Okay, good morning everyone. Welcome to The Cigna session. I'm Bob Jones. I'm joined by my colleague Kevin Hartman. We cover healthcare services here at Goldman . Joining us from Cigna , very excited to have Tim Wentworth, CEO of Evernorth, as well as Alexis Jones from Investor Relations. Welcome to you both. Really appreciate you guys both being here today.
Thanks, great to be here. Good to see you, Bob.
Good to see you too, Tim. You know the format, obviously keep it as conversational as possible. To the extent that folks in the audience have questions, you can email them to me. Before we dive into the Q&A, Tim, I was going to turn it over to you to see if maybe you had a few opening remarks you wanted to make.
Yeah, I'll be brief because I know there are a lot of questions and a few events even in the last week that you probably are going to want to talk about. Here's what I'd say. Appreciate everybody tuning in today. Appreciate the chance to, you know, sort of reinforce the story that Evernorth and Cigna really represent in the marketplace, which is a super capital-light, very focused services company that has hit the marks in terms of what we committed to do in the first couple of years plus of our merger. More importantly, I think we declared pretty clearly at our recent Investor Day the fact that we're going to create $50 billion of free cash flow over the next five years.
The fact we're going to deploy that incredibly responsibly, while at the same time dealing with the issues that are the most important and pressing issues in healthcare right now. Specifically around things like pharmacological innovation, around the tie-in between mental and behavioral health and whole person health, site of care. You've seen us make moves in all those places that really should give you a clear picture of where we are heading and why we're excited about our business long term. Love the chance to talk about our business today. I think a lot of the dynamics that we'll be talking about are things that we built this company to solve or to work with. I couldn't be more excited to be with you, Bob. Fire away.
Great, great. Thanks for that, Tim. Yeah, I mean, maybe just to start off with something pretty topical because we continue to get this question for obvious reasons. You know, we think about the pandemic and all the disruption it caused across healthcare and across Cigna 's enterprise, obviously as well. From a script perspective, you know, thinking about Evernorth's view of this, how would you characterize where we are today, you know, as far as a recovery back to pre-pandemic levels within script volumes? If there are areas where we're maybe not all the way back, you know, what are they and what's your thoughts on getting those areas kind of back up to where they were before this all started?
Yeah, I appreciate the question. What I would say, and I can only speak for our book of business, which is quite large, as you know, I would tell you that script volumes are very much back to pre-pandemic levels. They really didn't dip a lot during the pandemic. If you looked at the scripts that are the most important to us, which are the ongoing maintenance drugs that patients are taking, particularly patients who needed to stay on those drugs through the pandemic in the event that they were to contract COVID, they would have been at more serious risk than non-comorbid patients or morbid patients. From that standpoint, we didn't see the big drop-off. We clearly see on a go-forward basis, though, the prescriptions are strong. We see, again, some preference for mail service carrying through past the pandemic.
Folks that picked up mail have continued to use mail and like it. We got a little bit of a channel shift there, not major, but it was meaningful. In terms of areas that we would be focused on or looking at, I guess the big one that we don't directly manage is vaccines. We'd love to continue to see more vaccine volumes than we do because, again, we've got patients who are fairly fragile in some cases. What I would tell you is we've worked with our messaging to those patients specifically to be sure they understand the importance of being vaccinated, but more importantly, or as importantly, the importance of staying on their meds. Really not a major down headwind last year, not a major tailwind relatively this year. Instead, we did our job both years.
Got it, got it. One other one I wanted to touch on really quickly that's very kind of top of mind in the current market was around generic drug pricing. Seems to be a bit of a debate that's bubbled up in the last quarter or so around, you know, are there pockets of generic drugs that are seeing greater deflation than normal or not, or is it stable? Just given your perspective from Evernorth, both from somebody who obviously, you know, pays the claims, but also has, you know, a large purchasing presence as well, wanted to see what your views were, kind of real time on what you're seeing with generic drug pricing.
Yeah, we're seeing it largely in line with kind of what we've expected, which is there are pockets of deflation, nothing that I would point to being noteworthy. I think the good news is that deflation and more broadly our experience in working with the generic manufacturers indicates a highly competitive market still, which is really good because I think there was some concern over the last few years about would there be, you know, concentration in that market in a way that created some price adversity for us and for frankly the payers. You don't see that. The evidence of that, take a look at the companies launching $1 generics now and so forth. I mean, clearly there's plenty of demand. There's a lot of competition in the place. There are certainly still drugs that don't have competitors, right?
There are generic drugs that sort of, and some of them are fairly old, but don't have competitors. We continue to look to drive those prices down and in fact have in some cases encouraged manufacturers to step in or even supported a second manufacturer stepping in. There are some sub dynamics that we continue to work, but on a macro basis, very much in line with expectations, very much payer-friendly in terms of the generic pricing paradigm that we see.
Great, yeah, thanks for that. I guess maybe just to take a step back and think about, you know, Evernorth's performance in general as of late, and quite frankly, you know, PBM's performance in general, it's been very strong. I think it certainly has been exceeding expectations. Just this past quarter, you know, Evernorth saw EBIT growth of around 13%. Can you just help walk through what some of these drivers have been? I mean, I think, you know, you and I have been around the PBM industry for a long time. It certainly feels like we're in an outsized window of growth. I think a lot myself and a lot of folks just have a hard time unpacking what the real drivers underneath this are and how sustainable they can be.
That's a great question, thanks. First of all, I'm the only guy probably on here that's not surprised because, quite frankly, I love the business. The need has never been greater for what we do. It's why they can't get rid of me at this place because I love the two of them. The real fundamental fun part of the business is your levers continue to evolve and change. The things that have made us successful, some of the dynamics are the same. For example, you'll get the generic wave that you and I lived through over a 20-year period. We've largely captured that value. We're at almost 90% generic prescriptions now. We look forward to specialty generics and biologics as a huge forward-looking opportunity to take some of those same levers, use a much more clinically intensive model because you tend to have to there.
Those things are already starting to happen. Specialty generics have been very valuable. If you then zoom back out to specialty broadly, solving what is the number one concern for most of our payers through the number one asset in the class, that being Accredo, and the benefits management that we bring alongside of Accredo, has fueled a significant amount of the growth this year that you've seen. I remember, I'm old enough to remember when specialty drugs weren't even a contracted separate class of drugs in a PBM contract. Today, it's the most important thing that we're doing, I would argue, amongst several things that are terribly important. Supply chain. I hate to sound like a historian here, when we took Medco public in 2002, 2003, the concern was that rebates would go away.
Here we are 20 years later and everyone's still wringing their hands about rebates going away, even as we produce amazing amounts of net cost value by leveraging the PBM. Our results over this last several years, including the first quarter, were indicative of a continued expansion of opportunity, bringing ourselves to the table and collaborating with pharma companies to create value for the end user and create value for our GPO participants in a sense. You look at those two areas and they look like plain old vanilla PBM at one level, but at another level, you realize they are highly evolved mechanisms to create value. That's what we continue to see grow. The third piece is organically, we've grown scripts and we've grown relationships. The deepening of relationships is really important to us.
Eric Palmer, our President, and I were recently with one of the largest health plans in the country, a single blue plan, one of the largest, meeting with their top, top, top folks for an entire day. The conversation was in part fueled by the fact that they are growing because we're helping them grow. That's our job. We can grow by virtue of winning new labels, but we also grow by helping the marketplace grow. In the quarter, you really saw the sum effect of all of those things, certainly lapping and expanding on our Prime relationships specifically, produced incremental value in the quarter, both in terms of bringing on specialty lives, but also now it's a full, you know, we're entering the first full, full year of some of the things that we've done for them.
Again, producing more value for Prime and having a small piece of it stick to our ribs was a contributor. Really good quarter where really all the things that we're paid to do on the PBM side delivered. I would then more broadly zoom out and remind you, EviCore has had a really good year this year. The need for what they do and their product set, which has been expanding, has continued to be very, very well accepted and important. Again, across our pieces, even as we build out new things that don't have quite the heft yet to make a difference in the numbers, we're performing really well.
No, that makes a ton of sense. Appreciate that context, Tim. You mentioned specialty probably now being the most important thing, top of the list for your clients. Any sense you can give us on just how big specialty is within Evernorth? This is a question we get quite a bit. Obviously, the companies consistently, you and your peers consistently point to this as probably the most important thing to your clients, probably the biggest driver of growth. Yet we have a hard time on our side of the world and the investment side of the world really understanding the size and scope of it at this point.
Sure, I understand that. We don't purposely make that difficult for you, but I recognize that it's also really important to understand that specialty, the couple of dimensions I'll give you, it's for most of our clients now half or more of their spend. If you just look at pure drug spend, it has crossed that rubric of kind of being half of the spend. That's number one. Number two, for Evernorth, it's about, we've said that it's about a third. In fact, Alexis, keep me honest here, maybe slightly over a third of our revenue. What I would tell you is it's probably more than a third of our profitability, but we haven't given that number. To some extent, the profitability in specialty is a direct function of what your mix of drugs is and how much services you're providing to a patient.
High volume drugs that are relatively easy to stay stable on for a patient are going to be less interesting from a profitability standpoint, although very important because they support the overall capital structure of the company. Some of the rare diseases that we take care of, where we've got nurses going to people's homes on a weekly basis that develop relationships with these patients that help keep these patients on the drug healthy and so forth. As we look at the value creation on specialty, that's a piece.
What I would point to though, because I hate sort of talking about it being a third of our revenue, my hope is to drop to 20% of our revenue by virtue of adding a whole bunch of biosimilars which would be revenue depressing but be massively value creating both for the system and for us as the chassis through which that drug could find its patients.
The static view of what it is would almost be meaningless if we look out over the next five years because where value is really going to be created isn't only in potentially being able to negotiate and handle drugs, even like the drug that came out this week that'll be on the medical side to start with, but we're well equipped to potentially play a role in, particularly if we could get a sort of part B to look at PBMs seriously and what we could do. Also, the biosimilar wave over the next five to ten years and the opportunity to unlock that which is now becoming tangible and real. In 2019 and 2020 it was very frustrating, but as we're entering 2021 and looking at 2022, we can see 2023 coming and the very high likelihood of producing some real value on biosimilars.
I think that'll be a tipping point because the biosimilars that have come out so far have largely either been on the medical side or been priced in such a way as to not be amazingly attractive relative to moving patients and the investment in clinical that you would do to do that. We think over the next ten years that's going to be meaningfully valuable. The metrics even that would cause you to get excited about specialty will be different. I think ultimately the place to look for us is going to be how many patients are we touching. I know we don't completely give that number today. We are challenging ourselves to say how else can we help you understand kind of our footprint and the opportunity in that footprint.
That really comes down to how big is your patient base and what's the mix of those drugs that today you're handling. The thing you should look at is the chassis that we built, which we've used repeatedly to create value, is going to be more needed than ever in the next five to ten years.
Yeah, no, I think that's pretty clear. You mentioned the drug that was approved this week, big news in the Alzheimer's community. Maybe we'll go there next. Obviously, big win at Biogen, big progression win for folks with Alzheimer's. A lot of questions obviously at this point given that it was just approved. Wondering how is Cigna and Evernorth viewing this even kind of from a knee-jerk perspective? You mentioned being able to try to help manage and control costs. What are the types of things you think about or that immediately spring to mind when you see something like this come to market that obviously is going to come to market with a, maybe rightfully so, fairly healthy price tag?
Yeah, so first of all, our knee-jerk reaction is always the same, which is how can we get access to the patients who will benefit from the drug, access at an affordability level that both they and the system can afford, right? That's our first knee-jerk reaction. In this case, as you would have seen in the announcement, we're in conversations. I will actually say that I met with, I had a conversation with Biogen's board a number of years ago about pricing. I know that Biogen has been interested in understanding how to create access and affordability. Now, their list price is not where this conversation should end because we think there's a lot of opportunity to create meaningful value and access below that number. We're in the process of working with them to understand sort of how we can best do that.
You've seen us in other categories do value-based contracting that went beyond just get the list price low. I think this is a case where we can help both the payer and the originator, in this case, Biogen, by ensuring that the right patients are getting this drug and that the wrong patients aren't because that narrative isn't good for anybody. It just takes resources out of the system and creates waste. Over time, we can track how the patients are doing on this drug potentially. We're a chassis for that. I believe that one could envision that Biogen will be asked questions in the future about how this drug is working in market. We are in a position to potentially help them with some of that data as are others that do what we do.
In terms of, I'd like to believe that they're willing to stand behind this drug, that if it's given to the patient for whom it's indicated, that if it doesn't work, that there'd be a mechanism to potentially get a payer back some or all of their investment in trying this drug with that patient. There's a whole bunch of hurdles that one would have to envision as it relates to how do you ascertain whether it's working or not? How do you get a high fidelity of that? We have shown in other categories that we can obtain, because the pharma companies wanted to stand behind their product, we can actually create the mechanism to ensure that where the patient is not succeeding, that in fact they're getting, that they're then standing behind it.
The flip side of that is what the pharma company wants to know is we are going to do everything possible to ensure that the patient who is appropriate for the drug stays on the drug, works through side effects, is counseled appropriately from a pharmaceutical standpoint, their physician has a place they can go to for questions. That in fact we raise the odds materially of a patient who should be on the drug actually succeeding. All of those are things in our playbook. You would have seen us pull that playbook out for hepatitis C. You would have seen us pull that playbook out for two of the new genetic drugs, the gene therapies that came out and that we were able to leverage a number of mechanisms.
We come to the table not with a one-size-fits-all solution, but with a set of principles and a playbook that says we want to take the unique aspects of this particular product and this manufacturer's goals and the goals that we would have for patients. Now, in the end, Bob, it's going to be largely a government-paid product. You know, we're going to wait to hear how CMS feels about coverage determinations to see sort of how material is it to the med advantage players in the marketplace. From our standpoint, we think it's a natural place for a PBM to be moving. I hope it becomes a poster child for CMS to look at and to realize that perhaps PBMs on part B can bring some of those same principles to bear and help drive affordability and access.
Yeah, no, it'll be very interesting to see how this progresses and plays out. All that makes sense. I guess maybe one another question that comes up. Obviously, you've lived through a number of selling seasons in your career. I think the cadence of RFPs, potentially last year versus this year, there's a view that clearly last year a lot of things were maybe punted or put on hold or suppressed just given all that was going on and benefit managers being focused, rightfully so, in other areas. How are you seeing this selling season shape up? Is the view that this is going to be an outsized year of movement? Is that something that you would subscribe to and that you're seeing?
I'm not sure it will be. It's a modestly more robust year of sort of activity, but not, you know, all of us that compete, and I'm now talking specifically the PBM space, obviously, all of us that compete have gotten very good at taking the relationships that we've done a good job of and attempting to sort of protect them. All of us also tolerate a loss or two now and then. We've had a couple, we had a couple of health plan losses that, for example, are not systematic or systematically indicative of anything. They're also not things that were being stalled because of COVID. I think that as what we're seeing on the employer side is actually very high retention and some really interesting opportunities in the market.
I think employers may be particularly interested in just double checking that their alternatives are, you know, they've made the best set of choices given kind of a re-evaluation of how important benefits are in this very tight labor market. Therefore, making sure that also, as they put additional point solutions in to try to drive affordability because they're not going to be able to reduce benefits in this market, they're looking for other things to drive affordability, looking for partners that can actually integrate with those things really effectively and play nice, so to speak, with others or even better yet, play an integrator role in part of all of what's done. We're really well positioned, we think, in the employer space to keep our clients with fairly high retention rates as well as to potentially win some additional.
Again, in the health plan space, we like our book of business a lot. We like the market, the opportunities that are out there. Even the two plans, and this is again a reconceptualization of what we do that I don't think the market's caught up with yet, even the two plans who have decided from a PBM standpoint to go another direction actually remain very robust clients for Accredo and EviCore, as well as very interested in some of the other things that we'll be doing down the road with behavioral health, some of our advanced analytics. We've got to go back and earn our way in. Ultimately, I want to be their PBM again. For us, it's not this bipolar endpoint or a selling season that's all and only about the PBM. EviCore is having a terrific season in the market. For example, Accredo is growing tremendously.
As I look at our overall go-to-market piece from an Evernorth standpoint, and by the way, Cigna itself is from an enterprise, we've had very good results both in their government business, the select business, and the individual business. We're kind of humming on most of our cylinders in terms of organically showing up in the marketplace. I expect that should continue.
Thanks for that.
Hey, Tim, Alexis, thanks for doing this. I appreciate all the detail so far. I know you touched on some of the regulations, obviously, that's not a new thing in this industry. PCMA v. Rutledge, I think, has come up a lot. I think we've seen some states doing a little bit new things, I guess, on the PBM side just in the wake of that ruling. I'm just curious if you guys have been seeing broadly if it's anything new and just how you see the model potentially evolving as a result of some of these things that have been coming out.
Yeah, thanks. I mean, it's obviously, first of all, through PCMA as well as, you know, as an individual company, we engage in the states that are a very robust sort of area of activity right now, as you rightly point out. We've actually had a pretty good year in terms of what a legislator puts forward versus what actually gets turned into a bill versus what actually gets voted on versus what the governor ultimately signs. We've seen the opportunity across the piece to educate players about the value we create and about the patient focus that we bring. As we say at PCMA, the care, the C in PCMA, bringing that to the front of the conversation. We've been pretty successful. That said, you do see state legislators in particular somewhat prone to being somewhat protectionist of their local retailers, the independents in the state.
We would point out that the PBMs, frankly, have worked very constructively with the independents by and large. The large chain pharmacies is where a lot of that competition comes from. That's a different problem. If you look at the Rutledge piece, for example, while in Arkansas, which is a bit ironic that it's in Arkansas, if you look at the largest company in Arkansas and the number of other businesses that they've sort of, shall we say, challenged to protect a particular set of small businesses is an interesting approach. That being said, those retailers play an important role. We have never debated that. With the Rutledge decision, which is a fairly narrow interpretation, it's still protected. Plans can still design plans on a national level, which would include or exclude pharmacies that don't bring value and so forth.
What we're finding is there's plenty of pharmacies that will want to continue to provide value to our clients in the context of what Rutledge did. Our job becomes influence the law where we can, where it passes, then go back in and look at the other ways to drive affordability. We're actually really confident in Arkansas that we will be able to continue to drive affordability with the retailers to the end users. We stay very engaged because we do know that, you know, I told someone the other day, our industry faces off against a couple of very tough forces, retail being one of them, that if we didn't exist, the pricing to the end user would be different. We recognize that comes with the territory.
That is why we stay so engaged and try to work really, really hard to demonstrate the value that we create because I think that's important. I do think, by the way, that there are other patient-friendly, you know, we can call it transparency, but patient-friendly ways to manage networks and execute them and so forth, using digital tools and others that we've invested heavily in that we believe really help the patient experience, even as the payer is getting the benefit of potentially, say, a narrow network, for example. We continue to recognize that, at the end of the day, the people that vote in the legislators of these states are patients. We need to do a great job serving them. That's a big place that we invest.
That's super helpful. I think, you know, switching gears up a little bit more, I know you talked about the Prime relationship earlier. I think it's been about a year since that officially started. I was wondering if you could just give an update on how that's been progressing, what the feedback has been from Prime . I think initially when you had announced this partnership, you talked about an immaterial impact in 2020 and then with a more positive contribution in 2021. Is there any better sense you could give us on how to think through what that might be contributing this year, just on a year-over-year basis?
Sure. The answer to your last question is no. I'm not going to give you any frank and silly numbers. That being said, we invested some money up front, certainly to bring Prime on first, our first iteration, which was bringing them on to Ascent, as well as doing some work on the retail side for them. We've invested yet again, largely again around hiring people so we can provide amazing service because Prime did not have a great experience when the last time they made a major transition. We want them to have an amazing experience plan by plan as they come onto our platform for Accredo and for Mail.
I can tell you so far, I can't play the video for you, but I had Prime's CEO recently address our top 500 leaders because I thought it was important in Cigna, broadly, important that all of our leaders hear directly how important what we do is for them, how they are counting on us to deliver and to innovate and to perform, and how well we had done. It was a very positive, very, very positive report. I think the net effect of that is that as the plans are making decisions, we've had now two waves of three waves, actually, I guess now, of the Accredo implementations of individual plans inside of Prime's 23 plans. I am strongly of the view that we are likely to have nearly, if not all of them, nearly all of them come onto Accredo off of their current provider.
That's because we've performed really, really well. That's obviously really good for us in terms of the trust that it shows. It is our strategy in action, which is land in one place and then build trust and expand the relationship over time based on the needs of the client, not based on what we want to sell, based on the needs of the client and how we can, in a really nimble fashion, construct it in such a way as to work through them. What I would say is it couldn't be going much better right now. The one thing that I'm looking forward to, and Ken and I talk about this, is we have a great proposition. We've taken great care of Prime's owners and plans. They are benefiting massively.
He gave our team a number that I won't give you in terms of what he believes it's been worth to the plans. What I want to see us do is add to Prime's stable of plans that they're actually serving. We have a great Blues book of business. Prime has a great Blues book of business. There are plenty of other plans out in the marketplace who need a scaled help, particularly specifically Blues plans. I believe Prime is beautifully positioned to provide services to them. That's what we're really now focusing on. It's a great relationship and one we're very proud of and one that does continue to grow.
That's great. I wanted to follow up on one of the comments you made. On the specialty piece specifically, like you said, it sounds like a few plans had started in 2021. What would the timeline potentially look like for those other plans to move over, and how impactful could that potentially be?
Yeah, what I love about it, George Paz taught me this. I hope he's listening in on this. George Paz taught me this, which is it's always wonderful to have things ahead of you that you know are going to help contribute. The nice thing is that we won't bring the last plans on until probably 1/1/2022, which means that that's going to be all incremental for 2022, not to mention a fairly good number of plans coming on the middle of this year. You're going to get the annualization of that effect from a claims count standpoint and so forth, as well as a cost absorption standpoint. To answer your question, though, we see the likely scenario would be that by early 2022, we would have completed the implementation of the majority of plans. We're following the plans' lead.
We are doing what the plan can digest in terms of the transition of those patients and so forth. The good news is the rate limiter is not going to be our ability to service the patients. The rate limiter is not going to be the plan's concern that we won't do a good job. Those two things have been taken off the table by how well we performed so far.
That's super helpful. Thanks.
Hey, Tim, wanted to go over to the digital formulary. I think it's been a couple of years now since it was launched. I think it's a pretty, you know, ingenious, innovative way of thinking about non, you know, non-traditional therapeutics being on a formulary. Just wanted to get your updated thoughts, kind of what adoption maybe has looked like, you know, what's on the digital formulary? How do you envision this continuing to evolve?
Yeah, it's a great question. What I would say is it was a really good and appropriate innovation for us. It was natural because of our open architected approach, and also because we had clients that clearly were looking to validate what was just an exploding number of point solutions. Not all of our clients are in a position, particularly the small to mid-sized ones, to even do the security validation that you would want to do before you start sending data to some of these companies, right? We thought it was a great service that we provide our clients.
We also thought it was terrific for those clients who were using these point solutions that we would be able to provide an integrated view from a patient standpoint, working from the Levonbo shirt of my, you know, my poster child in Lifescan where that data goes straight to our pharmacist real time. We can actually intervene, or if we're talking to a patient, we can alert them or reinforce positive things that we see in the data and so forth. From our standpoint, the uptake has been good. I'm not going to tell you, first of all, we never built it to be wildly profitable because we think it's an added service that makes us even stickier in terms of the core business that we provide. We do like what it does.
We added a number of things in the musculoskeletal area and in the behavioral area because those are two cost areas that the market is very concerned about longer term and see the benefit of well-managed patients. Both of those, behavioral and musculoskeletal, do not just require you to go visit an outpatient clinic or go visit a human being in an office. There is an awful lot of appropriate care that can be delivered virtually or digitally. For us, it's early days, not giving numbers of accounts, but we've had good uptake from employers. In some cases, we've had employers say, wow, love that you validated it. I have a direct relationship with them anyway. In some cases, we can get them a better price. Again, the price arbitrage on that really was not the goal.
The goal was an integrated experience that over the next five years, we could really build out. Ultimately, it would give us one more element of playing a role as the coordinator for the patients, the clients that we have on a broader ecosystem basis. We launched Health Connect 360 a number of years ago that have put us sort of squarely in that position. We've got more than a dozen health plans using that. We think the digital formulary sort of gave us that with employers as well. Over time, what you'll see is all of that come together into a strategy around coordinated services that will give us a place with our clients that will be very helpful.
Now, just a quick follow-up on that, Tim. Can you talk a little bit about what MDLive adds to this? Obviously, that was a fairly significant transaction, at least within this context. What does that enable you to do better or differently with the digital formulary?
Yeah, I mean, MDLive is a great investment for us. To your point, the way we look at MDLive, and I'll come back to the digital formulary because it's relevant to what I'm about to say, is not, we didn't just buy MDLive so that we had an urgent care capability or a simple place for patients to just go and get access to care. We view long-term, MDLive can actually find its way into the more complex disease states that we can work with providers to link providers to the patients in meaningful ways that patients are looking for.
Importantly, when you have that provider-patient hookup and we're the chassis and helping the provider make that connection, to the extent that we have, whether it's pharmacy formularies or whether it's a digital formulary, your adherence and the ability to have the pick list for that provider really easily curated into the solutions that you know are value creating and therefore will be patient appropriate and so on and so forth is very high. We do absolutely view the ability to sort of have the integrated EMR for the MDLive patient, to call it sort of like that, be very clear about the opportunities. We could push opportunities at the point of that care that may otherwise be blind spots to the patient or to the provider that they're interacting with virtually. Do we think every encounter is going to be virtual in the future?
No, we did say that we think point or where care is delivered is one of the three fundamental vectors that we're really spending time thinking about. We do think people, whether it's skilled nursing facility at home sort of mindset or other things, post-acute care follow-up to keep people from going back in hospitals and virtually reconnecting with their provider after coming out of the hospital using the MDLive platform. We think there's just a lot that we can do there to take that platform and meaningfully deepen. I don't know that it's even expanded, deepen sort of the kind of care use cases that it's able to provide and the tools, including our digital formulary that can be made available to those clinicians to actually leverage.
Tim, we just have a couple of minutes left. I wanted to end on a longer-term question. You know, as you think about Evernorth and all, obviously, there's a lot of things going on, a lot of changes both in internal and external factors. Is there anything you could do to help kind of frame how you've envisioned the long-term algorithm from a growth and profit standpoint? I know your analysts say, you know, you talked about longer-term margins of 4.5%- 5.5%, you know, kind of towards the lower end as we sit here today. What are some of the things that you think about to get you well within to the top end of that range from a profitability standpoint? How would you have investors think about, you know, the long-term top line perspectives of Evernorth?
Yeah, I mean, I think what you will see over time with Evernorth is increasingly counting scripts or PBM wins is going to be less and less important. We are not de-emphasizing the PBM. We still think it's the great front door to care pharmacy is. We're clear about that, right? As our growth on the PBM side is on the lower end of what that range that we've indicated we think we can grow is, and as we add materially services that are higher value and therefore higher margin off of the back of that PBM, witness that the Prime relationship is a great example, right? Going in and doing Ascent and supply chain services, it's worth it for us to do. It's not a commodity, but it's certainly not nearly as interesting to us as caring for the most ill patients that those plans are actually covering.
That's more remunerative to us if we do our job well. As we grow specialty, as biosimilars become real, that will change the margin profile because we'll create additional value that we can keep a small piece of. As we look more broadly at a behavioral health offering or other care plus offerings, as we call it, MDLive for others, not for Cigna, but for other health plans that we can provide services to. Again, the services business, as you've seen in certain competitors, is more profitable on a per dollar of revenue basis than PBM is typically. If I go further and look at data and analytics as a service, particularly advanced analytics, we're being very thoughtful there because it's too easy to spend too much money to buy something that doesn't have much of a future in terms of some of that space. We're being very, very thoughtful.
We think we've got a lot of internal assets that can be combined to do some very interesting things potentially. We already do some of them. Some of the highest profit things that we do today are really derived from our data and analytics capabilities as they apply to things like RationalMed for our pharmacy customers that they pay us for. I think over time, what you'll see as we get to the top end of that, it's fairly, you know, if you model it, you don't have to believe some crazy stuff in order to say, wow, your business mix has evolved enough that you guys are doing more high-value services, even as you continue to provide that really important core set of services called pharmacy benefit, you know, it's called benefit management broadly, including on the EviCore side. From that standpoint, we see a lot to like there.
You know, the top line will kind of take care of itself when you do that. We're bottom line and capital use focused more than we are top line focused, if I'm honest. Investors kind of got to get comfortable with that, particularly, again, if you look at biosimilars, I'm hoping I depress my revenue for a period of time, but blow biosimilars out to create the value that they offer. That's kind of how we think about it.
No, that all makes good sense. I appreciate that. I think we're just about up on time here. I think it's a good place to wrap up. I wanted to thank Tim and Alexis for being with us today. Tim, I always appreciate the discussion and your time. Thanks everybody for joining. I hope everybody continues to enjoy the conference. Thanks so much.
Thanks, Bob.
Thanks.
Thank you.