During the third quarter, we delivered revenue growth of 10%.
We grew adjusted operating income by 12.5%.
We generated adjusted earnings per share of $1.97 and strong cash flow from operations of $5.5 billion.
Given these results and our outlook, we are raising our adjusted earnings per share guidance to $7.90 to $8.
We added over 1.3 million new integrated pharmacy and medical members through the 2021 and 2022 selling season.
This market-leading solution offers a national network of physicians virtually and access to convenient face-to-face care in our MinuteClinic locations when needed, often with 0 co-pay.
Our program has grown to 30 customer accounts with over 750,000 eligible members as of January 1, 2022.
Healthcare benefits revenue increased 9.5% year over year.
Strength in government services helped drive an adjusted operating income increase of 2.4% versus prior year despite higher costs related to COVID-19, net of deferred care primarily within our commercial book.
Our medical benefit ratio of 85.8% was above our expectations, driven by COVID-related costs, primarily driven by commercial.
Year to date, Medicare Advantage membership has grown 9.2%.
Our strong performance in Stars continues, as you saw for 2022, with 87% of our members in Star plans rated four and higher, up from 83% in 2021.
In our commercial business, we expect moderate growth in 2022 for national accounts, driven by both increased sales, which are up approximately 50% year over year, and a 95% client retention rate.
Enrollment began on Monday, and we anticipate our co-branded CVS Aetna offering and benefit design focused on consumer choice will result in gains of at least 100,000 new members in 2022.
We delivered third quarter revenue growth of 9.3% and adjusted operating income growth of 9.5% year over year.
For the 2022 selling season, we achieved a 98% retention rate.
We drove $10.4 billion of growth new business, resulting in $8.9 billion of net new business wins, providing evidence of our market-leading trend management, transparency customer service, and integrated offerings.
We maintained a strong momentum this quarter with specialty revenue up 8.7% versus prior year.
We delivered 10% revenue growth and 22% adjusted operating income growth year over year.
Pharmacy sales and prescriptions filled both increased 8% year over year, largely driven by COVID-19 vaccine administration and core pharmacy services.
Our patient satisfaction scores remain high with approximately 90% satisfied with their experience in our CVS Health locations.
We administered 11.6 million COVID-19 vaccines and 8.5 million COVID-19 tests in the quarter.
Since our program began, we have administered 43 million vaccines and approximately 38 million tests.
This new capability has driven over 1 million visits per month to vaccination records on cvs.com.
Front store sales momentum also continued with revenue growth of 13% versus prior year.
In fact, this year, 12.5% of new COVID-19 testing customers chose to fill new prescriptions or receive a COVID-19 vaccination with CVS Health.
Next, we are further strengthening the consumer experience through the expansion of digital services and platforms that connect to health services and in-person channels for our more than 35 million unique digital customers.
For example, more than 70% of CVS Pharmacy customers are enrolled in our text messaging programs today.
Within that group this quarter, adherence outreach drove 10% growth in prescriptions filled.
Last quarter, we announced the phased increase in the minimum wage to $15 an hour by July 2022.
Nearly 20,000 pharmacists, pharmacy technicians, and nurses recently joined the CVS Health team supporting flu season, as well as COVID-19 vaccinations and testing.
In addition to targeted vaccine and booster education efforts, we provided 31 million meals this year to people suffering from food insecurity and invested in 2,800 affordable housing units in 30 cities.
By helping address the social determinants of health, permanent housing can reduce healthcare costs by 59%.
We are guiding to a strong year end, all possible due to the leadership and commitment of our over 300,000 CVS Health colleagues that bring their heart to every moment of our customers' health.
Total revenues of $73.8 billion increased 10% year over year with robust growth in all three segments.
We reported adjusted operating income of $4.1 billion, a 12.5% increase versus the prior year.
with year-to-date cash flow from operations now exceeding $14 billion.
Adjusted earnings per share of $1.97 represent a nearly 19% year-over-year increase, generated by our adjusted operating income growth and lower interest expense resulting from our ongoing deleveraging efforts.
Healthcare benefits revenue increased by 9.5% year over year, driven by sustained growth in our Government Services business, slightly offset by the repeal of the health insurance fee.
In the third quarter, we saw Medicaid membership grow sequentially by 67,000 members across multiple geographies.
Medicare Advantage membership also continued to grow in the quarter, increasing by 42,000 members sequentially and representing year-over-year growth of 9.8%.
Our Medicare Advantage franchise continues to be a powerful growth engine with Medicare Advantage membership more than doubling since the third quarter of 2015, representing a 15% compound annual growth rate.
Second, COVID testing costs, which we had expected to moderate during the third quarter, also approached January 2021 levels and were more than 1.5 times the average we experienced in the second quarter.
It is critical to recognize the outsized impact of COVID testing on overall claim costs as testing costs represented approximately 35% of gross COVID costs in the quarter.
The resultant medical benefit ratio for the quarter of 85.8% was above our forecast and driven almost entirely by the higher-than-expected commercial COVID testing and treatment costs.
Days claims payable of 51 at the end of the third quarter is three days higher sequentially and two days above prior year.
2021 is expected to be the second year of adjusted operating income growth in excess of 10%.
This sustained growth has been driven by our track record of delivering industry-leading drug trend on behalf of our clients, our proven industry-leading capabilities, particularly in the specialty pharmacy arena our outstanding customer service, as reflected by our over 98% renewal rate for 2022.
During the third quarter, pharmacy revenues increased by 9.3% year over year, driven by increased pharmacy claims volume, growth in specialty pharmacy, and brand inflation.
Total pharmacy membership increased by 1.6 million lives sequentially, primarily reflecting growth in government programs.
Total pharmacy claims processed grew nearly 7% above the prior year.
Pharmacy adjusted operating income exceeded expectations in the quarter, up more than $150 million or 9.5% year over year.
Total revenue of just under $25 billion increased by $2.3 billion or 10% year over year.
Approximately half or $1.2 billion is attributable to the contributions from the more than 11 million COVID vaccines and over 8 million COVID tests we administered combined with strong front store sales driven by demand for over-the-counter COVID test kits and related treatment categories.
With this quarter's results, we are now on pace to deliver about 44 million to 49 million COVID vaccines and 28 million to 33 million COVID tests for full year 2021.
The remaining half or 1.1 billion was driven by a combination of sustained pharmacy growth and broad strength in front store trends across a range of categories, partially offset by continued pharmacy reimbursement pressure.
This strong revenue growth, combined with a 70-basis-point improvement in adjusted operating margin, produced adjusted operating income that exceeded our forecast and drove a year-over-year increase of $300 million.
Our liquidity and capital position remained excellent at the end of the third quarter with cash from operations of $5.5 billion for the quarter and $14.3 billion year to date.
Through our proactive liability management transaction in August, we paid down $1.1 billion in net long-term debt in the quarter.
As of the end of the third quarter 2021, we have repaid a net total of $18.7 billion in long-term debt since the close of the Aetna transaction.
In addition, we returned over $650 million to shareholders through our quarterly dividend.
We are raising our total revenue outlook to $286.5 billion to $290.3 billion and adjusted operating income outlook to $16.4 billion to $16.6 billion.
We are also increasing expected full year cash flow from operations to a range of $13 billion to $13.5 billion.
For the healthcare benefits segment, we are lowering our full year adjusted operating income guidance from $5.25 billion to $5.35 billion to $4.9 billion to $5 billion.
We expect the full year medical benefit ratio to be in a range of 84.4% to 85.6% or an increase of 30 basis points from our prior range.
For pharmacy services, given the continued strength in the quarter and our visibility to the remainder of the year, we are increasing full year 2021 adjusted operating income guidance to $6.85 billion to $6.94 billion, representing year-over-year growth of 20.5% to 22%.
In the retail/long-term care segment, we are also increasing our full year 2021 adjusted operating income guidance to $6.98 billion to $7.07 billion.
While there are still many factors to play out, we believe that current analyst estimates for 2022 adjusted earnings per share of approximately $8.20 are within our anticipated initial guidance range.
We estimate these factors combined represent approximately $0.40 per share.
Using the midpoint of our updated 2021 adjusted earnings per share guidance range, which is $7.95, these adjustments create a 2021 baseline of $7.55.
For retail, we expect that COVID-19 vaccine and testing volume, which is expected to generate over $3 billion of revenue in 2021, will decline significantly in 2022 to 30% to 40% of the volume we administered in 2021.
With all of this in mind, the current consensus of analyst estimates of approximately $8.20 for adjusted earnings per share would represent about an 8% increase over the 2021 baseline.

Summary:
We grew adjusted operating income by 12.5%.
We generated adjusted earnings per share of $1.97 and strong cash flow from operations of $5.5 billion.
Given these results and our outlook, we are raising our adjusted earnings per share guidance to $7.90 to $8.
In fact, this year, 12.5% of new COVID-19 testing customers chose to fill new prescriptions or receive a COVID-19 vaccination with CVS Health.
Total revenues of $73.8 billion increased 10% year over year with robust growth in all three segments.
We reported adjusted operating income of $4.1 billion, a 12.5% increase versus the prior year.
Adjusted earnings per share of $1.97 represent a nearly 19% year-over-year increase, generated by our adjusted operating income growth and lower interest expense resulting from our ongoing deleveraging efforts.
Approximately half or $1.2 billion is attributable to the contributions from the more than 11 million COVID vaccines and over 8 million COVID tests we administered combined with strong front store sales driven by demand for over-the-counter COVID test kits and related treatment categories.
We are also increasing expected full year cash flow from operations to a range of $13 billion to $13.5 billion.