CVS Health Corp (CVS) 2024 Q2 法說會逐字稿

(Operator Instructions) I'm now going to hand over to Larry McGrath to begin. Larry, please go ahead, when you're ready.

（操作員指示）我現在將交給 Larry McGrath 開始。拉里，當你準備好後，請繼續。

Good morning, and welcome to the CVS Health Second-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 年第二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. Today, we reported adjusted earnings per share of $1.83 and adjusted operating income of $3.7 billion for the quarter. Our total revenues were more than $91 billion and we generated $8 billion of operating cash flow in the first half of the year.

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，我們報告本季調整後每股收益為 1.83 美元，調整後營業收入為 37 億美元。上半年，我們的總收入超過 910 億美元，營運現金流達 80 億美元。

We are also updating our full year 2024 our adjusted EPS guidance to a range of $6.40 to $6.65 based on the continued pressure in our Health Care Benefits business, offset by strong performance in health services and the pharmacy and consumer wellness business.

基於我們的醫療保健福利業務的持續壓力，我們還將 2024 年全年調整後每股收益指導值更新為 6.40 至 6.65 美元，但被健康服務以及製藥和消費者健康業務的強勁表現所抵消。

So majority of our businesses are performing well, and we continue to drive the integrated value of our company by executing on our strategy to connect people to the care and the coverage they need. However, we are disappointed by the current performance and outlook for the Health Care Benefits segment, and I have decided to make leadership changes.

因此，我們的大多數業務都表現良好，我們透過執行我們的策略，將人們與他們所需的護理和保險聯繫起來，繼續推動我們公司的綜合價值。然而，我們對醫療保健福利部門目前的業績和前景感到失望，我決定進行領導層變動。

Effective immediately, Brian Kane is leaving the company. In the interim, I will assume direct leadership of the Health Care Benefits segment. As you know, managed care has been an integral part of both mine and Tom Cowhey's professional careers, and we will be overseeing the day-to-day management of this business.

布萊恩凱恩 (Brian Kane) 將離開公司，立即生效。在此期間，我將直接領導醫療保健福利部門。如您所知，管理式醫療一直是我和 Tom Cowhey 職業生涯中不可或缺的一部分，我們將監督這項業務的日常管理。

In addition, Katerina Guerraz, our Chief Strategy Officer, will become the Chief Operating Officer of the Health Care Benefits segment. Katrina is a 20-year Aetna veteran with extensive commercial and Medicare experience and has a track record of operational excellence.

此外，我們的首席策略長卡特琳娜·格拉茲（Katerina Guerraz）將成為醫療保健福利部門的營運長。 Katrina 是 Aetna 工作 20 年的資深人士，擁有豐富的商業和醫療保險經驗，並擁有卓越的營運記錄。

We are committed to returning health care benefits to its rightful place and will drive execution and address the challenges facing this business. Looking across the enterprise today, CVS Health, there's more than 186 million people, and we are making continued progress improving that our integrated model, create value.

我們致力於將醫療保健福利恢復到應有的地位，並將推動執行並解決該業務面臨的挑戰。縱觀當今的 CVS Health 企業，擁有超過 1.86 億員工，我們正在不斷進步，改善我們的綜合模式，創造價值。

When individuals engage with two or more offering, we can deliver better health experiences and outcomes. Over the first half of the year, we expanded the number of consumers accessing two or more CVS Health offerings to 57.7 million, an increase of nearly 2.5 million consumer.

當個人參與兩種或多種產品時，我們可以提供更好的健康體驗和結果。上半年，我們將使用兩種或兩種以上 CVS Health 產品的消費者數量擴大到 5,770 萬，增加了近 250 萬消費者。

We grew the number of Aetna medical members utilizing CVS pharmacies to 9 million, an increase of 8% from the prior year. We also now have $13.8 million Aetna medical members who are covered by Caremark, an increase of 13% compared to last year.

我們將使用 CVS 藥局的 Aetna 醫療會員人數增加到 900 萬人，比前一年增加 8%。現在，我們還有價值 1,380 萬美元的 Aetna 醫療會員享有 Caremark 保險，與去年相比增加了 13%。

We extended our digital reach with nearly 16 million unique digital customers utilizing our platform to schedule health services appointments, fill prescriptions and purchase wellness products, all contributing to the growth in our business.

我們擴大了數位覆蓋範圍，近 1,600 萬唯一數位客戶利用我們的平台安排健康服務預約、配藥和購買健康產品，所有這些都有助於我們業務的成長。

We are committed to transforming the industry with innovative pharmacy model that create greater transparency reflect the TrueCost of drugs and align incentives across stakeholder. We are driving significant progress on the adoption of CVS CostVantage and CVS Caremark TrueCost.

我們致力於透過創新的製藥模式來改變產業，提高透明度，反映藥品的真實成本，並調整利害關係人的誘因。我們正在推動 CVS CostVantage 和 CVS Caremark TrueCost 的採用取得重大進展。

To date, we signed CVS cost advantage agreements with eight pharmacy benefit managers, including CVS Caremark, who combined make up more than 50% of our commercial scrip. Discussions with our large PBM partners are active and constructive as we move forward with full implementation for our commercial contracts on January first, 2025.

迄今為止，我們已與八家藥品福利管理者簽署了 CVS 成本優勢協議，其中包括 CVS Caremark，他們合計占我們商業票據的 50% 以上。隨著我們於 2025 年 1 月 1 日全面實施我們的商業合同，與我們的大型 PBM 合作夥伴的討論是積極且富有建設性的。

Our two class offering is resonating with commercial clients as they strive to ensure pricing, simplicity and transparency for their members.

我們的兩級產品引起了商業客戶的共鳴，因為他們努力確保其會員的定價、簡單性和透明度。

We firmly believe that TrueCost will reshape the future pricing for every drug, every condition and every member. Additionally, we implemented this model for CVS Health, more than 300,000 colleagues.

我們堅信 TrueCost 將重塑每種藥物、每種病症和每位會員的未來定價。此外，我們也為 CVS Health 的超過 30 萬名同事實施了該模型。

Biosimilars create a meaningful opportunity to deliver additional pharmacy savings to our clients. Through Cordavis, we introduced our biosimilar products at a price more than 80% lower than a reference brand and we are the only company to move biosimilar share.

生物相似藥創造了一個有意義的機會，為我們的客戶提供額外的藥品節省。透過 Cordavis，我們以比參考品牌低 80% 以上的價格推出了生物相似藥產品，並且我們是唯一一家轉移生物相似藥份額的公司。

We have processed approximately 100,000 Cordavis bosimilar prescriptions since we launched our formulary change on April 1, which has contributed to nearly $400 million in net savings for our clients and their members. Cordavis and its success in the biosimilar market was possible because of the combined assets of CVS Health.

自 4 月 1 日推出處方變更以來，我們已經處理了大約 100,000 個 Cordavis 類似處方，這為我們的客戶及其會員節省了近 4 億美元的淨成本。 Cordavis 及其在生物相似藥市場的成功之所以成為可能，是因為 CVS Health 的資產合併。

We will continue to expand our offerings and drive greater access and savings for our customers. Before I share updates on performance in each of our segments, I wanted to provide an update on the enterprise productivity initiatives we discussed on our last call.

我們將繼續擴大我們的產品範圍，為我們的客戶帶來更多的機會和節省。在分享我們每個細分市場的績效更新之前，我想提供我們在上次電話會議中討論的企業生產力計劃的最新資訊。

We identified a multiyear opportunity to deliver $2 billion in savings. These savings will be driven by further streamlining and optimizing our operations and processes, continuing to rationalize our business portfolio and accelerating the use of artificial intelligence and automation across the enterprise as we consolidate and integrate platform.

我們發現了一個可以節省 20 億美元的多年機會。這些節省將透過進一步簡化和優化我們的營運和流程、繼續合理化我們的業務組合以及在我們整合和整合平台時加速在整個企業中使用人工智慧和自動化來推動。

We will be thoughtful and deliberate as we execute these actions to ensure we continue to meet consumer needs. These savings will create bulk capacity to invest in our businesses and opportunities for our performance.

在執行這些行動時，我們將深思熟慮、深思熟慮，以確保我們繼續滿足消費者的需求。這些節省將為我們的業務創造大​​量投資能力，並為我們的業績創造機會。

Now let's look at our businesses in detail. In healthcare benefits revenues for the quarter grew to over $32 billion and we delivered nearly $1 billion and adjusted operating income. Medical membership was nearly $27 million, primarily reflecting growth in our Medicare and individual exchange business.

現在讓我們詳細看看我們的業務。本季的醫療保健福利收入成長至超過 320 億美元，我們交付了近 10 億美元和調整後的營業收入。醫療會員人數接近 2700 萬美元，主要反映了我們的醫療保險和個人交換業務的成長。

Our medical benefit ratio for the quarter was 89.6%. Utilization in our Medicare business remained at elevated levels but was largely in line with expectations. Following the close of the second quarter, we saw indications of potential trend acceleration, which we have contemplated in our revised guidance range.

我們本季的醫療福利率為 89.6%。我們的醫療保險業務的利用率仍處於較高水平，但基本上符合預期。第二季結束後，我們看到了潛在趨勢加速的跡象，我們在修訂後的指導範圍中已經考慮到了這一點。

Similar to others in the industry, we saw an increase in the dislocation between Medicaid acuity level and rate. We will continue working closely with our state partners to advocate for rate that more closely align with changes in acuity.

與業內其他人類似，我們看到醫療補助敏銳度水平和比率之間的錯位有所增加。我們將繼續與我們的國家合作夥伴密切合作，倡導與敏銳度變化更加一致的利率。

Within the quarte, our MBR also reflected the impact of the final 2023 risk adjustment for our individual exchange business. Tom will provide additional details on utilization and the risk adjustment update. In June, we submitted our bid for the 2025 Medicare Advantage plans. Our bids, went through a rigorous internal review, and we are confident in our pricing for 2025, which reflects prudent assumptions for utilization trends.

在本季內，我們的 MBR 也反映了 2023 年最終風險調整對我們個人交易所業務的影響。湯姆將提供有關利用率和風險調整更新的更多詳細資訊。 6 月，我們提交了 2025 年 Medicare Advantage 計劃的投標。我們的投標經過了嚴格的內部審查，我們對 2025 年的定價充滿信心，這反映了對利用率趨勢的審慎假設。

The actions we took are expected to drive 100 basis points to 200 basis points of margin recovery in 2025 off of our current baseline and start them multiyear pathway to achieving target margins of 4% to 5%. As we have previously discussed, we expect to see a decline in Medicare membership in 2025, driven by our margin recovery efforts.

我們採取的行動預計將在 2025 年推動利潤率在當前基準基礎上恢復 100 個基點至 200 個基點，並開啟實現 4% 至 5% 目標利潤率的多年之路。正如我們之前所討論的，在我們的利潤恢復努力的推動下，我們預計 2025 年醫療保險會員人數將會下降。

In our commercial business, we expect membership growth in 2025, driven by new business wins and strong retention, both of which are running ahead of where we were at this time last year. Our retention rate is in the high 90s with our national accounts business.

在我們的商業業務中，我們預計在新業務的贏得和強勁的保留率的推動下，2025 年會員數量將增長，這兩者都超過了我們去年此時的水平。我們國民帳戶業務的保留率高達 90 多歲。

In our pharmacy and consumer wellness business, we effectively navigated the changing consumer environment and delivered another strong quarter that exceeded our expectations.

在我們的製藥和消費者健康業務中，我們有效地應對了不斷變化的消費者環境，並實現了另一個超出我們預期的強勁季度。

We grew revenues for the segment to approximately $30 billion of nearly 4% versus the prior year and generated $1.2 billion of adjusted operating income in the quarter. Our growing pharmacy share now at a record high of approximately 27.2% was a meaning contributor to these results.

我們該部門的營收成長至約 300 億美元，與去年相比成長近 4%，並在本季產生 12 億美元的調整後營業收入。我們不斷增長的藥房份額目前達到約 27.2% 的歷史新高，這是這些業績的重要貢獻者。

We continue playing a key role in delivering important community health services as demonstrated by the approximately 2 million immunizations we administered in the quarter. We are on track to achieve our three-year goal of closing 900 stores by the end of this year with 851 stores closed to date.

我們在提供重要的社區健康服務方面繼續發揮關鍵作用，本季我們管理的約 200 萬例免疫接種就證明了這一點。我們預計將實現今年年底關閉 900 家門市的三年目標，迄今已關閉 851 家門市。

We continued to exceed our goals for both [colleague] and scrip retention. As we look at the standalone stores, we have remaining across our national footprint, substantially all of profitable.

我們繼續超越[同事]和股票保留的目標。當我們審視獨立商店時，我們在全國範圍內的足跡仍然存在，基本上都是盈利的。

This measure highlights our leadership in this business and our ability to operate nationally while delivering unmatched level of consumer service. Our position will only improve as we we continue to optimize our footprint and implement innovations like CVS CostVantage.

這項措施凸顯了我們在該業務中的領導地位以及我們在全國範圍內運營的能力，同時提供無與倫比的消費者服務水平。隨著我們不斷優化我們的足跡並實施 CVS CostVantage 等創新，我們的地位只會得到改善。

In our Health Services segment, we generated revenues of more than $42 billion and deliver $1.9 billion in adjusted operating income. Our Pharmacy Services business, the largest component of Health Services segment delivered strong results, driven by execution on core principles of this business, lowering drug costs, creating savings for our clients.

在我們的健康服務部門，我們創造了超過 420 億美元的收入，並實現了 19 億美元的調整後營業收入。我們的藥局服務業務是健康服務領域最大的組成部分，在執行該業務核心原則的推動下，取得了強勁的業績，降低了藥品成本，為我們的客戶節省了開支。

We have retained approximately 99% of employer clients in the 2025 selling season. I wanted to take a moment to address the interim 60 study released by the FTC. We fundamentally disagree with the FTC position. When you look at the data, there's clear evidence that PBM play a crucial role in reducing drug costs.

在 2025 年銷售季，我們保留了約 99% 的雇主客戶。我想花點時間談談 FTC 發布的臨時 60 研究報告。我們從根本上不同意聯邦貿易委員會的立場。當您查看數據時，有明確的證據表明 PBM 在降低藥物成本方面發揮著至關重要的作用。

We have a decade-long track record of protecting American businesses, unions and patients rising prices on prescription drugs. We use competition among manufacturers to help keep drug costs affordable for our members.

我們在保護美國企業、工會和患者免受處方藥價格上漲方面有著長達十年的記錄。我們利用製造商之間的競爭來幫助我們的會員負擔得起藥品成本。

The FTC's report focuses on issues of the past. We are leading the industry as we innovate our business model with our TrueCost offering. We believe our model helps ensure greater transparency in the pricing and help consumers to be confident in their pharmacy benefit that is providing the best possible price.

聯邦貿易委員會的報告重點關注過去的問題。我們透過 TrueCost 產品創新業務模式，處於業界領先地位。我們相信我們的模型有助於確保定價更大的透明度，並幫助消費者對他們提供盡可能最佳價格的藥品福利充滿信心。

Additionally, our programs help patients affordably access critical drug like insulin, our members on average pay less than $25 for insulin. Through our reduced Rx program, we provide access to $25 insulin to every customer whether insured, underinsured or uninsured.

此外，我們的計劃還幫助患者以經濟實惠的方式獲得胰島素等關鍵藥物，我們的會員平均支付胰島素費用不到 25 美元。透過我們的減免處方計劃，我們為每位客戶提供 25 美元的胰島素，無論他們是否有保險、保險不足或沒有保險。

We are committed to delivering value every day to our clients and our members. In our Health Care delivery business, we are driving meaningful progress connecting patients to health services across all of our channels, primary and acute care, health services in the home and clinical program.

我們致力於每天為我們的客戶和會員創造價值。在我們的醫療保健服務業務中，我們正在推動有意義的進展，將患者與我們所有管道的醫療服務、初級和急診、家庭醫療服務和臨床計劃聯繫起來。

Signify exceeded expectations, delivering another quarter of record volume. We also continue to grow our patient base among Medicare Advantage members with our primary care clinics. Oak Street at-risk patient grew to 235,000 of nearly 30% over the same quarter last year.

Signify 超出預期，銷量又創歷史新季度紀錄。我們也透過初級保健診所繼續擴大 Medicare Advantage 會員的患者群體。橡樹街的高風險患者人數比去年同期增加了近 30%，達到 235,000 人。

We are accelerating opportunities that drive integrated value by connecting Signify and Oak Street to CVS Health assets such as Aetna MinuteClinic and CVS Pharmacy. Since we closed our health care delivery acquisitions Signify now serves nearly twice as many Aetna members. And to date, the number of Aetna members at Oak Street clinics has more than tripled. We expect this number to further expand as we introduce co-branded Aetna and Oak Street plants in the 2025 annual enrollment period.

我們正在透過將 Signify 和 Oak Street 與 Aetna MinuteClinic 和 CVS Pharmacy 等 CVS Health 資產連接起來，加速推動綜合價值的機會。自從我們完成醫療保健服務收購以來，Signify 目前為 Aetna 會員提供的服務數量幾乎是原來的兩倍。迄今為止，橡樹街診所的 Aetna 會員數量已增加兩倍多。隨著我們在 2025 年年度招生期間引入 Aetna 和 Oak Street 聯合品牌工廠，我們預計這一數字將進一步擴大。

We continue to use the powerful relationship we have with patients at the pharmacy counter. This quarter, we saw a 7 times increase in a number of pharmacies scheduled IHEs compare to last quarter. We have many points of differentiation that physicians CVS Health to win.

我們繼續利用與藥房櫃檯患者建立的強大關係。本季度，我們看到安排 IHE 的藥局數量比上季增加了 7 倍。我們擁有許多 CVS Health 醫生可以贏得的差異化優勢。

Our biggest differentiator is how we are running our assets together to deliver integrated solutions for our customers. We are working effectively to address the challenges we faced in 2024, the steps we are taking include our disciplined approach to Medicare Advantage pricing, progress on our innovative pharmacy model and our biosimilar strategy, early wins in both Caremark and Aetna selling season and accelerating the integration of healthcare delivery assets.

我們最大的區別在於我們如何共同經營我們的資產，為客戶提供整合解決方案。我們正在有效地努力應對 2024 年面臨的挑戰，我們正在採取的步驟包括我們嚴格的 Medicare Advantage 定價方法、我們的創新藥房模式和生物仿製藥戰略的進展、Caremark 和 Aetna 銷售季的早期勝利以及加速整合醫療保健服務資產。

These actions, combined with our multiyear productivity initiatives and improved operational performance in our Health Care Benefits segment give us the confidence that we are building positive momentum as we look to 2025 and beyond.

這些行動，加上我們多年來的生產力計劃和醫療保健福利部門營運績效的改善，讓我們相信，展望 2025 年及以後，我們正在建立積極的勢頭。

I will now pass it over to Tom for a more detailed view of our second quarter results. Tom?

我現在將其轉交給湯姆，以更詳細地了解我們第二季的業績。湯姆？

Thank you, Karen, and thanks to everyone for joining us this morning. I'll start with a few highlights on total company performance. Second quarter revenues were approximately $91.2 billion, an increase of approximately 2.6% over the prior year quarter, reflecting growth in our health care benefits and pharmacy and consumer wellness segments.

謝謝你，凱倫，也謝謝大家今天早上加入我們。我將首先介紹公司整體業績的一些亮點。第二季營收約 912 億美元，比去年同期成長約 2.6%，反映了我們的醫療保健福利以及藥品和消費者健康領域的成長。

We delivered adjusted operating income of over $3.7 billion and adjusted EPS of $1.83. We also generated year-to-date cash flow from operations of approximately $8 billion, lower results as compared to the same period last year, primarily due to timing of Medicare payments from the impact of Medicare utilization.

我們的調整後營業收入超過 37 億美元，調整後每股收益為 1.83 美元。年初至今，我們也從營運中產生了約 80 億美元的現金流，業績低於去年同期，主要是因為醫療保險支付時間受到醫療保險利用率的影響。

Let's look at some of the performance of our segments. In our Health Care Benefits segment, we delivered strong revenue growth versus the prior year. Second quarter revenues of approximately $32.5 billion increased by over 21% year over year, reflecting growth across all product lines.

讓我們來看看我們部門的一些表現。在我們的醫療保健福利部門，我們的收入較上年強勁成長。第二季營收約為 325 億美元，年成長超過 21%，反映了所有產品線的成長。

Medical membership grew to nearly 27 million members, an increase of 200,000 members sequentially, reflecting growth in Medicare and Medicaid products, including the Oklahoma Medicaid contract, which went live on April 1.

醫療會員數量增長至近 2700 萬，比上一季增加了 20 萬，反映出醫療保險和醫療補助產品的增長，其中包括 4 月 1 日生效的俄克拉荷馬州醫療補助合約。

Adjusted operating income for the quarter was approximately $938 million, down here over year due to higher medical benefit ratio, partially offset by an increase in net investment income. Our medical benefit ratio of 89.6% increased 340 basis points from the prior year quarter, primarily reflecting higher Medicare Advantage utilization for premium impact of lower Stars ratings for the payment year 2024 the impact of higher acuity in Medicaid and a change in estimate for individual extreme change risk adjustment accrual for the 2023 plan year. These increases were partially offset by the favorable year-over-year impact of prior period development.

該季度調整後營業收入約為 9.38 億美元，由於醫療福利比率較高，較上年同期有所下降，但部分被淨投資收入的成長所抵消。我們的醫療福利比率為89.6%，較去年同期增加了340 個基點，主要反映了Medicare Advantage 利用率較高，對2024 年付款年星級評級較低的保費影響、醫療補助敏銳度較高的影響以及個人極端情況估計的變化變更 2023 計畫年度的應計風險調整。這些成長被前期發展的有利同比影響部分抵消。

In Medicare Advantage strong prior period reserve development improved our first quarter medical cost trend estimates, but we continue to see elevated trends in the second quarter, largely in the same category as we previously discussed, including inpatient supplemental benefits such as dental and also in pharmacy.

在醫療保險優勢方面，前期準備金的強勁發展改善了我們對第一季度醫療成本趨勢的估計，但我們繼續看到第二季度的上升趨勢，主要與我們之前討論的類別相同，包括牙科和藥房等住院補充福利。

Following the close of the quarter, we have seen some evidence of an acceleration of trends in these same categories, which informed our view of risks for the remainder of 2024. We also experienced medical cost pressures in our Medicaid business.

本季結束後，我們看到了一些相同類別趨勢加速的證據，這讓我們對 2024 年剩餘時間的風險有了看法。

This pressure is largely driven by higher acuity resulting from member redeterminations. We believe this dislocation will self-correct over time as we continue to work closely with our state partners to ensure the underlying trends are reflected in our rates, but we have not assumed material improvement in our 2024 outlook.

這種壓力很大程度上是由會員重新決定帶來的更高的敏銳度所造成的。我們相信，隨著時間的推移，隨著我們繼續與國家合作夥伴密切合作，確保基本趨勢反映在我們的費率中，這種錯位將會自我糾正，但我們並沒有假設2024 年的前景會出現實質改善。

During the quarter, we received final 2023 risk adjustment data or individual exchange business. As a result, we increased our risk adjustment accrual for the 2023 plan year by approximately $225 million. We were disappointed to see such a large change in the final update.

本季度，我們收到了2023年最終風險調整數據或個別交易所業務。因此，我們將 2023 年計畫年度的風險調整應計額增加了約 2.25 億美元。我們很失望地看到最終更新中有如此大的變化。

We believe this change was in part driven by the significant growth and disruption in the market, particularly 2023. For 2024 population contains a significantly higher proportion of renewing members, and we continue to enhance our revenue integrity efforts to ensure we are appropriate recapturing there acuity.

我們認為，這項變革在某種程度上是由市場的顯著成長和混亂所推動的，尤其是2023 年。能夠適當地重新獲得敏銳度。

As a result of this update, we now expect margins for individual exchange business to be below breakeven this year. However, we are confident that our 2025 submitted rate filings, which we further enhanced following the 2023 risk adjustment update will place us back on our multiyear margin trajectory.

由於本次更新，我們現在預計今年個人交易所業務的利潤率將低於損益平衡點。然而，我們相信，我們在 2023 年風險調整更新後進一步加強了 2025 年提交的利率備案，將使我們回到多年利潤率軌跡。

Medical cost trends in our commercial business remain elevated, but are broadly in line with our expectations and pricing. These claims payable at the end of the quarter were 43.1 days, down 1.4 days sequentially and 3.8 days from the prior year quarter.

我們商業業務的醫療成本趨勢仍然較高，但與我們的預期和定價基本一致。本季末應付理賠為 43.1 天，較上一季減少 1.4 天，比去年同期減少 3.8 天。

The decrease versus the prior quarter was primarily driven by elevated reserves held in the first quarter of 2024, including the impact of the change healthcare cyber attack. The year-over-year change in DCP was primarily driven by growth in our Medicare business and the impact of increased pharmacy trends. We remain confident in the adequacy of our reserves.

與上一季相比下降的主要原因是 2024 年第一季持有的準備金增加，包括醫療保健網路攻擊變化的影響。 DCP 的同比變化主要是由我們的醫療保險業務的成長以及藥物趨勢增加的影響所推動的。我們對儲備充足性仍然充滿信心。

Our Health Services segment generated revenue of approximately $42.2 billion, a decrease of approximately 9% year over year, primarily driven by the previously announced loss of a large client and continued pharmacy client price improvements.

我們的健康服務部門產生了約 422 億美元的收入，年減約 9%，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。

These decreases were partially offset by pharmacy drug mix, increased contributions from a health care delivery assets and growth in specialty pharmacy. Adjusted operating income of approximately $1.9 billion, increased over 1% from the prior year quarter, reflecting improved purchasing economics, partially offset by continued pharmacy client price improvements and the previously announced loss of a large client.

這些下降被藥房藥物組合、醫療保健服務資產貢獻增加以及專業藥房的成長部分抵消。調整後營業收入約為 19 億美元，較去年同期成長超過 1%，反映出採購經濟性的改善，但部分被持續的藥房客戶價格上漲和先前宣布的大客戶流失所抵消。

Total pharmacy claims process in the quarter were approximately 471 million, and total membership as of the end of the quarter was approximately 90 million members. We continue to be encouraged by the performance and growth of our health care delivery assets.

本季藥局索賠流程總數約 4.71 億，截至本季末會員總數約 9,000 萬。我們的醫療保健服務資產的表現和成長繼續令我們感到鼓舞。

Signify completed its second consecutive quarter of record volume generated revenue growth of 27% over the prior year. Oak Street also significantly increased revenue in the quarter, growing approximately 32% compared to the same quarter last year, reflecting strong membership and clinic growth.

Signify 連續第二季創下銷售量創紀錄的成績，營收較上年同期成長 27%。 Oak Street 本季的營收也大幅成長，與去年同期相比成長約 32%，反映出會員資格和診所的強勁成長。

Oak Street ended the quarter was 207 centers, an increase of 30 centers year over year. Despite the challenging and dynamic operating environment and Medicare, we continue to see strong profitability of newer clinics and a consistent ramp in profitability of our newer clinics.

截至本季末，Oak Street 共有 207 個中心，較去年同期增加 30 個中心。儘管營運環境和醫療保險充滿挑戰且充滿活力，但我們仍然看到新診所的強勁盈利能力以及新診所盈利能力的持續增長。

We are encouraged by Oak Street's performance, which remains in line with our prior outlook and remain committed to growing our center footprint and expanding access to this leading care model. Our pharmacy and consumer wellness segment generated revenue of approximately $29.8 billion, reflecting an increase of 3.7% versus the prior year and 6.4% on a same-store basis.

我們對橡樹街的業績感到鼓舞，這與我們先前的預期一致，並繼續致力於擴大我們的中心足跡並擴大這種領先護理模式的覆蓋範圍。我們的藥品和消費者健康部門產生了約 298 億美元的收入，比上年增長 3.7%，同店成長 6.4%。

The primary drivers of this revenue growth were increased prescription volume and pharmacy drugs mix, partially offset by continued pharmacy room person pressure, the impact of recent generic introductions and lower front store volumes.

收入成長的主要驅動力是處方量和藥房藥品組合的增加，但部分被藥房人員持續壓力、最近推出仿製藥的影響和前台銷售下降所抵消。

Adjusted operating income was approximately $1.2 billion. This result is lower than the prior year quarter due to continued pharmacy reimbursement pressure, decreased front store volume and the timing of certain Medicare payments related to a CMS request.

調整後營業收入約 12 億美元。由於持續的藥房報銷壓力、前台商店數量減少以及與 CMS 請求相關的某些 Medicare 付款時間，這一結果低於去年同期。

These impacts were partially offset by increased prescription volume, improved drug purchasing and pharmacy drugs. This quarter, same-store pharmacy sales were up over 9% versus the prior year, and same-store prescription volumes increased by 6.5%.

這些影響被處方量的增加、藥品購買和藥房藥品的改善部分抵消。本季，同店藥局銷售額較上年成長超過 9%，同店處方量成長 6.5%。

We continue to increase our scripture during the quarter, achieving a 27.2% retail pharmacy share. Our results continue to demonstrate we are the best run national pharmacy chain in the country. Same store front, store sales were down by about 4% versus the same quarter last year.

本季我們繼續增加處方，實現了 27.2% 的零售藥房份額。我們的結果繼續證明我們是全國經營最好的全國藥局連鎖店。同一店面，店內銷售額比去年同期下降了約 4%。

Excluding OTC test kits, same store front, store sales were down about 2%, reflective of general softening of consumer demand. As a reminder, the public health emergency was active through mid-May last year.

不包括OTC檢測試劑盒，同一店銷售額下降約2%，反映消費者需求普遍疲軟。提醒一下，公共衛生緊急事件一直持續到去年五月中旬。

Shifting now to liquidity and our capital position. Through the second quarter, we generated year-to-date cash flow from operations of approximately $8 billion. During the quarter, we returned $858 million to shareholders through our quarterly dividend and ended the quarter with approximately $2.9 billion of cash at the parent and unrestricted subsidiaries. We remain committed to maintaining our current investment grade ratings.

現在轉向流動性和我們的資本狀況。在整個第二季度，我們年初至今的營運現金流量約為 80 億美元。本季度，我們透過季度股息向股東返還 8.58 億美元，本季結束時，母公司和不受限制的子公司擁有約 29 億美元的現金。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 are lowering our 2024 adjusted EPS guidance to a range of $6.40 to $6.65 per share. This revision reflects our performance through the second quarter and our latest expectations for the remainder of the year.

現在轉向我們對 2024 年的全年展望，正如 Karen 所提到的，我們將 2024 年調整後每股收益指引下調至每股 6.40 美元至 6.65 美元的範圍。此次修訂反映了我們第二季的業績以及我們對今年剩餘時間的最新預期。

Let me walk you through the major drivers of change. In our Health Care Benefits segment, we now expect adjusted operating income and a range of $2.25 billion to $2.55 billion. We expect HCBs full year medical benefit ratio to be in a range of 90.6% to 90.8%, an increase of 80 basis points to 100 basis points versus our prior guidance.

讓我帶您了解改變的主要驅動因素。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將在 22.5 億美元至 25.5 億美元之間。我們預計 HCB 全年醫療福利比率將在 90.6% 至 90.8% 範圍內，較我們先前的指引增加 80 個基點至 100 個基點。

At the midpoint for MBR shows a 150 basis points increase from the first half for the second half of 2024, consistent with historical patterns. In our Medicare Advantage block first half results remain largely in line with our prior expectation, although they have developed differently than we previously projected.

MBR 的中點顯示 2024 年下半年較上半年增加 150 個基點，與歷史模式一致。在我們的醫療保險優勢區塊中，上半年的結果基本上與我們先前預期的一致，儘管它們的發展與我們先前的預測不同。

Medical cost trends remained elevated in the second quarter at levels consistent with our restated first quarter experience, which benefited from strong prior period development. However, early indicators for July suggests we may see incremental pressure, particularly in inpatient.

第二季醫療成本趨勢仍然較高，水準與我們重申的第一季經驗一致，這得益於前期的強勁發展。然而，7 月的早期指標表明我們可能會看到壓力增加，特別是住院患者。

As a result, our updated guidance range now reflects the trends in the second half of 2024 could be higher than levels seen in the first half. It is worth noting that of trends persist at elevated levels we may be required to taken in year 2024 premium deficiency reserve in our Medicare business.

因此，我們更新的指導範圍現在反映了 2024 年下半年的趨勢可能高於上半年的水平。值得注意的是，如果趨勢持續保持在較高水平，我們可能需要在 2024 年的醫療保險業務中提取保費不足準備金。

While this premium deficiency reserve should now not having impact on our revised full year expectations for the Health Care Benefits segment, it could change the cadence of earnings between third and fourth quarters.

雖然這種保費不足準備金現在應該不會對我們對醫療保健福利部門修訂後的全年預期產生影響，但它可能會改變第三季和第四季之間的獲利節奏。

At this time, we have no expectation that we will need a premium deficiency reserve related to our Medicare Advantage block for 2025. Our updated guidance also reflects a continuation of the Medicaid acuity pressure we saw in the second quarter. Our teams are working closely with state partners to align Medicaid rates with higher acuity.

目前，我們預計不會需要與 2025 年 Medicare Advantage 計劃相關的保費不足準備金。我們的團隊正在與州合作夥伴密切合作，以更高的敏銳度調整醫療補助費率。

However, we are assuming no material improvement in the dislocation between rates and acuity through the second half of 2024.

然而，我們假設到 2024 年下半年，比率和敏銳度之間的錯位不會出現實質改善。

In our individual exchange business, given the magnitude of the negative surprise we experienced in our 2023 update, our outlook now reflects the provision for potential variability in our 2024 risk-adjusted position as our data matures over the remainder of the calendar year.

在我們的個人交易所業務中，考慮到我們在2023 年更新中經歷的負面意外的嚴重程度，我們的展望現在反映了隨著我們的數據在日曆年剩餘時間內成熟，我們2024 年風險調整頭寸的潛在變化。

As noted, we believe this variability has been appropriately reflected in our recently updated pricing for 2025. Our Health Services segment, we're increasing our estimate for 2024 adjusted operating income by a range of $200 million to $250 million or $7.2 billion to $7.25 billion.

如前所述，我們認為這種變化已適當地反映在我們最近更新的2025 年定價中。 72 億至72.5 億美元。

This increase reflects the return to strong performance in our pharmacy services business in the second quarter as well as the continuation of this exceptional execution for the remainder of the year. There is no change to the outlook for our health care delivery of assets as these businesses continue to perform in line with our expectations.

這一成長反映出我們的藥房服務業務在第二季度恢復了強勁的業績，以及在今年剩餘時間內繼續保持這種出色的執行力。我們的醫療保健資產交付前景沒有變化，因為這些業務的表現持續符合我們的預期。

In our pharmacy and consumer wellness segment, we now project adjusted operating income to increase by $100 million to $150 million for up to $5.7 billion to $5.75 billion. While we recognize that there has been macro shifts and economic and consumer dynamics, our pharmacy and consumer wellness segment continues to highlight the importance of our Community Health locations to the consumers we serve reflected in our growing pharmacy market share.

在我們的製藥和消費者健康部門，我們現在預計調整後的營業收入將增加 1 億美元至 1.5 億美元，達到 57 億美元至 57.5 億美元。雖然我們認識到宏觀變化以及經濟和消費者動態發生了變化，但我們的藥房和消費者健康部門繼續強調我們的社區健康地點對我們服務的消費者的重要性，這反映在我們不斷增長的藥房市場佔有率上。

As a result, we are pulling some of the strong first half performance into our expectations for the full year.

因此，我們將上半年的一些強勁表現納入我們對全年的預期中。

Finally, we updated our expectation for cash flows from operations to approximately $9 billion in 2024. This decrease was primarily driven by the timing of reinsurance payments from CMS, primarily related to our stand-alone prescription drug products and the impact of lower HCB earnings. The [Part D] receivable increase will be repaid by CMS during the fourth quarter of 2025.

最後，我們將 2024 年營運現金流量預期更新為約 90 億美元。 [D 部分] 應收帳款的增加將由 CMS 在 2025 年第四季償還。

You can find additional details on the components of our updated 2024 guidance on our Investor Relations webpage.

您可以在我們的投資者關係網頁上找到有關我們更新的 2024 年指南組成部分的更多詳細資訊。

We plan to share more detail in 2025 guidance later this year, but I want to provide some updates to our previous expectations for 2025. In Medicare Advantage, we remain committed to driving meaningful improvements in our margins in 2025.

我們計劃在今年稍後在2025 年指導中分享更多細節，但我想對我們之前對2025 年的預期進行一些更新。的提高。

As we look at the sources to pressure we discussed in our updated 2024 guidance. Not all of these sources will translate into pressure on our 2025 bits. Notably, within our 2025 bids, we made meaningful adjust payments to our offerings, including supplemental benefits and Part D, both sources of incremental pressure in 2024.

當我們審視壓力來源時，我們在更新的 2024 年指南中進行了討論。並非所有這些來源都會轉換為我們 2025 年比特幣的壓力。值得注意的是，在我們的 2025 年投標中，我們對我們的產品進行了有意義的調整付款，包括補充福利和 D 部分，這兩個都是 2024 年增量壓力的來源。

We currently project that we will improve Medicare Advantage margins between 100 basis points and 200 basis points in 2025. This will be a significant first step to achieving our target margins of 4% to 5% over the next several years. For individual exchange business, we had the opportunity to refile our bids to reflect the latest risk adjustment data and prudently reflected those updates in our 2025 bids.

我們目前預計，到 2025 年，我們將把 Medicare Advantage 的利潤率提高 100 個基點到 200 個基點。對於個人交易所業務，我們有機會重新提交投標以反映最新的風險調整數據，並在 2025 年投標中審慎地反映這些更新。

As a result, we continue to expect profit improvement in that business in 2025. In Medicaid, we believe the dislocation between acuity in rates is temporary and will be largely resolved through the next pricing cycle.

因此，我們繼續預期該業務的利潤將在 2025 年有所改善。

In Karen's remarks, she highlighted the work our team has underway to deliver on a multiyear enterprise productivity initiatives. In 2025. We expect savings from this initiative to drive at least $500 million of adjusted operating earnings.

在凱倫的演講中，她強調了我們的團隊為實現多年企業生產力計劃而正在進行的工作。到 2025 年，我們預計該計劃將節省至少 5 億美元的調整後營業利潤。

We are encouraged by our deliberate efforts to strengthen our outlook and generate meaningful positive momentum for 2025 and beyond. As is our customary practice, we will give more formal guidance later this year.

我們為增強我們的前景並為 2025 年及以後創造有意義的積極勢頭而做出的刻意努力感到鼓舞。按照我們的慣例，我們將在今年稍後提供更正式的指導。

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)

（操作員說明）

Lisa Gill, JP Morgan.

麗莎·吉爾，摩根大通。

Thanks very much, and good morning, Karen and Tom. I just wanted to start on EBITDA health benefits business. So if I go back to last quarter and we talked about the level of visibility that you had around cost trend and then I heard your comments, Karen, that as it closed Q2, the trend accelerated. There's really two questions here one, can you talk about the level of visibility that you have when they think about the trend going into the back half of the year?

非常感謝，早安，凱倫和湯姆。我只是想開始 EBITDA 健康福利業務。因此，如果我回到上個季度，我們討論了您對成本趨勢的了解程度，然後我聽到了您的評論，凱倫，隨著第二季度結束，這一趨勢加速了。這裡確實有兩個問題，第一，您能談談當他們考慮下半年的趨勢時您的可見度嗎？

And then secondly, can you talk about what was included in the 2025 bid? You talked about your level of confidence that you have, they are prudent in those bids. But if you are seeing that trend accelerate coming out of Q2, were you able to capture that in a bid for 2025?

其次，您能談談 2025 年申辦包含哪些內容嗎？您談到了您的信心程度，他們對這些出價持謹慎態度。但如果您看到第二季度出現這種趨勢加速，您是否能夠在 2025 年的競爭中抓住這一趨勢？

Yes, Lisa, I'll start with a 25 bids. I feel like we have a high degree of confidence that we cut the trend for 2025 bids. We took a very prudent approach. We talked about that last quarter relative to our elevated trends and that we expect that elevated trends for the rest of the year and into next year.

是的，麗莎，我將從 25 個出價開始。我覺得我們對削減 2025 年投標趨勢充滿信心。我們採取了非常謹慎的做法。我們討論了上個季度相對於我們的上升趨勢的情況，我們預計今年剩餘時間和明年的趨勢也會上升。

So we feel very confident had across enterprise team, looking at the bids and throughout the entire bid cycle. And we feel good that we'll achieve the 100 basis points to 200 basis points of margin recovery. And that's what we expect and are relative to utilization in the quarter. I'll ask Tom to comment on that.

因此，我們對整個企業團隊、查看投標以及整個投標週期都非常有信心。我們對利潤率恢復 100 到 200 個基點感到滿意。這就是我們的預期，並且與本季的利用率有關。我會請湯姆對此發表評論。

Hey, Lisa. So as you look at the trends on, there's a lot of things going on inside the quarter. So the first quarter we stated quite positively. A lot of that we think was a function of change. We actually saw some strong restatement and inpatient and first quarter trend.

嘿，麗莎。因此，當您觀察趨勢時，會發現本季內發生了很多事情。所以第一季我們表現得相當積極。我們認為其中很多都是變化的結果。我們實際上看到了一些強勁的重述和住院和第一季的趨勢。

But then as we looked at what happened in the second quarter, we actually -- the Medicare trends quarter over quarter they were roughly flat, but at a lower level than what we experienced or thought we have experienced in the first quarter. So inpatient trends were consistent, but at an elevated level.

但當我們觀察第二季度發生的情況時，我們實際上——醫療保險趨勢逐季度大致持平，但水平低於我們在第一季經歷或認為經歷的水平。因此，住院患者趨勢是一致的，但水平較高。

And then we continued to see some elevated trends in outpatient. We saw some pressure in supplemental benefits such as dental and also in pharmacy. We also saw some categories such as we talked a little bit about some of the outpatient pharmacy that we had seen that pressure in the first quarter. We saw some positive restatement there and actually some acceleration of trends, which was -- which was a nice offset

然後我們繼續看到門診病人數量呈上升趨勢。我們看到牙科和藥房等補充福利面臨一些壓力。我們還看到了一些類別，例如我們談論了一些我們在第一季看到的壓力的門診藥房。我們在那裡看到了一些積極的重述，實際上趨勢有所加速，這是一個很好的抵消

From our current outlook, we think prudently incorporates where we are for the remainder of the year. But as you think about the bids, part of the the question here is where exactly does this manifest? We had a substantial amount of contingency as we look at our 2024 baseline for those bids.

從我們目前的前景來看，我們謹慎地考慮了今年剩餘時間的情況。但當你考慮出價時，這裡的部分問題是這到底體現在哪裡？當我們考慮 2024 年這些投標的基線時，我們有大量的意外情況。

And remember, for 2025, we assumed that same level of trend persists for respectively, a third year in 2025 at -- essentially a double digit rate -- a very, very high abnormal trends. And so when you step back and look at where we've seen some of the pressure this quarter, dental, for example, has been completely restructured in our 2025 bids.

請記住，對於 2025 年，我們假設相同水準的趨勢將在 2025 年分別持續第三年，基本上是兩位數的成長率，這是一個非常非常高的異常趨勢。因此，當您退一步看看本季我們看到的一些壓力時，例如牙科，我們在 2025 年的投標中已經完全重組。

And so if we see pressure there throughout the remainder of the year, it's unlikely to translate. Part D, as we all know, has been completely restructured for 2025. And so we're not -- we don't believe that some of the pressure that we're seeing there is also in a carryover because those bids have been rebuilt from the ground up.

因此，如果我們在今年剩餘時間內看到壓力，它就不太可能轉化。眾所周知，D 部分已在 2025 年進行了徹底重組。

I would also highlight, you saw because in some of the changes and CMS star ratings, we did actually get a nice tailwind, in that one of our important our HMO contracts done in Florida, flipped over to four stars, which will also create an incremental tailwind.

我還想強調的是，你看到了，因為在一些變化和CMS 星級評級中，我們實際上確實獲得了很好的順風，因為我們在佛羅裡達州完成的一項重要的HMO 合約變成了四星，這也將創造一個增量順風。

And so we feel good about, over the range of outcomes that we've talked about, 100 basis points to 200 basis points of margin improvement. And, there are many scenarios where we think the high end of that range is entirely achievable.

因此，在我們討論的一系列結果中，利潤率提高了 100 到 200 個基點，我們對此感到滿意。而且，在許多情況下，我們認為該範圍的高端是完全可以實現的。

Can you talk about membership decline? I think Karen mentioned that today about that. When you said in the public form of to 10%, should that be our assumption for '25 that you can move up to 10% of their membership in MA?

能談談會員資格下降的情況嗎？我想凱倫今天有提到這一點。當您以公開形式表示增加到 10% 時，這是否應該是我們對 25 年的假設，即您可以將 MA 成員的比例提高到 10%？

I think we were out earlier last quarte, we talked about a range of 5% to 10%. That's a good baseline. But I also wanted to just highlight why is it that we expect to lose that membership? It's because there weer some county exit. So it's a small portion of what we think the loss membership will be.

我想我們上個季度早些時候就已經退出了，我們討論了 5% 到 10% 的範圍。這是一個很好的基線。但我也想強調為什麼我們預計會失去這個會員資格？因為有一些縣出口。因此，這只是我們認為的會員流失量的一小部分。

As you think about, though, where our assumptions have made some significant dislocation, -- is where we've had, we didn't have a product that we thought we could get back to target margins over the time period we have. And so we pulled those products. And then we refiled a new product with a different set of benefits that we would not have been able to achieve by just changing our existing benefit structure.

不過，正如你所想，我們的假設造成了一些重大錯位，我們沒有一種產品可以在我們擁有的時間段內恢復到目標利潤率。所以我們撤下了這些產品。然後，我們重新提交了一種新產品，該產品具有一系列不同的福利，而這些福利是我們僅透過改變現有福利結構無法實現的。

And so we believe we've been fairly prudent given the level of disruption that is likely in the marketplace next year in assuming that those terms and resells are going, those results are going to happen at a much lower rate than what we have historically experienced, but should we see some upside from that?

因此，我們相信，考慮到明年市場可能出現的混亂程度，假設這些條款和轉售正在進行，這些結果將以比我們歷史上經歷過的速度低得多的速度發生。好處嗎？

It is likely going to be in terms of membership relative to that range of 5% to 10% down? It's going to be in products where we restructure the benefits. So we don't necessarily feel that's a bad thing. In other words, I don't know that losing membership as part of the path to profitability. We think that a lot of that has been incorporated just simply into the bid pricing.

就會員數量而言，可能會下降 5% 到 10%？它將出現在我們重組利益的產品中。所以我們不一定覺得這是一件壞事。換句話說，我不知道失去會員資格是獲利之路的一部分。我們認為其中許多內容只是簡單地納入了投標定價中。

Justin Lake, Wolfe Research.

賈斯汀·萊克，沃爾夫研究中心。

Thanks. Good morning. First question is on the 2025. You've previously talked about double digit EPS growth next year. Is that still the target of your updated estimate? And what are some of the key headwinds tailwinds there beyond the 100 basis points to 200 basis points of M&A improvement you're talking about?

謝謝。早安.第一個問題是關於 2025 年的。這仍然是您更新估算的目標嗎？除了您所說的併購改善 100 個基點到 200 個基點之外，還有哪些主要的逆風和順風？

Yes, Justin. Thanks for the question. Yes, our goal obviously is double digit, and we're striving to achieve that. That's the goal will provide more detailed guidance later on in the year. But let me have Tom walked you through the half the headwinds and tailwinds as we think about 2025.

是的，賈斯汀。謝謝你的提問。是的，我們的目標顯然是兩位數，我們正在努力實現這一目標。這一目標將在今年稍後提供更詳細的指導。但是，讓我讓 Tom 帶領您度過我們對 2025 年的展望。

I talked a little bit about this in the prepared remarks, Justin. But I think just highlighting again, our goal is to grow double digit on, but we want to see how the remainder of the year plays out, and we'll provide guidance as we normally do officially later this year.

賈斯汀，我在準備好的發言中談到了這一點。但我想再次強調，我們的目標是實現兩位數成長，但我們希望看看今年剩餘時間的表現如何，我們將像通常在今年稍後正式發布的那樣提供指導。

I would say, as you look across the businesses, I just would remind investors that we've seen strong performance in health, safety and health services. We've seen strong performance in pharmacy and consumer wellness on it, and we are encouraged by the momentum in both of those businesses. The real question then, of course, become that now.

我想說，當你縱觀各個企業時，我只是想提醒投資者，我們在健康、安全和健康服務方面看到了強勁的表現。我們看到了其在製藥和消費者健康領域的強勁表現，我們對這兩項業務的發展勢頭感到鼓舞。當然，真正的問題變成了現在。

So let me break down a couple of the big pieces in there that I think you would like to focus on. First, the individual business, we made significant price increases in our baseline for 2025. That is likely to yield a slightly lower membership base, but with a much higher profit margins and where we are this year.

因此，讓我分解我認為您想要關注的幾個重要部分。首先，在個體業務方面，我們在 2025 年的基準上大幅提高了價格。

When we then learned about how 2023 risk adjustment had backed up on us, we actually, as part of the process, when that happens, you actually have the opportunity to reopening our bids. And so we work with our state partners and we put incremental rate into certain key states after receiving the 2023 risk adjustment update. So we feel good about our ability to make progress there.

當我們了解 2023 年風險調整如何支持我們時，實際上，作為流程的一部分，當這種情況發生時，您實際上有機會重新開始我們的投標。因此，我們與州合作夥伴合作，在收到 2023 年風險調整更新後，我們將增量利率納入某些關鍵州。因此，我們對自己在那裡取得進展的能力感到滿意。

In Medicaid, there are price increases that will go into effect on nearly half of our book on January first, 2025. And we're also I would say there are some isolated pockets on some very specific issues in certain states where we're seeing some isolated pressure on and we're working with those states to see what we can do to enhance some of our medical management to tried to improve the trend outlook there as well.

在醫療補助計劃中，我們的近一半書籍的價格將在 2025 年 1 月 1 日生效 一些我想說的是，在某些州，我們看到一些非常具體的問題存在一些孤立的情況。的壓力，我們正在與這些州合作，看看我們能做些什麼來加強我們的一些醫療管理，以試圖改善那裡的趨勢前景。

So we feel good about our ability to improve the outlook for that business. Now I will also just note, we do a large win in Texas that will have some startup costs associated with that next year. In Medicare Advantage I talked about this. We did make meaningful adjustments to our offerings. We feel good about our ability to get 100 basis points to 200 basis points improved margin in 2025.

因此，我們對改善該業務前景的能力感到滿意。現在我還要指出的是，我們在德克薩斯州取得了巨大的勝利，明年將產生一些與之相關的啟動成本。在《醫療保險優勢》中我談到了這一點。我們確實對我們的產品進行了有意義的調整。我們對 2025 年利潤率提高 100 到 200 個基點的能力感到滿意。

And then if medical costs were strictly and where to subside from our current outlook, which effectively carries this very high level of trend and then a little more more based on what we saw in early July throughout the remainder of the year, if some of that were to subside, there's obviously upside from that because we've been very explicit about what our trend assumptions are.

然後，如果嚴格控制醫療費用，以及從我們目前的前景來看，醫療費用會在哪裡下降，這實際上承載著非常高的趨勢，然後根據我們7 月初在今年剩餘時間裡看到的情況，更多一點，如果其中一些如果趨勢消退，這顯然有好處，因為我們已經非常明確地了解了我們的趨勢假設。

We have line of sight to over $500 million of incremental cost savings in 2025. And we believe that we have the opportunity to drive $2 billion worth of cost savings over time. Those efficiencies are going to allow us to drive results both for shareholders, but also invest in our products, processes and infrastructure.

我們預計到 2025 年，增量成本節約將超過 5 億美元。 而且我們相信，隨著時間的推移，我們有機會實現價值 20 億美元的成本節約。這些效率將使我們不僅能夠為股東帶來成果，還能投資於我們的產品、流程和基礎設施。

We think these are the right things to do. A lot of them were underway, but we really accelerated our focus on delivering near-term value to help improve our outlook. So when you pull all that together again, we feel like we have a lot of positive momentum, our goal is to grow double digits, and we're going to update investors later this year.

我們認為這些都是正確的做法。其中許多正在進行中，但我們確實加快了對提供短期價值的關注，以幫助改善我們的前景。因此，當你再次將所有這些放在一起時，我們感覺我們有很多積極的動力，我們的目標是實現兩位數增長，我們將在今年晚些時候向投資者通報最新情況。

And then, just a quick follow up on the question around Medicare Advantage. You mentioned cost trends elevated, you saw more in July. Where is medical cost trend running? Coming out of July, what are you assuming for the back half of the year and remind us what you reported your certain next year relative to that number? Lastly, can you share with us what percentage of members in 2025 and MA? We'll see their products pulled, the same products? Thanks.

然後，快速跟進有關 Medicare Advantage 的問題。您提到成本趨勢上升，您在 7 月看到了更多。醫療費用趨勢走向何方？七月之後，您對今年下半年的情況有何假設，並提醒我們您報告的明年相對於該數字的具體情況是什麼？最後，可以跟我們分享一下2025年和MA的會員比例嗎？我們會看到他們的產品被撤下，同樣的產品？謝謝。

So I'll answer the first -- the last one first. So we -- you'all have some better insights into that when we see the open enrollment period in the landscape filed later this year. Obviously how our membership is impacted is going to be highly dependent upon competitor actions. And so we'll give you a better sense on what that looks like later this year.

所以我先回答第一個——最後一個。因此，當我們看到今年稍後提交的申請中的開放註冊期時，你們都會對此有一些更好的見解。顯然，我們的會員資格受到的影響將在很大程度上取決於競爭對手的行動。因此，我們將在今年稍後讓您更好地了解情況。

As you think about medical cost trends, remember there are certain things this year that are specific to some of the pressures this year? And so when you think about trends in the bid, we think about some of the core trends on. And then we look at some of the things like supplemental benefits separately, but we are experiencing on all in, including pharmacy double digit trends this year.

當您思考醫療費用趨勢時，還記得今年有一些特定的事情是針對今年的一些壓力的嗎？因此，當您考慮出價趨勢時，我們會考慮一些核心趨勢。然後我們會單獨研究一些諸如補充福利之類的事情，但我們正在全面經歷，包括今年的藥品兩位數趨勢。

And when you look at the core trends associated with the baseline in the bids and then the baseline that we carried into 2025, it's consistent with the experience that we are seeing year to date that we've carried through for the next 18 months.

當您查看與出價基線相關的核心趨勢以及我們在 2025 年實施的基線時，您會發現，它與我們今年迄今為止在未來 18 個月中實施的經驗是一致的。

Stephen Baxter, Wells Fargo.

史蒂芬‧巴克斯特，富國銀行。

Yes. Thank you very much for the question. I just wanted to ask about the expected EBITDA margin improvement of 100 basis points to 200 basis points, obviously had expected that closer to the 200 basis points range on the last call. So can you talk about now -- seeing where utilization is has exiting the quarter? What do you think would get you to the low end of that range or you think would be required to drive you towards the higher end of the range? Thank you.

是的。非常感謝你的提問。我只是想問一下預期的 EBITDA 利潤率將提高 100 個基點到 200 個基點，顯然在上次電話會議中預計會接近 200 個基點的範圍。那麼您現在能談談—看看本季結束後的使用率如何嗎？您認為什麼會讓您達到該範圍的低端，或者您認為需要什麼才能推動您達到該範圍的高端？謝謝。

So I think there's a wide range on the the remaining results for the year. And it's really a function of how much credibility one was signed into some of the early indicators we saw in July on the Medicare business. So at the low end of that range, I think 200 has pressure, at the higher end of that range, I think 200 is very achievable.

因此，我認為今年剩餘的結果有很大差異。這實際上取決於我們在 7 月看到的有關醫療保險業務的一些早期指標中的可信度。因此，在該範圍的低端，我認為 200 有壓力，在該範圍的高端，我認為 200 是非常可實現的。

And really, Stephen, it is a function where some of the trends over the remainder of the year manifest. So to the extent that they occur in areas where we are going to reset and off of that of that is not going to carry forward into 2025.

事實上，史蒂芬，這是一個體現今年剩餘時間的一些趨勢的函數。因此，就其發生在我們將要重置的領域而言，這些情況不會延續到 2025 年。

I just again highlight, though, we believe we've been very conservative in both the baseline and the trend that way we assumed in 2025. And so even at low end of that range, depending upon how it manifests itself, we still might be able to get 200 basis points improvement next year, we need to see just how the baseline matures over the course of the next couple of months to give you more firm guidance on them?

不過，我再次強調，我們認為我們在 2025 年假設的基線和趨勢方面都非常保守。 ，我們需要看看基線在接下來的幾個月中如何成熟，以便為您提供更堅定的指導？

Ann Hyne, Mizuho.

安海因，瑞穗。

Hi, I'm great, thank you. So in your prepared remarks you talked about the retail cost plus we are gaining traction with about 2% and a claims, I think you said renegotiated. Can you just given lower an update on negotiations with the last two PBM it's like maybe handicap if you think you'll be able to strike a deal with them? Just any update on negotiations that would be great.

你好，我很棒，謝謝你。因此，在您準備好的發言中，您談到了零售成本，加上我們以大約 2% 的成本獲得了關注，並提出了索賠，我認為您說的是重新談判。您能否簡單介紹一下與最後兩個 PBM 談判的最新情況，如果您認為自己能夠與他們達成協議，這可能會是一個障礙？只要有任何有關談判的最新消息就太好了。

Yes, Ann. Just a reminder on cost advantage, and it would be really introduce this to simplify and address the pharmacy reimbursement mile and Brain and the team have been working with PBMs to really reach contract and address those pharmacy reimbursement has had success.

是的，安。只是提醒一下成本優勢，實際上引入這一點是為了簡化和解決藥房報銷里程問題，Brain 和團隊一直在與 PBM 合作，以真正達成合約並解決那些藥房報銷問題，並已取得成功。

As I mentioned in my prepared remarks, we had eight PBM contracts already signed and underway, but I'll let Brain talk more specifically about those contracts and where we're headed.

正如我在準備好的演講中提到的，我們已經簽署並正在進行八份 PBM 合同，但我會讓 Brain 更具體地談論這些合同以及我們的發展方向。

I appreciate the question, Ann. So look, we continue to have active productive discussions with our large PBM partners and continuing progress in transitioning all of our commercial contracts for January 1, 2025. At the end of the day if you think about the retail pharmacy reimbursement landscape and what kind of how it works, what we're doing with CVS CostVantage allows pharmacies to be reasonably compensated for the care of the value that they provide and the local communities.

我很欣賞這個問題，安。因此，我們將繼續與大型PBM 合作夥伴進行積極富有成效的討論，並在2025 年1 月1 日之前的所有商業合約過渡方面繼續取得進展。情況它是如何運作的，我們使用 CVS CostVantage 所做的事情使藥局能夠因其提供的價值和當地社區的關懷而獲得合理的補償。

So I would say more to come in the next couple of quarters, but we do remain positive about where we stand at this point with CVS cost advantage and how it resonate in the marketplace.

因此，我想說在接下來的幾季中會有更多內容，但我們仍然對 CVS 成本優勢的現狀及其在市場上的反應持樂觀態度。

Eric Percher, Nephron Research.

艾瑞克‧佩徹（Eric Percher），腎臟單位研究中心。

Thank you. I'd like to us from a little bit more on the Part D marketplace, given the initial bid direct direct subsidy exposure and the demo program, can you give us an idea for your response to that program? Is the Part D demo help to derisk this marketplace?

謝謝。我想從 D 部分市場上了解更多信息，考慮到最初的直接投標直接補貼風險和演示程序，您能給我們一個關於您對該計劃的回應的想法嗎？ D 部分演示是否有助於消除該市場的風險？

Eric, we're really pleased that and CMS phas offered on this Part D program to really stabilize on the Part D premiums. We are -- we have applied for the demonstration and are looking forward to working out the details. But we I really do think that this was the right answer, and we're very pleased with that. We're talking with CMS over the course of the last several months. And we felt like we had influence over that and feel good about what we are able to accomplish.

Eric，我們非常高興 CMS 階段提供了此 D 部分計劃，以真正穩定 D 部分保費。我們已經申請了演示，並期待制定細節。但我們確實認為這是正確的答案，我們對此感到非常滿意。在過去的幾個月裡，我們一直在與 CMS 進行洽談。我們覺得我們對此有影響力，並對我們所能取得的成就感到滿意。

Michael Cherny, Leerink Partners.

邁克爾·切爾尼，Leerink Partners。

Good morning. Thanks for taking the question. Maybe to go back to Ann's question asked a different direction. Seeing nice traction, obviously at a CostVantage, the logic behind that fairly sound. Is your intention if you don't get full compliance from the remaining 50% of the plans in place that you're going to have a dual reimbursement structure on the commercial side? And how exactly will that work functionally for the organization in terms of your pricing mechanism, your sourcing, et cetera?

早安.感謝您提出問題。也許回到安的問題問了一個不同的方向。看到良好的牽引力，顯然是在 CostVantage 下，背後的邏輯相當合理。如果剩餘 50% 的計劃沒有完全合規，您是否打算在商業方面採用雙重報銷結構？就定價機制、採購等方面而言，這對組織來說究竟如何發揮作用？

So today, we have multiple reference price models in the marketplace with payers. Our intention is to move all of our commercial hundreds of, as stated previously to our CostVantage model, it benefits both payers and us The predictability in the way cost of goods are passed through and provides predictable. What I would say is reasonable margin for the farmers as it relates to that.

因此，今天，我們在市場上為付款人提供了多種參考價格模型。我們的目的是將我們所有的商業成本轉移到我們的 CostVantage 模型中，正如之前所說，它對付款人和我們都有利。我想說的是與此相關的農民合理的利潤。

So our expectation is that we will move the commercial market over to this. We will still have a dual market, right, because of Medicare and Medicaid contracts still exist on another platform and as we said prior, we're going to move the commercial marketplace over [1125] and follow that with the Medicare and Medicaid markets that sometime in the future. So from my perspective, we'll handle that. But our expectation is ever moving the commercial marketplace over for [1125].

所以我們的期望是我們將把商業市場轉移到這個方面。我們仍然會有一個雙重市場，對吧，因為醫療保險和醫療補助合約仍然存在於另一個平台上，正如我們之前所說，我們將把商業市場轉移到[1125]，然後是醫療保險和醫療補助市場未來的某個時候。所以從我的角度來看，我們會處理這個問題。但我們的期望是永遠將商業市場轉移到[1125]。

Elizabeth Anderson, Evercore ISI.

伊麗莎白·安德森，Evercore ISI。

Hi, guys. Good morning and thanks for that question. Maybe just to piggyback on my math of what maybe let's just say. Is your expectation for those contracts -- the commercial contracts that you moved over so one [1125], that dose would have liked flat margins versus 2024?

嗨，大家好。早安，謝謝你提出這個問題。也許只是為了利用我的數學，也許我們只是說一下。您對這些合約（您移交的商業合約 [1125]）的預期是否與 2024 年相比希望利潤率持平？

Yes. But we have are not providing a guidance at this point. So our expectation is to -- as we've said, over the long term, if you think about what's happened with reimbursement pressure going all the way back to our Analyst Day, we've talked about how it's been a headwind for retail for very long times industry.

是的。但我們目前尚未提供指導。因此，我們的預期是——正如我們所說，從長遠來看，如果你考慮一下報銷壓力一直追溯到我們的分析師日所發生的情況，我們已經討論過這對零售業來說是如何不利的。

What CVS CostVantage will do, is over time it will flatten that out to basically allow payers to have the benefits of our industry-leading cost of goods to get passed through and a more transparent fashion and flatten out the reimbursement pressures over time. So they will provide a 2025 guidance yet. But the expectation of CVS CostVantages to really we do that over time and provide a floor in retail.

CVS CostVantage 將會做的是，隨著時間的推移，它將壓平這一點，基本上讓付款人能夠享受到我們行業領先的商品成本傳遞的好處和更透明的方式，並隨著時間的推移壓平報銷壓力。因此他們仍將提供 2025 年的指導。但 CVS CostVantages 期望我們隨著時間的推移能夠真正做到這一點，並為零售業提供一個基礎。

I'm going to ask David to talk a little bit about how that's translating on the PBM and TrueCost and how that's flowing all the way through. So David, why don't you take it?

我將請 David 談談如何將其轉化為 PBM 和 TrueCost，以及如何貫穿始終。那麼大衛，你為什麼不接受呢？

Yes, so I think it's important that you see both sides of the equation, and there's clearly recognition that their pain points and two, today's price model. So you have this average market basket pricing and what we see is and cross subsidization. So both what premise solving for on the retail side is exactly what we're solving for our TrueCost model with our clients.

是的，所以我認為重要的是你要看到等式的兩邊，並且清楚地認識到他們的痛點和兩個，今天的價格模型。所以你有這個平均市場籃子定價，我們看到的是交叉補貼。因此，零售方面解決的前提正是我們與客戶一起解決 TrueCost 模型的問題。

So the fact is that we're hitting what I believe are the issues head on by trying to drive a new price model that both serves our customers and creating, eliminating the price variability -- creating more simplicity and transparency at the at the member or the consumer level.

因此，事實是，我們正在透過嘗試推動一種新的價格模型來解決我認為面臨的問題，該模型既可以為我們的客戶服務，又可以創造、消除價格波動——為會員或會員創造更多的簡單性和透明度。

So the good news is that we've launched TrueCost for our own employees on [6-1]. We'd launch of what we believe it very successfully and helps create one is a platform and a demonstration that the at the product will actually work effectively for for members and a high deductible plan.

因此，好消息是我們已於 [6-1] 為我們自己的員工推出了 TrueCost。我們將推出我們認為非常成功的產品，並幫助創建一個平台和演示，表明該產品實際上將為會員和高免賠額計劃有效發揮作用。

And we're also beginning to evolve this enroll this model out to add to the rest of our book. So we're looking obviously, at waves are attributes of the model. And we suspect that we will have close to two-thirds of our customers on at least a couple of the attributes as we tried to rebalance and create more transparency at the member level.

我們也開始改進這個模型，以添加到我們本書的其餘部分。所以我們顯然看到，波浪是模型的屬性。我們懷疑，當我們試圖在會員層面重新平衡並提高透明度時，我們將擁有近三分之二的客戶，至少有幾個屬性。

So we feel really good about the fact that we're aligning both what's happening at retail and how it then connects with how we're basically driving the model in the payer community.

因此，我們對零售業正在發生的事情以及它如何與我們在付款人社區中推動該模式的基本方式相聯繫這一事實感到非常滿意。

Kevin Caliendo, UBS.

凱文‧卡里恩多，瑞銀集團。

Hey, guys, thanks for taking my question. I'm just thinking through some of these -- some of what we learned today, right? We have $500 million and operating savings that will flow through next year. We're going to have 100 basis points to 200 basis points of margin in MA, in cash flow you also have some benefits potentially from picks.

嘿，夥計們，謝謝你提出我的問題。我只是在思考其中的一些——我們今天學到的一些內容，對嗎？我們有 5 億美元的營運成本節省將用於明年。我們將在 MA 中獲得 100 個基點到 200 個基點的保證金，在現金流方面，您也可以從選擇中獲得一些潛在的好處。

All of those combined are well in excess of what would be 10% earnings growth of this new base. And that's not even including stars. And I'm just wondering, is your expectation for star still the same as it had been the star benefit in 2025. Is there anything that does anything that was changed there? That's my first question.

所有這些加起來都遠遠超過了這個新基地 10% 的獲利成長。這還不包括明星。我只是想知道，您對星級的期望是否仍與 2025 年星級福利相同。這是我的第一個問題。

Yes. Nothing has changed on relative to our star that actually have given some of the end of the changes that occurred earlier this quarter. And Kevin, you described and what we feel is very positive momentum going into 2025.

是的。相對於我們的明星來說，沒有任何變化，實際上已經結束了本季早些時候發生的一些變化。 Kevin，您描述了我們認為進入 2025 年的勢頭非常積極。

As both Tom and I talked about, we feel good about 2025 outlet relative to that positive momentum. In addition, we have very strong retention in our Aetna book and in our Caremark book, but relative to on client account. So generally speaking that they feel good about about 2025.

正如湯姆和我所說，相對於這種積極的勢頭，我們對 2025 年的出口感覺良好。此外，我們在 Aetna 帳簿和 Caremark 帳簿中的保留率非常高，但相對於客戶帳戶而言。總的來說，他們對 2025 年感覺良好。

But as Tom said, we want to see how the rest of the year plays out before we give formal guidance for 2025, which is typical of what we do anyway.

但正如 Tom 所說，在給出 2025 年的正式指導之前，我們希望看看今年剩餘時間的情況如何，無論如何，這都是我們所做的典型事情。

Kevin, one one just point of minor clarification. So the 100 basis points to 200 basis points has always been inclusive of the stores tailwind next year. But as you think about some of the pressures that we've seen, you know in or could see based on what we've heard in some of our early reads in July, really as we think about what's happened in June and get more data there. One of the positive offsets to that potential trend inside that range is further momentum on Stars because of that change, particularly to our Florida HMO contract.

凱文，一點一點澄清。因此，100 個基點到 200 個基點始終包含明年商店的順風。但是，當你思考我們所看到的一些壓力時，你知道或可以根據我們在7 月份的一些早期讀物中聽到的內容知道或可以看到，實際上當我們思考6 月份發生的事情並獲得更多數據時那裡。由於這一變化，特別是我們佛羅裡達州的 HMO 合同，對該範圍內潛在趨勢的積極抵消之一是 Stars 的進一步勢頭。

Lance Wilkes, Bernstein.

蘭斯威爾克斯，伯恩斯坦。

Chris, can you talk a little bit about the leadership changes for Aetna? In particular with you taking control of it, what are the changes and priorities are going to be establishing there? And what do you sort of the changes in the management process and any sort of or changes. And how much of the $500 million of incremental costs things that will fall to the bottom line would come through Atena? Thanks.

Chris，您能談談 Aetna 的領導層變動嗎？特別是當你控制了它之後，會發生哪些變化和優先事項？您如何看待管理流程中的變更以及任何類型的變更。在將降至底線的 5 億美元增量成本中，有多少是透過 Atena 承擔的？謝謝。

Thanks. As you ask me, the financial performance of this business was not meeting expectations and I decided to make a change relative to the priorities there. And I know I will be establishing a very strong management process, driving execution of improved on financial and operational performance. And that would be my key priorities.

謝謝。正如您問我的那樣，該業務的財務業績未達到預期，我決定根據該業務的優先事項進行更改。我知道我將建立一個非常強大的管理流程，推動財務和營運績效改善的執行。這將是我的首要任務。

Lance, just one quick follow-up. We're not parsing out where some of the $500 million in synergies comes from. That's all on bottom line. Reminder, though, as you think about 2025, we do have some expenses that are deferring that will come back in 2025, and this will, at that level helped to offset that. And we're not done yet. We're still working through what other opportunities we have this year. So I think of data for that will help to improve the outlook for next year.

蘭斯，只是一個快速跟進。我們並沒有分析 5 億美元的綜效中的一部分來自何處。這就是底線。但提醒一下，當你想到 2025 年時，我們確實有一些推遲的支出將在 2025 年收回，而這將在那個水平上幫助抵消這一點。我們還沒完成。我們仍在努力尋找今年的其他機會。所以我認為這方面的數據將有助於改善明年的前景。

Charles Rhyee, TD Cowen.

查爾斯‧萊伊 (Charles Rhyee)，TD 考恩 (TD Cowen)。

Yes, thanks for taking the question. karen, I wanted to ask, you mentioned earlier about, you know, the way the commercial save money and the role that PBMs play and really lowering drug prices for both employers and consumers.

是的，感謝您提出問題。凱倫，我想問，您之前提到商業省錢的方式以及 PBM 所發揮的作用，以及真正降低雇主和消費者的藥品價格。

I get all that and obviously we can debate the issues within the FTC interim report. But what does include those that that message though, doesn't seem to be resonating, particularly on the Hill? And certainly when it when you look at sort of the leading further portrays the PBM industry. Can you talk about sort what I see this is doing maybe in conjunction with PCMA to really kind of amplify the message of the PBM industry?

我明白了所有這些，顯然我們可以在聯邦貿易委員會中期報告中討論這些問題。但是，哪些訊息似乎沒有引起共鳴，特別是在國會山莊？當然，當你看到某種領先的產品時，它進一步描繪了 PBM 產業。您能否談談我所看到的與 PCMA 結合所做的事情，以真正放大 PBM 行業的資訊？

And why is that not what does that not resonated? Or or is that not gotten through to folks, particularly if you see, let's say, ahead of this interim report to trying to understand the role that PBMs play? And what can we do about that? Thanks.

為什麼這不引起共鳴呢？或者說，人們沒有理解這一點，特別是如果您在這份臨時報告之前看到試圖了解 PBM 所扮演的角色？我們能做些什麼呢？謝謝。

Yes, I think a couple of things. We've taken a very aggressive approach to us educating congress on the role of the PBM, we've been doing a lot relative to communications. One of the things that both David and I have spent a lot of time on the Hill and what we realize it is education thing and leave and amplifying our message.

是的，我認為有幾件事。我們採取了非常積極的方法來教育國會有關 PBM 的作用，我們在溝通方面做了很多工作。大衛和我在國會山莊花了很多時間，我們意識到這是教育的事情之一，留下並放大我們的訊息。

And you can do that. What I what I would I'd say is that we have demonstrated and proven over time that we are saving money and the results to reflect that. I think the FTC and was very much targeted and they took on certain data and not the whole holistic data to really amplify their story versus the real story. And we feel confident that we continue to have discussions.

你可以做到。我想說的是，隨著時間的推移，我們已經證明並證明我們正在節省資金，結果也反映了這一點。我認為聯邦貿易委員會非常有針對性，他們採用了某些數據而不是整個整體數據來真正放大他們的故事與真實故事的對比。我們對繼續進行討論充滿信心。

As you can see, nothing has happened in Congress because there's a lot of discussion going on around the PBMs I do think that if anything ever does happen, it will be on transparency. But yes, we continue to drive and educate Congress, and that's what we're doing and continue to add David, I'll ask David to see if there's anything else you want to comment on here.

正如您所看到的，國會沒有發生任何事情，因為圍繞 PBM 進行了大量討論，我確實認為如果真的發生任何事情，那將是關於透明度的。但是，是的，我們將繼續推動和教育國會，這就是我們正在做的事情，並繼續添加大衛，我會請大衛看看您是否還有其他要評論的內容。

Maybe just to reinforce, Charles, the this has been an industry that continues to innovate, adapt and evolve. And I think we're listening to the critiques and or the the concerns and just look specifically what we're seeing in DC, the focuses for the most part, what they out of pocket cost or for members that is the consumer.

也許只是為了強調，查爾斯，這是一個不斷創新、適應和發展的行業。我認為我們正在傾聽批評和/或擔憂，並具體關注我們在華盛頓所看到的情況，大部分的焦點，他們的自付費用或對於消費者會員的費用。

And when you look at now 80% plus generic dispensing rates and average out-of-pocket cost of $8 and actually that cost is actually less than what it was in years past. I think we're doing our job. And to your point, the messages that has not resonated as effectively because everybody is focusing on the high cost of brands, which is what we're solving for specifically with our customers.

當你看看現在 80% 以上的通用配藥率和 8 美元的平均自付費用時，實際上這個成本比過去幾年要低。我認為我們正在做我們的工作。就您而言，這些訊息並沒有引起有效的共鳴，因為每個人都在關注品牌的高成本，而這正是我們專門與客戶解決的問題。

And so that last 10%. And if you look specifically what we did with the with them with the biosimilars, we were the only PBM and we've actually got a lot of credit and recognition for this in both DC and among our customers.

最後 10%。如果你具體看看我們用生物相似藥對他們做了什麼，我們是唯一的 PBM，實際上我們在 DC 和我們的客戶中都獲得了很多信任和認可。

And that we say $400-plus million by converting a higher list price Humira brand to a lower list price product, too, the opposite, save our customers monitoring. And then the members will ultimately ended up paying close to $0 out of pocket.

我們說，將較高標價的 Humira 品牌轉換為較低標價的產品，也可以節省 4 億美元，相反，可以節省我們的客戶監控。然後會員最終將自掏腰包支付近 0 美元。

So if you demonstrate the fact that we are evolving and continuing to create value for our customers, which results in a high retention rate and high growth rate and our customers will ultimately be we can begin the to create the voice for making sure sure that we're protecting and actually a continuing into, what I think is reinvest in the things that the PBM tools and programs that we've delivered in the past.

因此，如果您證明我們正在不斷發展並繼續為客戶創造價值，這會帶來高保留率和高成長率，並且我們的客戶最終將成為我們的客戶，那麼我們就可以開始發出聲音，以確保我們我們正在保護，實際上是繼續，我認為是對我們過去交付的PBM 工具和專案進行再投資。

I think the last piece I'll just say, which I mentioned earlier is that the price models need to evolve with premise recognize that at retail, I think within the Caremark on the PBM side, we recognize the need to continue to evolve the price model, which is why we believe TrueCost is critical for the future of success.

我想我要說的最後一點，即我之前提到的，價格模型需要發展，前提是認識到在零售方面，我認為在 PBM 方面的 Caremark 內，我們認識到需要繼續發展價格模型，這就是為什麼我們相信TrueCost 對於未來的成功至關重要。

And what I believe is big is kind of the transformation of how pricing ultimately is delivered to the customer and ultimately down to the consumer. So I think the facts remain clear, the PBM industry and specifically CVS Caremark create significant value.

我認為最重要的是定價最終交付給客戶並最終交付給消費者的方式的轉變。因此，我認為事實很清楚，PBM 行業，特別是 CVS Caremark 創造了巨大的價值。

I think once the actual empirical evidence is there and actually begins to get passed into those that are I actually got the legislative branch and ultimately, those are those that are actually writing about this industry that the numbers speak for itself.

我認為，一旦實際的經驗證據出現，並且實際上開始傳遞給那些我實際上得到立法部門的人，最終，那些真正在寫關於這個行業的人，數字是不言而喻的。

And I just want to emphasize on the point David made. We are leading the industry and changing the way pricing is done on both at the retail counter and CVS Caremark. And I think that we set the standard first care innovations. And I think that's an important part to changing the dialogue and a landscape in this business.

我只想強調大衛提出的觀點。我們引領業界並改變零售櫃檯和 CVS Caremark 的定價方式。我認為我們設定了急救創新的標準。我認為這是改變這個行業的對話和格局的重要組成部分。

Brian Tanquilut, Jefferies.

布萊恩·坦奎魯特，傑弗里斯。

Thank you. Tom, maybe because as I think about the revised guidance, obviously adjust that at a few times already. So how would you give investors confidence that this is the right number at this point that you've baked enough Tread and prudent conservatism? And maybe any color you could share what bucket inpatient you saw the trend uptick in July? Thanks.

謝謝。湯姆，也許是因為當我考慮修訂後的指導方針時，顯然已經調整了幾次。那麼，你如何讓投資者相信這是正確的數字，表明你已經烘焙了足夠的 Tread 和謹慎的保守主義呢？也許您可以分享一下您在 7 月看到哪種趨勢上升的住院病人的顏色？謝謝。

Sure, Brian, thanks for the question. So maybe just let me just take a step back and just talk about the quarter because I think as you look at the quarter, it looks stronger than I think it is. We had $150 million worth of prior year reserve development, strong prior period reserve development off the first quarter, particularly as claims normalized after the change of the change cyber attack we had revenue pick up in Medicare, we had some positive settlement. Going the other way, we had to increase the risk and risk adjustments payable. But there's more positive than negatives as you look the quarter which I think I got us to there which I think got us to the printed result inside the quarter, but really masked some underlying pressure.

當然，布萊恩，謝謝你的提問。因此，也許讓我退後一步，談談這個季度，因為我認為，當你看到這個季度時，它看起來比我想像的要強。我們去年的準備金開發價值為 1.5 億美元，第一季前期準備金開發強勁，特別是在網路攻擊變更後索賠正常化，我們的醫療保險收入有所回升，我們達成了一些積極的和解。另一方面，我們不得不增加應付的風險和風險調整。但當你看看這個季度時，積極的一面多於消極的一面，我認為我讓我們達到了這個季度的結果，但實際上掩蓋了一些潛在的壓力。

And so we took the opportunity to really step back and reevaluate what we saw in the second quarter and really over the whole first half now that we have a more complete period and really tried to pull that forward into the remainder of the year. So if you look at the last five years at the very highest level, you say the MDR tends to tick up in the back half, how much of that pickup?

因此，我們藉此機會真正退後一步，重新評估我們在第二季度以及整個上半年所看到的情況，因為我們有一個更完整的時期，並且確實試圖將其推進到今年剩餘時間。因此，如果你以最高水準來看過去五年，你會說 MDR 往往會在後半段上升，上升幅度又是多少？

And so while for printed first half, you tend to see four out of the last five years, the one exception being 2020, when COVID really masked the underlying trends, you see 150 basis points of pickup in the MBR in the back half in deterioration it goes up the MBR and at the midpoint, that's exactly where this guidance is right that at the very highest level, I hope that that should give investors some confidence.

因此，就印刷版上半年而言，您往往會看到過去五年中的四年，唯一的例外是2020 年，當時新冠疫情確實掩蓋了潛在趨勢，您會看到下半年MBR 回升150 個基點，情況惡化MBR 上升，在中點，這正是該指導的正確之處，在最高水平上，我希望這應該給投資者一些信心。

Then as you look at the specific risks, what we've done is we've taken the presumption that the trends in Medicare that we've seen throughout the first half that they will persist throughout the remainder of the year and that they could modestly increase.

然後，當你考慮具體風險時，我們所做的就是假設我們在上半年看到的醫療保險趨勢將在今年剩餘時間內持續存在，並且可能會適度地持續下去。

As we noted, the first quarter did restate positively, but we continue to see elevated medical cost trends in the second quarter. And we did have some indications of the pressure in July. We don't believe is that, is an increase in to midnight, is this just we've seen broad-based inpatient pressures. And so the range of outcomes for the remainder of the year on the Aetna business is primarily driven by a very early read on an uptick in a long July.

正如我們所指出的，第一季確實重申了積極的態度，但我們繼續看到第二季醫療成本的上升趨勢。我們確實在 7 月看到了一些壓力的跡象。我們不認為午夜的增加只是我們所看到的廣泛的住院壓力。因此，Aetna 業務今年剩餘時間的業績範圍主要是由早期對漫長 7 月業務成長的預期所推動的。

And so that's part of the reason for the ranges to try to incorporate what some of that variability is off a early indicator. In our exchange business or outlook incorporates the potential for additional risks over the remainder of the year, particularly if we're not successful in maintaining or risk adjustment trajectory on the 2024 block.

因此，這就是範圍試圖納入早期指標之外的一些變化的部分原因。在我們的交易所業務或展望中，考慮到了今年剩餘時間內可能出現的額外風險，特別是如果我們未能成功維持或調整 2024 年區塊的風險軌跡。

And lastly, we incorporated the risk that the dislocation between that acute acuity and rates that pressured us inside the quarter persist throughout the remainder of the year. So maybe the easiest way to think about it is at the low end of that range, the AOI range for our health care benefits, the risks are probably all roughly equivalent in magnitude and the primary and they're really the primary drivers of the change in outlook.

最後，我們考慮了這樣的風險：本季內給我們帶來壓力的敏銳度與利率之間的錯位在今年剩餘時間內持續存在。因此，也許最簡單的思考方式是在該範圍的低端，即我們的醫療保健福利的 AOI 範圍，風險的大小可能大致相同，而且主要風險實際上是變化的主要驅動因素在展望中。

We think that we've captured it. But we're obviously watching the data very closely, but we tried to incorporate as much prudence into the outlook as we thought we knew it was appropriate.

我們認為我們已經抓住了它。但顯然我們正在非常密切地關注數據，但我們試圖在前景中加入我們認為適當的謹慎態度。

Thank you for joining our call today. I want to take the opportunity to thank all of our colleagues for their continued contributions, and I'm working to improve all the health of people that we serve. Thank you.

感謝您今天加入我們的電話會議。我想藉此機會感謝所有同事的持續貢獻，我正在努力改善我們所服務的人們的健康。謝謝。

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

今天的電話會議到此結束。非常感謝您的出席。現在您可以斷開線路。