Hi, everybody. I'm A.J. Rice, the Healthcare Services Analyst at Credit Suisse. Thank you for joining us at our conference. We're particularly pleased to have up next The Cigna Group. We've got Brian Evanko, Chief Financial Officer, and Alexis Jones, Head of Investor Relations at The Cigna Group. As you've seen, if you've been in other of the presentations, the way that someone can ask a question would be to email me a question. If you want to do that, I say that up front because by the time we get to the end of the presentation, it may be tough. aj.rice@credit-suisse.com. I'll give that now. Thank you guys for participating again this year. Brian, I know you guys just reported the third quarter results. I don't know if there were a couple of quick takeaways you wanted to offer. Then we'll jump right into questions. Thanks, A.J. And good morning, everybody. I appreciate you joining our session here. Just a quick summary of the headlines from our third quarter results, which we reported on Thursday. For one, we exceeded our expectation across the company for earnings in the quarter. We were certainly very pleased with that, demonstrating continued strength in our Evernorth business, which is the health services platform, inclusive of our Express Scripts PBM, our Accredo Specialty Pharmacy, as well as a variety of other health services capabilities. We exceeded expectations in the U.S. Medical segment as well. We had some non-recurring benefits in the quarter from net investment income in the U.S. Medical segment, which helped to offset a little bit of pressure that we had in the medical care ratio in the quarter from the individual exchange special enrollment period lives, as well as the impact of the Delta variant on our commercial employer book of business. Overall, the strong performance in the quarter gave us the confidence to increase our full-year earnings per share outlook up to at least $20.35. The prior was $20.20. We had a $0.15 raise on the full-year outlook. We also raised our revenue outlook for the full year to at least $172 billion, representing 11% year-on-year growth when you adjust for the divestiture of our group disability and life business in 2020. When you look forward in 2022, we provided an early indication that we're expecting at least 10% earnings per share growth off the all-in elevated performance of $20.35 here in 2021. We expect that 10%+ earnings per share growth to be comprised of approximately 5% - 6% of income growth and 4% - 5% of accretive capital deployment. 10% -13% earnings per share growth is our long-term growth rate range. This will be two years in a row that we achieve that following the 2021 performance of at least 10% as well. We're also committed to continuing to pay a meaningful dividend, which is currently yielding close to 2%. With that, A.J., I won't take any more time here on the intro. I'll let you direct the conversation to wherever you might want to go. OK. Some of these will be granular and some will be high level. In the second quarter conference call, the company had identified a COVID headwind of about $2.50 in EPS that Cigna was absorbing this year. On the third quarter call, the company said it no longer wanted to break out that net COVID headwind. That was sort of a helpful thing for people to have. Why would you decide to move away from talking about that specifically? Yeah, I realize the specificity there was helpful to some in terms of triangulating our performance. As the pandemic has continued to unfold and we're about to step into year three of the COVID pandemic, we realized that this was not going to be a transitory event in the sense that if you rewind the clock to February 2020, I think many of us hoped that it would be a 2020 phenomenon and then we'd be on with normal life. It has become clear that that's not the case and that we will now have to live with COVID for at least a certain period of time going forward. With respect to overall business, we've found that COVID's become increasingly intertwined with just the way we run the business. There were more and more situations where trying to ascribe it to COVID versus something else became very difficult. For example, I made reference earlier to the special enrollment period customers that we have in the individual exchange book. They created some pressure in our medical care ratio in the third quarter. I would assert that's associated with a regulatory change, not necessarily a COVID headwind. We were having debates internally as to the scorekeeping of matters like that. It became clear that not only was this not how we run our business, but to some degree, we were creating an artificial metric. We thought it was more instructive moving forward to incorporate it into the way we talk about the business in totality. We'll talk about all-in medical costs. We'll talk about the all-in performance of U.S. medical and the all-in performance of the company. Going forward, we'll not specifically size that. Importantly, we'll talk about our margin profile. We expect in 2022 to expand our profit margins in U.S. medical off where we were in 2021. You can think of that as a recovery of what we would have talked about before of a portion of that COVID headwind. That comes through the form of pricing actions, affordability actions, and to some degree, a reversal of some of the pressures that we experienced in 2021. That's a little bit more of the rationale for why we moved away from that. Again, going forward, we like the income growth opportunity and the margin expansion opportunities that are in front of us for U.S. medical. OK. No, that's helpful. When you think about, you mentioned two things that were responsible for the medical loss ratio, medical care ratio, being where it was at, the extended SEP, which seems like for everybody sort of calling that out that has any meaningful exposure to the exchanges. You also had the increased COVID costs associated with the surge. I guess coming out of the second quarter, you were starting to see the beginnings maybe when you reported at least of the surge. Was most of the, to the extent there was variance, was it mostly around that individual exchange? Did the COVID surge end up being significantly higher than you thought it would be as well? Yeah, you're right about the two sources of pressure in the quarter for us. The individual special enrollment period lives, which built up over the course of 2021, showed a significantly elevated MCR in the third quarter. Separate and distinct from that, though, is the pressure we saw from the Delta variant, which was more pronounced in our commercial employer book of business and more pronounced in the months of August and September. July was a little bit of a lighter month. August and September were a little bit heavier months. That created a bit of the uptrend in the MCR in the quarter. We were also really pleased with the ability through the diversification of the overall franchise to be able to beat our overall earnings expectations and raise the full-year outlook despite some of those pressures in the MCR in the third quarter. Cigna doesn't have a lot of exposure, it doesn't really have any with the divestiture of Texas, to Medicaid, but in Medicare and then the different books that you're involved in in commercial. Is just predicting the fallout of the COVID surge a little tougher in commercial because you got a lower vaccination rate, but you still have people that probably are less likely to defer than maybe you see in the MA? As you see these surges play out, is that one way to think about commercial versus, say, Medicare Advantage or even Medicaid, if you had any view on that? Yeah, you're right about our limited presence in Medicaid and the health plan space. Given our pending divestiture of Texas, we won't really have any presence in the health plan space post that. We do have a sizable amount of service-based business through Evernorth where we serve Medicaid lives through our Express Scripts PBM, through the eviCore medical benefit management chassis, and other parts of Evernorth. We do have some insight as to what the overall industry is seeing from a Medicaid standpoint as well as a Medicare and commercial standpoint. Overall, as you compare those different books of business, our commercial employer book has shown the least amount of care deferral throughout the pandemic. Even when there have been waves of COVID intensity, the amount of care deferral has been lesser on the commercial employer book than it has been on the Medicare book. It's been heavier on Medicare for sure. In this most recent wave of COVID, the Delta variant did hit the commercial employer book a little bit harder because it tended to get to younger ages more so than the earlier waves, which were more pronounced in the older ages. We had a little bit of a double whammy in the third quarter with the Delta variant hitting our commercial book and not having as much of an offset from care deferral. I think directionally, I agree with your comments where the care deferral has been the smallest in commercial, greater in Medicare. The data we do have would suggest there's been a meaningful amount of care deferral in Medicaid, again, through our service chassis, looking at the industry. OK. As you think about 2022, as you said, you stated you can grow 10% off the base. I think when you were talking last quarter about this $2.50, it seemed like you were not assuming that the risk coding headwind pretty much reversed next year. You picked that up in the Medicare Advantage book. It seemed like you were at least implicitly assuming there was a fair amount of net COVID direct and indirect costs that you were carrying. How would you describe that as you're now thinking about it coming out of the third quarter, looking at next year? Do you have an assumption of a fair amount of embedded COVID costs next year in that guidance toward the 10%, do you think? Yeah, let me try to unpack it a little bit because I realize this is a reconciliation challenge for maybe what we said last quarter overall. As you think about our 2021 results in totality, think of there being four discrete pieces that offset one another. Two of them were favorable in 2021, and two of them were unfavorable. The favorable items that benefited us that are non-recurring in nature are the non-recurring investment income, as well as the expense-oriented or SG&A benefits that we had in 2021. Those two things were favorable contributions to our all-in 2021 performance. We view there being two non-recurring unfavorable items in there as well, one being the Medicare Advantage risk adjuster headwind that you made reference to, and secondarily, an element of the overall COVID pressure, which we expect to unwind in 2022. Those four pieces you can think of as largely offsetting. Therefore, for 2021, we're getting back to our base of $20.35 through those four things offsetting. As we step into 2022, we're expecting income growth of 5% - 6% all-in for the franchise. That will be comprised of income growth from Evernorth as well as income growth from U.S. Medical. A portion of that income growth from U.S. Medical will be margin expansion that we expect to come through the form of an improved MCR as we both price business for where we think it needs to be across commercial, Medicare Advantage, the individual exchanges, as well as continue to invest in affordability initiatives. That's how I would encourage you to think about the 2022 outlook relative to 2021. We do expect there will continue to be COVID costs in 2022. All-in, we expect there to be testing and treatment costs associated with COVID in 2022. We expect non-COVID utilization to be near the baseline, if you will, of what we talked about historically. All-in, we would expect the total cost picture to be slightly above the baseline in 2022. That's embedded in our outlook in the 5% - 6% income growth and the 10% + EPS growth that I made reference to. OK. There are a couple of things in that I'd like to follow up on. One is, I mean, we're just trying always to say, OK, this is where they were a quarter or two ago, and this is where they are today. I understand the framing of these two factors or the headwinds. These are the tailwinds, and they largely offset each other. Would you have said that a quarter ago as well? Has there been an evolution in the last three months as you sort of seen everything play out the way it is? Is that pretty consistent with the way you would have described it if you were using that framework last quarter? I think three months have elapsed. We have more visibility into the 2022 operating environment, as well as we now have a greater proportion of our business essentially locked down from a revenue standpoint. For those reasons, we have more visibility into the income outlook and the growth outlook today than we did three months ago. I think that's an important point of departure. I talked about, I believe, on the second quarter call, at that point, we still had close to 2/3 of our commercial book to be priced in 2022. Right now, we only have about a quarter of the commercial book still open as it relates to the 2022 picture. We've got a much clearer picture as to the revenue implication of that book of business, not to mention the Medicare Advantage and the individual book, of course, get priced over the summer through the bid process. I would characterize it as greater visibility and across not only U.S. Medical, but also high confidence in growing the Evernorth platform from both the top and bottom line standpoint in 2022. When you talk about the percentage coming from the operating side versus the capital deployment side, is there a way to talk about building blocks to get to that 5% - 6% contribution? Is that Evernorth will get us this far of the different aspects of the medical business this far? Is there any way to piece that together to get to the building blocks of 5% - 6%? We're not ready yet to give segment-level guidance. That was a good way to poke at it. I appreciate that. I think in the fourth quarter, we'll certainly do that and outline all the different pieces. As I was saying earlier, we do expect income growth in both Evernorth and U.S. Medical, and we expect margin expansion in U.S. Medical, given we view 2021 as being a depressed year relative to our long-term targets. That's as specific as we'll be at this juncture. Let me try one other thing. If it's premature, that's fine. We talk a lot about the headwinds and tailwinds, and you've given these inputs broadly in the business. The Evernorth business itself, a lot of us talk about headwinds and tailwinds related to medical more so than Evernorth. What would the headwinds and tailwinds for Evernorth or the Pharmacy Benefit Management specifically, since that's a big part of it, be as you think about 2022? Are there things that happened this year that won't happen next year that we should remember? Are there new opportunities next year that may help the trajectory in some way or another? Yeah, the Evernorth business in totality is performing really well. We're extremely pleased with the performance here in 2021. Our income guide is for at least 8% growth off of 2020, and the top line will also grow at a very high rate relative to our longer-term expectation. As we talked about in our Investor Day earlier this year, we expect 4% -6% growth in both the revenue and the income line for Evernorth. 2021 was a year that will surpass that target for both the top and the bottom line. We're really pleased with the momentum we have stepping into 2022. I'm sure you're familiar with our Prime Therapeutics partnership that launched in 2020. We have one final wave of implementations that will hit for 1/1/2022. That gives us another push from the standpoint of tailwinds. We've got some new client wins, some in the health plan space, some in the employer space relative to our Pharmacy Benefit Management, which we're happy about. We've talked about in the past now for several months, we have two known health plan losses, which push a bit in the other direction. That's more of a revenue headwind than an income headwind as you think about 2022. On top of those things, we will continue to invest in the business strategically as we continue to diversify Evernorth over time. While today the scaled assets are the Pharmacy Benefit Management, the Specialty Pharmacy, and the mail order capability, over time, you will see more scaled businesses along the lines of care solutions as we think about virtual care, home care, behavioral health. You'll see more scaled assets in the intelligence vertical as we think about data and analytics, both as a service externally and for internal consumption, and more in the way of benefits management services if you think about our eviCore chassis. We're making strategic investments to continue to diversify and generate additional opportunities for both external and internal consumption as well, which will place a little bit of a headwind into the income picture. Overall, all-in, we will grow both the revenue and the income for Evernorth in 2022. OK. I'd like to come back to Evernorth in a minute. One of the things, late last week, we had this Pfizer announcement that they had some positive data on a potential treatment for COVID. Stocks were moving in our space all over the place on that potential news. It sort of begs the question if whether that drug or another drug were to come along and just wipe out COVID on January 1st of next year, so it was no longer in the picture. There are some aspects of COVID that have been problematic for you, created some other opportunities. Would that make you more optimistic about your 2022 outlook? Would that make you less optimistic or about the same if it were just to go away on January 1st of 2022? I think that's a scenario we all hope for, for sure. Whether it's the antivirals or even some of the more recent news about Regeneron's cocktail potentially working out there, I think those are items that could help from the standpoint of our health plan business, given that the average cost of hospitalization continues to be, call it $20,000 for a Medicare beneficiary, $40,000 for a commercial beneficiary who's hospitalized with COVID. If we're able to pay for an antiviral that's hundreds of dollars to defray something that's tens of thousands of dollars, that should be very helpful from the standpoint of our health plan performance. As we talked about earlier, we expect in 2022 that all-in costs will run above where our typical baseline would have been. In the absence of COVID, our pricing should be a little bit too high if that were the case. You should see a little bit of a tailwind if that scenario unfolded, A.J. However, we're not banking on that by any means. Sure. Clearly, there's some optimism to be had there. Through the Evernorth chassis, obviously, where we do quite a bit of drug procurement, it opens up some doors for us there as well to serve our health plan and employer and government clients in a different way through finding ways to prefer different drugs and drive competition. There's certainly some exciting things there to unpack. I think more dust needs to settle in terms of the viability of that hitting the market. Yeah, no, I think it just sometimes seems like there's a little bit of uncertainty, whether it's a net positive, net negative, to take this out for different subsectors. I think it's just interesting to say, what if it did happen that it was gone? What would it mean? We talked about the operating side of the 10% growth. There's the capital deployment side of 4% - 5%. You guys that you expect to help you next year, you're on track to buy about $7 billion of stock this year. What is the embedded assumption roughly behind that 4% - 5%? I'm sure you get the full-year benefit of all the buyout activity you've done this year. You have an asset sale that you said you'll use a bunch of that proceeds to buy back additional stock, and then you have your ongoing buyback program. Can you give us a flavor for how much of any of that is driving the 4% - 5% and how much incremental upside there might be from some of those other things or how much they're not reflected in this at least? Sure. Let me unpack the picture a little further on this one. Just to be clear, what we've talked about relative to 2022 is the company as it exists today prior to divestitures. I think that'll be part two of this part of the conversation as we unpack the impact of the pending international divestitures on capital deployment. In 2021, when you include the accelerated stock repurchase program that we put in place in August, we'll have repurchased about $6.3 billion of shares this year. That number, in addition to the dividends that we'll pay, so we have a quarterly dividend now of $1 per share, will yield in total, the total picture in there will get you to about $7.6 billion of deployment between repurchase and share dividends this year. That's to date. There could be more repurchase late in the year. We haven't yet factored all that in. As it relates to 2022, the 4% - 5% of capital deployment is reflective of a combination of expected repurchase and also strategic M&A. Over time, we would expect there to be about a 50/50 split between repurchase and M&A. In any given year, that will flex. This year in 2021, we've clearly done a lot more repurchase. MDLIVE has really been the only substantive acquisition we've done in 2021. Any other year, it could flex depending on the specific circumstances. The 4% to 5% of accretive capital deployment is reflective of either repurchase or strategic M&A that we expect to do in 2022 off the free cash flow that we'll generate in the year. If you step back and contemplate the international divestitures, as we said in the press release when we announced them back in October, we're expecting the majority of those proceeds to be used for share repurchase. That is what's driving the expectation of it being neutral to slightly dilutive to our 2022 outlook. We'll have a moment in 2022 where we cut over guide on a new basis. As a result of that, you should expect a greater contribution from capital deployment in 2022, assuming that the transaction closes at some point during the year because those proceeds will be used likely for repurchase in the 2022 calendar year. Hopefully, that helps to bifurcate the before the divestitures and the following the divestitures impact. Is there an assumption that the buyback activity, apart from the divestitures, is similar next year to what we've seen this year? The 4% - 5% of accretive capital deployment, again, we have an assumption of what the repurchase economics look like. There's also the equivalent on the M&A side where we'd say we would expect it not to be worse, making a move on the M&A side versus repurchase. That's sort of the frame of reference. OK. I think if you do the math on the $6.3 billion, it would be greater than 4% - 5%. Right. Kind of think of it in that context. It's a small assumption, but when you include the impact of the divestitures, it starts to become a greater contribution again to 2022. You laid out, I think in the second quarter call, you guys reiterated what your priorities for M&A are. Maybe just worth reiterating those. As you wind through the pandemic, are you more optimistic that you'll see something out there? Are there more discussions going on behind the scenes? Is it about the same? How would you describe it? We continue to be active looking for opportunities to advance our strategy. As always, we view M&A as an accelerant of our path forward and an important lever to pull. The four areas we talked about earlier in the year continue to be the same four that guide our actions today. These can broadly be teed up as expansion of Evernorth services, presence in the U.S. government space, and international health care. You can broadly think of it in those three categories. The four specific areas that we look at are, for one, care coordination and alternate site of care capabilities. You can think of this as Evernorth services, broadly speaking. MDLIVE is a good example of this. One of the megatrends we expect to continue for the next decade plus is more and more care moving to optimal sites, virtual care, home-based care, and helping individuals get to the right site of care from a cost and quality standpoint. Alternate sites of care coordination would be one area. The second one being U.S. government programs and services. You can think of this both through the Evernorth chassis, but also through the health plan chassis of U.S. Medical. When we say government, we're talking Medicare Advantage, individual exchange, and also Medicaid if the circumstances were right. The third area is intelligence and technology capabilities. Thinking about the Evernorth health services chassis, the importance of interoperability between providers, payers, customers, and the technology that underlies that, as well as customer-facing and provider-facing technological solutions, in the health services domain beyond pharmacy. Finally, international health care capabilities. While we divested a portion of our international markets operations, those operations were supplemental-oriented products or had more of a life insurance feel to them. International health care continues to be an area of great interest for us to continue to grow in the future. Those are the four specific priority areas for our M&A efforts. You mentioned Medicaid. You've obviously, you're divesting the Texas asset, which doesn't leave you with anything at this point. Can we assume that moving forward, if you were to move forward in Medicaid, it'd probably be an inorganic situation as opposed to you trying to pursue RFPs individually from here? What is the company's current thinking on Medicaid? Yeah, as I made reference to earlier, within Evernorth, we serve millions of Medicaid lives today through the services chassis with PBM relationships, as well as eviCore and PA services that we provide there. Health plan side, you're right. After the Texas divestiture, we'll have basically no presence. We view that as an if, not a when. We don't feel the need to be in the Medicaid health plan space to accomplish our long-term objectives of 6% to 8% revenue and earnings growth on average per year and the 10% - 13% EPS commitment that we've discussed many times. We don't feel the need to be there. If we do, then we'd concur with your comments in terms of we would likely make an inorganic move if we were to step into the Medicaid health plan space. We don't believe that we have a right to win on an organic basis, going out bidding one state at a time on Medicaid contracts. If we were to step into that space, it likely would be inorganic. Right. When you think about your comments about the individual exchanges, the marketplace, and so forth, as I said earlier, it's been a tough year for a lot of people because of the extended SEP and the way that's played out with some potential adverse selection. You said you priced for margin, and therefore, you're expecting potentially some attrition in the enrollment there next year. I know you've stated before a target margin sort of in the mid-single digits, I think 4% - 6%. Do you think you could get back to that next year? Your comments about enrollment, do you have a view on the entire market? Do you think, I think we picked up about 2 million people in the special enrollment. Do you believe a lot of those people won't sign up for a traditional plan during the regular open enrollment this year? Do you think we'll see some attrition in the aggregate size of the market? Yeah, on the individual exchange market overall, we start by seeing a societal need for that market to be successful. That's one of the reasons we've been participating even from the very beginning of the exchanges back in 2014. We've gotten a lot of learnings over the 7+ years that we've been in the space. For individuals who don't have access to an employer-sponsored plan or a government plan through Medicare and Medicaid, we think the individual market being healthy and sustainable is extremely important. After the early years of the exchanges, the markets stabilized. The margins were there. We're getting into a bit of a different cycle right now. The special enrollment period lives contributed to that. We're also seeing some pricing that we think is a bit aggressive in certain geographies from some competitors in 2022. We think we're likely in a different cycle right now as it relates to the individual exchange business. However, our expectation is we will be able to achieve 4% - 6% margins over the longer term in this business. In 2021, I think I mentioned in our release last week or on our call, our open enrollment business is performing well on the individual exchanges. The special enrollment period business, due to the extended window, is where we've seen the poor performance. To your question on how we think about 2022, for Cigna, as we look at how our offerings stack up from a price standpoint, geography to geography, we think we're likely to have some pressure on our enrollment compared to where we're likely to end in 2021. To your question on the industry, our expectation would be flat to maybe a little bit of pressure in 2022, given the attrition dynamics that we would anticipate. Many of the individuals that enrolled this year were previously uninsured. Even though they were eligible for tax credits, there was an awareness issue. Inertia could potentially drive some folks out when they realized what their premiums could do in the absence of a change. We think there could be some level of pressure on enrollment in aggregate in 2022 for the industry. For us specifically, we think there's likely to be a year of flat to a decline in enrollment. OK. I'm jumping around a little bit here. With the Medicare Advantage enrollment, you're up year to date, I think 8.4%. You did expand geographies and product offerings this year. Do you think it takes a couple of years of that before you see the benefits? Does that bode well for enrollment growth next year in Medicare Advantage? How would you describe what kind of trajectory you're on, you think, in the Medicare Advantage enrollment side? Yeah, so for Medicare Advantage, we continue to be really bullish, not only on the industry growth, but also on Cigna's role there. We continue to believe that we not only have a right to win with our existing commercial employer and individual exchange customers as they age in, but in the general market as seniors move more and more to a Medicare Advantage from a traditional Medicare offering. For all those reasons, we're very excited about this market. We've committed to a long-term growth of 10%- 15% per year on average. 2020 was the first year of that journey. We grew 18% - 19% last year. This year, we're obviously going to be a little bit lower than that, given the stat you quoted year to date in terms of enrollment. On balance, we would expect to be 10%- 15% per year in terms of our growth. Next year, we'll step into 108 new counties. We'll also introduce individual PPOs in about 150 counties that we already have a presence in. We're expanding both the geographic footprint and the product footprint. There's not necessarily a rule of thumb in terms of how many years it takes before we get to a mature point in a new geography. A.J., we do have some examples of it taking 2-3 years before we get to our kind of final destination market share. It's tough to generalize that. We've had other geographies where we've stepped in in year one and had good success. I wouldn't necessarily generalize that. As we look at the 2022 competitive landscape, overall, the pricing, the benefits look reasonably rational across the geographic footprint that we participate in. There are pockets of greater intensity, but I'd say reasonably rational overall. We continue to really like this space and are optimistic about the future for MA. OK. I did have an email question come in here. I guess it relates to all the discussion about changes in maybe Part D and even the commercial market and the PBM world. It says, could the company remind us how much in rebates are retained by Express Scripts/Evernorth now? I believe the prior disclosure, this was a while back, I think, was about 5% of rebates were retained. Any update comment on that? Yeah, I think there's a few different ways to measure the performance of rebates and the different mechanisms we have. Importantly, I just would remind everybody that our Evernorth business is built to have a lot of different value creation levers and a lot of different value capture levers. We're not single-threaded on rebates. We're not single-threaded on spread pricing. We're not single-threaded on fee-based relationships. We have a variety of different mechanisms to create value for clients and customers and let them essentially guide the relationship they want to have with us and with Evernorth. The statistic I think that's made reference to there was specifically what percentage, if you look at the total dollars of rebates, how many are retained by the company versus not. We haven't disclosed that since the time that we initially provided that estimate, which was a few years ago now. The overall composition hasn't changed materially if you look at the business today compared to then. I would note, though, we have a much higher percentage of our client relationships that are in full pass-through rebate situations today than we did 3-4 years ago. The proportion now is well in excess of 75% of our clients who are in full pass-through rebate situations. Importantly, the economics of that part of the company are not single-threaded to rebates by any means. We're well prepared to adjust the economic model as needed if regulations change or client preferences change. OK. Maybe just to stick on that, I had the question. I think you guys have described for 2022 about a mid-90% retention rate. That sounds pretty consistent with what you would have said the last few years. When you think about things like drug spend under management, covered lives, et c, do you think it'll be up next year, sort of consistent next year? How would you describe it versus with that mid-single digit retention, I mean, mid-90% retention rate? A few thoughts here. The mid-90% retention rate is specifically on scripts, and it's a measure of the 2021 book versus the retained scripts for 2022. It does not include new business. OK. That I had made reference to earlier. We have new client wins as well. Importantly, the script count is a very specific measure of the PBM. It does not necessarily give you a picture of what's happening in the Specialty Pharmacy, given specialty script counts are so low. Nor does it give you a picture of what's happening in the other parts of Evernorth in care solutions, in intelligence, and benefits management. All in, as I said earlier, we expect to grow revenue and income in Evernorth. We would expect strength in specialty in particular as we step into 2022. While that script metric is mid-90s, that should not imply to anybody that we're going to have a reduction in the business in aggregate because, again, we'll grow the top and the bottom line for Evernorth in 2022. I don't know whether you guys have disclosed this before, but how big is the specialty business in the context of the whole PBM or Evernorth or whatever? Because obviously, that seems like that's a pretty strong growth driver. We have not supplied consistent data on this. During our Investor Day, we described specialty being about a third of Evernorth's revenue today, and it's been growing at a double-digit clip. This is an area we've had a top-two market position for many years. We're also really excited about biosimilars and specialty generics continuing to drive affordability while also giving us the opportunity to create margin. That's an important part of the company. We'll look for further opportunities to provide additional disclosures in the future on that. A really strong part of Evernorth that we're excited about continued growth in. I'm just a final thing to wrap up on. You were talking on the third quarter call about the virtual-first offering. We're hearing more and more about that. Maybe I'm assuming that's leveraging off of MDLIVE, an acquisition you made over the last year or so. Can you tell us a little bit about where you're targeting that, what the opportunity is there? Do you have a sense of the demographics of the takeup or how fast the takeup might be? Yeah, the virtual-first offering, which we just announced a week or so ago, we're going to start with self-funded clients. Just given filing requirements that are associated with our fully insured businesses, it's a little bit easier for us to get out into the market quickly with our self-funded clients. That'll be available 1/1/2022 for our larger self-funded clients who are interested in such an offering. This is not meant to be exclusionary either. While it's a virtual-first offering, traditional supply from the standpoint of bricks and mortar physicians, of course, will be in our network as well. It's a $0 copay plan for individuals who leverage an MDLIVE primary care physician. We believe this is just an example of where the market is heading over time. Coming back to the notion of site of care optimization, there are still too many procedures that are occurring in higher cost settings than they need to be. There are a number of consults that we believe can be virtualized with the same exact clinical quality at a lower cost. We're starting with primary care. Over time, we think that'll move into more complex care, which was the rationale for the MDLIVE acquisition. The rationale for the MDLIVE acquisition was not urgent care or transactional care. It was to build for more complex care being virtualized in the future. This is a step one toward where we see the market going. Early interest has been strong with the few employer clients who have engaged with us on this. We expect there to be continued momentum as we step into 2022. Interesting. OK, great. Brian and Alexis, thanks so much. Thanks to The Cigna Group for participating once again in our conference. Hopefully, next year, we'll be doing this live. Take care, and thanks again. Thank you, A.J. Thank you.