opportunities to expand engagement with customers across CVS Health through our multipayer capability and vast consumer reach.

當我們所有資產協同運作時，我們能夠降低總護理成本，改善醫療結果，深化患者參與度並提升忠誠度。當我們讓會員參與多個 CVS Health 業務時，我們能夠釋放高達 3 到 4 倍的企業價值。如今，我們擁有超過 5,500 萬 CVS Health 客戶，他們至少使用過我們兩種產品。憑藉我們的多付款方能力和廣泛的消費者覆蓋面，我們看到了擴大與 CVS Health 各客戶互動的巨大機會。

We're also creating new value in health care with innovative models and offerings that create more transparency and choice for consumers and clients. In December, we unveiled our new CVS CostVantage model in our Pharmacy & Consumer Wellness business. This model proactively addresses the persistent reimbursement pressures in the retail pharmacy industry. It eliminates cross subsidization and creates a more durable and transparent pharmacy business that is fairly compensated for value delivered to customers and patients for all prescriptions dispensed.

我們也透過創新模式和產品在醫療保健領域創造新價值，為消費者和客戶帶來更高的透明度和更多選擇。去年12月，我們在藥局和消費者健康業務中推出了全新的CVS CostVantage模式。該模式積極應對零售藥房行業持續存在的報銷壓力。它消除了交叉補貼，打造了一個更持久、更透明的藥房業務，確保客戶和患者在配發所有處方時都能獲得公平的回報。

We have made notable progress since we announced the new model in December. We recently delivered initial terms and conditions to several PBM and are actively engaged in constructive discussions. CVS CostVantage is a dramatic change to the current reimbursement model and will provide a clear pathway to greater transparency while passing along our industry-leading cost of goods improvement.

自去年12月宣布新模式以來，我們取得了顯著進展。我們最近向多家藥品福利管理公司（PBM）提交了初步條款和條件，並正在積極進行建設性討論。 CVS CostVantage 對現行報銷模式進行了重大變革，將提供一條清晰的途徑，提高報銷透明度，同時延續我們行業領先的商品成本改進成果。

We've reached preliminary agreement with multiple cash discount card administrators to begin using CVS CostVantage on April 1. This is a foundational step that sets the stage to create more predictable pricing at the pharmacy counter for consumers.

我們與多家現金折扣卡管理機構達成初步協議，並將於 4 月 1 日開始使用 CVS CostVantage。這是一個基礎性舉措，為消費者在藥局櫃檯享受更可預測的定價奠定了基礎。

We also announced our new CVS Caremark TrueCost model. This innovative client option offers pricing that reflects the true net cost of prescription drugs with continued client visibility into administrative fees. Simplified pricing will help consumers be more confident that their pharmacy benefit provides the best possible price and ensures members have stable access to our national pharmacy network.

我們也宣布了全新的 CVS Caremark TrueCost 定價模式。這項創新的客戶選項提供反映處方藥真實淨成本的定價，並讓客戶持續了解管理費用。簡化的定價將幫助消費者更加確信他們的藥房福利提供了最優惠的價格，並確保會員能夠穩定地訪問我們的全國藥房網路。

Finally, we continue to drive greater adoption of biosimilars and increase the affordability of these critical specialty drugs for our clients and their members. Beginning on April 1, Caremark will remove HUMIRA from a major commercial template formulary. Through Cordavis, we will offer a co-branded HUMIRA product. Cordavis plays an important role in reducing drug costs while helping to ensure a consistent supply of affordable, high-quality biosimilars for the patients we serve.

最後，我們將繼續推動生物相似藥的廣泛應用，並提高我們的客戶及其會員對這些關鍵專科藥物的可負擔性。從4月1日起，Caremark將從主要商業模板處方集中移除HUMIRA。我們將透過Cordavis提供一款HUMIRA聯合品牌產品。 Cordavis在降低藥品成本方面發揮著重要作用，同時確保我們服務的患者能夠持續獲得價格合理、高品質的生物相似藥。

These steps are truly innovative and will be pivotal as we look to unlock the tremendous value that new pharmacy models and offerings will deliver for our clients and their members.

這些舉措確實具有創新性，並且在我們尋求釋放新的藥房模式和服務將為我們的客戶及其會員帶來的巨大價值時至關重要。

We are passionate about expanding access to care, lowering costs, improving health outcomes and creating more transparency and choice for consumers. Our colleagues are committed to this important purpose and will deliver on these goals.

我們熱衷於擴大醫療服務的可近性，降低成本，改善醫療效果，並為消費者創造更高的透明度和更多選擇。我們的同事致力於實現這一重要目標，並將不遺餘力地實現這些目標。

I'll now turn to the highlights from each of our businesses in the quarter. In our Health Care Benefits segment, we continue to navigate through elevated utilization trends in our Medicare Advantage business. In the quarter, we grew revenues to nearly $27 billion, an increase of over 16% and delivered adjusted operating income of $676 million. Medical membership ended the year at 25.7 million, an increase of 1.3 million members versus the prior year, reflecting growth across multiple product lines, including individual exchange, Medicare and commercial.

現在，我將介紹本季我們各項業務的亮點。在醫療保健福利部門，我們繼續應對醫療保險優勢計劃 (Medicare Advantage) 業務利用率上升的趨勢。本季度，我們的營收成長至近 270 億美元，增幅超過 16%，調整後營業利潤達 6.76 億美元。截至年底，醫療會員人數達 2,570 萬，較上年增加 130 萬，這反映了包括個人交易所、醫療保險和商業保險在內的多個產品線的成長。

Medicare Advantage is integral to the CVS Health strategy. After a very successful 2024 annual enrollment period, we expect to add at least 800,000 new members in 2024. Our success was driven by targeted investments that were strengthened by CVS Health assets and allowed us to create differentiated value for members. We are improving member experiences by focusing on simplicity, offering unique design and maintaining stable network.

Medicare Advantage 是 CVS Health 策略的重要組成部分。在 2024 年年度註冊期間取得巨大成功之後，我們預計 2024 年將新增至少 80 萬名會員。我們的成功源自於有針對性的投資，這些投資得到了 CVS Health 資產的強化，使我們能夠為會員創造差異化的價值。我們致力於透過簡化流程、提供獨特的設計並維護穩定的網路來提升會員體驗。

Last week, we received the proposed 2025 rate notice. The funding level was broadly consistent with our expectation, which we do not believe is sufficient to cover current medical cost trends. We believe that the changes to Part D as a consequence of the Inflation Reduction Act necessitate additional funding to cover the comprehensive member benefits provided and the increased risk that plans are assuming as a result of the redesign. We look forward to providing our comments to CMS in the coming weeks.

上週，我們收到了2025年擬議費率通知。資金水準與我們的預期大致一致，但我們認為這不足以涵蓋當前的醫療成本趨勢。我們認為，由於《降低通貨膨脹法案》對D部分的修改，需要額外資金來涵蓋提供的綜合會員福利以及重新設計後計劃承擔的更高風險。我們期待在未來幾週內向CMS提交我們的意見。

In our Health Services segment, CVS Healthspire, revenues grew to more than $49 billion in the quarter, an increase of more than 12%, reflecting strong growth in our Pharmacy Services business as well as the acquisitions of Oak Street and Signify Health. Adjusted operating income grew more than 4% to nearly $1.9 billion.

在我們的健康服務部門CVS Healthspire，本季營收成長至超過490億美元，增幅超過12%，這反映了我們藥局服務業務的強勁成長，以及對Oak Street和Signify Health的收購。調整後營業收入成長超過4%，達到近19億美元。

In our Caremark business, we recently completed a highly successful welcome season. We onboarded more than 3 million new members and ensured our patients had access to their critical medications and specialty therapies. Our consistent ability to deliver exceptional customer member experience is what makes Caremark a leader in the marketplace.

在 Caremark 業務方面，我們最近迎來了一個非常成功的迎新季。我們吸收了超過 300 萬名新會員，並確保我們的患者能夠獲得他們所需的關鍵藥物和專科治療。我們始終如一地提供卓越的客戶會員體驗，正是這一點使 Caremark 成為市場領導者。

We continue to drive success in our Health Care Delivery business. We have tremendous momentum engaging multipayer Medicare Advantage members with Oak Street Clinic through our extensive CVS Health touch points. Oak Street ended the year with 202,000 at-risk lives, an increase of 27% versus the prior year. Through January, the number of Aetna members enrolled in Oak Street Clinic has doubled.

我們持續推動醫療保健服務業務的成功。我們透過遍佈各地的CVS Health接觸點，積極推動多付款人Medicare Advantage會員加入Oak Street Clinic，勢頭強勁。 Oak Street診所截至今年底，共有20.2萬名高危險群，較前一年成長27%。截至1月份，加入Oak Street Clinic的Aetna會員數量已翻倍。

Signify Health continues to demonstrate the value of its in-home capabilities for all of our multipayer Medicare Advantage partner. Signify completed 649,000 in-home evaluations in the quarter, an increase of 20% versus the same period last year. Among our Aetna customers, we are broadening our addressable market, utilizing Signify's strong capabilities and other products, including individual exchange and Medicaid. We'll be expanding these capabilities with other clients and will deliver value by engaging consumers and their health across multiple channels.

Signify Health 繼續向我們所有多付款人 Medicare Advantage 合作夥伴展示其上門服務的價值。 Signify 本季完成了 64.9 萬次上門評估，年增 20%。在安泰 (Aetna) 客戶中，我們正在利用 Signify 強大的服務能力和其他產品（包括個人交換和醫療補助 (Medicaid)）拓展我們的目標市場。我們將與其他客戶拓展這些服務，並透過多種管道吸引消費者並關注他們的健康狀況來創造價值。

In our Pharmacy & Consumer Wellness segment, which serves more than 120 million customers, revenues grew to more than $31 billion, an increase of nearly 9% versus the prior year. We generated $2 billion of adjusted operating income in the quarter, up nearly 10% versus the prior year. PCW's performance in the fourth quarter was driven by strong operational execution. We continue to play an important role in providing access to critical immunization in the communities we serve and delivered on pharmacy performance measures for our health plan partners.

我們的藥局和消費者健康部門服務超過1.2億客戶，營收成長至超過310億美元，較上年成長近9%。本季度，我們實現了20億美元的調整後營業收入，較上年增長近10%。 PCW第四季的業績得益於強大的營運執行力。我們繼續在為所服務社區提供關鍵免疫接種方面發揮重要作用，並致力於為我們的醫療計劃合作夥伴提供藥房績效指標。

We made progress executing on our store closure initiative, having closed 630 stores to date and are on track to close 900 by the end of the year. On a comparable basis, total same store sales were up more than 11% versus the same quarter in the prior year. Same-store prescription volumes in the quarter were up more than 4% versus last year.

我們在關閉門市計畫的執行上取得了進展，迄今已關閉630家門市，並預計在年底前關閉900家。以可比口徑計算，本季同店總銷售額較去年同期成長逾11%。本季同店處方量較去年同期增加逾4%。

2023 highlighted our exceptional execution and the power of our diversified business. Our financial performance and differentiated strategy creates strong momentum into 2024. Our integrated health model grows in relevance and importance every day for the consumers, customers, communities and the shareholders we serve.

2023年彰顯了我們卓越的執行力和多元化業務的強勁實力。我們的財務業績和差異化策略為2024年創造了強勁發展動能。對於我們服務的消費者、客戶、社區和股東而言，我們的綜合健康模式的相關性和重要性日益提升。

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

現在我將把電話轉給湯姆，讓他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 fourth quarter results truly highlight our unwavering focus on execution and the power of our diversified businesses. We ended the year with strong results in key metrics such as revenue, adjusted earnings per share and cash flow from operations.

謝謝凱倫，大家早安。我們第四季的業績充分體現了我們對執行力的堅定關注以及多元化業務的強勁實力。我們在營收、調整後每股盈餘和經營現金流等關鍵指標上取得了強勁的業績，為今年畫上了圓滿的句號。

A few total company highlights. Fourth quarter revenues of nearly $94 billion increased by nearly 12% over the prior year quarter, reflecting strong growth across each of our businesses. We delivered adjusted operating income of approximately $4.2 billion and adjusted EPS of $2.12, representing growth of approximately 4% versus the prior year. These increases were primarily due to strong results in our Pharmacy & Consumer Wellness and Pharmacy Services businesses as well as lower corporate expenses, partially offset by continued pressure in Health Care Benefits. Our ability to generate cash remains outstanding with full year cash flow from operations of $13.4 billion.

以下是公司部分亮點。第四季營收近940億美元，較去年同期成長近12%，反映出我們各項業務的強勁成長。調整後營業利潤約42億美元，調整後每股收益為2.12美元，較去年同期成長約4%。這些成長主要得益於藥局與消費者健康業務和藥局服務業務的強勁業績，以及公司支出的降低，但醫療保健福利業務的持續壓力部分抵消了這些成長。我們創造現金的能力依然出色，全年營運現金流達134億美元。

Shifting to details for our Health Care Benefits segment. We delivered another strong quarter of revenue growth versus the prior year. Fourth quarter revenue of $26.7 billion increased more than 16% year-over-year, reflecting growth across all product lines particularly in our individual exchange and Medicare businesses. Membership was 25.7 million, a slight decrease of 29,000 members sequentially, reflecting the impact of Medicaid redeterminations, partially offset by growth in individual exchange.

轉至醫療保健福利部門的詳情。我們本季的營收較上年同期再次強勁成長。第四季營收267億美元，年增超過16%，這反映了所有產品線的成長，尤其是個人交易所和聯邦醫療保險（Medicare）業務的成長。會員人數為2570萬，環比略微減少2.9萬，這反映了醫療補助（Medicaid）重新認定的影響，但個人交易所的增長部分抵消了這一影響。

Adjusted operating income for the fourth quarter was $676 million. The decline in adjusted operating income versus the prior year was primarily driven by growth in the individual exchange business, including the related impact of seasonality and increased utilization in Medicare Advantage, partially offset by higher net investment income.

第四季調整後營業收入為6.76億美元。調整後營業收入較上年同期的下降主要由於個人交易業務的增長，包括季節性因素以及聯邦醫療保險優勢計劃（M​​edicare Advantage）使用率的提高，但淨投資收益的增加部分抵消了這一影響。

Our medical benefit ratio of 88.5% increased 270 basis points from the prior year quarter, primarily reflecting higher Medicare Advantage utilization and a lower contribution from positive prior period development. Utilization pressure continues to be attributable to the same categories we highlighted in the previous quarter, including outpatient and supplemental benefits such as dental and vision. We also saw an uptick in costs related to seasonal immunizations, including the newly launched RSV vaccine. Other categories remain largely consistent with our previous medical cost trend assumptions.

我們的醫療福利比率為88.5%，較去年同期上升了270個基點，主要反映了聯邦醫療保險優勢計劃（M​​edicare Advantage）利用率的提高以及前期積極發展帶來的貢獻下降。使用率壓力仍然源於我們上一季重點關注的類別，包括門診以及牙科和視力等補充福利。我們也發現與季節性免疫接種相關的成本上升，包括新推出的呼吸道合胞病毒（RSV）疫苗。其他類別與我們先前的醫療成本趨勢假設基本一致。

Days claims payable at the end of the quarter was 45.9, down 4.4 days sequentially and returning to normalized levels consistent with what we experienced in pre-COVID periods after adjusting for the impact of Medicaid pass-through payments. Overall, we remain confident in the adequacy of our reserves.

本季末的理賠應付天數為45.9天，季減4.4天，在調整醫療補助轉付的影響後，已恢復到與新冠疫情前時期一致的正常水準。總體而言，我們對儲備金的充足性仍然充滿信心。

Our Health Services segment, which includes our Pharmacy Services and Health Care Delivery businesses, generated revenue of approximately $49 billion, an increase of more than 12% 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（包括藥局服務和醫療保健配送業務）創造了約490億美元的收入，年增超過12%。這一增長主要得益於藥房藥品組合、專科藥房業務的成長、品牌擴張以及Signify和Oak Street的加入。這些成長部分被持續的客戶價格改善所抵消。

Adjusted operating income of nearly $1.9 billion grew approximately 4% year-over-year primarily driven by improved purchasing economics and growth in specialty pharmacy, partially offset by ongoing client price improvements.

調整後的營業收入接近 19 億美元，年增約 4%，主要原因是採購經濟狀況改善和專業藥局業務成長，但客戶價格持續改善部分抵銷了這一成長。

Total pharmacy claims processed in the quarter increased slightly versus the prior year. The increase was primarily driven by net new business and increased utilization. The increase was largely offset by the impact of the New York Medicaid carve-out. Total pharmacy membership as of January 1, 2024, is approximately 89 million members, down primarily due to the previously announced loss of a large client.

本季處理的藥局理賠總額較上年略有成長。成長主要得益於淨新增業務和利用率的提升。但這一增長在很大程度上被紐約州醫療補助計劃（Medicaid）豁免的影響所抵消。截至2024年1月1日，藥局會員總數約8,900萬，下降的主因是先前宣布失去一位大客戶。

We continue to be encouraged by the performance and growth of our Health Care Delivery assets. Signify generated revenue growth of 39% in the quarter compared to last year. Oak Street ended the quarter with 204 centers, an increase of 35 centers in 2023. We continue to expect to add 50 to 60 centers in 2024. Oak Street also significantly increased revenue in the quarter, growing 36% compared to the same quarter last year.

我們醫療服務交付業務的表現和成長持續鼓舞著我們。 Signify 本季營收年增 39%。 Oak Street 截至本季末擁有 204 家醫療中心，預計 2023 年將增加 35 家。我們預計 2024 年將新增 50 至 60 家醫療中心。 Oak Street 本季營收也大幅成長，年增 36%。

Shifting to our Pharmacy & Consumer Wellness segments. We generated revenue of over $31 billion, up nearly 9% versus the prior year and over 11% on a same-store basis, reflecting the impact of pharmacy drug mix, increased prescription volume, brand inflation and increased contributions from vaccinations. These revenue increases were partially offset by the impact of recent generic introductions, continued reimbursement pressure and a decrease in store counts.

轉向我們的藥房和消費者健康業務。我們實現了超過310億美元的收入，年增近9%，同店銷售額成長超過11%，這反映了藥局藥品組合、處方量成長、品牌藥價格上漲以及疫苗接種貢獻增加的影響。這些收入成長被近期仿製藥的推出、持續的報銷壓力以及門市數量減少的影響部分抵消。

Adjusted operating income was approximately $2 billion, an increase of nearly 10% versus the prior year, driven by improved drug purchasing, increased contributions from vaccinations, the increased prescription volume described above and lower operating expenses. These increases were partially offset by continued pharmacy reimbursement pressure. Same-store pharmacy sales were up 15.5% versus the prior year and same-store prescription volumes increased by 4.4%. Same-store sales in front store were down by about 3% versus the same quarter last year.

調整後營業收入約20億美元，較上年增加近10%，主要得益於藥品採購改善、疫苗接種補貼增加、上述處方量增加、營運費用下降。這些增長部分被持續的藥房報銷壓力所抵消。同店藥局銷售額較上年成長15.5%，同店處方量成長4.4%。門市同店銷售額較上年同期下降約3%。

Shifting to the balance sheet. Our liquidity and capital position remained excellent. Our ability to generate cash flow remains a core strength of our organization. Full year 2023 cash flow from operations were $13.4 billion. We ended the year with approximately $735 million of cash at the parent and unrestricted subsidiaries. We remain committed to maintaining our current investment-grade ratings while preserving flexibility to deploy capital strategically.

再來看看資產負債表。我們的流動性和資本狀況依然出色。我們創造現金流的能力仍然是我們公司的核心優勢。 2023年全年營運現金流為134億美元。截至年底，母公司和非限制性子公司的現金餘額約為7.35億美元。我們將繼續致力於維持目前的投資等級評級，同時保持策略性資本配置的靈活性。

In the fourth quarter, we returned $779 million to shareholders through our quarterly dividend. We also entered into a $3 billion fixed dollar accelerated share repurchase transaction, which became effective on January 3, 2024.

第四季度，我們透過季度股利向股東返還了7.79億美元。我們也達成了一項30億美元固定金額加速股票回購交易，該交易於2024年1月3日生效。

Turning now to our full year outlook for 2024. In recognition of the marketplace uncertainty around utilization trends in Medicare Advantage, we revised our 2024 adjusted EPS guidance to at least $8.30. In the Health Care Benefits segment, we now expect our 2024 medical benefit ratio to be approximately 87.7%, an increase of 50 basis points from our previous guidance.

現在回顧我們對2024年全年的展望。鑑於市場對醫療保險優勢計劃（M​​edicare Advantage）使用趨勢的不確定性，我們將2024年調整後每股收益指引至少修訂至8.30美元。在醫療保健福利部門，我們目前預計2024年的醫療福利比率約為87.7%，較先前的指引增加50個基點。

As I already noted, we observed elevated medical cost trends in our Medicare Advantage business in the fourth quarter, which pressured our full year 2023 medical benefit ratio by approximately 10 basis points relative to our prior guidance. The remaining pressure in the quarter was largely a function of mix and higher revenue offsets than we previously projected.

正如我之前提到的，我們觀察到第四季度醫療保險優勢計劃 (Medicare Advantage) 業務的醫療成本趨勢上升，這導致我們2023年全年的醫療福利比率較之前的預期下降了約10個基點。本季剩餘的壓力主要源自於產品組合以及高於我們先前預期的營收抵銷。

Based on our review of our recently completed fourth quarter 2023 medical cost trend analysis, we're prudently assuming that the elevated medical cost trends we observed in the fourth quarter will carry forward into 2024. Accordingly, we have increased our full year 2024 MBR guidance by approximately 40 basis points to account for this pressure.

根據我們對最近完成的 2023 年第四季度醫療成本趨勢分析的審查，我們謹慎地假設我們在第四季度觀察到的醫療成本上升趨勢將延續到 2024 年。因此，我們將 2024 年全年 MBR 指導提高了約 40 個基點，以應對這一壓力。

As discussed throughout 2023, we had included a provision for elevated utilization in our 2024 medical benefit ratio guidance and we'll continue to hold that provision until we have more clarity on the Medicare Advantage utilization environment. Our revised outlook also reflects an expectation of at least 800,000 new Medicare Advantage members in 2024.

正如我們在2023年全年討論的那樣，我們在2024年醫療福利比率指引中納入了一項針對高利用率的準備金，並且我們將繼續保留該準備金，直到我們對聯邦醫療保險優勢計劃（M​​edicare Advantage）的利用環境有了更清晰的了解。我們修訂後的展望也反映了預計2024年將至少新增80萬名聯邦醫療保險優勢計畫（Medicare Advantage）會員。

As we have previously discussed, the profile of these new members is attractive, with nearly 3/4 of these members switching from other Medicare plans and about 1/3 of members expected in D-SNP plans. We continue to expect these new members will be neutral to earnings, but the mix impact from incremental new membership represents approximately 10 basis points of today's 2024 MBR guidance revision. When combined with the additional 40 basis points of medical cost pressure we are projecting, we have increased our 2024 MBR projection by 50 basis points to 87.7%.

正如我們先前所討論的，這些新成員的組成頗具吸引力，其中近四分之三的成員是從其他Medicare計劃轉入的，預計約有三分之一的成員將加入D-SNP計劃。我們仍預期這些新成員對獲利的影響將為中性，但新增成員帶來的綜合影響約佔目前2024年MBR指引修訂的10個基點。加上我們預測的額外40個基點的醫療成本壓力，我們將2024年MBR預測上調了50個基點，達到87.7%。

We anticipate a number of favorable items will partially offset the impact of the expected elevated utilization levels including higher investment income and higher-than-previously projected commercial membership. Adding up all the pieces, we now expect adjusted operating income for the Health Care Benefits segment to be at least $5.4 billion, a decrease of $370 million from our prior estimates.

我們預計，一系列利多因素將部分抵消預期利用率上升的影響，包括更高的投資收益和高於先前預期的商業會員數量。綜合所有因素，我們目前預期醫療保健福利部門的調整後營業利潤至少為54億美元，較先前的預期減少3.7億美元。

In our Pharmacy & Consumer Wellness segment, we now expect a portion of the outperformance from the end of 2023 to persist into 2024. As a result, we now project adjusted operating income of at least $5.6 billion, an increase of approximately $90 million from our prior guidance.

在我們的藥品和消費者保健部門，我們現在預計 2023 年底的部分優異表現將持續到 2024 年。因此，我們現在預計調整後的營業收入至少為 56 億美元，比我們先前預期的增加約 9,000 萬美元。

In our Health Services segment, we're updating 2024 adjusted operating income to at least $7.4 billion, a decrease of approximately $90 million. While our Health Care Delivery businesses were able to successfully manage through medical cost trend pressures in 2023, we think it is prudent to recognize the potential for emerging risks on our payer partners until we have further clarity on 2024 utilization trends.

在醫療服務部門，我們將2024年調整後營業收入更新至至少74億美元，減少約9,000萬美元。雖然我們的醫療保健服務業務在2023年成功應對了醫療成本趨勢壓力，但我們認為，在2024年利用趨勢進一步明朗之前，謹慎地認識到付款方合作夥伴可能面臨的新風險。

Finally, we've made a corresponding adjustment to cash flow from operations, which we now project will be at least $12 billion this year.

最後，我們對經營現金流進行了相應的調整，我們預計今年的經營現金流將至少達到 120 億美元。

As you think about the cadence of earnings in 2024, we expect to generate less than 50% of our adjusted EPS in the first half. More specifically, we expect to generate roughly 20% of full year adjusted EPS in the first quarter. This pattern will be different than 2023, primarily due to the way Medicare Advantage utilization emerged over the course of 2023 and the timing and impact of prior period development. As a result, Health Care Benefits' 2024 MBR will see the largest year-over-year increase in the first quarter and the smallest in the fourth quarter. You can find additional details on the components of our updated 2024 guidance on our Investor Relations web page.

考慮到2024年的獲利節奏，我們預計上半年的調整後每股盈餘將佔全年調整後每股盈餘的不到50%。更具體地說，我們預計第一季的調整後每股收益將佔全年調整後每股收益的約20%。此模式將與2023年有所不同，主要原因是2023年期間醫療保險優勢計畫（Medicare Advantage）的使用情況，以及前期發展的時間和影響。因此，醫療保健福利部門2024年的MBR將在第一季實現最大的年增幅，在第四季實現最小的增幅。您可以在我們的投資者關係網頁上找到有關我們更新後的2024年指引各組成部分的更多詳細資訊。

Beyond 2024, we are committed to returning our Medicare Advantage margins to our target of 4% to 5% while also preserving the projected returns on capital for our 2023 acquisitions. Our Stars recovery in 2025 will enhance our earnings trajectory even as we work to adjust our plans to account for the preliminary 2025 Medicare Advantage rate notice, which does not adequately cover recent medical cost trends. For 2025, our goal is to deliver low double-digit adjusted EPS growth of our updated 2024 guidance. We expect to update investors later this year on our progress against this goal.

2024年之後，我們致力於將聯邦醫療保險優勢計劃（M​​edicare Advantage）的利潤率恢復到4%至5%的目標水平，同時保持2023年收購項目預期的資本回報率。 2025年，明星計劃（Stars）的復甦將提升我們的盈利軌跡，儘管我們正在努力調整計劃，以反映2025年聯邦醫療保險優勢計劃（M​​edicare Advantage）初步費率通知，該通知未能充分反映近期的醫療成本趨勢。 2025年，我們的目標是實現與2024年更新後的指引相比，低兩位數的調整後每股盈餘成長。我們預計將在今年稍後向投資者匯報實現這一目標的進展。

To conclude, 2023 was a year where CVS Health demonstrated the power of our diversified enterprise. As we begin 2024, we remain focused on operational execution and sustainable growth as we advance our goal of becoming the leading health solutions company for consumers.

總而言之，2023年是CVS Health展現多元化企業實力的一年。在2024年伊始，我們將繼續專注於營運執行和永續成長，並努力推動成為領先的消費者健康解決方案公司的目標。

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

好了，我們現在開始回答你們的問題。接線生？

(Operator Instructions) Our first question today comes from Lisa Gill from JPMorgan.

（操作員指示）我們今天的第一個問題來自摩根大通的麗莎吉爾。

Tom, thanks for all of that color. But I just want to go a little bit deeper and just really understand how do I think about what happened in the fourth quarter, how that is influencing how you're thinking about 2024? What happened from your Investor Day in December that's really influencing this? Did you see claims coming in throughout December that's influencing how you're thinking about '24?

湯姆，謝謝你的詳盡分析。但我想更深入地談談，真正了解我如何看待第四季發生的事情，以及這些事情如何影響你對2024年的展望？ 12月投資者日期間發生了什麼，對你的影響有多大？ 12月份的索賠申請是否影響了你對2024年的展望？

And then you touched a little bit on this around the new members and the fact that they're switchers and the impact there. But just wondering if you can give us any more color on how to think about the risk coding and the level of comfort that you have there, just dipping just 10 basis points with adding so much membership.

然後您稍微談到了新成員、他們的轉換情況以及由此帶來的影響。您能否進一步解釋一下，如何看待風險編碼，以及在新增如此多成員的情況下，僅降低10個基點的風險係數，您對此的承受程度如何？

And then just lastly, how do I think about medical cost trend versus supplemental benefits when we think about '24?

最後，當我們考慮 24 年時，我該如何看待醫療成本趨勢與補充福利？

Sure. Maybe -- thanks, Lisa. Maybe I'll take the first part of that, and I'll ask Brian to take the back parts. So as you think about what changed from our Investor Day, we actually saw really high levels of paid claims in the back half of December. And we noted that when we appeared at your conference in January.

當然。也許吧——謝謝，麗莎。也許我會負責第一部分，然後請布萊恩負責後面的部分。所以，想想與投資者日相比有什麼變化，我們在12月下半月的已付理賠金額其實非常高。我們在1月參加你們的會議時就提到了這一點。

As we dove deeper into what went on in the fourth quarter -- maybe let me just walk you through kind of what we've seen in aggregate. So if you start with the fourth quarter of 2023 and just let's think about its impact on the full year performance. So we ended the year at 86.2%, which was about 20 basis points higher than our guidance. Roughly half of that pressure is things that we do not believe should carry into 2024. So key drivers of that would be things like Medicaid pass-through payments and also higher SEP membership. As you know, once redeterminations start to end in the first half, we shouldn't see that same sort of pressure in the back half of this year. And we've also repositioned our portfolio across the board in individual.

隨著我們深入探討第四季的情況，或許我可以簡單介紹一下我們整體上看到的情況。如果從2023年第四季開始，我們來思考一下它對全年業績的影響。我們截至年底的業績為86.2%，比我們的預期高出約20個基點。我們認為，大約一半的壓力不會延續到2024年。因此，造成這種影響的關鍵因素包括醫療補助轉付以及更高的SEP會員人數。如你所知，一旦上半年重新認定開始結束，我們應該不會在今年下半年看到相同的壓力。此外，我們也對各個業務的投資組合進行了全面調整。

As you think about the other half, that 10 basis points, that's all related to the trend pressure that we saw in Medicare. So it's a lot of the same categories, though, that we've been talking about all year and that we've been trying to actively get ahead of in our guidance. So outpatient trend accelerated slightly in the fourth quarter, so hips and knees. We also continue to see elevated trends in supplemental benefits, but really it's more dental and vision than the OTC cards that we talked about earlier this year. And finally, we saw some pressure in the quarter from vaccinations, which is really RSV related.

至於另一半，也就是那10個基點，這都與我們在聯邦醫療保險（Medicare）中看到的趨勢壓力有關。所以，很多類別與我們全年都在討論的、並且我們一直努力在指引中積極領先於這些類別的趨勢相同。第四季門診趨勢略有加快，例如髖關節和膝關節疾病。我們也繼續看到補充福利的上升趨勢，但實際上更多的是牙科和視力保險，而不是我們今年早些時候談到的非處方藥卡。最後，我們在本季看到了來自疫苗接種的一些壓力，這實際上與呼吸道合胞病毒（RSV）有關。

As we look across the other categories, the cost trends themselves on a dollar basis, they're essentially in line with where it is that we thought that they would be.

當我們查看其他類別時，以美元為基礎的成本趨勢本身與我們預想的水平基本一致。

So how does that translate then into '24? We've taken that 10 basis points of pressure, and we've pulled it through into the 2024 baseline. So accordingly, we've increased our estimate for medical costs by over $400 million in our forward guidance for '24.

那麼，這如何轉化為2024年呢？我們已將10個基點的壓力轉化為2024年的基準。因此，我們在2024年的前瞻性指引中將醫療成本預估提高了4億多美元。

With the additional mix impacts from the new members, that additional 200,000 plus that we've talked about since Investor Day, we think that, that gets you to about a 50 basis point increase, which is the totality of what we've done this morning.

考慮到新成員帶來的額外組合影響，即自投資者日以來我們討論過的新增 20 多萬成員，我們認為這將使利率增加約 50 個基點，這就是我們今天上午所做的全部工作。

As I said in the prepared remarks, I'd just remind you, when we first started talking about our guidance for 2024 at the second quarter call, we talked about putting an additional provision into 2024 for enhanced utilization. We've maintained that provision in our guidance. And so we hope that, that will be a prudent posture but we want to see where trends are going to settle.

正如我在準備好的發言中所說，我只是想提醒大家，當我們在第二季度電話會議上首次討論2024年的業績指引時，我們曾提到要在2024年增加一項撥備，以提高利用率。我們在業績指引中保留了這項撥備。因此，我們希望這是一種審慎的姿態，但我們希望看到趨勢最終會穩定下來。

I'd also just note that as you think about the Medicare business now, that book is now only projected to be marginally profitable in 2024, and that's something that we will actively be looking to address with our 2025 bids. I'll turn it over to Brian.

我還要指出的是，考慮到您現在對醫療保險業務的考慮，預計到2024年，該業務的盈利能力將僅略有提升，而這正是我們將在2025年的競標中積極尋求解決的問題。現在，我把時間交給布萊恩。

Yes. I would just add on the new members, Lisa, to your question. There's nothing that we've seen in those new members that would give us pause. The risk scores look reasonable. The fact that so many of the members are switchers is a really important component of that. The fact that we have a big portion that are D-SNPs, 1/3, as Tom mentioned in his remarks, matters because we don't have a Stars issue in that book of business. So overall, we feel good about the new membership.

是的。麗莎，我想補充新成員的狀況。我們在這些新成員身上沒有發現任何值得我們質疑的地方。風險評分看起來很合理。很多成員都是轉換型成員，這是一個非常重要的因素。正如湯姆在演講中提到的，我們有很大一部分成員是D-SNP，佔1/3，這一點很重要，因為我們在業務方面沒有遇到Stars問題。所以總的來說，我們對新成員的加入感到滿意。

And I would just add that, that new membership also has a very important tailwind for 2025 as those members get coded next year and as the cost of the distribution wear off for 2025. So we feel very good about the new members that we received. There's nothing that we've seen that gives us pause there. And we think everything is fully reflected in our 2024 guide, as Tom went through.

我想補充一點，新成員的加入對2025年的發展也起到了非常重要的推動作用，因為這些成員明年就會開始編碼，而且2025年分銷成本也會逐漸降低。因此，我們對新成員的加入感到非常滿意。到目前為止，我們沒有發現任何讓我們猶豫不決的情況。正如湯姆所說，我們認為2024年的指南已經充分反映了這一點。

With respect to your question on supplemental benefits, we believe we've fully reflected the cost of those benefits in our '24 guide. We mentioned on the last quarterly call that we've effectively assumed full utilization of those flex cards that were giving us a lot of challenges this year. And the dental- and vision-type pressure has also been fully reflected in our guide.

關於您關於補充福利的問題，我們認為我們已經在24年指南中充分反映了這些福利的成本。我們在上次季度電話會議上提到，我們實際上已經假設了那些彈性卡的充分利用，這些卡今年給我們帶來了許多挑戰。牙科和視力方面的壓力也已充分反映在我們的指南中。

Again, we feel good, as Tom said, that we fully reflected the '23 baseline in our '24 numbers. We put a normalized, very reasonable trend on top of that baseline. And today, we put additional dollars on top of that through the increase in the MBR. So all in all, we feel good about how we're positioned for '24.

正如湯姆所說，我們再次感到欣慰，2024年的數據充分反映了2023年的基線。我們在此基線上建立了一個非常合理的、標準化的趨勢。今天，我們透過提高MBR（每月收入比率）在此基礎上投入了更多資金。總而言之，我們對2024年的業績表現感到滿意。

Yes. And Lisa, I just want to reemphasize the point that Tom made about 2025, and I said this in our prepared remarks, that we are committed for margin recovery in Medicare Advantage for 2025, and we'll account for that in our bids.

是的。麗莎，我只想再次強調湯姆關於2025年的觀點，我在準備好的發言中也提到過，我們致力於在2025年恢復醫療保險優勢計劃的利潤率，我們會在投標中考慮到這一點。

The next question comes from Justin Lake from Wolfe Research.

下一個問題來自 Wolfe Research 的 Justin Lake。

I wanted to ask about the 2025 bidding strategy. And specifically, I know you're going to get some tailwind in margin improvement from Stars in 2025. I want to talk beyond that. I found your comments helpful on the rates, and I know that could be a pressure and that's going to cause benefit reductions. But beyond that, do you expect to cut benefits beyond whatever the rates would suggest to start recapturing margin beyond Stars for the higher cost trend? How should we think about that positioning for 2025? And how quickly do you think you get back to that 4% to 5% margin?

我想問2025年的競標策略。具體來說，我知道到2025年，Stars的利潤率會有所提升，這對你們來說會是利好。我想進一步談談。我發現您對費率的評論很有幫助，我知道這可能會帶來壓力，並導致福利減少。但除此之外，您是否預計會削減福利，使其超出費率所建議的範圍，以便在成本上升的趨勢下，開始在Stars之外重新獲得利潤？我們該如何看待2025年的定位？您認為多久才能恢復到4%到5%的利潤率？

Justin, it's Karen, and I'll hand this over to Brian in a second, but I just want to comment on the rate notice because that's critical to how we think about 2025 bids. There's kind of three things I would say here. One is we believe it's in line with our expectations relative to being flat. However, we do not believe it covers overall cost trends that have been emerging in Medicare Advantage. We also know that there's complexity around the risk model. And so we'll be contemplating that as we think about our bids.

賈斯汀，我是凱倫，我一會兒就把發言權交給布萊恩。我只想就費率通知發表意見，因為這對我們思考2025年的投標至關重要。我想說三點。首先，我們認為它符合我們關於持平的預期。然而，我們認為它並沒有涵蓋醫療保險優勢計劃（M​​edicare Advantage）中出現的整體成本趨勢。我們也知道風險模型很複雜。因此，在考慮投標時，我們會考慮到這一點。

And then finally, there's some uncertainty around how the Inflation Reduction Act impacts Part D, and that we'll be taking that under consideration when we do our bids as well and providing comments to CMS relative to these points. So all of those will factor in to our bid process, but we will be driving for margin recovery. And let me have Brian specifically answer your detail question.

最後，關於《通膨削減法案》對D部分的影響存在一些不確定性，我們在投標時也會考慮到這一點，並就這些方面向CMS提供意見。所有這些因素都會影響我們的投標流程，但我們會努力提高利潤率。請Brian具體回答您的具體問題。

Sure. Thanks, Karen. And I'll just reiterate again that we are committed to the 4% to 5% margin. It's top of mind and extremely important that we get there. As we've said multiple times, it will be a multiyear journey to get there, but we intend to take significant ground against that target in 2025, while also being very disciplined and reflecting the trends that we see in our business to make sure that's fully reflected in the pricing.

當然。謝謝，凱倫。我再次重申，我們致力於實現4%到5%的利潤率。這是我們的首要任務，也至關重要。正如我們多次強調的那樣，實現這一目標將需要多年的時間，但我們計劃在2025年實現這一目標，同時嚴格遵守公司業務的趨勢，確保其在定價中得到充分體現。

Karen mentioned some of the headwinds with respect to the rate notice and that we don't believe it fully reflects medical trend. There are some issues around Part D that we need to work through as the benefit has been meaningfully enhanced as part of the IRA. And also we, as an industry, are taking on meaningfully more risk in the catastrophic layer that will have to be reflected in our bids, and that's something we intend to do.

Karen 提到了與費率通知相關的一些阻力，我們認為它並未完全反映醫療趨勢。 D 部分存在一些問題，我們需要解決，因為該福利作為 IRA 的一部分已經得到了顯著提升。此外，作為一個行業，我們在災難層面承擔的風險顯著增加，這些風險必須反映在我們的投標中，而這正是我們打算做的。

We are also limited, as you know, by TBC or total beneficiary change limitations that we are working through that could, to some extent, constrain what we're able to do. That being said, we do intend to take additional margin actions. Our goal is to do so in excess of our Stars tailwind that we have.

如您所知，我們也受到TBC（即總受益人變更）的限制，我們正在努力解決這個問題，這可能會在一定程度上限制我們的行動。話雖如此，我們確實打算採取額外的額外措施。我們的目標是在現有Stars順風優勢的基礎上再進一步。

I would also note, as I mentioned in the prior question that Lisa asked, it's really important to think about this 800,000 members that we're getting as a meaningful tailwind to 2025, again, because these members haven't been fully documented from a coding perspective and because the distribution costs are very expensive throughout the year. That will wear off in 2025. And so you get a nice tailwind there.

我還要指出，正如我在Lisa之前的問題中提到的，將我們即將獲得的這80萬名會員視為2025年的一個有意義的推動力非常重要，因為這些會員在編碼方面尚未得到充分記錄，而且全年的分發成本非常高昂。這種推動力將在2025年逐漸消退。所以，到那時，我們就能獲得一個好的動力。

The last point I'd make, which I think is important is that although the IRA did enhance the benefits, as we said on Part D, the result of that will likely be, notwithstanding some of the risk model changes that were made for PDP, will likely result in meaningful premium increases on the PDP side, which we believe will actually help the relative attractiveness of MA. And I think that's an important component as we think about the attractiveness of MA for 2025.

我想說的最後一點，我認為很重要：儘管IRA確實提升了福利，正如我們在D部分中提到的，但其結果很可能是，儘管PDP的風險模型有所調整，但PDP的保費仍有可能大幅上漲，我們認為這實際上會提升MA的相對吸引力。我認為，在我們思考2025年MA的吸引力時，這是一個重要的因素。

And the last point I'd make, which I think is important, as an industry, not only does MA offer superior benefits, and we believe that even with some of the changes that we intend on making, it will still be a compelling value proposition for our customers, but the thing that doesn't get talked about enough is the significant benefits around care coordination, around navigating the health care system that our members get as a result of choosing an MA plan that is far superior to a traditional Medicare fee-for-service plan, and that's something that will be top of mind for us. And our intention is to continue to enhance that experience, especially with our new members to make sure that we retain them for 2025.

我想說的最後一點，我認為很重要，作為一個行業，MA 不僅提供了卓越的福利，而且我們相信，即使我們打算做出一些改變，它對我們的客戶來說仍然是一個極具吸引力的價值主張。但人們沒有充分討論的是，我們的會員選擇 MA 計劃後，在護理協調、醫療體系導航方面獲得的顯著優勢，這些優勢遠遠優於傳統的聯邦醫療保險按服務收費計劃，而這正是我們最關心的問題。我們的目標是繼續提升這種體驗，尤其是對新會員，以確保在 2025 年之前留住他們。

The next question comes from Kevin Caliendo from UBS.

下一個問題來自瑞銀的 Kevin Caliendo。

I want to go maybe a little bit further on Justin's question. And when you think about getting to 4% to 5% over time, I guess what we're all trying to understand or worried about or just trying -- maybe it's the strategy, it's like your positioning. Can you still take share and enhance margin, knowing what you know?

我想進一步談談賈斯汀的問題。當你考慮到隨著時間的推移將市場份額提升到4%到5%時，我想我們都在試圖理解、擔心或嘗試——也許是策略，就像你的定位一樣。在了解了這些之後，你還能繼續佔據市場份額並提高利潤率嗎？

Maybe talk a little bit about how CVS is positioned in their ability to bid versus others in the marketplace. What are your advantages and disadvantages? And can you, with Stars coming back or not, but can you get to your margin targets and still grow in line or better than the expected market growth?

或許可以稍微談談CVS在競價能力上相對於其他競爭對手的定位。你們的優勢和劣勢是什麼？無論明星回歸與否，你們能否在達到利潤目標的同時，保持與市場預期一致甚至更好的成長？

Well, look, I appreciate the question. There's still some questions out there. We got to see where the final rate notice obviously shakes out in terms of overall where margins can go and of course, get a real handle around where we think trend will be for 2025, be very disciplined about that. And so that will be an important calculus as we think about margin recovery.

嗯，我很感謝你的提問。還有一些問題。我們必須觀察最終的利率通知對整體利潤率走勢的影響，當然，我們也要真正了解2025年的趨勢，對此要非常謹慎。因此，當我們考慮利潤率復甦時，這將是一個重要的考慮因素。

As we think about relative share, look, we believe that we have a compelling value proposition as an enterprise, with all the various assets we can bring to bear for our Medicare members. We do think that our Stars coming back does on the margin, provide an advantage there. As I will reiterate again, the significant membership growth that we got in 2024 also gives us some tailwinds going into 2025.

當我們考慮相對份額時，我們相信，作為一家企業，我們擁有令人信服的價值主張，能夠為我們的聯邦醫療保險（Medicare）會員帶來各種資產。我們確實認為，星級會員的回歸確實為我們帶來了邊際優勢。我再次重申，我們在2024年取得的顯著會員成長也為我們邁向2025年帶來了一些助力。

But I will tell you, we are first and foremost focused on recovering margin and market share gains is a secondary consideration. Obviously, we want to grow, as I said in the prior question. We believe this is a compelling space. And we believe it's compelling for members. And we believe we have the assets to be able to manage those members and provide superior customer experience relative to the competition. As a consequence, I think we're very well positioned to grow our business and over time take share.

但我要告訴你，我們首要關注的是恢復利潤率，市佔率成長是其次。顯然，正如我在上一個問題中所說，我們想要成長。我們相信這是一個極具吸引力的領域，對會員來說也同樣具有吸引力。我們相信我們擁有管理這些會員的資源，並提供優於競爭對手的客戶體驗。因此，我認為我們完全有能力發展業務，並隨著時間的推移不斷提升市場份額。

The next question comes from Nathan Rich from Goldman Sachs.

下一個問題來自高盛的 Nathan Rich。

It's obviously been challenging this year for many companies to kind of get their hands around utilization. So I don't know if you have any kind of early comments on how January played out maybe relative to the fourth quarter on both the outpatient trend as well as supplemental benefits.

今年，許多公司顯然面臨挑戰，難以控制利用率。所以，我不知道您是否能就1月門診趨勢以及補充福利與第四季度相比的表現發表一些初步評論。

And then as it relates to the 2024 MBR now, I think, being up 150 basis points. I guess at a high level, would you be able to break that increase down between utilization pressure, the impact that new members will have, the Stars headwind that you face? And is there a pressure also in there from the risk model? Or is that something that you price for, just as we think about the different components that contribute to the '24 MBR?

然後，就目前而言，我認為2024年MBR上漲了150個基點。我想，從宏觀層面來看，您能否將這種成長分解為利用率壓力、新成員帶來的影響以及您面臨的Stars逆風？其中是否也存在來自風險模型的壓力？或者，正如我們考慮構成24年MBR的不同組成部分一樣，您在定價時是否也考慮到了這一點？

Nate, why don't I take the second part of your question first, and then I'll turn it back over to Brian. So as you look at the year-over-year MBR increase, almost the entirety of it is related to the Medicare Advantage business. So there are some smaller items. So we have an improvement in our individual exchange business. And then there's some other offsets there. But we also -- as we think about our guidance, we never project prior year reserve development. And so that's -- those two, for the most part, net.

內特，我先回答你問題的第二部分，然後再把問題交還給布萊恩。你看，MBR 的年成長幾乎全部與 Medicare Advantage 業務有關。所以也有一些小項目。我們的個人交易業務有所改善。此外，還有一些其他的抵銷因素。但是，在製定指導方針時，我們從未預測過上一年的儲備金增長。所以，這兩項數據，基本上就是淨值。

And so what you are left with is the vast majority of the increase is related to Medicare. And so about 65 basis points of that specifically relates to the $800 million Stars headwind that we have. And then the remainder is a combination of provisions for the new member mix because we're assuming a higher MBR there and that, that will be plus or minus breakeven and then the rest of it is really a provision for Medicare utilization pressure.

所以剩下的就是絕大部分的成長都與聯邦醫療保險（Medicare）有關。其中大約65個基點與我們面臨的8億美元「明星計畫」（Stars）逆風有關。剩下的部分是針對新成員組合的各項準備金，因為我們假設新成員的MBR更高，這將帶來盈虧平衡點的正負變化，剩下的部分實際上是針對聯邦醫療保險利用壓力的準備金。

And with respect to January trends, it's really way too early to comment on that. There's nothing that we've seen in our January data that gives us pause relative to the guidance that we've given today. Obviously, we're going to monitor it very closely, as you can imagine. And as we get more information, we will absolutely share that with you.

至於1月的趨勢，現在評論還為時過早。 1月份的數據並未顯示任何值得我們暫停執行我們今天給出的指引的跡象。正如您所想像的，我們當然會密切關注。一旦我們獲得更多信息，我們一定會與您分享。

I would comment just on the risk model, just make a quick comment about the V28 provisions, and we talked about this at our Investor Day, not every player is impacted the same way by this. And as we've said, we have a relatively low portion of duals and D-SNPs. It's obviously something that we're growing significantly this year, but we're way over -- way under-indexed to D-SNP relative to some of our competitors. And I think that's an important element because that's a population that's been impacted more by these risk model changes.

我只想就風險模型發表一下看法，簡單談談V28條款。我們在投資者日也討論過這個問題。並非所有參與者都會受到相同的影響。正如我們之前所說，我們的雙重SNP和D-SNP佔比相對較低。今年我們顯然在顯著成長，但與一些競爭對手相比，我們對D-SNP的指數化程度遠低於——遠低於。我認為這是一個重要因素，因為這類族群受風險模型變化的影響更大。

We also -- and we think this is ultimately an opportunity, but we also are underpenetrated when it comes to our full-risk VBC relationships. And those types of relationships also result in, I would say, bigger impact on V28 relative to a non-VBC type relationship. This is something, again, we want to expand over time, and it's a critical strategic priority for us. But with respect to the risk model change, we're actually benefited by the fact that we have a much lower penetration than some of our peers.

我們認為這最終是個機遇，但我們在全風險VBC關係方面的滲透率也不足。我想說，這類關係對V28的影響，相對於非VBC類型的關係，也更大。我們希望隨著時間的推移進一步拓展這方面業務，這是我們的關鍵策略重點。但就風險模型的轉變而言，我們實際上受益於我們的滲透率遠低於一些同業。

Nate, I might just say one of the things that we spent a lot of time looking at specifically was inpatient. And there are some puts and takes there. But on the whole, that category remains consistent with our expectations. Now we did make a provision in both our bids and therefore -- which is incorporated in our guidance for the changes that would happen in January from the Two-Midnight Rule. That's fully encapsulated inside the guide, and it's something that we're obviously watching very closely because of -- to make sure that our estimate is consistent with what we're going to see come through the system.

內特，我想說的是，我們花了很多時間專門研究的一件事就是住院病人。這方面確實有些利弊。但總的來說，這個類別仍然符合我們的預期。現在，我們在兩次投標中都做了準備，因此——這已納入我們的指導中，以應對明年1月「兩夜規則」將發生的變化。這完全包含在指南中，我們顯然正在密切關注——以確保我們的預估與我們將要看到的系統結果一致。

The next question comes from Ann Hynes from Mizuho.

下一個問題來自瑞穗的 Ann Hynes。

Maybe I'll shift away from MLR and focus on retail and just the new pricing model. I know you discussed in your comments, but can you just give us any more details on the initial feedback you're receiving from payers? Have your discussions changed your view on the ability to change the model -- the timing?

也許我會把重點從MLR轉移到零售和新的定價模式。我知道您在評論中討論過這個問題，但您能否詳細介紹一下您從付款人那裡收到的初步回饋？您的討論是否改變了您對改變模式的能力—以及時機的看法？

And just to clarify, this is a mandatory program, so payers basically have to switch with you. And I guess, what's the risk of payer relationships that they don't want to?

需要澄清的是，這是一個強制性項目，所以付款人基本上必須和你一起轉換。如果他們不願意轉換，那對付款人關係有什麼風險呢？

Yes, I would say that the comments and the feedback have generally been positive with the discussions. Initially, obviously, there's a lot of details to go through and to work through. But we're really pleased with sort of the initial reaction. And I'll ask Prem to give you a little bit more detail here.

是的，我想說，大家對討論的評論和回饋總體上是正面的。顯然，初期還有很多細節需要討論和改進。但我們對初步反應非常滿意。我請普雷姆在這裡向您詳細介紹一下。

Yes. Thanks for the question, Ann. And what I'd say is we launched the model at Analyst Day and really excited about the progress we've made. We've been able to, over the course of the last week, deliver the initial terms and conditions to several of the pharmacy benefit managers are and we're engaged in constructive discussions with all of them.

是的。謝謝你的提問，安。我想說的是，我們在分析師日推出了這個模型，我們對取得的進展感到非常興奮。在過去一周裡，我們已經向幾家藥品福利管理機構提交了初步條款和條件，並且正在與他們進行建設性的討論。

What really excites me is we're leading the way in providing greater transparency in drug pricing and passing through our leading cost of goods through to payers in our new model. So this is not about effectively raising prices. It's about continuing to pass through our size and scale and the acquisition costs that we received back to payers and provide a transparent model that can benefit consumers and payers as we go forward.

真正讓我興奮的是，我們在提高藥品定價透明度方面處於領先地位，並透過新模式將我們領先的產品成本轉嫁給付款人。所以，這並非為了有效地提高價格，而是為了繼續將我們的規模和我們收到的收購成本轉嫁給付款人，並提供一種透明的模式，使消費者和付款人在未來都能受益。

Remember, one of the biggest challenges as you think about the health care ecosystem, the problems we face is the rising cost of brand drugs. And if you think about what the biggest pain point for our payers is, it's the fact that these brand drugs and specialty drugs now constitute the majority of the trend that kind of get passed through to the payers and plan sponsors. It's not the pharmacy reimbursement that's driving that.

記住，當你思考醫療保健生態系統時，我們面臨的最大挑戰之一就是品牌藥價格上漲。如果你思考我們付款人最大的痛點是什麼，你會發現這些品牌藥和特種藥現在構成了這種趨勢的主體，而這些成本最終會轉嫁給付款人和計畫發起人。推動這一趨勢的並非藥房報銷。

So -- and just some quick data points on that. If you think about the impact of GLP-1 in 2022 to the system, it was about $14 billion, right? And that continues to grow. So from my perspective, we continue to be -- have good discussions with payers. We're driving forward on eliminating some of the key problems in the systems such as cross subsidization and creating an easier path and a much more transparent path to allow payers and consumers to receive their pharmacy -- pharmaceuticals in the U.S. And more to come as we make progress over the course of the next couple of quarters.

所以——我簡單介紹一些數據。想想2022年GLP-1對醫療體系的影響，大概是140億美元，對吧？而且還在持續成長。所以，在我看來，我們一直在與付款人進行良好的溝通。我們正在努力消除系統中的一些關鍵問題，例如交叉補貼，並創造一條更便利、更透明的途徑，讓付款人和消費者能夠在美國獲得藥品。隨著我們在接下來的幾季取得進展，我們將推出更多措施。

And Ann, I would just remind everyone that the industry has continually talked about the importance of driving cost transparency and affordability and simplicity. And with this model and our TrueCost model, we are really kind of leading at the forefront to support those items. And I think as Prem has been out in the market, there is a lot of support for this.

安，我想提醒大家，業界一直在強調推動成本透明度、可負擔性和簡單性的重要性。憑藉這個模型和我們的TrueCost模型，我們在支持這些方面確實處於領先地位。我認為，隨著Prem在市場上的推出，我們在這方面得到了許多支持。

The next question comes from Josh Raskin from Nephron Research.

下一個問題來自 Nephron Research 的 Josh Raskin。

Here with Eric as well. I'm going to hopefully close the loop on the MA side. So can you speak to just your philosophy overall on MA bids? And do you consider the benefit of the enterprise from growth? Or does the HCB segment have to stand on its own when you talk about that 4% to 5% margin?

Eric 也在這裡。我希望能夠結束關於併購交易（MA）的討論。您能否談談您對併購交易投標的整體理念？您是否考慮過企業從成長中獲得的利益？或者，當您談到 4% 到 5% 的利潤率時，HCB 部門是否必須獨立存在？

And can you speak to the impact of growing your Healthspire assets and how that impacts your MA bid strategy? I'm specifically thinking about growth in Oak Street probably creates a short-term headwind but long-term enterprise value.

您能否談談擴大 Healthspire 資產的影響，以及這對您的併購交易競標策略有何影響？我特別想到的是，Oak Street 的成長可能會帶來短期阻力，但會帶來長期的企業價值。

So Josh, the way we think about it is that 4% to 5% margin needs to be at HCB. And then we get the benefit of our growth from all the other assets that we can bring to bear for the company. So that's our philosophical approach to MA bids.

所以，Josh，我們的想法是，4%到5%的利潤率需要達到HCB。然後，我們才能從公司所能帶來的所有其他資產中獲得成長的收益。這就是我們對待併購投標的理念。

And then relative to how the Healthspire assets can support MA, I'll ask Mike to give you some comments on that.

然後，關於 Healthspire 資產如何支持 MA，我會請 Mike 對此發表一些評論。

Yes. So one of the, I think, key parts of the partnership we have with Aetna but with all of our payers as we have additional levers we can pull at HCB to positively impact patient care quality, positively impact outcomes and then lower medical costs, right? And that can be Signify delivering in-home assessments to identify patient disease burdens we can treat it appropriately. And that can be on Oak Street Health having more levers with PCP defer the lower MOR. So our job is for all of our payer partners to provide substantially better care.

是的。所以，我認為，我們與安泰合作的關鍵部分之一，以及我們與所有付款方的合作，因為我們在HCB方面擁有更多槓桿，可以積極提升患者護理質量，積極改善治療結果，從而降低醫療成本，對吧？這可以是Signify提供上門評估，以識別患者的疾病負擔，從而進行適當的治療。這可以是Oak Street Health與PCP合作，利用更多槓桿來延緩較低的MOR。所以我們的工作是讓所有付款方合作夥伴提供更優質的醫療服務。

And so obviously, when our payer partners are growing and taking share, right, a lot of that growth trickles down to us and becomes a tailwind for us. But one of the advantages I think we have as a health care delivery organization is the more levers to pull. And one quick example for the group is we bought a company at Oak Street called RubiconMD a couple of years ago, and we leverage e-consults to help provide better access to specialty care and lower costs. And we fully implemented the e-consult program in 2023 at Oak Street.

顯然，當我們的付款合作夥伴不斷成長並佔據市場份額時，這種成長很大一部分會惠及我們，成為我們的順風。但我認為，作為一個醫療服務提供機構，我們的優勢之一是擁有更多可以利用的槓桿。舉個簡單的例子，幾年前我們收購了橡樹街（Oak Street）的一家名為 RubiconMD 的公司，我們利用電子諮詢服務，幫助人們更好地獲得專科護理並降低成本。我們於 2023 年在橡樹街全面實施了電子諮詢計畫。

And through that implementation, we were able to lower trend 1% across our entire book. And that is one reason we were able to hit our expectations of Oak Street on MLR and profitability despite the increase in a lot of the utilization categories that Tom discussed and we saw as well. And so I think a lot of our strategy is dependent upon being able to drive higher quality and lower cost through those levers.

透過這項實施，我們得以將整個帳簿的趨勢線降低1%。這也是我們能夠達到Oak Street在MLR和盈利能力方面的預期的原因之一，儘管Tom提到的許多利用率類別有所上升，我們也看到了這一點。因此，我認為我們的許多策略都依賴於透過這些槓桿來提高品質並降低成本。

Josh, maybe let me wrap this up. The -- as we think about this from the enterprise perspective, all of our businesses need to earn their cost of capital and they need to earn their return on that capital. And so as you think about Medicare, it's a mid-60s billion dollar revenue business that we targeted a 4% to 5% margin on for 2023. We clearly didn't achieve that. And as we look at our projections for 2024, as I noted, it's only marginally profitable.

喬希，也許我來總結一下。從企業的角度來看，我們所有的業務都需要收回資本成本，也需要獲得資本回報。以醫療保險為例，它是一項年收入600億美元左右的業務，我們的目標是2023年的利潤率達到4%到5%。顯然，我們並沒有達成這個目標。而正如我之前提到的，我們對2024年的預測也只是略有獲利。

As you think about that business, we're putting a high-teens percentage of dollars and risk-based capital behind every dollar of premium. And so it's imperative that, that business earn its margin to earn its cost of capital and returns on capital. That's just how we think about it from an enterprise perspective. And we've spent a lot of money over the course of 2023 to develop capabilities, which we believe will be additive. And we have been very specific with investors about what we expect those returns on capital to be over time, and we're committed to achieving them, which means we're committed to achieving target margins in each of those businesses that we acquired.

說到這項業務，我們每一美元的保費背後都投入了高達15%的資金和基於風險的資本。因此，這項業務必須賺取利潤，才能收回資本成本並實現資本回報。這只是我們從企業角度來考慮的問題。我們在2023年投入了大量資金來提升各項能力，我們相信這些能力將帶來附加價值。我們已經非常明確地告知投資者，我們預期的長期資本回報率是多少，並且我們致力於實現這些目標，這意味著我們致力於在我們收購的每項業務中實現目標利潤率。

The next question comes from Elizabeth Anderson from Evercore ISI.

下一個問題來自 Evercore ISI 的 Elizabeth Anderson。

I wanted to maybe dig into the Pharmacy Services profit guidance for 2024 in a little bit more detail. Can you just go through sort of what are the key tenets of your assumptions that changed there versus the guidance that you gave at the Investor Day in December?

我想更詳細地探討一下藥局服務2024年的利潤指引。您能否簡單介紹一下，與您在12月投資者日給予的指引相比，您的主要假設有哪些變化？

Elizabeth, did you mean the Health Services segment, I presume. So really what's changed there, I'd say...

伊莉莎白，我想你是指健康服務部門吧。那麼，那裡到底發生了什麼變化呢？

Yes. (inaudible). Yes.

是的。 （聽不清楚）。是的。

Yes. As you think about that, I noted this a little bit in the prepared remarks, as we think about what the external utilization environment looks like, we felt it was prudent to recognize that as a multipayer business, that there could be impacts outside our ecosystem that might pull through into that business.

是的。正如您所想，我在準備好的發言中稍微提到了這一點，當我們思考外部利用環境是什麼樣的時，我們認為謹慎的做法是，作為一家多付款人企業，我們的生態系統之外可能會受到一些影響，這些影響可能會波及到我們的業務中。

As Mike said, we spent a lot of time -- he spends a lot of time thinking about what the reserving practice are and what their medical cost trends are inside the Oak Street and also our ACO businesses. And we try to supplement that as we can with other insights about what it is that we're seeing across our book. But as we thought about what we're hearing in the marketplace, what we saw in our own book in the fourth quarter, we thought it was prudent to pull through some of that potential utilization pressure into our outlook, primarily at our Health Care Delivery assets.

正如麥克所說，我們花了很多時間——他花了很多時間思考Oak Street和ACO業務的準備金做法以及醫療成本趨勢。我們盡力補充其他關於我們在財務報告中所見的見解。但當我們思考市場上聽到的消息，以及我們在第四季度財務報告中所看到的情況時，我們認為將部分潛在的利用率壓力納入我們的展望是明智之舉，主要體現在我們的醫療保健交付資產上。

The next question comes from Stephen Baxter from Wells Fargo.

下一個問題來自富國銀行的史蒂芬‧巴克斯特。

I just wanted to follow up on that question precisely. When we look at the guidance reduction for the services business, it does look like it's less than, I think, the kind of implied 100 basis point guide up on MA MLR that you're talking about for your own book of business. So just hoping you could expand a little more specifically what's included in the increased loss ratios for the Oak Street business? And then are you potentially also carrying some of the 2023 outperformance into your 2024 outlook as an offset?

我只是想準確地跟進這個問題。當我們查看服務業務的指引下調時，我認為它確實低於您所說的針對您自己業務的、基於MA MLR的隱含100個基點的指引。所以，希望您能更具體地解釋一下，橡樹街業務的損失率上升都包含了哪些內容？然後，您是否有可能將2023年的部分優異表現納入2024年的展望中作為抵銷？

Yes, Steve, I think that it's important as you think about the guide that you realize two things. Number one, Health Care Delivery is part of a much larger segment, right? And so we believe that we've made appropriate provisions in the segmental guidance there for what the potential pressures might look like.

是的，史蒂夫，我認為在思考這份指南時，重要的是要意識到兩點。第一，醫療保健服務是一個更大的細分領域的一部分，對吧？因此，我們認為，我們已經在細分指南中針對可能出現的壓力做出了適當的規定。

The second thing I would just remind you is that we had a very successful 2023 in those businesses. And so those businesses were able to successfully manage through the pressures that we and most of our peers saw in Medicare Advantage and still achieve the targets that we were looking for out of those businesses in 2023. So we were very pleased with that performance. And -- but we took a prudent outlook and cautious, hopefully, outlook as we thought about where 2024 might land based on the external environment.

我想提醒您的第二件事是，我們在2023年這些業務取得了非常成功的表現。這些業務成功地克服了我們以及大多數同行在醫療保險優勢計劃（M​​edicare Advantage）中面臨的壓力，並且仍然實現了我們期望在2023年實現的目標。我們對這樣的業績非常滿意。但是，在根據外部環境考慮2024年可能的發展方向時，我們採取了審慎謹慎的態度，並充滿希望。

The next question comes from Allen Lutz from Bank of America.

下一個問題來自美國銀行的艾倫·盧茨。

One for Tom or Prem. On the retail pharmacy side, pharmacy script volume was really strong. So how should we think about growth there through the end of the year and ex-COVID? And then are you seeing any noticeable benefits from the bankruptcy of one of your peers?

湯姆或普雷姆各佔一半。在零售藥局方面，藥局的處方量非常強勁。那麼，我們該如何看待到年底以及疫情結束後的成長呢？然後，您是否看到同儕破產帶來了任何明顯的好處？

Thanks for the question. I'd say a few things. One, as we've entered this year and throughout Q4, we've had extremely strong service in our pharmacy businesses. And as we mentioned before, pharmacy relationships are sticky, and they really are driven by the great experiences we can provide at the counter. So we feel really good going to this year as it relates to our service.

謝謝你的提問。我想說幾點。首先，進入今年以來，以及整個第四季度，我們的藥局業務服務表現非常出色。正如我們之前提到的，藥房關係非常緊密，而這種關係的真正驅動力在於我們能夠在櫃檯提供的卓越體驗。因此，我們對今年的服務發展前景充滿信心。

And there's been a few market disruptions, as you mentioned in the marketplace. From our perspective, we continue to make sure that we invest in our stores in the right way, prioritizing experiences, as I said. And we'll look at certain markets for opportunistic [buys], if they make sense, as we've historically done over time. But we feel really good about our script performance coming into the year, and it's in line with our expectations as we look at this.

正如您所提到的，市場確實出現了一些波動。從我們的角度來看，我們將繼續確保以正確的方式投資門市，並優先考慮體驗，正如我之前所說。我們會關注某些市場，尋找合適的機會進行收購，就像我們過去一直在做的那樣。我們對今年的業績表現非常滿意，目前來看，這符合我們的預期。

Nate, as you think about this business, one of the things that we've said that we've tried to do consistently is to grow share to help to offset reimbursement pressures. And as you look at the fourth quarter, we certainly had -- I'm sorry, that was Allen. We certainly had -- we had same-store growth. You got to really think about what the impact of store closures might be as you think about our overall market share. But we had same-store growth in prescriptions that was in the high 4% range versus a market that grew in kind of mid-2s.

內特，說到這項業務，我們說過我們一直在努力做的一件事就是提高市場份額，以抵消報銷壓力。回顧第四季度，我們確實——抱歉，那是艾倫說的。我們確實－同店銷售額有所成長。考慮到我們整體的市場份額，你必須認真思考關閉門市可能造成的影響。但我們處方藥的同店銷售額成長率達到了4%左右，而市場成長率只有2%左右。

And so we feel like the teams really continue to execute really well in helping to drive to the results that ultimately get us onto this long-term trajectory that we outlined at Investor Day.

因此，我們覺得團隊確實繼續表現得非常好，幫助推動成果，最終使我們走上我們在投資者日概述的長期軌跡。

And Allen, I'd also note, and we said this in the prepared remarks that we've been making good progress on our store closures, and we've been retaining scripts and retaining colleagues, which was critical to the success of those store closures as well.

艾倫，我還想指出，我們在準備好的發言中說過，我們在關閉門市方面取得了良好進展，我們一直在保留劇本和留住同事，這對於關閉門市的成功也至關重要。

The next question comes from Charles Rhyee from TD Cowen.

下一個問題來自 TD Cowen 的 Charles Rhyee。

I wanted to go back to CostVantage a little bit here. And when we think about how you're setting up those acquisition costs, can you talk about sort of the reaction from peers, a little bit more in regard to how they're seeing what costs that you're passing through? I think one of the issues or concerns that have been raised is the potential for sort of perverse incentives, right, a pharmacy could prefer a higher acquisition cost drug because the markup is higher.

我想稍微回顧一下 CostVantage 的問題。說到您如何設定這些購置成本，您能否談談同行的反應，以及他們如何看待您轉嫁的成本？我認為大家提出的問題或擔憂之一是，這可能會產生某種不正當的激勵機制，例如藥局可能會因為更高的加價而選擇購置成本較高的藥品。

And one of the solutions that we've heard mentioned was potential setting up maybe global caps on reimbursement for class of drugs, just making up numbers here, no more than, let's say, AWP minus [$9.90] for generics or something like that. Is that something that you are discussing with payers? And what are sort of the measures that you are contemplating to ensure sort of the incentives are aligned? Because I'd imagine payers are really interested in that.

我們聽到的解決方案之一是，可能設定全球範圍內針對不同類別藥品報銷的上限，比如說，仿製藥的報銷上限不超過平均年費（AWP）減去9.90美元之類的。您正在和付款人討論這個問題嗎？您正在考慮採取哪些措施來確保激勵措施的一致性？因為我想付款人對此非常感興趣。

Yes. I think the -- first and foremost, I think there's a few parts to your question. For -- we've -- last week we delivered our terms and conditions. So the payers now have the ability to understand how our model will work. As a reminder, our model is based on a simple transparent formula that's built upon the underlying acquisition cost of the drugs, defined by -- plus a defined markup and dispensing fee.

是的。首先，我認為你的問題包含幾個部分。我們上週已經發布了條款和條件。所以付款人現在能夠理解我們的模式如何運作。提醒一下，我們的模式是基於一個簡單透明的公式，該公式建立在藥品的基本購置成本之上，加上確定的加價和配藥費。

To your point on there's many different ways in pharmacy pricing. My perspective on this is the way we've approached this is in a very transparent way so that payers can receive the benefits of someone like CVS Retail Pharmacy, where we have the operating scale and the operating discipline to drive further acquisition costs down on generics through our procurement and other strategies.

關於您提到的藥局定價方式有很多種，我的看法是，我們採取了一種非常透明的定價方式，以便付款人能夠享受到像CVS零售藥局這樣的公司帶來的益處。我們擁有營運規模和營運紀律，可以透過採購和其他策略進一步降低仿製藥的購買成本。

And so we will always be held accountable for reducing acquisition costs, leveraging our scale and size to do that and also performing and delivering services at the lowest price possible. At the same time, payers also need a viable pharmacy marketplace across the community that can provide what I would say is consistent care across all the communities that we serve. So it's critical to meet both of those.

因此，我們將始終致力於降低購置成本，充分利用我們的規模優勢，並以盡可能低的價格提供服務。同時，付款人也需要一個涵蓋整個社區的、切實可行的藥房市場，能夠為我們所服務的所有社區提供一致的醫療服務。因此，兼顧這兩點至關重要。

And look, it's February 7, so we're still early in this journey, but we're excited about the progress we've made since Analyst Day, and we're going to continue these payer negotiations and payer discussions over the course of the coming weeks and months and we'll provide an update as we go forward. And all the things that you're describing are things that we're contemplating and discussing with payers in a very transparent way to eliminate some of the challenges that this industry has had over the course of the last few decades.

現在是2月7日，所以我們才剛開始，但我們對分析師日以來的進展感到興奮。在接下來的幾週和幾個月裡，我們將繼續進行付款人進行談判和討論，並在進展過程中提供最新進展。您所描述的所有事情，都是我們正在以非常透明的方式與付款人進行思考和討論的事情，旨在消除這個行業在過去幾十年中遇到的一些挑戰。

The next question comes from John Ransom from Raymond James.

下一個問題來自雷蒙德詹姆斯公司的約翰·蘭瑟姆。

The question I have is just RSV. It's a good guy to your retail franchise. It's a bad guy to HCB. How do we think about the net benefit or net drag to the enterprise for fourth quarter? And what's embedded in your '24 outlook just for RSV?

我的問題只是關於RSV。它對你的零售連鎖店來說是好事，但對HCB來說卻不是好事。我們如何看待第四季對企業的淨收益或淨拖累？你對RSV的24年展望都包含哪些內容？

John, I don't know that we're going to give a specific on that as you think about RSV. I would say net because of the relative market share differences between our pharmacy business and the Aetna business. That tends to be a net tailwind for the enterprise. We did see pressure inside fourth quarter in the -- in particular, in our Medicare business, but also a little bit in the commercial business inside Aetna as you think about those vaccinations. Correspondingly, we saw more of a benefit in the Pharmacy & Consumer Wellness segment.

約翰，考慮到呼吸道合胞病毒（RSV），我不知道我們是否會對此給出具體說明。我會說是淨收入，因為我們的藥房業務和安泰業務之間的市場份額相對差異。這往往對企業來說是淨順風。我們確實在第四季度看到了壓力——尤其是在我們的醫療保險業務方面，但考慮到疫苗接種，安泰內部的商業業務也受到了一些影響。相應地，我們在藥局和消費者健康業務方面看到了更大的收益。

As we think about 2024, given the newness of some of these vaccines, what we've tried to do is take a little bit more cautious outlook as we thought about what the pull-through might be for that outperformance in the fourth quarter. And that's why the beat doesn't match the raise as you think about '24. We'd like to see a little bit more history here before we lean in on that projection.

展望2024年，考慮到部分疫苗尚處於研發初期，我們試圖採取更謹慎的展望，因為我們在思考第四季的優異表現可能帶來的支撐。這就是為什麼預期的超出預期與預期的上漲幅度不一致的原因。在最終確定這項預測之前，我們希望先了解一些歷史資料。

And John, strategically, I wouldn't just think about one type of RSV as a vaccine. I want you to think about kind of an immunization franchise that the retail business has really developed and which is really creating strong value for that business.

約翰，從策略角度來看，我不會只考慮將一種呼吸道合胞病毒（RSV）病毒作為疫苗。我希望你考慮一下零售業務已經真正發展的免疫特許經營模式，這種模式確實為零售業務創造了巨大的價值。

Final question today is from Erin Wright from Morgan Stanley.

今天的最後一個問題來自摩根士丹利的艾琳·賴特。

On Cordavis, I'm just curious, how meaningful is the contribution to segment profit? Or how meaningful is that embedded in your guidance? And how is that just generally playing out relative to your expectations?

關於Cordavis，我很好奇，它對分部利潤的貢獻有多大？或者說，它在你的業績指引中佔比有多大？相對於你的預期，它的整體表現如何？

And then just a quick one on just PBM and transparency. Just your latest thoughts on regulatory changes potentially across the PBM, what you can -- what we could potentially see this year in terms of what gets passed and ability to manage around that?

然後簡單談談PBM和透明度。您對PBM領域監管變化的最新看法是什麼？今年我們可能看到哪些法案獲得通過，以及我們能如何應對這些變化？

Thanks, Erin. Maybe I'll start with Cordavis. I'd say we've been very pleased with the progress to date. And we do have a projection for a positive contribution from that business inside the Health Services segment. And we'll continue to give more details on that as we get through the year. But we haven't disclosed that specific contribution at this point. And maybe I'll turn it over to Karen to talk a little bit more about PBM transparency.

謝謝，Erin。我先從Cordavis開始。我們對目前的進展非常滿意。我們預計該業務將為健康服務部門帶來積極貢獻。我們將在今年繼續提供更多細節。但目前我們還沒有揭露具體的貢獻。或許我可以把時間交給Karen，讓她進一步談談PBM的透明度。

Yes, relative to what's going on in Washington, obviously, this is -- continued discussions are going on there. I do think that they're talking about transparency. If anything does get passed, I think it will be around transparency. But I would tell you that given some of the actions that we have taken with both TrueCost and CostVantage, that is resonating with the legislators and is helpful in driving overall cost transparency. And I can't predict what's going on in D.C., but I know that we're taking action to improve overall outcome.

是的，相對於華盛頓的情況，顯然，那裡的討論仍在繼續。我確實認為他們正在討論透明度問題。如果最終通過，我認為也會圍繞透明度展開。但我想說，鑑於我們在 TrueCost 和 CostVantage 方面採取的一些行動，這些行動引起了立法者的共鳴，有助於提高整體成本透明度。我無法預測華盛頓的情況，但我知道我們正在採取行動，以改善整體結果。

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

今天的問答環節到此結束。接下來，請Karen做總結發言。

Yes. Thank you for all joining the call today, and I want to thank our colleagues for their continued commitment to delivering on our performance. Thank you.

是的。感謝大家今天參加電話會議，我也要感謝我們的同事們一直以來對績效的貢獻。謝謝大家。

This concludes today's call. Thank you very much for your 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。現在您可以掛斷電話了。