Healthcare service companies. This year, we're doing something where we're kind of focusing in on differentiating areas of operations within companies and some attention to our Disruptor Conference, which will be tomorrow. We're focused on the disruptive companies on the private side. And so we're really excited to have Cigna provide us the opportunity to talk about one of the most disruptive trends that's out there, which is obviously driven specialty drugs shift to more pharma spend as well as the medical spend. And Matt is the head of, you know, more than just specialty pharmacy, but specialty and care services with us today. So what I want to do is kick things off. Again, I've got a list of questions, we're going to try to fit it all in. But first, Matt, welcome. Maybe if you just take a minute and introduce yourself, give a little background for folks and also just a little bit of responsibilities so I understand, you know, the types of questions you're really talking about. Yeah, happy to, and thanks for having me today. So, Matt Perlberg, I lead Pharmacy and Care Delivery for Evernorth Health Services, as part of the Cigna Group. I've been with the company for about eleven years now, and I've been in this role for about, and yeah, so we're excited to be talking with you today about specialty. It's an exciting area, as you mentioned, a lot of growth, and we have a leadership position, so excited to talk with you about it. Yeah, great. Well, we're going to go through a series of questions, just make sure we're diving into Accredo, CuraScript, you know, some of the really meaty questions here. And so let's just talk now, talk a little bit about the range of businesses. I know David's been on the road a little bit and has been talking, really promoting this area in Investor Day. There's a lot of promotion on the magnitude of the opportunity here with, if you can just maybe parse for us and give us the framework that you think of, how do you temper the scope of responsibilities you've got and, you know, the differentiation between Accredo and CuraScript and anything else that you think is relevant to frame? Sure. So maybe stepping back a little bit, if you think about the Cigna Group overall, we have about 40% of our businesses are U.S. employer-based. There's another 30% or so that's pharmacy benefit services, and then there's 30%, which is specialty and care services, the vast majority of that is specialty. Specialty drugs are those that are used to treat patients with complex conditions. Very often these are infused or injectable medications. They'll typically have strict storage and handling requirements. And the pharmacies that treat patients do a lot more than just dispense. We provide highly specialized patient care. Specialty drugs, as you mentioned, can also often be quite costly. Many specialty drugs can cost hundreds of thousands or even millions of dollars per patient. So within that specialty space, we have a number of different ways in which we compete. We have our leading specialty pharmacy, Accredo. Accredo treats over 1 million patients with over 7 million specialty prescriptions annually. We have our specialty distributor, CuraScript. CuraScript serves over 12,000 healthcare providers and distributes complex medications to those providers. Then we have a collaboration with a company called Carepath Rx. CarePath serves over 700 hospitals, health systems, and their providers, and provides specialty pharmacy and infusion services on their behalf. So we have about the scope of opportunity. If I step back a little bit, within healthcare today, about 25% of the total cost of care comes from pharmaceuticals. We expect that to go to about 40% within the next decade. That is very much driven by a wave of complex drug innovation. So just a data point on that. Last year, over 70% of the drugs that were approved by the FDA were specialty drugs, and we expect that growth to continue, and that creates challenges for a lot of the different stakeholders in the ecosystem, so within our businesses, we serve employers, we serve health plans, we serve governmental entities, we serve healthcare providers. Most importantly, of course, we serve patients. And all of those stakeholders have challenges when you think about that growth, so if you're a patient, you're trying to get the care that you need and access to these medications. You need help navigating that healthcare journey. If you're an employer or a plan sponsor, you're trying to figure out how do you provide access to those medications in a cost-efficient way. If you're a manufacturer, you're trying to figure out how do you make sure that patients get the care that they need, so that the drugs work as intended. We sit fundamentally at the intersection of all of those stakeholder needs. So our vision in this space is to extend and expand our leadership, and we do that through clinical specialization. We do it through a scaled operating model, we do it with a comprehensive and complementary set of assets and capabilities, and we do it with a culture of innovation at heart. But ultimately, this is a large, fast-growing market, and it's one in which we are the leader in the space. Yeah, that is that's really helpful for, for framing this. Sometimes when you're talking, you, well, Cigna Group, he's talking about some of the areas of opportunities. You'll point to a couple of the areas, and maybe if I can just better understand where those would reside, if those are Accredo or if those are more naturally you know, some other sister organization as well. So rare and orphan drugs, is that like a condition, like a TRC within Accredo, or is that something that would be kind of in parallel to all? Yeah, so maybe just to kind of frame that a little bit. So if we think about the specialty drug market overall, it's a $400 billion market growing in the high single digits today. As a point of comparison, you referenced that, that's larger and growing faster than the individual Medicare Advantage system. Within that $400 billion specialty market, you can think of patients as being treated under either their pharmacy benefit or their medical benefit. Pharmacy benefit space is about 60% or so of the overall market, and that's gonna be for treatments that are primarily self-injected or treatments in a patient's home. And then the other 40%, the medical benefit space, that's gonna be for treatments that are more in a provider setting. What makes us unique at the Cigna Group is that we compete in that whole market, so Accredo has served about a quarter of the pharmacy benefit space, but Accredo treats patients under both the pharmacy benefit and the medical benefit, and then those other businesses that we referenced, so CuraScript and Carepath, they are largely serving providers, and in some cases, treating patients, and those are disproportionately going to be focused on that provider part of the market, so depending on which part of the market you're talking about, the services might be a little different. What makes us unique is our ability to compete in that entire $400 billion specialty market. Gotcha. A little more into some of the creative aspects in a second, but can you also just paint for us the growth algorithm for the company? I know it's sort of an investor day growth algorithm, so certainly happy and able to do that. The other aspect that is really intriguing to me is, how much of the growth is coming from sort of market growth, and that could be driven by adoption, that could be driven by innovation? How much is coming from, you know, the opportunity for you guys to reduce leakage to, you know, kind of further penetrate maybe the things that are related to the Cigna, other assets, we see pharmacy benefits. And how is going out winning standalone with functions, that sort of an opportunity when you think of this growth? Yeah. So, so stepping back, you, you referenced, that's what we, what we've guided. So specialty and care services overall, we expect 8-12% long-term average annual earnings growth, 8-11% of that coming from specialty. And within that 8-11%, we expect 7-9% of that to come from secular growth, just growth in the industry, that high single digit growth, and then up to 2% share gains because of, of our leadership in the space. And there's a number of different tailwinds that we think about as helping drive that, and one way to maybe help frame that a bit is, you can think of specialty drugs as, as operating on a bit of a spectrum. On one end of the spectrum, some specialty drugs will treat higher prevalence conditions. So think of these as things like rheumatoid arthritis or MS, or Crohn's disease. It's about 50% of our business today. The other 40% is in rare conditions. So think of these things as like hemophilia or pulmonary arterial hypertension, spinal muscular atrophy. That's about 40% or so of our business today. In that first part, the higher prevalence conditions, this is where we'll see the vast majority of biosimilars. We see that as both a near-term opportunity, certainly with Humira, but also a long-term opportunity as we think about even beyond Humira, biosimilars representing an over $100 billion dollar opportunity for the market by the end of the decade. In that rarer space, the other side of the spectrum, that's where we'll see a lot of continued drug innovation. So last year, over half of the drugs that were approved by the FDA had a rare or orphan drug designation. This is where we'll see secular trends like gene therapies. So there are about 20 or so gene and cell therapies currently on the market today, but there are nearly 1,000 more of those drugs in the pipeline, and each and every one of them can cost $hundreds of thousands or millions of thousands per patient. So combination of secular tailwinds, as well as our leadership in space, gives us confidence in that 8-11% specialty growth, 8-12% specialty and care services growth. Yeah. And one of the things just for the benefit of the audience, you know, obviously I've got perspectives on how we look at the PBM market and regulatory risks and things like that. One of the things that I've always firmly believed in, you know, from my background in just dealing with PBMs and things like that, this is the fastest growing component of medical spend. Like, there has to be somebody that manages the costs associated with drugs. So the core need for a PBM, for someone to manage those costs is really important. When, you know, when I talk with Blues, when I'm talking with private companies are out there, I've seen frequently with CFOs, the top concern I get is, oh, we get hit with an orphan, like an extra orphan drug or an extra rare drug than we were expecting. We get an extra $1 million in cost, in cases like that, we're just done. So this is, this is a really important, you know, consumer need. I, I guess, or, client need. I guess that transitions us over to Accredo. Can you talk a little bit about, okay, this is an investor group, this is client. You're going out, you're marketing to a client, but what's the value prop, and what's the areas of differentiation that you really, utilize for Accredo, obviously, broadly, as you're kinda going in there? Yeah. So several differentiators for, you know, I think one thing that's important is that specialty is really different from that pharmacy benefit space. To put it in perspective, about 40% of Accredo's business comes from outside of the Cigna Group. So outside of Cigna Healthcare, outside of Express Scripts. And that's because payers, patients, providers are choosing us because of the differentiated capabilities we have. So Accredo, our leading specialty pharmacy, we treat over 1 million patients with over 7 million specialty prescriptions annually, and there's four different differentiators that I'd highlight. The first is our clinical specialization. At Accredo, we organize patient care by disease state. So we have fifteen, we call Therapeutic Resource Centers or TRCs, where our clinical teams, our pharmacists, nurses, dieticians, social workers, specialize by disease. We organize this way because this gives us the benefit of being large and small, so we have a deep level of specialization, but we deploy that nationwide. You see that, for example, with our nurses, so we have over 600 field-based infusion nurses on our team. Unlike most of our competitors, we employ our nurses directly, gives us a much tighter and more coordinated level of care. 90% of our patients live within one hour of one of our nurses, so each specialization, highly trained nurses, but deployed nationally. A second differentiator is our scaled operating model. We have 30 care delivery sites, well, that's one of the largest footprints in the industry. We have four total clean rooms, which are highly sterile environments where we can safely mix some really complex drugs. Takes years to build and fully license these clean rooms. Most pharmacies don't have one. We have four of them deployed across the country. I think dwell on those two differentiators just for a second. It's really important to understand how different specialty medications are than other medications. These are not medications you will typically find in a traditional retail setting. It can take a highly trained, specialized pharmacist twenty minutes or more just to validate a single prescription, because they're doing things like they have to check it against a white light, they have to check it against a black light, they have to check for air bubbles, they have to weigh it. It's got to weigh within a certain number of micrograms to be safe for a patient. It's got to be mixed and titrated a certain way. Then it's got to get to the patient. Sometimes it has to be stored in super cold or even subzero temperatures. If you ever get one of these medications, it looks like, it can come, it looks like a giant moving box, because it has to include supplies, syringes, pumps, not just the medication itself, all the things that go along with it. Now, your patient, you get this medication at home, there's sometimes nursing support that's required. So a nurse is there to help you to titrate the medications, to load it into the syringe, to load the syringe to the pump, attach the pump to the patient. If any one of these steps goes wrong, the patient can have an adverse medical event, end up in the hospital or worse. So highly specialized care that really is quite different. There's two more differentiators on it really quickly. The third I will call out is our comprehensive drug access. In this space, in the specialty space, manufacturers often choose one or a limited number of partners to treat patients on their products. And at Accredo, we are the leader in access to those limited and exclusive distribution drugs. We have access to over 98%, which is more than any one of our competitors. Then the fourth and final differentiator I'd call out is that ability to compete across the entire $400 billion specialty market, pharmacy and medical, with Accredo CuraScript care. That's, that's really helpful. And when you're dealing with either an employer market or an MCO market, and some of these, so you're going in there and let's say you're winning with a carve-out business or some of these small community, how much of this is sort of carved out, and how much of the opportunity is, somebody may have an integrated specialty pharmacy within a PBM, but it's insufficient because the limited distribution ones, or it needs to be supplemented. So just interested in, like, the market trend there and where you're going to go. Yeah. So about 40% of our business comes from outside the Cigna Group, so outside Cigna Healthcare, outside Express Scripts. And we are chosen because of those differentiators that I mentioned. You referenced, for example, you know, limited distribution drugs. One thing to understand about limited distribution drugs, about half of specialty drugs or so, give or take, have some sort of limited or exclusive network. These are manufacturers that are making the choice as to which specialty pharmacies they partner with. You may wonder, well, why would a manufacturer do that? Why would they limit to a few pharmacies? And a couple of things to keep in mind. First is we are talking about a fairly limited number of patients, so only 2% of patients, give or take, have a specialty condition. Yet that accounts for, those patients account for about a third of the total cost of care, about half of drug spend. So when you're dealing with a relatively small number of patients, you don't need ten, twenty, thirty, forty thousand locations. You can even practically stock the medications in all those locations, right? You're looking for a limited number of highly specialized pharmacies that can handle your product. The second thing is back to that clinical specialization. So I referenced all the different things that have to happen to make sure a patient safely gets that medication. There are FDA-mandated risk programs. There's things that have to be done. If you're a manufacturer, put yourself in the shoes of a manufacturer.... You've spent years, maybe decades, and God knows how much money developing a product, and now you're bringing it to market. And all of these clinical things have to happen for your product to work as intended. And the question comes down to, who are you going to trust? Are you going to trust somebody who's never done this before? Are you going to trust somebody who doesn't have these capabilities? Or do you want the leader in the space, somebody that you know has the clinical specialization, the operating model, and the scale capabilities in order to treat patients effectively? That's why we are the leader. And if you're a payer, and you referenced, you know, what payers, you want a partner with leading drug access. You don't want your patients having to switch pharmacies as they progress through their disease. You want leading drug access and the specialization that you need in order to treat patients. Let's just take a second. I know when, you know, back when I was in industry, I remember going out and diligencing, you know, and other specialty pharmacies and, you know, someone who is newer into that field and seeing things like that for the first time, it was startling, like, the scope of, you know, or a leader versus just how quickly you drop to much smaller and really, physically, you can just see a very different environment in some of these. Maybe you can just talk really briefly on, like, TRCs, maybe just to give folks an example of, like, what some of the condition categories would be for therapeutic resource centers. Then if you could talk, you know, I naturally, I'm a specialty guy in here, so I naturally think about, like, more mail order pharmacy, phenomenal levels of automation and things like that. Could you talk for a minute about what are some of the key differentiators that somebody at scale that you have when you're talking about the specialty pharmacies? Just contrasting with, you know, somebody decides, like, "Hey, I'm a middle-market PBM, I'm gonna do some specialty pharmacy." Let me spot something. No, I appreciate the question. And specialty really is quite different than traditional pharmacy. So you referenced the Therapeutic Resource Centers, and I go back to thinking about the high prevalence conditions, 60% of the business, 40% of the business being in the rare condition space. And these diseases are quite different, and the things that matter to me are different. And that's part of why that specialization by TRC matters. I'll just give you a few examples. We have a TRC that focuses on rheumatoid arthritis and inflammatory conditions. In that space right now, that's where we're seeing the vast majority of biosimilars. So much of the focus certainly is on Humira, and that's understandable. It's one of the top-selling drugs of all time. We were the first at Evernorth to announce that we would have a biosimilar for Humira available at Accredo with no patient out-of-pocket. We've had that product now at Accredo for, I should say, no patient out-of-pocket for those patients who are eligible for that. We've had that product at Accredo now for about two months or so. We've seen about 25% of eligible patients have chosen that biosimilar, and we expect that to continue to grow as patients become, you know, more educated and familiar with the options that are available to them. Then you can look at a different therapeutic area, something like advanced pulmonary disease. This is a much rarer disease or much rarer set of diseases, like pulmonary arterial hypertension, which would fall into that space. And in that case, you're talking about an even smaller number of patients. This is gonna be more rare conditions. You have newer products with very, very complex needs. And so in that case, that's where you're going to see a lot of those, you know, really scaled operational capabilities come into play. That's where the team of nurses that we have really matter. We have a highly trained, specialized nurses. If you're in a typical retail pharmacist, it's unlikely they would ever see a pulmonary arterial hypertension patient in their entire career. Whereas our nurses, our pharmacists, they're treating these patients every single day. These medications, some of them have half-lives of, you know, just a few minutes, which means that in a few minutes, if something goes wrong with the medication, the medication's out of your system, and it can land you in the hospital or worse at that point. We have a 24/7 nursing line for those patients to make sure that they can get the care that they need. In many cases, our pharmacists and our nurses are much more familiar with the products than even the physicians themselves because the model changes so much, and there are so many different requirements associated with medication. So by specializing by TRC, different things, depending on the needs of the disease, whether it's helping educate patients about the opportunities with biosimilars, or it's helping educate and take care of patients on, you know, very, very rare complex diseases with complex drugs. One more question on the Accredo category. I think most of these things are already... Totally just related to the price growth, you know, space. So we talked about, like, okay, there's gonna be, you know, the market growing broadly, there's gonna be an opportunity for share taking. Markets growing broadly, obviously, component of that is greater adoption and innovation, so new drugs out there, more patients. But what are some of the inflation trends that you see on existing drugs in that space? Is it something where it's, you know, pretty biosimilar? Is it inflationary, is it stable, or do you see, like, pretty consistent inflation with existing drugs? Yeah, it's a good question, and it goes back to thinking about each of the diseases. So, for example, the rare disease space, this is where we see you know, a really significant growth in the pipeline. That's where you're seeing a lot of the gene therapy activity. For example, some of those drugs, you know, are now reaching hundreds of thousands, millions of dollars in some cases per patient, and there's pretty significant growth in those products. And it's not even just whether an individual drug is inflating, but whether there's an explosion and growth in the therapies themselves that are of increasing cost, like in the space, like what we have in the rare disease space. Contrast that a little bit with the biosimilar space. Biosimilars offer significant potential for savings for clients and for patients. And because of our alignment, that also helps fuel our growth as well. And there's a really robust pipeline of these biosimilars. Even beyond Humira, we see biosimilars as an over $100 billion opportunity for the market by the end of the decade. You may have seen recently, just a few weeks ago, we announced that early next year, Evernorth would have a biosimilar for Stelara available, again, with no out-of-pocket costs for eligible patients at Accredo. And we expect that to save patients about upwards of $4,000 per year, on average. Even if you start going beyond Stelara, though, there's a really robust line of these. We'll see them in the you know for diseases like rheumatoid arthritis, Crohn's disease. If you start getting out there, there's some big ticket drugs. You know, as we go through the day, Enbrel, Humira, Cosentyx. Even go a little further out, you start seeing oncology products, Keytruda, Opdivo. So while biosimilars represent a near-term opportunity, at the same time, we're in the early innings of biosimilars. We're much closer to the beginning to the end. And I think that's important because as we think about the growth in specialty, that high single-digit growth, you know, on an already large $400 billion market, that's fueled by that drug innovation. What creates the capacity for that are things like biosimilars, which also offer savings for clients and patients. What I think positions us very well is that whether we're talking about the growth in the drug pipeline, or we're talking about biosimilars, because of our alignment with our patients and clients, that both of those help fuel our growth. Let's turn to biosimilars and go a little further into that. Can you talk a little bit about the role and function? So you guys have obviously been really one of the leaders with Humira now as you're starting to work your way through Stelara and moving into others. Can you talk a little about kind of the roles you're playing in that whole process and kind of what you're performing yourself, what you're curating, what you're outsourcing, et cetera, and kind of like a biosimilar performance? Sure. So a lot of different ways to help patients and clients save from biosimilar. One of the mechanisms that we've used with and I'm saying, you know, Evernorth broadly now with Humira, and we've said that we'll do it with Stelara, is what we call private label. So private label is kind of a new capability for something that we've had for several years, and deployed that in, you know, outside of the biosimilar space, and that's through Quallent Pharmaceuticals. Quallent performs a number of different functions. Quallent is ensuring supply for those products. They're contracting with downstream manufacturers for the manufacturing of those products. They're doing a number of different checks for the supply stability for those products. They're ensuring that we have appropriate access to different dosage forms, interchangeability, for example, and then Quallent providing copay assistance programs, as well for patients who are eligible for those. So a number of different functions that we perform. I think importantly, that private label capability is an important tool, but it's one of a number of different tools to get savings from, you know, biosimilar with biosimilars. And I would think of those as that kind of model as being appropriate for. It's typically larger volume products. It's gonna be typically for products where you'll have multiple manufacturers. That's usually where you'll see private label come up. But even outside of private label, whether we're directly contracting with manufacturers, whether we're, or any other mechanism, there are lots of different ways that we can capture, that we can make sure that we capture those savings for patients and clients through biosimilars. One other note I would talk about with that private label capability, this is also where CuraScript is important. You know, we see an opportunity. CuraScript today only provides about 20% of the Freedom total spend, and we see an opportunity to meaningfully increase that over the next couple of years. And an example of where that's happening is for the Quallent products, CuraScript is the distributor for those products, so for the Humira biosimilar and will be for the Stelara biosimilar as well. That's really interesting. One of the things you guys talk about, probably because it's valuable to keep focused policymakers on what the impacts of the patients are, and patients talk about for things like biosimilars. Can you talk a little bit from a client perspective? You know, when you're talking with your employers, your MCOs, ESI, whomever, like, what's the magnitude of savings opportunities? Again, from a policymaker's perspective, and really, this is just as important as, you know, Treasury as opposed to the voter, but it's ultimately the voter, too. So what's sort of like, you know, the way you look at the magnitude of costs is about maybe sort of the cost? Yeah. What's exciting about biosimilars is savings for patients and savings for clients. So, for Humira and Stelara, the biosimilars that Quallent either has made or plans to make available for early next year, we're talking about 80+ percent savings off of list price for Humira. And so that's a very significant savings for clients. And then for patients, Quallent made that available, you know, for eligible patients with no out-of-pocket costs available. So we're talking about $3,500, you know, up to $3,500 in annual savings for a patient on Humira, up to $4,000 annual savings for a patient on Stelara. So I think what's exciting about this opportunity is, and part of the way that we've made sure that we've architected ourselves and our model is that we want to make sure we create opportunities for savings for both clients and for patients, because ultimately that's how you drive that alignment. And based on the way it works, figure that helps you a lot as well. Got you. Let me start with a question that is more than just limited in the biosimilars, but it gets to this whole thing of client savings. One of the things that's interesting is, again, someone like me, I do naturally think of integrated value propositions, and you guys have a variety of ways you can go to market, whereas Evernorth can be going, whether it's for scripts in Accredo, or scripts can go to market, Accredo can go to market. From Accredo, or specialty perspective, can you tell me about the pricing model that clients looking for with the pricing model use? Where I'm interested there is, not the numbers, so they're like, "Oh, is this a unit price thing?" And they're looking at a discount. Is it a unit price, but they're looking for, like, controls and guarantees, or is this something that integrates together, like, guarantees and what not? So they're interested in what their overall impacts are, the medical, or they're interested in the access. So how does a client look at these sort of- Yeah, the economic model and specialty is really much more about the value that we provide, the depth and breadth of the services that we provide, and then the clinical care that we provide. Because ultimately, like I said, clients are looking for value, they're looking for drug access, and most importantly, they're looking for that high-quality clinical care for patients. And so we've and that's really how we've architected the economic model for specialty. Got you. That's really all. Let's turn around to CuraScript for a minute, and maybe we can start off a little bit with just a framing of CuraScript and you know, maybe if we just go back to kind of like, oh, where did CuraScript come from? What is maybe you are the business, you guys, bringing the role that they play, and maybe the scope of operations. And then we can get a little bit into what are the opportunities for the future. Yeah, very, very excited about the CuraScript. So CuraScript is about a-- it's over $10 billion account. It's consistently been growing in the double digits for us. So it's really nice. We serve over 12,000 healthcare providers through CuraScript. So CuraScript is serving physicians, offices, hospitals, health systems, infusion centers, and CuraScript is distributing really those highly complex specialty drugs in those settings. There's a couple of different things that differentiate CuraScript. The first, I would say is a very unique and specialized account model. We have dedicated account representatives for each of our clients, which is more unique in the wholesale and distribution space, and that's because of our the complexity and highly centralized nature of the drugs that CuraScript is distributing. This is one of the reasons that CuraScript is a leading Net Promoter Score amongst our customer base. It's a much more high touch, highly specialized model. The second differentiator I would highlight for CuraScript goes back to the alignment that we have with Accredo. We see this in two areas. One, I referenced, which is CuraScript serving more of Accredo's business, and over at about 20% today. We see an opportunity to meaningfully increase that. I gave some examples of biosimilars or Quallent as one, but CuraScript continues to serve a greater portion of Accredo's spend. But beyond just that, one of the things that makes CuraScript unique in terms of alignment with Accredo, is we represent a one-stop shop for manufacturers. So going back to that conversation we were having around limited and exclusive distribution drugs, not only is Accredo a leader in exclusive and limited distribution, drugs and drug access, but CuraScript is a leader as well. Because if you're a manufacturer, and let's say you have a product, and you want that to be available to patients for treatments in their homes, and you want that to be available for treatments in a provider setting, we represent a one-stop shop. We have capabilities that can treat patients, whether they're in their home, whether they're in a hospital setting, a physician's office, in an infusion center, and so if you're a manufacturer thinking about, who you want to partner with, having somebody that has those capabilities that span the supply chain is a real differentiator for us. Talk a little bit about that 20% increase. What, what are some of the initiatives or levers you've got to drive that up in the, you know, again, in the related to the Accredo and the role itself? Yeah. So, CuraScript's bread and butter business for a very long time has been the 12,000 healthcare provider, and that's really where CuraScript grew up. It was the provider-focused business. And it's only within the last couple of years that CuraScript has started to increase the proportion of spend that is served with Accredo, and that CuraScript has developed into a bigger business. The biggest near-term opportunities currently are some of these biosimilars that are coming from Quallent. But as CuraScript gets, you know, embedded with more of those products and more of those manufacturers, CuraScript portfolio grows. That not only helps CuraScript in terms of supplying Accredo, but that also then gives CuraScript now access to products that it can use for other provider customers as well. The fact that CuraScript has access, for example, to Quallent products, means that to the extent that provider customers also want, you know, products of that nature, CuraScript now has the ability to supply that as well. It's a nice virtuous cycle for CuraScript to be able to continue to grow and win access to drugs beyond just the drugs that are typically in that provider setting today, and that'll continue to help fuel CuraScript's growth as well. Just to help frame kind of the sourcing of these drugs, just a little illustration. I understand, like, okay, if you get your pharmacy spend, your medical spend, for drugs that are just pharmacy spend, those are gonna be, you know, for distributors that are supporting, like, an Accredo. For things that are just for a medical spend, you know, CuraScript always have been doing that, and there'll be some portion, this combination. How large is the universe of products that are both of those, and so you're able to more easily leverage, you know, the ability to service, right? with the fact that you even have the access to provide? Yeah. So I go back to that. The market's about $400 billion, the total specialty market. About 60% of the market today, pharmacy benefit, about 40% of the market or so is medical benefit. Where CuraScript's bread and butter historically has been, is in that medical benefit, those drugs that are provider administered. Where you're seeing CuraScript now have some of the capability that pharmacy space is really through that through the Evernorth. And so I think about that as kind of CuraScript, and CuraScript having some access to that 60% would be in Evernorth. And then can you talk a little bit about margin profiles? So you, maybe you just contrast your Accredo business and maybe you put the difference, margin on business like that versus CuraScript. Yes. If you think about the Evernorth margin profile, we're about 3.5%-4.5%, you know, expected target margin for Evernorth. You can think of CuraScript's gonna be more in line with typical distributor or wholesaler businesses. That's gonna be, you know, towards the lower end of that, whereas in Accredo, given the depth and breadth of the services that we provide, is gonna be more towards the higher end. We're on page two of the questions here. So, let's talk a little bit about your infusion capability. And you could maybe talk about, is this, you know, an area of growth for you from a capability standpoint, or is that really just a capability to be able to administer the product and move on? Yeah, so think of the infusion space, there's really two buckets of infusions. There's acute infusions, and then there's chronic infusions. Acute infusions are gonna be more, you know, antibiotics, procedures at all or something like that. I would say where our business is largely focused today is really on chronic infusions. These are gonna be things like specialty infusions, in a patient's home, and this is where our team of over 600, you know, highly trained infusion nurses really shine. That's partly what they're doing, those chronic infusions in patient's home. This is also where our collaboration with support. So CarePath is providing both specialty pharmacy and infusion services on behalf of the hospital health system that we serve. They can do that at home, they can do that on a physical site as well. So I think about that as typically more of a chronic infusion space, in terms of where historically we've had success with. Great. Last couple questions, and then we've got all kinds of meetings for you, so we want to make sure we get through those as well. One is on strategy, so you know, you get this, obviously, you got a leading asset in Evernorth. You've got this, faster growing, opportunity, or less penetrated, with CuraScript. What are some of the other capabilities that you look at and say, "Well, these are things that either we're gonna build, we're gonna buy, we're gonna partner to further develop, your opportunities in this industry? Yeah, so I think, you know, today, we have the capabilities we need to compete, to win, and to grow and to continue our leadership in the $400 billion specialty market, so when we think about additional capabilities, think of it as the enhancing, augmenting capabilities that we have today. I'll give maybe two examples of that, so one, we, for example, recently acquired a fertility pharmacy. We had a fertility pharmacy and a fertility pharmacy, Freedom Fertility, but we saw an opportunity to extend and expand our reach in that space, and so we acquired an additional fertility pharmacy, and we're in the process of bringing that, you know, into our ecosystem now, then we referenced Carepath Rx. So Carepath Rx added an additional set of capabilities with providers and health systems, in terms of specialty pharmacy and infusion services, on their behalf as well, which extended the leadership that we had already within CuraScript. So I think about our... You know, when I think about sort of additional enhanced capabilities, it tends to be things that augment our leadership in the space as opposed to, you know, something that we did in sort of wholesale. And then, on the policy front, obviously, PBM has been a real big policy area of focus, maybe not a policy necessarily, for the last few years, specialty pharmacy. I'd say less so. I think there's, you know, some emerging... focused on that with some FTC letters and reports. Just interested in your perspective on what do you see as kind of the top policy topics from a specialty pharmacy perspective and any particular areas that you think maybe are less well understood? As you said, you know, the focus of the FTC, regulators, lawmakers, has really been in that pharmacy benefit space, but so on, on the specialty side. I think, you know, what's important about that in a couple of things. One, also, we're keeping in mind about 40% of our business comes from outside the group entirely. That's number one. Two, when we've had the opportunity to sit down and talk with lawmakers and regulators, it's an opportunity to educate on the difference that within specialty, and seeing is believing. You come and visit our site, which we've had the opportunity to give many different visits or to regulators, lawmakers. You see our clean room, you talk to our nurses, you see the, you know, they can step inside our, you know, our fridge, our refrigerator space, that you know hold or see, you know, medications on dry ice, or you watch our pharmacist checking and validating prescriptions, and you see the difference, and you see the complex care that's needed. You understand then why manufacturers are making a choice to place or partner with us and place their limited and exclusive distribution drugs. Not obligated to. They're doing it because they know that that's the place where patients are going to get taken care of, and patients are going to get the care they need, so you know, we welcome the opportunity to be able to help educate regulators and lawmakers about the distinction and the differences in specialty. And I think the more we can do that, the more they see it, the more they understand why. I think it will end just to 9:45 A.M. 9:45 A.M. Thanks so much. I really appreciate it, and I hope you have a great rest of the day. Thanks, everybody, and we'll talk to you later. Thanks a lot.