CVS Health Corp (CVS) 2024 Q1 法說會逐字稿

Hello, and welcome to today's CVS Health Q1 2024 Earnings Conference Call. My name is Jordan, and I'll be coordinating your call today. (Operator Instructions)

大家好，歡迎參加今天的 CVS Health 2024 年第一季財報電話會議。我叫喬丹，今天將負責協調您的電話會議。 （接線生指示）

I'm now going to hand over to Larry McGrath to begin. Larry, please go ahead.

現在，我將把發言權交給拉里·麥格拉斯。拉里，請講。

Good morning, and welcome to the CVS Health First Quarter 2024 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.

早安，歡迎參加 CVS Health 2024 年第一季財報電話會議和網路直播。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，與我一起參加會議的還有總裁兼執行長 Karen Lynch 和財務長 Tom Cowhey。

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

在我們準備好的發言之後，我們將舉行問答環節，其他領導團隊成員也將參與其中。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-Q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 most recent annual report filed on Form 10-K, our quarterly report on Form 10-Q filed this morning and our recent filings on Form 8-K, including this morning's earnings press release.

在本次電話會議中，我們將做出一些前瞻性陳述。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的結果有重大差異。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，特別是我們最近提交的 10-K 表格年度報告、今天上午提交的 10-Q 表格季度報告以及我們最近提交的 8-K 表格文件（包括今天上午發布的收益新聞稿）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 the 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」版塊發布的對帳文件中查看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. This morning, we announced first quarter results that were burdened by utilization pressures in Medicare Advantage, which materially impacted our Health Care Benefits segment.

謝謝，拉里。大家早安，感謝大家今天參加我們的電話會議。今天上午，我們公佈了第一季的業績，但受到聯邦醫療保險優勢計劃（M​​edicare Advantage）使用壓力的影響，這嚴重影響了我們的醫療福利部門。

We generated adjusted EPS of $1.31, which fell short of our expectations. As a result of this performance as well as our updated expectations for the rest of 2024, we are lowering our full year 2024 guidance for adjusted EPS to at least $7. Tom will go through these results and our revised guidance in more detail.

我們實現了1.31美元的調整後每股收益，低於我們的預期。鑑於此業績以及我們對2024年剩餘時間的預期更新，我們將2024年全年調整後每股盈餘的預期下調至至少7美元。 Tom將更詳細地闡述這些業績以及我們修訂後的預期。

I want to start our discussion this morning by focusing on the challenges we are seeing in our Medicare Advantage business and what we are doing to address these pressures. When we last gave 2024 guidance, our outlook assumed normalized Medicare Advantage trends on top of the elevated baseline we experienced in the fourth quarter of 2023. It is now clear that the first quarter 2024 Medicare Advantage trends are notably above this level.

今天上午，我想先討論我們在聯邦醫療保險優勢計劃 (Medicare Advantage) 業務中面臨的挑戰，以及我們為應對這些壓力所做的努力。我們上次發布 2024 年業績指引時，假設聯邦醫療保險優勢計畫的趨勢在 2023 年第四季經歷的較高基線水準之上實現正常化。現在很明顯，2024 年第一季的聯邦醫療保險優勢計劃趨勢明顯高於這一水平。

Like others in the industry, our visibility in the quarter was impaired by the cyberattack on Change Healthcare. At the close of the quarter, we established a reserve of nearly $500 million for claims that we estimated we had not received. This represents our best estimate of missing claims with approximately half of the reserve attributed to our Medicare business.

與業內其他公司一樣，我們本季的聲譽也因Change Healthcare遭受的網路攻擊而受損。本季末，我們設立了近5億美元的準備金，用於應對我們估計尚未收到的索賠。這是我們對未收到索賠的最佳估計，其中約一半的準備金歸因於我們的醫療保險業務。

As we closed the quarter, it became apparent we were experiencing broad-based utilization pressure in our Medicare Advantage business in a few areas. Outpatient services and supplemental benefits continued to be elevated in the first quarter and exceeded our projections. We also saw new pressures in the inpatient and pharmacy categories, some of which were seasonal or onetime in nature. April inpatient authorizations and admissions appear to have moderated.

截至本季末，我們明顯感受到Medicare Advantage業務在部分領域普遍面臨使用率壓力。第一季門診服務和補充福利持續成長，超出了我們的預期。住院和藥房類別也出現了新的壓力，其中一些是季節性或一次性的。 4月住院授權和入院人數似乎有所緩和。

In response to these pressures, at a time when we have seen very strong enrollment growth, we implemented a series of actions to ensure our clinical operations are performing at levels consistent with our expectations. We formed multidisciplinary teams to do a retrospective review of our claims data, searching for condition-specific, geographic or facility-based outliers as well as to uncover any selection bias in our new and existing membership base. We ensured clinical teams are staffed for current volumes by redeploying nurses from across CVS Health and increasing hiring where necessary. And we evaluated opportunities and implemented actions to optimize our pharmacy benefit spend.

為了因應這些壓力，在註冊人數強勁成長的時期，我們採取了一系列措施，以確保臨床營運的績效符合我們的預期。我們組建了一個多學科團隊，對理賠數據進行回顧性審查，尋找特定疾病、地理或機構的異常值，並發現新舊會員群體中是否存在任何選擇偏差。我們透過從CVS Health內部調配護理師並在必要時增加招聘，確保臨床團隊的人員配備能夠滿足當前的需求。此外，我們還評估了優化藥房福利支出的機會並採取了相應措施。

In addition to those efforts, we are accelerating enterprise productivity initiatives to streamline and optimize our operations, ensuring our costs are aligned to the business operation, environment and conditions. We are implementing these actions with speed and urgency, utilizing the broad resources and experience across CVS Health. We have a track record of successfully navigating complex industry pressure, and we'll continue to demonstrate our resilience. We will provide updates throughout the year on these efforts.

除了這些努力之外，我們還在加速推進企業生產力計劃，以精簡和優化我們的運營，確保我們的成本與業務運營、環境和條件相符。我們正在迅速且緊急地實施這些行動，並利用CVS Health的廣泛資源和經驗。我們擁有成功應對複雜產業壓力的良好記錄，我們將繼續展現我們的韌性。我們將全年更新這些努力的最新進展。

I also feel it is important to discuss our long-term outlook for Medicare Advantage. We recently received the final 2025 rate notice. And when combined with the Part D changes prescribed by the Inflation Reduction Act, we believe the rate is insufficient. This update will result in significant added disruption to benefit levels and choice for seniors across the country. While we strive to deliver benefit stability to seniors, we will be adjusting plan-level benefits and exiting counties as we construct our bids for 2025. We are committed to improving margins.

我還認為，討論一下我們對聯邦醫療保險優勢計劃（M​​edicare Advantage）的長期前景也很重要。我們最近收到了2025年最終費率通知。我們認為，如果將《降低通貨膨脹法案》D部分規定的變更與此結合，目前的費率是不夠的。此次更新將對全國老年人的福利水準和選擇造成重大影響。在我們努力為老年人提供穩定的福利的同時，我們將在製定2025年投標方案的同時，調整計劃層面的福利並退出一些縣。我們致力於提高利潤率。

Despite the recent challenges in Medicare Advantage, we firmly believe the program can remain a compelling offering for seniors and a very attractive business for Aetna and CVS Health over time. Medicare Advantage will continue to deliver significant value to members as well as better outcomes and patient experiences. Over the next few years, we are determined to improve our positioning in Medicare Advantage. The combination of our internal efforts and the multiyear repricing opportunity gives us confidence in our ability to return to our target margin of 4% to 5% in 3 to 4 years.

儘管Medicare Advantage近期面臨挑戰，但我們堅信，該計劃將持續成為老年人群體的有力選擇，並長期成為Aetna和CVS Health極具吸引力的業務。 Medicare Advantage將繼續為會員帶來顯著價值，並帶來更佳的診療結果和患者體驗。未來幾年，我們決心提升Medicare Advantage的市場地位。內部努力加上多年的重新定價機會，讓我們有信心在3到4年內恢復4%到5%的目標利潤率。

Our top priority in the near term is addressing the pressures faced by our Medicare Advantage business. However, I urge you not to lose sight of the power of our enterprise. The strength and diversity of our business positions us for growth in 2025 as we deliver value to our patients, customers and shareholders. We are ensuring a viable biosimilars market in the U.S. with our Cordavis business, which will drive lower cost for our customers, savings for consumers and will lead to higher retention and growth.

我們近期的首要任務是應對聯邦醫療保險優勢計劃 (Medicare Advantage) 業務面臨的壓力。然而，我懇請各位不要忽略我們企業的力量。我們業務的實力和多樣性將助力我們在2025年實現成長，為患者、客戶和股東創造價值。我們正透過Cordavis業務確保美國生物相似藥市場的活力，這將降低客戶成本，為消費者節省開支，並帶來更高的留存率和成長。

On April 1, we implemented our unique and meaningful formulary change related to Humira. We have already made a significant impact in the first month since the formulary change, dispensing more biosimilar Humira prescriptions than the entire U.S. market in 2023. This accomplishment truly highlights the combined strength of our CVS Caremark, CVS Specialty and Cordavis businesses to accelerate biosimilar adoption and our commitment to customers to lower pharmacy costs.

4月1日，我們實施了與修美樂（Humira）相關的獨特且意義深遠的處方變更。自變更以來的第一個月，我們已取得顯著成效，2023年修美樂生物類似藥的處方量超過了整個美國市場的處方量。這項成就充分彰顯了CVS Caremark、CVS Specialty和Cordavis業務部門在加速生物相似藥應用方面的綜合實力，以及我們致力於降低客戶藥局成本的承諾。

Our Pharmacy & Consumer Wellness business delivered strong performance this quarter, highlighted by our ability to grow pharmacy share despite softening consumer demand in an uncertain macroeconomic environment. Our CVS Pharmacy locations continue to serve an important and expanding role in communities across the country.

本季度，我們的藥房和消費者保健業務表現強勁，尤其體現在儘管宏觀經濟環境不確定，消費者需求有所減弱，但我們仍能提升藥房市場份額。我們的CVS藥局繼續在全國各地社區發揮重要作用，且作用日益增強。

Since we unveiled CVS CostVantage and TrueCost, we have seen a tremendous interest in these more simple and transparent pharmacy models. We are engaged in active discussion with PBMs to roll out CVS CostVantage for commercial contracts on January 1, 2025. Additionally, we signed CVS CostVantage agreements with multiple third-party discount card administrators that were effective on April 1 and represent more than 50% of all CVS discount card volume. We continue to have constructive dialogue with our partners and look forward to updating you later this year.

自從我們推出 CVS CostVantage 和 TrueCost 以來，我們看到人們對這些更簡單透明的藥房模式產生了濃厚的興趣。我們正與藥品福利管理公司 (PBM) 積極商討，爭取在 2025 年 1 月 1 日將 CVS CostVantage 推廣到商業合約中。此外，我們也與多家第三方折扣卡管理公司簽署了 CVS CostVantage 協議，該協議於 4 月 1 日生效，佔 CVS 折扣卡總交易量的 50% 以上。我們將繼續與合作夥伴進行建設性對話，並期待在今年稍後向您報告最新進展。

In our Health Care Delivery business, we are seeing meaningful progress in our integration efforts. This quarter, Signify had the highest volume of in-home evaluations in their history. Oak Street at-risk patients grew nearly 20% over the same quarter last year, supported by our ability to utilize touch points across CVS Health. In Aetna, our Commercial business had several wins with large group clients with 2025 effective dates, demonstrating our ability to deliver integrated benefit solutions with our diversified portfolio of offerings.

在我們的醫療保健交付業務中，我們的整合工作取得了顯著進展。本季度，Signify 的上門評估量創歷史新高。由於我們能夠充分利用 CVS Health 的接點，Oak Street 的高風險患者數量較去年同期增加了近 20%。在安泰，我們的商業業務贏得了幾家大型團體客戶的青睞，這些客戶的保單生效日期為 2025 年，這證明了我們能夠透過多元化的產品組合提供全面福利解決方案。

In our Medicaid business, we have been successful in several RFPs, including Virginia, Michigan and Texas, where our CVS Health assets were highlighted as differentiators. These represent a few recent highlights from across our businesses and demonstrate the value and positive momentum across our broad-based portfolio of assets.

在醫療補助 (Medicaid) 業務方面，我們已成功贏得弗吉尼亞州、密西根州和德克薩斯州等地的多個招標書 (RFP)，其中，CVS Health 的資產成為我們業務的亮點。這些資產代表了我們近期各項業務的亮點，展現了我們廣泛資產組合的價值和積極發展勢頭。

The current environment does not diminish our opportunities, our enthusiasm or the long-term earnings power of our company. We are confident that we have a pathway to address our near-term Medicare Advantage challenges. While recent results have been pressured, our actions will return our earnings to their appropriate levels and will result in a stronger CVS Health. We remain as committed as ever to our strategy and believe that we have the right assets in place to deliver value to our customers, members, patients and our shareholders.

當前的環境不會削弱我們的機會、我們的熱情或公司的長期獲利能力。我們相信，我們擁有應對近期醫療保險優勢計劃 (Medicare Advantage) 挑戰的途徑。儘管近期業績承壓，但我們的行動將使盈利恢復到合理水平，並最終打造更強大的 CVS 健康。我們一如既往地致力於我們的策略，並相信我們擁有為客戶、會員、患者和股東創造價值的合適資產。

Tom will provide details on the results of each of our businesses and the components of our updated guidance. Tom?

湯姆將詳細介紹我們每項業務的表現以及更新後的指引的組成部分。湯姆？

Thank you, Karen, and thanks to everyone for joining us this morning.

謝謝你，凱倫，也謝謝大家今天早上加入我們。

In the first quarter, our revenues were approximately $88 billion, an increase of approximately 4% over the prior year quarter. We delivered adjusted operating income of approximately $3 billion and adjusted EPS of $1.31. We also generated cash flow from operations of $4.9 billion, a lower result compared to the same quarter last year, primarily due to the timing of Medicare payments.

第一季度，我們的營收約880億美元，較去年同期成長約4%。調整後營業利潤約30億美元，調整後每股收益為1.31美元。我們的經營現金流為49億美元，較去年同期下降，主要原因是健保支付時間安排不當。

Each of our segments and the enterprise as a whole are focused on executing against their goals and delivering on their financial targets. However, our Health Care Benefits and enterprise results are being materially pressured by the level of Medicare Advantage utilization that we are experiencing. Clearly, this is a disappointing result for us. Let me walk you through some of the drivers and help you understand how we expect them to impact the remainder of the year.

我們的各個部門以及整個企業都專注於實現各自的目標和財務目標。然而，我們的醫療保健福利和企業績效正受到當前醫療保險優勢計劃（M​​edicare Advantage）使用率的嚴重影響。顯然，這對我們來說是一個令人失望的結果。讓我來為您介紹一些驅動因素，並幫助您了解我們預計它們將如何影響今年剩餘時間的表現。

In our Health Care Benefits segment, we delivered revenues of approximately $32 billion, an increase of approximately 25% year-over-year. Medical membership was 26.8 million, up 1.1 million members sequentially, reflecting growth in Medicare, Individual Exchange and Commercial group products, partially offset by the impact of Medicaid redeterminations.

在我們的醫療保健福利部門，我們的收入約為320億美元，年增約25%。醫療會員人數為2680萬，環比增加110萬，反映了聯邦醫療保險（Medicare）、個人交換和商業團體產品的增長，但部分抵消了醫療補助（Medicaid）重新確定的影響。

Adjusted operating income for the first quarter was $732 million. This result reflects a higher medical benefit ratio, partially offset by higher net investment income and the impact of favorable fixed cost leverage due to membership growth. Our medical benefit ratio of 90.4% increased 580 basis points from the prior year quarter, primarily reflecting higher Medicare Advantage utilization, the premium impact of lower Stars Ratings for payment year 2024 and unfavorable prior year development as compared to the prior year.

第一季調整後營業利潤為7.32億美元。這一結果反映了更高的醫療福利比率，但部分被更高的淨投資收益以及會員成長帶來的有利固定成本槓桿的影響所抵消。我們的醫療福利比率為90.4%，較去年同期上升了580個基點，主要反映了聯邦醫療保險優勢計劃（M​​edicare Advantage）使用率的提高、2024年繳費年度星級評分降低對保費的影響，以及去年同期業績與去年相比的不利變化。

Digging into the drivers of Medicare Advantage cost trends, we saw meaningful increases in utilization. We continue to see elevated trends in the same categories we discussed at the end of 2023, including outpatient and supplemental benefits, categories that appeared to be moderating earlier in the quarter, but which completed at levels and, in some cases, exceeded expectations.

深入研究聯邦醫療保險優勢計劃 (Medicare Advantage) 成本趨勢的驅動因素，我們發現利用率顯著上升。我們繼續看到我們在 2023 年底討論過的相同類別的上升趨勢，包括門診和補充福利，這些類別在本季度初似乎有所放緩，但最終達到了預期水平，在某些情況下甚至超出了預期。

Adding to the outpatient and supplemental benefits pressure, we saw new pressures emerge from inpatient categories, RSV vaccines and other pharmacy benefits. Inpatient admits per 1,000 in the first quarter were up high single digits versus the first quarter of 2023. While a portion of this increase was anticipated because of the implementation of the Two-Midnight Rule, this result meaningfully exceeded our expectations for the quarter as inpatient seasonality returned to patterns we have not seen since the start of the pandemic.

除了門診和補充福利的壓力外，我們還發現住院類別、呼吸道合胞病毒疫苗和其他藥房福利也帶來了新的壓力。第一季每千人次住院患者入院人數較2023年第一季增加了高個位數。雖然部分增長是由於「兩夜規則」的實施而預期的，但這一結果顯著超出了我們對本季度的預期，因為住院患者的季節性已恢復到疫情爆發以來從未見過的模式。

In our Medicaid business, we experienced medical cost pressures, largely driven by higher acuity from member redeterminations. We are working closely with our state partners to ensure the underlying trends are reflected in our rates going forward.

在我們的醫療補助 (Medicaid) 業務中，我們經歷了醫療成本壓力，這主要是由於會員重新確定費用的敏感度更高。我們正與各州合作夥伴密切合作，以確保這些潛在趨勢能夠反映在未來的費率中。

Medical cost trends in our Commercial business have not shown the same pressures we are experiencing in Medicare. Inpatient bed days are favorable to expectations, although higher than prior years. Mental health and pharmacy trends remain elevated, but overall performance of the commercial block is consistent with our projections.

我們商業業務的醫療成本趨勢並未像聯邦醫療保險一樣面臨同樣的壓力。住院床位天數符合預期，儘管高於往年。精神健康和藥房的趨勢仍然高漲，但商業板塊的整體表現符合我們的預期。

Individual exchange medical costs are elevated, but are consistent with projected membership mix and lower revenue payables in 2024. Our Individual Exchange business remains on target to achieve its profit goals this year. We will continue to monitor both of these blocks closely, but their performance to date is consistent with our prior projections.

個人交易所醫療成本有所上升，但與2024年預計的會員結構和較低的應付收入相符。我們的個人交易所業務今年仍有望實現獲利目標。我們將繼續密切關注這兩個板塊，但迄今為止的表現與我們先前的預測一致。

Days claims payable at the end of the quarter were 44.5 days, down 1.4 days sequentially. This decrease is primarily driven by the impact of membership growth and higher pharmacy trends, which tend to complete quicker and reduce DCP, as well as other typical seasonal items. Premiums and reserves both grew sequentially approximately 20%. As a reminder, DCP is an output of our reserving process. And overall, we remain confident in the adequacy of our reserves.

本季末理賠應付天數為44.5天，季減1.4天。下降主要受會員成長、藥局業務成長（這些業務往往完成速度更快，從而降低了DCP）以及其他典型季節性項目的影響。保費和準備金月增約20%。需要提醒的是，DCP是我們準備金流程的成果。總體而言，我們對準備金的充足性仍然充滿信心。

In early April, we saw multiple days of high paid claim activity, which is consistent with the restoration of Change Healthcare and the associated backlog from that disruption. While the final impact of the Change Healthcare disruption will not be known for several months, our most recent interim reporting suggests that our March 31 reserve balances are stable and could show modest levels of positive development, which is not incorporated into our current outlook.

4月初，我們連續多日看到高額理賠活動，這與Change Healthcare的恢復以及由此引發的市場中斷導致的積壓情況相符。雖然Change Healthcare業務中斷的最終影響還需要幾個月才能知曉，但我們最新的中期報告顯示，我們3月31日的準備金餘額保持穩定，並可能出現適度的積極增長，但這並未反映在我們目前的展望中。

Our Health Services segment generated revenue of approximately $40 billion, a decrease of nearly 10% year-over-year, primarily driven by the previously announced loss of a large client and continued pharmacy client price improvements. This decrease was partially offset by pharmacy drug mix, growth in specialty pharmacy and the acquisitions of Oak Street Health and Signify Health.

我們的健康服務部門營收約400億美元，年減近10%，主要原因是先前宣布的失去一位大客戶以及藥局客戶價格持續下調。藥房藥品組合、專科藥房業務成長以及對Oak Street Health和Signify Health的收購部分抵消了這一下降。

Adjusted operating income of approximately $1.4 billion declined nearly 19% year-over-year, primarily driven by continued pharmacy client price improvements, lower contributions from 340B and a previously announced loss of a large client. This decrease was partially offset by improved purchasing economics. Total pharmacy claims processed in the quarter were nearly 463 million, and total pharmacy membership as of the end of the quarter was approximately 90 million members.

調整後營業收入約14億美元，年減近19%，主要原因是藥局客戶價格持續改善、340B貢獻下降以及先前宣布的失去一位大客戶。採購經濟效益的改善部分抵消了這一下降。本季處理的藥房理賠總額接近4.63億，截至本季末，藥局會員總數約為9,000萬。

We continue to drive growth in our Health Care Delivery assets. Signify generated revenue growth of 24% compared to the same quarter last year. Oak Street ended the quarter with 205 centers, an increase of 33 centers year-over-year. We continue to expect to add 50 to 60 centers in 2024. At-risk members at Oak Street ended the quarter at 211,000, an increase of 34,000 year-over-year. Oak Street also significantly increased revenue in the quarter, growing over 25% compared to the same quarter last year.

我們持續推動醫療保健服務資產的成長。 Signify 的營收與去年同期相比成長了 24%。橡樹街 (Oak Street) 本季末擁有 205 家中心，較去年同期成長 33 家。我們預計 2024 年將新增 50 至 60 家中心。橡樹街的高風險會員數量與去年同期相比增加了 3.4 萬人，本季末達到 21.1 萬人。橡樹街本季的營收也大幅成長，與去年同期相比成長了 25% 以上。

In our Pharmacy & Consumer Wellness segment, we generated revenue of approximately $29 billion, reflecting an increase of nearly 3% versus the prior year and over 5% on a same-store basis. Drivers of this revenue growth in the PCW segment included increased prescription volume with increased contributions from vaccinations as well as pharmacy drug mix. These revenue increases were partially offset by the impact of recent generic introductions, continued reimbursement pressure, a decrease in store count and lower contributions from OTC test kits.

在我們的藥品及消費者健康業務部門，我們創造了約290億美元的收入，較去年同期成長近3%，同店銷售額成長超過5%。 PCW業務部門收入成長的驅動因素包括處方量成長、疫苗接種貢獻的增加以及藥品組合的最佳化。這些收入成長被近期仿製藥的推出、持續的報銷壓力、門市數量減少以及非處方藥檢測試劑盒貢獻的下降部分抵消。

Adjusted operating income was approximately $1.2 billion, an increase of approximately 4% versus the prior year, driven by increased prescription volume, improved drug purchasing and lower operating expenses, including the impact of store closures. These increases were partially offset by continued pharmacy reimbursement pressure.

調整後營業利潤約12億美元，較上年增長約4%，主要得益於處方量增長、藥品採購改善以及營業費用下降（包括門市關閉的影響）。這些增長部分被持續的藥房報銷壓力所抵消。

Same-store pharmacy sales were up over 7% versus the prior year, and same-store prescription volumes increased by nearly 6%. Same-store front store sales were down by about 2% versus the same quarter last year, but up 1% when excluding OTC test kits. As a reminder, the public health emergency was still active during the first quarter of last year.

藥局同店銷售額年增逾7%，同店處方量成長近6%。門市同店銷售額較去年同期下降約2%，但若剔除非處方藥檢測試劑盒，則成長1%。需要提醒的是，去年第一季度，公共衛生緊急事件仍在持續。

Shifting to liquidity and our capital position. First quarter cash flow from operations was $4.9 billion. We ended the quarter with approximately $1.9 billion of cash at the parent and unrestricted subsidiaries.

轉向流動性和資本狀況。第一季營運現金流為49億美元。本季末，母公司和非限制性子公司的現金餘額約為19億美元。

In the first quarter, we returned $840 million to shareholders through our quarterly dividend. We also completed our $3 billion accelerated share repurchase transaction, retiring approximately 40 million shares in the quarter. We do not expect to repurchase any additional shares for the remainder of 2024.

第一季度，我們透過季度股利向股東返還了8.4億美元。我們也完成了30億美元的加速股票回購交易，本季回購了約4,000萬股。我們預計在2024年剩餘時間內不會再回購任何股票。

Our leverage ratio at the end of the quarter was approximately 4x. This leverage ratio was higher than we expect to maintain on a normalized basis. We remain committed to maintaining our current investment-grade ratings.

本季末，我們的槓桿率約為4倍。這一槓桿率高於我們預期的正常水平。我們將繼續致力於維持目前的投資等級。

Turning now to our full year outlook for 2024. As Karen mentioned, we revised our 2024 adjusted EPS guidance to at least $7 to reflect our first quarter results as well as our updated expectations for the remainder of 2024.

現在談談我們對 2024 年全年的展望。正如 Karen 所提到的，我們將 2024 年調整後的每股盈餘指引修訂為至少 7 美元，以反映我們第一季的業績以及我們對 2024 年剩餘時間的最新預期。

In our Health Care Benefits segment, we now expect adjusted operating income of at least $3.6 billion, down from our previous guidance of at least $5.4 billion. We now expect our 2024 medical benefit ratio to be approximately 89.8%, an increase of 210 basis points from our previous guidance.

在醫療保健福利部門，我們目前預計調整後營業收入至少為36億美元，低於先前至少54億美元的預期。我們目前預計2024年的醫療福利比率約為89.8%，較先前預期增加210個基點。

In the first quarter, Health Care Benefits medical costs, primarily attributable to Medicare Advantage, came in approximately $900 million above our expectations. If we break that down further, we estimate that roughly $500 million of that variance is specific to the quarter or seasonal, including the larger-than-expected impact of seasonal respiratory and RSV costs and a return to inpatient seasonality patterns that look much more like pre-pandemic periods. As Karen mentioned, early indicators for April inpatient authorization support our current seasonality projections and their return to pre-COVID patterns.

第一季度，主要歸因於聯邦醫療保險優勢計劃（M​​edicare Advantage）的醫療保健福利醫療成本比我們預期高出約9億美元。如果進一步細分，我們估計其中約5億美元差異是季度性或季節性因素造成的，包括季節性呼吸道疾病和呼吸道合胞病毒（RSV）成本的影響大於預期，以及住院患者季節性模式回歸到疫情前水準。正如Karen所提到的，4月住院授權的早期指標支持我們目前的季節性預測及其回歸疫情前模式的趨勢。

We have also raised our expectations for RSV-related costs in the second half based on our experience in the first quarter. The remaining approximately $400 million of medical cost pressure in the first quarter is driven by elevated utilization trend that our guidance now assumes will persist for the remainder of 2024.

根據第一季的經驗，我們也上調了下半年呼吸道合胞病毒 (RSV) 相關成本的預期。第一季剩餘約 4 億美元的醫療成本壓力是由利用率上升趨勢所致，我們目前的指引假設這種趨勢將持續到 2024 年剩餘時間。

The primary drivers of this projected variance include outpatient service categories, such as mental health and medical pharmacy, as well as supplemental benefits such as dental. Partially offsetting some of this pressure is better-than-expected volumes, expense management and increased net investment income, which together are expected to contribute approximately $500 million more than we assumed in our previous full year guidance, with roughly half of this offset occurring in the first quarter.

造成此預期差異的主要因素包括門診服務類別（例如精神健康和醫藥藥房）以及牙科等補充福利。好於預期的業務量、費用管理以及淨投資收益的增加部分抵消了這一壓力，預計這些因素合計將比我們之前全年業績指引中的預期多貢獻約5億美元，其中約一半的抵銷額將在第一季度實現。

In our Health Services segment, we are updating our estimate for 2024 adjusted operating income to at least $7 billion, a decrease of approximately $400 million. The majority of this adjustment is attributable to health care delivery, predominantly in our CVS Accountable Care business, driven by Medicare utilization and some out-of-period pressure.

在醫療服務部門，我們將2024年調整後營業收入的預期更新為至少70億美元，減少約4億美元。此次調整主要歸因於醫療保健服務，主要是CVS Accountable Care業務，受Medicare使用率上升和一些非週期性壓力的推動。

We also saw some modest utilization pressure on Oak Street during the quarter and are including a provision for higher trends for the remainder of the year in our updated guidance. The remainder of the pressure is in our other businesses in the Health Services segment, primarily driven by volume and mix trends and the associated impact on our ability to deliver on network and client guarantees.

本季度，我們也發現Oak Street的使用率略有下降，因此在最新的業績指引中已計入了今年剩餘時間利用率上升趨勢的撥備。其餘壓力則來自我們醫療服務部門的其他業務，主要受業務量和產品組合趨勢以及由此對我們履行網絡和客戶承諾能力的影響所致。

Our expectations for the Pharmacy & Consumer Wellness segment remain the same with adjusted operating income of at least $5.6 billion. This outlook incorporates a cautious stance on consumer activity over the remainder of the year due to slowing front store activity in the first quarter. We now expect 2024 share count to be approximately 1.265 billion shares and our adjusted tax rate to be approximately 25.6%.

我們對藥品和消費者健康業務的預期保持不變，調整後營業收入至少為56億美元。由於第一季門市活動放緩，我們對今年剩餘時間的消費者活動持謹慎態度。我們目前預計2024年股票數量約為12.65億股，調整後稅率約為25.6%。

Finally, we updated our expectation for cash flow from operations to at least $10.5 billion in 2024. You can find additional details on the components of our updated 2024 guidance on our Investor Relations web page. We plan to share more detailed 2025 guidance later this year. But in an effort to help investors build reasonable expectations for next year, we wanted to share some preliminary thoughts on our outlook.

最後，我們將2024年的營運現金流量預期更新至至少105億美元。您可以在我們的投資者關係網頁上找到更多關於我們更新後的2024年指引內容的詳細資訊。我們計劃在今年稍後發布更詳細的2025年指引。但為了幫助投資人對明年建立合理的預期，我們想分享一些關於展望的初步想法。

Within Health Care Benefits, our Medicare Advantage business is projected to generate between $65 billion and $70 billion in revenues in 2024, but will experience significant losses. We are committed to driving meaningful improvements in our Medicare Advantage margins in 2025.

在醫療保健福利領域，我們的醫療保險優勢計劃 (Medicare Advantage) 業務預計在 2024 年創造 650 億至 700 億美元的收入，但將出現大幅虧損。我們致力於在 2025 年大幅提升醫療保險優勢計畫的利潤率。

Given our projected baseline performance, 2025 will be the first step in a 3- to 4-year journey to get back to our target margins of 4% to 5%. Improved Star Ratings in 2025 could represent a $700 million tailwind depending on membership retention levels, but also reduces our ability to adjust certain benefits.

鑑於我們預期的基準業績，2025年將是我們在3到4年內恢復4%到5%目標利潤率的第一步。 2025年星級評定的提升可能帶來7億美元的順風，取決於會員保留率，但同時也會削弱我們調整某些福利的能力。

The remainder of our margin improvement in 2025 will be a function of pricing actions in an environment where we are facing headwinds from an insufficient rate notice and prescription drug coverage changes that substantially increase plan liability. We will take material pricing and benefit design actions for 2025, and the impact of those changes will depend on how cost trends develop in both 2024 and 2025 and how the market responds to those trends.

2025年，我們剩餘的利潤率提升將取決於定價策略，因為目前我們正面臨利率通知不足和處方藥承保範圍變更導致計劃負債大幅增加等不利因素。我們將在2025年採取重大定價和福利設計措施，這些變化的影響將取決於2024年和2025年成本趨勢的發展以及市場對這些趨勢的反應。

In Health Care Benefits' other business lines, we are building strong momentum. We are planning for another year of margin progression in our Individual Exchange business. We've seen success in the group commercial selling season this year and were recently awarded several key Medicaid RFPs.

在醫療保健福利的其他業務方面，我們正保持強勁成長動能。我們計劃在個人交易業務中繼續保持利潤成長。今年的團體商業銷售季，我們取得了成功，並且最近獲得了幾份重要的醫療補助 (Medicaid) 招標書 (RFP)。

In our Health Services segment, early progress of our Cordavis business is encouraging and supports our innovative approach to the biosimilar opportunity, driving differential savings for our PBM customers.

在我們的健康服務領域，Cordavis 業務的早期進展令人鼓舞，並支持我們對生物相似藥機會的創新方法，為我們的 PBM 客戶帶來差異化節省。

In our Health Care Delivery business, we are committed to improving margins in CVS Accountable Care. Oak Street's margin trajectory will be supported by meaningful patient enrollment and a realignment of Medicare Advantage benefits as the market adjusts to elevated utilization. Signify continues to show impressive growth and is building momentum into 2025. We have received a strong early reception to our new pharmacy [model], which creates potential for outperformance in our PCW segment.

在我們的醫療保健配送業務中，我們致力於提高CVS Accountable Care的利潤率。隨著市場適應更高的利用率，顯著的患者入組和Medicare Advantage福利的調整將支撐Oak Street的利潤率走勢。 Signify繼續保持令人矚目的成長勢頭，並將在2025年積聚成長動力。我們的新藥房[模式]早期獲得了熱烈的反響，這為我們PCW部門創造了超越業績的潛力。

As Karen mentioned, we are accelerating multiyear enterprise productivity initiatives to streamline and optimize our operations. Finally, our framework contemplates a stable share count in 2025. While many uncertainties remain that could drive a wide range of outcomes, including our 2024 baseline performance and the potential that medical cost trends subside as compared to our current outlook, at this distance, our goal remains to deliver low double-digit adjusted EPS growth in 2025. Our team remains committed to executing against the opportunities to outperform this guidance.

正如Karen所提到的，我們正在加速實施多年的企業生產力計劃，以精簡和優化我們的營運。最後，我們的框架設想在2025年保持穩定的股票數量。儘管仍有許多不確定因素，這些因素可能會對業績產生廣泛的影響，包括我們2024年的基準業績，以及醫療成本趨勢可能較目前的預期有所減弱，但就目前而言，我們的目標仍然是在2025年實現低兩位數的調整後每股收益增長。我們的團隊將繼續致力於抓住機遇，超越這項預期。

With that, we will 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 comes from Justin Lake of Wolfe Research.

（操作員指示）我們的第一個問題來自 Wolfe Research 的 Justin Lake。

A couple of questions here. First, on the cost trend in the first quarter, would like to get some more detail on the $500 million that you said is in Q1 that's not going to reoccur, right? I think everyone would like to get comfort that the $7 is a baseline that we can be comfortable with. So if that's not reoccurring, can you just walk us through what the moving parts are there?

這裡有幾個問題。首先，關於第一季的成本趨勢，我想了解更多關於您所說的第一季5億美元的成本不會再次發生的細節，對嗎？我想每個人都希望7美元是一個我們可以接受的基準。如果這種情況不會再發生，您能否向我們介紹其中的變化？

For instance, it looks to me like your PYD was $200 million below the last couple of years. Maybe that's a big part -- that's clearly a big part of it. How much was RSV? Any other moving parts? Anything you could do to get us comfortable that, that $500 million is seasonal would be a good start.

例如，在我看來，你們的PYD在過去幾年少了2億美元。也許這是很大一部分原因——這顯然是很大一部分原因。 RSV（季節性收入）是多少？還有其他變動嗎？你們能做些什麼讓我們放心，這5億美元是季節性支出，這將是一個好的開始。

Justin, it's Tom. So the largest impact within that -- within the quarter is the seasonality adjustment on inpatient. And as I noted in the prepared remarks, our April authorization data supports our updated seasonality projection as we did experience some negative prior year development in the quarter, and that is clearly part of the $500 million. But as you look at where that occurred, that was really in some of our inpatient categories where the trends restated negatively.

賈斯汀，我是湯姆。所以，本季最大的影響就是住院病患的季節性調整。正如我在準備好的演講中提到的，我們4月份的授權數據支持我們更新的季節性預測，因為我們在本季度確實經歷了一些去年同期的負面發展，這顯然是5億美元的一部分。但你看看發生這種情況的地方，實際上是在我們的一些住院類別中，趨勢再次呈現負面。

And so you saw the beginning of that uptick. You saw an uptick, again, January admits were higher than our expectations. February was improved versus January. March was improved versus February. And so we've seen really a -- we saw a spike earlier in the quarter, which really started, in hindsight, in the fourth quarter.

所以你看到了這種上升趨勢的開始。你再次看到了上升趨勢，1月的承認率高於我們的預期。 2月份的承認率比1月有所改善。 3月的承認率也比2月有所改善。所以我們確實看到了——我們在本季度初看到了一個高峰，回想起來，這實際上是在第四季度開始的。

And as you look at that pattern, it very closely resembles what we would have seen in a 2018, 2019 period trended forward. And so that gives us a lot of comfort as we look at what we're seeing now versus what the historic patterns pre-COVID looked like that a lot of this was actually seasonal.

觀察這個模式，你會發現它與我們在2018年、2019年期間看到的趨勢非常相似。因此，當我們將現在的情況與新冠疫情之前的歷史模式進行比較時，我們感到很欣慰，因為許多情況實際上是季節性的。

So if you take out the prior period developments, you also had some provider liabilities that were settled inside the quarter. As we did have some policy liberalizations that took place inside the quarter, I mean, they've been reinstated since the quarter end, so that should not be an ongoing impact. And then there were some other onetime impacts, including the initial reserve build for some of our new membership growth that would be incorporated inside that $500 million.

因此，如果剔除前期發展，我們也會發現一些供應商的負債在本季內已結清。由於我們在本季度確實實施了一些政策自由化，我的意思是，這些政策自季度末起已恢復，因此這應該不會造成持續影響。此外，還有一些其他一次性影響，包括為部分新會員成長而建立的初始儲備金，這些儲備金將計入這5億美元。

We also -- as you noted, we did see some RSV in the quarter. We did make a revision for some of those costs of the $500 million to recur in the back half of the year, but we're not projecting that the vast majority of those costs are going to be part of the run rate, unlike the $400 million that we're pulling through.

正如您所說，我們在本季度確實看到了一些RSV。我們確實對這5億美元成本中的部分成本進行了修訂，使其在下半年再次發生，但我們預計這些成本中的絕大部分不會像我們正在處理的4億美元那樣，成為營運成本的一部分。

Got it. And then just some color on the Medicare Advantage margin and improvement in any offset. So right now, it looks like, if I estimate your MA margins, I was thinking minus 3%, minus 4% negative. Is that the right ballpark? How much of an improvement -- you said material improvement, that would seem -- if you got a couple 100 basis points there, by my estimate, that's $0.70, $0.80 alone.

明白了。然後稍微解釋一下聯邦醫療保險優勢計劃（M​​edicare Advantage）的利潤率，以及任何抵消計劃的改善。現在看來，如果我估算一下你們的醫療保險優勢計畫（MA）利潤率，我估計應該是負3%或負4%。這個大概數字對嗎？如果你們的利潤率提高幾百個基點，那麼改善幅度有多大——你說的是實質改善，這看起來是——根據我的估計，也就是0.70美元或0.80美元。

So can you talk us through how much improvement would you think is material to get back that trajectory to the over 3 to 4 years? And anything that would be an offset there, any kind of onetime benefits this year, like bonuses, things like that, that would work against it would be helpful. And I'll jump on the queue.

那麼，您能否談談，您認為需要多大的改進才能讓業績在未來3到4年內回到預期的軌道？任何可以彌補這一差距的措施，例如今年提供的任何一次性福利，例如獎金之類的，如果能抵消這一差距，都會有所幫助。我先加入討論。

Justin, great question. So as you think about Medicare Advantage, as I said, it's a $65 billion to $70 billion revenue portfolio today. And our goal for next year is that we would get about 200 basis points of margin improvement in that business or up to that amount. And we obviously haven't finalized our bids yet.

賈斯汀，好問題。說到醫療保險優勢計劃（M​​edicare Advantage），正如我所說，它目前的營收組合高達650億到700億美元。我們明年的目標是，這項業務的利潤率能提高約200個基點，甚至達到這個水準。顯然，我們還沒有最終確定報價。

You're in probably the right ZIP code as you think about what the margin is on the -- or implied margin is on the Medicare business. As you think about that business, we talked last quarter about the fact that it was going to be breakeven in our current projections, and we lowered the guidance in Health Care Benefits by $1.8 billion, and so the majority of that is related to Medicare. So we've given you all the pieces to kind of understand why we think it will lose a significant amount of money this year.

說到醫療保險業務的利潤率，或者說隱含利潤率，你可能剛好在郵遞區號區。說到這項業務，我們上個季度談到，按照目前的預測，它將實現盈虧平衡，並且我們將醫療保健福利的預期下調了18億美元，其中大部分與醫療保險有關。所以，我們已經把所有資訊都告訴了大家，以便大家大致了解為什麼我們認為今年該業務將出現大幅虧損。

But as you think about improvement there, obviously, there's a lot of work that we still need to do to understand what benefits we're going to adjust and what ones we can and can't. Our Stars is a tailwind, but also impacts our ability to adjust because it lowers our TBC availability on that national PPO contract.

但說到改進，顯然我們還有很多工作要做，才能弄清楚哪些福利需要調整，哪些可以調整，哪些不能調整。我們的「明星計畫」對我們有利，但也影響了我們的調整能力，因為它降低了我們在全國PPO合約中TBC的可用性。

And maybe, Brian, do you want to give a little bit of color how you're thinking about bids and margin improvement?

布萊恩，也許你想稍微解釋一下你對投標和利潤率提高的看法？

Sure. Thanks, Justin. So I would talk about 2025 in terms of headwinds and tailwinds. Let me just walk through those. So obviously, we have a very significant high trend that we are absolutely going to incorporate into our pricing. And so the trends that Tom talked about for 2024, we will reflect again in 2025. So that's clearly a headwind, but we're not going to miss on trend.

當然。謝謝，賈斯汀。所以我想從逆風和順風的角度來談談2025年的情況。讓我簡單介紹一下。顯然，我們有一個非常顯著的高成長趨勢，我們絕對會將其納入定價中。所以，湯姆提到的2024年的趨勢，我們將在2025年再次體現。這顯然是一個逆風，但我們不會錯過這個趨勢。

We've talked in the past about the Part D changes, which is a really important element here, and there's really 2 elements of that. One is that the benefit has been enriched pretty significantly by the IRA. And then secondly, the plan is on the hook for greater liability in the catastrophic layer in that we get less reinsurance than we used to. And so we intend to price for that and be very thoughtful around that.

我們過去討論過D部分的變化，這是一個非常重要的因素，它實際上包含兩個面向。首先，IRA大大豐富了福利。其次，該計劃在巨災險方面承擔了更大的責任，因為我們獲得的再保險比以前少了。因此，我們打算為此進行定價，並對此進行深思熟慮。

Third, as we -- as Karen mentioned in her remarks, the rates that we received were clearly disappointing and not sufficient to make up the trend pressures and IRA pressures that we're seeing. And then finally, as Tom mentioned, around TBC, that's clearly a limitation that we need to be focused on. It's focused on the general enrollment block. It does not apply to D-SNP, and it does not apply to certain supplemental benefits as well, which we'll be very focused on to make sure we rightsize for 2025 pricing. As we think about tailwinds, though, Tom mentioned the Stars tailwind, which is about $700 million, assuming a stabilized membership, and I'll come back and talk about that a little bit.

第三，正如卡倫在發言中提到的，我們收到的費率顯然令人失望，不足以彌補我們所看到的趨勢壓力和個人退休帳戶（IRA）壓力。最後，正如湯姆所提到的，關於TBC，這顯然是我們需要關注的一個限制。它主要針對的是一般的投保群體。它不適用於D-SNP，也不適用於某些補充福利，我們將非常關注這些福利，以確保我們根據2025年的定價進行合理調整。不過，當我們考慮順風因素時，湯姆提到了星空計畫的順風因素，假設會員人數穩定，大約是7億美元，我稍後會稍微討論一下。

With respect to the pricing actions, we're going to be very focused on taking those pricing actions, as I mentioned, to incorporate the trends, but also be mindful of how we think about TBC. Stars does impact TBC in that it reduces the amount of allowance we have under the regs. But as I mentioned, there are opportunities we have to trim benefits around TBC, and we will be very focused on doing that.

關於定價措施，正如我之前提到的，我們將非常專注於採取這些定價措施來順應趨勢，同時也會留意我們對TBC的考量。 Stars確實會影響TBC，因為它會減少我們根據法規獲得的配額。但正如我之前提到的，我們有機會削減TBC的福利，我們將非常專注於此。

On the D-SNP product, our intention is to reduce our supplemental benefits in certain areas, including some of the kind of FlexCards that we put in the market this year. And so you'll see us reduce those benefits, and that allows us to capture margin without impacting TBC, and so that's important.

關於D-SNP產品，我們打算減少某些領域的補充福利，包括我們今年推出市場的一些FlexCard。因此，您會看到我們減少這些福利，這使我們能夠在不影響TBC的情況下獲得利潤，這一點很重要。

The other point I'd make, and Karen and Tom alluded to it, we will be taking actions around certain service areas. So to the extent that we don't believe we can credibly recapture margin in a reasonable period of time, we will exit those counties. We will also be looking at areas where we believe that it makes sense to actually discontinue a specific product, then reintroduce a new product where TBC won't apply. And we'll be looking at those opportunities as well, being mindful of the member disruption and some of the churn that you might see.

我想說的另一點，Karen 和 Tom 也提到了，我們將針對某些服務區域採取行動。如果我們認為無法在合理的時間內可靠地恢復利潤，我們將退出這些縣。我們還將考慮在我們認為合理的情況下停止特定產品的服務，然後在不適用 TBC 的地區重新推出新產品。我們也會考慮這些機會，同時注意會員中斷和可能出現的客戶流失。

And so as we step back, we are very focused on margin over membership. Obviously, we're trying to create a stable book with respect to our membership. As we think about the membership impacts, I think there are several things that go into that calculation. One is we believe there will be significant disruption in the PDP market. And the med sup market, we're going to see prices go up. We're going to see people exit certain plans, and we know prices are increasing on med sup.

因此，我們非常注重利潤，而不是會員費。顯然，我們正在努力保持會員費的穩定。考慮到會員費的影響，我認為有幾個因素需要考慮。首先，我們認為PDP市場將出現重大波動。在醫療輔助服務市場，我們將看到價格上漲。我們將看到人們退出某些計劃，我們知道醫療輔助服務的價格正在上漲。

And so that will be a tailwind to our membership projections, offset by the fact, as I mentioned, as we've all mentioned, that we're going to be taking significant pricing actions. And really, it's going to depend on what our competitors do. We believe that they're rational. We believe they're seeing similar type trends, and so they're going to price as well for some of these pressures. But that's something that we'll have to calibrate as we get into pricing. And as I mentioned, there will be some service area reductions.

因此，這將對我們的會員數量預測產生推動作用，但正如我之前提到的，我們也都提到過，我們將採取重大的價格調整措施，這將抵消這一影響。實際上，這將取決於我們的競爭對手的做法。我們相信他們是理性的。我們相信他們也看到了類似的趨勢，因此他們也會針對這些壓力進行定價。但這是我們在定價過程中必須進行調整的地方。正如我之前提到的，服務區域將會縮減。

But again, the focus is on margin over membership. If there's a membership reduction, it's relatively small impacts on margin, and we're focused on making sure we price this product appropriately for 2025 and beyond.

但再次強調，我們的重點是利潤而非會員數。如果會員數量減少，對利潤的影響相對較小，我們專注於確保產品在2025年及以後的定價合理。

Yes. Justin, I'm just going to reiterate what I said in my prepared remarks. We are committed to improving margin in Medicare Advantage, and we will do so by pricing for the expected trends. We will do so by adjusting benefits and exiting service counties, and we are committed to doing that.

是的。賈斯汀，我只是想重申我在準備好的演講稿中說過的內容。我們致力於提高聯邦醫療保險優勢計劃的利潤率，我們將根據預期趨勢定價來實現這一目標。我們將透過調整福利和退出服務縣來實現這一目標，我們致力於做到這一點。

Our next question comes from Lisa Gill of JPMorgan.

我們的下一個問題來自摩根大通的麗莎吉爾。

I just want to follow up on a few things that you said. Brian, I want to go back to your comment around membership and your expectation that the decline in Medicare Advantage membership could be small. Is that based on the assumption that the pressure we're feeling is for everybody in Medicare Advantage and that, therefore, everyone will readjust? And again, to Karen's point, you'll look at certain counties and adjusting certain plan levels, so you could lose some membership, but you're not expecting a large membership decline as you think about 2025, just with the increased cost and changing benefits, et cetera. I just want to make sure that I understand that to start.

我只是想跟進一下你剛才提到的幾點。布萊恩，我想回到你對會員人數的評論，以及你預期聯邦醫療保險優勢計劃（M​​edicare Advantage）會員人數下降幅度可能很小的問題。這是基於這樣的假設嗎：我們感受到的壓力是針對所有聯邦醫療保險優勢計劃（M​​edicare Advantage）會員的，因此每個人都會重新調整？再說一次，回到卡倫的觀點，你會關注某些縣並調整某些計劃級別，因此你可能會失去一些會員，但你預計到2025年會員人數不會大幅下降，只是費用會增加、福利會發生變化等等。首先，我想確認一下我理解這一點。

Sure. And thanks for the question, Lisa. So I would say there are 2 elements here. There's the what's going to happen from an industry perspective in growth and then what we at Aetna are going to do.

當然。謝謝你的提問，麗莎。我想說這裡有兩個要素。一個是從產業角度來看未來成長會發生什麼，另一個是我們安泰將要做什麼。

So on the industry side, as I mentioned, I think there are some clear tailwinds from the perspective of what's going to happen in the traditional fee-for-service market, i.e., PDP and med sup. And so as members -- potential members are evaluating their choices, they're going to have to take a look at what are the price increases and some of the disruption that's going to happen in the traditional fee-for-service market. So that would be a tailwind.

因此，正如我之前提到的，從行業角度來看，我認為從傳統按服務收費市場（例如PDP和醫療支持）未來發展來看，存在一些明顯的利好因素。因此，作為會員——潛在會員——在評估他們的選擇時，他們必須考慮價格上漲以及傳統按服務收費市場即將發生的一些顛覆性變化。所以，這將是一個利好因素。

I do think, though, that the industry broadly is going to be trimming benefits, in some cases, significantly and exiting from certain counties that aren't profitable. I think that's an industry issue, and I think it's clearly an Aetna focus as well. And so how that calibrates where we ultimately end up on membership is something that, again, we've got to work through bids and pricing to sort of estimate what we think our competitors are going to do.

不過，我確實認為，整個產業將會大幅削減福利，並退出某些不獲利的縣。我認為這是行業問題，也顯然是安泰關注的重點。因此，如何最終確定我們的會員數量，這需要我們透過投標和定價來評估競爭對手的行動。

So it's hard to say right now that we won't have a meaningful decrease in membership. It's certainly possible. What -- the message we're trying to communicate is we are focused on margin over membership. And to the extent that we do have a larger-than-desired membership reduction, then that will occur, and we'll focus on the margin side.

所以現在很難說我們的會員數不會大幅下降。當然有可能。我們試圖傳達的訊息是，我們更重視利潤而不是會員數。如果會員數量確實比預期減少得更多，那麼這種情況就會發生，我們會專注於利潤方面。

But again, I think our competitors here are rational. I think they are facing a number of similar pressures. Obviously, we have our own unique elements that we need to address as well. And so I think that calibration as well as what happens to the broader industry will really dictate where our membership goes next year.

但我再次強調，我們的競爭對手是理性的。我認為他們面臨著許多類似的壓力。顯然，我們也需要應對自身的獨特因素。因此，我認為這種調整以及整個行業的發展將真正決定我們明年的會員歸屬。

Lisa, from a very high level, as you think about what the potential -- List, just as you -- from a very high level, as you think about what the impact of membership loss is, just when you think about the comments that we made about margin restoration relative to the implied losses in the book, and so losing additional members doesn't necessarily contribute to lost profit in 2025.

麗莎，從非常高的層面來看，當你思考潛在的——列表，就像你一樣——從非常高的層面來看，當你思考會員流失的影響是什麼時，當你思考我們關於保證金恢復相對於賬簿中隱含損失的評論時，因此失去額外的會員並不一定會導致 2025 年的利潤損失。

And then, Tom, if I can just understand the cadence of 2024. And you, obviously, you talked about low double-digit growth in 2025. How do we think about that cadence as we're continuing throughout 2024? Anything you would specifically call out as we think about the rest of '24?

然後，湯姆，請問您能否理解2024年的節奏？您之前提到2025年經濟將維持低兩位數成長。那麼，在2024年，我們該如何看待這種節奏呢？在展望2024年剩餘時間時，您有什麼特別想說的嗎？

Yes. One of the things that I think is worth talking a little bit about, as you think about the Health Services segment, we do have some pressures in there that we think are Medicare market-related in the Health Care Delivery business. We also saw some timing and mix-related impacts in our other Health Services segment businesses.

是的。我認為值得一提的是，說到醫療服務部門，我們確實面臨一些壓力，我們認為這些壓力與醫療保健配送業務中的醫療保險市場有關。我們也看到了其他醫療服務部門業務中一些與時間和組合相關的影響。

And we've taken a cautious stance right now on in-year recovery on those, and that's because we lost a large client there. We had some in-sourcing activity at another large client. We've had some supply shortages in some other categories. We also delayed the initial launch of our biosimilar product to April 1 from our initial plans. So accordingly, as we look at the seasonality of earnings, we think -- we currently expect that you'll see probably more like 55% to 60% of our earnings in the second half of 2024 to adjust for some of that sloping.

我們目前對這些業務的年內復甦持謹慎態度，因為我們失去了那裡的一個大客戶。我們在另一個大客戶那裡進行了一些內包活動。我們在其他一些產品類別中也出現了供應短缺。我們也將生物相似藥產品的首次上市時間從最初的計畫推遲到了4月1日。因此，考慮到獲利的季節性，我們認為－我們目前預計，為了適應部分獲利的波動，2024年下半年的獲利可能會下降55%到60%。

Our next question comes from Nathan Rich of Goldman Sachs.

我們的下一個問題來自高盛的 Nathan Rich。

I just wanted to follow up on some of the drivers for 2025. I guess from this point in the year, I mean, can you talk about how big of a shortfall the final rate was relative to what your current view of kind of cost trend will be for 2025? And then how are you thinking about the change in profitability for the Part D business next year in light of the benefit design changes that you've talked about?

我只是想跟進2025年的一些驅動因素。我想從今年的這個時間點來看，您能否談談最終費率與您目前對2025年成本趨勢的看法相比，差距有多大？然後，考慮到您提到的福利設計變化，您如何看待明年D部分業務盈利能力的變化？

I might leave it to Brian to talk about the Part D changes and their impact on profitability. There is a very substantial change in plan liability there, which will result in much higher premiums, which we think is going to impact both overall benefits within the bids. But also, as we think about those seniors that are currently in the market to purchase a bundle, that the cost of that bundle is going to rise pretty dramatically for them, which may, even with a less robust set of benefits, make Medicare Advantage an attractive option in 2025.

我可能會讓布萊恩來談談D部分的變化及其對獲利能力的影響。該計劃的責任發生了非常重大的變化，這將導致保費大幅上漲，我們認為這將影響投標中的整體福利。而且，考慮到目前市場上正在購買捆綁計劃的老年人，捆綁計劃的成本對他們來說將大幅上漲，即使福利不那麼豐厚，也可能使Medicare Advantage在2025年成為一個有吸引力的選擇。

The bid itself for 2025, what we received from CMS, the pricing was just disappointing. It's -- clearly, as we look at our trends, as we look at the market trends, we don't think that the rate sufficiently reflects that. We have another year of the phase-in of the risk adjustment model. There's no flexibility that's been given to date on TBC despite the material changes that we are experiencing because of the Inflation Reduction Act on Part D.

我們從CMS收到的2025年投標報價本身就令人失望。顯然，從我們的趨勢和市場趨勢來看，我們認為利率並沒有充分反映這一點。我們還需要一年時間逐步實施風險調整模型。儘管《通膨削減法案》D部分條款為我們帶來了重大變化，但迄今為止，TBC方面仍未獲得任何彈性。

And so the combination of those things just makes a tough year for 2025 pricing harder when we don't see the pull-through of what most of the market participants are experiencing into the bid baseline.

因此，當我們沒有看到大多數市場參與者在投標基準中所經歷的拉動動作時，這些因素的結合只會使 2025 年的定價變得更加艱難。

And Brian, maybe you could talk a little bit more about that.

布萊恩，也許你可以再多談這個。

Sure. I mean, first, with respect to Part D, I think Tom articulated it well. There's just incremental benefits that are being offered and significant increase in plan liability. And while there'll be an increase in direct subsidy, and we're expecting that, it really isn't sufficient to cover that increased liability that the plans have.

當然。首先，關於D部分，我認為湯姆表達得很好。目前提供的福利只是增量，而計畫責任卻大幅增加。雖然直接補貼會增加，這也是我們預期的，但這實際上不足以彌補計劃增加的責任。

And so there's going to be a lot of discussion, I imagine, in the industry, certainly here at Aetna, about what product is ultimately viable for us as we think about the potential risks and volatility that could result from putting out a product and the impact of potential adverse selection in terms of who you attract. The types of members who use brand utilizers, specialty utilizers, et cetera, creates additional uncertainty, particularly because of that enhanced liability and the fact that the benefits are so rich that typical traditional views of insurance and getting low price and those sorts of things may or may not apply in the same way as it did. And so those are the types of things we're thinking through.

因此，我想，業內，尤其是在安泰，將會有很多關於什麼產品最終對我們有利的討論，因為我們會考慮推出一款產品可能帶來的潛在風險和波動性，以及潛在的逆向選擇對目標客戶的影響。使用品牌保險、專業保險等等的會員類型會帶來額外的不確定性，尤其是因為責任加重，而且這些保險的福利如此豐厚，以至於人們對保險的傳統觀念——低價保險等等——可能仍然適用，也可能不再適用。所以，這些正是我們正在思考的問題。

And obviously, as we come back on the next quarter call, we'll give you more color about our perspective on the Part D market. We do think there's going to be disruption. We do think it's going to necessitate premium increases. And that's why there's just some uncertainty about where the ultimate industry goes from an MA perspective in terms of membership.

顯然，在下次季度電話會議中，我們會更詳細地闡述我們對 D 部分市場的看法。我們確實認為市場將會出現混亂。我們確實認為這將導致保費上漲。因此，從 MA 的角度來看，就會員人數而言，最終產業的走向存在一些不確定性。

With respect to your first question on the trend delta, look, it's obviously very significant. We've been very clear that the trends that we're seeing in 2024, which are really consistent with 2023, we expected some measure of break to a more normalized trend, as Karen and Tom said. And frankly, I think we were conservative on what a normalized trend would be.

關於你關於趨勢增量的第一個問題，你看，它顯然非常重要。我們已經非常清楚，我們在2024年看到的趨勢與2023年非常一致，正如Karen和Tom所說，我們預計會在一定程度上打破更正常的趨勢。坦白說，我認為我們對正常化趨勢的預期比較保守。

If you go back historically, even before the pandemic, for many, many years, trends were in the 3% to 5% range. We saw trends in 2023 approaching 10%. We're seeing trends in 2024 mirror those levels, exacerbated even more so by some of the seasonal factors that Tom mentioned in the first quarter. And so we're going to continue those trends into 2025.

回顧歷史，即使在疫情爆發之前，在許多年裡，趨勢都在3%到5%之間。我們看到2023年的趨勢接近10%。我們看到2024年的趨勢與這一水平相似，而且由於湯姆在第一季提到的一些季節性因素，這一趨勢更加惡化。因此，我們將在2025年延續這些趨勢。

Now we have really not seen 2 years, let alone 3 years of those levels of elevated trends without break. But it's imperative that we include that in our pricing, and we intend to do that. And our expectation is our competitors will be thinking about it in a similar fashion. And so we need to think hard about how we're going to make up that delta between what we got in the pricing and what we got in trend, what we have in trend. And there are a number of levers we're going to pull. Benefits is one that clearly we're going to be focused on.

現在，我們真的還沒有看到連續兩年，更不用說三年，這種持續不斷的上升趨勢。但我們必須將這一點納入定價，我們也打算這麼做。我們預期競爭對手也會以類似的方式考慮這個問題。因此，我們需要認真思考如何彌補定價與趨勢之間的差距。我們將採取一系列措施。其中，效益顯然是我們將重點關注的。

And if I just think about stepping back from your question, Nate, revenue in that product per member is clearly going to go up. It's just not clear exactly what's going to happen to the overall membership base, but we're going to price for a profitable product and what's ultimately going to be a higher premium product on Part D.

內特，如果我退一步來說你的問題，那款產品的每位會員收入顯然會上升。目前還不清楚整體會員基礎會發生什麼變化，但我們會為一款獲利產品定價，最終會成為D部分中更高端的產品。

Okay. Great. And sort of where I wanted to go with the follow-up, you talked, Tom, about the 200 basis points of margin improvement in the MA business next year. So that's around $1.3 billion, $1.4 billion, depending on where membership shakes out, and half of that is the Stars tailwind. I think if we just look at the other $700 million on a PMPM basis, it's $10 to $15 PMPM. But it sounds like there may be some cost headwinds that are maybe offsetting the change in benefits.

好的。太好了。接下來我想問的是，湯姆，你提到了明年會員管理業務的利潤率將提高200個基點。也就是說，大約是13億美元到14億美元，取決於會員的變動情況，其中一半是Stars帶來的收益。我認為，如果我們只按月平均會員費（PMPM）來算，剩下的7億美元應該是月平均會員費（PMPM）10到15美元。但聽起來可能存在一些成本上的阻力，這些阻力可能會抵銷福利的變化。

And so I guess I wanted to see if you could give us a rough sense of maybe the type of reduction that you're talking about in terms of the benefit design as we think about next year and then what the opportunity would be as we think 3 or 4 years down the road.

所以我想看看您是否可以給我們一個大致的了解，就我們考慮的明年的福利設計而言，您談論的削減類型，以及我們認為 3 或 4 年後的機會是什麼。

Yes, Nate, I think for competitive reasons, I don't want to get into any more than we've already given relative to the improvement or any more granularity there other than to say I think we've made it clear that everything is on the table. So there are TBC benefits that will probably get adjusted. There are non-TBC benefits that will get adjusted. We'll look at all -- like this is not an acceptable result where we're going to be for this year in terms of profitability on this block of business. And so we're going to look at everything that we can do to try to improve profits for next year and maintain some level of stability inside the book.

是的，Nate，出於競爭原因，我不想就改進方案或更詳細的細節進行過多的討論，只想說，我們已經明確表示，所有方案都在考慮之中。因此，TBC 福利可能會進行調整。非 TBC 福利也會進行調整。我們會仔細考慮所有因素——例如，就這部分業務的獲利能力而言，這是否是我們今年無法接受的結果。因此，我們將盡一切努力，努力提高明年的利潤，並保持一定程度的帳面穩定性。

As you're doing the bridge between '24 and '25, there are some variable expense items that are clearly going to come back in 2025. That's part of the reason that we've talked about how we're going to accelerate some of our expense efforts to try to offset any restoration of expense that would come back in 2025. It's a little early days to try to talk about what that will yield in 2025, but we're committed to taking action to help offset any headwinds there. And we'll give you more updates on that as we get to next quarter.

在2024年和2025年之間搭建橋樑時，有些變動費用項目顯然會在2025年恢復。這也是我們討論如何加速部分費用支出管理力度，以抵銷2025年可能出現的支出恢復的部分原因。現在談論2025年將產生什麼結果還為時過早，但我們致力於採取行動，幫助抵消任何不利因素。下個季度我們將為您提供更多相關資訊。

Yes. Nate, I would just add that we continue to evaluate our overall cost structure with respect to operations, process, productivity. And we began a comprehensive review of that last year, we took actions, they're showing up this year and now we're going to accelerate other initiatives over the next few months. And as we continue to size those efforts, we'll update you throughout the year.

是的。 Nate，我想補充一點，我們一直在評估我們的整體成本結構，包括營運、流程和生產力。去年我們對此進行了全面審查，並採取了行動，這些措施今年已經顯現出來。接下來幾個月，我們將加快其他措施。隨著我們繼續推動這些舉措，我們將在全年向大家通報最新進展。

Our next question comes from Stephen Baxter of Wells Fargo.

我們的下一個問題來自富國銀行的史蒂芬‧巴克斯特。

Another follow-up on Medicare Advantage. You mentioned in the prepared remarks that I think you spent time looking for potential selection bias, either with new members or inside of your existing book. I'm not sure if you talked about what you actually found when you did that. So just trying to understand whether you saw greater-than-expected switching from your own members or if the step-down in profitability across the broader book was mirrored in your new membership or maybe that was something in excess of that to consider.

關於聯邦醫療保險優勢計劃 (Medicare Advantage) 的另一個後續問題。您在準備好的評論中提到，我認為您花時間尋找潛在的選擇偏差，無論是在新會員中還是在現有會員中。我不確定您是否談到了您在這樣做時實際發現了什麼。所以，我只是想了解一下，您是否看到了超出預期的會員轉換率，或者整體會員盈利能力的下降是否反映在了新會員人數中，或者也許這是需要考慮的額外因素。

Yes. So we've looked at it very closely, as you can imagine, trying to understand whether the new members are creating disproportionate impact on our results. And we've analyzed it every which way we can. And when you look at basic results such as their emissions per thousand or their pharmacy spend or their risk or other categories of care, we're really not seeing a material difference between the new members and the old members. And so what we're really seeing is a pressure on our entire book that we are having to take action against ultimately.

是的。所以，正如你所想像的，我們對此進行了非常仔細的研究，試圖了解新成員是否對我們的表現造成了不成比例的影響。我們已經盡一切可能地進行了分析。當你查看基本結果，例如他們的千人排放量、藥房支出、風險或其他護理類別時，我們並沒有發現新成員和老成員之間有實質的差異。因此，我們真正看到的是，我們整個財務狀況都面臨壓力，最終我們必須採取行動來應對。

We looked at things, of course, and I know there's been a lot of discussion around the fitness benefit, for example. That was clearly something that was appealing to our members on the general enrollment block. It's just some of the general enrollment block in terms of selecting that benefit. When we look at the financial impact of that, actually, it's pretty modest. It's actually running in line with our pricing expectation.

當然，我們也研究過一些事情，我知道關於健身福利的討論已經很多了。這顯然對我們普通會員來說很有吸引力。這只是普通會員在選擇這項福利時的一些小建議。實際上，從財務影響來看，它的影響相當小。它實際上符合我們的定價預期。

Some of the dental benefit enrichment that we did, we are seeing some pressure, as Tom mentioned, on that supplemental benefit. We are seeing more members use that benefit and use more of it. And so -- but that's really across the book. And so again, I don't see a selection bias between old and new members, but rather pressures throughout that we need to address for 2025.

正如湯姆所說，我們先前對牙科福利的提升，也看到了一些對補充福利的壓力。我們看到越來越多的會員使用這項福利，而且使用量也越來越大。但這其實是普遍現象。所以，我再次強調，我沒有看到新舊會員之間有選擇偏差，而是看到了我們需要在2025年解決的普遍壓力。

The next question comes from Michael Cherny of Leerink Partners.

下一個問題來自 Leerink Partners 的 Michael Cherny。

Maybe I'll step to Health Services for a second. I'm sure others may come back to other MA questions. But as you think about the performance in the quarter and the dynamics you're seeing about prepping both for changes in members, changes in the customer losses in terms of the large customer rollout, how do you think about the scaling dynamics of your purchasing capabilities and how that's ramping into Cordavis as you've launched that?

也許我會先談談醫療服務。我相信其他人可能會回到其他行銷問題。但是，考慮到本季的業績表現，以及您所看到的為應對會員變化和大規模客戶推出帶來的客戶流失變化所做的準備，您如何看待採購能力的擴展動態，以及隨著Cordavis的推出，採購能力將如何向其擴展？

And I guess you gave some early look there. But are there any additional signs you can give us on how you think about the financial contribution of Cordavis baked into either this year's guidance or in terms of the targets for next year?

我想您已經對此做了一些初步的了解。但是，您能否提供一些其他信息，說明您如何看待Cordavis在今年的業績指引或明年的目標中所佔的財務份額？

There is a contribution from Cordavis that's embedded in our Health Services guidance. We haven't disclosed the date, Michael, what that impact is, other than to say versus our initial projection because we delayed the formulary change to 4/01, we had hoped to do it a little earlier in the year. That did have a little bit of a timing impact inside the quarter, but the adoption there has been fabulous. The client reception has been fabulous.

Cordavis 的貢獻已納入我們的醫療服務指南。 Michael，我們尚未透露具體日期，也不知道具體影響如何，只能說與我們最初的預測相比，因為我們將處方集變更推遲到了 4 月 1 日，我們原本希望在今年早些時候完成。這確實對季度內的時間安排產生了一些影響，但 Cordavis 的採用情況非常好。客戶反應也非常好。

And maybe, David, you could talk a little bit more about what you're seeing there.

大衛，也許你可以再多談談你在那裡看到的情況。

Sure. Thanks, Tom. And before I get into the actual results for the biosimilar change, maybe I'll just spend a second talking more broadly about the question you asked around control and kind of our confidence on the ability to continue to have purchasing advantages in the market.

當然。謝謝，湯姆。在我討論生物相似藥變革的實際結果之前，我想先花一點時間更廣泛地談談你提出的關於控制的問題，以及我們對繼續在市場上保持採購優勢的信心。

And so I go back to the strength that we have in specialty. So most of all the success we've delivered is because of our leadership position, specifically in the specialty marketplace. So we have unmatched access both across mail, retail and in the home infusion space. We have broad set of products, both in the pharmacy and the medical benefits side; continue to be a leader in the limited distribution category; continue to be a leader in the new developing cell and gene therapy marketplace.

所以，我再回到我們在專科領域的優勢。我們所取得的成功，最主要歸功於我們的領導地位，尤其是在專科市場。因此，我們在郵寄、零售和家庭輸液領域都擁有無與倫比的管道。我們擁有廣泛的產品組合，涵蓋藥房和醫療福利領域；我們將繼續在有限分銷領域保持領先地位；我們將繼續在新興的細胞和基因治療市場保持領先地位。

So that, combined with the technology that we've invested, has allowed us to be kind of the leading provider in this space. So that is the foundation, allowed us to have the confidence to make the change for the formulary position on April 1. So if you look and what was mentioned in the prepared remarks, we've actually had a change as of 4/01, removing Humira from the formulary and replacing it with a low list-priced biosimilar.

因此，結合我們投入的技術，我們得以成為該領域的領先供應商。這奠定了基礎，讓我們有信心在4月1日對處方集進行調整。如果您查看準備好的發言稿中提到的內容，您會發現我們實際上已於4月1日起進行了調整，將修美樂從處方集中移除，並用低價生物仿製藥取而代之。

And as we said earlier, in just 3 weeks' time, we've actually surpassed all the biosimilar volume in all of 2023. So that's -- we've been able to hit what is important in terms of control and towards the purchasing, which is that we've been able to migrate more than 90% of the volume in the first month.

正如我們之前所說，在短短 3 週的時間內，我們的生物相似藥銷售量實際上已經超過了 2023 年全年的銷售量。因此，我們已經能夠在控制和採購方面達到重要目標​​，即我們能夠在第一個月遷移超過 90% 的銷售量。

And then when you look specifically inside the CVS Specialty Pharmacy, where we had a set of new services around technology, access to the prescribers and the members, we've been -- we've actually had a 94% conversion rate. So it's a really powerful outcome, and I think it speaks to obviously the strength of our business.

具體到CVS專業藥房，我們推出了一系列圍繞技術、處方醫生和會員服務的新服務，轉換率實際上已經達到了94%。所以，這是一個非常強勁的成果，我認為這顯然證明了我們業務的實力。

And as that translates into savings for our customers, we had mentioned that we're delivering a 50% savings on the [22] run rate for this drug. And then as you translate that into the member benefits, because we've actually moved to a low list price product and we've actually had clients adopt what we would call an intelligent benefit design, we've been able to have 80% of the members with a $0 out of pocket.

這轉化為我們客戶的成本節省，我們之前提到過，我們為這款藥物的[22]運行成本節省了50%。而將其轉化為會員福利，由於我們實際上已經轉向了低價產品，並且我們讓客戶採用了我們所謂的智能福利設計，我們能夠讓80%的會員自付額為0美元。

So again, I think if you look at what we've done, it's a clear win for our clients, our patients, and we've also made a considerable investment in the durability of the biosimilar market. So I think all of that then contributes to the question you originally asked, which is size and scale really is generally driven, and what I would believe the strength in our purchasing economics is the ability to control and move market share. And again, this is another evidence in the market that we hope to continue down that path.

所以，我再說一遍，如果你看看我們所做的一切，你會發現這對我們的客戶和患者來說無疑是一次勝利，而且我們也在生物相似藥市場的持久性方面投入了大量資金。所以我認為所有這些都解釋了你最初提出的問題，即規模和規模通常才是驅動因素，而我認為我們採購經濟的優勢在於控制和轉移市場份額的能力。這再次證明了我們希望繼續沿著這條道路前進的市場證據。

Yes. Mike, I would just say on the biosimilars, obviously, it represents one of the biggest opportunities to reduce overall pharmacy cost for the U.S. health care system. As you know, it's a $100 billion market by 2030. And as you can see in the very first few weeks of our launch, we've had incredible adoption, and we continue to evaluate the pipeline of opportunities. So we are excited about the potential in the future of the biosimilar market.

是的。麥克，關於生物相似藥，我想說的是，它顯然代表著降低美國醫療保健系統整體藥房成本的最大機會之一。如你所知，到2030年，這個市場規模將達到1000億美元。正如你所看到的，在我們產品上市後的最初幾週，我們的產品就獲得了驚人的採用率，我們也持續評估未來的機會。因此，我們對生物相似藥市場未來的潛力感到興奮。

Our next question comes from Josh Raskin of Nephron Research.

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

Here with Eric as well. So my question is -- well, first, just a numbers question. The $400 million in Health Care Services guidance reduction, how much of that is specifically Oak Street? And then on the MA, I hear still committed to 4 to 5, the journey starts in '25. That's very, very clear. How much of your membership is in counties that you're contemplating exiting, just sort of wholesale leaving of the market? And then also, how does the repricing of MA fit into your overall enterprise strategy as, obviously, lots of your assets sell into that channel as well?

Eric 也在這裡。所以我的問題是──首先，只是一個數字問題。醫療保健服務指導金額削減了 4 億美元，其中有多少是專門用於 Oak Street 的？然後關於合併行銷 (MA)，我聽說仍然承諾在 4 到 5 個縣開展業務，旅程從 2025 年開始。這非常非常清楚。你們有多少會員位於你們正在考慮退出的縣，也就是你們打算徹底退出的縣？然後，合併行銷的重新定價如何融入你們的整體企業策略，因為顯然你們的許多資產也透過這個管道銷售？

Let me start with the HSS question, Josh, and then we can try to get to the other ones. So as you think about HSS, and we took it down by about $400 million, the majority of that reduction is the Health Care Delivery business. And the largest driver in there is unfavorability on CVS Accountable Care that came through in terms of the savings rate, which is driven by Medicare utilization, and that includes an out-of-period charge that was taken in the first quarter that's embedded in there.

喬希，我先從 HSS 的問題開始，然後再談其他問題。說到 HSS，我們把它削減了大約 4 億美元，其中大部分削減來自醫療保健配送業務。其中最大的驅動因素是對 CVS Accountable Care 的不利影響，這體現在儲蓄率上，而儲蓄率是由醫療保險使用率驅動的，其中包括第一季發生的期外費用。

I'd say the remainder of that piece of a piece is really Oak Street. But as we think about the first quarter, the performance in that business was reasonably good. And so as we think about what we've seen in the broader market, we made a provision that perhaps some -- there could be some lag there in our forward outlook. We'll obviously have to see how that ultimately develops.

我想說，剩下的部分其實是橡樹街的。但考慮到第一季度，這項業務的表現相當不錯。因此，考慮到我們在更廣闊的市場中所看到的情況，我們考慮到了未來展望可能會存在一些滯後。我們顯然要觀察最終情況如何發展。

As you think about 2023, the business did an excellent job of navigating some of the broader headwinds in the marketplace with some of their new clinical programs and how they played out over the course of the year. We're hopeful that we could see some favorability to that number over time, but we have to see how that all manifest itself in the results.

展望2023年，該公司憑藉一些新的臨床項目以及這些項目在過去一年中取得的成果，出色地應對了市場上一些更廣泛的不利因素。我們希望隨著時間的推移，這一數字能夠有所提升，但我們必須觀察這一切在業績中如何體現。

Mike, I don't know, anything else that you would add?

麥克，我不知道，您還有什麼要補充的嗎？

Yes, Tom, I think you summed it up well from a financial perspective. And the thing I would add when I think about Health Care Delivery more broadly and specifically Oak Street is for the rest of '24 and really in '25 and beyond, I think there's a huge opportunity that Brian and I are working really closely on, on how do we leverage the quality of care and the ability to really bend med cost trend and drive MLR improvement, how do we leverage that more broadly across Aetna with Oak Street.

是的，湯姆，我認為你從財務角度總結得很好。當我更廣泛地、更具體地思考橡樹街的醫療保健服務時，我想補充的是，在2024年剩餘時間以及2025年及以後，我認為布萊恩和我正密切合作，共同探討如何利用醫療品質和真正扭轉醫療成本趨勢、推動最低醫療成本率（MLR）改善的能力，以及如何透過橡樹街在安泰保險中更廣泛地利用這些機會。

And so there's a lot of things we're doing, both from adding membership from Aetna to Oak Street centers, but also leveraging some of the out-of-center capabilities we have around transitions programs and care in the home that we use at Oak Street today. Let's use that for more Aetna members. So there's a lot of opportunity here that we'll see play through in the coming years.

所以，我們正在做很多事情，既包括將安泰的會員加入橡樹街中心，也包括利用我們目前在橡樹街中心使用的過渡項目和居家護理等中心外服務能力。讓我們利用這些能力來吸引更多安泰會員。所以，未來幾年，我們將看到這裡有很多機會可以發揮。

And I would just add to Mike that, as you said, we are working very closely together. And for example, while obviously, we're not going to provide color today on specific counties and the extent which counties will exit, we wouldn't do that in an Oak Street footprint as an example, right? So we're going to be very thoughtful about how we trim our book with the goal of, over time, retaining the margins and attaining the margins that Tom articulated.

我想補充一點，正如麥克所說，我們正在密切合作。例如，雖然我們今天顯然不會透露具體縣的具體情況以及哪些縣將退出，但我們不會以橡樹街的足跡為例這樣做，對吧？因此，我們將非常認真地考慮如何精簡我們的書籍，目標是隨著時間的推移，保留利潤空間並達到湯姆所說的利潤空間。

I'd also remind you that every 100 basis points is worth more than $500 million on a trend basis. And so if we think about where historical trends have been, if we think about where trends are today, we're in no way baking this into our assumptions. But as you think about recovery here, this has the potential to bounce back and retain those, get back to that profitability as well, which I think is important to mention.

我還要提醒大家，以趨勢來看，每100個基點的價值都超過5億美元。因此，如果我們思考歷史趨勢，思考當前的趨勢，我們絕對不會將這些因素納入我們的假設中。但說到復甦，這有潛力反彈並保持盈利，恢復盈利能力，我認為這一點值得一提。

But we're going to be very thoughtful about how we think about our membership footprint. And again, the ultimate goal is membership stability, but we're going to favor margin over membership for next year.

但我們會非常認真地考慮如何規劃我們的會員足跡。再次強調，最終目標是會員穩定，但明年我們會更重視利潤率而不是會員數。

Our next question comes from Elizabeth Anderson of Evercore ISI.

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

I was wondering, can you talk about sort of care management tools and sort of the impact that you are thinking about in terms of their impact on '24? And then any sort of changes you're making in '24 that you think will have an impact as we think about the 2025 results for HCB?

我想知道，您能否談談護理管理工具以及它們對2024年的影響？您認為2024年做出的哪些改變會對2025年HCB的結果產生影響？

Well, clearly, care management is an important tool that we use to engage our members. And we spend a lot of time sort of segmenting who our high-risk members are, who are the members who would benefit most from care management. We're actually using a lot of really advanced AI tools to identify those members. We really think we have excellent analytics to be able to pinpoint who those members are and how are we best able to engage with them or the types of things that will get them to engage with us, and then also make it easier for our care management nurses at the point of care to be able to provide the level of advice and support that a member needs.

顯然，護理管理是我們用來吸引會員的重要工具。我們花費大量時間來細分高風險會員，以及哪些會員最能從護理管理中受益。我們實際上正在使用許多非常先進的人工智慧工具來識別這些會員。我們堅信，我們擁有出色的分析能力，能夠精準識別這些會員，以及我們如何才能最好地與他們互動，或者透過哪些方式吸引他們與我們互動，同時也讓我們的護理管理護士能夠更輕鬆地在護理點提供會員所需的建議和支持。

And so it's something that we're very focused on. I would tell you that we continue to roll out some of these AI capabilities that makes these programs much more effective with much better ROIs. And so while there'll be modest impacts in '24, over time, we expect that to be a differentiator for us. And so we're very focused there.

所以這是我們非常關注的事情。我想說的是，我們正在持續推出一些人工智慧功能，使這些專案更有效率，投資報酬率也更高。雖然2024年的影響不大，但隨著時間的推移，我們預計這將成為我們的差異化優勢。所以我們非常關注這一點。

Yes, I would just add to that, and this is where the partnership between Health Care Delivery and Aetna comes in. Between Signify and some of the capabilities we have at Oak Street, there's a lot of boots on the ground, in-market capabilities that we have to really change the health trajectory of patients, whether that be readmissions to the hospital or managing your most complex chronic patients.

是的，我只想補充一點，這就是 Health Care Delivery 和 Aetna 之間的合作。在 Signify 和我們在 Oak Street 擁有的一些能力之間，我們擁有許多實地、市場化的能力，這些能力可以真正改變患者的健康軌跡，無論是重新入院還是管理最複雜的慢性病患者。

And so this is where I think a lot of that partnership plays out is in that space of getting a deeper level of impact because we have the resources, we have the programs, we have the know-how. Now we can extend those over a lot more members. And so I think both Signify and Oak Street will bring a lot to the table over the coming years on how we can really bend that cost trend.

所以我認為，這種合作關係的很大一部分在於能夠產生更深層的影響，因為我們擁有資源、專案和專業知識。現在，我們可以將這些擴展到更多成員。因此，我認為，Signify 和 Oak Street 在未來幾年將在如何真正扭轉成本趨勢方面發揮重要作用。

Our final question comes from Ann Hynes of Mizuho Securities.

我們的最後一個問題來自瑞穗證券的安·海因斯。

You talked about pharmacy services. There were some pressure on mix and also your inability to make prior guarantees. Can you just elaborate on both comments? Is the prior guarantee a diabetes issue given the GLP class?

您談到了藥房服務。產品組合方面存在一些壓力，而且您無法提供預先保證。能詳細說明一下這兩點嗎？考慮到GLP等級，預先保證是否與糖尿病有關？

It's not a diabetes issue. Think of it as the -- we have to have projections about what the mix looks like to ensure that we appropriately hit all of our client guarantees. And with the changing mix inside the quarter, given some of the disruptions that we saw not only with the loss of a large client, but with the in-sourcing of another client's business and some of the disruptions in the marketplace in terms of volumes, specifically GLP-1s was part of that, we were -- we missed our guarantees by a little bit.

這不是糖尿病的問題。可以這樣想——我們必須對產品組合進行預測，以確保我們能夠適當地兌現所有客戶的保證。隨著本季產品組合的變化，考慮到我們不僅失去了一個大客戶，還承接了另一個客戶的業務，以及市場在產量方面的一些波動，特別是GLP-1藥物，我們——我們稍微偏離了承諾目標。

We'll see how we're able to recoup that over the remainder of the year. But at this point, what we've assumed is that, that first quarter is permanent and that we can get back to our previous projections for the remainder of the year.

我們將看看如何在今年剩餘時間內收回這些損失。但目前，我們假設第一季的業績將保持不變，並且我們能夠恢復到今年剩餘時間的先前預測。

David, anything you'd add to that?

大衛，您還有什麼要補充的嗎？

No, I think that's consistent with the way we see it. I will just add one thing on GLP-1. Obviously, it's -- there's been a lot of volatility, one, because of supply constraints that we've experienced and, obviously, a lot of work around managing what we would see as this unprecedented demand, combined with a very challenging price point, is leading to a lot of energy around how to best manage this category through whether it be formulary, more aggressive utilization management and then the broader care management wrappers on this.

不，我認為這與我們的看法一致。關於GLP-1，我只想補充一點。顯然，市場波動很大，首先，我們經歷了供應限制，其次，顯然，我們需要做大量工作來應對這種前所未有的需求，再加上極具挑戰性的價格點，這導致我們投入大量精力來研究如何透過處方集、更積極的利用管理以及更廣泛的護理管理方案來更好地管理這一類別。

But this category alone is driving obviously significant costs for our clients, and it's also driving significant expense within our organization just to support what is now one of our highest drivers of call volume around people trying to find access to the product and making sure that we get consistent supply in the market.

但僅此一項就明顯為我們的客戶帶來了巨大的成本，也為我們組織帶來了巨大的開支，僅僅為了支持現在我們最大的呼叫量驅動因素之一，人們試圖找到產品的途徑，並確保我們在市場上獲得穩定的供應。

So we believe we've got a really strong set of programs and services to manage the category. And we believe once there's competition and adequate supply, we'll be able to have more consistency around how we manage this category.

所以我們相信，我們擁有一套非常強大的專案和服務來管理這個品類。我們相信，一旦有了競爭和充足的供應，我們就能在這個品類的管理上更加一致。

And as we close the call, I wanted to take this opportunity to thank our colleagues for their many contributions, and we look forward to providing you updates throughout the year. Thank you for joining the call today.

在電話會議結束之際，我想藉此機會感謝各位同事的辛勤貢獻，並期待全年持續更新資訊。感謝您今天的參與。

Ladies and gentlemen, this concludes today's call. Thank you for joining. You may now disconnect [your lines].

女士們，先生們，今天的電話會議到此結束。感謝各位的參與。現在您可以掛斷電話了。