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)

您好，歡迎參加今天的 CVS Health 2024 年第一季財報電話會議。我叫喬丹，今天我將協調您的電話。 （操作員說明）

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

我現在將由拉里·麥格拉思開始。拉里，請繼續。

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。

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，我們將舉辦問答會議，其中包括我們領導團隊的其他成員。我們的新聞稿和幻燈片演示以及今天早上向 SEC 提交的 10-Q 表格已發佈到我們的網站上。今天的電話會議也會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，特別是我們在 10-K 表格上提交的最新年度報告中有關前瞻性陳述和風險因素的警告聲明中描述的報告、我們今天早上提交的10-Q 表格季度報告以及我們最近提交的8-K 表格，包括今天早上的收益新聞稿。

During this call, we'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. This morning, we announced first quarter results that were burdened by utilization pressures in Medicare Advantage, which materially impacted our Health Care Benefits segment.

謝謝你，拉里。大家早安，感謝您今天加入我們的電話會議。今天早上，我們公佈了第一季業績，該業績受到 Medicare Advantage 的利用壓力的影響，這對我們的醫療保健福利部門產生了重大影響。

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.

調整後每股收益為 1.31 美元，低於我們的預期。鑑於此表現以及我們對 2024 年剩餘時間的最新預期，我們將 2024 年全年調整後每股盈餘指引下調至至少 7 美元。湯姆將更詳細地了解這些結果和我們修訂後的指南。

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.

我想在今天早上開始我們的討論，重點關注我們在 Medicare Advantage 業務中遇到的挑戰以及我們正在採取哪些措施來應對這些壓力。當我們上次給予2024 年指引時，我們的展望假設Medicare Advantage 趨勢正常化，而基礎是我們在2023 年第四季經歷的較高基線。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，我們本季的知名度因 Change Healthcare 的網路攻擊而受到損害。截至本季末，我們為估計尚未收到的索賠建立了近 5 億美元的準備金。這是我們對缺失索賠的最佳估計，其中大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.

當我們結束本季時，我們的 Medicare Advantage 業務在幾個領域明顯面臨廣泛的利用壓力。第一季門診服務和補充福利持續增加，超出了我們的預測。我們也看到住院和藥房類別面臨新的壓力，其中一些是季節性或一次性的。四月的住院授權和入院人數似乎有所放緩。

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.

為了應對這些壓力，在我們看到入學人數成長非常強勁的情況下，我們採取了一系列行動，以確保我們的臨床業務的執行水準符合我們的預期。我們組建了一個多學科團隊，對我們的索賠數據進行回顧性審查，尋找特定條件、地理或基於設施的異常值，並發現我們新的和現有的會員基礎中的任何選擇偏差。我們透過從 CVS Health 重新部署護理師並在必要時增加招募來確保臨床團隊的人員配備符合當前的數量。我們評估了機會並採取了行動來優化我們的藥品福利支出。

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，我們還在加快企業生產力計劃，以簡化和優化我們的運營，確保我們的成本與業務運營、環境和條件保持一致。我們正在利用 CVS Health 的廣泛資源和經驗，快速且迫切地實施這些行動。我們擁有成功應對複雜行業壓力的記錄，我們將繼續展示我們的韌性。我們將全年提供這些努力的最新情況。

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.

我還認為討論我們對 Medicare Advantage 的長期前景很重要。我們最近收到了 2025 年最終費率通知。與《通貨膨脹減少法案》規定的 D 部分變更相結合，我們認為該利率是不夠的。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福利的同時，我們將在構建 2025 年投標時調整計劃層面的福利並退出縣。

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 最近面臨挑戰，但我們堅信，隨著時間的推移，該計劃仍然可以為老年人提供有吸引力的服務，並且對 Aetna 和 CVS Health 來說是一個非常有吸引力的業務。 Medicare Advantage 將繼續為會員提供巨大的價值以及更好的結果和患者體驗。在接下來的幾年裡，我們決心提高我們在 Medicare Advantage 中的定位。我們的內部努力和多年重新定價機會相結合，使我們對在 3 至 4 年內恢復到 4% 至 5% 的目標利潤率的能力充滿信心。

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解決 Medicare Advantage 業務面臨的壓力。但是，我敦促您不要忽視我們企業的力量。我們業務的優勢和多樣性使我們能夠在 2025 年實現成長，為患者、客戶和股東創造價值。我們透過 Cordavis 業務確保美國生物相似藥市場的可行，這將為我們的客戶降低成本，為消費者節省開支，並帶來更高的保留率和成長。

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 Humira 相關的獨特且有意義的處方變更。自處方變更後的第一個月，我們就已經產生了重大影響，到2023 年，所配發的生物相似藥Humira 處方數量將超過整個美國市場。和Cordavis 業務在加速生物相似藥採用方面的綜合實力以及我們對客戶降低藥房成本的承諾。

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.

我們的藥房和消費者健康業務本季表現強勁，儘管在不確定的宏觀經濟環境下消費者需求疲軟，但我們仍能夠增加藥房份額，這凸顯了我們的藥房份額的能力。我們的 CVS 藥局地點繼續在全國各地的社區中發揮著重要且不斷擴大的作用。

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，我們發現人們對這些更簡單、透明的藥局模型產生了極大的興趣。我們正在與PBM 進行積極討論，以便於2025 年1 月1 日在商業合約中推出CVS CostVantage。 ，代表了超過50% 的第三方折扣卡管理機構。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通報最新情況。

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.

在我們的醫療保健服務業務中，我們在整合工作中看到了有意義的進展。本季度，Signify 的家庭評估量創下歷史新高。由於我們利用 CVS Health 接觸點的能力，Oak Street 的高風險患者比去年同期成長了近 20%。在 Aetna，我們的商業業務在 2025 年生效日期內贏得了大型集團客戶的多項勝利，這證明了我們透過多元化的產品組合提供全面福利解決方案的能力。

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.

在我們的醫療補助業務中，我們在多個 RFP 中取得了成功，包括維吉尼亞州、密西根州和德克薩斯州，我們的 CVS Health 資產在這些地區被強調為差異化優勢。這些代表了我們各業務近期的一些亮點，並展示了我們廣泛的資產組合的價值和積極勢頭。

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.

目前的環境並沒有減少我們的機會、我們的熱情或我們公司的長期獲利能力。我們相信，我們有辦法解決近期的 Medicare Advantage 挑戰。雖然最近的業績受到壓力，但我們的行動將使我們的收入恢復到適當的水平，並將帶來更強勁的 CVS Health。我們一如既往地致力於我們的策略，並相信我們擁有合適的資產來為我們的客戶、會員、患者和股東創造價值。

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

湯姆將提供有關我們每項業務的結果以及更新指南的組成部分的詳細資訊。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，我們的營收約為 880 億美元，比去年同期成長約 4%。我們的調整後營業收入約為 30 億美元，調整後每股收益為 1.31 美元。我們也從營運中產生了 49 億美元的現金流，與去年同期相比有所下降，這主要是由於醫療保險支付的時間安排所致。

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.

我們的每個部門和整個企業都專注於執行他們的目標並實現他們的財務目標。然而，我們的醫療保健福利和企業表現正受到我們正在經歷的醫療保險優勢利用水平的重大壓力。顯然，這對我們來說是一個令人失望的結果。讓我向您介紹一些驅動因素，並幫助您了解我們期望它們如何影響今年剩餘時間。

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.

在醫療保健福利領域，我們實現了約 320 億美元的收入，年增約 25%。醫療會員人數為 2,680 萬，較上一季增加 110 萬，反映出醫療保險、個人交換和商業團體產品的增長，但部分被醫療補助重新確定的影響所抵消。

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.

第一季調整後營業收入為 7.32 億美元。這一結果反映了較高的醫療福利比率，但部分被較高的淨投資收入和會員成長帶來的有利的固定成本槓桿的影響所抵消。我們的醫療福利比率為90.4%，較上年同期增長580 個基點，主要反映了Medicare Advantage 利用率的提高、2024 年付款年星級評級較低的保費影響以及上一年與上年相比不利的發展。

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 Medicare Advantage 成本趨勢的驅動因素，我們發現利用率顯著增加。我們繼續看到我們在2023 年底討論的相同類別的上升趨勢，包括門診和補充福利，這些類別在本季度早些時候似乎有所放緩，但已達到一定水平，在某些情況下超出了預期。

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壓力之外，我們還看到住院類別、RSV 疫苗和其他藥物福利帶來了新的壓力。與2023 年第一季度相比，第一季每1,000 名住院患者入院人數出現高個位數增長。了我們對本季度住院患者的預期季節性回到了大流行開始以來我們從未見過的模式。

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.

在我們的醫療補助業務中，我們經歷了醫療成本壓力，這主要是由於會員重新決定的敏銳度更高。我們正在與我們的州合作夥伴密切合作，以確保我們未來的費率能夠反映基本趨勢。

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.

我們商業業務中的醫療成本趨勢並未顯示我們在醫療保險中所經歷的相同壓力。住院床位天數符合預期，但高於往年。心理健康和藥房趨勢仍然較高，但商業街區的整體表現與我們的預測一致。

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.

個人交換醫療成本有所上升，但與預計的會員結構和 2024 年應付收入的下降相一致。我們將繼續密切監控這兩個區塊，但它們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.

本季末應付理賠天數為 44.5 天，比上一季減少 1.4 天。這一下降主要是由於會員成長和藥房趨勢上升的影響，這些趨勢往往會更快完成並減少 DCP 以及其他典型的季節性商品。保費和準備金均較上季成長約 20%。提醒一下，DCP 是我們預訂流程的產出。整體而言，我們對儲備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，我們看到了多日的高薪理賠活動，這與 Change Healthcare 的恢復以及因中斷而造成的相關積壓是一致的。雖然醫療保健變革中斷的最終影響要幾個月後才能得知，但我們最近的中期報告表明，我們3 月31 日的準備金餘額是穩定的，並可能顯示出適度的積極發展，但這並未納入我們當前的前景。

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產生了約 400 億美元的收入，年減近 10%，這主要是由於先前宣布的大客戶流失以及藥房客戶價格持續上漲所致。這一下降被藥房藥物組合、專業藥房的成長以及 Oak Street Health 和 Signify Health 的收購部分抵消。

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.

調整後營業收入約為 14 億美元，年減近 19%，這主要是由於藥局客戶價格持續上漲、340B 貢獻減少以及先前宣布的大客戶流失所致。這一下降被採購經濟的改善部分抵消。本季處理的藥房索賠總數接近 4.63 億，截至本季末藥房會員總數約為 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.

我們繼續推動醫療保健服務資產的成長。與去年同期相比，Signify 的營收成長了 24%。截至本季末，Oak Street 擁有 205 個中心，較去年同期增加 33 個。我們仍預計 2024 年將增加 50 至 60 個中心。 Oak Street 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.

在我們的藥局和消費者健康部門，我們創造了約 290 億美元的收入，比上年增長近 3%，同店收入增長超過 5%。 PCW 部門收入成長的推動因素包括處方量的增加以及疫苗和藥品組合貢獻的增加。這些收入成長部分被近期仿製藥推出、持續報銷壓力、商店數量減少以及非處方藥檢測試劑盒貢獻減少的影響所抵消。

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.

調整後的營業收入約為 12 億美元，比上年增長約 4%，這得益於處方量增加、藥品採購改善和營運費用降低（包括商店關閉的影響）。這些增長被持續的藥房報銷壓力部分抵消。

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.

同店藥局銷售額較前一年成長超過 7%，同店處方藥量成長近 6%。同店前店銷售額與去年同期相比下降了約 2%，但如果不包括 OTC 檢測試劑盒，則增加了 1%。提醒一下，去年第一季突發公共衛生事件仍然活躍。

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.

轉向流動性和我們的資本狀況。第一季營運現金流為 49 億美元。截至本季末，我們的母公司和不受限制的子公司擁有約 19 億美元的現金。

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 8.4 億美元。我們也完成了 30 億美元的加速股票回購交易，在本季回購了約 4,000 萬股股票。我們預計在 2024 年剩餘時間內不會回購任何額外股份。

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在正常化基礎上維持的水平。我們仍然致力於維持目前的投資等級評級。

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.

現在轉向我們對2024 年的全年展望。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.

在我們的醫療保健福利部門，我們現在預計調整後的營業收入至少為 36 億美元，低於我們之前至少 54 億美元的指引。我們現在預計 2024 年的醫療福利比率約為 89.8%，比先前的指導提高了 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，醫療保健福利醫療費用（主要歸因於 Medicare Advantage）比我們的預期高出約 9 億美元。如果我們進一步細分，我們估計大約5 億美元的差異是特定於季度或季節性的，包括季節性呼吸和RSV 成本超出預期的影響，以及住院患者季節性模式的回歸，這些模式看起來更像是大流行前時期。正如凱倫所提到的，四月住院授權的早期指標支持我們當前的季節性預測及其回歸到新冠疫情前的模式。

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.

我們也根據第一季的經驗，上調了下半年 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推動的，我們的指導現在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.

這項預期差異的主要驅動因素包括門診服務類別，例如心理健康和醫療藥房，以及補充福利，例如牙科。優於預期的銷售、費用管理和增加的淨投資收入可以部分抵消部分壓力，預計這些壓力合計將比我們先前全年指引中的假設多貢獻約 5 億美元，其中約一半發生在 2019 年。一季。

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.

在我們的健康服務部門，我們將 2024 年調整後營業收入的估計更新為至少 70 億美元，減少了約 4 億美元。這項調整的大部分歸因於醫療保健服務，主要是我們的 CVS Accountable Care 業務，由醫療保險利用率和一些期外壓力推動。

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.

我們還看到橡樹街在本季度出現了一些適度的利用率壓力，並在我們的更新指導中納入了今年剩餘時間更高趨勢的規定。其餘的壓力來自我們健康服務領域的其他業務，主要是由數量和組合趨勢以及對我們提供網路和客戶保證的能力的相關影響所推動的。

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部門的預期保持不變，調整後的營業收入至少為 56 億美元。由於第一季店面活動放緩，這一前景包含了對今年剩餘時間消費者活動的謹慎立場。我們現在預計 2024 年的股票數量約為 12.65 億股，調整後的稅率約為 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 年營運現金流量預期更新為至少 105 億美元。我們計劃在今年稍後分享更詳細的 2025 年指導。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我們前景的初步想法。

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.

在醫療保健福利方面，我們的 Medicare Advantage 業務預計到 2024 年將產生 650 億至 700 億美元的收入，但將遭受重大損失。我們致力於在 2025 年推動 Medicare Advantage 利潤率實現有意義的提高。

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績效，2025 年將是我們在 3 至 4 年內恢復 4% 至 5% 目標利潤率的第一步。根據會員保留水平，2025 年星級評級的提高可能帶來 7 億美元的收益，但也會降低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，我們的利潤率改善的剩餘部分將取決於定價行動，因為我們面臨費率通知不足和處方藥承保範圍變化導致計劃責任大幅增加的不利因素。我們將在 2025 年採取材料定價和效益設計行動，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領域，我們正在建立強勁的勢頭。我們計劃個人交易所業務的利潤率再提升一年。我們在今年的團體商業銷售季取得了成功，並且最近獲得了幾項重要的醫療補助徵求建議書。

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，並支持我們利用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.

在我們的醫療保健服務業務中，我們致力於提高 CVS Accountable Care 的利潤率。隨著市場適應提高的利用率，橡樹街的利潤軌跡將受到有意義的患者註冊和醫療保險優勢福利重新調整的支持。 Signify 繼續展現出令人印象深刻的成長勢頭，並在 2025 年積蓄動力。

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.

正如凱倫所提到的，我們正在加速多年的企業生產力計劃，以簡化和優化我們的營運。最後，我們的框架考慮了2025 年穩定的份額計數。 ，但從目前的情況來看，我們的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成長。

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

（操作員說明）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的 5 億美元成本不會再次發生的細節，對嗎？我認為每個人都希望 7 美元是我們可以接受的基線。那麼，如果這種情況沒有再次發生，您能否向我們介紹其中的活動部件？

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，您的 PYD 比過去幾年低了 2 億美元。也許這是一個重要的部分——這顯然是其中一個重要的部分。 RSV 多少錢？還有其他活動部件嗎？你可以採取任何措施讓我們放心，5 億美元是季節性的，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，是湯姆。因此，本季最大的影響是住院患者的季節性調整。正如我在準備好的發言中指出的那樣，我們4 月份的授權數據支持了我們更新的季節性預測，因為我們在該季度確實經歷了上一年的一些負面發展，而這顯然是5 億美元的一部分。但當你看看這種情況發生的地方時，你會發現，這實際上是在我們的一些住院患者類別中，趨勢再次呈現負面趨勢。

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的開始。一月承認，你再次看到了上升，高於我們的預期。 2 月較 1 月有所改善。 3 月較 2 月有所改善。因此，我們確實看到了——我們在本季度早些時候看到了峰值，事後看來，它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.

當你觀察這個模式時，你會發現它與我們在 2018 年、2019 年看到的趨勢非常相似。因此，當我們審視現在所看到的情況與新冠疫情之前的歷史模式時，這給了我們很大的安慰，其中許多實際上是季節性的。

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，如果您除去前期的發展，您還會有一些在本季內結算的提供者負債。由於我們確實在本季度內進行了一些政策自由化，我的意思是，它們自季度末以來已恢復，因此這不應該成為持續的影響。然後還有一些其他一次性影響，包括為我們的一些新會員成長而建立的初始儲備金，這些儲備金將納入這 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.

正如您所指出的，我們確實在本季度看到了一些 RSV。我們確實對今年下半年發生的 5 億美元成本中的一些進行了修訂，但我們並不預測這些成本中的絕大多數將成為運行率的一部分，這與 400 美元不同我們正在渡過的一百萬美元。

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.

知道了。然後只是對 Medicare Advantage 利潤率和任何抵消額的改善進行一些描述。所以現在看來，如果我估計你們的 MA 利潤率，我認為是負 3%、負 4%。這是正確的球場嗎？根據我的估計，如果你在那裡得到了 100 個基點，那麼改善幅度有多大——你說的是實質改善——只有 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.

那麼您能否告訴我們，您認為需要多大程度的改進才能恢復 3 到 4 年的發展軌跡？任何可以抵消的東西，任何今年的一次性福利，例如獎金，類似的東西，都會有幫助。我會插隊。

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。因此，正如我所說，當您想到 Medicare Advantage 時，它今天的收入組合為 650 億至 700 億美元。我們明年的目標是該業務的利潤率提高約 200 個基點或達到這個數字。我們顯然還沒有最終確定出價。

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.

當您考慮醫療保險業務的利潤或隱含利潤時，您的郵遞區號可能是正確的。當你想到該業務時，我們在上個季度談到了這樣一個事實，即我們當前的預測將實現盈虧平衡，並且我們將醫療保健福利的指導降低了18 億美元，因此其中大部分與醫療保險有關。因此，我們已經向您提供了所有信息，以幫助您理解為什麼我們認為今年它將損失大量資金。

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.

但當你考慮那裡的改進時，顯然，我們仍然需要做很多工作來了解我們將要調整哪些好處以及我們可以和不能調整哪些好處。我們的星星是一種順風，但也會影響我們的調整能力，因為它降低了我們在國家 PPO 合約上的 TBC 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，也許您想透露一下您對出價和利潤改善的看法嗎？

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。因此，我會從逆風和順風的角度來談論 2025 年。讓我簡單介紹一下這些內容。顯然，我們有一個非常顯著的高趨勢，我們絕對會將其納入我們的定價中。因此，Tom 談到的 2024 年趨勢，我們將在 2025 年再次反思。

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 部分的更改，這是一個非常重要的元素，其中實際上有 2 個元素。一是愛爾蘭共和軍大大豐富了福利。其次，該計劃在災難層承擔了更大的責任，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，正如凱倫在她的演講中提到的那樣，我們收到的利率顯然令人失望，不足以彌補我們所看到的趨勢壓力和愛爾蘭共和軍壓力。最後，正如 Tom 所提到的，在 TBC 前後，這顯然是我們需要關注的限制。它的重點是普通招生。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，以確保我們調整規模以適應 2025 年的定價。不過，當我們考慮順風車時，湯姆提到了明星順風車，假設會員資格穩定，該金額約為 7 億美元，我會回來稍微討論一下。

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.

關於定價行為，正如我所提到的，我們將非常專注於採取這些定價行為來融入趨勢，但也要注意我們對 TBC 的看法。星星確實會影響 TBC，因為它減少了我們在法規下的津貼金額。但正如我所提到的，我們有機會在 TBC 期間削減福利，我們將非常專注於這樣做。

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，我們的目的是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。所以你會看到我們減少了這些好處，這使我們能夠在不影響 TBC 的情況下獲得利潤，所以這很重要。

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.

我要說的另一點，凱倫和湯姆也提到過，我們將圍繞某些服務領域採取行動。因此，如果我們不相信我們能夠在合理的時間內可靠地重新獲得利潤，我們將退出這些縣。我們還將研究我們認為有必要實際停止特定產品的領域，然後重新推出 TBC 不適用的新產品。我們也會關注這些機會，並注意會員的干擾和您可能會看到的一些流失。

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，當我們退後一步時，我們非常關注利潤而非會員資格。顯然，我們正在努力創建一本關於我們的會員資格的穩定的書。當我們考慮會員影響時，我認為計算中需要考慮幾個因素。一是我們相信 PDP 市場將會出現重大混亂。在醫療用品市場，我們將看到價格上漲。我們將看到人們退出某些計劃，我們知道醫療用品的價格正在上漲。

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，這將成為我們的會員預測的順風車，正如我所提到的，正如我們都提到的，我們將採取重大的定價行動，這一事實抵消了這一影響。事實上，這將取決於我們的競爭對手做什麼。我們相信他們是理性的。我們相信他們看到了類似的趨勢，因此他們也會為其中一些壓力定價。但這是我們在定價時必須校準的事情。正如我所提到的，服務區域將會減少。

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.

但同樣，重點是利潤而不是會員資格。如果會員數量減少，對利潤率的影響相對較小，我們致力於確保 2025 年及以後的產品定價適當。

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，我只想重申我在準備好的發言中所說的話。我們致力於提高 Medicare Advantage 的利潤率，我們將透過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，我們也致力於這樣做。

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.

我只是想跟進你所說的一些事情。 Brian，我想回到您對會員資格的評論，以及您對 Medicare Advantage 會員資格下降幅度可能很小的預期。這是基於這樣的假設：我們感受到的壓力是針對 Medicare Advantage 中的每個人的，因此每個人都會重新調整？再說一次，就凱倫的觀點而言，您將查看某些縣並調整某些計劃水平，因此您可能會失去一些會員資格，但您預計 2025 年會員資格不會大幅下降，只是成本增加和變化好處等等。我只是想確保我明白這一點。

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。所以我想說這裡有兩個要素。從行業的角度來看，成長將會發生什麼，然後是我們安泰保險將要做的事情。

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，在行業方面，正如我所提到的，我認為從傳統的按服務付費市場（即 PDP 和 med sep）將發生的情況來看，存在一些明顯的有利因素。因此，作為會員 - 潛在會員正在評估他們的選擇，他們將不得不考慮價格上漲的情況以及傳統收費服務市場將發生的一些破壞。所以這將是一個順風車。

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，在某些情況下，該行業將大幅削減福利，並退出某些無法獲利的縣。我認為這是一個行業問題，而且我認為這顯然也是 Aetna 的焦點。因此，如何校準我們最終獲得的會員資格，我們必須透過出價和定價來估計我們認為競爭對手會做什麼。

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.

因此，現在很難說我們的會員人數不會大幅減少。這當然是可能的。我們試圖傳達的訊息是，我們關注的是利潤而不是會員資格。如果我們的會員減少幅度確實大於預期，那麼這種情況就會發生，我們將重點放在利潤方面。

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.

但我再次認為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，我們也有自己獨特的因素需要解決。因此，我認為校準以及更廣泛的行業發生的情況將真正決定我們的會員明年的去向。

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，從一個非常高的層面，當你思考潛力是什麼時——名單，就像你一樣——從一個非常高的層面，當你思考會員資格喪失的影響是什麼時，當你思考以下評論時：我們根據帳簿中的隱含損失進行了利潤恢復，因此失去更多會員並不一定會導致 2025 年利潤損失。

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，如果我能理解 2024 年的節奏的話。當我們思考 24 週年剩下的時間時，您有什麼特別要說的嗎？

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。我認為值得討論的一件事是，當你想到醫療服務領域時，我們確實面臨一些壓力，我們認為這些壓力與醫療保健服務市場中的醫療保險市場有關。我們也看到了我們其他健康服務部門業務中的一些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.

我們現在對這些的年內復甦採取了謹慎的立場，那是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至 4 月 1 日。因此，相應地，當我們考慮收​​益的季節性時，我們認為 - 我們目前預計，在 2024 年下半年，您可能會看到我們收益的 55% 至 60% 左右，以適應其中的一些傾斜。

Our next question comes from Nathan Rich of Goldman Sachs.

我們的下一個問題來自高盛的內森·里奇。

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。年嗎？那麼，根據您談到的福利設計變化，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 Brian 來談談 D 部分的變化及其對盈利能力的影響。那裡的計劃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效益。而且，當我們考慮到那些目前在市場上購買捆綁服務的老年人時，他們的捆綁服務成本將會大幅上升，即使福利不太完善，這也可能使醫療保險優勢2025 年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 年投標本身的定價令人失望。顯然，當我們審視我們的趨勢、市場趨勢時，我們認為該比率不足以反映這一點。我們又迎來了風險調整模型逐步實施的一年。儘管由於 D 部分的《通貨膨脹削減法案》而導致我們正在經歷重大變化，但到目前為止，TBC 還沒有給予任何靈活性。

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，當我們看不到大多數市場參與者所經歷的情況進入出價基準時，這些因素的結合只會讓 2025 年的定價變得更加困難。

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

布萊恩，也許你可以多談談這一點。

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。我的意思是，首先，關於 D 部分，我認為 Tom 表達得很好。只是提供了增量福利，並且計劃責任顯著增加。雖然直接補貼將會增加，而且我們預計會增加，但這確實不足以彌補計劃所增加的責任。

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，在行業中，尤其是在 Aetna，當我們考慮推出產品和產品可能帶來的潛在風險和波動性時，將會有很多關於什麼產品最終對我們可行的討論。你所吸引的人的影響。使用品牌利用者、專業利用者等的會員類型會產生額外的不確定性，特別是因為責任增加，而且福利如此豐富，以至於保險和低價等典型的傳統觀點 或者可能不會以與以前相同的方式應用。這些就是我們正在考慮的事情類型。

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，當我們回到下個季度的電話會議時，我們將向您提供更多有關我們對 D 部分市場的看法的資訊。我們確實認為將會出現混亂。我們確實認為這將需要增加保費。這就是為什麼從會員資格的角度來看，最終行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，這顯然非常重要。正如凱倫和湯姆所說，我們非常清楚，我們在 2024 年看到的趨勢與 2023 年非常一致，我們預計會出現某種程度的突破，走向更正常化的趨勢。坦白說，我認為我們對正常化趨勢持保守態度。

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.

如果你回顧歷史，甚至在大流行之前，很多很多年來，趨勢都在 3% 到 5% 的範圍內。我們看到 2023 年的趨勢接近 10%。我們看到 2024 年的趨勢反映了這些水平，湯姆在第一季提到的一些季節性因素甚至加劇了這一趨勢。因此，我們將把這些趨勢延續到 2025 年。

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.

現在我們確實還沒有看到2年，更不用說3年的那些水準不斷上升的趨勢。但我們必須將其納入我們的定價中，而且我們打算這樣做。我們期望我們的競爭對手也會以類似的方式思考這個問題。因此，我們需要認真思考如何彌補定價和趨勢之間的差異。我們要動用很多槓桿。好處顯然是我們要關注的焦點之一。

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.

如果我只是想從你的問題上退一步，內特，該產品的每位會員收入顯然會上升。目前尚不清楚整個會員基礎會發生什麼，但我們將為可獲利的產品定價，並且最終將成為 D 部分的更高溢價產品。

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。偉大的。湯姆，我想在後續行動中談到明年 MA 業務的利潤率提高 200 個基點。因此，這大約是 13 億美元、14 億美元，具體取決於會員資格的變化，其中一半是明星順風車。我認為，如果我們僅以 PMPM 為基礎查看另外 7 億美元，那麼 PMPM 為 10 至 15 美元。但聽起來可能存在一些成本阻力，可能抵銷了效益的變化。

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.

因此，我想我想看看您能否讓我們大致了解一下您在明年考慮的福利設計方面所討論的削減類型，以及我們認為的機會是什麼3、4年後。

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，內特，我認為出於競爭原因，除了說我認為我們已經明確表示一切都在進行之外，我不想討論任何超出我們已經給出的改進或任何更多粒度的內容。 。因此，TBC 中的一些福利可能會進行調整。有一些非 TBC 的福利將會進行調整。我們將全面審視—就這一業務領域的獲利能力而言，這不是一個可接受的結果。因此，我們將考慮採取一切措施來提高明年的利潤並保持帳面一定程度的穩定性。

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.

當你在 24 和 25 之間做橋樑時，有一些可變費用項目顯然會在 2025 年回歸。支出恢復。到下個季度，我們將向您提供更多相關更新。

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。內特，我想補充一點，我們將繼續評估營運、流程和生產力方面的整體成本結構。我們去年開始對此進行全面審查，我們採取了行動，這些行動今年就會出現，現在我們將在接下來的幾個月內加快其他舉措。隨著我們繼續加大力度，我們將全年向您通報最新情況。

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.

醫療保險優勢的另一個後續行動。您在準備好的評論中提到，我認為您花了時間尋找潛在的選擇偏見，無論是在新成員中還是在現有書中。我不確定您是否談論了這樣做時實際發現的內容。因此，只是想了解您是否看到自己的會員的轉換超出預期，或者整個賬簿中盈利能力的下降是否反映在您的新會員中，或者也許這超出了需要考慮的範圍。

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。因此，正如您可以想像的那樣，我們非常仔細地研究了它，試圖了解新成員是否對我們的結果產生了不成比例的影響。我們已經盡一切可能對其進行了分析。當你查看基本結果，例如他們的每千人排放量或他們的藥品支出或他們的風險或其他類別的護理時，我們確實沒有看到新成員和老成員之間存在實質差異。因此，我們真正看到的是整本書所承受的壓力，我們最終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，我們研究了一些事情，例如，我知道圍繞健身益處進行了很多討論。這顯然對我們的普通招生成員有吸引力。這只是選擇該福利方面的一些一般註冊區塊。當我們考慮其財務影響時，實際上，這是相當有限的。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.

正如湯姆所提到的，我們在豐富牙科福利方面看到了一些壓力，即補充福利。我們看到越來越多的會員使用這項福利，並且使用得越來越多。所以——但這確實是整本書的內容。再說一遍，我不認為新舊成員之間有選擇偏見，而是我們需要在 2025 年解決的壓力。

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?

也許我會暫時談談衛生服務部門。我相信其他人可能會回到其他 MA 問題。但是，當您考慮本季度的業績以及您看到的為會員變化做好準備的動態以及大客戶推出方面的客戶流失變化時，您如何看待採購能力的擴展動態當你推出Cordavis 時，它是如何滲透到Cordavis 中的？

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?

我想你早早就看過了。但是，您是否可以向我們提供任何其他跡象，表明您如何看待 Cordavis 納入今年指導或明年目標的財務貢獻？

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.

我們的健康服務指南中包含了 Cordavis 的貢獻。我們還沒有透露具體日期，邁克爾，除了與我們最初的預測相比之外，我們沒有透露具體的影響，因為我們將處方變更推遲到了 4 月 1 日，我們本來希望在今年早些時候這樣做。這確實在本季度內產生了一點時間影響，但那裡的採用情況非常好。客戶接待非常好。

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化的實際結果之前，也許我會花一點時間更廣泛地討論您提出的有關控制的問題以及我們對繼續在市場上擁有購買優勢的能力的信心。

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.

所以我回到我們在專業領域的優勢。因此，我們所取得的成功最重要的是因為我們的領導地位，特別是在專業市場上。因此，我們在郵件、零售和家庭輸液領域都擁有無與倫比的存取權限。我們在藥品和醫療福利方面擁有廣泛的產品；持續成為有限分銷類別的領導者；繼續成為新興細胞和基因治療市場的領導者。

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，與我們投資的技術相結合，使我們成為該領域的領先提供者。所以這是基礎，讓我們有信心在 4 月 1 日對規定位置進行更改。 所以，如果你看看準備好的評論中提到的內容，我們實際上已經在 4 月 1 日進行了更改，將修美樂（Humira）從處方集中刪除，並以低標價的生物相似藥取代。

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 週的時間裡，我們實際上已經超過了 2023 年全年的所有生物仿製藥數量。我們在第一個月內就遷移了超過90% 的容量。

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.

然後，當您具體查看 CVS 專業藥房內部時，我們提供了一系列圍繞技術、接觸處方者和會員的新服務，我們實際上擁有 94% 的轉換率。所以這是一個非常強大的結果，我認為這顯然說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.

由於這可以為我們的客戶帶來節省，我們曾提到我們將在該藥物的 [22] 運行率上節省 50%。然後，當你將其轉化為會員福利時，因為我們實際上已經轉向低標價產品，並且我們實際上已經讓客戶採用了我們所謂的智能福利設計，所以我們已經能夠擁有 80% 的會員福利。掏腰包0 美元的會員。

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.

再說一次，我認為如果你看看我們所做的事情，這對我們的客戶、我們的患者來說是明顯的勝利，而且我們還在生物仿製藥市場的持久性方面進行了大量投資。因此，我認為所有這些都有助於回答您最初提出的問題，即規模和規模確實是普遍驅動的，我相信我們的採購經濟學的優勢在於控制和移動市場份額的能力。這再次是市場上我們希望繼續沿著這條道路走下去的另一個證據。

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，我只想說，關於生物相似藥，顯然，它代表了降低美國醫療保健系統整體藥品成本的最大機會之一。如您所知，到2030 年，這是一個價值1000 億美元的市場。的渠道。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?

埃里克也在這裡。所以我的問題是──首先，只是一個數字問題。醫療保健服務指引減少了 4 億美元，其中有多少是專門用於橡樹街的？然後在 MA 上，我聽說仍然致力於 4 到 5，旅程從 25 年開始。這非常非常清楚。您有多少會員來自您正在考慮退出的縣（即大規模退出市場）？然後，MA 的重新定價如何適應您的整體企業策略，因為顯然您的許多資產也出售到該管道？

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.

喬什，讓我從 HSS 問題開始，然後我們可以嘗試討論其他問題。因此，當您考慮 HSS 時，我們將其削減了約 4 億美元，其中大部分是醫療保健服務業務。其中最大的推動因素是 CVS Accountable Care 的不利因素，即儲蓄率，這是由醫療保險利用率驅動的，其中包括第一季收取的期外費用。

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.

我想說那件作品的其餘部分確實是橡樹街。但當我們回顧第一季時，該業務的表現相當不錯。因此，當我們思考我們在更廣泛的市場中看到的情況時，我們做出了一項規定，也許我們的前瞻性前景可能會有一些滯後。顯然，我們必須看看最終會如何發展。

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，該公司透過一些新的臨床計畫及其在這一年中的表現，出色地應對了市場上一些更廣泛的逆風。我們希望隨著時間的推移，我們能夠看到這個數字有一些好轉，但我們必須看看這一切如何在結果中體現出來。

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

麥克，我不知道，你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、具體地考慮橡樹街的醫療保健服務時，我要補充的是，在24 年剩餘時間以及實際上在25 年及以後，我認為布萊恩和我正在密切合作，這是一個巨大的機會，關於我們如何利用護理品質和真正扭轉醫療成本趨勢並推動 MLR 改進的能力，我們如何在 Aetna 和 Oak Street 更廣泛地利用這一點。

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.

因此，我們正在做很多事情，包括增加 Aetna 到 Oak Street 中心的會員資格，也利用我們在 Oak 所使用的過渡計劃和家庭護理方面擁有的一些中心外功能今天的街頭。讓我們將其用於更多 Aetna 會員。因此，這裡有很多機會，我們將在未來幾年看到這些機會。

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.

我想向麥克補充一點，正如您所說，我們正在非常密切地合作。例如，雖然很明顯，我們今天不會提供特定縣的顏色以及縣將退出的範圍，但我們不會以橡樹街足跡為例，對吧？因此，我們將非常仔細地考慮如何調整我們的書，以期隨著時間的推移，保留利潤並達到湯姆所闡述的利潤。

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.

我還想提醒您，以趨勢計算，每 100 個基點的價值超過 5 億美元。因此，如果我們考慮歷史趨勢，如果我們考慮今天的趨勢，我們絕不會將其納入我們的假設中。但當你考慮這裡的復甦時，這有可能反彈並保留這些，也恢復盈利能力，我認為這一點很重要。

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.

但我們將非常認真地考慮如何看待我們的會員足跡。再說一遍，最終目標是會員資格穩定性，但明年我們將更重視利潤而不是會員資格。

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，您能談談護理管理工具的種類以及您正在考慮的它們對「24」的影響嗎？然後，當我們考慮 HCB 的 2025 年結果時，您認為您在 24 年所做的任何改變都會產生影響？

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。我們花了很多時間來細分誰是我們的高風險成員，誰是最能從護理管理中受益的成員。實際上，我們正​​在使用許多非常先進的人工智慧工具來識別這些成員。我們確實認為我們擁有出色的分析能力，能夠找出這些成員是誰，以及我們如何最好地與他們互動，或者使他們與我們互動的事情類型，然後也使我們的護理管理變得更容易護士在護理點能夠提供會員所需的建議和支援。

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。我想告訴你，我們將繼續推出其中一些人工智慧功能，使這些計劃更加有效，並帶來更好的投資報酬率。因此，雖然 24 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因素。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，我想補充一點，這就是醫療保健服務和 Aetna 之間的合作關係。健康軌跡，無論是重新入院或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.

因此，我認為，合作關係的大部分作用在於產生更深層的影響，因為我們擁有資源、我們有計劃、我們有專業知識。現在我們可以將這些擴展到更多的成員。因此，我認為 Signify 和 Oak Street 都將在未來幾年為我們如何真正扭轉這種成本趨勢帶來許多好處。

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。混合方面存在一些壓力，而且您無法事先做出保證。能詳細說明一下這兩則評論嗎？鑑於 GLP 類別，先前的保證是否有糖尿病問題？

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.

這不是糖尿病問題。將其視為 - 我們必須對組合的外觀進行預測，以確保我們適當地滿足所有客戶的保證。隨著本季內組合的變化，考慮到我們不僅看到了大客戶的流失，還看到了另一個客戶業務的內包，以及市場數量方面的一些中斷，具體來說，GLP-1 是其中的一部分，我們有點錯過了我們的保證。

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彌補這一損失。但目前，我們的假設是，第一季是永久性的，我們可以回到先前對今年剩餘時間的預測。

David, anything you'd add to that?

大衛，你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是一致的。我只想在 GLP-1 上添加一件事。顯然，存在著很大的波動性，一是因為我們經歷了供應限制，而且顯然，為了管理我們所看到的前所未有的需求，再加上非常具有挑戰性的價格點，我們需要做很多工作，圍繞如何最好地管理這個類別，無論是透過規定的、更積極的利用管理，或是更廣泛的護理管理包裝，人們都投入了大量的精力。

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.

但僅此一類別就明顯為我們的客戶帶來了巨大的成本，而且它還在我們組織內帶來了巨大的支出，只是為了支持目前我們最大的呼叫量驅動因素之一，圍繞著人們試圖找到產品的存取權限，並確保我們獲得市場穩定的供應。

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.

因此，我們相信我們擁有一套非常強大的計劃和服務來管理該類別。我們相信，一旦存在競爭和充足的供應，我們將能夠在管理這一類別的方式上更加一致。

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.

在我們結束通話時，我想藉此機會感謝我們的同事所做的許多貢獻，我們期待為您提供全年的最新資訊。感謝您今天加入通話。

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。感謝您的加入。現在您可以斷開[您的線路]。