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)

大家早上好或下午好，歡迎參加 CVS Health 2023 年第四季獲利結果電話會議。我叫 Adam，今天我將成為您的接線生。 （操作員說明）

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

現在我將把電話交給拉里·麥格拉思（Larry McGrath）開始。所以，拉里，請在你準備好後繼續。

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.

早上好，歡迎參加 CVS Health 2023 年第四季和全年收益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。和首席財務長湯姆考伊。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。

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演示以及今天早上向 SEC 提交的 10-K 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'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.

在這次電話會議中，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，特別是我們今天早上提交的 10-K 表格中有關前瞻性陳述和風險因素的警告聲明中描述的報告。

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，我們將在談論公司的財務表現和財務狀況時使用非公認會計準則衡量標準。您可以在今天早上的新聞稿以及我們網站投資者關係部分發布的對帳文件中找到這些非公認會計原則措施的對帳。

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. 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.

謝謝你，拉里。大家早安，感謝您今天加入我們的電話會議。 2023 年，我們在旅程中取得了巨大進展，匯集了全面健康解決方案，滿足消費者隨時隨地想要獲得醫療保健的需求。我們成功地度過了充滿挑戰的環境並兌現了我們的財務承諾，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、方便且負擔得起的護理，以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 年第四季度，我們實現調整後營業收入 42 億美元，調整後每股收益 2.12 美元。全年總收入為 3,580 億美元，比上年增長 11%。我們的調整後營業收入為 175 億美元，調整後每股收益為 8.74 美元。我們產生了 134 億美元的營運現金流，展示了我們商業模式的力量並支持我們的策略。今天上午，我們修訂了 2024 年全年指引，調整後每股收益至少為 8.30 美元，營運現金流至少為 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 Medicare Advantage 的利用壓力仍然歸因於我們先前強調的相同類別（我們的 2024 年指導中考慮了其中一部分），但我們對 Medicare Advantage 的利用前景持謹慎立場，直到我們進一步明確這些類別全行業趨勢。湯姆將提供有關我們指南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.

儘管醫療保險優勢市場最近受到挑戰，但我們對該業務提供的長期機會的看法保持不變。正如我們在 12 月討論的那樣，我們致力於隨著時間的推移實現 Medicare Advantage 利潤率 4% 至 5% 的目標，我們將於 2025 年開始這一旅程。

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，我們已經建立了規模來改變醫療保健的提供方式以及為我們服務的每個人提供個人化護理和承保的能力。透過整合我們品牌（包括 Aetna、CVS Pharmacy、CVS Healthspire 和 Caremark）的強大能力，我們可以為我們服務的客戶和社區提供巨大的價值，並為我們的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.

當我們所有的資產共同發揮作用時，我們就能夠降低護理總成本、改善健康結果、加深患者參與度並提高忠誠度。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 5500 萬 CVS Health 客戶，他們至少使用了我們的兩種產品。我們看到了透過我們的多支付能力和廣泛的消費者覆蓋範圍擴大與 CVS Health 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，為消費者和客戶創造更多透明度和更多選擇。 12 月，我們在藥局和消費者健康業務中推出了新的 CVS CostVantage 模型。此模式積極解決零售藥品產業持續存在的報銷壓力。它消除了交叉補貼，創造了更持久、更透明的藥房業務，為客戶和患者提供的所有處方藥所帶來的價值得到了公平的補償。

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 12 月推出新型號以來，我們取得了顯著進展。我們最近向幾個 PBM 提供了初步條款和條件，並積極參與建設性討論。 CVS CostVantage 是對當前報銷模式的巨大改變，它將提供一條提高透明度的清晰途徑，同時傳遞我們行業領先的商品成本改進。

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員達成初步協議，將於 4 月 1 日開始使用 CVS CostVantage。這是一個基礎步驟，為在藥局櫃檯為消費者創建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.

我們也發布了新的 CVS Caremark TrueCost 模型。這種創新的客戶選項提供的定價反映了處方藥的真實淨成本，並且客戶可以持續了解管理費用。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盡可能最好的價格，並確保會員可以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，我們繼續推動更多採用生物相似藥，並提高我們的客戶及其會員對這些關鍵特種藥物的負擔能力。從 4 月 1 日開始，Caremark 將從主要商業模板處方集中刪除 HUMIRA。透過 Cordavis，我們將提供聯合品牌 HUMIRA 產品。 Cordavis 在降低藥品成本方面發揮著重要作用，同時幫助確保為我們服務的患者持續供應負擔得起的高品質生物相似藥。

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.

這些步驟確實具有創新性，並且對於我們希望釋放新藥房模式和產品將為我們的客戶及其會員帶來的巨大價值至關重要。

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覆蓋範圍、降低成本、改善健康結果並為消費者創造更多透明度和更多選擇。我們的同事致力於這一重要目標並將實現這些目標。

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.

現在我將談談本季我們每項業務的亮點。在我們的醫療保健福利部門，我們持續順應醫療保險優勢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%，調整後營業收入達 6.76 億美元。截至年底，醫療會員人數達 2,570 萬，比上年增加 130 萬，反映出個人交換、醫療保險和商業等多個產品線的成長。

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 策略不可或缺的一部分。在 2024 年年度註冊期非常成功之後，我們預計將在 2024 年增加至少 80 萬名新會員。我們的成功得益於 CVS Health 資產強化的針對性投資，並使我們能夠為會員創造差異化價值。我們透過專注於簡單性、提供獨特的設計和維護穩定的網路來改善會員體驗。

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基本一致，我們認為這不足以涵蓋當前的醫療費用趨勢。我們認為，由於《通貨膨脹減少法案》而對 D 部分進行的變更需要額外的資金來支付所提供的全面會員福利以及計劃因重新設計而承擔的增加的風險。我們期待在未來幾週內向 CMS 提供意見。

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%，反映出我們的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.

在我們的 Caremark 業務中，我們最近完成了一個非常成功的迎新季。我們招募了超過 300 萬新會員，並確保我們的患者能夠獲得關鍵藥物和特殊治療。我們始終如一地提供卓越的客戶會員體驗，這使得 Caremark 成為市場的領導者。

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取得成功。我們擁有巨大的動力，透過我們廣泛的 CVS Health 接觸點吸引多支付醫療保險優勢會員與 Oak Street Clinic 合作。截至年底，橡樹街有 202,000 人處於危險之中，比前一年增加了 27%。截至一月份，參加 Oak Street Clinic 的 Aetna 會員人數增加了一倍。

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醫療保險優勢合作夥伴展示其家庭功能的價值。 Signify 本季完成了 649,000 次家庭評估，比去年同期成長了 20%。在我們的 Aetna 客戶中，我們正在利用 Signify 強大的能力和其他產品（包括個人交換和醫療補助）來擴大我們的目標市場。我們將與其他客戶一起擴展這些能力，並透過跨多個管道吸引消費者及其健康來提供價值。

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為超過 1.2 億客戶提供服務，營收成長至超過 310 億美元，比上年成長近 9%。本季我們產生了 20 億美元的調整後營業收入，比上年成長近 10%。 PCW 第四季的業績得益於強勁的營運執行力。我們繼續在為我們服務的社區提供關鍵免疫接種方面發揮重要作用，並為我們的健康計劃合作夥伴提供藥房績效衡量標準。

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.

我們在執行門市關閉計劃方面取得了進展，迄今已關閉 630 家門市，並預計在年底前關閉 900 家門市。以可比口徑計算，同店總銷售額比去年同期成長了 11% 以上。本季同店處方藥銷量比去年增長了 4% 以上。

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 年凸顯了我們卓越的執行力和多元化業務的力量。我們的財務表現和差異化策略為 2024 年創造了強勁動力。對於我們所服務的消費者、客戶、社區和股東來說，我們的綜合健康模式的相關性和重要性與日俱增。

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 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.

謝謝你，凱倫，大家早安。我們第四季的業績真正凸顯了我們對執行力的堅定不移和多元化業務的力量。年底，我們在營收、調整後每股盈餘和營運現金流等關鍵指標上取得了強勁的業績。

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.

公司的一些整體亮點。第四季營收近 940 億美元，比去年同期成長近 12%，反映出我們各項業務的強勁成長。我們的調整後營業收入約為 42 億美元，調整後每股收益為 2.12 美元，較上年增長約 4%。這些成長主要是由於我們的藥房和消費者健康以及藥房服務業務的強勁業績以及較低的企業開支，部分被醫療保健福利的持續壓力所抵消。我們產生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，我們又實現了一個強勁的季度營收成長。第四季營收為 267 億美元，年成長超過 16%，反映出所有產品線的成長，特別是我們的個人交易所和醫療保險業務。會員人數為 2,570 萬，比上一季小幅減少 29,000 名，反映了醫療補助重新確定的影響，但部分被個人交易所的成長所抵消。

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下降的主要原因是個人兌換業務的成長，包括季節性的相關影響和 Medicare Advantage 利用率的提高，但部分被較高的淨投資收入所抵銷。

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%，比去年同期增加了 270 個基點，主要反映了 Medicare Advantage 利用率的提高以及前期積極發展的貢獻降低。使用壓力仍然歸因於我們在上一季強調的相同類別，包括門診和補充福利，例如牙科和視力。我們也看到與季節性免疫相關的成本上升，包括新推出的 RSV 疫苗。其他類別與我們先前的醫療費用趨勢假設基本一致。

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.

本季末的應付索賠天數為 45.9 天，環比下降 4.4 天，在調整醫療補助轉嫁付款的影響後，恢復到與我們在新冠疫情爆發前時期經歷的正常水平一致。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 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（包括藥房服務和醫療保健服務業務）創造了約 490 億美元的收入，年增超過 12%。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 4% year-over-year primarily driven by improved purchasing economics and growth in specialty pharmacy, partially offset by ongoing client price improvements.

調整後營業收入接近 19 億美元，年增約 4%，這主要是由於採購經濟的改善和專業藥房的成長所推動，但部分被持續的客戶價格上漲所抵消。

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.

本季處理的藥品索賠總額與去年同期相比略有增加。這一成長主要是由淨新業務和利用率增加所推動的。這一增長在很大程度上被紐約醫療補助計劃的影響所抵消。截至 2024 年 1 月 1 日，藥局會員總數約為 8,900 萬會員，下降的主要原因是先前宣布的大客戶流失。

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.

我們的醫療保健服務資產的表現和成長繼續令我們感到鼓舞。與去年相比，Signify 本季的營收成長了 39%。橡樹街本季末擁有 204 個中心，到 2023 年將增加 35 個中心。我們繼續預計 2024 年將增加 50 至 60 個中心。橡樹街本季的營收也大幅成長，與去年同期相比成長 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領域。我們的收入超過 310 億美元，比上年增長近 9%，同店收入增長超過 11%，反映了藥房藥物組合、處方量增加、品牌膨脹和疫苗接種貢獻增加的影響。這些收入的成長部分被最近推出的仿製藥、持續的報銷壓力和商店數量減少的影響所抵消。

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.

調整後的營業收入約為 20 億美元，比上年增長近 10%，這得益於藥品採購的改善、疫苗接種貢獻的增加、上述處方量的增加以及營運費用的降低。這些增長被持續的藥房報銷壓力部分抵消。同店藥局銷售額較前一年成長 15.5%，同店處方藥量成長 4.4%。前店同店銷售額較去年同期下降約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.

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。 2023 年全年營運現金流為 134 億美元。截至年底，我們的母公司和非受限子公司擁有約 7.35 億美元的現金。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。

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 7.79 億美元。我們也達成了一項價值 30 億美元的固定美元加速股票回購交易，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.

現在轉向我們對 2024 年的全年展望。考慮到 Medicare Advantage 使用趨勢的市場不確定性，我們將 2024 年調整後每股收益指引修訂為至少 8.30 美元。在醫療保健福利領域，我們目前預計 2024 年的醫療福利比率約為 87.7%，比先前的指導提高了 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.

正如我已經指出的那樣，我們觀察到第四季度 Medicare Advantage 業務的醫療成本趨勢上升，這使我們的 2023 年全年醫療福利比率相對於我們之前的指導增加了約 10 個基點。本季度剩餘的壓力主要是由於組合和收入抵消高於我們先前的預期而造成的。

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，我們提高了2024 年全年MBR指導大約 40 個基點來應對這一壓力。

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 2023 年全年討論的那樣，我們在 2024 年醫療福利比率指南中納入了提高利用率的規定，並且我們將繼續保留該規定，直到我們對 Medicare Advantage 的利用率環境有更清晰的了解。我們修訂後的前景也反映了 2024 年至少有 80 萬名新 Medicare Advantage 會員的預期。

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%.

正如我們之前所討論的，這些新會員的概況很有吸引力，其中近 3/4 的會員從其他 Medicare 計劃轉來，約 1/3 的會員預計會加入 D-SNP 計劃。我們仍預期這些新會員對獲利的影響是中性的，但新增會員的綜合影響相當於今天 2024 年 MBR 指引修訂的約 10 個基點。加上我們預期的額外 40 個基點的醫療成本壓力，我們將 2024 年 MBR 預測提高了 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，一些有利的項目將部分抵消預期利用率提高的影響，包括更高的投資收入和高於先前預期的商業會員資格。將所有各項加起來，我們現在預計醫療保健福利部門調整後的營業收入至少為 54 億美元，比我們先前的估計減少 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.

在我們的製藥和消費者健康部門，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，比我們的預期增加了約9,000 萬美元。事先指導。

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.

在我們的健康服務部門，我們將 2024 年調整後營業收入更新為至少 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能夠成功應對 2023 年的醫療成本趨勢壓力，但我們認為，在我們進一步明確 2024 年的使用趨勢之前，應謹慎認識到我們的付款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，我們對營運現金流做了相應的調整，我們現在預計今年至少會達到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低於 50%。更具體地說，我們預計第一季將產生約 20% 的全年調整後每股收益。這種模式將與 2023 年不同，主要是由於 2023 年 Medicare Advantage 的利用方式以及前期發展的時機和影響。因此，醫療保健福利的 2024 年 MBR 將在第一季出現最大年增幅，在第四季出現最小增幅。您可以在我們的投資者關係網頁上找到有關我們更新的 2024 年指南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 Medicare Advantage 利潤率恢復到 4% 至 5% 的目標，同時維持 2023 年收購的預期資本回報率。儘管我們正在努力調整計劃以考慮 2025 年初步 Medicare Advantage 費率通知（該通知並未充分涵蓋近期的醫療費用趨勢），但我們在 2025 年的星級復甦將改善我們的盈利軌跡。 2025 年，我們的目標是實現更新後的 2024 年指引的低兩位數調整後每股盈餘成長。我們預計將在今年稍後向投資者通報我們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 展現多元化企業力量的一年。 2024 年伊始，我們將繼續專注於營運執行和永續成長，努力實現成為消費者領先的健康解決方案公司的目標。

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) 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 Lisa Gill。

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，謝謝你給我的所有顏色。但我只是想更深入一點，真正了解我如何看待第四季發生的事情，這如何影響你對 2024 年的看法？ 12 月份的投資者日發生了什麼真正影響了這一點？您是否看到整個 12 月不斷出現的聲明影響了您對「24」的看法？

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.

然後你談到了一些關於新成員的問題，以及他們是轉換者的事實以及那裡的影響。但只是想知道您是否可以給我們更多關於如何考慮風險編碼和您在那裡的舒適程度的信息，只是增加了這麼多會員，僅下降了 10 個基點。

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」時，我如何考慮醫療費用趨勢與補充福利？

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——謝謝，麗莎。也許我會承擔第一部分，然後我會請布萊恩承擔後面的部分。因此，當您思考我們的投資者日發生的變化時，我們實際上看到 12 月下半月的已支付索賠水平非常高。我們在一月份出席你們的會議時注意到了這一點。

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.

當我們更深入地了解第四季度發生的事情時，也許讓我向您介紹我們所看到的整體情況。因此，如果從 2023 年第四季開始，讓我們考慮一下它對全年業績的影響。因此，我們年底的利率為 86.2%，比我們的指導值高出約 20 個基點。大約一半的壓力是我們認為不應該延續到 2024 年的事情。因此，這一壓力的關鍵驅動因素是醫療補助轉嫁付款和更高的 SEP 會員資格等。如你所知，一旦重新確定在上半年開始結束，我們在今年下半年就不應該看到相同的壓力。我們也全面重新定位了我們的投資組合。

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.

當你想到另一半時，即 10 個基點，這都與我們在醫療保險中看到的趨勢壓力有關。因此，儘管如此，我們一整年都在談論很多相同的類別，並且我們一直在努力積極超越我們的指導。因此，門診趨勢在第四季度略有加速，因此臀部和膝蓋。我們也繼續看到補充福利的成長趨勢，但實際上它比我們今年稍早討論的 OTC 卡更多的是牙科和視力卡。最後，我們在本季度看到了來自疫苗接種的一些壓力，這確實與 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.

當我們審視其他類別時，以美元為基礎的成本趨勢本身，它們基本上與我們認為的情況一致。

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「24」呢？我們已經承受了 10 個基點的壓力，並將其拉入 2024 年的基線。因此，我們在 24 年的前瞻性指引中將醫療費用預估增加了 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混合影響，即自投資者日以來我們一直在討論的額外 200,000 個基點，我們認為，這將使您實現約 50 個基點的增長，這是我們所做的全部工作早晨。

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.

正如我在準備好的演講中所說，我只是提醒您，當我們第一次在第二季度電話會議上開始討論2024 年的指導時，我們談到了在2024 年增加一項額外準備金以提高利用率。我們在我們的指導中保留了這項規定。因此，我們希望這將是一種謹慎的態度，但我們希望看看趨勢將如何穩定。

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.

我還想指出的是，當您現在考慮醫療保險業務時，該書目前預計在 2024 年只能實現微利盈利，而這是我們將在 2025 年投標中積極尋求解決的問題。我會把它交給布萊恩。

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。我只想在你的問題中補充新成員麗莎。我們在這些新成員身上看到的一切都不會讓我們猶豫。風險評分看起來很合理。事實上，如此多的成員都是轉換者，這是其中一個非常重要的組成部分。事實上，正如 Tom 在他的演講中提到的，我們有很大一部分是 D-SNP，即 1/3，這一事實很重要，因為我們在那本業務手冊中沒有明星問題。總的來說，我們對新成員感覺良好。

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，新會員對 2025 年也有非常重要的推動作用，因為這些會員明年將獲得編碼，並且隨著 2025 年分配成本的逐漸減少。因此，我們對收到的新會員感到非常滿意。我們所看到的一切都沒有讓我們停下來。我們認為一切都在我們的 2024 年指南中得到了充分體現，正如湯姆所經歷的那樣。

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，我們相信我們已在 '24 指南中充分反映了這些福利的成本。我們在上一季電話會議上提到，我們已經有效地充分利用了這些今年給我們帶來很多挑戰的靈活卡。而牙科和視覺類的壓力也在我們的指南中得到了充分的體現。

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 Tom 所說，我們再次感覺良好，我們在 24 年的數據中充分反映了 23 年的基線。我們在該基線之上放置了一個標準化的、非常合理的趨勢。今天，我們透過增加 MBR 投入了額外的資金。總而言之，我們對 24 世紀的定位感到滿意。

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在 2025 年提出的觀點，我在我們準備好的發言中說過，我們致力於在 2025 年恢復 Medicare Advantage 的利潤率，我們將在投標中考慮到這一點。

The next question comes from Justin Lake from Wolfe Research.

下一個問題來自沃爾夫研究中心的賈斯汀·萊克。

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年的競價策略。具體來說，我知道 2025 年，您將從 Stars 獲得一些利潤改善的順風車。我想談的不止於此。我發現您的評論對費率很有幫助，我知道這可能是一種壓力，並且會導致福利減少。但除此之外，您是否希望將福利削減到超出利率建議的水平，以開始重新獲得星級以外的利潤，以適應更高的成本趨勢？我們該如何考慮 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，我稍後會將其交給布萊恩，但我只想對費率通知發表評論，因為這對我們如何考慮 2025 年出價至關重要。我在這裡要說三件事。一是我們相信這符合我們相對於持平的預期。然而，我們不認為它涵蓋了 Medicare Advantage 中出現的總體成本趨勢。我們也知道風險模型很複雜。因此，當我們考慮我們的出價時，我們會考慮這一點。

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，《通貨膨脹減少法案》如何影響 D 部分存在一些不確定性，我們在進行投標並向 CMS 提供與這些要點相關的評論時也會考慮到這一點。因此，所有這些都將影響我們的投標過程，但我們將推動利潤率恢復。讓我讓布萊恩具體回答你的詳細問題。

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 4% 到 5% 的利潤率。這是我們的首要任務，也是我們實現這目標的首要任務。正如我們多次說過的那樣，實現這一目標將需要多年的歷程，但我們打算在2025 年實現這一目標，同時也非常自律並反映我們在業務中看到的趨勢，以確保實現這一目標充分體現在定價上。

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.

凱倫提到了利率通知的一些不利因素，我們認為它並不能完全反映醫療趨勢。 D 部分存在一些我們需要解決的問題，因為作為 IRA 的一部分，福利已得到有意義的增強。而且，作為一個產業，我們在災難性層面承擔了更多有意義的風險，這必須反映在我們的投標中，這就是我們打算做的事情。

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 或我們正在解決的總受益人變更限制的限制，這可能在某種程度上限制我們能夠做的事情。話雖這麼說，我們確實打算採取額外的保證金行動。我們的目標是超越我們現有的明星順風車。

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.

我還想指出，正如我在 Lisa 提出的上一個問題中提到的那樣，考慮一下我們將獲得的這 800,000 名成員是 2025 年有意義的推動力，這一點非常重要，因為這些成員尚未從編碼角度，因為全年的分銷成本非常昂貴。這種情況會在 2025 年消失。所以你會在那裡得到一個很好的順風。

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.

我要說的最後一點（我認為很重要）是，雖然 IRA 確實增強了福利，正如我們在 D 部分中所說，但其結果很可能是，儘管對 PDP 進行了一些風險模型更改，可能會導致PDP 方面的保費顯著增加，我們認為這實際上將有助於提高MA 的相對吸引力。我認為，當我們考慮 2025 年 MA 的吸引力時，這是一個重要的組成部分。

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.

我要說的最後一點，我認為這一點很重要，作為一個行業，MA 不僅提供卓越的效益，而且我們相信，即使我們打算做出一些改變，它仍然具有令人信服的價值為我們的客戶提出的建議，但沒有得到充分討論的是，我們的會員因選擇遠遠優於傳統醫療保險的MA 計劃而獲得的護理協調、醫療保健系統方面的顯著好處按服務付費計劃，這將是我們首要考慮的事情。我們的目的是繼續增強這種體驗，尤其是我們的新會員，以確保我們在 2025 年留住他們。

The next question comes from Kevin Caliendo from UBS.

下一個問題來自瑞銀集團的 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?

我想進一步討論賈斯汀的問題。當你考慮到隨著時間的推移達到 4% 到 5% 時，我想我們都在試圖理解或擔心或只是嘗試——也許是策略，就像你的定位一樣。了解您所知道的情況後，您還能獲得份額並提高利潤嗎？

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?

也許可以談談 CVS 相對於市場上其他公司的競價能力如何定位。你的優點和缺點是什麼？無論明星是否回歸，您能否達到利潤目標，並且仍能實現與預期市場成長一致或更好的成長？

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，聽著，我很欣賞這個問題。還有一些問題。我們必須了解最終利率通知在整體利潤率方面的明顯變化，當然，要真正掌握我們認為 2025 年的趨勢，對此要非常自律。因此，當我們考慮利潤率恢復時，這將是一個重要的計算。

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，我們可以為我們的醫療保險會員提供各種資產。我們確實認為我們的明星回歸確實在一定程度上提供了優勢。正如我再次重申的那樣，我們在 2024 年實現的會員數量大幅增長也為我們進入 2025 年帶來了一些推動力。

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.

但我會告訴你，我們首先關注的是恢復利潤，而市佔率的成長是次要的考慮因素。顯然，正如我在上一個問題中所說，我們希望成長。我們相信這是一個引人注目的空間。我們相信這對會員來說很有吸引力。我們相信，我們擁有能夠管理這些會員並提供相對於競爭對手而言卓越的客戶體驗的資產。因此，我認為我們完全有能力發展我們的業務，並隨著時間的推移搶佔市場份額。

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'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.

對許多公司來說，今年顯然在提高利用率方面面臨挑戰。因此，我不知道您是否對 1 月相對於第四季度的門診趨勢和補充福利的表現有何早期評論。

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，由於它與 2024 年 MBR 相關，我認為上漲了 150 個基點。我想在較高的層面上，您是否能夠打破利用率壓力、新成員將產生的影響以及您面臨的明星逆風之間的增加？風險模型是否也有壓力？或者這是您定價的東西，就像我們考慮構成 '24 MBR 的不同組件一樣？

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，我為什麼不先回答你問題的第二部分，然後再把它轉回給布萊恩。因此，當您查看 MBR 的同比增長時，幾乎全部都與 Medicare Advantage 業務相關。所以還有一些較小的物品。所以我們的個人兌換業務有所改善。然後還有一些其他的偏移量。但當我們考慮我們的指導時，我們也從不預測前一年的儲備發展。所以這兩個，在很大程度上，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.

因此，剩下的大部分增長都與醫療保險有關。因此，其中大約 65 個基點與我們面臨的 8 億美元的 Stars 逆風特別相關。然後剩下的部分是針對新成員組合的規定的組合，因為我們假設那裡有更高的 MBR，這將是正負盈虧平衡，然後其餘部分實際上是針對醫療保險利用壓力的規定。

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.

至於一月份的趨勢，現在評論還為時過早。相對於我們今天給予的指導，我們在 1 月的數據中沒有看到任何讓我們猶豫的內容。顯然，正如你可以想像的那樣，我們將非常密切地監視它。當我們獲得更多資訊時，我們絕對會與您分享。

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.

我只想評論一下風險模型，簡單評論一下 V28 條款，我們在投資者日討論過這一點，並不是每個玩家都會受到同樣的影響。正如我們所說，我們的雙核心和 D-SNP 比例相對較低。顯然，我們今年的成長顯著，但與我們的一些競爭對手相比，D-SNP 的指數遠低於我們的水平。我認為這是一個重要因素，因為這一人群受這些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.

我們也認為這最終是一個機會，但在我們的全風險 VBC 關係方面，我們的滲透率也不足。我想說，相對於非 VBC 類型的關係，這些類型的關係對 V28 的影響也更大。這也是我們希望隨著時間的推移而擴展的東西，這對我們來說是一個關鍵的策略優先事項。但就風險模型的變化而言，我們實際上受益於我們的滲透率比一些同行低得多的事實。

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，我可能只是說我們花了很多時間專門研究的一件事是住院病人。那裡有一些看跌期權和索取期權。但總體而言，該類別仍然符合我們的預期。現在，我們確實在兩次出價中都做出了規定，因此，這已納入我們對一月份將發生的午夜兩點規則變化的指導中。這完全封裝在指南中，我們顯然正在密切關注這一點，因為確保我們的估計與我們將透過系統看到的結果一致。

The next question comes from Ann Hynes from Mizuho.

下一個問題來自 Mizuho 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?

也許我會放棄 MLR，專注於零售和新的定價模式。我知道您在評論中進行了討論，但是您能否向我們提供有關您從付款人收到的初步反饋的更多詳細信息？你們的討論是否改變了你們對改變模型的能力－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，這是一個強制性計劃，因此付款人基本上必須與您一起切換。我想，他們不想要的付款人關係有什麼風險？

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，我想說的是，討論中的評論和回饋總體上是正面的。顯然，最初有許多細節需要處理和解決。但我們對最初的反應感到非常滿意。我將請 Prem 為您提供更多詳細資訊。

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該模型，並對我們所取得的進展感到非常興奮。在上週的過程中，我們已經向幾位藥品福利經理提供了初步條款和條件，我們正在與他們所有人進行建設性討論。

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.

真正令我興奮的是，我們在提高藥品定價透明度方面處於領先地位，並在新模式中將我們領先的商品成本轉嫁給付款人。所以這不是為了有效提高價格。這是關於繼續將我們的規模和規模以及我們收到的收購成本返還給付款人，並提供一個透明的模型，在我們前進的過程中使消費者和付款人受益。

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.

請記住，當您考慮醫療保健生態系統時，我們面臨的最大挑戰之一是品牌藥品成本的上漲。如果您考慮我們的付款人最大的痛點是什麼，您會發現這些品牌藥物和特殊藥物現在構成了傳遞給付款人和計劃贊助商的大部分趨勢。造成這種情況的並不是藥局報銷。

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.

那麼——以及一些相關的快速數據點。如果你考慮一下 2022 年 GLP-1 對系統的影響，大約是 140 億美元，對嗎？而且這種情況還在持續成長。因此，從我的角度來看，我們將繼續與付款人進行良好的討論。我們正在努力消除系統中的一些關鍵問題，例如交叉補貼，並創建一條更簡單和更透明的路徑，讓付款人和消費者能夠在美國收到他們的藥品以及更多的藥品。我們將在接在下來的幾個季度中取得進展。

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，業界一直在談論提高成本透明度、可負擔性和簡單性的重要性。透過這個模型和我們的 TrueCost 模型，我們確實處於支持這些專案的最前沿。我認為隨著 Prem 已經進入市場，對此有很多支持。

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?

埃里克也在這裡。我希望能夠關閉 MA 方面的循環。那麼您能談談您對 MA 投標的整體理念嗎？您是否考慮過企業成長帶來的好處？或者說，當您談論 4% 至 5% 的利潤率時，HCB 細分市場是否必須獨立存在？

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.

您能否談談增加 Healthspire 資產的影響以及這對您的 MA 出價策略有何影響？我特別認為橡樹街的成長可能會帶來短期阻力，但會產生長期企業價值。

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.

所以喬希，我們的想法是 HCB 需要 4% 到 5% 的利潤率。然後，我們可以從我們可以為公司帶來的所有其他資產中獲得成長的好處。這就是我們進行 MA 投標的哲學方法。

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。因此，我認為，這是我們與 Aetna 以及所有付款人合作的關鍵部分之一，因為我們可以利用 HCB 的額外槓桿來積極影響患者護理品質、積極影響結果，然後降低醫療成本，對吧？這可以是 Signify 提供家庭評估，以確定患者的疾病負擔，我們可以對其進行適當的治療。這可以是 Oak Street Health 擁有更多的 PCP 槓桿來推遲較低的 MOR。因此，我們的工作是為所有付款合作夥伴提供更好的照護。

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，當我們的支付合作夥伴不斷成長並佔據份額時，許多成長都會流向我們，並成為我們的順風。但我認為我們作為醫療保健提供組織的優勢之一是可以使用更多槓桿。集團的一個簡單例子是，幾年前我們在橡樹街收購了一家名為 RubiconMD 的公司，我們利用電子諮詢來幫助提供更好的專業護理服務並降低成本。我們於 2023 年在橡樹街全面實施了電子諮詢計劃。

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.

透過該實施，我們能夠將整本書的趨勢降低 1%。這就是我們能夠在 MLR 和盈利能力方面達到 Oak Street 預期的原因之一，儘管 Tom 討論過並且我們也看到了許多利用率類別的增加。因此，我認為我們的許多策略都依賴能夠透過這些槓桿來提高品質和降低成本。

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.

喬什，也許讓我總結一下。當我們從企業的角度思考這個問題時，我們所有的企業都需要賺取資本成本，並且需要賺取資本回報。因此，當你想到 Medicare 時，它是一項收入 600 億美元左右的業務，我們的目標是 2023 年利潤率達到 4% 到 5%。顯然我們沒有實現這一目標。正如我所指出的，當我們審視 2024 年的預測時，它的利潤微乎其微。

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.

當你想到這項業務時，我們在每一美元的保費背後都投入了高比例的美元和基於風險的資本。因此，該企業必須賺取利潤，以賺取資本成本和資本回報。這就是我們從企業角度思考的方式。我們在 2023 年花費了大量資金來開發能力，我們相信這將是附加的。我們一直非常具體地向投資者明確我們期望隨著時間的推移獲得的資本回報率，並且我們致力於實現這些回報，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?

我想更詳細地了解 2024 年藥品服務利潤指引。您能否簡單介紹一下您的假設發生變化的主要原則是什麼以及您在 12 月投資者日提供的指導？

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

伊莉莎白，我想你指的是健康服務部門嗎？所以我想說的是，那裡真的發生了變化…

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。當你想到這一點時，我在準備好的評論中註意到了這一點，當我們考慮外部使用環境是什麼樣子時，我們認為應該謹慎地認識到，作為一個多支付業務，可能會對我們的生態系統之外產生影響這可能會影響該業務。

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儲備實踐是什麼以及橡樹街和我們的 ACO 業務內的醫療成本趨勢是什麼。我們嘗試用關於我們在本書中看到的內容的其他見解來補充這一點。但當我們思考我們在市場上聽到的情況以及我們在第四季度自己的書中看到的情況時，我們認為將一些潛在的利用壓力納入我們的前景中是謹慎的做法，主要是在我們的醫療保健服務方面資產。

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。當我們考慮服務業務的指引下調時，我認為，它看起來確實低於您為自己的業務手冊談論的 MA MLR 的隱含 100 個基點指引。那麼，只是希望您能更具體地擴展一下橡樹街業務增加的損失率中包含哪些內容？那麼，您是否也可能將 2023 年的部分優異表現納入您的 2024 年展望中作為抵銷？

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，我認為當你思考這份指南時，你意識到兩件事很重要。第一，醫療保健服務是一個更大的細分市場的一部分，對吧？因此，我們認為，我們已經在部門指南中針對潛在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.

我想提醒大家的第二件事是，我們在這些業務上度過了非常成功的 2023 年。因此，這些企業能夠成功應對我們和大多數同行在 Medicare Advantage 中看到的壓力，並且仍然實現我們在 2023 年為這些企業尋找的目標。因此，我們對這一表現非常滿意。但是，當我們根據外部環境思考 2024 年可能會發生什麼時，我們採取了謹慎的態度和謹慎的、充滿希望的態度。

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?

一份給湯姆或普雷姆。在零售藥局方面，藥局腳本量非常強勁。那麼，我們該如何看待今年年底以及新冠疫情爆發後的成長呢？那麼您是否從同行之一的破產中看到了任何明顯的好處？

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。我想說幾句話。第一，隨著我們進入今年和整個第四季度，我們的製藥業務提供了非常強大的服務。正如我們之前提到的，藥房關係是黏性的，它們實際上是由我們在櫃檯提供的優質體驗所驅動的。因此，我們對今年感到非常高興，因為這與我們的服務有關。

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.

正如您在市場中提到的，市場出現了一些混亂。從我們的角度來看，正如我所說，我們將繼續確保以正確的方式投資我們的商店，並優先考慮體驗。我們將關注某些市場的機會主義[購買]，如果它們有意義的話，正如我們長期以來所做的那樣。但我們對今年的劇本表現感到非常滿意，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，當你想到這項業務時，我們說過我們一直在努力做的事情之一就是增加份額以幫助抵消報銷壓力。當你看第四節時，我們當然有──對不起，那是艾倫。我們當然有——我們有同店成長。當你考慮我們的整體市場份額時，你必須真正考慮商店關閉可能會產生什麼影響。但我們的同店處方藥成長幅度高達 4%，而市場成長幅度為 2%。

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出色，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，我還要指出，我們在準備好的發言中說過，我們在關閉商店方面取得了良好進展，我們一直在保留腳本和保留同事，這對於這些商店的成功至關重要關閉也是如此。

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.

我想在這裡稍微回顧一下 CostVantage。當我們考慮您如何設定這些購買成本時，您能否談談同行的反應，並更多地談談他們如何看待您正在承擔的成本？我認為已經提出的問題或擔憂之一是可能存在某種不正當的激勵措施，對吧，藥房可能更喜歡購買成本較高的藥物，因為加價更高。

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.

我們聽說過的解決方案之一是可能為某類藥物的報銷設定全球上限，只是在這裡編造數字，不超過，比方說，AWP 減去仿製藥或類似藥物的 [9.90 美元]。您正在與付款人討論這個問題嗎？您正在考慮採取哪些措施來確保各種激勵措施的協調一致？因為我想付款人對此真的很感興趣。

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。我認為──首先也是最重要的，我認為你的問題有幾個部分。因為——我們——上週我們交付了我們的條款和條件。因此，付款人現在有能力了解我們的模型將如何運作。提醒一下，我們的模型基於一個簡單透明的公式，該公式建立在藥物的基本採購成本之上，定義為 - 加上確定的加價和配藥費用。

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.

根據您的觀點，藥房定價有很多不同的方式。我對此的看法是，我們以一種非常透明的方式處理這個問題，以便付款人可以獲得像CVS Retail Pharmacy 這樣的公司的好處，我們擁有營運規模和營運紀律，可以進一步降低仿製藥的採購成本透過我們的採購和其他策略。

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，我們將始終負責降低採購成本，利用我們的規模和規模來做到這一點，並以盡可能低的價格執行和提供服務。同時，付款人還需要一個跨社區的可行的藥房市場，可以為我們服務的所有社區提供我所說的一致的護理。因此，滿足這兩個要求至關重要。

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.

看，現在是 2 月 7 日，所以我們還處於這一旅程的早期階段，但我們對自分析師日以來取得的進展感到興奮，我們將在 2019 年期間繼續這些付款人談判和付款人討論在在接下來的幾週和幾個月裡，我們將在接下來的過程中提供最新資訊。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考慮和討論的事情，以消除該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·詹姆斯的約翰·蘭塞姆。

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RSV。對於您的零售特許經營來說，這是一個好人。對HCB來說是個壞人。我們如何看待第四季對企業的淨效益或淨拖累？您 24 年的 RSV 展望中包含哪些內容？

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，我不知道我們是否會像您考慮 RSV 時那樣具體說明這一點。我之所以說淨額，是因為我們的製藥業務和安泰保險業務之間的相對市場份額存在差異。這往往對企業來說是一個淨推動力。我們確實看到了第四季度的壓力——特別是我們的醫療保險業務，但考慮到這些疫苗接種，安泰保險內部的商業業務也有一些壓力。相應地，我們在製藥和消費者健康領域看到了更多的好處。

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.

當我們考慮 2024 年時，考慮到其中一些疫苗的新穎性，我們試圖採取更謹慎的態度，同時考慮第四季度的優異表現可能會出現什麼情況。這就是為什麼節奏與你想像的 24 年來的加薪不符。在我們做出預測之前，我們希望先了解更多歷史。

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，從戰略上講，我不會只考慮將一種 RSV 作為疫苗。我希望您考慮零售業務真正開發的免疫特許經營權，它確實為該業務創造了強大的價值。

Final question today is from Erin Wright from Morgan Stanley.

今天的最後一個問題是來自摩根士丹利的艾琳·賴特 (Erin Wright)。

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?

對於 Cordavis，我只是好奇，對部門利潤的貢獻又有多大意義？或者您的指導中包含的內容有多大意義？相對於您的期望來說，整體情況如何？

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?

然後簡單介紹 PBM 和透明度。您對整個 PBM 中可能發生的監管變化的最新想法是，今年我們在通過的內容和管理能力方面可能會看到什麼？

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，艾琳。也許我會從科達維斯開始。我想說，我們對迄今為止的進展感到非常滿意。我們確實預計該業務將在健康服務領域做出積極貢獻。隨著這一年的到來，我們將繼續提供更多細節。但目前我們還沒有透露具體的貢獻。也許我會把它交給 Karen，讓她多談談 PBM 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，相對於華盛頓正在發生的事情，顯然，那裡正在進行持續的討論。我確實認為他們正在談論透明度。如果有任何事情真的獲得通過，我認為這將是圍繞透明度。但我想告訴您，考慮到我們對 TrueCost 和 CostVantage 採取的一些行動，這引起了立法者的共鳴，並有助於提高整體成本透明度。我無法預測華盛頓特區會發生什麼，但我知道我們正在採取行動來改善整體結果。

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。因此，我會將其交還給凱倫，讓其發表結論性意見。

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，我要感謝我們的同事對我們績效的持續承諾。謝謝。

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。現在您可以斷開線路。