Earnings Labs

CVS Health Corporation (CVS)

Q3 2018 Earnings Call· Tue, Nov 6, 2018

$83.14

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Transcript

Michael P. McGuire

Management

Good morning, everyone. I'm Mike McGuire, Senior Vice President of Investor Relations for CVS Health. Thanks for standing by and thanks for joining us for our third quarter 2018 earnings conference call. As a reminder, this call is being recorded on Tuesday, November 6, 2018. In addition to this call and our press release, we have posted a slide presentation on our website that summarizes the information in our prepared remarks as well as some additional facts and figures regarding our operating performance and guidance. Our Form 10-Q will be filed at the end of the day today and that too will be available on our website. After prepared remarks, we'll be opening the call up for Q&A. In order to provide more people with the chance to ask their questions, please limit yourself to no more than one question with a quick follow-up. During this call, we will make certain forward-looking statements that reflect our current views related to our future financial performance, future events and industry and market conditions as well as the expected consumer benefits, financial projections and synergies from the soon to be completed acquisition of Aetna. These forward-looking statements are subject to risks and uncertainties that could cause actual results to differ materially from what maybe indicated in the forward-looking statements. We strongly encourage you to review the information in the reports we file with the SEC regarding these specific risks and uncertainties, in particular, those that are described in the Risk Factors section of our most recently filed Annual Report on Form 10-K and the cautionary statement disclosures in our Quarterly Report on Form 10-Q. You should also review the section entitled Forward-Looking Statements in our earnings press release. Additionally, we will use non-GAAP financial measures when talking about our company's performance during this call. In accordance with SEC regulations, you can find a discussion of these non-GAAP measures and the comparable GAAP measures in the associated reconciliation document to be posted on the Investor Relations portion of our website. And as always, today's call is being webcast on our website and it will be archived there following the call for one year. Now, I'll turn this over to our President and CEO, Larry Merlo.

Larry J. Merlo

Management

Thanks, Mike. Good morning everyone and thanks for joining us today. We're pleased with the solid performance of our business in the third quarter, and strong revenue and adjusted earnings per share along with significant cash flow year-to-date demonstrate our success in driving value. And I would note that Aetna reported its quarterly results on October 30, which were also strong. And the performance of both companies highlights the very solid financial foundation on which we will build our revolutionary new model, which will transform the health care experience for consumers and, in the process, deliver substantial value for our shareholders. Now as most of you know, we received Department of Justice approval of the transaction on October 10 and we're now in the final stages of the state approval process. Of the 28 states, we have approvals in 23 including Connecticut, our lead regulator, and we're well down the line with the remaining five and expect to close prior to Thanksgiving. In the meantime, our integration work continues to make great progress and our teams are working extremely well together to assure that once final approvals are obtained, we can immediately begin to execute our integration plans. Both CVS and Aetna are passionate about revolutionizing the consumer health care experience and while we have been clear that the cost savings are substantial, this transaction is about the significant value creation that will be realized as a result of growth. We'll be able to share more of the specifics after our two teams come together to begin the real groundbreaking work, but we thought it would be helpful to get a bit more granular by highlighting the work streams we have underway. And our integration and innovation teams' immediate priorities in preparation for close fall into two broad categories: first,…

Eva C. Boratto

Management

Thanks, Larry, and good morning, everyone. I look forward to seeing many of you in person in the weeks and months ahead. This is a transformational moment for our company and I'm excited to have the opportunity in this new role to help shape the future of our combined companies. Over the past number of months, I've been deeply involved in our integration and planning effort, and I look forward to helping lead the company in bringing this vision to life. This morning, I'll share some business and financial highlights and provide a brief update on our guidance. Additional details are included in the slide presentation we posted on our website as well as in our SEC filings. Overall, our financial performance was solid as we met or exceeded all elements of our guidance in the quarter. Let me start with a review of our capital allocation program. Year-to-date through the third quarter, we have generated approximately $4.9 billion in free cash, in line with our expectation. Our full year expectations of approximately $7 billion for the standalone business remain on track. Due to the acquisition, our share repurchase program and our shareholder dividend increases remain suspended until we achieve a leverage ratio in the low 3 times adjusted debt-to-EBITDA. In Q3, $2.25 billion of senior notes were paid at maturity, and upon the closing of the deal, we'll take on $8.2 billion of Aetna senior notes. As discussed previously, with the addition of Aetna's business and balance sheet and given the additional debt issued for the acquisition, our combined company pro forma trailing 12 months leverage ratio is expected to be approximately 4.6 times. We are committed to improving this ratio to about 3.5 times within two years after closing, utilizing the strength of our business and our strong…

Larry J. Merlo

Management

Thanks, Eva. And as we near the close of the transaction, we are confident in the long-term value we believe this deal will create for shareholders and the clients and members we serve. Before I turn the call over to your questions, I'd like to ask that you reserve time in your calendars for our CVS Health Analyst Day, which will be held on Tuesday, June 4 in New York City. Again, that's Tuesday, June 4. With several months of integration planning under our belts, our senior management team will be able to provide you with a deeper dive into our short and long-term strategies for growth, updates on our integration work, and the status of our efforts to drive both short and long-term synergies and medical cost savings. In the meantime, as Eva mentioned, we won't be silent. We know how important it is that you thoroughly understand our strategy, our progress, and the benefits we expect to derive from the bold, disruptive, and truly unique model we are creating. Our companies have put in many hours of thoughtful and meaningful work to get to this point and I would like to thank both the CVS and Aetna teams for their contributions. And we certainly look forward to welcoming our new colleagues from Aetna upon closing. We know there is a lot more work ahead of us and we've got the team and the plan to get it done. So, with that, Jon Roberts, our Chief Operating Officer, is joining us today for the Q&A. And let's go ahead and open it up for your questions.

Operator

Operator

And our first question comes from the line of Ricky Goldwasser with Morgan Stanley. Please proceed. Your line is open.

Ricky R. Goldwasser

Analyst · Morgan Stanley. Please proceed. Your line is open

Yeah, hi, good morning. Thank you for all the details, and Eva, welcome, I'm looking forward to working with you in the future. A couple of questions here. I appreciate it's a little bit early to talk about 2019 and 2020, but when you announced the deal you gave us some idea also of how we should think about the accretion in year two. Do you have any updated thoughts for us or give us some context of how we should be thinking about that or any changes from what you disclosed in the past?

Eva C. Boratto

Management

So, hi, Ricky. This is Eva. I look forward to meeting you or working with you in the future. We have not changed our point of view on the value being created by the transaction. As you know, and as Larry stated earlier on the call, we have increased our synergy target to more than $750 million in year two and feel very comfortable with that. So overall, we're comfortable with our previous comments.

Ricky R. Goldwasser

Analyst · Morgan Stanley. Please proceed. Your line is open

Okay. And when we think about the pilot program, the potential opportunity there, is the pilot really going to be focused on Aetna members? Or do you have early health plan customers that are – early adopters that are interested in participating as well? And if you can give us some more color on how we should think about the opportunity that relates both to your commercial customers but also to the faster-growing Medicare population that you manage?

Larry J. Merlo

Management

Sure. Ricky, good morning. It's Larry. Ricky, we will start obviously with the Aetna members where, as we mentioned in our prepared remarks, where the integration and innovation teams are working closely around that. But as you've heard us state many times, our goal is to create an open platform model that we can partner broadly. Today, we've got more than 70 health plan clients, and I do believe that there'll be elements of innovation that will apply broadly in the marketplace. But to be clear, we'll be starting first with our Aetna members.

Michael P. McGuire

Management

Next question, operator.

Operator

Operator

Thank you. Our next question comes from the line of Ralph Giacobbe with Citi. Please proceed. Your line is open.

Ralph Giacobbe

Analyst · Ralph Giacobbe with Citi. Please proceed. Your line is open

Thanks. Good morning. I just want to go back to the – to exceeding the $750 million. Any way you can sort of help frame the size of that or how meaningful above the $750 million where that incremental savings is coming from, and maybe the visibility that you have on that? And then the last piece is just the pacing of it. Obviously, it's a two-year target. Is it half and half? Is the bulk of it front-end loaded? Just any consideration of timing around that capture (31:20).

Larry J. Merlo

Management

Yeah, Ralph, it's Larry. Listen, we will talk more about that as we get into next year and talk more about 2019 and beyond. Obviously, the integration teams are doing a terrific job, as we mentioned in our prepared remarks. And listen, we're continuing to push the teams. I don't want to say that we're done yet. And again, we've talked about the areas of opportunity as part of the initial integration work. There's really nothing that has changed beyond that. We've talked about some expense and operating savings as well as some elements of medical cost savings that are – I'll put it under the heading of low-hanging fruit from the two companies coming together. So again, we'll talk more about that as we get into next year in terms of quantifying the cadence of it as well as the dollar value.

Ralph Giacobbe

Analyst · Ralph Giacobbe with Citi. Please proceed. Your line is open

Okay. All right. Fair enough. And then just to follow up, can you give any more details around the new economic models you're discussing with consultants and customers? Is that largely fee-based with risk sharing? Any detail there? And then, maybe also what the reception has been to this point in going back to those customers and consultants? Thanks.

Jonathan C. Roberts

Analyst · Ralph Giacobbe with Citi. Please proceed. Your line is open

Yeah. Ralph, this is Jon. So yeah, today the model that is in the marketplace is based on unit discounts off of AWP, and we feel there's an opportunity to create better alignment and reduce the complexity. So when we talk about alignment, today we align around not only unit discounts, but we think there's an opportunity to align around drug mix, which also drives overall cost to our clients. And that's not in the pricing model today. And when we think about complexity, there's 14 pricing levers, approximately, that consultants use to evaluate and compare price points. But again, there's no net cost to the client based on changes to drug mix that are driven by formularies that we have in the marketplace. So we feel like there's an opportunity to greatly simplify the model and create alignment. I would say the clients are very interested and I think the market is ripe for this type of change, and we'll have more to say about this next year.

Ralph Giacobbe

Analyst · Ralph Giacobbe with Citi. Please proceed. Your line is open

Okay. Thank you.

Operator

Operator

Thank you. Our next question comes from the line of Michael Cherny with Bank of America Merrill Lynch. Your line is open. Please proceed.

Michael Cherny

Analyst · Michael Cherny with Bank of America Merrill Lynch. Your line is open. Please proceed

Good morning, and thanks for all the details as well. Thinking about the quarter, and I know, again, not trying to get to 2019 guidance, but if you think about the performance on the Retail/LTC side, you've seen the strong script growth come in over the course of the year thanks to your payer partnerships and PBMs. How do you think, especially in a future world where you own Aetna, some of those preferred or narrower networks start to develop for other payers that are not Aetna? And what is the appetite, as you've seen yourself setting up for 2019 network access, for either expansion or potentially even reductions of preferred networks?

Eva C. Boratto

Management

Hi, Mike. This is Eva. Let me try to break apart your question. Overall, from a script performance, we're very – extremely pleased with the progress that we've made achieving nearly 9% script comp growth this year. That growth came from three different key areas: our clinical program, our network arrangements beyond Caremark as a PBM with other payers, and including our strong position in Med D. So we continue to see substantial opportunity here to continue to outpace the market and continue to grow our retail share.

Jonathan C. Roberts

Analyst · Michael Cherny with Bank of America Merrill Lynch. Your line is open. Please proceed

And Michael, this is Jon. I think as CVS and Aetna comes together and with our programs, we can demonstrate the activities that pharmacies can drive around improving health and lowering overall healthcare costs. We think there's an opportunity to move the market to more performance-based networks where part of the pharmacies' reimbursement will be based on their ability to execute against clinical programs that do lower costs for our clients. So I think there's lots of opportunity here.

Michael Cherny

Analyst · Michael Cherny with Bank of America Merrill Lynch. Your line is open. Please proceed

Great. Thanks. Just one quick housekeeping question. The five states that are left, I believe New York and California are two. Can you just update us on where the other three are?

Larry J. Merlo

Management

Sure. Mike, it's Larry. Let me just talk about where we're at with the remaining states broadly. You mentioned New York, we're pretty far down the road in our engagement with the Department of Financial Services. We're in active and productive discussions. We look forward to bringing those conversations to a successful close in the very near term. California, I am pleased that after productive discussions and engagement, we have reached agreement on all the material terms with the state. And we're in the process of finalizing the form of agreement and all the appropriate paperwork. We expect that that will be done over the next couple days. As far as the remaining couple of states, what I can add is that New Jersey was the very last state to have a hearing. That took place yesterday. So the other couple of states are in the process of finalizing their orders and all of that's reflected in our earlier comments that we expect to close before Thanksgiving.

Michael Cherny

Analyst · Michael Cherny with Bank of America Merrill Lynch. Your line is open. Please proceed

Perfect. Thanks, Larry.

Larry J. Merlo

Management

All right. Thanks, Mike.

Operator

Operator

Thank you. Our next question comes from the line of Lisa Gill with JPMorgan. Your line is open. Please proceed.

Lisa C. Gill

Analyst · Lisa Gill with JPMorgan. Your line is open. Please proceed

Great. Thanks very much. Eva, when we look at where current consensus is for 2019, I know that some people have the transaction included, some don't have it included. When we think about core CVS in 2019, is there a way to maybe think about some of the headwinds and tailwinds for the core business, so that everybody can get aligned? And then Aetna is going to be what it's going to be when you add that on top of it?

Eva C. Boratto

Management

Yes. Thanks, Lisa, for the question. Obviously, we're going to have much more to say in February, but let me try to outline for you some of the moving pieces. As I think about tailwinds we just spoke about one of them, continued strength in our retail script growth and outpacing the market due to the programs I mentioned previously. As you heard on the call, PBM had a net positive selling season albeit lower than the last few years still net positive and we continue to see specialty as a growth driver. Streamlining continues – our expectations continue to accelerate there to deliver the long term savings Dave outlined a couple of years ago. From a headwind's perspective, I would say it's going to be a lighter year from a break-open generics perspective. You can think about pricing and reimbursement pressures at comparable levels to what we've seen the last few years. And obviously we'll have the wrap of the tax reform investment that started about mid-year this year. The other thing is, there are also some unknowns with the regulatory changes. And some of those what HHS is talking about could be positive or negative. So we're going to continue to evaluate that and have our clarity on our call in February.

Lisa C. Gill

Analyst · Lisa Gill with JPMorgan. Your line is open. Please proceed

Okay. That's helpful. And then, Larry, looking back at the slides where you talk about the building blocks of multiple levers being medical cost, membership, et cetera. As we think about the health plan business and growth in membership, there really hasn't been a lot of growth in membership for Aetna over the last several years. Can you talk about philosophically how you think about trading off membership growth for price in the market?

Larry J. Merlo

Management

Well, Lisa, as you've heard us mention since we announced the transaction, actually it's coming up on a year, that we really view the opportunity of the two companies coming together as a growth story. And obviously, there's – continues to be tremendous opportunity in the Medicare space. And I do believe for the reasons that we've begun to talk about, to be clear we have a lot of work ahead of us. But you look at the billions of dollars that are being spent unnecessarily they could be prevented, avoided in just the management of chronic disease. And the opportunity through this new model to meaningfully help people achieve a better health outcome at a lower cost or reduced cost we believe can create a new model that will allow for membership growth in the marketplace. So, again, we've got a lot of work ahead of us, but that's the trajectory that we're working towards.

Lisa C. Gill

Analyst · Lisa Gill with JPMorgan. Your line is open. Please proceed

I appreciate the comments.

Larry J. Merlo

Management

Thanks, Lisa.

Operator

Operator

Our next question comes from the line of Robert Jones with Goldman Sachs. Your line is open. Please proceed.

Robert Patrick Jones

Analyst · Robert Jones with Goldman Sachs. Your line is open. Please proceed

Great. Thanks for the questions. And it sounds like, we'll obviously get a lot more detail not only in February but in June. But Larry you guys did share a few more examples of kind of the longer-term goal of bringing these two companies together. You mentioned medical adherence, infusion, generally expanding the scope of care within the MinuteClinic the concept stores. So, I guess, it seems like we'll get more details and it's a little bit maybe down the road. But I was wondering, if you could maybe just share directionally how we should be thinking about the necessary infrastructure relative to kind of the current CVS footprint in order to accomplish some of these examples that you've laid out today?

Larry J. Merlo

Management

Yeah, Bob, it's Larry. Maybe I'll start, and then I'll ask Eva to jump in as well. But Bob, I think you've probably heard us talk a little bit about that. You look at the CVS community assets today. We've got 10,000 points of distribution in communities all across the country. And we envision a hub-and-spoke concept where as we've talked about the concept stores or some have referred to them as health hubs we don't know what we'll call them yet, okay. But think about those as the hubs, okay? And we would have those in a set number of stores within a given market and the balance of the stores would have a core set of offerings that would serve as a referral source to those hub stores. So from a bricks-and-mortar perspective, I think we have the assets to create that local presence in communities again across the country. And let's not forget about the role that digital plays or the fact that we're going to have almost 40,000 healthcare professionals that not just work within those bricks-and-mortar assets, but – or within a few miles of where people live. So there's the concept of, we can come to them at their doorsteps as well. Maybe I'll flip it over to Eva to talk more about how we're thinking about the CapEx component of that.

Eva C. Boratto

Management

Yeah. Hi, Bob. If you think about our capital allocations, between the two companies our CapEx is about $2.5 billion to $2.8 billion. As Larry said, what we'll be changing in the stores, think about that as a shifting of investment from our normal refreshes to investing in some of these health hub changes for which we will need. So largely, we expect to be able to do this within what you would consider normal CapEx spend.

Robert Patrick Jones

Analyst · Robert Jones with Goldman Sachs. Your line is open. Please proceed

Got it. And then, I guess, just one quick follow-up. If I look at the performance in the Retail gross margin, Eva you mentioned the strong script growth and how some of those programs could help carry that through to next year. The margin decline in the quarter seemed to be a little bit worse than what we saw in the first half. So I was just wondering was there anything worth calling out there? And then relative, again not looking for guidance, but just directionally relative to how script trends are going in the Retail Pharmacy segment. Anything you can share to help us think about how we should be modeling those margins going forward?

Eva C. Boratto

Management

Sure. In terms of the quarter-to-quarter impact, Bob, I would say there was really nothing unique in the third quarter. As CIR (44:23) has become an increasing component and that's performance-based, relative Q2 versus Q3, you had some timing differences there year-over-year. As we look at overall margin, things that will pressure our margins are success in Medicare Part D. We've spoken many times that those are at lower margins. Additionally, as we increase our 90-day penetration that carries a slightly lower margin as well.

Robert Patrick Jones

Analyst · Robert Jones with Goldman Sachs. Your line is open. Please proceed

Okay. Got it. Thanks so much.

Larry J. Merlo

Management

Thanks, Bob.

Operator

Operator

Thank you. Our next question comes from George Hill with RBC. Your line is open. Please proceed.

George Hill

Analyst · RBC. Your line is open. Please proceed

Good morning, guys. Thanks for taking the question. And Eva, welcome to the call. I guess my question is two parts is, I guess, Larry and Eva, number one, can you talk about how you think about synergy delivery gross versus net? So, I guess, how much gets generated by the end of year two versus how much flows to the bottom line? And then typically when you see transactions of this size, there's a significant level of investment spend that comes with executing the deal. I don't know if you've contemplated that as we think about 2019 and if there's any color that you can provide around that. Like is there either a big charge or a big investment spend number coming forward that investors should be looking towards?

Larry J. Merlo

Management

Yeah, George, it's Larry. I'll start. George, in terms of what we talked about in our prepared remarks around the synergies, those are net synergy numbers reflecting investments that we would need to make, I'll say, ongoing investments that would be tied to achieving those synergy dollars.

George Hill

Analyst · RBC. Your line is open. Please proceed

Okay. That's all I have. Thank you.

Operator

Operator

Thank you. Our next question comes from the line of Eric Percher with Nephron Research. Please proceed. Your line is open.

Clayton Meyers

Analyst · Eric Percher with Nephron Research. Please proceed. Your line is open

Hi. Good morning. This is actually Clayton Meyers on the line for Eric this morning. Eva, welcome to the team. Looking forward to working with you going forward. I know people have been kind of asking about the 2020 EPS number, and I want to try to come at it from a different direction. And when the time the deal was announced, it's expected to be accretive relative to consensus at that point. Is the way that we should think about it is to take that consensus number and then kind of adjust it for tax reform and then adjust it for the lines of the business that's happening, the increased operating investment that's happening in the business? Do you think that logic is kind of roughly sound as you think about where to base the accretion number as we go forward to 2020?

Eva C. Boratto

Management

So Eric (sic) [Clayton], this is Eva. Obviously you're on the mark in terms of tax reform has occurred since we jumped off of that consensus number. So that's one of the biggest things that have happened. The base is no longer valid, so it's difficult with all of the moving pieces for us at this point to update that. But what I can say is as it pertains to the transaction, there have been no changes.

Clayton Meyers

Analyst · Eric Percher with Nephron Research. Please proceed. Your line is open

Okay. Very cool. It helps. Thanks for the color. That's helpful. Then just one other question just going back to the Part B mechanisms that's coming through with step therapy. Is that an area that you think CVS's asset in Coram Infusion particularly could benefit as it comes to CVS? And how have the payers been responsive to CVS' PBM capabilities within the space, given that Part B hasn't really been a space that PBMs have played with – with in the past. And then finally, just a follow-up to that. With the new advance notice for the Part B IPI, would that impact CVS' business in any way? And how should we think about the role that CVS could potentially play as a vendor for that proposal?

Larry J. Merlo

Management

Yeah, it's Larry. Let me just talk broadly about the proposals that we've seen in terms of [Part] B to [Part] D. And obviously we see a tremendous opportunity to be an important part of that solution for the reasons that I think have been well quantified in terms of there is more competition today in Part B with the various therapies from where the reimbursement model started with Part B many years ago when there were single source products and very little competition. We would sit here today and say the Part B mimicking the role that the private sector plays as part of Part D is the answer. I would sit here and say it's highly unlikely that an international price index, the other proposal, would result in net prices that are lower than what the private sector can negotiate through competition and innovation as part of the processes that exist with Part D. And we're excited by the opportunity to play a bigger role there.

Michael P. McGuire

Management

Melanie?

Operator

Operator

Thank you. Our next question comes from the line of Justin Lake with Wolfe Research. Your line is open. Please proceed.

Justin Lake

Analyst · Justin Lake with Wolfe Research. Your line is open. Please proceed

Thanks. Good morning. My first question is just on your segment guidance. It appears the Retail business for the fourth quarter would be down mid-teens on an EBIT perspective with the PBM up high-single digits. So just with that divergence, if my math is correct in the first place, I was hoping you can share what is driving that seasonality and divergence versus the year-to-date results, and how we should think about that as informing our view into 2019, if at all?

Eva C. Boratto

Management

Hi, Justin. This is Eva. As it pertains to our guidance, I think your math is – we said for the year down low-single digit, so in the quarter, obviously given our year-to-date performance, you would be down in the mid- to high-single digits, depending on what point you picked. In terms of any context for 2019, it's really too early to provide as I earlier discussed some of the headwinds and tailwinds.

Justin Lake

Analyst · Justin Lake with Wolfe Research. Your line is open. Please proceed

Okay. And then just a follow-up on the debt side. Is there anything you could share with us in terms of where you expect your gross and net debt to look like at year end post the deal close?

Eva C. Boratto

Management

Let me get back to you on that, Justin, if I could.

Justin Lake

Analyst · Justin Lake with Wolfe Research. Your line is open. Please proceed

Okay. Thank you very much.

Operator

Operator

Our next question comes from the line of Charles Rhyee with Cowen. Please proceed. Your line is open.

James Auh

Analyst · Charles Rhyee with Cowen. Please proceed. Your line is open

Hi. It's actually James on for Charles. So, on Teladoc, recently you talked about the soft rollout of the telehealth capabilities in about 18 states and Washington D.C. Can you talk about how Teladoc affects your clinic strategy and when we should expect a full-blown rollout?

Larry J. Merlo

Management

Yeah, James, it's Larry. As you mentioned, we've been rolling it out state-by-state. There are some state processes that we're going through to turn them on. And once we get more of a critical mass, we will begin broader marketing of that. As you look at the complementary strategy to the clinics, it has the opportunity to expand our reach as well as expand our scope of practice. And those were the use cases that we've been piloting. We're pleased with how it's going and we see more opportunities there, especially with the role that it can play after-hours, the role that it can play as part of what the announcement that you saw in terms of the role that telemedicine can play with Medicare, and more to come.

James Auh

Analyst · Charles Rhyee with Cowen. Please proceed. Your line is open

Okay. Great. And so synergies are now expected to exceed $750 million by year two, which is ahead of the original expectations. Can you elaborate for us where the upside in synergies is coming from? Is it more corporate expenses, reduction in medical costs? Also can you maybe touch on the revenue synergy opportunities a little bit more? Thank you.

Larry J. Merlo

Management

Yeah, James. It's really – we're not going to break those out at this point. It's really the areas that we broadly talked about. And as I mentioned earlier, the teams are continuing to work hard in those areas. And we'll talk about the opportunities for revenue synergies as we work through our longer-term plans. And we'll get into more details around that next year. So Melanie, we'll take – I think we have time for two more questions.

Operator

Operator

Thank you. Our next question comes from the line of Steven Valiquette with Barclays. Please proceed. Your line is open.

Steven Valiquette

Analyst · Steven Valiquette with Barclays. Please proceed. Your line is open

Thanks. Good morning, everyone. So during the quarter, there was obviously a large expanded store-within-a-store deal announced away from you for greater lab services in the retail pharmacy setting. So I'm just curious if you can maybe just remind investors what your general preferences are in relation to that type of opportunity, or are you just kind of looking past that event in the marketplace and just focusing on the other concepts that you're talking about for your retail footprint? Thanks.

Larry J. Merlo

Management

Yeah, Steve, there are certainly opportunities in front of us as we think about the companies coming together. And you think about whether it's through integration and absolutely having aligned incentives, the value that can be created, that can't necessarily be achieved through partnerships. At the same time, I want to be clear, we are certainly not opposed to partnerships. And as I mentioned earlier, as we build out these new programs and service offerings, we intend to create an open platform for others to participate in and we'll go from there.

Steven Valiquette

Analyst · Steven Valiquette with Barclays. Please proceed. Your line is open

Okay. All right. Thanks.

Operator

Operator

And our final question comes from the line of David Larsen with Leerink Partners. Please proceed, your line is open.

David Larsen

Analyst · Leerink Partners. Please proceed, your line is open

Hi. Can you talk a bit about the PBM selling season? It looks like there was a pretty good increase there, the retention rate looks pretty high, Express Scripts reported a very high retention rate and pretty good core claims growth expectations for 2019. Just how is that shaping up? And what does that leave you to think preliminarily about 2019 growth expectations and operating income? Thanks.

Jonathan C. Roberts

Analyst · Leerink Partners. Please proceed, your line is open

Yeah, David, this is Jon. So, we saw less movement of business from one PBM to another this year, I think that has a lot to do with the mergers that are happening in healthcare. And yeah, our retention as Eva talked about was 98%, so very happy and a little higher than we've historically had. As far as 2020, it's too early for us to really comment on the RFP activity, it's just starting to gear up. And then, as we mentioned, we do have the Anthem contract that's coming onboard for 1/1/2020, which is a very large health plan obviously.

Eva C. Boratto

Management

And as we think about that Anthem contract, you can think about it in terms of a net accounting contract given the terms of that business.

David Larsen

Analyst · Leerink Partners. Please proceed, your line is open

Okay. Has there been any sort of shift in the sort of profitability or nature of the PBM contracts that are going to roll on in 2019 and 2020, like any general thoughts there? Has it been a highly competitive selling season? Has pricing been aggressive? Or any comments there would be helpful.

Jonathan C. Roberts

Analyst · Leerink Partners. Please proceed, your line is open

This is Jon. The pricing environment, it's a very competitive industry as we all know, and it typically gets a little more competitive as you go through the season. I would say it's consistent with what we've seen over the last several years, so not really a step change. We do, from time-to-time, see some PBMs get very aggressive on certain accounts based on their own strategies, and I think this year is no different than what we've seen in years past.

David Larsen

Analyst · Leerink Partners. Please proceed, your line is open

Okay. And then just one more quick one for Eva. Can you talk a little bit about your streamlining effort there? And operating income sort of growth expectations in retail, retail's obviously been under a lot of pressure. Just any thoughts around cost reduction efforts and initiatives and when can that streamlining gross benefit turn into a net benefit? Any thoughts around that at a high level would be great Eva? Thanks.

Eva C. Boratto

Management

Yeah. So overall as it pertains to the streamlining, we're extremely pleased with the results we've rolled out numerous programs, we highlighted the one in specialty today. We're also looking to reduce overall call volume that comes into the retail channels through better sharing of data between the PBMs not in the Caremark, but other PBMs, not only to reduce our cost but to make the customer experience better as well. We continue to expect to see these benefits ramp in 2019 to give broader color than that we'll provide more in February.

Larry J. Merlo

Management

And Dave, listen, we have – I think you know – we have always had a cost focus in terms of how can we do things better while continuing to enhance levels of service. So it's not just about cost cutting, okay, but it's about doing things faster, better and cheaper. And that's – we believe that that's in our DNA and that work never stops. Before we round out the call we're going to – let's go back to I think Justin had asked the question about the debt, so...

Eva C. Boratto

Management

Justin, you'd asked the question about the total debt on the balance sheet post closure. It would be around $75 billion when you look at our existing debt plus bringing on Aetna steps.

Larry J. Merlo

Management

So with that, everyone, thanks again for your time this morning. And as always, if there are any follow-up questions, Mike's available. And we'll see many of you soon, and have a great Thanksgiving.

Operator

Operator

Ladies and gentlemen, that does conclude today's conference call. We thank you for your participation and ask that you please disconnect your lines.