CVS HEALTH CORP, 10-K filed on 2/7/2024
Annual Report
v3.24.0.1
Cover Page - USD ($)
 12 Months Ended
Dec. 31, 2023
Jan. 31, 2024
Jun. 30, 2023
Cover [Abstract]      
Document Type 10-K    
Document Annual Report true    
Document Period End Date Dec. 31, 2023    
Current Fiscal Year End Date --12-31    
Document Transition Report false    
Entity File Number 001-01011    
Entity Registrant Name CVS HEALTH CORPORATION    
Entity Incorporation, State or Country Code DE    
Entity Tax Identification Number 05-0494040    
Entity Address, Address Line One One CVS Drive,    
Entity Address, City or Town Woonsocket,    
Entity Address, State or Province RI    
Entity Address, Postal Zip Code 02895    
City Area Code (401)    
Local Phone Number 765-1500    
Title of 12(b) Security Common Stock, par value $0.01 per share    
Trading Symbol CVS    
Security Exchange Name NYSE    
Entity Well-known Seasoned Issuer Yes    
Entity Voluntary Filers No    
Entity Current Reporting Status Yes    
Entity Interactive Data Current Yes    
Entity Filer Category Large Accelerated Filer    
Entity Small Business false    
Entity Emerging Growth Company false    
ICFR Auditor Attestation Flag true    
Document Financial Statement Error Correction [Flag] false    
Entity Shell Company false    
Entity Public Float     $ 88,547,881,979
Entity Common Stock, Shares Outstanding   1,258,449,553  
Documents Incorporated by Reference
The following materials are incorporated by reference into this Form 10-K:
Information contained in the definitive proxy statement for CVS Health Corporation’s 2024 Annual Meeting of Stockholders, to be filed with the Securities and Exchange Commission within 120 days after the end of the fiscal year ended December 31, 2023 (the “Proxy Statement”), is incorporated by reference in Parts III and IV to the extent described therein.
    
Entity Central Index Key 0000064803    
Document Fiscal Year Focus 2023    
Document Fiscal Period Focus FY    
Amendment Flag false    
v3.24.0.1
Audit Information
 12 Months Ended
Dec. 31, 2023
Auditor Information [Abstract]  
Auditor Name Ernst & Young LLP
Auditor Location Boston, Massachusetts
Auditor Firm ID 42
v3.24.0.1
Consolidated Statements of Operations - USD ($)
shares in Millions, $ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Revenues:      
Premiums $ 99,192 $ 85,330 $ 76,132
Net investment income 1,153 838 1,199
Total revenues 357,776 322,467 292,111
Operating costs:      
Cost of products sold 217,098 196,892 175,803
Health care costs 86,247 71,073 64,188
Restructuring charges 507 0 0
Opioid litigation charges 0 5,803 0
Loss on assets held for sale 349 2,533 0
Store impairments 0 0 1,358
Goodwill impairment 0 0 431
Operating expenses 39,832 38,212 37,021
Total operating costs 344,033 314,513 278,801
Operating income 13,743 7,954 13,310
Interest expense 2,658 2,287 2,503
Loss on early extinguishment of debt 0 0 452
Other income (88) (169) (182)
Income before income tax provision 11,173 5,836 10,537
Income tax provision 2,805 1,509 2,548
Net income 8,368 4,327 7,989
Net (income) loss attributable to noncontrolling interests (24) (16) 12
Net income attributable to CVS Health $ 8,344 $ 4,311 $ 8,001
Net income per share attributable to CVS Health:      
Basic (in dollars per share) $ 6.49 $ 3.29 $ 6.07
Diluted (in dollars per share) $ 6.47 $ 3.26 $ 6.02
Weighted average shares outstanding:      
Basic (in shares) 1,285 1,312 1,319
Diluted (in shares) 1,290 1,323 1,329
Dividends declared per share (in dollars per share) $ 2.42 $ 2.20 $ 2.00
Cost, Product and Service [Extensible List] Products Products Products
Products      
Revenues:      
Revenues $ 245,138 $ 226,616 $ 203,738
Services      
Revenues:      
Revenues $ 12,293 $ 9,683 $ 11,042
v3.24.0.1
Consolidated Statements of Comprehensive Income - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Statement of Comprehensive Income [Abstract]      
Net income $ 8,368 $ 4,327 $ 7,989
Other comprehensive income (loss), net of tax:      
Net unrealized investment gains (losses) 1,090 (2,317) (556)
Change in discount rate on insurance reserves (67) 870 255
Foreign currency translation adjustments 0 0 (7)
Net cash flow hedges 5 17 (26)
Pension and other postretirement benefits (61) (168) 20
Other comprehensive income (loss) 967 (1,598) (314)
Comprehensive income 9,335 2,729 7,675
Comprehensive (income) loss attributable to noncontrolling interests (24) (16) 12
Comprehensive income attributable to CVS Health $ 9,311 $ 2,713 $ 7,687
v3.24.0.1
Consolidated Balance Sheets - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Assets:    
Cash and cash equivalents $ 8,196 $ 12,945
Investments 3,259 2,778
Accounts receivable, net 35,227 27,276
Inventories 18,025 19,090
Assets held for sale 0 908
Other current assets 3,151 2,636
Total current assets 67,858 65,633
Long-term investments 23,019 21,096
Property and equipment, net 13,183 12,873
Operating lease right-of-use assets 17,252 17,872
Goodwill 91,272 78,150
Intangible assets, net 29,234 24,803
Separate accounts assets 3,250 3,228
Other assets 4,660 4,620
Total assets 249,728 228,275
Liabilities:    
Accounts payable 14,897 14,838
Pharmacy claims and discounts payable 22,874 19,423
Health care costs payable 12,049  
Health care costs payable   10,142
Policyholders’ funds 1,326 1,500
Accrued expenses 22,189 18,745
Other insurance liabilities 1,141 1,089
Current portion of operating lease liabilities 1,741 1,678
Short-term debt 200 0
Current portion of long-term debt 2,772 1,778
Liabilities held for sale 0 228
Total current liabilities 79,189 69,421
Long-term operating lease liabilities 16,034 16,800
Long-term debt 58,638 50,476
Deferred income taxes 4,311 4,016
Separate accounts liabilities 3,250 3,228
Other long-term insurance liabilities 5,459 5,835
Other long-term liabilities 6,211 6,730
Total liabilities 173,092 156,506
Commitments and contingencies (Note 18)
Shareholders’ equity:    
Preferred stock, par value $0.01: 0.1 shares authorized; none issued or outstanding 0 0
Common stock, par value $0.01: 3,200 shares authorized; 1,768 shares issued and 1,288 shares outstanding at December 31, 2023 and 1,758 shares issued and 1,300 shares outstanding at December 31, 2022 and capital surplus 48,992 48,193
Treasury stock, at cost: 480 and 458 shares at December 31, 2023 and 2022 (33,838) (31,858)
Retained earnings 61,604 56,398
Accumulated other comprehensive loss (297) (1,264)
Total CVS Health shareholders’ equity 76,461 71,469
Noncontrolling interests 175 300
Total shareholders’ equity 76,636 71,769
Total liabilities and shareholders’ equity $ 249,728 $ 228,275
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Consolidated Balance Sheets (Parenthetical) - $ / shares
Dec. 31, 2023
Dec. 31, 2022
Statement of Financial Position [Abstract]    
Preferred stock, par value (in dollars per share) $ 0.01 $ 0.01
Preferred stock, shares authorized (in shares) 100,000 100,000
Preferred stock, shares issued (in shares) 0 0
Preferred stock, shares outstanding (in shares) 0 0
Common stock, par value (in dollars per share) $ 0.01 $ 0.01
Common stock, shares authorized (in shares) 3,200,000,000 3,200,000,000
Common stock, shares issued (in shares) 1,768,000,000 1,758,000,000
Common stock, shares outstanding (in shares) 1,288,000,000 1,300,000,000
Treasury stock (in shares) 480,000,000 458,000,000
v3.24.0.1
Consolidated Statements of Cash Flows - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Cash flows from operating activities:      
Cash receipts from customers $ 345,464 $ 313,662 $ 284,219
Cash paid for inventory, prescriptions dispensed and health services rendered (208,848) (189,766) (165,783)
Insurance benefits paid (84,097) (69,728) (63,598)
Cash paid to other suppliers and employees (34,735) (32,662) (31,652)
Interest and investment income received 1,584 1,026 743
Interest paid (2,418) (2,239) (2,469)
Income taxes paid (3,524) (4,116) (3,195)
Net cash provided by operating activities 13,426 16,177 18,265
Cash flows from investing activities:      
Proceeds from sales and maturities of investments 7,729 6,729 7,246
Purchases of investments (9,043) (7,746) (9,963)
Purchases of property and equipment (3,031) (2,727) (2,520)
Acquisitions (net of cash and restricted cash acquired) (16,612) (139) (146)
Proceeds from sale of subsidiaries (net of cash and restricted cash sold of $2,854 in 2022) 0 (1,249) 0
Other 68 85 122
Net cash used in investing activities (20,889) (5,047) (5,261)
Cash flows from financing activities:      
Commercial paper borrowings (repayments), net 200 0 0
Proceeds from issuance of short-term loan 5,000 0 0
Repayment of short-term loan (5,000) 0 0
Proceeds from issuance of long-term debt 10,898 0 987
Repayments of long-term debt (3,166) (4,211) (10,254)
Repurchase of common stock (2,012) (3,500) 0
Dividends paid (3,132) (2,907) (2,625)
Proceeds from exercise of stock options 277 551 549
Payments for taxes related to net share settlement of equity awards (181) (370) (168)
Other (201) (79) 155
Net cash provided by (used in) financing activities 2,683 (10,516) (11,356)
Net increase (decrease) in cash, cash equivalents and restricted cash (4,780) 614 1,648
Cash, cash equivalents and restricted cash at the beginning of the period 13,305 12,691 11,043
Cash, cash equivalents and restricted cash at the end of the period 8,525 13,305 12,691
Reconciliation of net income to net cash provided by operating activities:      
Net income 8,368 4,327 7,989
Adjustments required to reconcile net income to net cash provided by operating activities:      
Depreciation and amortization 4,366 4,224 4,486
Loss on assets held for sale 349 2,533 0
Store impairments 0 0 1,358
Goodwill impairment 0 0 431
Stock-based compensation 588 447 484
Gain on sale of subsidiaries 0 (475) 0
Loss on early extinguishment of debt 0 0 452
Deferred income taxes (676) (2,029) (402)
Other noncash items 416 332 (390)
Change in operating assets and liabilities, net of effects from acquisitions:      
Accounts receivable, net (6,260) (2,971) (2,703)
Inventories 1,233 (1,435) 735
Other assets (510) (491) (30)
Accounts payable and pharmacy claims and discounts payable 3,618 4,260 2,898
Health care costs payable and other insurance liabilities 394 992 101
Other liabilities 1,540 6,463 2,856
Net cash provided by operating activities $ 13,426 $ 16,177 $ 18,265
v3.24.0.1
Consolidated Statements of Cash Flows (Parenthetical)
$ in Millions
 12 Months Ended
Dec. 31, 2022
USD ($)
Statement of Cash Flows [Abstract]  
Cash and restricted cash sold $ 2,854
v3.24.0.1
Consolidated Statements of Shareholders' Equity - USD ($)
shares in Millions, $ in Millions
Total
Adoption of new accounting standard, adjustment
Total CVS Health Shareholders’ Equity
Total CVS Health Shareholders’ Equity
Adoption of new accounting standard, adjustment
 [2]
Common Shares
Treasury Shares
Common Stock and Capital Surplus
 [3]
Retained Earnings
Accumulated Other Comprehensive Income (Loss)
Accumulated Other Comprehensive Income (Loss)
Adoption of new accounting standard, adjustment
 [2]
Noncontrolling Interests
Shares outstanding, beginning of year balance (in shares) at Dec. 31, 2020         1,733            
Treasury shares outstanding, beginning of year balance (in shares) at Dec. 31, 2020 [1]           (423)          
Beginning of year balance at Dec. 31, 2020 $ 69,701 $ (766) [2] $ 69,389 $ (766)   $ (28,178) [1] $ 46,513 $ 49,640 $ 1,414 $ (766) $ 312
Stockholders' Equity [Roll Forward]                      
Net income 7,989 91 8,001         8,001     (12)
Other comprehensive income (loss) (314)   (314)           (314)    
Stock option activity, stock awards and other (in shares)         11            
Stock option activity, stock awards and other 864   864       864        
ESPP issuances, net of purchase of treasury shares (in shares) [1]           1          
ESPP issuances, net of purchase of treasury shares 5   5     $ 5 [1]          
Common stock dividends (2,644)   (2,644)         (2,644)      
Other increases (decreases) in noncontrolling interests 6                   6
Shares outstanding, end of year balance (in shares) at Dec. 31, 2021         1,744            
Treasury shares outstanding, end of year balance (in shares) at Dec. 31, 2021 [1]           (422)          
End of year balance at Dec. 31, 2021 74,841   74,535     $ (28,173) [1] 47,377 54,997 334   306
Stockholders' Equity [Roll Forward]                      
Net income 4,327 162 4,311         4,311     16
Other comprehensive income (loss) (1,598)   (1,598)           (1,598)    
Stock option activity, stock awards and other (in shares)         14            
Stock option activity, stock awards and other 816   816       816        
Purchase of treasury shares, net of ESPP issuances (in shares) [1]           (36)          
Purchase of treasury shares, net of ESPP issuances (3,685)   (3,685)     $ (3,685) [1]          
Common stock dividends (2,910)   (2,910)         (2,910)      
Other increases (decreases) in noncontrolling interests $ (22)                   (22)
Shares outstanding, end of year balance (in shares) at Dec. 31, 2022         1,758            
Treasury shares outstanding, end of year balance (in shares) at Dec. 31, 2022 (458)         (458) [1]          
End of year balance at Dec. 31, 2022 $ 71,769 $ 454 71,469     $ (31,858) [1] 48,193 56,398 (1,264)   300
Stockholders' Equity [Roll Forward]                      
Net income 8,368   8,344         8,344     24
Other comprehensive income (loss) 967   967           967    
Stock option activity, stock awards and other (in shares)         10            
Stock option activity, stock awards and other 795   795       795        
Purchase of treasury shares, net of ESPP issuances (in shares) [1]           (22)          
Purchase of treasury shares, net of ESPP issuances (1,992)   (1,992)     $ (1,980) [1] (12)        
Common stock dividends (3,138)   (3,138)         (3,138)      
Acquisition of noncontrolling interests 66                   66
Other increases (decreases) in noncontrolling interests $ (199)   16       16       (215)
Shares outstanding, end of year balance (in shares) at Dec. 31, 2023         1,768            
Treasury shares outstanding, end of year balance (in shares) at Dec. 31, 2023 (480)         (480) [1]          
End of year balance at Dec. 31, 2023 $ 76,636   $ 76,461     $ (33,838) [1] $ 48,992 $ 61,604 $ (297)   $ 175
[1] Treasury shares include 1 million shares held in trust for each of the years ended December 31, 2023, 2022 and 2021. Treasury stock includes $29 million related to shares held in trust for each of the years ended December 31, 2023, 2022 and 2021. See Note 1 ‘‘Significant Accounting Policies’’ for additional information.
[2] Reflects the adoption of Accounting Standards Update (“ASU”) 2018-12, Targeted Improvements to the Accounting for Long-Duration Contracts (Topic 944) during the year ended December 31, 2021. See Note 1 ‘‘Significant Accounting Policies’’ for additional information.
[3] Common stock and capital surplus includes the par value of common stock of $18 million as of December 31, 2023 and 2022 and $17 million as of December 31, 2021.
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Consolidated Statements of Shareholders' Equity (Parentheticals) - USD ($)
shares in Millions, $ in Millions
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Statement of Stockholders' Equity [Abstract]      
Treasury shares held in trust (in shares) 1 1 1
Treasury shares held in trust $ 29 $ 29 $ 29
Common stock $ 18 $ 18 $ 17
v3.24.0.1
Significant Accounting Policies
 12 Months Ended
Dec. 31, 2023
Accounting Policies [Abstract]  
Significant Accounting Policies Significant Accounting Policies
Description of Business 

CVS Health Corporation, together with its subsidiaries (collectively, “CVS Health” or the “Company”), is a leading health solutions company building a world of health around every consumer it serves and connecting care so that it works for people wherever they are. As of December 31, 2023, the Company had more than 9,000 retail locations, more than 1,000 walk-in medical clinics, 204 primary care medical clinics, a leading pharmacy benefits manager with approximately 108 million plan members and expanding specialty pharmacy solutions, and a dedicated senior pharmacy care business serving more than one million patients per year. The Company also serves an estimated more than 35 million people through traditional, voluntary and consumer-directed health insurance products and related services, including expanding Medicare Advantage offerings and a leading standalone Medicare Part D prescription drug plan (“PDP”). The Company is creating new sources of value through its integrated model allowing it to expand into personalized, technology driven care delivery and health services, increasing access to quality care, delivering better health outcomes and lowering overall health care costs.

During the year ended December 31, 2023, the Company completed the acquisition of two key health care delivery assets to enhance its ability to execute on its care delivery strategy by advancing its primary care, home-based care and provider enablement capabilities. On March 29, 2023, the Company acquired Signify Health, Inc. (“Signify Health”), a leader in health risk assessments, value-based care and provider enablement services. On May 2, 2023, the Company also acquired Oak Street Health, Inc. (“Oak Street Health”), a leading multi-payor operator of value-based primary care centers serving Medicare eligible patients. Both Signify Health and Oak Street Health are included within the Health Services segment.

In connection with its new operating model adopted in the first quarter of 2023, the Company realigned the composition of its segments to reflect how its Chief Operating Decision Maker (the “CODM”) reviews information and manages the business. The Company’s CODM is the Chief Executive Officer. As a result of this realignment, the Company formed a new Health Services segment, which in addition to providing a full range of pharmacy benefit management (“PBM”) solutions, also delivers health care services in the Company’s medical clinics, virtually, and in the home, as well as provider enablement solutions. In addition, the Company created a new Pharmacy & Consumer Wellness segment, which includes its retail and long-term care pharmacy (“LTC”) operations and related pharmacy services, as well as its retail front store operations. This segment will also provide pharmacy fulfillment services to support the Health Services segment’s specialty and mail order pharmacy offerings. Prior period segment financial information has been recast to conform with the current period presentation.

The Company has four reportable segments: Health Care Benefits, Health Services, Pharmacy & Consumer Wellness and Corporate/Other, which are described below.

Health Care Benefits Segment
The Health Care Benefits segment operates as one of the nation’s leading diversified health care benefits providers. The Health Care Benefits segment has the information and resources to help members, in consultation with their health care professionals, make more informed decisions about their health care. The Health Care Benefits segment offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental and behavioral health plans, medical management capabilities, Medicare Advantage and Medicare Supplement plans, PDPs and Medicaid health care management services. The Health Care Benefits segment’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers (“providers”), governmental units, government-sponsored plans, labor groups and expatriates. The Company refers to insurance products (where it assumes all or a majority of the risk for medical and dental care costs) as “Insured” and administrative services contract products (where the plan sponsor assumes all or a majority of the risk for medical and dental care costs) as “ASC.” The Company sold Insured plans directly to individual consumers through the individual public health insurance exchanges (“Public Exchanges”) in 12 states as of December 31, 2023. The Company entered Public Exchanges in five additional states effective January 2024.

Health Services Segment
The Health Services segment provides a full range of PBM solutions, delivers health care services in its medical clinics, virtually, and in the home, and offers provider enablement solutions. PBM solutions include plan design offerings and administration, formulary management, retail pharmacy network management services, and specialty and mail order pharmacy services. In addition, the Company provides clinical services, disease management services, medical spend management and pharmacy and/or other administrative services for providers and federal 340B drug pricing program covered entities (“Covered Entities”). The Company operates a group purchasing organization that negotiates pricing for the purchase of pharmaceuticals
and rebates with pharmaceutical manufacturers on behalf of its participants and provides various administrative, management and reporting services to pharmaceutical manufacturers. During 2023, the Company completed the acquisition of two key health care delivery assets – Signify Health, a leader in health risk assessments, value-based care and provider enablement services, and Oak Street Health, a leading multi-payor operator of value-based primary care centers serving Medicare eligible patients. The Company also announced the launch of CordavisTM, a wholly owned subsidiary that will work directly with pharmaceutical manufacturers to commercialize and/or co-produce high quality biosimilar products. The Health Services segment’s clients and customers are primarily employers, insurance companies, unions, government employee groups, health plans, PDPs, Medicaid managed care plans, CMS, plans offered on Insurance Exchanges and other sponsors of health benefit plans throughout the U.S., patients who receive care in the Health Services segment’s medical clinics, virtually or in the home, as well as Covered Entities.

Pharmacy & Consumer Wellness Segment
The Pharmacy & Consumer Wellness segment dispenses prescriptions in its retail pharmacies and through its infusion operations, provides ancillary pharmacy services including pharmacy patient care programs, diagnostic testing and vaccination administration, and sells a wide assortment of health and wellness products and general merchandise. The segment also conducts long-term care pharmacy (“LTC”) operations, which distribute prescription drugs and provide related pharmacy consulting and ancillary services to long-term care facilities and other care settings, and provides pharmacy fulfillment services to support the Health Services segment’s specialty and mail order pharmacy offerings. As of December 31, 2023, the Pharmacy & Consumer Wellness segment operated more than 9,000 retail locations, as well as online retail pharmacy websites, LTC pharmacies and on-site pharmacies, retail specialty pharmacy stores, compounding pharmacies and branches for infusion and enteral nutrition services.

Corporate/Other Segment
The Company presents the remainder of its financial results in the Corporate/Other segment, which primarily consists of:

•Management and administrative expenses to support the Company’s overall operations, which include certain aspects of executive management and the corporate relations, legal, compliance, human resources and finance departments, information technology, digital, data and analytics, as well as acquisition-related transaction and integration costs; and
•Products for which the Company no longer solicits or accepts new customers such as its large case pensions and long-term care insurance products.

Basis of Presentation

The accompanying consolidated financial statements of CVS Health and its subsidiaries have been prepared in accordance with accounting principles generally accepted in the United States of America (“GAAP”). The consolidated financial statements include the accounts of the Company and its majority-owned subsidiaries and variable interest entities (“VIEs”) for which the Company is the primary beneficiary. All material intercompany balances and transactions have been eliminated.

Use of Estimates

The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts in the consolidated financial statements and accompanying notes. Actual results could differ from those estimates.

Cash and Cash Equivalents

Cash and cash equivalents consist of cash and temporary investments with maturities of three months or less when purchased. The Company invests in short-term money market funds, commercial paper and time deposits, as well as other debt securities that are classified as cash equivalents within the accompanying consolidated balance sheets, as these funds are highly liquid and readily convertible to known amounts of cash.

Restricted Cash

Restricted cash included in other current assets on the consolidated balance sheets represents funds held on behalf of members and funds held in escrow in connection with agreements with accountable care organizations. Restricted cash included in other assets on the consolidated balance sheets represents amounts held in a trust in one of the Company’s captive insurance companies to satisfy collateral requirements associated with the assignment of certain insurance policies. All restricted cash is invested in time deposits and money market funds.
The following is a reconciliation of cash and cash equivalents on the consolidated balance sheets to total cash, cash equivalents and restricted cash on the consolidated statements of cash flows as of December 31, 2023, 2022 and 2021:
In millions202320222021
Cash and cash equivalents$8,196 $12,945 $9,408 
Restricted cash (included in other current assets)90 144 3,065 
Restricted cash (included in other assets)239 216 218 
Total cash, cash equivalents and restricted cash in the consolidated statements of cash flows$8,525 $13,305 $12,691 

The decrease in restricted cash included in other current assets as of December 31, 2022 compared to December 31, 2021 was primarily due to a decrease in health savings account funds held on behalf of customers as a result of the sale of PayFlex Holdings, Inc. (“PayFlex”). See Note 2 ‘‘Acquisitions, Divestitures and Asset Sales’’ for additional information on the Company’s sale of PayFlex.

Investments

Debt Securities
Debt securities consist primarily of U.S. Treasury and agency securities, mortgage-backed securities, corporate and foreign bonds and other debt securities. Debt securities are classified as either current or long-term investments based on their contractual maturities unless the Company intends to sell an investment within the next twelve months, in which case it is classified as current on the consolidated balance sheets. Debt securities are classified as available for sale and are carried at fair value. See Note 5 ‘‘Fair Value’’ for additional information on how the Company estimates the fair value of these investments.

If a debt security is in an unrealized loss position and the Company has the intent to sell the security, or it is more likely than not that the Company will have to sell the security before recovery of its amortized cost basis, the amortized cost basis of the security is written down to its fair value and the difference is recognized in net income. If a debt security is in an unrealized loss position and the Company does not have the intent to sell and it is more likely than not that the Company will not have to sell such security before recovery of its amortized cost basis, the Company bifurcates the impairment into credit-related and non-credit related (yield-related) components. In evaluating whether a credit related loss exists, the Company considers a variety of factors including: the extent to which the fair value is less than the amortized cost basis; adverse conditions specifically related to the issuer of a security, an industry or geographic area; the payment structure of the security; the failure of the issuer of the security to make scheduled interest or principal payments; and any changes to the rating of the security by a rating agency. The amount of the credit-related component is recorded as an allowance for credit losses and recognized in net income, and the amount of the non-credit related component is included in other comprehensive income (loss). Interest is not accrued on debt securities when management believes the collection of interest is unlikely.

The credit-related component is determined by comparing the present value of cash flows expected to be collected from the security, considering all reasonably available information relevant to the collectability of the security, with the amortized cost basis of the security. If the present value of cash flows expected to be collected is less than the amortized cost basis of the security, the Company records an allowance for credit losses, which is limited by the amount that the fair value is less than amortized cost basis.

For mortgage-backed and other asset-backed securities, the Company recognizes income using an effective yield based on anticipated prepayments and the estimated economic life of the securities. When estimates of prepayments change, the effective yield is recalculated to reflect actual payments to date and anticipated future payments. The Company’s investment in the security is adjusted to the amount that would have existed had the new effective yield been applied since the acquisition of the security, with adjustments recognized in net income.

Equity Securities
Equity securities with readily available fair values are measured at fair value with changes in fair value recognized in net income.

Mortgage Loans
Mortgage loan investments on the consolidated balance sheets are valued at the unpaid principal balance, net of an allowance for credit losses. Mortgage loans with a maturity date or a committed prepayment date within twelve months are classified as
current on the consolidated balance sheets. The Company assesses whether its loans share similar risk characteristics and, if so, groups such loans in a risk pool when measuring expected credit losses. The Company considers the following characteristics when evaluating whether its loans share similar risk characteristics: loan-to-value ratios, property type (e.g., office, retail, apartment, industrial), geographic location, vacancy rates and property condition.

Credit loss reserves are determined using a loss rate method that multiplies the unpaid principal balance of each loan within a risk pool group by an estimated loss rate percentage. The loss rate percentage considers both the expected loan loss severity and the probability of loan default. For periods where the Company is able to make or obtain reasonable and supportable forecasts of expected economic conditions (e.g., gross domestic product, employment), the Company adjusts its expected loss rates to reflect these forecasted economic conditions. For periods beyond which the Company is able to make or obtain reasonable and supportable forecasts of expected economic conditions, the Company reverts to historical loss rates in determining expected credit losses.

Interest income on a potential problem loan (i.e., high probability of default) or restructured loan is accrued to the extent it is deemed to be collectible and the loan continues to perform under its original or restructured terms. Interest income on problem loans (i.e., more than 60 days delinquent, in bankruptcy or in process of foreclosure) is recognized on a cash basis. Cash payments on loans in the process of foreclosure are treated as a return of principal.

Other Investments
Other investments consist primarily of the following:

•Private equity and hedge fund limited partnerships, which are accounted for using the equity method of accounting. Under this method, the carrying value of the investment is based on the value of the Company’s equity ownership of the underlying investment funds provided by the general partner or manager of the investments, the financial statements of which generally are audited. As a result of the timing of the receipt of the valuation information provided by the fund managers, these investments are generally reported on up to a three month lag. The Company reviews investments for impairment at least quarterly and monitors their performance throughout the year through discussions with the administrators, managers and/or general partners. If the Company becomes aware of an impairment of a limited partnership’s investments through its review or prior to receiving the limited partnership’s financial statements at the financial statement date, an impairment will be recognized by recording a reduction in the carrying value of the limited partnership with a corresponding charge to net investment income.
•Investment real estate, which is carried on the consolidated balance sheets at depreciated cost, including capital additions, net of write-downs for other-than-temporary declines in fair value. Depreciation is calculated using the straight-line method based on the estimated useful life of each asset. If any real estate investment is considered held-for-sale, it is carried at the lower of its carrying value or fair value less estimated selling costs. The Company generally estimates fair value using net operating income and applying a capitalization rate in conjunction with comparable sales information. At the time of the sale, the difference between the sales price and the carrying value is recorded as a realized capital gain or loss.
•Privately-placed equity securities, which are carried on the consolidated balance sheets at cost less impairments, plus or minus subsequent adjustments for observable price changes. Additionally, as a member of the Federal Home Loan Bank of Boston (“FHLBB”), a subsidiary of the Company is required to purchase and hold shares of the FHLBB. These shares are restricted and carried at cost.

Net Investment Income
Net investment income on the Company’s investments is recorded when earned and is reflected in the Company’s net income (other than net investment income on assets supporting experience-rated products). Experience-rated products are products in the large case pensions business where the contract holder, not the Company, assumes investment and other risks, subject to, among other things, minimum guarantees provided by the Company. The effect of investment performance on experience-rated products is allocated to contract holders’ accounts daily, based on the underlying investment experience and, therefore, does not impact the Company’s net income (as long as the contract’s minimum guarantees are not triggered). Net investment income on assets supporting large case pensions’ experience-rated products is included in net investment income in the consolidated statements of operations and is credited to contract holders’ accounts through a charge to benefit costs. The contract holders’ accounts are reflected in policyholders’ funds on the consolidated balance sheets.

Realized capital gains and losses on investments (other than realized capital gains and losses on investments supporting experience-rated products) are included as a component of net investment income in the consolidated statements of operations. Realized capital gains and losses are determined on a specific identification basis. Purchases and sales of debt and equity securities and alternative investments are reflected on the trade date. Purchases and sales of mortgage loans and investment real estate are reflected on the closing date.
Realized capital gains and losses on investments supporting large case pensions’ experience-rated products are not included in realized capital gains and losses in the consolidated statements of operations and instead are credited directly to contract holders’ accounts. The contract holders’ accounts are reflected in policyholders’ funds on the consolidated balance sheets.

Unrealized capital gains and losses on investments (other than unrealized capital gains and losses on investments supporting experience-rated products) are reflected in shareholders’ equity, net of tax, as a component of accumulated other comprehensive income (loss). Unrealized capital gains and losses on investments supporting large case pensions’ experience-rated products are credited directly to contract holders’ accounts. The contract holders’ accounts are reflected in policyholders’ funds on the consolidated balance sheets.

Derivative Financial Instruments

The Company uses derivative financial instruments in order to manage interest rate and foreign exchange risk and credit exposure. The Company’s use of these derivatives is generally limited to hedging risk and has principally consisted of using interest rate swaps, treasury rate locks, forward contracts, futures contracts, warrants, put options and credit default swaps.

Accounts Receivable

Accounts receivable are stated net of allowances for credit losses, customer credit allowances, contractual allowances and estimated terminations. Accounts receivable, net was composed of the following at December 31, 2023 and 2022:
In millions20232022
Trade receivables$11,908 $8,983 
Vendor and manufacturer receivables15,711 12,395 
Premium receivables3,714 2,676 
Other receivables3,894 3,449 
   Total accounts receivable, net (1)
$35,227 $27,503 
_____________________________________
(1)Includes accounts receivable of $227 million which were accounted for as assets held for sale and were included in assets held for sale on the consolidated balance sheet at December 31, 2022. See Note 2 ‘‘Acquisitions, Divestitures and Asset Sales’’ for additional information.

The Company’s allowance for credit losses was $343 million and $333 million as of December 31, 2023 and 2022, respectively. When developing an estimate of the Company’s expected credit losses, the Company considers all available relevant information regarding the collectability of cash flows, including historical information, current conditions and reasonable and supportable forecasts of future economic conditions over the contractual life of the receivable. The Company’s accounts receivable are short duration in nature and typically settle in less than 30 days.

Inventories

Inventories are valued at the lower of cost or net realizable value using the weighted average cost method. Physical inventory counts are taken on a regular basis in each retail store and pharmacy, and a continuous cycle count process is the primary procedure used to validate the inventory balances on hand in each distribution center and mail facility to ensure that the amounts reflected in the consolidated financial statements are properly stated. During the interim period between physical inventory counts, the Company accrues for anticipated physical inventory losses on a location-by-location basis based on historical results and current physical inventory trends.

Reinsurance Recoverables

The Company utilizes reinsurance agreements primarily to: (a) reduce required capital and (b) facilitate the acquisition or disposition of certain insurance contracts. Ceded reinsurance agreements permit the Company to recover a portion of its losses from reinsurers, although they do not discharge the Company’s primary liability as the direct insurer of the risks reinsured. Failure of reinsurers to indemnify the Company could result in losses; however, the Company does not expect charges for unrecoverable reinsurance to have a material effect on its consolidated operating results or financial condition. The Company evaluates the financial condition of its reinsurers and monitors concentrations of credit risk arising from similar geographic regions, activities or economic characteristics of its reinsurers. At December 31, 2023, the Company’s reinsurance recoverables consisted primarily of amounts due from third parties that are rated consistent with companies that are considered to have the
ability to meet their obligations. Reinsurance recoverables are recorded as other current assets or other assets on the consolidated balance sheets.

Health Care Contract Acquisition Costs

Insurance products included in the Health Care Benefits segment are cancellable by either the customer or the member monthly upon written notice. Acquisition costs related to prepaid health care and health indemnity contracts are generally expensed as incurred. For certain long-duration insurance contracts, acquisition costs directly related to the successful acquisition of a new or renewal insurance contract, including commissions, are deferred and are recorded as other current assets or other assets on the consolidated balance sheets. Contracts are grouped by product and issue year into cohorts consistent with the grouping used in estimating the associated liability and are amortized on a constant level basis based on the remaining in-force policies over the estimated term of the contracts to approximate straight-line amortization. Changes to the Company’s assumptions, including assumptions related to persistency, are reflected at the cohort level at the time of change and are recognized prospectively over the estimated terms of the contract. The amortization of deferred acquisition costs is recorded in operating expenses in the consolidated statements of operations.

The following is a roll forward of deferred acquisition costs for the years ended December 31, 2023 and 2022:
In millions20232022
Deferred acquisition costs, beginning of the period$1,219 $879 
Capitalizations548 564 
Amortization expense(265)(224)
Deferred acquisition costs, end of the period$1,502 $1,219 

Property and Equipment

Property and equipment is reported at historical cost, net of accumulated depreciation. Property, equipment and improvements to leased premises are depreciated using the straight-line method over the estimated useful lives of the assets, or when applicable, the term of the lease, whichever is shorter. Estimated useful lives generally range from 1 to 40 years for buildings, building improvements and leasehold improvements and 3 to 10 years for fixtures, equipment and internally developed software. Repair and maintenance costs are charged directly to expense as incurred. Major renewals or replacements that substantially extend the useful life of an asset are capitalized and depreciated. Application development stage costs for significant internally developed software projects are capitalized and depreciated.

Property and equipment consisted of the following at December 31, 2023 and 2022:
In millions20232022
Land$1,958 $1,996 
Building and improvements4,571 4,545 
Fixtures and equipment11,024 12,978 
Leasehold improvements6,511 6,238 
Software9,818 8,843 
Total property and equipment33,882 34,600 
Accumulated depreciation and amortization(20,699)(21,483)
Property and equipment, net (1)
$13,183 $13,117 
_____________________________________
(1)Includes property and equipment of $244 million which were accounted for as assets held for sale and were included in assets held for sale on the consolidated balance sheet at December 31, 2022. See Note 2 ‘‘Acquisitions, Divestitures and Asset Sales’’ for additional information.

Depreciation expense (which includes the amortization of property and equipment under finance or capital leases) totaled $2.5 billion, $2.4 billion and $2.3 billion for the years ended December 31, 2023, 2022 and 2021, respectively. See Note 7 ‘‘Leases’’ for additional information about the Company’s finance leases.
Right-of-Use Assets and Lease Liabilities

The Company determines if an arrangement contains a lease at the inception of a contract. Right-of-use assets represent the Company’s right to use an underlying asset for the lease term and lease liabilities represent the Company’s obligation to make lease payments arising from the lease. Right-of-use assets and lease liabilities are recognized at the commencement date of the lease, renewal date of the lease or significant remodeling of the lease space based on the present value of the remaining future minimum lease payments. As the interest rate implicit in the Company’s leases is not readily determinable, the Company utilizes its incremental borrowing rate, determined by class of underlying asset, to discount the lease payments. The operating lease right-of-use assets also include lease payments made before commencement and are reduced by lease incentives.

The Company’s real estate leases typically contain options that permit renewals for additional periods of up to five years each. For real estate leases, the options to extend are not considered reasonably certain at lease commencement because the Company reevaluates each lease on a regular basis to consider the economic and strategic incentives of exercising the renewal options and regularly opens or closes stores to align with its operating strategy. Generally, the renewal option periods are not included within the lease term and the associated payments are not included in the measurement of the right-of-use asset and lease liability. Similarly, renewal options are not included in the lease term for non-real estate leases because they are not considered reasonably certain of being exercised at lease commencement. Leases with an initial term of 12 months or less are not recorded on the balance sheets, and lease expense is recognized on a straight-line basis over the term of the short-term lease.

For real estate leases, the Company accounts for lease components and nonlease components as a single lease component. Certain real estate leases require additional payments based on sales volume, as well as reimbursement for real estate taxes, common area maintenance and insurance, which are expensed as incurred as variable lease costs. Other real estate leases contain one fixed lease payment that includes real estate taxes, common area maintenance and insurance. These fixed payments are considered part of the lease payment and included in the right-of-use assets and lease liabilities.

See Note 7 ‘‘Leases’’ for additional information about right-of-use assets and lease liabilities.

Goodwill

The Company accounts for business combinations using the acquisition method of accounting, which requires the excess cost of an acquisition over the fair value of net assets acquired and identifiable intangible assets to be recorded as goodwill. Goodwill is not amortized, but is subject to impairment reviews annually, or more frequently, if necessary, as further described in “Recoverability of Long-Lived Assets” below. See Note 6 ‘‘Goodwill and Other Intangibles’’ for additional information about goodwill.

Intangible Assets

The Company’s identifiable intangible assets consist primarily of trademarks, trade names, customer contracts/relationships, covenants not to compete, technology, provider networks and value of business acquired (“VOBA”). These intangible assets arise primarily from the determination of their respective fair market values at the date of acquisition. Amounts assigned to identifiable intangible assets, and their related useful lives, are derived from established valuation techniques and management estimates.

The Company’s definite-lived intangible assets are amortized over their estimated useful lives based upon the pattern of future cash flows attributable to the asset. Definite-lived intangible assets are amortized using the straight-line method. VOBA is subject to loss recognition testing annually, or more frequently, if necessary.

Indefinite-lived intangible assets are not amortized but are tested for impairment annually, or more frequently, if necessary, as further described in “Recoverability of Long-Lived Assets” below.

See Note 6 ‘‘Goodwill and Other Intangibles’’ for additional information about intangible assets.

Recoverability of Long-Lived Assets

The Company evaluates the recoverability of long-lived assets, excluding goodwill and indefinite-lived intangible assets, which are tested for impairment using separate tests described below, whenever events or changes in circumstances indicate that the carrying value of such asset may not be recoverable. The Company groups and evaluates these long-lived assets for impairment at the lowest level at which individual cash flows can be identified. If indicators of impairment are present, the Company first
compares the carrying amount of the asset group to the estimated future cash flows associated with the asset group (undiscounted). If the estimated future cash flows used in this analysis are less than the carrying amount of the asset group, an impairment loss calculation is prepared. The impairment loss calculation compares the carrying amount of the asset group to the asset group’s estimated future cash flows (discounted). If required, an impairment loss is recorded for the portion of the asset group’s carrying value that exceeds the asset group’s estimated future cash flows (discounted).

During the years ended December 31, 2023 and 2022, the Company recorded office real estate optimization charges of $46 million and $117 million, respectively, primarily related to the abandonment of leased real estate and the related right-of-use assets and property and equipment in connection with the planned reduction of corporate office real estate space in response to its new flexible work arrangement.

During the year ended December 31, 2021, the Company recorded a store impairment charge of approximately $1.4 billion primarily related to the write down of operating lease right-of-use assets and property and equipment in connection with the planned closure of approximately 900 retail stores between 2022 and 2024.

See Note 7 ‘‘Leases’’ for additional information about the right-of-use asset charges.

When evaluating goodwill for potential impairment, the Company compares the fair value of its reporting units to their respective carrying amounts. The Company estimates the fair value of its reporting units using a combination of a discounted cash flow method and a market multiple method. If the carrying amount of a reporting unit exceeds its estimated fair value, an impairment loss is recognized in an amount equal to that excess.

Effective for the 2023 annual goodwill impairment test, the Company elected to change its annual goodwill impairment test date from August 31st to October 31st to better align with its annual budgeting processes, as its previous election predated large acquisitions such as Caremark Rx, Inc. and Aetna Inc. (“Aetna”). Prior to the Company’s 2023 goodwill impairment test, the most recent goodwill impairment test was performed as of January 1, 2023, in connection with the segment realignment previously described in the “Description of Business” section.

During the fourth quarter of 2023 and the third quarter of 2022, the Company performed its required annual impairment tests of goodwill and concluded there were no goodwill impairments as of the testing dates or during the years ended December 31, 2023 and 2022.
During the third quarter of 2021, the Company performed its required annual impairment tests of goodwill, the results of which indicated an impairment of the goodwill associated with the LTC reporting unit. Accordingly, during the third quarter of 2021, the Company recorded a $431 million goodwill impairment charge on the remaining goodwill of the LTC reporting unit. The results of the impairment tests indicated that there was no impairment of goodwill of the remaining reporting units as of the testing date or during the year ended December 31, 2021. See Note 6 ‘‘Goodwill and Other Intangibles’’ for additional information about the goodwill impairment charge recorded during the year ended December 31, 2021.

Indefinite-lived intangible assets are tested for impairment by comparing the estimated fair value of the asset to its carrying value. The Company estimates the fair value of its indefinite-lived trademarks using the relief from royalty method under the income approach. If the carrying value of the asset exceeds its estimated fair value, an impairment loss is recognized, and the asset is written down to its estimated fair value. There were no impairment losses recognized on indefinite-lived intangible assets in any of the years ended December 31, 2023, 2022 or 2021.

Separate Accounts

Separate Accounts assets and liabilities related to large case pensions products represent funds maintained to meet specific objectives of contract holders who bear the investment risk. These assets and liabilities are carried at fair value. Net investment income (including net realized capital gains and losses) accrue directly to such contract holders. The assets of each account are legally segregated and are not subject to claims arising from the Company’s other businesses. Deposits, withdrawals and net investment income (including net realized and net unrealized capital gains and losses) on Separate Accounts assets are not reflected in the consolidated statements of operations or cash flows. Management fees charged to contract holders are included in services revenue and recognized over the period earned.
Health Care Costs Payable

Health care costs payable within the Health Care Benefits segment consist principally of unpaid fee-for-service medical, dental and pharmacy claims, capitation costs, other amounts due to providers pursuant to risk-sharing arrangements related to the Health Care Benefits segment’s Insured Commercial, Medicare and Medicaid products and accruals for state assessments. Unpaid health care claims include an estimate of payments the Company will make for (i) services rendered to the Company’s Insured members but not yet reported to the Company and (ii) claims which have been reported to the Company but not yet paid, each as of the financial statement date (collectively, “IBNR”). Health care costs payable also include an estimate of the cost of services that will continue to be rendered after the financial statement date if the Company is obligated to pay for such services in accordance with contractual or regulatory requirements. Such estimates are developed using actuarial principles and assumptions which consider, among other things, historical and projected claim submission and processing patterns, assumed and historical medical cost trends, historical utilization of medical services, claim inventory levels, changes in Insured membership and product mix, seasonality and other relevant factors. The Company reflects changes in these estimates in benefit costs in the Company’s consolidated operating results in the period they are determined. Capitation costs represent contractual monthly fees paid to participating physicians and other medical providers for providing medical care, regardless of the volume of medical services provided to the Insured member. Amounts due under risk-sharing arrangements are based on the terms of the underlying contracts with the providers and consider claims experience under the contracts through the financial statement date. Within the Health Services segment, health care costs payable includes estimates of the Company’s obligations for medical care services that have been rendered by third parties on behalf of consumers for which the Company is contractually obligated to pay, but for which claims have either not yet been received, processed or paid.

The Company develops its estimate of IBNR using actuarial principles and assumptions that consider numerous factors. Of those factors, the Company considers the analysis of historical and projected claim payment patterns (including claims submission and processing patterns) and the assumed health care cost trend rate (the year-over-year change in per member per month health care costs) to be the most critical assumptions. In developing its IBNR estimate, the Company consistently applies these actuarial principles and assumptions each period, with consideration to the variability of related factors. There have been no significant changes to the methodologies or assumptions used to develop the Company’s estimate of IBNR in 2023.

The Company analyzes historical claim payment patterns by comparing claim incurred dates (i.e., the date services were provided) to claim payment dates to estimate “completion factors.” The Company uses completion factors predominantly to estimate the ultimate cost of claims incurred more than three months before the financial statement date. The Company estimates completion factors by aggregating claim data based on the month of service and month of claim payment and estimating the percentage of claims incurred for a given month that are complete by each month thereafter. For any given month, substantially all claims are paid within six months of the date of service, but it can take up to 48 months or longer after the date of service before all of the claims are completely resolved and paid. These historically-derived completion factors are then applied to claims paid through the financial statement date to estimate the ultimate claim cost for a given month’s incurred claim activity. The difference between the estimated ultimate claim cost and the claims paid through the financial statement date represents the Company’s estimate of claims remaining to be paid as of the financial statement date and is included in the Company’s health care costs payable. The completion factors the Company uses reflect judgments and possible adjustments based on data such as claim inventory levels, claim submission and processing patterns and, to a lesser extent, other factors such as changes in health care cost trend rates, changes in Insured membership and changes in product mix. If claims are submitted or processed on a faster (slower) pace than prior periods, the actual claims may be more (less) complete than originally estimated using the Company’s completion factors, which may result in reserves that are higher (lower) than the ultimate cost of claims.

Because claims incurred within three months before the financial statement date are less mature, the Company uses a combination of historically-derived completion factors and the assumed health care cost trend rate to estimate the ultimate cost of claims incurred for these months. The Company applies its actuarial judgment and places a greater emphasis on the assumed health care cost trend rate for the most recent claim incurred dates as these months may be influenced by seasonal patterns and changes in membership and product mix.

The Company’s health care cost trend rate is affected by changes in per member utilization of medical services as well as changes in the unit cost of such services. Many factors influence the health care cost trend rate, including the Company’s ability to manage benefit costs through product design, negotiation of favorable provider contracts and medical management programs, as well as the mix of the Company’s business. The health status of the Company’s Insured members, aging of the population and other demographic characteristics, advances in medical technology and other factors continue to contribute to rising per member utilization and unit costs. Changes in health care practices, inflation, new technologies, increases in the cost of prescription drugs (including specialty pharmacy drugs), direct-to-consumer marketing by pharmaceutical companies, clusters
of high-cost cases, claim intensity, changes in the regulatory environment, health care provider or member fraud and numerous other factors also contribute to the cost of health care and the Company’s health care cost trend rate.

For each reporting period, the Company uses an extensive degree of judgment in the process of estimating its health care costs payable. As a result, considerable variability and uncertainty is inherent in such estimates, particularly with respect to claims with claim incurred dates of three months or less before the financial statement date; and the adequacy of such estimates is highly sensitive to changes in assumed completion factors and the assumed health care cost trend rates. For each reporting period the Company recognizes the actuarial best estimate of health care costs payable considering the potential volatility in assumed completion factors and health care cost trend rates, as well as other factors. The Company believes its estimate of health care costs payable is reasonable and adequate to cover its obligations at December 31, 2023; however, actual claim payments may differ from the Company’s estimates. A worsening (or improvement) of the Company’s health care cost trend rates or changes in completion factors from those that the Company assumed in estimating health care costs payable at December 31, 2023 would cause these estimates to change in the near term, and such a change could be material.

Each quarter, the Company re-examines previously established health care costs payable estimates based on actual claim payments for prior periods and other changes in facts and circumstances. Given the extensive degree of judgment in this estimate, it is possible that the Company’s estimates of health care costs payable could develop either favorably (that is, its actual benefit costs for the period were less than estimated) or unfavorably. The changes in the Company’s estimate of health care costs payable may relate to a prior quarter, prior year or earlier periods. For a roll forward of the Company’s health care costs payable, see Note 8 ‘‘Health Care Costs Payable.’’ The Company’s reserving practice is to consistently recognize the actuarial best estimate of its ultimate liability for health care costs payable.

Other Insurance Liabilities

Unpaid Claims
Unpaid claims consist primarily of reserves associated with certain short-duration group disability and term life insurance contracts, including an estimate for IBNR as of the financial statement date. Reserves associated with certain short-duration group disability and term life insurance contracts are based upon the Company’s estimate of the present value of future benefits, which is based on assumed investment yields and assumptions regarding mortality, morbidity and recoveries from the U.S. Social Security Administration. The Company develops its estimate of IBNR using actuarial principles and assumptions which consider, among other things, contractual requirements, claim incidence rates, claim recovery rates, seasonality and other relevant factors. The Company discounts certain claim liabilities related to group long-term disability and life insurance waiver of premium contracts. The discount rates generally reflect the Company’s expected investment returns for the investments supporting all incurral years of these liabilities. The discount rates for retrospectively-rated contracts are set at contractually specified levels. The Company’s estimates of unpaid claims are subject to change due to changes in the underlying experience of the insurance contracts, changes in investment yields or other factors, and these changes are recorded in current and future benefits in the consolidated statements of operations in the period they are determined. The Company estimates its reserve for claims IBNR for life products largely based on completion factors. The completion factors used are based on the Company’s historical experience and reflect judgments and possible adjustments based on data such as claim inventory levels, claim payment patterns, changes in business volume and other factors. If claims are submitted or processed on a faster (slower) pace than historical periods, the actual claims may be more (less) complete than originally estimated using completion factors, which may result in reserves that are higher (lower) than required to cover future life benefit payments. There have been no significant changes to the methodologies or assumptions used to develop the Company’s estimate of unpaid claims IBNR in 2023. As of December 31, 2023, unpaid claims balances of $285 million and $834 million were recorded in other insurance liabilities and other long-term insurance liabilities, respectively. As of December 31, 2022, unpaid claims balances of $243 million and $1.1 billion were recorded in other insurance liabilities and other long-term insurance liabilities, respectively.

Substantially all life and disability insurance liabilities have been fully ceded to unrelated third parties through indemnity reinsurance agreements; however, the Company remains directly obligated to the policyholders.

Future Policy Benefits
Future policy benefits consist primarily of reserves for products for which the Company no longer solicits or accepts new customers, including limited payment pension and annuity contracts and long-term care insurance contracts. Contracts are grouped into cohorts by contract type and issue year. The liability for future policy benefits is adjusted for differences between actual and expected experience.

Reserves for limited payment pension and annuity contracts represent the Company’s estimate of the present value of future benefits to be paid to or on behalf of policyholders and are computed using actuarial principles that consider, among other
things, assumptions reflecting anticipated mortality and retirement experience. On an annual basis, or more frequently if necessary, the Company reviews mortality assumptions against both industry standards and its experience.

Reserves for long-term care insurance contracts represent the Company’s estimate of the present value of future benefits and settlement costs to be paid to or on behalf of policyholders less the present value of future net premiums. The Company’s estimate of the present value of future benefits under such contracts is based upon mortality, morbidity, lapse and interest rate assumptions. On an annual basis, or more frequently if necessary, the Company reviews its mortality, morbidity and lapse assumptions against its experience. Annually, or each time the assumptions are changed, the net premium ratio used to calculate the future policy benefit liability is updated to reflect actual experience, as well as the impact of any change in assumptions on the Company’s future cash flows.

The Company discounts its future policy benefit liability using a curve of spot rates derived from Single A rated fixed income instruments. At each reporting date, the Company will measure its liability for future policy benefits using both the current spot rate curve and the locked-in discount rate at each cohort’s inception. Any difference between the measured liabilities is recorded in other comprehensive income (loss).

As of December 31, 2023, future policy benefits balances of $393 million and $4.6 billion were recorded in other insurance liabilities and other long-term insurance liabilities, respectively. As of December 31, 2022, future policy benefits balances of $334 million and $4.7 billion were recorded in other insurance liabilities and other long-term insurance liabilities, respectively.

Premium Deficiency Reserves

The Company evaluates its short-duration insurance contracts to determine if it is probable that a loss will be incurred. A premium deficiency loss is recognized when it is probable that expected future claims, including maintenance costs (for example, direct costs such as claim processing costs), will exceed existing reserves plus anticipated future premiums and reinsurance recoveries. Anticipated investment income is not considered in the calculation of premium deficiency losses. For purposes of determining premium deficiency losses, contracts are grouped consistent with the Company’s method of acquiring, servicing and measuring the profitability of such contracts. The Company did not have any premium deficiency reserves as of December 31, 2023 or 2022.

Policyholders’ Funds

Policyholders’ funds consist primarily of reserves for pension and annuity investment contracts and customer funds associated with certain health contracts. Reserves for such contracts are equal to cumulative deposits less withdrawals and charges plus interest credited thereon, net of experience-rated adjustments. Reserves for contracts subject to experience rating reflect the Company’s rights as well as the rights of policyholders and plan participants.

Policyholders’ funds liabilities that are expected to be paid within twelve months from the balance sheet date are classified as current on the consolidated balance sheets. Policyholders’ funds liabilities that are expected to be paid greater than twelve months from the balance sheet date are included in other long-term liabilities on the consolidated balance sheets.

Self-Insurance Liabilities

The Company is self-insured for certain losses related to general liability, workers’ compensation and auto liability. The Company obtains third party insurance coverage to limit exposure from these claims. The Company is also self-insured for certain losses related to health and medical liabilities. The Company’s self-insurance accruals, which include reported claims and claims incurred but not reported, are calculated using standard insurance industry actuarial assumptions and the Company’s historical claims experience. As of both December 31, 2023 and 2022, self-insurance liabilities totaled $1.1 billion and were recorded in accrued expenses and other long-term liabilities on the consolidated balance sheets.

Foreign Currency Translation and Transactions

For non-U.S. dollar functional currency locations, (i) assets and liabilities are translated at end-of-period exchange rates, (ii) revenues and expenses are translated at average exchange rates in effect during the period and (iii) equity is translated at historical exchange rates. The resulting cumulative translation adjustments are included as a component of accumulated other comprehensive loss.
For U.S. dollar functional currency locations, foreign currency assets and liabilities are remeasured into U.S. dollars at end-of-period exchange rates, except for nonmonetary balance sheet accounts which are remeasured at historical exchange rates. Revenues and expenses are remeasured at average exchange rates in effect during each period, except for those expenses related to the nonmonetary balance sheet amounts which are remeasured at historical exchange rates. Gains or losses from foreign currency remeasurement are included in net income.

Gains and losses from foreign currency transactions and the effects of foreign currency remeasurements were not material in the years ended December 31, 2023, 2022 or 2021.

Revenue Recognition

Health Care Benefits Segment
Health Care Benefits revenue is principally derived from insurance premiums and fees billed to customers. Revenue is recognized based on customer billings, which, in the Company’s Commercial business, reflect contracted rates per member and the number of covered members recorded in the Company’s records at the time the billings are prepared. Billings are generally sent monthly for coverage during the following month. Revenue related to the Company’s Government business is collected monthly from the U.S. federal government and various government agencies based on fixed payment rates and member eligibility.

The Company’s billings may be subsequently adjusted to reflect enrollment changes due to member terminations or other factors. These adjustments are known as retroactivity adjustments. In each period, the Company estimates the amount of future retroactivity and adjusts the recorded revenue accordingly. As information regarding actual retroactivity amounts becomes known, the Company refines its estimates and records any required adjustments to revenues in the period in which they arise.

Premium Revenue
Premiums are recognized as revenue in the month in which the enrollee is entitled to receive health care services. Premiums are reported net of an allowance for estimated terminations and uncollectible amounts. Additionally, premium revenue subject to the minimum medical loss ratio (“MLR”) rebate requirements of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (as amended, collectively, the “ACA”) is recorded net of the estimated minimum MLR rebates for the current calendar year. Premiums related to unexpired contractual coverage periods (unearned premiums) are reported as other insurance liabilities on the consolidated balance sheets and recognized as revenue when earned.

Some of the Company’s contracts allow for premiums to be adjusted to reflect actual experience or the relative health status of Insured members. Such adjustments are reasonably estimable at the outset of the contract, and adjustments to those estimates are made based on actual experience of the customer emerging under the contract and the terms of the underlying contract.

The ACA established a permanent risk adjustment program to transfer funds from qualified individual and small group insurance plans with below average risk scores to plans with above average risk scores. Based on the risk of the Company’s qualified plan members relative to the average risk of members of other qualified plans in comparable markets, as defined by the ACA, the Company estimates its ultimate risk adjustment receivable (recorded in accounts receivable) or payable (recorded in accrued expenses) for the current calendar year and reflects the pro-rata year-to-date impact as an adjustment to premium revenue. As of December 31, 2023, the Company recorded an ACA risk adjustment payable of $1.2 billion. As of December 31, 2022, the Company’s ACA risk adjustment payable was not material.

Services Revenue
Services revenue relates to contracts that can include various combinations of services or series of services which generally are capable of being distinct and accounted for as separate performance obligations. The Health Care Benefits segment’s services revenue primarily consists of ASC fees received in exchange for performing certain claim processing and member services for ASC members. ASC fee revenue is recognized over the period the service is provided. Some of the Company’s administrative services contracts include guarantees with respect to certain functions, such as customer service response time, claim processing accuracy and claim processing turnaround time, as well as certain guarantees that a plan sponsor’s benefit claim experience will fall within a certain range. With any of these guarantees, the Company is financially at risk if the conditions of the arrangements are not met, although the maximum amount at risk typically is limited to a percentage of the fees otherwise payable to the Company by the customer involved. Each period the Company estimates its obligations under the terms of these guarantees and records its estimate as an offset to services revenues.
Accounting for Medicare Part D
Revenues include insurance premiums earned by the Company’s PDPs, which are determined based on the PDP’s annual bid and related contractual arrangements with the U.S. Centers for Medicare & Medicaid Services (“CMS”). The insurance premiums include a beneficiary premium, which is the responsibility of the PDP member, and can be subsidized by CMS in the case of low-income members, and a direct premium paid by CMS. Premiums collected in advance are initially recorded within other insurance liabilities and are then recognized ratably as revenue over the period in which members are entitled to receive benefits.

Revenues also include a risk-sharing feature of the Medicare Part D program design referred to as the risk corridor. The Company estimates variable consideration in the form of amounts payable to, or receivable from, CMS under the risk corridor, and adjusts revenue based on calculations of additional subsidies to be received from or owed to CMS at the end of the reporting year.

In addition to Medicare Part D premiums, the Company receives additional payments each month from CMS related to catastrophic reinsurance, low-income cost-sharing subsidies and coverage gap benefits. If the subsidies received differ from the amounts earned from actual prescriptions transferred, the difference is recorded in either accounts receivable, net or accrued expenses.

Health Services Segment

Pharmacy Solutions
The Health Services segment sells prescription drugs directly through its specialty and mail order pharmacy offerings and indirectly through the Company’s retail pharmacy network. The Company’s pharmacy benefit arrangements are accounted for in a manner consistent with a master supply arrangement as there are no contractual minimum volumes and each prescription is considered a separate purchasing decision and distinct performance obligation transferred at a point in time. PBM services performed in connection with each prescription claim are considered part of a single performance obligation which culminates in the fulfillment of prescription drugs.

The Company recognizes revenue using the gross method at the contract price negotiated with its clients when the Company has concluded it controls the prescription drug before it is transferred to the client plan members. The Company controls prescriptions fulfilled indirectly through its retail pharmacy network because it has separate contractual arrangements with those pharmacies, has discretion in setting the price for the transaction and assumes primary responsibility for fulfilling the promise to provide prescription drugs to its client plan members while also performing the related PBM services.

Revenues include (i) the portion of the price the client pays directly to the Company, net of any discounts earned on brand name drugs or other discounts and refunds paid back to the client (see “Drug Discounts” and “Guarantees” below), (ii) the price paid to the Company by client plan members for mail order prescriptions and the price paid to retail network pharmacies by client plan members for retail prescriptions (“retail co-payments”), and (iii) claims based administrative fees for retail pharmacy network contracts. Sales taxes are not included in revenues.

The Company recognizes revenue when control of the prescription drugs is transferred to customers, in an amount that reflects the consideration the Company expects to be entitled to receive in exchange for those prescription drugs. The Company has established the following revenue recognition policies for the Health Services segment:

•Revenues generated from prescription drugs sold by third party pharmacies in the Company’s retail pharmacy network and associated administrative fees are recognized at the Company’s point-of-sale, which is when the claim is adjudicated by the Company’s online claims processing system and the Company has transferred control of the prescription drug and completed all of its performance obligations.
•Revenues generated from prescription drugs sold by specialty and mail order pharmacies are recognized when the prescription drug is delivered to the client plan member. At the time of delivery, the Company has performed substantially all of its performance obligations under its client contracts and does not experience a significant level of returns or reshipments.

For contracts under which the Company acts as an agent or does not control the prescription drugs prior to transfer to the client plan member, revenue is recognized using the net method.
Drug Discounts
The Company records revenue net of manufacturers’ rebates earned by its clients based on their plan members’ utilization of brand-name formulary drugs. The Company estimates these rebates at period-end based on actual and estimated claims data and its estimates of the manufacturers’ rebates earned by its clients. The estimates are based on the best available data at period-end and recent history for the various factors that can affect the amount of rebates due to the client. The Company adjusts its rebates payable to clients to the actual amounts paid when these rebates are paid or as significant events occur. Any cumulative effect of these adjustments is recorded against revenues at the time it is identified. Adjustments generally result from contract changes with clients or manufacturers that have retroactive rebate adjustments, differences between the estimated and actual product mix subject to rebates, or whether the brand name drug was included in the applicable formulary. The effect of adjustments between estimated and actual manufacturers’ rebate amounts has not been material to the Company’s operating results or financial condition.

Guarantees
The Company also adjusts revenues for refunds owed to clients resulting from pricing guarantees and performance against defined service and performance metrics. The inputs to these estimates are not subject to a high degree of subjectivity or volatility. The effect of adjustments between estimated and actual pricing and performance refund amounts has not been material to the Company’s operating results or financial condition.

Walk-In Medical Clinics
For services provided by the Company’s walk-in medical clinics, revenue recognition occurs for completed services provided to patients, with adjustments taken for third party payor contractual obligations and patient direct bill historical collection rates.

Primary Care Capitated Revenue
Capitated revenue related to the Company’s primary care operations consists primarily of capitated fees for medical services it provides under capitated or capitation arrangements directly made with various Medicare Advantage managed care payors or CMS. Under the risk contracts, the Company receives from the third-party payor a fixed payment per patient per month for a defined patient population, and the Company is then responsible for providing, managing and paying for healthcare services for that patient population, including those not provided by the Company. The Company recognizes revenue using the gross method as the Company is the principal in arranging, providing and controlling the managed healthcare services provided to the defined patient population. The Company considers all contracts with customers (enrolled patients) as a single performance obligation to stand ready to provide healthcare services. This performance obligation is satisfied over time as the Company stands ready to fulfill its obligation to enrolled patients.

In-Home Health Evaluations
Revenue generated from IHEs relates to the assessments performed either within the patient’s home, virtually or at a healthcare provider facility as well as certain in-home clinical evaluations performed by the Company’s mobile network of providers. Revenue is recognized when the IHEs are submitted to customers on a daily basis. Submission to the customer occurs after the IHEs are completed and coded, a process which may take one to several days after completion of the evaluation. The pricing for the IHEs is generally based on a fixed transaction fee, which is directly linked to the usage of the service by the customer during a distinct service period. Customers are invoiced for evaluations performed each month and remit payment accordingly. Each IHE represents a single performance obligation for which revenue is recognized at a point in time when control is transferred to the customer upon submission of the completed and coded evaluation.

Pharmacy & Consumer Wellness Segment

Retail Pharmacy
The Company’s retail drugstores recognize revenue at the time the customer takes possession of the merchandise. For pharmacy sales, each prescription claim is its own arrangement with the customer and is a performance obligation, separate and distinct from other prescription claims under other retail network arrangements. Revenues are adjusted for refunds owed to third party payers resulting from pricing guarantees and performance against defined value-based service and performance metrics. The inputs to these estimates are not subject to a high degree of subjectivity or volatility. The effect of adjustments between estimated and actual pricing and performance refund amounts has not been material to the Company’s operating results or financial condition.

Revenue from Company gift cards purchased by customers is deferred as a contract liability until goods or services are transferred. Any amounts not expected to be redeemed by customers (i.e., breakage) are recognized based on historical redemption patterns.
Customer returns are not material to the Company’s operating results or financial condition. Sales taxes are not included in revenues.

Loyalty and Other Programs
The Company’s customer loyalty program, ExtraCare®, consists of two components, ExtraSavingsTM and ExtraBucks® Rewards. ExtraSavings are coupons that are recorded as a reduction of revenue when redeemed as the Company concluded that they do not represent a promise to the customer to deliver additional goods or services at the time of issuance because they are not tied to a specific transaction or spending level.

ExtraBucks Rewards are accumulated by customers based on their historical spending levels. Thus, the Company has determined that there is an additional performance obligation to those customers at the time of the initial transaction. The Company allocates the transaction price to the initial transaction and the ExtraBucks Rewards transaction based upon the relative standalone selling price, which considers historical redemption patterns for the rewards. Revenue allocated to ExtraBucks Rewards is recognized as those rewards are redeemed. At the end of each period, unredeemed ExtraBucks Rewards are reflected as a contract liability.

The Company also offers a subscription-based membership program, ExtraCare PlusTM, under which members are entitled to a suite of benefits delivered over the course of the subscription period, as well as a promotional reward that can be redeemed for future goods and services. Subscriptions are paid for on a monthly or annual basis at the time of or in advance of the Company delivering the goods and services. Revenue from these arrangements is recognized as the performance obligations are satisfied.

Long-term Care
Revenue is recognized when control of the promised goods or services is transferred to customers in an amount that reflects the consideration the Company expects to be entitled to receive in exchange for those goods or services. Each prescription claim represents a separate performance obligation of the Company, separate and distinct from other prescription claims under customer arrangements. A significant portion of long-term care revenue from sales of pharmaceutical and medical products is reimbursed by the federal Medicare Part D program and, to a lesser extent, state Medicaid programs. The Company monitors its revenues and receivables from these reimbursement sources, as well as long-term care facilities and other third party insurance payors, and reduces revenue at the revenue recognition date to properly account for the variable consideration due to anticipated differences between billed and reimbursed amounts. Accordingly, the total revenues and receivables reported in the Company’s consolidated financial statements are recorded at the amount expected to be ultimately received from these payors.

Patient co-payments associated with Medicare Part D, certain state Medicaid programs, Medicare Part B and certain third party payors typically are not collected at the time products are delivered or services are rendered, but are billed to the individuals as part of normal billing procedures and subject to normal accounts receivable collections procedures.
Disaggregation of Revenue
The following table disaggregates the Company’s revenue by major source in each segment for the years ended December 31, 2023, 2022 and 2021:
In millionsHealth Care
Benefits		Health
Services		Pharmacy &
Consumer
Wellness		Corporate/
Other		Intersegment
Eliminations		Consolidated
Totals
2023
Major goods/services lines:
Pharmacy$— $180,710 $92,111 $— $(49,369)$223,452 
Front Store— — 22,458 — — 22,458 
Premiums99,144 — — 48 — 99,192 
Net investment income (loss)765 (1)(5)394 — 1,153 
Other5,737 6,134 2,199 9 (2,558)11,521 
Total$105,646 $186,843 $116,763 $451 $(51,927)$357,776 
Health Services distribution channel:
Pharmacy network (1)
$112,718 
Mail & specialty (2)
67,992 
Net investment income (loss)(1)
Other6,134 
Total$186,843 
2022
Major goods/services lines:
Pharmacy$— $166,793 $83,480 $— $(45,154)$205,119 
Front Store— — 22,780 — — 22,780 
Premiums85,274 — — 56 — 85,330 
Net investment income (loss)476 — (44)406 — 838 
Other5,600 2,783 2,380 68 (2,431)8,400 
Total$91,350 $169,576 $108,596 $530 $(47,585)$322,467 
Health Services distribution channel:
Pharmacy network (1)
$102,968 
Mail & specialty (2)
63,825 
Other2,783 
Total$169,576 
In millionsHealth Care
Benefits		Health
Services		Pharmacy &
Consumer
Wellness		Corporate/
Other		Intersegment
Eliminations		Consolidated
Totals
2021
Major goods/services lines:
Pharmacy$— $150,646 $77,886 $— $(43,913)$184,619 
Front Store— — 21,315 — — 21,315 
Premiums76,064 — — 68 — 76,132 
Net investment income586 — 17 596 — 1,199 
Other5,469 3,246 2,402 57 (2,328)8,846 
Total$82,119 $153,892 $101,620 $721 $(46,241)$292,111 
Health Services distribution channel:
Pharmacy network (1)
$96,834 
Mail & specialty (2)
53,812 
Other3,246 
Total$153,892 
_____________________________________________
(1)Health Services pharmacy network is defined as claims filled at retail and specialty retail pharmacies, including the Company’s retail pharmacies and LTC pharmacies. Effective January 1, 2023, pharmacy network also includes activity associated with Maintenance Choice®, which permits eligible client plan members to fill their maintenance prescriptions through mail order delivery or at a CVS pharmacy retail store for the same price as mail order. Maintenance Choice activity was previously reflected in mail & specialty. Segment financial information has been revised to reflect these changes.
(2)Health Services mail & specialty is defined as specialty mail claims inclusive of Specialty Connect® claims picked up at a retail pharmacy, as well as mail order and specialty claims fulfilled by the Pharmacy & Consumer Wellness segment. Effective January 1, 2023, mail & specialty excludes Maintenance Choice activity, which is now reflected within pharmacy network. Segment financial information has been revised to reflect these changes.

Contract Balances
Contract liabilities primarily represent the Company’s obligation to transfer additional goods or services to a customer for which the Company has received consideration, and include ExtraBucks Rewards and unredeemed Company gift cards. The consideration received remains a contract liability until goods or services have been provided to the customer. In addition, the Company recognizes breakage on Company gift cards based on historical redemption patterns.

The following table provides information about receivables and contract liabilities from contracts with customers as of December 31, 2023 and 2022:
In millions20232022
Trade receivables (included in accounts receivable, net)$11,908 $8,983 
Contract liabilities (included in accrued expenses)149 71 

During the years ended December 31, 2023 and 2022, the contract liabilities balance includes increases related to customers’ earnings in ExtraBucks Rewards or issuances of Company gift cards and decreases for revenues recognized during the period as a result of the redemption of ExtraBucks Rewards or Company gift cards and breakage of Company gift cards. During the year ended December 31, 2023, the contract liabilities balance also reflects the addition of contract liabilities acquired in connection with the Company’s acquisitions of Signify Health and Oak Street Health on March 29, 2023 and May 2, 2023, respectively. Below is a summary of such changes:
In millions20232022
Contract liabilities, beginning of period$71 $87 
Rewards earnings and gift card issuances357 340 
Redemption and breakage(363)(356)
Acquired contract liabilities109 — 
Other(25)— 
Contract liabilities, end of period$149 $71 
Cost of Products Sold

The Company accounts for cost of products sold as follows:

Health Services Segment
Cost of products sold includes: (i) the cost of prescription drugs sold during the reporting period directly through the Company’s specialty and mail order pharmacies and indirectly through the Company’s retail pharmacy network, (ii) the cost of care provided within the Company’s primary care centers, (iii) direct operating costs associated with generating revenues related to services provided, including fees paid to clinicians for performing IHEs, (iv) administrative service fees paid to the Pharmacy & Consumer Wellness segment for specialty and mail order pharmacy fulfillment services and (v) shipping and handling costs.

The cost of prescription drugs sold component of cost of products sold includes: (i) the cost of the prescription drugs purchased from manufacturers or distributors and shipped to members in clients’ benefit plans from the Company’s mail order pharmacies, net of any volume-related or other discounts (see “Vendor Allowances and Purchase Discounts” below) and (ii) the cost of prescription drugs sold (including retail co-payments) through the Company’s retail pharmacy network under contracts where the Company is the principal, net of any volume-related or other discounts.

The cost of care provided within the Company’s costs of products sold includes the costs incurred to operate the primary care centers and care model. These costs consist of care team and patient support employee-related costs, occupancy costs, patient transportation, medical supplies, insurance, fees paid to specialists and other operating costs.

Pharmacy & Consumer Wellness Segment
Cost of products sold includes: the cost of merchandise sold during the reporting period, including the costs of prescription drugs sold through its retail pharmacies, net of any volume-related or other discounts, the related purchasing costs, warehousing and delivery costs (including depreciation and amortization), the operating costs of the Company’s specialty and mail order pharmacy fulfillment operations and inventory losses.

Vendor Allowances and Purchase Discounts

The Company accounts for vendor allowances and purchase discounts as follows:

Health Services Segment
The Health Services segment receives purchase discounts on pharmaceutical products purchased. Contractual arrangements with vendors, including manufacturers, wholesalers and retail pharmacies, normally provide for the Health Services segment to receive purchase discounts from established list prices in one, or a combination, of the following forms: (i) a direct discount at the time of purchase, (ii) a discount for the prompt payment of invoices or (iii) when products are purchased indirectly from a manufacturer (e.g., through a wholesaler or retail pharmacy), a discount (or rebate) paid subsequent to dispensing. These rebates are recognized when prescriptions are dispensed and are generally calculated and billed to manufacturers within 30 days of the end of each completed quarter. Historically, the effect of adjustments resulting from the reconciliation of rebates recognized to the amounts billed and collected has not been material to the Company’s operating results or financial condition. The Company accounts for the effect of any such differences as a change in accounting estimate in the period the reconciliation is completed. The Health Services segment also receives additional discounts under its wholesaler contracts if it exceeds contractually defined purchase volumes. In addition, the Health Services segment receives fees from pharmaceutical manufacturers for administrative services. Purchase discounts and administrative service fees are recorded as a reduction of cost of products sold.

Pharmacy & Consumer Wellness Segment
Vendor allowances received by the Pharmacy & Consumer Wellness segment reduce the carrying cost of inventory and are recognized in cost of products sold when the related inventory is sold, unless they are specifically identified as a reimbursement of incremental costs for promotional programs and/or other services provided. Amounts that are directly linked to advertising commitments are recognized as a reduction of advertising expense (included in operating expenses) when the related advertising commitment is satisfied. Any amounts received in excess of the actual cost incurred also reduce the carrying cost of inventory. The total value of any upfront payments received from vendors that are linked to purchase commitments is initially deferred. The deferred amounts are then amortized to reduce cost of products sold over the life of the contract based upon sales volume. The total value of any upfront payments received from vendors that are not linked to purchase commitments is also initially deferred. The deferred amounts are then amortized to reduce cost of products sold on a straight-line basis over the life
of the related contract. The total amortization of these upfront payments was not material to the Company’s consolidated financial statements in any of the periods presented.

Advertising Costs

Advertising costs, which are reduced by the portion funded by vendors, are expensed when the related advertising takes place. Net advertising costs, which are included in operating expenses, were $985 million, $745 million and $707 million in 2023, 2022 and 2021, respectively.

Stock-Based Compensation

Stock-based compensation is measured at the grant date based on the fair value of the award and is recognized as expense over the requisite service period of the stock award (generally three to five years) using the straight-line method.

Income Taxes

The Company accounts for income taxes under the asset and liability method, which requires the recognition of deferred tax assets and liabilities for the expected future tax consequences of events that have been included in the consolidated financial statements. Under this method, deferred tax assets and liabilities are determined on the basis of the differences between the consolidated financial statements and tax basis of assets and liabilities using enacted tax rates in effect for the year or years in which the differences are expected to reverse. The effect of a change in the tax rates on deferred tax assets and liabilities is recognized in income in the period that includes the enactment date of such change.

The Company recognizes deferred tax assets to the extent that it believes these assets are more likely than not to be realized. In making such a determination, the Company considers all available positive and negative evidence, including future reversals of existing taxable temporary differences, projected future taxable income, tax planning strategies, and the Company’s recent operating results. The Company establishes a valuation allowance when it does not consider it more likely than not that a deferred tax asset will be recovered.

The Company records uncertain tax positions on the basis of a two-step process whereby (1) the Company determines whether it is more likely than not that the tax positions will be sustained on the basis of the technical merits of the position and (2) for those tax positions that meet the more-likely-than-not recognition threshold, the Company recognizes the largest amount of tax benefit that is more than 50% likely to be realized upon ultimate settlement with the related tax authority.

Interest and/or penalties related to uncertain tax positions are recognized in the income tax provision.

Measurement of Defined Benefit Pension and Other Postretirement Employee Benefit Plans

The Company sponsors defined benefit pension plans (“pension plans”) and other postretirement employee benefit plans (“OPEB plans”) for its employees and retirees. The Company recognizes the funded status of its pension and OPEB plans on the consolidated balance sheets based on the year-end measurements of plan assets and benefit obligations. When the fair value of plan assets are in excess of the plan benefit obligations, the amounts are reported in other current assets and other assets. When the fair value of plan benefit obligations are in excess of plan assets, the amounts are reported in accrued expenses and other long-term liabilities based on the amount by which the actuarial present value of benefits payable in the next twelve months included in the benefit obligation exceeds the fair value of plan assets. The net periodic benefit income for the Company’s pension and OPEB plans do not contain a service cost component as these plans have been frozen for an extended period of time. Non-service cost components of pension and postretirement net periodic benefit income are included in other income in the consolidated statements of operations.

Earnings per Share

Earnings per share is computed using the treasury stock method. The Company calculates basic earnings per share based on the weighted average number of common shares outstanding for the period. See Note 16 ‘‘Earnings Per Share’’ for additional information.
Shares Held in Trust

The Company maintains grantor trusts, which held approximately one million shares of its common stock at both December 31, 2023 and 2022. These shares are designated for use under various employee compensation plans. Since the Company holds these shares, they are excluded from the computation of basic and diluted shares outstanding.

VIEs

The Company has various investments that are considered VIEs. The Company does not have a future obligation to fund losses or debts on behalf of these investments; however, it may voluntarily contribute funds. In evaluating whether the Company is the primary beneficiary of a VIE, the Company considers several factors, including whether the Company has (a) the power to direct the activities that most significantly impact the VIE’s economic performance and (b) the obligation to absorb losses and the right to receive benefits that could potentially be significant to the VIE.

VIEs - Primary Beneficiary

Red Oak Sourcing, LLC (“Red Oak”)
In 2014, the Company and Cardinal Health, Inc. (“Cardinal”) established Red Oak, a generic pharmaceutical sourcing entity in which the Company and Cardinal each own 50%. The Red Oak arrangement had an initial term of ten years. In 2021, the Red Oak arrangement was amended to extend the initial term an additional five years, for a total term of 15 years. Under this arrangement, the Company and Cardinal contributed their sourcing and supply chain expertise to Red Oak and agreed to source and negotiate generic pharmaceutical supply contracts for both companies through Red Oak; however, Red Oak does not own or hold inventory on behalf of either company. No physical assets (e.g., property and equipment) were contributed to Red Oak by either company, and minimal funding was provided to capitalize Red Oak. The Company has determined that it is the primary beneficiary of this VIE because it has the ability to direct the activities of Red Oak. Consequently, the Company consolidates Red Oak in its consolidated financial statements within the Pharmacy & Consumer Wellness segment.

Cardinal is required to pay the Company quarterly payments, which began in October 2014 and will extend through June 2029. As milestones are met, the quarterly payments increase. The Company received $183 million from Cardinal during each of the years ended December 31, 2023, 2022 and 2021. The payments reduce the Company’s carrying value of inventory and are recognized in cost of products sold when the related inventory is sold.

Physician Groups
The Company has entered into management and/or administrative services agreements with affiliated physician practice organizations (the “Physician Groups”). Physician Groups employ healthcare providers, contract with managed care payors and deliver healthcare services to patients in the markets that the Company serves. Oak Street Health, MSO LLC (“OSH MSO”), a wholly owned subsidiary of the Company, provides management services to the Physician Groups. Activities include but are not limited to operational support of the centers, marketing, information technology infrastructure and the sourcing and managing of health plan contracts. The Company concluded that it has variable interests in the Physician Groups on the basis of its administrative service agreement, which includes the reimbursement of costs and a management fee payable to the Company from the Physician Groups for the management services provided, which are eliminated in consolidation. The Physician Groups are considered VIEs as additional support is needed to finance their operations. Neither shareholders, employees nor their designees have the individual power to direct the activities of the Physician Groups that significantly impact its economic performance. The success or failure of OSH MSO in performing the activities impacting the growth of patients and management of healthcare services of the Physicians Groups’ patient base is significant to the economic performance of the Physician Groups. Therefore, the Company is the primary beneficiary of the Physician Groups and, consequently, consolidates the Physician Groups in its consolidated financial statements within the Health Services segment.

Physician Groups VIE assets and liabilities included on the consolidated balance sheet at December 31, 2023 were as follows:

In millions2023
Total assets$1,515 
Total liabilities1,503 
There are no restrictions on the Physician Groups’ assets or on the settlement of its liabilities. The assets of the Physician Groups are all current and can be used to settle obligations of the Company. The Physician Groups are included in the Company’s obligated group; thus, creditors of the Company have recourse to the assets owned by the Physician Groups. There
are no liabilities for which creditors of the Physician Groups do not have recourse to the general credit of the Company. There are no restrictions placed on the retained earnings or net income of the Physician Groups with respect to potential dividend payments.

Physician Owned Entities
The Company’s consolidated VIEs include certain IHE related physician practices that require an individual physician to legally own the equity interests as certain state laws and regulations prohibit non-physician owned business entities from practicing medicine or employing licensed healthcare providers. The Company determined it was the primary beneficiary of these VIEs as it has the obligation to absorb the losses from and direct the activities of these operations. As a result, these VIEs are consolidated and any noncontrolling interest is not presented. The carrying amount of these VIEs’ assets and liabilities are not material to the consolidated balance sheets.

Accountable Care Organizations (“ACOs”)
The Company is the sole member of certain ACOs which are considered VIEs. CMS offers a Medicare Shared Savings Program (“MSSP”) to ACOs where the goal of the program is to reward the ACO participants when specific quality metrics are met and expenditures are lowered. The MSSPs have different risk models where the ACOs can either share in both savings and losses or share in only the savings. The governance structure of the VIEs does not provide the Company with the ultimate decision-making authority to direct the activities that most significantly impact the VIEs’ economic performance. For certain ACO VIEs, the Company is ultimately liable for losses incurred or is required to secure and have sole authority over all aspects of the repayment of any shared losses incurred in the program in exchange for a higher percentage of savings and, accordingly, the Company is taking on the risk to absorb losses, resulting in a financial responsibility to ensure that these VIEs operate as designed. For these VIEs, the Company has determined it is the primary beneficiary and therefore consolidates the results of these ACOs. The carrying amount of these VIEs’ assets and liabilities are not material to the consolidated balance sheets.

VIEs - Other Variable Interest Holder
The Company has invested in certain VIEs for which it has determined that it is not the primary beneficiary, consisting of the following:

•Hedge fund and private equity investments - The Company invests in hedge fund and private equity investments in order to generate investment returns for its investment portfolio supporting its insurance businesses.
•Real estate partnerships - The Company invests in various real estate partnerships, including those that construct, own and manage low-income housing developments. For the low income housing development investments, substantially all of the projected benefits to the Company are from tax credits and other tax benefits.

The Company is not the primary beneficiary of these VIEs because the nature of the Company’s involvement with the activities of these VIEs does not give the Company the power to direct the activities that most significantly impact their economic performance. The Company records the amount of its investment in these VIEs as long-term investments on the consolidated balance sheets and recognizes its share of each VIE’s income or losses in net income. The Company’s maximum exposure to loss from these VIEs is limited to its investment balances as disclosed below and the risk of recapture of previously recognized tax credits related to the real estate partnerships, which the Company does not consider significant.

Other variable interest holder VIE assets included in long-term investments on the consolidated balance sheets at December 31, 2023 and 2022 were as follows:
In millions20232022
Hedge fund investments$859 $589 
Private equity investments840 707 
Real estate partnerships319 241 
Total$2,018 $1,537 

Related Party Transactions

The Company has an equity method investment in SureScripts, LLC (“SureScripts”), which operates a clinical health information network. The Company utilizes this clinical health information network in providing services to its client plan members and retail customers. The Company expensed fees for the use of this network of $59 million, $60 million and $52 million in the years ended December 31, 2023, 2022 and 2021, respectively. The Company’s investment in and equity in the earnings of SureScripts for all periods presented is immaterial.
The Company has an equity method investment in Heartland Healthcare Services, LLC (“Heartland”), which previously operated LTC pharmacies. During the year ended December 31, 2023, Heartland ceased operations. Heartland paid the Company $35 million, $87 million and $79 million for pharmaceutical inventory purchases during the years ended December 31, 2023, 2022 and 2021, respectively. Additionally, the Company performed certain collection functions for Heartland and then transferred those customer cash collections to Heartland. The Company’s investment in and equity in the earnings of Heartland for all periods presented is immaterial.

During the years ended December 31, 2022 and 2021, the Company made charitable contributions of $25 million and $50 million, respectively, to the CVS Health Foundation, a non-profit entity that focuses on health, education and community involvement programs. The charitable contributions were recorded as operating expenses in the consolidated statements of operations within the Corporate/Other segment for the years ended December 31, 2022 and 2021. The Company did not make any charitable contributions to the CVS Health Foundation during the year ended December 31, 2023.

Discontinued Operations

In connection with certain business dispositions completed between 1995 and 1997, the Company retained guarantees on store lease obligations for a number of former subsidiaries, including Linens ‘n Things and Bob’s Stores, each of which subsequently filed for bankruptcy. The Company’s loss from discontinued operations includes lease-related costs that the Company believes it will likely be required to satisfy pursuant to these lease guarantees. See “Lease Guarantees” in Note 18 ‘‘Commitments and Contingencies’’ for additional information.

Results from discontinued operations were immaterial for the years ended December 31, 2023, 2022 and 2021.

New Accounting Pronouncements Recently Adopted

Targeted Improvements to the Accounting for Long-Duration Insurance Contracts
In August 2018, the Financial Accounting Standards Board (“FASB”) issued ASU 2018-12, Targeted Improvements to the Accounting for Long-Duration Contracts (Topic 944) (the “long-duration insurance standard”). This standard requires the Company to review cash flow assumptions for its long-duration insurance contracts at least annually and recognize the effect of changes in future cash flow assumptions in net income. This standard also requires the Company to update discount rate assumptions quarterly and recognize the effect of changes in these assumptions in other comprehensive income. The rate used to discount the Company’s liability for future policy benefits will be based on an estimate of the yield for an upper-medium grade fixed-income instrument with a duration profile matching that of the Company’s liabilities. In addition, this standard changes the amortization method for deferred acquisition costs and requires additional disclosures regarding the long duration insurance contract liabilities in the Company’s interim and annual financial statements.

The Company adopted this accounting standard on January 1, 2023, using the modified retrospective transition method as of January 1, 2021, also referred to as the “transition date”, for changes to its liabilities for future policy benefits, deferred acquisition costs and VOBA intangible asset. Upon adoption, the Company recorded a transition date net adjustment to reduce accumulated other comprehensive income (loss) by $986 million ($766 million after-tax) with a corresponding increase to its liability for future policy benefits, the majority of which is included within other insurance liabilities and other long-term liabilities on the consolidated balance sheets. The transition date net adjustment was a result of updating the rate used to discount the liabilities to reflect the yield for an upper-medium grade fixed-income instrument compared to the Company’s expected investment yield under the historical guidance. The Company was not required to record an adjustment to retained earnings on the transition date. Prior period financial information subsequent to the transition date has been revised to reflect the adoption of the long-duration insurance standard.
The following summarizes changes in the balances of long-duration insurance liabilities as a result of the adoption of the long-duration insurance standard effective January 1, 2021:
In millionsLarge Case
Pensions		Long-Term
Care		Other
Balance at December 31, 2020, net of reinsurance$3,224$1,142$480
Add: Reinsurance recoverable——274
Balance at December 31, 20203,2241,142754
Change in discount rate assumptions60455344
Removal of shadow adjustments in accumulated other comprehensive income(181)——
Adjusted balance at January 1, 20213,6471,695798
Less: Reinsurance recoverable——308
Adjusted balance at January 1, 2021, net of reinsurance$3,647$1,695$490

Impact of New Long-Duration Insurance Contracts Standard on Financial Statement Line Items
As a result of applying the long-duration insurance standard using a modified retrospective method, the following adjustments were made to amounts reported in the consolidated statement of operations for the years ended December 31, 2022 and 2021:
Impact of Change in Accounting Policy
In millionsAs Reported
December 31, 2022		AdjustmentsAdjusted
December 31, 2022
Consolidated Statement of Operations:
Operating costs:
Health care costs$71,281$(208)$71,073
Total operating costs314,721(208)314,513
Operating income7,7462087,954
Income before income tax provision5,6282085,836
Income tax provision1,463461,509
Net income4,1651624,327
Net income attributable to CVS Health4,1491624,311
Net income per share attributable to CVS Health:
Basic$3.16 $0.13 $3.29 
Diluted$3.14 $0.12 $3.26 
Impact of Change in Accounting Policy
In millionsAs Reported
December 31, 2021		AdjustmentsAdjusted
December 31, 2021
Consolidated Statement of Operations:
Operating costs:
Health care costs$64,260$(72)$64,188
Operating expenses37,066(45)37,021
Total operating costs278,918(117)278,801
Operating income13,19311713,310
Income before income tax provision10,42011710,537
Income tax provision2,522262,548
Net income7,898917,989
Net income attributable to CVS Health7,910918,001
Net income per share attributable to CVS Health:
Basic$6.00 $0.07 $6.07 
Diluted$5.95 $0.07 $6.02 
As a result of applying the long-duration insurance standard using a modified retrospective method, the following adjustments were made to amounts reported in the consolidated balance sheet as of December 31, 2022:
Impact of Change in Accounting Policy
In millionsAs Reported
December 31, 2022		AdjustmentsAdjusted
December 31, 2022
Consolidated Balance Sheet:
Other current assets$2,685$(49)$2,636
Total current assets65,682(49)65,633
Intangible assets, net24,7544924,803
Total assets228,275—228,275
Health care costs payable10,406(264)10,142
Other insurance liabilities1,140(51)1,089
Total current liabilities69,736(315)69,421
Deferred income taxes3,8801364,016
Other long-term insurance liabilities6,108(273)5,835
Other long-term liabilities6,732(2)6,730
Total liabilities156,960(454)156,506
Retained earnings56,14525356,398
Accumulated other comprehensive loss(1,465)201(1,264)
Total CVS Health shareholders’ equity71,01545471,469
Total shareholders’ equity71,31545471,769
Total liabilities and shareholders’ equity228,275—228,275
As a result of applying the long-duration insurance standard using a modified retrospective method, the following adjustments were made to amounts reported in the consolidated statement of cash flows for the years ended December 31, 2022 and 2021:
Impact of Change in Accounting Policy
In millionsAs Reported
December 31, 2022		AdjustmentsAdjusted
December 31, 2022
Consolidated Statement of Cash Flows:
Reconciliation of net income to net cash provided by operating activities:
Net income$4,165$162$4,327
Adjustments required to reconcile net income to net cash provided by operating activities:
Depreciation and amortization4,247(23)4,224
Deferred income taxes(2,075)46(2,029)
Change in operating assets and liabilities, net of effects from acquisitions:
Other assets(566)75(491)
Health care costs payable and other insurance liabilities1,247(255)992
Other liabilities6,468(5)6,463
Impact of Change in Accounting Policy
In millionsAs Reported
December 31, 2021		AdjustmentsAdjusted
December 31, 2021
Consolidated Statement of Cash Flows:
Reconciliation of net income to net cash provided by operating activities:
Net income$7,898$91$7,989
Adjustments required to reconcile net income to net cash provided by operating activities:
Depreciation and amortization4,512(26)4,486
Deferred income taxes(428)26(402)
Change in operating assets and liabilities, net of effects from acquisitions:
Other assets(3)(27)(30)
Health care costs payable and other insurance liabilities169(68)101
Other liabilities2,85242,856

New Accounting Pronouncements Not Yet Adopted

Segment Reporting
In November 2023, the FASB issued ASU 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures. This standard requires the Company to disclose significant segment expenses that are regularly provided to the CODM and are included within each reported measure of segment operating results. The standard also requires the Company to disclose the total amount of any other items included in segment operating results which were not deemed to be significant expenses for separate disclosure, along with a qualitative description of the composition of these other items. In addition, the standard also requires disclosure of the CODM’s title and position, as well as detail on how the CODM uses the reported measure of segment operating results to evaluate segment performance and allocate resources. The standard also aligns interim segment reporting disclosure requirements with annual segment reporting disclosure requirements. The Company adopted the standard on January 1, 2024 for fiscal year reporting and the standard will be effective for interim reporting periods in fiscal years beginning after December 15, 2024, with early adoption permitted. The standard requires retrospective application to all prior periods presented. While the standard requires additional disclosures related to the Company’s reportable segments, the standard did not have any impact on the Company’s consolidated operating results, financial condition or cash flows as of the date of adoption.

Income Taxes
In December 2023, the FASB issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures. The standard requires the Company to provide further disaggregated income tax disclosures for specific categories on the effective
tax rate reconciliation, as well as additional information about federal, state/local and foreign income taxes. The standard also requires the Company to annually disclose its income taxes paid (net of refunds received), disaggregated by jurisdiction. The standard is effective for fiscal years beginning after December 15, 2024, with early adoption permitted. The standard is to be applied on a prospective basis, although optional retrospective application is permitted. While the standard will require additional disclosures related to the Company’s income taxes, the standard is not expected have any impact on the Company’s consolidated operating results, financial condition or cash flows.
v3.24.0.1
Acquisitions, Divestitures and Asset Sales
 12 Months Ended
Dec. 31, 2023
Business Combination and Asset Acquisition [Abstract]  
Acquisitions, Divestitures and Asset Sales Acquisitions, Divestitures and Asset Sales
Oak Street Health Acquisition

On May 2, 2023 (the “Oak Street Health Acquisition Date”), the Company acquired 100% of the outstanding shares and voting interest of Oak Street Health for cash (“Oak Street Health Acquisition”). Under the terms of the merger agreement, Oak Street Health stockholders received $39.00 per share in cash. The Company financed the transaction with borrowings of $5.0 billion from a term loan agreement entered into on May 1, 2023 as described in Note 10 ‘‘Borrowings and Credit Agreements’’ and cash on hand. Oak Street Health is a leading multi-payor, senior focused value-based primary care company. Oak Street Health is included within the Health Services segment. The Company acquired Oak Street Health to advance its value-based care strategy and broaden its platform into primary care.

The fair value of the consideration transferred on the date of acquisition consisted of the following:
In millions
Cash$9,579 
Fair value of replacement equity awards for pre-combination services (3.9 million shares) (1)
118 
Effective settlement of pre-existing relationship (2)
(29)
Total consideration transferred$9,668 
_____________________________________________
(1)The fair value of the replacement equity awards issued by the Company was determined as of the Oak Street Health Acquisition Date. The fair value of the awards attributed to pre-combination services of $118 million is included in the consideration transferred and the fair value of the awards attributed to post-combination services of $165 million has been, or will be, included in the Company’s post-combination financial statements as compensation costs.
(2)The purchase price included $29 million of effectively settled liabilities the Company owed to Oak Street Health from their pre-existing relationship.

The transaction has been accounted for using the acquisition method of accounting which requires, among other things, the assets acquired and liabilities assumed to be recognized at their fair values at the date of acquisition. The following table summarizes the estimated fair values of the assets acquired and liabilities assumed at the date of acquisition:
In millions
Cash and cash equivalents$201 
Investments168 
Accounts receivable1,143 
Other current assets46 
Property and equipment180 
Operating lease right-of-use assets316 
Goodwill7,213 
Intangible assets4,233 
Other long-term assets7 
Total assets acquired13,507 
Health care costs payable 1,098 
Other current liabilities444 
Operating lease liabilities (current and long-term)378 
Debt (current and long-term)1,028 
Deferred income taxes796 
Other long-term liabilities 29 
Total liabilities assumed3,773 
Noncontrolling interests66 
Total consideration transferred$9,668 
The assessment of fair value is preliminary and is based on information that was available to management at the time the consolidated financial statements were prepared. The most significant open items included the accounting for contingencies and the accounting for income taxes as management is awaiting additional information to complete its assessment of these matters. Measurement period adjustments will be recorded in the period in which they are determined, as if they had been completed at the acquisition date. The finalization of the Company’s purchase accounting assessment could result in changes in the valuation of assets acquired and liabilities assumed, which could be material.

Goodwill
Goodwill represents future economic benefits expected to arise from the Company’s expanded presence in the health services industry, the assembled workforce acquired, expected revenue and medical cost synergies, as well as operating efficiencies and cost savings. The preliminary valuation of goodwill was allocated to the Company’s business segments as follows:
In millions
Health Services$6,936 
Pharmacy & Consumer Wellness156 
Health Care Benefits121 
Total goodwill$7,213 

The amount of goodwill deductible for income tax purposes was not material.

Intangible Assets
The following table summarizes the fair values and weighted average useful lives for intangible assets acquired in the Oak Street Health Acquisition:
In millions, except weighted average useful lifeGross
Fair Value		Weighted
Average Useful
Life (years)
Customer relationships (1)
$3,620 19.9
Technology143 3.0
Trademark (definite-lived)470 8.0
Total intangible assets$4,233 18.0
_____________________________________________
(1) The substantial majority of the customer relationships intangible asset relates to relationships with health plan payors.

Deferred Income Taxes
The purchase price allocation includes net deferred tax liabilities of $796 million, primarily related to deferred tax liabilities established on the identifiable acquired intangible assets.

Consolidated Results of Operations
During the period from the Oak Street Health Acquisition Date through December 31, 2023, the Company’s consolidated results of operations included $2.1 billion of revenues and $520 million of operating losses, including $193 million of intangible asset amortization and $71 million of stock-based compensation, associated with the results of operations of Oak Street Health.

During the year ended December 31, 2023, the Company incurred transaction costs of $77 million associated with the Oak Street Health Acquisition, which were recorded in operating expenses.

Signify Health Acquisition

On March 29, 2023 (the “Signify Health Acquisition Date”), the Company acquired 100% of the outstanding shares and voting interest of Signify Health for cash (“Signify Health Acquisition”). Under the terms of the merger agreement, Signify Health stockholders received $30.50 per share in cash. The Company financed the transaction with cash on hand, which included approximately $6 billion of proceeds from the issuance of senior unsecured notes in February 2023. Signify Health is a leader in health risk assessments, value-based care and provider enablement services. Signify Health is included within the Health Services segment. The Company acquired Signify Health to advance its health care services strategy, growth in value-based care and new product offerings for other payers.
The fair value of the consideration transferred on the date of acquisition consisted of the following:
In millions
Cash$7,450 
Fair value of replacement equity awards for pre-combination services (3.2 million shares) (1)
14 
Effective settlement of pre-existing relationship (2)
(111)
Total consideration transferred$7,353 
_____________________________________________
(1)The fair value of the replacement equity awards issued by the Company was determined as of the Signify Health Acquisition Date. The fair value of the awards attributed to pre-combination services of $14 million is included in the consideration transferred and the fair value of the awards attributed to post-combination services of $167 million has been, or will be, included in the Company’s post-combination financial statements as compensation costs.
(2)The purchase price included $111 million of effectively settled liabilities the Company owed to Signify Health from their pre-existing relationship.

The transaction has been accounted for using the acquisition method of accounting which requires, among other things, the assets acquired and liabilities assumed to be recognized at their fair values at the date of acquisition. The following table summarizes the fair values of the assets acquired and liabilities assumed at the date of acquisition:
In millions
Cash and cash equivalents$376 
Accounts receivable190 
Other current assets (including restricted cash of $28)
147 
Property and equipment25 
Goodwill5,909 
Intangible assets1,920 
Other long-term assets23 
Total assets acquired8,590 
Other current liabilities606 
Debt (current and long-term)346 
Deferred income taxes259 
Other long-term liabilities 26 
Total liabilities assumed1,237 
Total consideration transferred$7,353 

The Company’s assessment of the fair value of assets acquired and liabilities assumed was finalized during the fourth quarter of 2023. Measurement period adjustments to assets acquired and liabilities assumed during the year ended December 31, 2023 were not material.

Goodwill
Goodwill represents future economic benefits expected to arise from the Company’s expanded presence in the health services industry, the assembled workforce acquired, expected revenue and medical cost synergies, as well as operating efficiencies and cost savings. Goodwill was allocated to the Company’s business segments as follows:
In millions
Health Services$3,406 
Health Care Benefits2,473 
Pharmacy & Consumer Wellness30 
Total goodwill$5,909 

Approximately $1.7 billion of goodwill is deductible for income tax purposes.
Intangible Assets
The following table summarizes the fair values and weighted average useful lives for intangible assets acquired in the Signify Health Acquisition:
In millions, except weighted average useful lifeGross
Fair Value		Weighted
Average Useful
Life (years)
Customer relationships$1,810 16.7
Technology 50 3.0
Trademark (definite-lived)60 5.0
Total intangible assets$1,920 16.0

Deferred Income Taxes
The purchase price allocation includes net deferred tax liabilities of $259 million, primarily related to deferred tax liabilities established on the identifiable acquired intangible assets.

Consolidated Results of Operations
During the period from the Signify Health Acquisition Date through December 31, 2023, the Company’s consolidated results of operations included $797 million of revenues and $123 million of operating income, including $106 million of intangible asset amortization and $72 million of stock-based compensation, associated with the results of operations of Signify Health.

During the year ended December 31, 2023, the Company incurred transaction costs of $37 million associated with the Signify Health Acquisition, which were recorded in operating expenses.

Assets Held For Sale

The Company continually evaluates its portfolio for non-strategic assets. The Company determined that its Omnicare® long-term care business (“LTC business”), which is included within the Pharmacy & Consumer Wellness segment, was no longer a strategic asset and during the third quarter of 2022 committed to a plan to sell the LTC business. At that time, the LTC business met the criteria to be classified as held for sale.

During 2022, the carrying value of the LTC business was determined to be greater than its estimated fair value less costs to sell. Accordingly, the Company recorded total losses on assets held for sale of $2.5 billion during the year ended December 31, 2022. During the first quarter of 2023, an incremental loss on assets held for sale of $349 million was recorded to write-down the carrying value of the LTC business to the Company’s best estimate of the ultimate selling price which reflects its estimated fair value less costs to sell. The loss on assets held for sale represents the write-down of long-lived assets and was recorded in the Company’s consolidated statement of operations within the Pharmacy & Consumer Wellness segment.

While the Company continues to evaluate strategic alternatives for the LTC business, during the third quarter of 2023, the Company determined it was no longer probable that a sale would be completed in the near term. At that time, the Company concluded that the LTC business no longer met the criteria to be classified as held for sale and, accordingly, the assets and liabilities associated with this business were reclassified to held and used at their respective fair values on the consolidated balance sheet.

Divestiture of bswift

In November 2022, the Company sold its wholly-owned subsidiary bswift LLC (“bswift”) for approximately $735 million. bswift offers software and services that streamline benefits and human resource administration. The results of this business have historically been recorded within the Health Care Benefits segment. The Company recorded a pre-tax gain on the divestiture of $250 million in the year ended December 31, 2022, which is reflected as a reduction of operating expenses in the Company’s consolidated statement of operations within the Health Care Benefits segment.

Divestiture of PayFlex

In June 2022, the Company sold PayFlex for approximately $775 million. PayFlex provides services to employers, their employees, and their former employees in the areas of tax-advantaged account reimbursement administration (flexible spending, health reimbursement, health savings, transit and parking), Consolidated Omnibus Budget Reconciliation Act administration and special-member billing administration. The results of this business have historically been reported within the
Health Care Benefits segment. The Company recorded a pre-tax gain on the divestiture of $225 million in the year ended December 31, 2022, which is reflected as a reduction of operating expenses in the Company’s consolidated statement of operations within the Health Care Benefits segment.

Divestiture of Thailand Health Care Business

In March 2022, the Company reached an agreement to sell its international health care business domiciled in Thailand (“Thailand business”), comprised of approximately 266,000 medical members, which was included in the Commercial Business reporting unit within the Health Care Benefits segment. At that time, a portion of the Commercial Business goodwill was specifically allocated to the Thailand business. The net assets of the Thailand business were accounted for as assets held for sale at March 31, 2022. The carrying value of the Thailand business was determined to be greater than its estimated fair value less costs to sell and, accordingly, the Company recorded a $41 million loss on assets held for sale within the Health Care Benefits segment during the first quarter of 2022. The sale of the Thailand business closed in the second quarter of 2022, and the consideration received and ultimate loss on the sale were not material.

International Health Care Benefits Renewal Rights Asset Sale

In May 2022, the Company sold the renewal rights of approximately 200,000 international medical members outside of the Americas, Thailand and India in connection with an Asset Purchase Agreement. As part of this agreement, the Company will introduce and help migrate these existing international medical members to the purchaser upon renewal. The migration process was completed during 2023. The Company ceased writing any new or renewal business for international medical members outside of the Americas during the fourth quarter of 2022. The consideration received related to this agreement was not material.
v3.24.0.1
Restructuring Program
 12 Months Ended
Dec. 31, 2023
Restructuring and Related Activities [Abstract]  
Restructuring Program Restructuring Program
During the second quarter of 2023, the Company developed an enterprise-wide restructuring plan intended to streamline and simplify the organization, improve efficiency and reduce costs. In connection with the development of this plan and the recently completed acquisitions of Signify Health and Oak Street Health, the Company also conducted a strategic review of its various transformation initiatives and determined that it would terminate certain initiatives, including providing clinical trials services. In connection with the restructuring plan, during 2023, the Company recorded $507 million in pre-tax restructuring charges, comprised of $344 million of severance and employee-related costs associated with corporate workforce optimization, $152 million of asset impairment charges and an $11 million stock-based compensation charge associated with the impacted employees. These restructuring charges are reflected in the Corporate/Other segment. The severance and employee-related costs were recorded in accrued expenses and the asset impairments were recorded as a reduction of property and equipment, net, while the stock-based compensation charge was reflected as an adjustment to common stock and capital surplus on the consolidated balance sheet.

The following table shows the change in the severance and employee-related restructuring charge liability during the year ended December 31, 2023:

In millions2023
Restructuring charge liability, beginning of the period$— 
Restructuring charges344 
Payments(194)
Restructuring charge liability, end of the period$150 

Severance and employee-related costs consist primarily of salary continuation benefits, prorated annual incentive compensation, continuation of health care benefits and outplacement services. Severance and employee-related benefits are determined pursuant to the Company’s written severance plans and are recognized when the benefits are determined to be probable of being paid and are reasonably estimable.

As of December 31, 2023, the restructuring program was substantially complete.
v3.24.0.1
Investments
 12 Months Ended
Dec. 31, 2023
Investments [Abstract]  
Investments Investments
Total investments at December 31, 2023 and 2022 were as follows:
20232022
In millionsCurrentLong-termTotalCurrentLong-termTotal
Debt securities available for sale$3,131 $18,582 $21,713 $2,718 $17,562 $20,280 
Mortgage loans128 1,183 1,311 55 989 1,044 
Other investments— 3,254 3,254 5 2,562 2,567 
Total investments (1)
$3,259 $23,019 $26,278 $2,778 $21,113 $23,891 
_____________________________________________
(1)Includes long-term investments of $17 million which were accounted for as assets held for sale and were included in assets held for sale on the consolidated balance sheet at December 31, 2022. See Note 2 ‘‘Acquisitions, Divestitures and Asset Sales’’ for additional information.

At December 31, 2023 and 2022, the Company held investments of $307 million and $331 million, respectively, related to the 2012 conversion of an existing group annuity contract from a participating to a non-participating contract. These investments are included in the total investments of large case pensions supporting non-experience-rated products. Although these investments are not accounted for as Separate Accounts assets, they are legally segregated and are not subject to claims that arise out of the Company’s business and only support future policy benefits obligations under that group annuity contract.

Debt Securities

Debt securities available for sale at December 31, 2023 and 2022 were as follows:
In millionsGross
Amortized
Cost		Allowance
for Credit
Losses		Net
Amortized
Cost		Gross
Unrealized
Gains		Gross
Unrealized
Losses		Fair
Value
December 31, 2023   
Debt securities:   
U.S. government securities$2,071 $— $2,071 $19 $(54)$2,036 
States, municipalities and political subdivisions2,219 — 2,219 31 (35)2,215 
U.S. corporate securities10,156 — 10,156 133 (446)9,843 
Foreign securities2,593 — 2,593 41 (122)2,512 
Residential mortgage-backed securities862 — 862 8 (60)810 
Commercial mortgage-backed securities1,066 — 1,066 9 (100)975 
Other asset-backed securities3,294 — 3,294 26 (18)3,302 
Redeemable preferred securities21 — 21 — (1)20 
Total debt securities (1)
$22,282 $— $22,282 $267 $(836)$21,713 
December 31, 2022
Debt securities:
U.S. government securities$2,074 $— $2,074 $— $(182)$1,892 
States, municipalities and political subdivisions2,393 — 2,393 8 (129)2,272 
U.S. corporate securities9,838 (3)9,835 26 (903)8,958 
Foreign securities2,780 (1)2,779 15 (244)2,550 
Residential mortgage-backed securities845 — 845 1 (89)757 
Commercial mortgage-backed securities1,172 — 1,172 1 (155)1,018 
Other asset-backed securities2,940 — 2,940 6 (136)2,810 
Redeemable preferred securities25 — 25 — (2)23 
Total debt securities (1)
$22,067 $(4)$22,063 $57 $(1,840)$20,280 
_____________________________________________
(1)Investment risks associated with the Company’s experience-rated products generally do not impact the Company’s consolidated operating results. At December 31, 2023, debt securities with a fair value of $592 million, gross unrealized capital gains of $10 million and gross unrealized capital losses of
$28 million, and at December 31, 2022, debt securities with a fair value of $609 million, gross unrealized capital gains of $3 million and gross unrealized capital losses of $59 million were included in total debt securities, but support experience-rated products. Changes in net unrealized capital gains (losses) on these securities are not reflected in accumulated other comprehensive loss.

The amortized cost and fair value of debt securities at December 31, 2023 are shown below by contractual maturity. Actual maturities may differ from contractual maturities because securities may be restructured, called or prepaid, or the Company intends to sell a security prior to maturity.
In millions Amortized
Cost		Fair
Value
Due to mature: 
Less than one year$1,244 $1,230 
One year through five years7,563 7,390 
After five years through ten years4,302 4,204 
Greater than ten years3,951 3,802 
Residential mortgage-backed securities862 810 
Commercial mortgage-backed securities1,066 975 
Other asset-backed securities3,294 3,302 
Total$22,282 $21,713 

Mortgage-Backed and Other Asset-Backed Securities
All of the Company’s residential mortgage-backed securities at December 31, 2023 were issued by the Government National Mortgage Association, the Federal National Mortgage Association or the Federal Home Loan Mortgage Corporation and carry agency guarantees and explicit or implicit guarantees by the U.S. Government. At December 31, 2023, the Company’s residential mortgage-backed securities had an average credit quality rating of AA and a weighted average duration of 5.9 years.

The Company’s commercial mortgage-backed securities have underlying loans that are dispersed throughout the U.S. Significant market observable inputs used to value these securities include loss severity and probability of default. At December 31, 2023, these securities had an average credit quality rating of AAA and a weighted average duration of 5.4 years.

The Company’s other asset-backed securities have a variety of underlying collateral (e.g., automobile loans, credit card receivables, home equity loans and commercial loans). Significant market observable inputs used to value these securities include the unemployment rate, loss severity and probability of default. At December 31, 2023, these securities had an average credit quality rating of AA and a weighted average duration of less than one year.
Summarized below are the debt securities the Company held at December 31, 2023 and 2022 that were in an unrealized capital loss position, aggregated by the length of time the investments have been in that position:
Less than 12 monthsGreater than 12 monthsTotal
In millions, except number of securitiesNumber
of
 Securities		Fair
Value		Unrealized
Losses		Number
of
 Securities		Fair
Value		Unrealized
Losses		Number
of
 Securities		Fair
Value		Unrealized
Losses
December 31, 2023
Debt securities:  
U.S. government securities74 $194 $2 280 $891 $52 354 $1,085 $54 
States, municipalities and political subdivisions95 181 1 455 733 34 550 914 35 
U.S. corporate securities576 672 14 4,120 5,602 432 4,696 6,274 446 
Foreign securities160 243 4 964 1,407 118 1,124 1,650 122 
Residential mortgage-backed securities33 97 1 461 517 59 494 614 60 
Commercial mortgage-backed securities44 94 2 287 581 98 331 675 100 
Other asset-backed securities196 449 4 443 867 14 639 1,316 18 
Redeemable preferred securities4 2 — 8 18 1 12 20 1 
Total debt securities1,182 $1,932 $28 7,018 $10,616 $808 8,200 $12,548 $836 
December 31, 2022
Debt securities:
U.S. government securities519 $1,620 $164 35 $191 $18 554 $1,811 $182 
States, municipalities and political subdivisions859 1,370 95 196 322 34 1,055 1,692 129 
U.S. corporate securities5,193 6,537 622 1,479 1,822 281 6,672 8,359 903 
Foreign securities1,168 1,715 147 403 592 97 1,571 2,307 244 
Residential mortgage-backed securities452 464 39 91 257 50 543 721 89 
Commercial mortgage-backed securities288 611 69 187 381 86 475 992 155 
Other asset-backed securities1,008 1,893 88 391 694 48 1,399 2,587 136 
Redeemable preferred securities13 18 2 2 5 — 15 23 2 
Total debt securities9,500 $14,228 $1,226 2,784 $4,264 $614 12,284 $18,492 $1,840 

The Company reviewed the securities in the table above and concluded that they are performing assets generating investment income to support the needs of the Company’s business. In performing this review, the Company considered factors such as the quality of the investment security based on research performed by the Company’s internal credit analysts and external rating agencies and the prospects of realizing the carrying value of the security based on the investment’s current prospects for recovery. Unrealized capital losses at December 31, 2023 were generally caused by interest rate increases and not by unfavorable changes in the credit quality associated with these securities. As of December 31, 2023, the Company did not intend to sell these securities, and did not believe it was more likely than not that it would be required to sell these securities prior to the anticipated recovery of their amortized cost basis.
The maturity dates for debt securities in an unrealized capital loss position at December 31, 2023 were as follows:
 Supporting experience-
rated products		Supporting remaining
products		Total
In millionsFair
Value		Unrealized
Losses		Fair
Value		Unrealized
Losses		Fair
Value		Unrealized
Losses
Due to mature:      
Less than one year$15 $— $1,057 $16 $1,072 $16 
One year through five years128 3 4,504 226 4,632 229 
After five years through ten years87 7 1,925 172 2,012 179 
Greater than ten years137 14 2,090 220 2,227 234 
Residential mortgage-backed securities9 1 605 59 614 60 
Commercial mortgage-backed securities15 2 660 98 675 100 
Other asset-backed securities12 1 1,304 17 1,316 18 
Total$403 $28 $12,145 $808 $12,548 $836 

Mortgage Loans

The Company’s mortgage loans are collateralized by commercial real estate. During the years ended December 31, 2023 and 2022, the Company had the following activity in its mortgage loan portfolio:
In millions20232022
New mortgage loans$342 $356 
Mortgage loans fully repaid43 178 
Mortgage loans foreclosed— — 

The Company assesses mortgage loans on a regular basis for credit impairments, and assigns a credit quality indicator to each loan. The Company’s credit quality indicator is internally developed and categorizes each loan in its portfolio on a scale from 1 to 7. These indicators are based upon several factors, including current loan-to-value ratios, current and future property cash flow, property condition, market trends, creditworthiness of the borrower and deal structure.

•Category 1 - Represents loans of superior quality.
•Categories 2 to 4 - Represent loans where credit risk is minimal to acceptable; however, these loans may display some susceptibility to economic changes.
•Categories 5 and 6 - Represent loans where credit risk is not substantial, but these loans warrant management’s close attention.
•Category 7 - Represents loans where collections are potentially at risk; if necessary, an impairment is recorded.
Based upon the Company’s assessments at December 31, 2023 and 2022, the amortized cost basis of the Company’s mortgage loans within each credit quality indicator by year of origination was as follows:

Amortized Cost Basis by Year of Origination
In millions, except credit quality indicator20232022202120202019PriorTotal
December 31, 2023
1$— $— $— $— $— $11 $11 
2 to 4302 346 225 35 11 343 1,262 
5 and 6— — 13 — — 19 32 
7— — 6 — — — 6 
Total$302 $346 $244 $35 $11 $373 $1,311 
December 31, 2022
1$— $— $— $— $15 $15 
2 to 4326 247 36 11 402 1,022 
5 and 6— — — — 7 7 
7— — — — — — 
Total$326 $247 $36 $11 $424 $1,044 

At December 31, 2023 scheduled mortgage loan principal repayments were as follows:
In millions
2024$128 
2025123 
2026179 
2027229 
2028300 
Thereafter352 
Total$1,311 

Net Investment Income

Sources of net investment income for the years ended December 31, 2023, 2022 and 2021 were as follows:
In millions202320222021
Debt securities$841 $702 $634 
Mortgage loans59 51 55 
Other investments796 448 381 
Gross investment income1,696 1,201 1,070 
Investment expenses(46)(43)(47)
Net investment income (excluding net realized capital gains or losses)1,650 1,158 1,023 
Net realized capital gains (losses) (1)
(497)(320)176 
Net investment income (2)
$1,153 $838 $1,199 
_____________________________________________
(1)Net realized capital losses include yield-related impairment losses on debt securities of $152 million and are net of the reversal of previously recorded credit-related impairment losses on debt securities of $3 million in the year ended December 31, 2023. Net realized capital losses include yield-related impairment losses on debt securities of $143 million and credit-related impairment losses on debt securities of $13 million in the year ended December 31, 2022. Net realized capital gains are net of yield-related impairment losses on debt securities of $42 million for the year ended December 31, 2021. There were no credit-related impairment losses on debt securities in the year ended December 31, 2021.
(2)Net investment income includes $34 million, $35 million and $38 million for the years ended December 31, 2023, 2022 and 2021, respectively, related to investments supporting experience-rated products.
Capital gains and losses recognized during the year ended December 31, 2023 related to investments in equity securities held as of December 31, 2023 were not material.

Excluding amounts related to experience-rated products, proceeds from the sale of available-for-sale debt securities and the related gross realized capital gains and losses in the years ended December 31, 2023, 2022 and 2021 were as follows:
In millions202320222021
Proceeds from sales$5,031 $4,243 $3,572 
Gross realized capital gains9 24 72 
Gross realized capital losses420 177 14 
v3.24.0.1
Fair Value
 12 Months Ended
Dec. 31, 2023
Fair Value Disclosures [Abstract]  
Fair Value Fair Value
The preparation of the Company’s consolidated financial statements requires certain assets and liabilities to be reflected at their fair value and others to be reflected on another basis, such as an adjusted historical cost basis. In this note, the Company provides details on the fair value of financial assets and liabilities and how it determines those fair values. The Company presents this information for those financial instruments that are measured at fair value for which the change in fair value impacts net income attributable to CVS Health or other comprehensive income (loss) separately from other financial assets and liabilities.

Financial Instruments Measured at Fair Value on the Consolidated Balance Sheets

Certain of the Company’s financial instruments are measured at fair value on the consolidated balance sheets. The fair values of these instruments are based on valuations that include inputs that can be classified within one of three levels of a hierarchy established by GAAP. The following are the levels of the hierarchy and a brief description of the type of valuation information (“valuation inputs”) that qualifies a financial asset or liability for each level:

•Level 1 – Unadjusted quoted prices for identical assets or liabilities in active markets.
•Level 2 – Valuation inputs other than Level 1 that are based on observable market data. These include: quoted prices for similar assets in active markets, quoted prices for identical assets in inactive markets, valuation inputs that are observable that are not prices (such as interest rates and credit risks) and valuation inputs that are derived from or corroborated by observable markets.
•Level 3 – Developed from unobservable data, reflecting the Company’s assumptions.

Financial assets and liabilities are classified based upon the lowest level of input that is significant to the valuation. When quoted prices in active markets for identical assets and liabilities are available, the Company uses these quoted market prices to determine the fair value of financial assets and liabilities and classifies these assets and liabilities in Level 1. In other cases where a quoted market price for identical assets and liabilities in an active market is either not available or not observable, the Company estimates fair value using valuation methodologies based on available and observable market information or by using a matrix pricing model. These financial assets and liabilities are classified in Level 2. If quoted market prices are not available, the Company determines fair value using broker quotes or an internal analysis of each investment’s financial performance and cash flow projections. Thus, financial assets and liabilities may be classified in Level 3 even though there may be some significant inputs that may be observable.

The following is a description of the valuation methodologies used for the Company’s financial assets and liabilities that are measured at fair value, including the general classification of such assets and liabilities pursuant to the valuation hierarchy.

Cash and Cash Equivalents – The carrying value of cash and cash equivalents approximates fair value as maturities are less than three months. When quoted prices are available in an active market, cash equivalents are classified in Level 1 of the fair value hierarchy. Fair values of cash equivalent instruments that do not trade on a regular basis in active markets are classified as Level 2.

Debt Securities – Where quoted prices are available in an active market, debt securities are classified in Level 1 of the fair value hierarchy. The Company’s Level 1 debt securities consist primarily of U.S. Treasury securities.

The fair values of the Company’s Level 2 debt securities are obtained using models, such as matrix pricing, which use quoted market prices of debt securities with similar characteristics or discounted cash flows to estimate fair value. The
Company reviews these prices to ensure they are based on observable market inputs that include quoted prices for similar assets in active markets, quoted prices for identical assets in inactive markets and inputs that are observable that are not prices (such as interest rates and credit risks). The Company also reviews the methodologies and the assumptions used to calculate prices from these observable inputs. On a quarterly basis, the Company selects a sample of its Level 2 debt securities’ prices and compares them to prices provided by a secondary source. Variances over a specified threshold are identified and reviewed to confirm the price provided by the primary source represents an appropriate estimate of fair value. In addition, the Company’s internal investment team consistently compares the prices obtained for select Level 2 debt securities to the team’s own independent estimates of fair value for those securities. The Company obtained one price for each of its Level 2 debt securities and did not adjust any of those prices at December 31, 2023 or 2022.

The Company also values certain debt securities using Level 3 inputs. For Level 3 debt securities, fair values are determined by outside brokers or, in the case of certain private placement securities, are priced internally. Outside brokers determine the value of these debt securities through a combination of their knowledge of the current pricing environment and market flows. The Company did not have any broker quoted debt securities for the years ended December 31, 2023 and 2022. For some private placement securities, the Company’s internal staff determines the value of these debt securities by analyzing spreads of corporate and sector indices as well as interest spreads of comparable public bonds. Examples of these private placement Level 3 debt securities include certain U.S. and foreign securities and certain tax-exempt municipal securities.

Equity Securities – The Company currently has two classifications of equity securities: those that are publicly traded and those that are privately placed. Publicly-traded equity securities are classified in Level 1 because quoted prices are available for these securities in an active market. For privately placed equity securities, there is no active market; therefore, these securities are classified in Level 3 because the Company prices these securities through an internal analysis of each investment’s financial statements and cash flow projections. Significant unobservable inputs consist of earnings and revenue multiples, discount for lack of marketability and comparability adjustments. An increase or decrease in any of these unobservable inputs would have resulted in a change in the fair value measurement.
There were no financial liabilities measured at fair value on a recurring basis on the consolidated balance sheets at December 31, 2023 or 2022. Financial assets measured at fair value on a recurring basis on the consolidated balance sheets at December 31, 2023 and 2022 were as follows:
In millionsLevel 1Level 2Level 3Total
December 31, 2023    
Cash and cash equivalents$2,174 $6,022 $— $8,196 
Debt securities:    
U.S. government securities2,013 23 — 2,036 
States, municipalities and political subdivisions— 2,215 — 2,215 
U.S. corporate securities— 9,814 29 9,843 
Foreign securities— 2,512 — 2,512 
Residential mortgage-backed securities— 810 — 810 
Commercial mortgage-backed securities— 975 — 975 
Other asset-backed securities— 3,302 — 3,302 
Redeemable preferred securities— 20 — 20 
Total debt securities2,013 19,671 29 21,713 
Equity securities194 — 79 273 
Total$4,381 $25,693 $108 $30,182 
December 31, 2022    
Cash and cash equivalents (1)
$6,902 $6,049 $— $12,951 
Debt securities:
U.S. government securities1,860 32 — 1,892 
States, municipalities and political subdivisions— 2,272 — 2,272 
U.S. corporate securities— 8,897 61 8,958 
Foreign securities— 2,542 8 2,550 
Residential mortgage-backed securities— 757 — 757 
Commercial mortgage-backed securities— 1,018 — 1,018 
Other asset-backed securities— 2,810 — 2,810 
Redeemable preferred securities— 23 — 23 
Total debt securities1,860 18,351 69 20,280 
Equity securities116 — 60 176 
Total$8,878 $24,400 $129 $33,407 
_______________________________________
(1)Includes cash and cash equivalents of $6 million which were accounted for as assets held for sale and were included in assets held for sale on the consolidated balance sheet at December 31, 2022. See Note 2 ‘‘Acquisitions, Divestitures and Asset Sales’’ for additional information.
The changes in the balances of Level 3 financial assets during the year ended December 31, 2023 were as follows:
In millionsCommercial mortgage-backed securitiesU.S.
corporate
securities		Foreign
securities		Equity
securities		Total
Beginning balance$— $61 $8 $60 $129 
Net realized and unrealized capital losses:
Included in earnings — (8)— (2)(10)
Included in other comprehensive income— 1 — — 1 
Purchases13 5 — 23 41 
Sales— (1)— (2)(3)
Transfers out of Level 3, net(13)(29)(8)— (50)
Ending balance$— $29 $— $79 $108 

The change in net unrealized capital losses included in other comprehensive income associated with Level 3 financial assets which were held as of December 31, 2023 was $9 million during the year ended December 31, 2023.

The changes in the balances of Level 3 financial assets during the year ended December 31, 2022 were as follows:
In millionsStates,
municipalities
 and political
subdivisions		U.S.
corporate
securities		Foreign
securities		Other asset-
backed
securities		Equity
securities		Total
Beginning balance$5 $38 $10 $3 $55 $111 
Net realized and unrealized capital losses:
Included in earnings— (8)— (1)(9)
Included in other comprehensive loss— (5)(2)(2)— (9)
Purchases— 36 — 30 29 95 
Sales(5)— — (2)(23)(30)
Settlements— — — — — — 
Transfers out of Level 3, net— — — (29)— (29)
Ending balance$— $61 $8 $— $60 $129 

The change in net unrealized capital losses included in other comprehensive loss associated with Level 3 financial assets which were held as of December 31, 2022 was $9 million during the year ended December 31, 2022.

The total gross transfers into (out of) Level 3 during the years ended December 31, 2023 and 2022 were as follows:
In millions20232022
Gross transfers into Level 3$— $— 
Gross transfers out of Level 3(50)(29)
Net transfers out of Level 3$(50)$(29)
Financial Instruments Not Measured at Fair Value on the Consolidated Balance Sheets

The carrying value and estimated fair value classified by level of fair value hierarchy for financial instruments carried on the consolidated balance sheets at adjusted cost or contract value at December 31, 2023 and 2022 were as follows:
Carrying
Value		 Estimated Fair Value
In millionsLevel 1Level 2Level 3Total
December 31, 2023
Assets: 
Mortgage loans$1,311 $— $— $1,274 $1,274 
Equity securities (1)
534 N/AN/AN/AN/A
Liabilities:
Investment contract liabilities:
With a fixed maturity1 — — 1 1 
Without a fixed maturity312 — — 279 279 
Long-term debt61,410 58,451 — — 58,451 
December 31, 2022
Assets:
Mortgage loans$1,044 $— $— $978 $978 
Equity securities (1)
411 N/AN/AN/AN/A
Liabilities:
Investment contract liabilities:
With a fixed maturity3 — — 3 3 
Without a fixed maturity332 — — 305 305 
Long-term debt (2)
52,257 47,653 — — 47,653 
______________________________________
(1)It was not practical to estimate the fair value of these cost-method investments as it represents shares of unlisted companies. See Note 1 ‘‘Significant Accounting Policies’’ for additional information regarding the valuation of cost method investments.
(2)Includes long-term debt of $3 million which was accounted for as liabilities held for sale and was included in liabilities held for sale on the consolidated balance sheet at December 31, 2022. See Note 2 ‘‘Acquisitions, Divestitures and Asset Sales’’ for additional information.

Separate Accounts Measured at Fair Value on the Consolidated Balance Sheets

Separate Accounts assets relate to the Company’s large case pensions products which represent funds maintained to meet specific objectives of contract holders. Since contract holders bear the investment risk of these assets, a corresponding Separate Accounts liability has been established equal to the assets. These assets and liabilities are carried at fair value. Net investment income and capital gains and losses on Separate Accounts assets accrue directly to such contract holders. The assets of each account are legally segregated and are not subject to claims arising from the Company’s other businesses. Deposits, withdrawals, net investment income and realized and unrealized capital gains and losses on Separate Accounts assets are not reflected in the consolidated statements of operations, shareholders’ equity or cash flows.

Separate Accounts assets include debt and equity securities. The valuation methodologies used for these assets are similar to the methodologies described above in this Note 5 ‘‘Fair Value.’’ Separate Accounts assets also include investments in common/collective trusts that are carried at fair value. Common/collective trusts invest in other investment funds otherwise known as the underlying funds. The Separate Accounts’ interests in the common/collective trust funds are based on the fair values of the investments of the underlying funds and therefore are classified in Level 2. The assets in the underlying funds primarily consist of equity securities. Investments in common/collective trust funds are valued at their respective net asset value (“NAV”) per share/unit on the valuation date.
Separate Accounts financial assets at December 31, 2023 and 2022 were as follows:
December 31, 2023December 31, 2022
In millionsLevel 1Level 2Level 3TotalLevel 1Level 2Level 3Total
Cash and cash equivalents$2 $166 $— $168 $2 $154 $— $156 
Debt securities558 1,949 — 2,507 712 1,965 — 2,677 
Common/collective trusts— 529 — 529 — 480 — 480 
Total (1)
$560 $2,644 $— $3,204 $714 $2,599 $— $3,313 
_____________________________________
(1)Excludes $46 million of other receivables and $85 million of other payables at December 31, 2023 and 2022, respectively.

During the years ended December 31, 2023 and 2022, the Company had no gross transfers of Separate Accounts financial assets into or out of Level 3.
v3.24.0.1
Goodwill and Other Intangibles
 12 Months Ended
Dec. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]  
Goodwill and Other Intangibles Goodwill and Other Intangibles
Goodwill

Below is a summary of the changes in the carrying amount of goodwill by segment for the years ended December 31, 2023 and 2022:
In millionsHealth Care
Benefits		Health
Services		Pharmacy &
Consumer
Wellness		Total
Balance at December 31, 2021$45,130 $23,615 $10,376 $79,121 
Divestitures
(971)— — (971)
Balance at December 31, 202244,159 23,615 10,376 78,150 
Segment realignment(109)109 — — 
Acquisitions2,594 10,342 186 13,122 
Balance at December 31, 2023$46,644 $34,066 $10,562 $91,272 

During the year ended December 31, 2023, the increase in the carrying amount of goodwill was primarily driven by the acquisitions of Oak Street Health and Signify Health. See Note 2 ‘‘Acquisitions, Divestitures and Asset Sales’’ for additional information. During 2023, the Company also realigned the composition of its segments to correspond with changes to its operating model and reflect how the CODM reviews information and manages the business as discussed in Note 1 “Significant Accounting Policies.” As a result of this realignment, the Company reallocated a portion of the goodwill balance associated with these movements from the Health Care Benefits segment to the Health Services segment based on a relative fair value approach.

During the year ended December 31, 2022, the decrease in the carrying amount of goodwill was primarily driven by the divestitures of bswift, PayFlex and the Thailand business. See Note 2 ‘‘Acquisitions, Divestitures and Asset Sales’’ for additional information.

During the fourth quarter of 2023 and the third quarter of 2022, the Company performed its required annual impairment tests of goodwill. The results of these impairment tests indicated that there was no impairment of goodwill.

During the third quarter of 2021, the Company performed its required annual impairment tests of goodwill. The results of the impairment tests indicated an impairment of the goodwill associated with the LTC reporting unit, as the reporting unit’s carrying value exceeded its fair value as of the testing date. The results of the impairment tests of the remaining reporting units indicated that there was no impairment of goodwill as of the testing date.

During 2021, the LTC reporting unit within the Pharmacy & Consumer Wellness segment continued to face challenges that impacted the Company’s ability to grow the LTC reporting unit’s business at the rate estimated when its 2020 goodwill impairment test was performed. These challenges included lower net facility admissions, net long-term care facility customer losses and the prolonged adverse impact of the COVID-19 pandemic and the emerging new variants, which resulted in more significant declines in occupancy rates experienced by the Company’s long-term care facility customers than previously
anticipated. During the third quarter of 2021, LTC management updated their 2021 annual forecast and submitted their long-term plan which showed deterioration in the financial results for the remainder of 2021 and beyond. The Company utilized these updated projections in performing its annual impairment test, which indicated that the fair value of the LTC reporting unit was lower than its carrying value, resulting in a $431 million goodwill impairment charge in the third quarter of 2021. The fair value of the LTC reporting unit was determined using a combination of a discounted cash flow method and a market multiple method. As of December 31, 2021, there was no remaining goodwill balance in the LTC reporting unit.

At December 31, 2023 and 2022, cumulative goodwill impairments were $6.6 billion.

Intangible Assets

The following table is a summary of the Company’s intangible assets as of December 31, 2023 and 2022:
In millions, except weighted average lifeGross
Carrying
Amount		Accumulated
Amortization		Net
Carrying
Amount		Weighted
Average
Life (years)
2023
Trademarks (indefinite-lived)$10,498 $— $10,498 N/A
Customer contracts/relationships and covenants not to compete26,784 (12,241)14,543 14.2
Technology1,253 (1,104)149 3.0
Provider networks4,203 (1,072)3,131 20.0
Value of Business Acquired 590 (201)389 20.0
Other838 (314)524 9.3
Total$44,166 $(14,932)$29,234 14.5
2022
Trademarks (indefinite-lived)$10,498 $— $10,498 N/A
Customer contracts/relationships and covenants not to compete21,206 (10,668)10,538 13.3
Technology1,060 (1,060)— — 
Provider networks4,203 (862)3,341 20.0
Value of Business Acquired 590 (174)416 20.0
Other302 (264)38 12.4
Total (1)
$37,859 $(13,028)$24,831 13.9
_____________________________________
(1)Includes intangible assets of $28 million which were accounted for as assets held for sale and were included in assets held for sale on the consolidated balance sheet at December 31, 2022. See Note 2 ‘‘Acquisitions, Divestitures and Asset Sales’’ for additional information.

During the year ended December 31, 2023, the increase in the customer contracts/relationships intangible assets was primarily related to relationships with health plan payors acquired in the Oak Street Health Acquisition and the Signify Health Acquisition. See Note 2 ‘‘Acquisitions, Divestitures and Asset Sales’’ for additional information.

Amortization expense for intangible assets totaled $1.9 billion, $1.8 billion and $2.2 billion for the years ended December 31, 2023, 2022 and 2021, respectively. The projected annual amortization expense for the Company’s intangible assets for the next five years is as follows:
In millions
2024$2,011 
20251,964 
20261,687 
20271,580 
20281,306 
v3.24.0.1
Leases
 12 Months Ended
Dec. 31, 2023
Leases [Abstract]  
Leases Leases
The Company leases most of its retail stores, mail order facilities and primary care centers, as well as certain distribution centers and corporate offices under operating or finance leases, typically with initial terms of 15 to 25 years. The Company also leases certain equipment and other assets under operating or finance leases, typically with initial terms of 3 to 10 years.

In addition, the Company leases pharmacy space at the stores of another retail chain for which the noncancelable contractual term of the pharmacy lease arrangement exceeds the remaining estimated economic life of the buildings. For these pharmacy lease arrangements, the Company concluded that for accounting purposes the lease term was the remaining estimated economic life of the buildings. Consequently, most of these individual pharmacy leases are finance leases.

The following table is a summary of the components of net lease cost for the years ended December 31, 2023, 2022 and 2021:
In millions202320222021
Operating lease cost$2,532 $2,579 $2,633 
Finance lease cost:
Amortization of right-of-use assets84 79 62 
Interest on lease liabilities73 68 62 
Total finance lease costs157 147 124 
Short-term lease costs22 27 25 
Variable lease costs635 610 604 
Less: sublease income(63)(61)(59)
Net lease cost$3,283 $3,302 $3,327 

Supplemental cash flow information related to leases for the years ended December 31, 2023, 2022 and 2021 was as follows:
In millions202320222021
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows paid for operating leases$2,756 $2,689 $2,714 
Operating cash flows paid for interest portion of finance leases73 68 62 
Financing cash flows paid for principal portion of finance leases70 62 50 
Right-of-use assets obtained in exchange for lease obligations:
Operating leases1,132 591 1,254 
Finance leases(4)232 278 
Supplemental balance sheet information related to leases as of December 31, 2023 and 2022 is as follows:
In millions, except remaining lease term and discount rate20232022
Operating leases:
Operating lease right-of-use assets (1)
$17,252$17,928
Current portion of operating lease liabilities$1,741$1,699
Long-term operating lease liabilities16,03416,839
Total operating lease liabilities (2)
$17,775$18,538
Finance leases:
Property and equipment, gross$1,604$1,608
Accumulated depreciation(375)(284)
Property and equipment, net$1,229$1,324
Current portion of long-term debt$66$59
Long-term debt1,3251,406
Total finance lease liabilities$1,391$1,465
Weighted average remaining lease term (in years)
Operating leases11.412.2
Finance leases17.319.4
Weighted average discount rate
Operating leases4.5 %4.4 %
Finance leases5.0 %4.9 %
_____________________________________________
(1)Includes operating lease right-of-use assets of $56 million which were accounted for as assets held for sale and were included in assets held for sale on the consolidated balance sheet at December 31, 2022. See Note 2 ‘‘Acquisitions, Divestitures and Asset Sales’’ for additional information.
(2)Includes current portion of operating lease liabilities of $21 million and long-term operating lease liabilities of $39 million which were accounted for as liabilities held for sale and were included in liabilities held for sale on the consolidated balance sheet at December 31, 2022. See Note 2 ‘‘Acquisitions, Divestitures and Asset Sales’’ for additional information.

The following table summarizes the maturity of lease liabilities under finance and operating leases as of December 31, 2023:
In millionsFinance
Leases
Operating
Leases (1)
Total
2024$143 $2,716 $2,859 
2025138 2,559 2,697 
2026130 2,369 2,499 
2027127 2,181 2,308 
2028124 2,024 2,148 
Thereafter1,446 11,004 12,450 
Total lease payments (2)
2,108 22,853 24,961 
Less: imputed interest(717)(5,078)(5,795)
Total lease liabilities$1,391 $17,775 $19,166 
_____________________________________________
(1)Future operating lease payments have not been reduced by minimum sublease rentals of $289 million due in the future under noncancelable subleases.
(2)The Company leases pharmacy and clinic space from Target Corporation. Amounts related to such finance and operating leases are reflected above. Pharmacy lease amounts due in excess of the remaining estimated economic life of the buildings of approximately $2.1 billion are not reflected in this table since the estimated economic life of the buildings is shorter than the contractual term of the pharmacy lease arrangement.
Office Real Estate Optimization Charges
During the fourth quarter of 2022, the Company undertook an initiative to evaluate its corporate office real estate space in response to its new flexible work arrangement. As part of this initiative, the Company evaluated its current real estate space and changes in employee work arrangement requirements to ensure it had the appropriate space to support the business. As a result of this assessment, the Company determined that it would vacate and abandon certain leased corporate office spaces. Accordingly, in the three months ended December 31, 2022, the Company recorded office real estate optimization charges of $117 million, primarily consisting of $71 million related to operating lease right-of-use assets and $44 million related to property and equipment. During the year ended December 31, 2023, the Company recorded an incremental $46 million of office real estate optimization charges associated with this initiative, primarily consisting of $20 million related to operating lease right-of-use assets and $18 million related to property and equipment. The office real estate optimization charges were recorded within the Health Care Benefits, Corporate/Other and Health Services segments.

Store Impairment Charges
The Company evaluates its retail store right-of-use and property and equipment assets for impairment at the retail store level, which is the lowest level at which cash flows can be identified. For retail stores where there is an indicator of impairment present, the Company first compares the carrying amount of the asset group to the estimated future cash flows associated with the asset group (undiscounted). If the estimated undiscounted future cash flows used in the analysis are less than the carrying amount of the asset group, an impairment loss calculation is prepared. The impairment loss calculation compares the carrying amount of the asset group to its estimated fair value which is the greater of the asset group’s estimated future cash flows (discounted), or the consideration of what a market participant would pay to lease the assets, net of leasing costs. The Company’s estimate of fair value considers historical results, current operating trends, consolidated sales, profitability and cash flow results and forecasts. For assets which the Company has determined it will be able to sublease, the estimated future cash flows include the estimated sublease income, net of estimated leasing costs.

When the carrying value of an asset group exceeds its estimated fair value, an impairment loss is recorded to reduce the value of the asset group to its estimated fair value. As the impaired assets are measured at fair value on a nonrecurring basis primarily using unobservable inputs as of the measurement date, the assets are classified in Level 3 of the fair value hierarchy.

During the fourth quarter of 2021, the Company completed a strategic review of its retail business and announced the creation of new formats for its stores to continue to drive higher engagement with customers. As part of this review, the Company evaluated changes in population, consumer buying patterns and future health needs to ensure it has the right kinds of stores in the right locations for consumers and for the business. In connection with this initiative, on November 17, 2021, the Board of Directors of CVS Health Corporation (the “Board”) authorized the closing of approximately 900 retail stores, approximately 300 stores each year, between 2022 and 2024. As a result, management determined that there were indicators of impairment with respect to the impacted stores’ asset groups, including the associated operating lease right-of-use assets and property and equipment. A long-lived asset impairment test was performed during the fourth quarter of 2021 and the results of the impairment test indicated that the fair value of certain retail store asset groups was lower than their respective carrying values. Accordingly, in the three months ended December 31, 2021, the Company recorded a store impairment charge of approximately $1.4 billion, consisting of a write down of approximately $1.1 billion related to operating lease right-of-use assets and $261 million related to property and equipment, within the Pharmacy & Consumer Wellness segment. Subsequent to the impairment loss, the fair value of the associated operating lease right-of use assets and property and equipment were $356 million and $185 million, respectively.
Leases Leases
The Company leases most of its retail stores, mail order facilities and primary care centers, as well as certain distribution centers and corporate offices under operating or finance leases, typically with initial terms of 15 to 25 years. The Company also leases certain equipment and other assets under operating or finance leases, typically with initial terms of 3 to 10 years.

In addition, the Company leases pharmacy space at the stores of another retail chain for which the noncancelable contractual term of the pharmacy lease arrangement exceeds the remaining estimated economic life of the buildings. For these pharmacy lease arrangements, the Company concluded that for accounting purposes the lease term was the remaining estimated economic life of the buildings. Consequently, most of these individual pharmacy leases are finance leases.

The following table is a summary of the components of net lease cost for the years ended December 31, 2023, 2022 and 2021:
In millions202320222021
Operating lease cost$2,532 $2,579 $2,633 
Finance lease cost:
Amortization of right-of-use assets84 79 62 
Interest on lease liabilities73 68 62 
Total finance lease costs157 147 124 
Short-term lease costs22 27 25 
Variable lease costs635 610 604 
Less: sublease income(63)(61)(59)
Net lease cost$3,283 $3,302 $3,327 

Supplemental cash flow information related to leases for the years ended December 31, 2023, 2022 and 2021 was as follows:
In millions202320222021
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows paid for operating leases$2,756 $2,689 $2,714 
Operating cash flows paid for interest portion of finance leases73 68 62 
Financing cash flows paid for principal portion of finance leases70 62 50 
Right-of-use assets obtained in exchange for lease obligations:
Operating leases1,132 591 1,254 
Finance leases(4)232 278 
Supplemental balance sheet information related to leases as of December 31, 2023 and 2022 is as follows:
In millions, except remaining lease term and discount rate20232022
Operating leases:
Operating lease right-of-use assets (1)
$17,252$17,928
Current portion of operating lease liabilities$1,741$1,699
Long-term operating lease liabilities16,03416,839
Total operating lease liabilities (2)
$17,775$18,538
Finance leases:
Property and equipment, gross$1,604$1,608
Accumulated depreciation(375)(284)
Property and equipment, net$1,229$1,324
Current portion of long-term debt$66$59
Long-term debt1,3251,406
Total finance lease liabilities$1,391$1,465
Weighted average remaining lease term (in years)
Operating leases11.412.2
Finance leases17.319.4
Weighted average discount rate
Operating leases4.5 %4.4 %
Finance leases5.0 %4.9 %
_____________________________________________
(1)Includes operating lease right-of-use assets of $56 million which were accounted for as assets held for sale and were included in assets held for sale on the consolidated balance sheet at December 31, 2022. See Note 2 ‘‘Acquisitions, Divestitures and Asset Sales’’ for additional information.
(2)Includes current portion of operating lease liabilities of $21 million and long-term operating lease liabilities of $39 million which were accounted for as liabilities held for sale and were included in liabilities held for sale on the consolidated balance sheet at December 31, 2022. See Note 2 ‘‘Acquisitions, Divestitures and Asset Sales’’ for additional information.

The following table summarizes the maturity of lease liabilities under finance and operating leases as of December 31, 2023:
In millionsFinance
Leases
Operating
Leases (1)
Total
2024$143 $2,716 $2,859 
2025138 2,559 2,697 
2026130 2,369 2,499 
2027127 2,181 2,308 
2028124 2,024 2,148 
Thereafter1,446 11,004 12,450 
Total lease payments (2)
2,108 22,853 24,961 
Less: imputed interest(717)(5,078)(5,795)
Total lease liabilities$1,391 $17,775 $19,166 
_____________________________________________
(1)Future operating lease payments have not been reduced by minimum sublease rentals of $289 million due in the future under noncancelable subleases.
(2)The Company leases pharmacy and clinic space from Target Corporation. Amounts related to such finance and operating leases are reflected above. Pharmacy lease amounts due in excess of the remaining estimated economic life of the buildings of approximately $2.1 billion are not reflected in this table since the estimated economic life of the buildings is shorter than the contractual term of the pharmacy lease arrangement.
Office Real Estate Optimization Charges
During the fourth quarter of 2022, the Company undertook an initiative to evaluate its corporate office real estate space in response to its new flexible work arrangement. As part of this initiative, the Company evaluated its current real estate space and changes in employee work arrangement requirements to ensure it had the appropriate space to support the business. As a result of this assessment, the Company determined that it would vacate and abandon certain leased corporate office spaces. Accordingly, in the three months ended December 31, 2022, the Company recorded office real estate optimization charges of $117 million, primarily consisting of $71 million related to operating lease right-of-use assets and $44 million related to property and equipment. During the year ended December 31, 2023, the Company recorded an incremental $46 million of office real estate optimization charges associated with this initiative, primarily consisting of $20 million related to operating lease right-of-use assets and $18 million related to property and equipment. The office real estate optimization charges were recorded within the Health Care Benefits, Corporate/Other and Health Services segments.

Store Impairment Charges
The Company evaluates its retail store right-of-use and property and equipment assets for impairment at the retail store level, which is the lowest level at which cash flows can be identified. For retail stores where there is an indicator of impairment present, the Company first compares the carrying amount of the asset group to the estimated future cash flows associated with the asset group (undiscounted). If the estimated undiscounted future cash flows used in the analysis are less than the carrying amount of the asset group, an impairment loss calculation is prepared. The impairment loss calculation compares the carrying amount of the asset group to its estimated fair value which is the greater of the asset group’s estimated future cash flows (discounted), or the consideration of what a market participant would pay to lease the assets, net of leasing costs. The Company’s estimate of fair value considers historical results, current operating trends, consolidated sales, profitability and cash flow results and forecasts. For assets which the Company has determined it will be able to sublease, the estimated future cash flows include the estimated sublease income, net of estimated leasing costs.

When the carrying value of an asset group exceeds its estimated fair value, an impairment loss is recorded to reduce the value of the asset group to its estimated fair value. As the impaired assets are measured at fair value on a nonrecurring basis primarily using unobservable inputs as of the measurement date, the assets are classified in Level 3 of the fair value hierarchy.

During the fourth quarter of 2021, the Company completed a strategic review of its retail business and announced the creation of new formats for its stores to continue to drive higher engagement with customers. As part of this review, the Company evaluated changes in population, consumer buying patterns and future health needs to ensure it has the right kinds of stores in the right locations for consumers and for the business. In connection with this initiative, on November 17, 2021, the Board of Directors of CVS Health Corporation (the “Board”) authorized the closing of approximately 900 retail stores, approximately 300 stores each year, between 2022 and 2024. As a result, management determined that there were indicators of impairment with respect to the impacted stores’ asset groups, including the associated operating lease right-of-use assets and property and equipment. A long-lived asset impairment test was performed during the fourth quarter of 2021 and the results of the impairment test indicated that the fair value of certain retail store asset groups was lower than their respective carrying values. Accordingly, in the three months ended December 31, 2021, the Company recorded a store impairment charge of approximately $1.4 billion, consisting of a write down of approximately $1.1 billion related to operating lease right-of-use assets and $261 million related to property and equipment, within the Pharmacy & Consumer Wellness segment. Subsequent to the impairment loss, the fair value of the associated operating lease right-of use assets and property and equipment were $356 million and $185 million, respectively.
v3.24.0.1
Health Care Costs Payable
 12 Months Ended
Dec. 31, 2023
Health Care and Other Insurance Liabilities [Abstract]  
Health Care Costs Payable Health Care Costs Payable
The following is information about incurred and cumulative paid health care claims development as of December 31, 2023, net of reinsurance, and the total IBNR liabilities plus expected development on reported claims included within the net incurred claims amounts. See Note 1 ‘‘Significant Accounting Policies’’ for information on how the Company estimates IBNR reserves and health care costs payable as well as changes to those methodologies, if any. The Company’s estimate of IBNR liabilities is primarily based on trend and completion factors. Claim frequency is not used in the calculation of the Company’s liability. In addition, it is impracticable to disclose claim frequency information for health care claims due to the Company’s inability to gather consistent claim frequency information across its multiple claims processing systems. Any claim frequency count disclosure would not be comparable across the Company’s different claim processing systems and would not be consistent from period to period based on the volume of claims processed through each system. As a result, health care claim count frequency is not included in the disclosures below.

The information about incurred and paid health care claims development for the year ended December 31, 2022 is presented as required unaudited supplemental information.
In millionsIncurred Health Care Claims,
Net of Reinsurance
For the Years Ended December 31,
Date of Service20222023
(Unaudited)
2022$69,185 $68,540 
202382,362 
Total$150,902 
In millionsCumulative Paid Health Care Claims,
Net of Reinsurance
For the Years Ended December 31,
Date of Service20222023
(Unaudited)
2022$59,570 $68,363 
202372,175 
Total$140,538 
All outstanding liabilities for health care costs payable prior to 2022, net of reinsurance171 
Total outstanding liabilities for health care costs payable, net of reinsurance$10,535 

At December 31, 2023, the Company’s liabilities for IBNR plus expected development on reported claims totaled approximately $8.7 billion. Substantially all of the Company’s liabilities for IBNR plus expected development on reported claims at December 31, 2023 related to the current calendar year.

The reconciliation of the December 31, 2023 health care net incurred and paid claims development tables to the health care costs payable liability on the consolidated balance sheet were as follows:
In millionsDecember 31, 2023
Short-duration health care costs payable, net of reinsurance$10,535 
Reinsurance recoverables5 
Insurance lines other than short duration217 
Other non-insurance health care costs payable1,292 
Total health care costs payable$12,049 
The following table shows the components of the change in health care costs payable during the years ended December 31, 2023, 2022 and 2021:
In millions202320222021
Health care costs payable, beginning of period $10,142 $8,678 $7,936 
Less: Reinsurance recoverables5 8 10 
Less: Impact of discount rate on long-duration insurance reserves (1)
8 — — 
Health care costs payable, beginning of period, net10,129 8,670 7,926 
Acquisition, net1,098 — — 
Add: Components of incurred health care costs
  Current year86,639 71,399 64,631 
  Prior years(685)(654)(788)
Total incurred health care costs (2)
85,954 70,745 63,843 
Less: Claims paid
  Current year75,529 61,640 56,323 
  Prior years9,585 7,646 6,792 
Total claims paid85,114 69,286 63,115 
Add: Premium deficiency reserve— — 16 
Health care costs payable, end of period, net12,067 10,129 8,670 
Add: Reinsurance recoverables5 5 8 
Add: Impact of discount rate on long-duration insurance reserves (1)
(23)8 — 
Health care costs payable, end of period$12,049 $10,142 $8,678 
_____________________________________
(1)Reflects the difference between the current discount rate and the locked-in discount rate on long-duration insurance reserves which is recorded within accumulated other comprehensive loss on the consolidated balance sheets. Refer to Note 1 ‘‘Significant Accounting Policies’’ for further information related to the adoption of the long-duration insurance contracts accounting standard.
(2)Total incurred health care costs for the years ended December 31, 2023, 2022 and 2021 in the table above exclude $83 million, $79 million and $58 million, respectively, of benefit costs recorded in the Health Care Benefits segment that are included in other insurance liabilities on the consolidated balance sheets and $210 million, $249 million and $271 million, respectively, of benefit costs recorded in the Corporate/Other segment that are included in other insurance liabilities on the consolidated balance sheets. The incurred health care costs for the year ended December 31, 2021 also exclude $16 million for premium deficiency reserves related to the Company’s Medicaid products.

The Company’s estimates of prior years’ health care costs payable decreased by $685 million, $654 million and $788 million in 2023, 2022 and 2021, respectively, because claims were settled for amounts less than originally estimated (i.e., the amount of claims incurred was lower than originally estimated), primarily due to lower health care cost trends as well as the actual claim submission time being faster than originally assumed (i.e., the Company’s completion factors were higher than originally assumed) in estimating health care costs payable at the end of the prior year. This development does not directly correspond to an increase in the Company’s operating results as these reductions were offset by estimated current period health care costs when the Company established the estimate of the current year health care costs payable.
v3.24.0.1
Other Insurance Liabilities and Separate Accounts
 12 Months Ended
Dec. 31, 2023
Insurance [Abstract]  
Other Insurance Liabilities and Separate Accounts Other Insurance Liabilities and Separate Accounts
Future Policy Benefits

The following tables show the components of the change in the liability for future policy benefits, which is included in other insurance liabilities and other long-term insurance liabilities on the consolidated balance sheets, during the years ended December 31, 2023 and 2022:
2023
In millionsLarge Case
Pensions		Long-Term
Care
Present value of expected net premiums (1)
Liability for future policy benefits, beginning of period - current discount rate$300 
Beginning liability for future policy benefits at original (locked-in) discount rate$302 
Effect of changes in cash flow assumptions— 
Effect of actual variances from expected experience10 
Adjusted beginning liability for future policy benefits - original (locked-in) discount rate312 
Interest accrual (using locked-in discount rate)15 
Net premiums (actual)(39)
Ending liability for future policy benefits at original (locked-in) discount rate288 
Effect of changes in discount rate assumptions5 
Liability for future policy benefits, end of period - current discount rate$293 
Present value of expected future policy benefits
Liability for future policy benefits, beginning of period - current discount rate$2,253 $1,566 
Beginning liability for future policy benefits at original (locked-in) discount rate$2,425 $1,613 
Effect of changes in cash flow assumptions— — 
Effect of actual variances from expected experience(3)8 
Adjusted beginning liability for future policy benefits - original (locked-in) discount rate2,422 1,621 
Issuances8 — 
Interest accrual (using locked-in discount rate)97 82 
Benefit payments (actual)(276)(71)
Ending liability for future policy benefits at original (locked-in) discount rate2,251 1,632 
Effect of changes in discount rate assumptions(112)8 
Liability for future policy benefits, end of period - current discount rate$2,139 $1,640 
Net liability for future policy benefits$2,139 $1,347 
Less: Reinsurance recoverable— — 
Net liability for future policy benefits, net of reinsurance recoverable$2,139 $1,347 
_____________________________________________
(1)The present value of expected net premiums is equivalent to the present value of expected gross premiums for the long-term care insurance contracts as net premiums are set equal to gross premiums.
2022
In millionsLarge Case
Pensions		Long-Term
Care
Present value of expected net premiums (1)
Liability for future policy benefits, beginning of period - current discount rate$389 
Beginning liability for future policy benefits at original (locked-in) discount rate$323 
Effect of changes in cash flow assumptions(15)
Effect of actual variances from expected experience18 
Adjusted beginning liability for future policy benefits - original (locked-in) discount rate326 
Interest accrual (using locked-in discount rate)16 
Net premiums (actual)(40)
Ending liability for future policy benefits at original (locked-in) discount rate302 
Effect of changes in discount rate assumptions(2)
Liability for future policy benefits, end of period - current discount rate$300 
Present value of expected future policy benefits
Liability for future policy benefits, beginning of period - current discount rate$3,034 $1,991 
Beginning liability for future policy benefits at original (locked-in) discount rate$2,650 $1,480 
Effect of changes in cash flow assumptions— 99 
Effect of actual variances from expected experience(44)18 
Adjusted beginning liability for future policy benefits - original (locked-in) discount rate2,606 1,597 
Issuances4 — 
Interest accrual (using locked-in discount rate)106 80 
Benefit payments (actual)(291)(64)
Ending liability for future policy benefits at original (locked-in) discount rate2,425 1,613 
Effect of changes in discount rate assumptions(172)(47)
Liability for future policy benefits, end of period - current discount rate$2,253 $1,566 
Net liability for future policy benefits$2,253 $1,266 
Less: Reinsurance recoverable— — 
Net liability for future policy benefits, net of reinsurance recoverable$2,253 $1,266 
_____________________________________________
(1)The present value of expected net premiums is equivalent to the present value of expected gross premiums for the long-term care insurance contracts as net premiums are set equal to gross premiums.

The Company did not have any material differences between the actual experience and expected experience for the significant assumptions used in the computation of the liability for future policy benefits.

The amount of undiscounted expected gross premiums and expected future benefit payments for long-duration insurance liabilities as of December 31, 2023 and 2022 were as follows:
In millions20232022
Large case pensions
Expected future benefit payments$3,266$3,539
Expected gross premiums——
Long-term care
Expected future benefit payments$3,224$3,265
Expected gross premiums414437
The weighted-average interest rate used in the measurement of the long-duration insurance liabilities as of December 31, 2023 and 2022 were as follows:
20232022
Large case pensions
Interest accretion rate4.20%4.20%
Current discount rate4.93%5.24%
Long-term care
Interest accretion rate5.11%5.11%
Current discount rate5.08%5.39%

The weighted-average durations (in years) of the long-duration insurance liabilities as of December 31, 2023 and 2022 were as follows:
20232022
Large case pensions7.37.4
Long-term care12.112.6

Policyholders’ Funds

The following table shows the components of the change in policyholders’ funds related to long-duration insurance contracts, which are included in policyholders’ funds and other long-term liabilities on the consolidated balance sheets, during the years ended December 31, 2023 and 2022:
In millions, except weighted average crediting rate20232022
Policyholders’ funds, beginning of the period$345$522
Deposits received—13
Policy charges(2)(2)
Surrenders and withdrawals(35)(31)
Interest credited911
Change in net unrealized gains (losses)39(148)
Other(24)(20)
Policyholders’ funds, end of the period$332$345
Weighted average crediting rate4.32%4.72%
Net amount at risk$— $— 
Cash surrender value$313 $339 
Separate Accounts

The following table shows the fair value of assets, by major investment category, supporting Separate Accounts as of December 31, 2023 and 2022:
In millions20232022
Cash and cash equivalents$168 156 
Debt securities:
U.S. government securities573 717 
States, municipalities and political subdivisions28 27 
U.S. corporate securities1,632 1,667 
Foreign securities202 201 
Residential mortgage-backed securities51 41 
Commercial mortgage-backed securities6 6 
Other asset-backed securities15 18 
Total debt securities2,507 2,677 
Common/collective trusts529 480 
Total (1)
$3,204 $3,313 
_____________________________________________
(1)Excludes $46 million of other receivables and $85 million of other payables at December 31, 2023 and 2022, respectively.

The following table shows the components of the change in Separate Accounts liabilities during the years ended December 31, 2023 and 2022:
In millions20232022
Separate Accounts liability, beginning of the period$3,228 $5,087 
Premiums and deposits860 853 
Surrenders and withdrawals(9)(581)
Benefit payments(938)(947)
Investment earnings100 (1,130)
Net transfers from general account7 9 
Other2 (63)
Separate Accounts liability, end of the period$3,250 $3,228 
Cash surrender value, end of the period$2,181 $2,087 
The Company did not recognize any gains or losses on assets transferred to Separate Accounts during the years ended December 31, 2023 or 2022.
v3.24.0.1
Borrowings and Credit Agreements
 12 Months Ended
Dec. 31, 2023
Debt Disclosure [Abstract]  
Borrowings and Credit Agreements Borrowings and Credit Agreements
The following table is a summary of the Company’s borrowings as of December 31, 2023 and 2022:
In millions20232022
Short-term debt
Commercial paper$200 $— 
Long-term debt
2.8% senior notes due June 2023
— 1,300 
4% senior notes due December 2023
— 414 
3.375% senior notes due August 2024
650 650 
2.625% senior notes due August 2024
1,000 1,000 
3.5% senior notes due November 2024
750 750 
5% senior notes due December 2024 (1)
299 299 
4.1% senior notes due March 2025
950 950 
3.875% senior notes due July 2025
2,828 2,828 
5% senior notes due February 2026
1,500 — 
2.875% senior notes due June 2026
1,750 1,750 
3% senior notes due August 2026
750 750 
3.625% senior notes due April 2027
750 750 
6.25% senior notes due June 2027
372 372 
1.3% senior notes due August 2027
2,250 2,250 
4.3% senior notes due March 2028
5,000 5,000 
5% senior notes due January 2029
1,000 — 
3.25% senior notes due August 2029
1,750 1,750 
5.125% senior notes due February 2030
1,500 — 
3.75% senior notes due April 2030
1,500 1,500 
1.75% senior notes due August 2030
1,250 1,250 
5.25% senior notes due January 2031
750 — 
1.875% senior notes due February 2031
1,250 1,250 
2.125% senior notes due September 2031
1,000 1,000 
5.25% senior notes due February 2033
1,750 — 
5.3% senior notes due June 2033
1,250 — 
4.875% senior notes due July 2035
652 652 
6.625% senior notes due June 2036
771 771 
6.75% senior notes due December 2037
533 533 
4.78% senior notes due March 2038
5,000 5,000 
6.125% senior notes due September 2039
447 447 
4.125% senior notes due April 2040
1,000 1,000 
2.7% senior notes due August 2040
1,250 1,250 
5.75% senior notes due May 2041
133 133 
4.5% senior notes due May 2042
500 500 
4.125% senior notes due November 2042
500 500 
5.3% senior notes due December 2043
750 750 
4.75% senior notes due March 2044
375 375 
5.125% senior notes due July 2045
3,500 3,500 
3.875% senior notes due August 2047
1,000 1,000 
5.05% senior notes due March 2048
8,000 8,000 
4.25% senior notes due April 2050
750 750 
5.625% senior notes due February 2053
1,250 — 
5.875% senior notes due June 2053
1,250 — 
6% senior notes due June 2063
750 — 
Finance lease liabilities1,391 1,465 
Other309 314 
Total debt principal62,160 52,753 
Debt premiums186 200 
Debt discounts and deferred financing costs(736)(696)
61,610 52,257 
Less:
Short-term debt (commercial paper)(200)— 
Current portion of long-term debt(2,772)(1,778)
Long-term debt (1)
$58,638 $50,479 
__________________________________________
(1)Includes long-term debt of $3 million which was accounted for as liabilities held for sale and was included in liabilities held for sale on the consolidated balance sheet at December 31, 2022. See Note 2 ‘‘Acquisitions, Divestitures and Asset Sales’’ for additional information.

The following is a summary of the Company’s required repayments of long-term debt principal due during each of the next five years and thereafter, as of December 31, 2023:
In millions
2024$2,705 
20253,785 
20264,008 
20273,379 
20285,007 
Thereafter41,685 
Subtotal60,569 
Commercial paper200 
Finance lease liabilities (1)
1,391 
Total debt principal$62,160 
_____________________________________________
(1)See Note 7 ‘‘Leases’’ for a summary of maturities of the Company’s finance lease liabilities.

Short-term Borrowings

Commercial Paper and Back-up Credit Facilities
The Company had $200 million of commercial paper outstanding at a weighted average interest rate of 4.31% as of December 31, 2023. The Company did not have any commercial paper outstanding as of December 31, 2022. In connection with its commercial paper program, the Company maintains a $2.5 billion, five-year unsecured back-up revolving credit facility, which expires on May 16, 2025, a $2.5 billion, five-year unsecured back-up revolving credit facility, which expires on May 11, 2026, and a $2.5 billion, five-year unsecured back-up revolving credit facility, which expires on May 16, 2027. The credit facilities allow for borrowings at various rates that are dependent, in part, on the Company’s public debt ratings and require the Company to pay a weighted average quarterly facility fee of approximately 0.03%, regardless of usage. As of December 31, 2023 and 2022, there were no borrowings outstanding under any of the Company’s back-up credit facilities.

Term Loan Agreement
On May 1, 2023, the Company entered into a 364-day $5.0 billion term loan agreement. The term loan agreement allows for borrowings at various rates that are dependent, in part, on the Company’s debt ratings. On May 2, 2023, the Company borrowed $5.0 billion at an interest rate of approximately 6.2% under the term loan agreement to fund a portion of the Oak Street Health acquisition purchase price. On June 2, 2023, the Company repaid the outstanding balance under the term loan agreement.
FHLBB
A subsidiary of the Company is a member of the FHLBB. As a member, the subsidiary has the ability to obtain cash advances, subject to certain minimum collateral requirements. The maximum borrowing capacity available from the FHLBB as of December 31, 2023 was approximately $1.0 billion. At both December 31, 2023 and 2022, there were no outstanding advances from the FHLBB.

Long-term Borrowings

2023 Notes
On June 2, 2023, the Company issued $1.0 billion aggregate principal amount of 5.0% senior notes due January 2029, $750 million aggregate principal amount of 5.25% senior notes due January 2031, $1.25 billion aggregate principal amount of 5.3% senior notes due June 2033, $1.25 billion aggregate principal amount of 5.875% senior notes due June 2053 and $750 million aggregate principal amount of 6.0% senior notes due June 2063 for total proceeds of approximately $4.9 billion, net of discounts and underwriting fees. The net proceeds of these offerings were used, along with cash on hand, to repay the outstanding balance under the term loan agreement described above.

On February 21, 2023, the Company issued $1.5 billion aggregate principal amount of 5.0% senior notes due February 2026, $1.5 billion aggregate principal amount of 5.125% senior notes due February 2030, $1.75 billion aggregate principal amount of 5.25% senior notes due February 2033 and $1.25 billion aggregate principal amount of 5.625% senior notes due February 2053 for total proceeds of approximately $6.0 billion, net of discounts and underwriting fees. The net proceeds of these offerings were used to fund general corporate purposes, including a portion of the Signify Health Acquisition purchase price.

Oak Street Health Convertible Notes
Prior to the Oak Street Health Acquisition, Oak Street Health held 0% convertible senior notes with an aggregate principal amount of $920 million (the “Convertible Notes”), which were assumed by the Company in connection with the Oak Street Health Acquisition. The Oak Street Health Acquisition constituted a fundamental change in the Convertible Notes giving the holders the right to require the Company to repurchase the Convertible Notes. The repurchase price was an amount in cash equal to 100% of the principal amount of the Convertible Notes. On May 31, 2023, the Company issued a notice of repurchase to the holders of the Convertible Notes. In connection with this notice, $917 million of the Convertible Notes were submitted for repurchase and settled on July 21, 2023. Substantially all of the remaining $3 million of the Convertible Notes were submitted for repurchase and settled on October 20, 2023.

Exercise of Par Call Redemptions
In May 2022, the Company exercised the par call redemption on its outstanding 3.5% senior notes due July 2022 to redeem for cash on hand the entire $1.5 billion aggregate principal amount.

In August 2022, the Company exercised the par call redemption on its outstanding 2.75% senior notes due November 2022 (issued by Aetna) to redeem for cash on hand the entire $1.0 billion aggregate principal amount.

In September 2022, the Company exercised the par call redemptions on its outstanding 2.75% senior notes due December 2022 and 4.75% senior notes due December 2022 (including notes issued by Omnicare, Inc.) to redeem for cash on hand the entire aggregate principal amount of $1.25 billion and $399 million, respectively.

Early Extinguishments of Debt
In December 2021, the Company redeemed for cash the remaining $2.3 billion of its outstanding 3.7% senior notes due 2023. In connection with the early redemption of such senior notes, the Company paid a make-whole premium of $80 million in excess of the aggregate principal amount of the senior notes that were redeemed, wrote-off $8 million of unamortized deferred financing costs and incurred $1 million in fees, for a total loss on early extinguishment of debt of $89 million.

In August 2021, the Company purchased approximately $2.0 billion of its outstanding 4.3% senior notes due 2028 through a cash tender offer. In connection with the purchase of such senior notes, the Company paid a premium of $332 million in excess of the aggregate principal amount of the senior notes that were purchased, wrote-off $26 million of unamortized deferred financing costs and incurred $5 million in fees, for a total loss on early extinguishment of debt of $363 million.

Debt Covenants

The Company’s back-up revolving credit facilities and unsecured senior notes contain customary restrictive financial and operating covenants. These covenants do not include an acceleration of the Company’s debt maturities in the event of a
downgrade in the Company’s credit ratings. The Company does not believe the restrictions contained in these covenants materially affect its financial or operating flexibility. As of December 31, 2023, the Company was in compliance with all of its debt covenants.
v3.24.0.1
Pension Plans and Other Postretirement Benefits
 12 Months Ended
Dec. 31, 2023
Retirement Benefits [Abstract]  
Pension Plans and Other Postretirement Benefits Pension Plans and Other Postretirement Benefits
Defined Contribution Plans

As of December 31, 2023, the Company sponsors several active 401(k) savings plans that cover all employees who meet plan eligibility requirements.

The Company makes matching contributions consistent with the provisions of the respective plans. At the participant’s option, account balances, including the Company’s matching contribution, can be invested among various investment options under each plan. The CVS Health Future Fund 401(k) Plan offers CVS Health Corporation’s common stock fund as an investment option. The Company also maintains nonqualified, unfunded deferred compensation plans for certain key employees. The plans provide participants the opportunity to defer portions of their eligible compensation and for certain nonqualified plans, participants receive matching contributions equivalent to what they could have received under the CVS Health Future Fund 401(k) Plan absent certain restrictions and limitations under the Internal Revenue Code. The Company’s contributions under its defined contribution plans were $581 million, $567 million and $552 million in the years ended December 31, 2023, 2022 and 2021, respectively.

Defined Benefit Pension Plans

The Company sponsors a tax-qualified defined benefit pension plan that was frozen in 2010 and a nonqualified supplemental pension plan that was frozen in 2007. The Company also sponsors several other defined benefit pension plans that are unfunded nonqualified supplemental retirement plans.

Pension Benefit Obligation and Plan Assets
The following tables outline the change in pension benefit obligation and plan assets over the specified periods:
In millions20232022
Change in benefit obligation:
Benefit obligation, beginning of year$4,740 $6,009 
Interest cost231 132 
Actuarial loss (gain)145 (1,011)
Benefit payments(380)(387)
Settlements— (3)
Benefit obligation, end of year4,736 4,740 
Change in plan assets:
Fair value of plan assets, beginning of year5,346 6,677 
Actual return on plan assets389 (968)
Employer contributions24 27 
Benefit payments(380)(387)
Settlements— (3)
Fair value of plan assets, end of year5,379 5,346 
Funded status$643 $606 

The change in the pension benefit obligation during the years ended December 31, 2023 and 2022 was primarily driven by the change in the discount rate during each respective period.
The assets (liabilities) recognized on the consolidated balance sheets at December 31, 2023 and 2022 for the defined benefit pension plans consisted of the following:
In millions20232022
Noncurrent assets reflected in other assets$856 $827 
Current liabilities reflected in accrued expenses(24)(24)
Noncurrent liabilities reflected in other long-term liabilities(189)(197)
Net assets$643 $606 

Net Periodic Benefit Cost (Income)
The components of net periodic benefit cost (income) for the years ended December 31, 2023, 2022 and 2021 are shown below:
In millions202320222021
Components of net periodic benefit cost (income):
Interest cost$231 $132 $110 
Expected return on plan assets(326)(309)(317)
Amortization of net actuarial loss1 3 5 
Settlement losses— 1 16 
Net periodic benefit cost (income)$(94)$(173)$(186)

Pension Plan Assumptions
The Company uses a series of actuarial assumptions to determine its benefit obligation and net periodic benefit income, the most significant of which include discount rates and expected return on plan assets assumptions.

Discount Rates - The discount rate is determined using a yield curve as of the annual measurement date. The yield curve consists of a series of individual discount rates, with each discount rate corresponding to a single point in time, based on high-quality bonds. Projected benefit payments are discounted to the measurement date using the corresponding rate from the yield curve that is consistent with the maturity profile of the expected liability cash flows.

Expected Return on Plan Assets - The expected long-term rate of return on plan assets is determined by using the plan’s target allocation and return expectations based on many factors including forecasted long-term capital market real returns and the inflationary outlook on a plan by plan basis. See “Pension Plan Assets” below for additional details regarding the pension plan assets as of December 31, 2023 and 2022.

The Company also considers other assumptions including mortality, interest crediting rate, termination and retirement rates, and cost of living adjustments.

The Company determined its benefit obligation based on the following weighted average assumptions as of December 31, 2023 and 2022:
20232022
Discount rate5.0 %5.2 %

The Company determined its net periodic benefit cost (income) based on the following weighted average assumptions for the years ended December 31, 2023, 2022 and 2021:
202320222021
Discount rate5.1 %2.3 %1.8 %
Expected long-term rate of return on plan assets6.3 %4.8 %4.8 %

Pension Plan Assets
The Company’s pension plan assets primarily include debt and equity securities held in separate accounts, common/collective trusts and real estate investments. The valuation methodologies used to value these debt and equity securities and common/collective trusts are similar to the methodologies described in Note 5 “Fair Value.” Pension plan assets also include investments
in other assets that are carried at fair value. The following is a description of the valuation methodologies used to value real estate investments and these additional investments, including the general classification pursuant to the fair value hierarchy.

Real Estate - Real estate investments are valued by independent third party appraisers. The appraisals comply with the Uniform Standards of Professional Appraisal Practice, which include, among other things, the income, cost, and sales comparison approaches to estimating property value. Therefore, these investments are classified in Level 3.

Private equity and hedge fund limited partnerships - Private equity and hedge fund limited partnerships are carried at fair value which is estimated using the NAV per unit as reported by the administrator of the underlying investment fund as a practical expedient to fair value. Therefore, these investments have been excluded from the fair value table below.

Pension plan assets with changes in fair value measured on a recurring basis at December 31, 2023 were as follows:
In millionsLevel 1Level 2Level 3Total
Cash and cash equivalents$12 $69 $— $81 
Debt securities:
    U.S. government securities518 4 — 522 
    States, municipalities and political subdivisions— 94 — 94 
    U.S. corporate securities— 2,649 — 2,649 
    Foreign securities— 106 — 106 
    Residential mortgage-backed securities— 17 — 17 
    Commercial mortgage-backed securities— 9 — 9 
    Other asset-backed securities— 8 — 8 
    Redeemable preferred securities— 1 — 1 
Total debt securities518 2,888 — 3,406 
Equity securities:
    U.S. domestic150 — — 150 
    International34 — — 34 
Total equity securities184 — — 184 
Other investments:
    Real estate— — 290 290 
    Common/collective trusts (1)
— 405 — 405 
    Derivatives— (14)— (14)
Total other investments— 391 290 681 
Total pension investments (2)
$714 $3,348 $290 $4,352 
_____________________________________________
(1)The assets in the underlying funds of common/collective trusts consist of $114 million of equity securities and $291 million of debt securities.
(2)Excludes $314 million of other receivables as well as $461 million of private equity limited partnership investments and $252 million of hedge fund limited partnership investments as these amounts are measured at NAV per share or an equivalent and are not subject to leveling within the fair value hierarchy.
Pension plan assets with changes in fair value measured on a recurring basis at December 31, 2022 were as follows:
In millionsLevel 1Level 2Level 3Total
Cash and cash equivalents$7 $81 $— $88 
Debt securities:
    U.S. government securities566 4 — 570 
    States, municipalities and political subdivisions— 102 — 102 
    U.S. corporate securities— 2,611 — 2,611 
    Foreign securities— 101 — 101 
    Residential mortgage-backed securities— 6 — 6 
    Commercial mortgage-backed securities— 1 — 1 
    Other asset-backed securities— 11 — 11 
    Redeemable preferred securities— 1 — 1 
Total debt securities566 2,837 — 3,403 
Equity securities:
    U.S. domestic133 — — 133 
    International43 — — 43 
Total equity securities176 — — 176 
Other investments:
    Real estate— — 325 325 
    Common/collective trusts (1)
— 307 — 307 
Total other investments— 307 325 632 
Total pension investments (2)
$749 $3,225 $325 $4,299 
_____________________________________________
(1)The assets in the underlying funds of common/collective trusts consist of $104 million of equity securities and $203 million of debt securities.
(2)Excludes $390 million of other receivables as well as $432 million of private equity limited partnership investments and $225 million of hedge fund limited partnership investments as these amounts are measured at NAV per share or an equivalent and are not subject to leveling within the fair value hierarchy.

The changes in the balances of Level 3 pension plan assets during the year ended December 31, 2023 were as follows:
In millionsReal estate
Beginning balance$325 
Actual return on plan assets(23)
Purchases, sales and settlements(12)
Transfers out of Level 3— 
Ending balance$290 

The changes in the balances of Level 3 pension plan assets during the year ended December 31, 2022 were as follows:

In millionsReal estate
Beginning balance$378 
Actual return on plan assets21 
Purchases, sales and settlements(74)
Transfers out of Level 3— 
Ending balance$325 

The Company’s pension plan invests in a diversified mix of assets designed to generate returns that will enable the plan to meet its future benefit obligations. The risk of unexpected investment and actuarial outcomes is regularly evaluated. This evaluation is performed through forecasting and assessing ranges of investment outcomes over short- and long-term horizons and by
assessing the pension plan’s liability characteristics. Complementary investment styles and strategies are utilized by professional investment management firms to further improve portfolio and operational risk characteristics. Public and private equity investments are used primarily to increase overall plan returns. Real estate investments are viewed favorably for their diversification benefits and above-average dividend generation. Fixed income investments provide diversification benefits and liability hedging attributes that are desirable, especially in falling interest rate environments.

At December 31, 2023, target investment allocations for the Company’s pension plan were: 12% in equity securities, 77% in fixed income and debt securities, 5% in real estate, 3% in private equity limited partnerships and 3% in hedge funds. Actual asset allocations may differ from target allocations due to tactical decisions to overweight or underweight certain assets or as a result of normal fluctuations in asset values. Asset allocations are consistent with stated investment policies and, as a general rule, periodically rebalanced back to target asset allocations. Asset allocations and investment performance are formally reviewed periodically throughout the year by the pension plan’s Investment Subcommittee. Forecasting of asset and liability growth is performed at least annually.

Cash Flows
The Company generally contributes to its tax-qualified pension plan based on minimum funding requirements determined under applicable federal laws and regulations. Employer contributions related to the nonqualified supplemental pension plans generally represent payments to retirees for current benefits. The Company contributed $24 million, $27 million and $78 million to its pension plans during 2023, 2022 and 2021, respectively. No contributions are required for the tax-qualified pension plan in 2024. The Company expects to make an immaterial amount of contributions for all other pension plans in 2024.

The Company estimates the following future benefit payments, which are calculated using the same actuarial assumptions used to measure the pension benefit obligation as of December 31, 2023:
In millions
2024$393 
2025388 
2026384 
2027380 
2028378 
2029-20331,746 

Multiemployer Pension Plans
The Company also contributes to a number of multiemployer pension plans under the terms of collective-bargaining agreements that cover its union-represented employees. The risks of participating in these multiemployer plans are different from single-employer pension plans in the following respects: (i) assets contributed to the multiemployer plan by one employer may be used to provide benefits to employees of other participating employers, (ii) if a participating employer stops contributing to the plan, the unfunded obligations of the plan may be borne by the remaining participating employers, and (iii) if the Company chooses to stop participating in some of its multiemployer plans, the Company may be required to pay those plans an amount based on the underfunded status of the applicable plan, which is referred to as a withdrawal liability.

None of the multiemployer pension plans in which the Company participates are individually significant to the Company. The Company’s contributions to multiemployer pension plans were $19 million, $20 million and $19 million in 2023, 2022 and 2021, respectively.

Other Postretirement Benefits

The Company provides postretirement health care and life insurance benefits to certain retirees who meet eligibility requirements. The Company’s funding policy is generally to pay covered expenses as they are incurred. For retiree medical plan accounting, the Company reviews external data and its own historical trends for health care costs to determine the health care cost trend rates. As of December 31, 2023 and 2022, the Company’s other postretirement benefits had an accumulated postretirement benefit obligation of $155 million and $159 million, respectively. Net periodic benefit costs related to these other postretirement benefits were $6 million, $4 million and $4 million in 2023, 2022 and 2021, respectively.
The Company estimates the following future benefit payments, which are calculated using the same actuarial assumptions used to measure the accumulated other postretirement benefit obligation as of December 31, 2023:
In millions
2024$12 
202512 
202612 
202712 
202812 
2029-203358 
Pursuant to various collective bargaining agreements, the Company also contributes to multiemployer health and welfare plans that cover certain union-represented employees. The plans provide postretirement health care and life insurance benefits to certain employees who meet eligibility requirements. The Company’s contributions to multiemployer health and welfare plans totaled $60 million, $62 million and $60 million in 2023, 2022 and 2021, respectively.
v3.24.0.1
Income Taxes
 12 Months Ended
Dec. 31, 2023
Income Tax Disclosure [Abstract]  
Income Taxes Income Taxes
The income tax provision consisted of the following for the years ended December 31, 2023, 2022 and 2021:
In millions202320222021
Current:
Federal$2,819 $2,803 $2,285 
State662 735 665 
3,481 3,538 2,950 
Deferred:
Federal(537)(1,526)(282)
State(139)(503)(120)
(676)(2,029)(402)
Total$2,805 $1,509 $2,548 

The following table is a reconciliation of the statutory income tax rate to the Company’s effective income tax rate for the years ended December 31, 2023, 2022 and 2021:
202320222021
Statutory income tax rate21.0 %21.0 %21.0 %
State income taxes, net of federal tax benefit3.7 3.2 4.1 
Legal charges— 3.4 — 
Basis difference upon disposition of subsidiary— 1.6 — 
Prior year refunds and unrecognized tax benefits— (2.6)(1.2)
Other0.4 (0.7)0.3 
Effective income tax rate25.1 %25.9 %24.2 %
The following table is a summary of the components of the Company’s deferred income tax assets and liabilities as of December 31, 2023 and 2022:
In millions20232022
Deferred income tax assets:
Lease and rents$5,059 $5,242 
Legal charges1,205 1,260 
Inventory94 103 
Employee benefits168 153 
Bad debts and other allowances606 480 
Net operating loss and capital loss carryforwards409 266 
Deferred income62 66 
Insurance reserves356 319 
Investments56 293 
Other372 335 
Valuation allowance(385)(532)
Total deferred income tax assets (1)
8,002 7,985 
Deferred income tax liabilities:
Retirement benefits112 92 
Lease and rents4,469 4,639 
Depreciation and amortization7,732 7,139 
Total deferred income tax liabilities12,313 11,870 
Net deferred income tax liabilities$4,311 $3,885 
_____________________________________________
(1)Includes deferred income tax assets of $131 million which were accounted for as assets held for sale and were included in assets held for sale on the consolidated balance sheet at December 31, 2022. See Note 2 ‘‘Acquisitions, Divestitures and Asset Sales’’ for additional information.

When evaluating the realizability of deferred tax assets, the Company considers all available positive and negative evidence, including future reversals of existing taxable temporary differences, projected future taxable income, tax planning strategies and the Company’s recent operating results. The Company established a valuation allowance of $385 million and $532 million as of December 31, 2023 and 2022, respectively, because it does not consider it more likely than not that certain deferred tax assets will be recovered.

As of December 31, 2023, the Company had net operating and capital loss carryovers of $409 million, a portion of which has an indefinite carryforward period, while the remainder expires between 2024 and 2043.

A reconciliation of the beginning and ending balance of unrecognized tax benefits in 2023, 2022 and 2021 is as follows:
In millions202320222021
Beginning balance$446 $782 $768 
Additions based on tax positions related to the current year2 5 3 
Additions based on tax positions related to prior years46 42 52 
Reductions for tax positions of prior years(24)(166)(33)
Expiration of statutes of limitation(34)(4)(1)
Settlements— (213)(7)
Ending balance$436 $446 $782 

CVS Health Corporation and most of its subsidiaries are subject to U.S. federal income tax as well as income tax of numerous state and local jurisdictions. The IRS has completed its examinations of the Company’s consolidated U.S. federal income tax returns for tax years through 2016, 2018 and 2019. The IRS has substantially completed its examination of the Company’s consolidated U.S. federal income tax return for tax year 2017.
CVS Health Corporation and its subsidiaries are also currently under income tax examinations by a number of state and local tax authorities. As of December 31, 2023, no examination has resulted in any proposed adjustments that would result in a material change to the Company’s operating results, financial condition or liquidity.

Substantially all material state and local income tax matters have been concluded for fiscal years through 2015. Certain state exams are likely to be concluded and certain state statutes of limitations will lapse in 2024, but the change in the balance of the Company’s uncertain tax positions is projected to be immaterial. In addition, it is reasonably possible that the Company’s unrecognized tax benefits could change within the next twelve months due to the anticipated conclusion of various examinations with the IRS for certain previous years. An estimate of the range of the possible change cannot be made at this time.

The Company records interest expense related to unrecognized tax benefits and penalties in the income tax provision. The Company accrued interest expense of approximately $31 million, $29 million and $40 million in 2023, 2022 and 2021, respectively. The Company had approximately $134 million and $112 million accrued for interest and penalties as of December 31, 2023 and 2022, respectively.

As of December 31, 2023, the total amount of unrecognized tax benefits that, if recognized, would affect the Company’s effective income tax rate is approximately $330 million, after considering the federal benefit of state income taxes.
v3.24.0.1
Stock Incentive Plans
 12 Months Ended
Dec. 31, 2023
Share-Based Payment Arrangement [Abstract]  
Stock Incentive Plans Stock Incentive Plans
The terms of the CVS Health 2017 Incentive Compensation Plan (“ICP”) provide for grants of annual incentive and long-term performance awards to executive officers and other officers and employees of the Company or any subsidiary of the Company, as well as equity compensation to outside directors of CVS Health Corporation. Payment of such annual incentive and long-term performance awards will be in cash, stock, other awards or other property, at the discretion of the Management Planning and Development Committee (the “MP&D Committee”) of the Board. The ICP allows for a maximum of 58 million shares of CVS Health Corporation common stock to be reserved and available for grants. As of December 31, 2023, there were approximately 11 million shares of CVS Health Corporation common stock available for future grants under the ICP.

As of the Oak Street Health Acquisition Date, Oak Street Health common stock subject to awards outstanding under the Oak Street Health, Inc. Omnibus Incentive Plan (the “Oak Street Health Plan”) was converted into approximately 3.9 million shares of CVS Health Corporation underlying replacement equity awards. In addition, in accordance with the merger agreement, shares which were available for future issuance under the Oak Street Health Plan were converted into approximately 7 million shares of CVS Health common stock which were reserved and available for issuance pursuant to future awards as of December 31, 2023.

As of the Signify Health Acquisition Date, Signify Health common stock subject to awards outstanding under the Signify Health, Inc. 2021 Long-Term Incentive Plan (the “Signify Plan”) was converted into approximately 3.2 million shares of CVS Health Corporation underlying replacement equity awards. In addition, in accordance with the merger agreement, shares which were available for future issuance under the Signify Plan were converted into approximately 9 million shares of CVS Health common stock which were reserved and available for issuance pursuant to future awards as of December 31, 2023.

Stock-Based Compensation Expense

Stock-based compensation is measured at the grant date based on the fair value of the award and is recognized as expense over the requisite service period of the stock award (generally three to five years) using the straight-line method. The following table is a summary of stock-based compensation for the years ended December 31, 2023, 2022 and 2021:
In millions202320222021
Restricted stock units and performance stock units
$497 $369 $404 
Stock options and stock appreciation rights (“SARs”) (1)
91 78 80 
Total stock-based compensation (2)
$588 $447 $484 
_____________________________________________
(1)Includes the Employee Stock Purchase Plan (“ESPP”).
(2)Total stock-based compensation for the year ended December 31, 2023 included $71 million and $72 million of post-combination expense associated with replacement equity awards granted in connection with the Oak Street Health and Signify Health acquisitions, respectively.
Restricted Stock Units and Performance Stock Units

The Company’s restricted stock units and performance stock units are considered nonvested share awards and require no payment from the employee. The fair value of the restricted stock units is based on the market price of CVS Health Corporation common stock on the grant date and is recognized on a straight-line basis over the vesting period. For each restricted stock unit granted, employees receive one share of common stock, net of taxes, at the end of the vesting period.

The Company’s performance stock units contain performance vesting conditions in addition to a service vesting condition. Vesting of the Company’s performance stock units is dependent upon the degree to which the Company achieves its performance goals, which are generally set for a three-year performance period and are approved at the time of grant by the MP&D Committee.

The fair value of performance stock units granted with service and performance vesting conditions is based on the market price of CVS Health Corporation common stock on the grant date and is recognized over the vesting period. Certain of the performance stock units also contain a market vesting condition based on the performance of CVS Health Corporation common stock relative to a comparator group. The fair value of these performance stock units is determined using a Monte Carlo simulation as of the grant date and is recognized over the vesting period.

As of December 31, 2023, there was $790 million of total unrecognized compensation cost related to the Company’s restricted stock units and performance stock units that are expected to vest. These costs are expected to be recognized over a weighted-average period of 2.1 years. The total fair value of restricted stock units vested during 2023, 2022 and 2021 was $525 million, $328 million and $406 million, respectively.

The following table is a summary of the restricted stock unit and performance stock unit activity for the year ended December 31, 2023:
In thousands, except weighted average grant date fair valueUnitsWeighted Average
Grant Date
Fair Value
Outstanding at beginning of year, nonvested12,681 $80.25 
Granted (1)
13,918 $71.06 
Vested (2)
(7,346)$71.46 
Forfeited(2,259)$71.78 
Outstanding at end of year, nonvested16,994 $77.65 
_____________________________________________
(1)Includes 3.9 million and 1.8 million restricted stock replacement equity awards granted in connection with the Oak Street Health and Signify Health acquisitions, respectively.
(2)Vested performance stock units have been included at target level performance. Based on actual performance, the number of restricted stock units and performance stock units vested during the year ended December 31, 2023 was 7.8 million.

Stock Options and SARs

All stock option grants are awarded at fair value on the date of grant. The fair value of stock options is estimated using the Black-Scholes option pricing model, and stock-based compensation is recognized on a straight-line basis over the requisite service period. Stock options granted generally become exercisable over a four-year period from the grant date. Stock options granted through 2018 generally expire seven years after the grant date. Stock options granted subsequent to 2018 generally expire ten years after the grant date.

All unvested Aetna SARs outstanding upon the acquisition of Aetna were converted into replacement CVS Health Corporation SARs. The replacement SARs granted are settled in CVS Health Corporation common stock, net of taxes, based on the appreciation of the stock price on the exercise date over the market price on the date of grant. The fair value of SARs is estimated using the Black-Scholes option pricing model, and stock-based compensation is recognized on a straight-line basis over the requisite service period. SARs generally become exercisable over a three-year period from the grant date. SARs generally expire ten years after the grant date. No SARs have been granted subsequent to the acquisition of Aetna.
The following table is a summary of stock option and SAR activity that occurred for the years ended December 31, 2023, 2022 and 2021:
In millions202320222021
Cash received from stock options exercised (including ESPP)
$277 $551 $549 
Payments for taxes for net share settlement of equity awards
181 370 168 
Intrinsic value of stock options and SARs exercised
31 118 105 
Fair value of stock options and SARs vested
227 219 224 

The fair value of each stock option is estimated using the Black-Scholes option pricing model based on the following assumptions at the time of grant:
202320222021
Dividend yield (1)
3.27 %2.18 %2.68 %
Expected volatility (2)
28.15 %27.34 %27.10 %
Risk-free interest rate (3)
3.55 %2.46 %1.13 %
Expected life (in years) (4)
5.96.36.3
Weighted-average grant date fair value$21.78 $24.15 $14.57 
_____________________________________________
(1)The dividend yield is based on annual dividends paid and the fair market value of CVS Health Corporation stock at the grant date.
(2)The expected volatility is estimated based on the historical volatility of CVS Health Corporation’s daily stock price over a period equal to the expected life of each option grant after adjustments for infrequent events such as stock splits.
(3)The risk-free interest rate is selected based on yields from U.S. Treasury zero-coupon issues with a remaining term equal to the expected term of the options being valued.
(4)The expected life represents the number of years the options are expected to be outstanding from grant date based on historical option or SAR holder exercise experience.

As of December 31, 2023, unrecognized compensation expense related to unvested stock options totaled $58 million, which the Company expects to be recognized over a weighted-average period of 2.0 years. After considering anticipated forfeitures, the Company expects approximately 7 million of the unvested stock options to vest over the requisite service period.

The following table is a summary of the Company’s stock option and SAR activity for the year ended December 31, 2023:
In thousands, except weighted average exercise price and remaining contractual termSharesWeighted
Average
Exercise
 Price		Weighted
Average
Remaining
Contractual
Term		Aggregate
Intrinsic
Value
Outstanding at beginning of year15,040 $73.15 
Granted (1)
4,595 $63.06 
Exercised(1,652)$50.03 
Forfeited(624)$76.74 
Expired(2,233)$102.47 
Outstanding at end of year15,126 $68.13 5.21$203,645 
Exercisable at end of year7,785 $63.64 3.35130,509 
Vested at end of year and expected to vest in the future14,793 $67.95 5.14201,439 
_____________________________________________
(1)Includes 1.4 million stock option replacement equity awards granted in connection with the Signify Health acquisition.

ESPP

The Company’s ESPP provides for the purchase of up to 60 million shares of CVS Health Corporation common stock. Under the ESPP, eligible employees may purchase common stock at the end of each six month offering period at a purchase price equal to 90% of the lower of the fair market value on the first day or the last day of the offering period. During 2023, approximately 3 million shares of common stock were purchased under the provisions of the ESPP at an average price of
$70.99 per share. As of December 31, 2023, approximately 26 million shares of common stock were available for issuance under the ESPP.

The fair value of stock-based compensation associated with the ESPP is estimated on the date of grant (the first day of the six-month offering period) using the Black-Scholes option pricing model.

The following table is a summary of the assumptions used to value the ESPP awards for the years ended December 31, 2023, 2022 and 2021:
202320222021
Dividend yield (1)
1.54 %1.12 %1.34 %
Expected volatility (2)
25.61 %23.54 %25.27 %
Risk-free interest rate (3)
5.17 %1.42 %0.08 %
Expected life (in years) (4)
0.50.50.5
Weighted-average grant date fair value$14.26 $16.25 $12.55 
_____________________________________________
(1)The dividend yield is calculated based on semi-annual dividends paid and the fair market value of CVS Health Corporation stock at the grant date.
(2)The expected volatility is estimated based on the historical volatility of CVS Health Corporation’s daily stock price over the previous six month period.
(3)The risk-free interest rate is selected based on the Treasury constant maturity interest rate whose term is consistent with the expected term of ESPP purchases (i.e., six months).
(4)The expected life is based on the semi-annual purchase period.
v3.24.0.1
Shareholders' Equity
 12 Months Ended
Dec. 31, 2023
Equity [Abstract]  
Shareholders' Equity Shareholders’ Equity
Share Repurchases

The following share repurchase programs have been authorized by the Board:
In billions
Authorization Date
AuthorizedRemaining as of
December 31, 2023
November 17, 2022 (“2022 Repurchase Program”)$10.0 $10.0 
December 9, 2021 (“2021 Repurchase Program”)10.0 4.5 

Each of the share Repurchase Programs was effective immediately and permit the Company to effect repurchases from time to time through a combination of open market repurchases, privately negotiated transactions, accelerated share repurchase (“ASR”) transactions, and/or other derivative transactions. Both the 2022 and 2021 Repurchase Programs can be modified or terminated by the Board at any time.

During the years ended December 31, 2023 and 2022, the Company repurchased an aggregate of 22.8 million shares of common stock for approximately $2.0 billion and an aggregate of 34.1 million shares of common stock for approximately $3.5 billion, respectively, both pursuant to the 2021 Repurchase Program. This activity includes the share repurchases under the ASR transactions described below. During the year ended December 31, 2021, the Company did not repurchase any shares of common stock.

Pursuant to the authorization under the 2021 Repurchase Program, the Company entered into a $3.0 billion fixed dollar ASR with Morgan Stanley & Co. LLC (“Morgan Stanley”). Upon payment of the $3.0 billion purchase price on January 4, 2024, the Company received a number of shares of CVS Health Corporation’s common stock equal to 85% of the $3.0 billion notional amount of the ASR or approximately 31.4 million shares at a price of $81.19 per share, which were placed into treasury stock in January 2024. At the conclusion of the ASR, the Company may receive additional shares representing the remaining 15% of the $3.0 billion notional amount. The ultimate number of shares the Company may receive will depend on the daily volume-weighted average price of the Company’s stock over an averaging period, less a discount. It is also possible, depending on such weighted average price, that the Company will have an obligation to Morgan Stanley which, at the Company’s option, could be settled in additional cash or by issuing shares. Under the terms of the ASR, the maximum number of shares that could be delivered to the Company is 73.9 million.

Pursuant to the authorization under the 2021 Repurchase Program, the Company entered into a $2.0 billion fixed dollar ASR with Citibank, N.A. Upon payment of the $2.0 billion purchase price on January 4, 2023, the Company received a number of shares of CVS Health Corporation’s common stock equal to 80% of the $2.0 billion notional amount of the ASR or
approximately 17.4 million shares at a price of $92.19 per share, which were placed into treasury stock in January 2023. The ASR was accounted for as an initial treasury stock transaction for $1.6 billion and a forward contract for $0.4 billion. The forward contract was classified as an equity instrument and was recorded within capital surplus. In February 2023, the Company received approximately 5.4 million shares of CVS Health Corporation’s common stock, representing the remaining 20% of the $2.0 billion notional amount of the ASR, thereby concluding the ASR. These shares were placed into treasury and the forward contract was reclassified from capital surplus to treasury stock in February 2023.

Pursuant to the authorization under the 2021 Repurchase Program, the Company entered into a $1.5 billion fixed dollar ASR with Barclays Bank PLC. Upon payment of the $1.5 billion purchase price on January 4, 2022, the Company received a number of shares of CVS Health Corporation’s common stock equal to 80% of the $1.5 billion notional amount of the ASR or approximately 11.6 million shares at a price of $103.34 per share, which were placed into treasury stock in January 2022. The ASR was accounted for as an initial treasury stock transaction for $1.2 billion and a forward contract for $0.3 billion. The forward contract was classified as an equity instrument and was recorded within capital surplus. In February 2022, the Company received approximately 2.7 million shares of CVS Health Corporation’s common stock, representing the remaining 20% of the $1.5 billion notional amount of the ASR, thereby concluding the ASR. These shares were placed into treasury stock and the forward contract was reclassified from capital surplus to treasury stock in February 2022.

At the time they were received, the initial and final receipt of shares resulted in an immediate reduction of the outstanding shares used to calculate the weighted average common shares outstanding for basic and diluted earnings per share.

Dividends

The quarterly cash dividend declared by the Board was $0.605 and $0.55 per share in 2023 and 2022, respectively. In December 2023, the Board authorized an increase of approximately 10% in the quarterly cash dividend to $0.665 per share effective in 2024. CVS Health Corporation has paid cash dividends every quarter since becoming a public company. Future dividend payments will depend on the Company’s earnings, capital requirements, financial condition and other factors considered relevant by the Board.

Regulatory Requirements

The Company’s insurance business operations are conducted through subsidiaries that principally consist of health maintenance organizations (“HMOs”) and insurance companies. The Company’s HMO and insurance subsidiaries report their financial statements in accordance with accounting practices prescribed by state regulatory authorities which may differ from GAAP. The combined statutory net income for the years ended and estimated combined statutory and capital surplus at December 31, 2023, 2022 and 2021 for the Company’s insurance and HMO subsidiaries were as follows:
In millions202320222021
Statutory net income
$2,757 $2,851 $3,302 
Estimated statutory capital and surplus
16,961 15,503 14,879 

The Company’s insurance and HMO subsidiaries paid $1.9 billion of gross dividends to the Company for the year ended December 31, 2023.

In addition to general state law restrictions on payments of dividends and other distributions to stockholders applicable to all corporations, HMOs and insurance companies are subject to further regulations that, among other things, may require those companies to maintain certain levels of equity and restrict the amount of dividends and other distributions that may be paid to their equity holders. In addition, in connection with the acquisition of Aetna, the Company made certain undertakings that require prior regulatory approval of dividends by certain of its HMOs and insurance companies. At December 31, 2023, these amounts were as follows:
In millions
Estimated minimum statutory surplus required by regulators$9,011 
Investments on deposit with regulatory bodies684 
Estimated maximum dividend distributions permitted in 2024 without prior regulatory approval3,098 
Noncontrolling Interests

At December 31, 2023 and 2022, noncontrolling interests were $175 million and $300 million, respectively, primarily related to third party interests in the Company’s operating entities. During the year ended December 31, 2023, the decrease in noncontrolling interests reflects the Company’s purchase of the noncontrolling interest of certain insurance subsidiaries, partially offset by the acquisition of noncontrolling interests in connection with the Oak Street Health acquisition in May 2023. The noncontrolling entities’ share is included in total shareholders’ equity on the consolidated balance sheets.
v3.24.0.1
Other Comprehensive Income (Loss)
 12 Months Ended
Dec. 31, 2023
Other Comprehensive Income (Loss), Net of Tax [Abstract]  
Other Comprehensive Income (Loss) Other Comprehensive Income (Loss)
Shareholders’ equity included the following activity in accumulated other comprehensive income (loss) in 2023, 2022 and 2021:
At December 31,
In millions202320222021
Net unrealized investment gains (losses):
Beginning of year balance$(1,519)$798 $1,214 
Adoption of new accounting standard ($0, $0 and $181 pretax) (1)
— — 140 
Other comprehensive income (loss) before reclassifications ($612, $(3,021) and $(644) pretax)
603 (2,556)(530)
Amounts reclassified from accumulated other comprehensive income (loss) ($566, $315 and $(32) pretax) (2)
487 239 (26)
Other comprehensive income (loss)1,090 (2,317)(556)
End of year balance(429)(1,519)798 
Change in discount rate on long-duration insurance reserves:
Beginning of period balance219 (651)— 
Adoption of new accounting standard ($0, $0 and $(1,166) pretax) (1)
— — (906)
Other comprehensive income (loss) before reclassifications ($(92), $1,126, and $328 pretax)
(67)870 255 
Other comprehensive income (loss)(67)870 255 
End of period balance152 219 (651)
Foreign currency translation adjustments:
Beginning of year balance— — 7 
Other comprehensive loss before reclassifications— — (7)
Other comprehensive loss— — (7)
End of year balance— — — 
Net cash flow hedges:
Beginning of year balance239 222 248 
Other comprehensive income before reclassifications ($25, $38 and $0 pretax)
19 28 — 
Amounts reclassified from accumulated other comprehensive income ($(19), $(15) and $(34) pretax) (3)
(14)(11)(26)
Other comprehensive income (loss)5 17 (26)
End of year balance244 239 222 
Pension and other postretirement benefits:
Beginning of year balance(203)(35)(55)
Other comprehensive income (loss) before reclassifications ($(81), $(229) and $20 pretax)
(61)(170)15 
Amounts reclassified from accumulated other comprehensive loss ($0, $3 and $6 pretax) (4)
— 2 5 
Other comprehensive income (loss) (61)(168)20 
End of year balance(264)(203)(35)
Total beginning of year accumulated other comprehensive income (loss)(1,264)334 1,414 
Adoption of new accounting standard (1)
— — (766)
Total other comprehensive income (loss)967 (1,598)(314)
Total end of year accumulated other comprehensive income (loss)$(297)$(1,264)$334 
_______________________________________
(1)Reflects the adoption of ASU 2018-12, Targeted Improvements to the Accounting for Long-Duration Contracts (Topic 944) during the year ended December 31, 2021. See Note 1 ‘‘Significant Accounting Policies’’ for additional information.
(2)Amounts reclassified from accumulated other comprehensive income (loss) for specifically identified debt securities are included in net investment income in the consolidated statements of operations.
(3)Amounts reclassified from accumulated other comprehensive income for specifically identified cash flow hedges are included within interest expense in the consolidated statements of operations. The Company expects to reclassify $15 million, net of tax, in net gains associated with its cash flow hedges into net income within the next 12 months.
(4)Amounts reclassified from accumulated other comprehensive loss for specifically identified pension and other postretirement benefits are included in other income in the consolidated statements of operations.
v3.24.0.1
Earnings Per Share
 12 Months Ended
Dec. 31, 2023
Earnings Per Share [Abstract]  
Earnings Per Share Earnings Per Share
Earnings per share is computed using the treasury stock method. Stock options and SARs to purchase 8 million, 4 million and 7 million shares of common stock were outstanding, but were excluded from the calculation of diluted earnings per share for the years ended December 31, 2023, 2022 and 2021, respectively, because their exercise prices were greater than the average market price of the common shares and, therefore, the effect would be antidilutive.

The following is a reconciliation of basic and diluted earnings per share for the years ended December 31, 2023, 2022 and 2021:
In millions, except per share amounts202320222021
Numerator for earnings per share calculation:
Net income attributable to CVS Health$8,344 $4,311 $8,001 
Denominator for earnings per share calculation:
Weighted average shares, basic1,285 1,312 1,319 
Restricted stock units and performance stock units3 6 6 
Stock options and SARs2 5 4 
Weighted average shares, diluted1,290 1,323 1,329 
Earnings per share:
Basic$6.49 $3.29 $6.07 
Diluted$6.47 $3.26 $6.02 
v3.24.0.1
Reinsurance
 12 Months Ended
Dec. 31, 2023
Reinsurance Disclosures [Abstract]  
Reinsurance Reinsurance
The Company utilizes reinsurance agreements primarily to: (a) reduce required capital and (b) facilitate the acquisition or disposition of certain insurance contracts. Ceded reinsurance agreements permit the Company to recover a portion of its losses from reinsurers, although they do not discharge the Company’s primary liability as the direct insurer of the risks reinsured.

In January 2024, the Company entered into two four-year reinsurance agreements with an unrelated reinsurer that allow it to reduce required capital and provide collateralized excess of loss reinsurance coverage on a portion of the Health Care Benefits segment’s group Commercial Insured business.
Reinsurance recoverables (recorded as other current assets or other assets on the consolidated balance sheets) at December 31, 2023 and 2022 were as follows:
In millions20232022
Reinsurer
Hartford Life and Accident Insurance Company$1,314 $1,549 
Lincoln Life & Annuity Company of New York480 385 
VOYA Retirement Insurance and Annuity Company — 159 
Fresenius Medical Care Reinsurance Company (Cayman) Ltd. 54 102 
Resolution Life Group Holdings Ltd.35 — 
All Other115 55 
Total$1,998 $2,250 

Direct, assumed and ceded premiums earned for the years ended December 31, 2023, 2022 and 2021 were as follows:
In millions202320222021
Direct$99,753 $85,670 $76,320 
Assumed350 432 492 
Ceded(911)(772)(680)
Net premiums$99,192 $85,330 $76,132 

The impact of reinsurance on benefit costs for the years ended December 31, 2023, 2022 and 2021 was as follows:
In millions202320222021
Direct$86,738 $71,357 $64,339 
Assumed223 379 398 
Ceded(714)(663)(549)
Net benefit costs$86,247 $71,073 $64,188 

There is not a material difference between premiums on a written basis versus an earned basis.

The Company also has various agreements with unrelated reinsurers that do not qualify for reinsurance accounting under GAAP, and consequently are accounted for using deposit accounting. The Company entered into these contracts to reduce the risk of catastrophic loss which in turn reduces the Company’s capital and surplus requirements. Total deposit assets and liabilities related to reinsurance agreements that do not qualify for reinsurance accounting under GAAP were not material as of December 31, 2023 or 2022.
v3.24.0.1
Commitments and Contingencies
 12 Months Ended
Dec. 31, 2023
Commitments and Contingencies Disclosure [Abstract]  
Commitments and Contingencies Commitments and Contingencies
Guarantees

The Company had the following significant guarantee arrangements at December 31, 2023:

•ASC Claim Funding Accounts - The Company has arrangements with certain banks for the processing of claim payments for its ASC customers. The banks maintain accounts to fund claims of the Company’s ASC customers. The customer is responsible for funding the amount paid by the bank each day. In these arrangements, the Company guarantees that the banks will not sustain losses if the responsible ASC customer does not properly fund its account. The aggregate maximum exposure under these arrangements is generally limited to $300 million. The Company can limit its exposure to these guarantees by suspending the payment of claims for ASC customers that have not adequately funded the amount paid by the bank.
•Separate Accounts Assets - Certain Separate Accounts assets associated with the large case pensions business in the Corporate/Other segment represent funds maintained as a contractual requirement to fund specific pension annuities that the Company has guaranteed. Minimum contractual obligations underlying the guaranteed benefits in these Separate Accounts were approximately $834 million and $941 million at December 31, 2023 and 2022, respectively. See Note 1
‘‘Significant Accounting Policies’’ for additional information on Separate Accounts. Contract holders assume all investment and mortality risk and are required to maintain Separate Accounts balances at or above a specified level. The level of required funds is a function of the risk underlying the Separate Account’s investment strategy. If contract holders do not maintain the required level of Separate Accounts assets to meet the annuity guarantees, the Company would establish an additional liability. Contract holders’ balances in the Separate Accounts at December 31, 2023 exceeded the value of the guaranteed benefit obligation. As a result, the Company was not required to maintain any additional liability for its related guarantees at December 31, 2023.

Lease Guarantees

Between 1995 and 1997, the Company sold or spun off a number of subsidiaries, including Bob’s Stores and Linens ‘n Things, each of which subsequently filed for bankruptcy, and Marshalls. In many cases, when a former subsidiary leased a store, the Company provided a guarantee of the former subsidiary’s lease obligations for the initial lease term and any extension thereof pursuant to a renewal option provided for in the lease prior to the time of the disposition. When the subsidiaries were disposed of and accounted for as discontinued operations, the Company’s guarantees remained in place, although each initial purchaser agreed to indemnify the Company for any lease obligations the Company was required to satisfy. If any of the purchasers or any of the former subsidiaries fail to make the required payments under a store lease, the Company could be required to satisfy those obligations. As of December 31, 2023, the Company guaranteed 63 such store leases (excluding the lease guarantees related to Linens ‘n Things, which have been recorded as a liability on the consolidated balance sheets), with the maximum remaining lease term extending through 2035.

Guaranty Fund Assessments, Market Stabilization and Other Non-Voluntary Risk Sharing Pools

Under guaranty fund laws existing in all states, insurers doing business in those states can be assessed (in most states up to prescribed limits) for certain obligations of insolvent insurance companies to policyholders and claimants. The life and health insurance guaranty associations in which the Company participates that operate under these laws respond to insolvencies of long-term care insurers and life insurers as well as health insurers. The Company’s assessments generally are based on a formula relating to the Company’s health care premiums in the state compared to the premiums of other insurers. Certain states allow assessments to be recovered over time as offsets to premium taxes. Some states have similar laws relating to HMOs and/or other payors such as not-for-profit consumer-governed health plans established under the ACA.

In 2009, the Pennsylvania Insurance Commissioner placed long-term care insurer Penn Treaty Network America Insurance Company and one of its subsidiaries (collectively, “Penn Treaty”) in rehabilitation, an intermediate action before insolvency, and subsequently petitioned a state court to convert the rehabilitation into a liquidation. Penn Treaty was placed in liquidation in March 2017. The Company has recorded a liability for its estimated share of future assessments by applicable life and health insurance guaranty associations. It is reasonably possible that in the future the Company may record a liability and expense relating to other insolvencies which could have a material adverse effect on the Company’s operating results, financial condition and cash flows. While historically the Company has ultimately recovered more than half of guaranty fund assessments through statutorily permitted premium tax offsets, significant increases in assessments could lead to legislative and/or regulatory actions that limit future offsets.

HMOs in certain states in which the Company does business are subject to assessments, including market stabilization and other risk-sharing pools, for which the Company is assessed charges based on incurred claims, demographic membership mix and other factors. The Company establishes liabilities for these assessments based on applicable laws and regulations. In certain states, the ultimate assessments the Company pays are dependent upon the Company’s experience relative to other entities subject to the assessment, and the ultimate liability is not known at the financial statement date. While the ultimate amount of the assessment is dependent upon the experience of all pool participants, the Company believes it has adequate reserves to cover such assessments.

The Company’s total guaranty fund assessments liability was immaterial at both December 31, 2023 and 2022.

Litigation and Regulatory Proceedings

The Company has been involved or is currently involved in numerous legal proceedings, including litigation, arbitration, government investigations, audits, reviews and claims. These include routine, regular and special investigations, audits and reviews by CMS, state insurance and health and welfare departments, the U.S. Department of Justice (the “DOJ”), state Attorneys General, the U.S. Drug Enforcement Administration (the “DEA”), the U.S. Federal Trade Commission (the “FTC”) and other governmental authorities.
Legal proceedings, in general, and securities, class action and multi-district litigation, in particular, and governmental special investigations, audits and reviews can be expensive and disruptive. Some of the litigation matters may purport or be determined to be class actions and/or involve parties seeking large and/or indeterminate amounts, including punitive or exemplary damages, and may remain unresolved for several years. The Company also may be named from time to time in qui tam actions initiated by private third parties that could also be separately pursued by a governmental body. The results of legal proceedings, including government investigations, are often uncertain and difficult to predict, and the costs incurred in these matters can be substantial, regardless of the outcome.

The Company records accruals for outstanding legal matters when it believes it is probable that a loss will be incurred and the amount can be reasonably estimated. The Company evaluates, on a quarterly basis, developments in legal matters that could affect the amount of any accrual and developments that would make a loss contingency both probable and reasonably estimable. If a loss contingency is not both probable and reasonably estimable, the Company does not establish an accrued liability. Other than the controlled substances litigation accruals described below, none of the Company’s accruals for outstanding legal matters are material individually or in the aggregate to the Company’s consolidated balance sheets.

Except as otherwise noted, the Company cannot predict with certainty the timing or outcome of the legal matters described below, and the Company is unable to reasonably estimate a possible loss or range of possible loss in excess of amounts already accrued for these matters. The Company believes that its defenses and assertions in pending legal proceedings have merit and does not believe that any of these pending matters, after consideration of applicable reserves and rights to indemnification, will have a material adverse effect on the Company’s financial position. Substantial unanticipated verdicts, fines and rulings, however, do sometimes occur, which could result in judgments against the Company, entry into settlements or a revision to its expectations regarding the outcome of certain matters, and such developments could have a material adverse effect on its results of operations. In addition, as a result of governmental investigations or proceedings, the Company may be subject to damages, civil or criminal fines or penalties, or other sanctions including possible suspension or loss of licensure and/or exclusion from participating in government programs. The outcome of such governmental investigations of proceedings could be material to the Company.

Usual and Customary Pricing Litigation

The Company is named as a defendant in a number of lawsuits that allege that the Company’s retail pharmacies overcharged for prescription drugs by not submitting the correct usual and customary price during the claims adjudication process. These actions are brought by a number of different types of plaintiffs, including plan members, private payors and government payors, and are based on different legal theories. Some of these cases are brought as putative class actions, and in some instances, classes have been certified. The Company is defending itself against these claims. In October 2022, one of the litigating shareholders made a litigation demand to the Board related to these and other issues after his amended derivative complaint was dismissed for failing to demonstrate demand futility. An independent review committee was created to review the demand and determined that the Board would take no further action with respect to the claims alleged in the demand.

PBM Litigation and Investigations

The Company is named as a defendant in a number of lawsuits and is subject to a number of investigations concerning its PBM practices.

The Company is facing multiple lawsuits, including by state Attorneys General, governmental subdivisions, private parties and several putative class actions regarding drug pricing and its rebate arrangements with drug manufacturers. These complaints, brought by a number of different types of plaintiffs under a variety of legal theories, generally allege that rebate agreements between the drug manufacturers and PBMs caused inflated prices for certain drug products. The majority of these cases have now been transferred into a multi-district litigation in the U.S. District Court for the District of New Jersey. The Company is defending itself against these claims. The Company has also received subpoenas, civil investigative demands (“CIDs”), and other requests for documents and information from, and is being investigated by, the FTC and Attorneys General of several states and the District of Columbia regarding its PBM practices, including pharmacy contracting practices and reimbursement, pricing and rebates. The Company has been providing documents and information in response to these subpoenas, CIDs, and requests for information.

United States ex rel. Behnke v. CVS Caremark Corporation, et al. (U.S. District Court for the Eastern District of Pennsylvania). In April 2018, the Court unsealed a complaint filed in February 2014. The government has declined to intervene in this case. The relator alleges that the Company submitted, or caused to be submitted, to Part D of the Medicare program Prescription
Drug Event data and/or Direct and Indirect Remuneration reports that misrepresented true prices paid by the Company’s PBM to pharmacies for drugs dispensed to Part D beneficiaries with prescription benefits administered by the Company’s PBM. The Company is defending itself against these claims.

Controlled Substances Litigation, Audits and Subpoenas

In December 2022, the Company agreed to a formal settlement agreement, the financial amounts of which were agreed to in principle in October 2022, with a leadership group of a number of state Attorneys General and the Plaintiffs’ Executive Committee. Upon finalization, the agreement resolves substantially all opioid claims against Company entities by participating states and political subdivisions but not private plaintiffs, alleging claims beginning as far back as the early 2000s generally concerning the impacts of widespread prescription opioid abuse. The maximum amount payable by the Company under the settlement is approximately $4.3 billion in opioid remediation and $625 million in attorneys’ fees and costs and additional remediation. The amounts are payable over 10 years, beginning in 2023. The agreement also contains injunctive terms relating to the dispensing of opioid medications. The settlement agreement is available at nationalopioidsettlement.com.

Upon reaching an agreement in principle in October 2022, the Company concluded that settlement of opioid claims by governmental entities and tribes was probable, and the loss related thereto could be reasonably estimated. As a result of that conclusion, and its assessment of certain other opioid-related claims including those for which the Company reached agreement in August and September 2022, the Company recorded pre-tax charges of $5.3 billion during the year ended December 31, 2022. Settlement accruals expected to be paid within twelve months from the balance sheet date are classified as accrued expenses on the consolidated balance sheets and settlement accruals expected to be paid greater than twelve months from the balance sheet date are classified as other long-term liabilities on the consolidated balance sheets.

In June 2023, the Company elected to move forward with a final settlement agreement, the financial amounts of which were agreed to in principle in October 2022, to resolve claims brought by participating states and political subdivisions such as counties, cities, and towns, but not by private plaintiffs, alleging claims beginning as far back as the early 2000s generally concerning the impacts of widespread prescription opioid abuse. The agreement became effective in June 2023.

Forty-five states, the District of Columbia, and all eligible U.S. territories are participating in the settlement. A high percentage of eligible subdivisions within the participating states also have elected to join the settlement. The Company has separately entered into settlement agreements with four states – Florida, West Virginia, New Mexico, and Nevada – and a high percentage of eligible subdivisions within those states also have elected to participate.

The final settlement agreement contains certain contingencies related to payment obligations. Because these contingencies are inherently unpredictable, the assessment requires judgments about future events. The amount of ultimate loss may differ from the amount accrued by the Company.

The State of Maryland has not elected to participate in the settlement. Subdivisions within the State of Maryland thus may not participate in the settlement. The State of Maryland has issued a civil subpoena for information from the Company.

In December 2022, the Company also agreed to a formal settlement agreement with a leadership group representing tribes throughout the U.S. The agreement resolves substantially all opioid claims against Company entities by such tribes. The maximum amount payable by the Company under the settlement is $113 million in opioid remediation and $16 million in attorneys’ fees and costs, payable over 10 years. The Company also entered into a separate settlement with the Cherokee Nation.

These settlements resolve a majority of the cases against the Company that had been pending in the consolidated multidistrict litigation captioned In re National Prescription Opiate Litigation (MDL No. 2804) pending in the U.S. District Court for the Northern District of Ohio. However, certain opioid-related cases against the Company remain pending in the multidistrict litigation and in various state courts, including those brought by non-participating subdivisions and private parties such as hospitals and third-party payors. The Company continues to defend those cases.

In November 2021, the Company was among the chain pharmacies found liable by a jury in a trial in federal court in Ohio; in August 2022, the court issued a judgment jointly against the three defendants in the amount of $651 million to be paid over 15 years and also ordered certain injunctive relief. The Company is appealing the judgment and has not accrued a liability for this matter.
Because of the many uncertainties associated with any settlement arrangement or other resolution of opioid-related litigation matters, and because the Company continues to actively defend ongoing litigation for which it believes it has defenses and assertions that have merit, the Company is not able to reasonably estimate the range of ultimate possible loss for all opioid-related litigation matters at this time. The outcome of these legal matters could have a material effect on the Company’s business, financial condition, operating results and/or cash flows.

In January 2020, the DOJ served the Company with a DEA administrative subpoena. The subpoena seeks documents relating to practices with respect to prescription opioids and other controlled substances at CVS pharmacy locations concerning potential violations of the federal Controlled Substances Act and the federal False Claims Act. The DOJ subsequently served additional DEA administrative subpoenas relating to controlled substances. The DOJ also served the Company with additional CIDs relating to controlled substances. The Company is providing documents and information in response to these matters.

Prescription Processing Litigation and Investigations

The Company is named as a defendant in a number of lawsuits and is subject to a number of investigations concerning its prescription processing practices, including related to billing government payors for prescriptions, and the following:

U.S. ex rel. Bassan et al. v. Omnicare, Inc. and CVS Health Corp. (U.S. District Court for the Southern District of New York). In December 2019, the U.S. Attorney’s Office for the Southern District of New York filed a complaint-in-intervention in this previously sealed qui tam case. The complaint alleges that for certain non-skilled nursing facilities, Omnicare improperly filled prescriptions beyond one year where a valid prescription did not exist and that these dispensing events violated the federal False Claims Act. The Company is defending itself against these claims.

U.S. ex rel. Gill et al. v. CVS Health Corp. et al. (U.S. District Court for the Northern District of Illinois). In July 2022, the Delaware Attorney General’s Office moved for partial intervention as to allegations under the Delaware false claims act related to not escheating alleged overpayments in this previously sealed qui tam case. The federal government and the remaining states declined to intervene on other additional theories in the relator’s complaint. The Company is defending itself against all of the claims.

Provider Proceedings

The Company is named as a defendant in purported class actions and individual lawsuits arising out of its practices related to the payment of claims for services rendered to its members by providers with whom the Company has a contract and with whom the Company does not have a contract (“out-of-network providers”). Among other things, these lawsuits allege that the Company paid too little to its health plan members and/or providers for out-of-network services (including COVID-19 testing) and/or otherwise allege that the Company failed to timely or appropriately pay or administer claims and benefits (including the Company’s post payment audit and collection practices). Other major health insurers are the subject of similar litigation or have settled similar litigation.

The Company also has received subpoenas and/or requests for documents and other information from, and been investigated by, state Attorneys General and other state and/or federal regulators, legislators and agencies relating to claims payments, and the Company is involved in other litigation regarding its out-of-network benefit payment and administration practices. It is reasonably possible that others could initiate additional litigation or additional regulatory action against the Company with respect to its out-of-network benefit payment and/or administration practices.

CMS Actions

CMS regularly audits the Company’s performance to determine its compliance with CMS’s regulations and its contracts with CMS and to assess the quality of services it provides to Medicare beneficiaries. CMS uses various payment mechanisms to allocate and adjust premium payments to the Company’s and other companies’ Medicare plans by considering the applicable health status of Medicare members as supported by information prepared, maintained and provided by providers. The Company collects claim and encounter data from providers and generally relies on providers to appropriately code their submissions to the Company and document their medical records, including the diagnosis data submitted to the Company with claims. CMS pays increased premiums to Medicare Advantage plans and Medicare PDP plans for members who have certain medical conditions identified with specific diagnosis codes. Federal regulators review and audit the providers’ medical records to determine whether those records support the related diagnosis codes that determine the members’ health status and the resulting risk-adjusted premium payments to the Company. In that regard, CMS has instituted risk adjustment data validation (“RADV”) audits of various Medicare Advantage plans, including certain of the Company’s plans, to validate coding practices and
supporting medical record documentation maintained by providers and the resulting risk-adjusted premium payments to the plans. CMS may require the Company to refund premium payments if the Company’s risk-adjusted premiums are not properly supported by medical record data. The Office of the Inspector General of the OIG also is auditing the Company’s risk adjustment-related data and that of other companies. The Company expects CMS and the OIG to continue these types of audits.

In 2012, in the “Notice of Final Payment Error Calculation for Part C Medicare Advantage Risk Adjustment Validation Data (RADV) Contract-Level Audits,” CMS revised its audit methodology for RADV contract-level audits to determine refunds payable by Medicare Advantage plans for contract year 2011 and forward. Under the revised methodology, among other things, CMS announced extrapolation of the error rate identified in the audit sample along with the application of a process to account for errors in the government’s traditional fee-for-service Medicare program (“FFS Adjuster”). For contract years prior to 2011, CMS did not extrapolate sample error rates to the entire contract, nor did CMS propose to apply a FFS adjuster. By applying the FFS Adjuster, Medicare Advantage organizations would have been liable for repayments only to the extent that their extrapolated payment errors exceeded the error rate in Original Medicare, which could have impacted the extrapolated repayments to which Medicare Advantage organizations are subject. This revised contract-level audit methodology increased the Company’s exposure to premium refunds to CMS based on incomplete medical records maintained by providers. In the RADV audit methodology CMS used from 2011-2013, CMS selected only a few of the Company’s Medicare Advantage contracts for various contract years for contract-level RADV audits. In October 2018, CMS in the proposed rule (“Proposed Rule”) announced a new methodology for RADV audits targeting certain health conditions and members with many diagnostic conditions along with extrapolation for the error rates identified without use of a FFS Adjuster. While the rule was under proposal, CMS initiated contract-level RADV audits for the years 2014 and 2015 with this new RADV methodology without a final rule.

On January 30, 2023, CMS released the final rule (“RADV Audit Rule”), announcing it may use extrapolation for payment years 2018 forward, for both RADV audits and OIG contract level audits, and eliminated the application of a FFS Adjuster in Part C contract-level RADV audits of Medicare Advantage organizations. In the RADV Audit Rule, CMS indicated that it will use more than one audit methodology going forward and indicated CMS will audit contracts it believes are at the highest risk for overpayments based on its statistical modeling, citing a 2016 Governmental Accountability Office report that recommended selection of contract-level RADV audits with a focus on contracts likely to have high rates of improper payment, the highest coding intensity scores, and contracts with high levels of unsupported diagnoses from prior RADV audits.

The Company is currently unable to predict which of its Medicare Advantage contracts will be selected for future audit, the amounts of any retroactive refunds for years prior to 2018 or prospective adjustments to Medicare Advantage premium payments made to the Company, the effect of any such refunds or adjustments on the actuarial soundness of the Company’s Medicare Advantage bids, or whether any RADV audit findings would require the Company to change its method of estimating future premium revenue in future bid submissions to CMS or compromise premium assumptions made in the Company’s bids for prior contract years, the current contract year or future contract years. Any premium or fee refunds or adjustments resulting from regulatory audits, whether as a result of RADV, Public Exchange related or other audits by CMS, the OIG or otherwise, including audits of the Company’s minimum loss ratio rebates, methodology and/or reports, could be material and could adversely affect the Company’s operating results, cash flows and/or financial condition.

The RADV Audit Rule does not apply to the CMS Part C Improper Payment Measures audits nor the U.S. Department of Health and Human Services RADV programs.

Medicare and Medicaid Litigation and Investigations

The Company has received CIDs from the Civil Division of the DOJ in connection with investigations of the Company’s identification and/or submission of diagnosis codes related to risk adjustment payments, including patient chart review processes, under Parts C and D of the Medicare program. The Company is cooperating with the government and providing documents and information in response to these CIDs.

In May 2017, the Company received a CID from the U.S. Attorney’s Office for the Southern District of New York requesting documents and information concerning possible false claims submitted to Medicare in connection with reimbursements for prescription drugs under the Medicare Part D program. The Company has been cooperating with the government and providing documents and information in response to this CID.

In November 2021, prior to its acquisition by the Company, Oak Street Health received a CID from the DOJ in connection with an investigation of possible false claims submitted to Medicare related to Oak Street Health’s relationships with third-party
marketing agents and Oak Street Health’s provision of free transportation to federal health care beneficiaries. The Company has been cooperating with the government and has provided documents and information in response to the CID.

In January 2022, the U.S. Attorney’s Office for the District of Massachusetts issued a subpoena to Aetna Life Insurance Company seeking, among other things, information in connection with its relationship and compensation arrangements with certain brokers, and the Company may receive similar inquiries in the future. The Company is cooperating with the subpoena.

Stockholder Matters

Beginning in February 2019, multiple class action complaints, as well as a derivative complaint, were filed by putative plaintiffs against the Company and certain current and former officers and directors. The plaintiffs in these cases assert a variety of causes of action under federal securities laws that are premised on allegations that the defendants made certain omissions and misrepresentations relating to the performance of the Company’s LTC business unit. Since filing, several of the cases have been consolidated, and two have resolved, including the first-filed federal case, City of Miami Fire Fighters’ and Police Officers’ Retirement Trust, et al. (formerly known as Anarkat), the dismissal of which the First Circuit affirmed in August 2022. The Company and its current and former officers and directors are defending themselves against remaining claims. The Company has moved to dismiss the amended complaint in In re CVS Health Corp. Securities Act Litigation (formerly known as Waterford). In In re CVS Health Corp. Securities Litigation (formerly known as City of Warren and Freundlich), the court granted the Company’s motion to dismiss in February 2023 and the plaintiffs have filed a notice of appeal.

Beginning in December 2021, the Company has received three demands for inspection of books and records pursuant to Delaware Corporation Law Section 220, as well as a derivative complaint (Vladimir Gusinsky Revocable Trust v. Lynch, et al.) that was filed in January 2023. The demands and the complaint purport to be related to potential breaches of fiduciary duties by the Board in relation to certain matters concerning opioids. The Company and its current and former officers and directors are defending themselves against these matters.

In January 2022, a shareholder class action complaint was filed in the Northern District of Illinois, Allison v. Oak Street Health, Inc., et al. Defendants include Oak Street Health and certain of its pre-acquisition officers and directors. The putative plaintiffs assert causes of action under various securities laws premised on allegations that defendants made omissions and misrepresentations to investors relating to marketing conduct they allege may violate the False Claims Act. The Company and the individual defendants are defending themselves against these claims.

Other Legal and Regulatory Proceedings

The Company is also a party to other legal proceedings and is subject to government investigations, inquiries and audits, and has received and is cooperating with the government in response to CIDs, subpoenas, or similar process from various governmental agencies requesting information. These other legal proceedings and government actions include claims of or relating to bad faith, medical or professional malpractice, breach of fiduciary duty, claims processing, dispensing of medications, the use of medical testing devices in the in-home evaluation setting, non-compliance with state and federal regulatory regimes, marketing misconduct, denial of or failure to timely or appropriately pay or administer claims and benefits, provider network structure (including the use of performance-based networks and termination of provider contracts), rescission of insurance coverage, improper disclosure or use of personal information, anticompetitive practices, the Company’s participation in the 340B program, general contractual matters, product liability, intellectual property litigation, discrimination and employment litigation. Some of these other legal proceedings are or are purported to be class actions or derivative claims. The Company is defending itself against the claims brought in these matters.

Awards to the Company and others of certain government contracts, particularly Medicaid contracts and other contracts with government customers in the Company’s Health Care Benefits segment, frequently are subject to protests by unsuccessful bidders. These protests may result in awards to the Company being reversed, delayed, or modified. The loss or delay in implementation of any government contract could adversely affect the Company’s operating results. The Company will continue to defend contract awards it receives.

There also continues to be a heightened level of review and/or audit by regulatory authorities and legislators of, and increased litigation regarding, the Company’s and the rest of the health care and related benefits industry’s business and reporting practices, including premium rate increases, utilization management, development and application of medical policies, complaint, grievance and appeal processing, information privacy, provider network structure (including provider network adequacy, the use of performance-based networks and termination of provider contracts), provider directory accuracy, calculation of minimum MLRs and/or payment of related rebates, delegated arrangements, rescission of insurance coverage,
limited benefit health products, student health products, PBM practices (including manufacturers’ rebates, pricing, the use of narrow networks and the placement of drugs in formulary tiers), sales practices, customer service practices, vendor oversight, and claim payment practices (including payments to out-of-network providers).

As a leading national health solutions company, the Company regularly is the subject of government actions of the types described above. These government actions may prevent or delay the Company from implementing planned premium rate increases and may result, and have resulted, in restrictions on the Company’s businesses, changes to or clarifications of the Company’s business practices, retroactive adjustments to premiums, refunds or other payments to members, beneficiaries, states or the federal government, withholding of premium payments to the Company by government agencies, assessments of damages, civil or criminal fines or penalties, or other sanctions, including the possible suspension or loss of licensure and/or suspension or exclusion from participation in government programs.

The Company can give no assurance that its businesses, financial condition, operating results and/or cash flows will not be materially adversely affected, or that the Company will not be required to materially change its business practices, based on: (i) future enactment of new health care or other laws or regulations; (ii) the interpretation or application of existing laws or regulations as they may relate to one or more of the Company’s businesses, one or more of the industries in which the Company competes and/or the health care industry generally; (iii) pending or future federal or state government investigations of one or more of the Company’s businesses, one or more of the industries in which the Company competes and/or the health care industry generally; (iv) pending or future government audits, investigations or enforcement actions against the Company; (v) adverse developments in any pending qui tam lawsuit against the Company, whether sealed or unsealed, or in any future qui tam lawsuit that may be filed against the Company; or (vi) adverse developments in pending or future legal proceedings against the Company or affecting one or more of the industries in which the Company competes and/or the health care industry generally.
v3.24.0.1
Segment Reporting
 12 Months Ended
Dec. 31, 2023
Segment Reporting [Abstract]  
Segment Reporting Segment Reporting
The Company has three operating segments, Health Care Benefits, Health Services and Pharmacy & Consumer Wellness, as well as a Corporate/Other segment. The Company’s segments maintain separate financial information, and the CODM evaluates the segments’ operating results on a regular basis in deciding how to allocate resources among the segments and in assessing segment performance. The CODM evaluates the performance of the Company’s segments based on adjusted operating income. Total assets by segment are not used by the CODM to assess the performance of, or allocate resources to, the Company’s segments, therefore total assets by segment are not disclosed.

Adjusted operating income is defined as operating income (GAAP measure) excluding the impact of amortization of intangible assets and other items, if any, that neither relate to the ordinary course of the Company’s business nor reflect the Company’s underlying business performance. Effective for the first quarter of 2023, adjusted operating income also excludes the impact of net realized capital gains or losses. See the reconciliation of consolidated operating income (GAAP measure) to consolidated adjusted operating income below for further context regarding the items excluded from operating income in determining adjusted operating income. The Company uses adjusted operating income as its principal measure of segment performance as it enhances the Company’s ability to compare past financial performance with current performance and analyze underlying business performance and trends. Non-GAAP financial measures the Company discloses, such as consolidated adjusted operating income, should not be considered a substitute for, or superior to, financial measures determined or calculated in accordance with GAAP.

Segment financial information for the years ended December 31, 2022 and 2021 has been revised to conform with the current period presentation for the following items:
•The realignment of the Company’s segments to correspond with changes made to its operating model as described in Note 1 “Significant Accounting Policies,” including the discontinuance of the former Maintenance Choice segment reporting practice as described in Note (1) of the table included on the next page.
•The impact of the adoption of the long-duration insurance accounting standard, which the Company adopted on January 1, 2023 using a modified retrospective transition method as of January 1, 2021, as described in Note 1 “Significant Accounting Policies.”
•The exclusion of the impact of net realized capital gains or losses from adjusted operating income, as described above.

The impact of these items on segment financial information for the years ended December 31, 2022 and 2021 is reflected in the “Adjustments” lines of the table included on the next page.
Year Ended December 31, 2022
In millionsHealth Care
Benefits		Health
Services		Pharmacy &
Consumer
Wellness		Corporate/
Other
Intersegment
Eliminations (1)
Consolidated
Totals
Total revenues, as previously reported$91,409 $169,236 $106,594 $530 $(45,302)$322,467 
Adjustments(59)340 2,002 — (2,283)— 
Total revenues, as adjusted$91,350 $169,576 $108,596 $530 $(47,585)$322,467 
Adjusted operating income (loss), as previously reported$5,984 $7,356 $6,705 $(1,785)$(728)$17,532 
Adjustments354 (575)(174)172 728 505 
Adjusted operating income (loss), as adjusted$6,338 $6,781 $6,531 $(1,613)$— $18,037 

Year Ended December 31, 2021
In millionsHealth Care
Benefits		Health
Services		Pharmacy &
Consumer
Wellness		Corporate/
Other
Intersegment
Eliminations (1)
Consolidated
Totals
Total revenues, as previously reported$82,186 $153,022 $100,105 $721 $(43,923)$292,111 
Adjustments(67)870 1,515 — (2,318)— 
Total revenues, as adjusted$82,119 $153,892 $101,620 $721 $(46,241)$292,111 
Adjusted operating income (loss), as previously reported$5,012 $6,859 $7,623 $(1,471)$(711)$17,312 
Adjustments98 (367)(363)(164)711 (85)
Adjusted operating income (loss), as adjusted$5,110 $6,492 $7,260 $(1,635)$— $17,227 
_____________________________________________
(1)Intersegment revenue eliminations relate to intersegment revenue generating activities that occur between the Health Care Benefits segment, the Health Services segment, and/or the Pharmacy & Consumer Wellness segment. Prior to January 1, 2023, intersegment adjusted operating income eliminations occurred when members of the Health Services segment's clients enrolled in Maintenance Choice elected to pick up maintenance prescriptions at one of the Company’s retail pharmacies instead of receiving them through the mail. When this occurred, both the Health Services and Pharmacy & Consumer Wellness segments recorded the adjusted operating income on a stand-alone basis. Effective January 1, 2023, the adjusted operating income associated with such transactions is reported only in the Pharmacy & Consumer Wellness segment, therefore no adjusted operating income elimination is required. Segment financial information has been recast to reflect this change.

In 2023, 2022 and 2021, revenues from the federal government accounted for 19%, 18% and 17%, respectively, of the Company’s consolidated total revenues, primarily related to contracts with CMS for coverage of Medicare-eligible individuals within the Health Care Benefits segment.
The following is a reconciliation of financial measures of the Company’s segments to the consolidated totals:
In millionsHealth Care
Benefits
Health
Services (1)
Pharmacy &
Consumer
Wellness		Corporate/
Other
Intersegment
Eliminations (2)
Consolidated
Totals
2023:
Revenues from external customers$104,800 $174,018 $77,748 $57 $— $356,623 
Intersegment revenues81 12,826 39,020 — (51,927)— 
Net investment income (loss)765 (1)(5)394 — 1,153 
Total revenues105,646 186,843 116,763 451 (51,927)357,776 
  Adjusted operating income (loss) 5,577 7,312 5,963 (1,318)— 17,534 
Depreciation and amortization1,572 880 1,549 365 — 4,366 
2022:
Revenues from external customers90,798 157,968 72,739 124 — 321,629 
Intersegment revenues76 11,608 35,901 — (47,585)— 
Net investment income (loss)476 — (44)406 — 838 
Total revenues 91,350 169,576 108,596 530 (47,585)322,467 
  Adjusted operating income (loss) 6,338 6,781 6,531 (1,613)— 18,037 
Depreciation and amortization1,579 519 1,889 237 — 4,224 
2021:
Revenues from external customers81,457 143,912 65,418 125 — 290,912 
Intersegment revenues76 9,980 36,185 — (46,241)— 
Net investment income586 — 17 596 — 1,199 
Total revenues82,119 153,892 101,620 721 (46,241)292,111 
  Adjusted operating income (loss) 5,110 6,492 7,260 (1,635)— 17,227 
Depreciation and amortization1,811 505 1,955 215 — 4,486 
_____________________________________________
(1)Total revenues of the Health Services segment include approximately $13.7 billion, $12.6 billion and $11.6 billion of retail co-payments for 2023, 2022 and 2021, respectively. See Note 1 ‘‘Significant Accounting Policies’’ for additional information about retail co-payments.
(2)Intersegment revenue eliminations relate to intersegment revenue generating activities that occur between the Health Care Benefits segment, the Health Services segment, and/or the Pharmacy & Consumer Wellness segment.
The following is a reconciliation of consolidated operating income to adjusted operating income for the years ended December 31, 2023, 2022 and 2021:
In millions202320222021
Operating income (GAAP measure)$13,743 $7,954 $13,310 
Amortization of intangible assets (1)
1,905 1,785 2,233 
Net realized capital (gains) losses (2)
497 320 (176)
Acquisition-related transaction and integration costs (3)
487 — 132 
Restructuring charges (4)
507 — — 
Office real estate optimization charges (5)
46 117 — 
Loss on assets held for sale (6)
349 2,533 — 
Opioid litigation charges (7)
— 5,803 — 
Gain on divestiture of subsidiaries (8)
— (475)— 
Store impairments (9)
— — 1,358 
Goodwill impairment (10)
— — 431 
Acquisition purchase price adjustment outside of measurement period (11)
— — (61)
Adjusted operating income$17,534 $18,037 $17,227 
_____________________________________________
(1)The Company’s acquisition activities have resulted in the recognition of intangible assets as required under the acquisition method of accounting which consist primarily of trademarks, customer contracts/relationships, covenants not to compete, technology, provider networks and value of business acquired. Definite-lived intangible assets are amortized over their estimated useful lives and are tested for impairment when events indicate that the carrying value may not be recoverable. The amortization of intangible assets is reflected in the Company’s GAAP consolidated statements of operations in operating expenses within each segment. Although intangible assets contribute to the Company’s revenue generation, the amortization of intangible assets does not directly relate to the underwriting of the Company’s insurance products, the services performed for the Company’s customers or the sale of the Company’s products or services. Additionally, intangible asset amortization expense typically fluctuates based on the size and timing of the Company’s acquisition activity. Accordingly, the Company believes excluding the amortization of intangible assets enhances the Company’s and investors’ ability to compare the Company’s past financial performance with its current performance and to analyze underlying business performance and trends. Intangible asset amortization excluded from the related non-GAAP financial measure represents the entire amount recorded within the Company’s GAAP financial statements, and the revenue generated by the associated intangible assets has not been excluded from the related non-GAAP financial measure. Intangible asset amortization is excluded from the related non-GAAP financial measure because the amortization, unlike the related revenue, is not affected by operations of any particular period unless an intangible asset becomes impaired or the estimated useful life of an intangible asset is revised.
(2)The Company’s net realized capital gains and losses arise from various types of transactions, primarily in the course of managing a portfolio of assets that support the payment of insurance liabilities. Net realized capital gains and losses are reflected in the consolidated statements of operations in net investment income within each segment. These capital gains and losses are the result of investment decisions, market conditions and other economic developments that are unrelated to the performance of the Company’s business, and the amount and timing of these capital gains and losses do not directly relate to the underwriting of the Company’s insurance products, the services performed for the Company’s customers or the sale of the Company’s products or services. Accordingly, the Company believes excluding net realized capital gains and losses enhances the Company’s and investors’ ability to compare the Company’s past financial performance with its current performance and to analyze underlying business performance and trends.
(3)In 2023, the acquisition-related transaction and integration costs relate to the acquisitions of Signify Health and Oak Street Health. In 2021, the acquisition-related integration costs relate to the acquisition of Aetna. The acquisition-related transaction and integration costs are reflected in the Company’s GAAP consolidated statements of operations in operating expenses within the Corporate/Other segment.
(4)In 2023, the restructuring charges are primarily comprised of severance and employee-related costs, asset impairment charges and a stock-based compensation charge. During the second quarter of 2023, the Company developed an enterprise-wide restructuring plan intended to streamline and simplify the organization, improve efficiency and reduce costs. In connection with the development of this plan and the recently completed acquisitions of Signify Health and Oak Street Health, the Company also conducted a strategic review of its various transformation initiatives and determined that it would terminate certain initiatives. The restructuring charges are reflected within the Corporate/Other segment.
(5)In 2023 and 2022, the office real estate optimization charges primarily relate to the abandonment of leased real estate and the related right-of-use assets and property and equipment in connection with the planned reduction of corporate office real estate space in response to the Company’s new flexible work arrangement. The office real estate optimization charges are reflected in the Company’s GAAP consolidated statements of operations in operating expenses within the Health Care Benefits, Corporate/Other and Health Services segments.
(6)In 2023 and 2022, the loss on assets held for sale relates to the LTC reporting unit within the Pharmacy & Consumer Wellness segment. During 2022, the Company determined that its LTC business was no longer a strategic asset and committed to a plan to sell it, at which time the LTC business met the criteria for held-for-sale accounting and its net assets were accounted for as assets held for sale. The carrying value of the LTC business was determined to be greater than its estimated fair value less costs to sell and, accordingly, the Company recorded a loss on assets held for sale during 2022. During the first quarter of 2023, a loss on assets held for sale was recorded to write down the carrying value of the LTC business to the Company’s best estimate of the ultimate selling price which reflected its estimated fair value less costs to sell. As of September 30, 2023, the Company determined the LTC business no longer met the criteria for held-for-sale accounting and, accordingly, the net assets associated with the LTC business were reclassified to held and used at their respective fair values. During 2022, the loss on assets held for sale also relates to the Company’s Thailand business, which was included in the Commercial Business reporting unit in the Health Care Benefits segment. The sale of the Thailand business closed in the second quarter of 2022, and the ultimate loss on the sale was not material.
(7)In 2022, the opioid litigation charges relate to agreements to resolve substantially all opioid claims against the Company by certain states and governmental entities. The opioid litigation charges are reflected within the Corporate/Other segment.
(8)In 2022, the gain on divestiture of subsidiaries represents the pre-tax gain on the sale of bswift, which the Company sold in November 2022, and the pre-tax gain on the sale of PayFlex, which the Company sold in June 2022. The gains on divestitures are reflected as a reduction of operating expenses in the Company’s GAAP consolidated statement of operations within the Health Care Benefits segment.
(9)In 2021, the store impairment charge relates to the write down of operating lease right-of-use assets and property and equipment in connection with the planned closure of approximately 900 retail stores between 2022 and 2024. The store impairment charge is reflected within the Pharmacy & Consumer Wellness segment.
(10)In 2021, the goodwill impairment charge relates to an impairment of the remaining goodwill of the LTC reporting unit within the Pharmacy & Consumer Wellness segment.
(11)In 2021, the Company received $61 million related to a purchase price working capital adjustment for an acquisition completed during the first quarter of 2020. The resolution of this matter occurred subsequent to the acquisition accounting measurement period and is reflected in the Company’s GAAP consolidated statement of operations as a reduction of operating expenses within the Health Care Benefits segment.
v3.24.0.1
Pay vs Performance Disclosure - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Pay vs Performance Disclosure      
Net income attributable to CVS Health $ 8,344 $ 4,311 $ 8,001
v3.24.0.1
Insider Trading Arrangements
 3 Months Ended
Dec. 31, 2023
Trading Arrangements, by Individual  
Rule 10b5-1 Arrangement Adopted false
Non-Rule 10b5-1 Arrangement Adopted false
Rule 10b5-1 Arrangement Terminated false
Non-Rule 10b5-1 Arrangement Terminated false
v3.24.0.1
Significant Accounting Policies (Policies)
 12 Months Ended
Dec. 31, 2023
Accounting Policies [Abstract]  
Segment Reporting
The Company has four reportable segments: Health Care Benefits, Health Services, Pharmacy & Consumer Wellness and Corporate/Other, which are described below.

Health Care Benefits Segment
The Health Care Benefits segment operates as one of the nation’s leading diversified health care benefits providers. The Health Care Benefits segment has the information and resources to help members, in consultation with their health care professionals, make more informed decisions about their health care. The Health Care Benefits segment offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental and behavioral health plans, medical management capabilities, Medicare Advantage and Medicare Supplement plans, PDPs and Medicaid health care management services. The Health Care Benefits segment’s customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers (“providers”), governmental units, government-sponsored plans, labor groups and expatriates. The Company refers to insurance products (where it assumes all or a majority of the risk for medical and dental care costs) as “Insured” and administrative services contract products (where the plan sponsor assumes all or a majority of the risk for medical and dental care costs) as “ASC.” The Company sold Insured plans directly to individual consumers through the individual public health insurance exchanges (“Public Exchanges”) in 12 states as of December 31, 2023. The Company entered Public Exchanges in five additional states effective January 2024.

Health Services Segment
The Health Services segment provides a full range of PBM solutions, delivers health care services in its medical clinics, virtually, and in the home, and offers provider enablement solutions. PBM solutions include plan design offerings and administration, formulary management, retail pharmacy network management services, and specialty and mail order pharmacy services. In addition, the Company provides clinical services, disease management services, medical spend management and pharmacy and/or other administrative services for providers and federal 340B drug pricing program covered entities (“Covered Entities”). The Company operates a group purchasing organization that negotiates pricing for the purchase of pharmaceuticals
and rebates with pharmaceutical manufacturers on behalf of its participants and provides various administrative, management and reporting services to pharmaceutical manufacturers. During 2023, the Company completed the acquisition of two key health care delivery assets – Signify Health, a leader in health risk assessments, value-based care and provider enablement services, and Oak Street Health, a leading multi-payor operator of value-based primary care centers serving Medicare eligible patients. The Company also announced the launch of CordavisTM, a wholly owned subsidiary that will work directly with pharmaceutical manufacturers to commercialize and/or co-produce high quality biosimilar products. The Health Services segment’s clients and customers are primarily employers, insurance companies, unions, government employee groups, health plans, PDPs, Medicaid managed care plans, CMS, plans offered on Insurance Exchanges and other sponsors of health benefit plans throughout the U.S., patients who receive care in the Health Services segment’s medical clinics, virtually or in the home, as well as Covered Entities.

Pharmacy & Consumer Wellness Segment
The Pharmacy & Consumer Wellness segment dispenses prescriptions in its retail pharmacies and through its infusion operations, provides ancillary pharmacy services including pharmacy patient care programs, diagnostic testing and vaccination administration, and sells a wide assortment of health and wellness products and general merchandise. The segment also conducts long-term care pharmacy (“LTC”) operations, which distribute prescription drugs and provide related pharmacy consulting and ancillary services to long-term care facilities and other care settings, and provides pharmacy fulfillment services to support the Health Services segment’s specialty and mail order pharmacy offerings. As of December 31, 2023, the Pharmacy & Consumer Wellness segment operated more than 9,000 retail locations, as well as online retail pharmacy websites, LTC pharmacies and on-site pharmacies, retail specialty pharmacy stores, compounding pharmacies and branches for infusion and enteral nutrition services.

Corporate/Other Segment
The Company presents the remainder of its financial results in the Corporate/Other segment, which primarily consists of:

•Management and administrative expenses to support the Company’s overall operations, which include certain aspects of executive management and the corporate relations, legal, compliance, human resources and finance departments, information technology, digital, data and analytics, as well as acquisition-related transaction and integration costs; and
•Products for which the Company no longer solicits or accepts new customers such as its large case pensions and long-term care insurance products.
Basis of Presentation
Basis of Presentation

The accompanying consolidated financial statements of CVS Health and its subsidiaries have been prepared in accordance with accounting principles generally accepted in the United States of America (“GAAP”). The consolidated financial statements include the accounts of the Company and its majority-owned subsidiaries and variable interest entities (“VIEs”) for which the Company is the primary beneficiary. All material intercompany balances and transactions have been eliminated.
Use of Estimates
Use of Estimates
The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts in the consolidated financial statements and accompanying notes. Actual results could differ from those estimates.
Cash and Cash Equivalents and Restricted Cash
Cash and Cash Equivalents

Cash and cash equivalents consist of cash and temporary investments with maturities of three months or less when purchased. The Company invests in short-term money market funds, commercial paper and time deposits, as well as other debt securities that are classified as cash equivalents within the accompanying consolidated balance sheets, as these funds are highly liquid and readily convertible to known amounts of cash.

Restricted Cash

Restricted cash included in other current assets on the consolidated balance sheets represents funds held on behalf of members and funds held in escrow in connection with agreements with accountable care organizations. Restricted cash included in other assets on the consolidated balance sheets represents amounts held in a trust in one of the Company’s captive insurance companies to satisfy collateral requirements associated with the assignment of certain insurance policies. All restricted cash is invested in time deposits and money market funds.
Investments
Investments

Debt Securities
Debt securities consist primarily of U.S. Treasury and agency securities, mortgage-backed securities, corporate and foreign bonds and other debt securities. Debt securities are classified as either current or long-term investments based on their contractual maturities unless the Company intends to sell an investment within the next twelve months, in which case it is classified as current on the consolidated balance sheets. Debt securities are classified as available for sale and are carried at fair value. See Note 5 ‘‘Fair Value’’ for additional information on how the Company estimates the fair value of these investments.

If a debt security is in an unrealized loss position and the Company has the intent to sell the security, or it is more likely than not that the Company will have to sell the security before recovery of its amortized cost basis, the amortized cost basis of the security is written down to its fair value and the difference is recognized in net income. If a debt security is in an unrealized loss position and the Company does not have the intent to sell and it is more likely than not that the Company will not have to sell such security before recovery of its amortized cost basis, the Company bifurcates the impairment into credit-related and non-credit related (yield-related) components. In evaluating whether a credit related loss exists, the Company considers a variety of factors including: the extent to which the fair value is less than the amortized cost basis; adverse conditions specifically related to the issuer of a security, an industry or geographic area; the payment structure of the security; the failure of the issuer of the security to make scheduled interest or principal payments; and any changes to the rating of the security by a rating agency. The amount of the credit-related component is recorded as an allowance for credit losses and recognized in net income, and the amount of the non-credit related component is included in other comprehensive income (loss). Interest is not accrued on debt securities when management believes the collection of interest is unlikely.

The credit-related component is determined by comparing the present value of cash flows expected to be collected from the security, considering all reasonably available information relevant to the collectability of the security, with the amortized cost basis of the security. If the present value of cash flows expected to be collected is less than the amortized cost basis of the security, the Company records an allowance for credit losses, which is limited by the amount that the fair value is less than amortized cost basis.

For mortgage-backed and other asset-backed securities, the Company recognizes income using an effective yield based on anticipated prepayments and the estimated economic life of the securities. When estimates of prepayments change, the effective yield is recalculated to reflect actual payments to date and anticipated future payments. The Company’s investment in the security is adjusted to the amount that would have existed had the new effective yield been applied since the acquisition of the security, with adjustments recognized in net income.

Equity Securities
Equity securities with readily available fair values are measured at fair value with changes in fair value recognized in net income.

Mortgage Loans
Mortgage loan investments on the consolidated balance sheets are valued at the unpaid principal balance, net of an allowance for credit losses. Mortgage loans with a maturity date or a committed prepayment date within twelve months are classified as
current on the consolidated balance sheets. The Company assesses whether its loans share similar risk characteristics and, if so, groups such loans in a risk pool when measuring expected credit losses. The Company considers the following characteristics when evaluating whether its loans share similar risk characteristics: loan-to-value ratios, property type (e.g., office, retail, apartment, industrial), geographic location, vacancy rates and property condition.

Credit loss reserves are determined using a loss rate method that multiplies the unpaid principal balance of each loan within a risk pool group by an estimated loss rate percentage. The loss rate percentage considers both the expected loan loss severity and the probability of loan default. For periods where the Company is able to make or obtain reasonable and supportable forecasts of expected economic conditions (e.g., gross domestic product, employment), the Company adjusts its expected loss rates to reflect these forecasted economic conditions. For periods beyond which the Company is able to make or obtain reasonable and supportable forecasts of expected economic conditions, the Company reverts to historical loss rates in determining expected credit losses.

Interest income on a potential problem loan (i.e., high probability of default) or restructured loan is accrued to the extent it is deemed to be collectible and the loan continues to perform under its original or restructured terms. Interest income on problem loans (i.e., more than 60 days delinquent, in bankruptcy or in process of foreclosure) is recognized on a cash basis. Cash payments on loans in the process of foreclosure are treated as a return of principal.

Other Investments
Other investments consist primarily of the following:

•Private equity and hedge fund limited partnerships, which are accounted for using the equity method of accounting. Under this method, the carrying value of the investment is based on the value of the Company’s equity ownership of the underlying investment funds provided by the general partner or manager of the investments, the financial statements of which generally are audited. As a result of the timing of the receipt of the valuation information provided by the fund managers, these investments are generally reported on up to a three month lag. The Company reviews investments for impairment at least quarterly and monitors their performance throughout the year through discussions with the administrators, managers and/or general partners. If the Company becomes aware of an impairment of a limited partnership’s investments through its review or prior to receiving the limited partnership’s financial statements at the financial statement date, an impairment will be recognized by recording a reduction in the carrying value of the limited partnership with a corresponding charge to net investment income.
•Investment real estate, which is carried on the consolidated balance sheets at depreciated cost, including capital additions, net of write-downs for other-than-temporary declines in fair value. Depreciation is calculated using the straight-line method based on the estimated useful life of each asset. If any real estate investment is considered held-for-sale, it is carried at the lower of its carrying value or fair value less estimated selling costs. The Company generally estimates fair value using net operating income and applying a capitalization rate in conjunction with comparable sales information. At the time of the sale, the difference between the sales price and the carrying value is recorded as a realized capital gain or loss.
•Privately-placed equity securities, which are carried on the consolidated balance sheets at cost less impairments, plus or minus subsequent adjustments for observable price changes. Additionally, as a member of the Federal Home Loan Bank of Boston (“FHLBB”), a subsidiary of the Company is required to purchase and hold shares of the FHLBB. These shares are restricted and carried at cost.

Net Investment Income
Net investment income on the Company’s investments is recorded when earned and is reflected in the Company’s net income (other than net investment income on assets supporting experience-rated products). Experience-rated products are products in the large case pensions business where the contract holder, not the Company, assumes investment and other risks, subject to, among other things, minimum guarantees provided by the Company. The effect of investment performance on experience-rated products is allocated to contract holders’ accounts daily, based on the underlying investment experience and, therefore, does not impact the Company’s net income (as long as the contract’s minimum guarantees are not triggered). Net investment income on assets supporting large case pensions’ experience-rated products is included in net investment income in the consolidated statements of operations and is credited to contract holders’ accounts through a charge to benefit costs. The contract holders’ accounts are reflected in policyholders’ funds on the consolidated balance sheets.

Realized capital gains and losses on investments (other than realized capital gains and losses on investments supporting experience-rated products) are included as a component of net investment income in the consolidated statements of operations. Realized capital gains and losses are determined on a specific identification basis. Purchases and sales of debt and equity securities and alternative investments are reflected on the trade date. Purchases and sales of mortgage loans and investment real estate are reflected on the closing date.
Realized capital gains and losses on investments supporting large case pensions’ experience-rated products are not included in realized capital gains and losses in the consolidated statements of operations and instead are credited directly to contract holders’ accounts. The contract holders’ accounts are reflected in policyholders’ funds on the consolidated balance sheets.

Unrealized capital gains and losses on investments (other than unrealized capital gains and losses on investments supporting experience-rated products) are reflected in shareholders’ equity, net of tax, as a component of accumulated other comprehensive income (loss). Unrealized capital gains and losses on investments supporting large case pensions’ experience-rated products are credited directly to contract holders’ accounts. The contract holders’ accounts are reflected in policyholders’ funds on the consolidated balance sheets.
Derivative Financial Instruments
Derivative Financial Instruments

The Company uses derivative financial instruments in order to manage interest rate and foreign exchange risk and credit exposure. The Company’s use of these derivatives is generally limited to hedging risk and has principally consisted of using interest rate swaps, treasury rate locks, forward contracts, futures contracts, warrants, put options and credit default swaps.
Accounts Receivable
Accounts Receivable
Accounts receivable are stated net of allowances for credit losses, customer credit allowances, contractual allowances and estimated terminations.When developing an estimate of the Company’s expected credit losses, the Company considers all available relevant information regarding the collectability of cash flows, including historical information, current conditions and reasonable and supportable forecasts of future economic conditions over the contractual life of the receivable. The Company’s accounts receivable are short duration in nature and typically settle in less than 30 days.
Inventories
Inventories
Inventories are valued at the lower of cost or net realizable value using the weighted average cost method. Physical inventory counts are taken on a regular basis in each retail store and pharmacy, and a continuous cycle count process is the primary procedure used to validate the inventory balances on hand in each distribution center and mail facility to ensure that the amounts reflected in the consolidated financial statements are properly stated. During the interim period between physical inventory counts, the Company accrues for anticipated physical inventory losses on a location-by-location basis based on historical results and current physical inventory trends.
Reinsurance Recoverables
Reinsurance Recoverables

The Company utilizes reinsurance agreements primarily to: (a) reduce required capital and (b) facilitate the acquisition or disposition of certain insurance contracts. Ceded reinsurance agreements permit the Company to recover a portion of its losses from reinsurers, although they do not discharge the Company’s primary liability as the direct insurer of the risks reinsured. Failure of reinsurers to indemnify the Company could result in losses; however, the Company does not expect charges for unrecoverable reinsurance to have a material effect on its consolidated operating results or financial condition. The Company evaluates the financial condition of its reinsurers and monitors concentrations of credit risk arising from similar geographic regions, activities or economic characteristics of its reinsurers. At December 31, 2023, the Company’s reinsurance recoverables consisted primarily of amounts due from third parties that are rated consistent with companies that are considered to have the
ability to meet their obligations. Reinsurance recoverables are recorded as other current assets or other assets on the consolidated balance sheets.
Health Care Contract Acquisition Costs
Health Care Contract Acquisition Costs
Insurance products included in the Health Care Benefits segment are cancellable by either the customer or the member monthly upon written notice. Acquisition costs related to prepaid health care and health indemnity contracts are generally expensed as incurred. For certain long-duration insurance contracts, acquisition costs directly related to the successful acquisition of a new or renewal insurance contract, including commissions, are deferred and are recorded as other current assets or other assets on the consolidated balance sheets. Contracts are grouped by product and issue year into cohorts consistent with the grouping used in estimating the associated liability and are amortized on a constant level basis based on the remaining in-force policies over the estimated term of the contracts to approximate straight-line amortization. Changes to the Company’s assumptions, including assumptions related to persistency, are reflected at the cohort level at the time of change and are recognized prospectively over the estimated terms of the contract. The amortization of deferred acquisition costs is recorded in operating expenses in the consolidated statements of operations.
Property and Equipment
Property and Equipment
Property and equipment is reported at historical cost, net of accumulated depreciation. Property, equipment and improvements to leased premises are depreciated using the straight-line method over the estimated useful lives of the assets, or when applicable, the term of the lease, whichever is shorter. Estimated useful lives generally range from 1 to 40 years for buildings, building improvements and leasehold improvements and 3 to 10 years for fixtures, equipment and internally developed software. Repair and maintenance costs are charged directly to expense as incurred. Major renewals or replacements that substantially extend the useful life of an asset are capitalized and depreciated. Application development stage costs for significant internally developed software projects are capitalized and depreciated.
Right-of-Use Assets and Lease Liabilities
Right-of-Use Assets and Lease Liabilities

The Company determines if an arrangement contains a lease at the inception of a contract. Right-of-use assets represent the Company’s right to use an underlying asset for the lease term and lease liabilities represent the Company’s obligation to make lease payments arising from the lease. Right-of-use assets and lease liabilities are recognized at the commencement date of the lease, renewal date of the lease or significant remodeling of the lease space based on the present value of the remaining future minimum lease payments. As the interest rate implicit in the Company’s leases is not readily determinable, the Company utilizes its incremental borrowing rate, determined by class of underlying asset, to discount the lease payments. The operating lease right-of-use assets also include lease payments made before commencement and are reduced by lease incentives.

The Company’s real estate leases typically contain options that permit renewals for additional periods of up to five years each. For real estate leases, the options to extend are not considered reasonably certain at lease commencement because the Company reevaluates each lease on a regular basis to consider the economic and strategic incentives of exercising the renewal options and regularly opens or closes stores to align with its operating strategy. Generally, the renewal option periods are not included within the lease term and the associated payments are not included in the measurement of the right-of-use asset and lease liability. Similarly, renewal options are not included in the lease term for non-real estate leases because they are not considered reasonably certain of being exercised at lease commencement. Leases with an initial term of 12 months or less are not recorded on the balance sheets, and lease expense is recognized on a straight-line basis over the term of the short-term lease.

For real estate leases, the Company accounts for lease components and nonlease components as a single lease component. Certain real estate leases require additional payments based on sales volume, as well as reimbursement for real estate taxes, common area maintenance and insurance, which are expensed as incurred as variable lease costs. Other real estate leases contain one fixed lease payment that includes real estate taxes, common area maintenance and insurance. These fixed payments are considered part of the lease payment and included in the right-of-use assets and lease liabilities.
Goodwill
Goodwill
The Company accounts for business combinations using the acquisition method of accounting, which requires the excess cost of an acquisition over the fair value of net assets acquired and identifiable intangible assets to be recorded as goodwill. Goodwill is not amortized, but is subject to impairment reviews annually, or more frequently, if necessary, as further described in “Recoverability of Long-Lived Assets” below.
Intangible Assets
Intangible Assets

The Company’s identifiable intangible assets consist primarily of trademarks, trade names, customer contracts/relationships, covenants not to compete, technology, provider networks and value of business acquired (“VOBA”). These intangible assets arise primarily from the determination of their respective fair market values at the date of acquisition. Amounts assigned to identifiable intangible assets, and their related useful lives, are derived from established valuation techniques and management estimates.

The Company’s definite-lived intangible assets are amortized over their estimated useful lives based upon the pattern of future cash flows attributable to the asset. Definite-lived intangible assets are amortized using the straight-line method. VOBA is subject to loss recognition testing annually, or more frequently, if necessary.

Indefinite-lived intangible assets are not amortized but are tested for impairment annually, or more frequently, if necessary, as further described in “Recoverability of Long-Lived Assets” below.
Recoverability of Long-Lived Assets
Recoverability of Long-Lived Assets

The Company evaluates the recoverability of long-lived assets, excluding goodwill and indefinite-lived intangible assets, which are tested for impairment using separate tests described below, whenever events or changes in circumstances indicate that the carrying value of such asset may not be recoverable. The Company groups and evaluates these long-lived assets for impairment at the lowest level at which individual cash flows can be identified. If indicators of impairment are present, the Company first
compares the carrying amount of the asset group to the estimated future cash flows associated with the asset group (undiscounted). If the estimated future cash flows used in this analysis are less than the carrying amount of the asset group, an impairment loss calculation is prepared. The impairment loss calculation compares the carrying amount of the asset group to the asset group’s estimated future cash flows (discounted). If required, an impairment loss is recorded for the portion of the asset group’s carrying value that exceeds the asset group’s estimated future cash flows (discounted).

During the years ended December 31, 2023 and 2022, the Company recorded office real estate optimization charges of $46 million and $117 million, respectively, primarily related to the abandonment of leased real estate and the related right-of-use assets and property and equipment in connection with the planned reduction of corporate office real estate space in response to its new flexible work arrangement.

During the year ended December 31, 2021, the Company recorded a store impairment charge of approximately $1.4 billion primarily related to the write down of operating lease right-of-use assets and property and equipment in connection with the planned closure of approximately 900 retail stores between 2022 and 2024.

See Note 7 ‘‘Leases’’ for additional information about the right-of-use asset charges.

When evaluating goodwill for potential impairment, the Company compares the fair value of its reporting units to their respective carrying amounts. The Company estimates the fair value of its reporting units using a combination of a discounted cash flow method and a market multiple method. If the carrying amount of a reporting unit exceeds its estimated fair value, an impairment loss is recognized in an amount equal to that excess.

Effective for the 2023 annual goodwill impairment test, the Company elected to change its annual goodwill impairment test date from August 31st to October 31st to better align with its annual budgeting processes, as its previous election predated large acquisitions such as Caremark Rx, Inc. and Aetna Inc. (“Aetna”). Prior to the Company’s 2023 goodwill impairment test, the most recent goodwill impairment test was performed as of January 1, 2023, in connection with the segment realignment previously described in the “Description of Business” section.

During the fourth quarter of 2023 and the third quarter of 2022, the Company performed its required annual impairment tests of goodwill and concluded there were no goodwill impairments as of the testing dates or during the years ended December 31, 2023 and 2022.
During the third quarter of 2021, the Company performed its required annual impairment tests of goodwill, the results of which indicated an impairment of the goodwill associated with the LTC reporting unit. Accordingly, during the third quarter of 2021, the Company recorded a $431 million goodwill impairment charge on the remaining goodwill of the LTC reporting unit. The results of the impairment tests indicated that there was no impairment of goodwill of the remaining reporting units as of the testing date or during the year ended December 31, 2021. See Note 6 ‘‘Goodwill and Other Intangibles’’ for additional information about the goodwill impairment charge recorded during the year ended December 31, 2021.
Indefinite-lived intangible assets are tested for impairment by comparing the estimated fair value of the asset to its carrying value. The Company estimates the fair value of its indefinite-lived trademarks using the relief from royalty method under the income approach. If the carrying value of the asset exceeds its estimated fair value, an impairment loss is recognized, and the asset is written down to its estimated fair value.
Separate Accounts
Separate Accounts

Separate Accounts assets and liabilities related to large case pensions products represent funds maintained to meet specific objectives of contract holders who bear the investment risk. These assets and liabilities are carried at fair value. Net investment income (including net realized capital gains and losses) accrue directly to such contract holders. The assets of each account are legally segregated and are not subject to claims arising from the Company’s other businesses. Deposits, withdrawals and net investment income (including net realized and net unrealized capital gains and losses) on Separate Accounts assets are not reflected in the consolidated statements of operations or cash flows. Management fees charged to contract holders are included in services revenue and recognized over the period earned.
Health Care Costs Payable
Health Care Costs Payable

Health care costs payable within the Health Care Benefits segment consist principally of unpaid fee-for-service medical, dental and pharmacy claims, capitation costs, other amounts due to providers pursuant to risk-sharing arrangements related to the Health Care Benefits segment’s Insured Commercial, Medicare and Medicaid products and accruals for state assessments. Unpaid health care claims include an estimate of payments the Company will make for (i) services rendered to the Company’s Insured members but not yet reported to the Company and (ii) claims which have been reported to the Company but not yet paid, each as of the financial statement date (collectively, “IBNR”). Health care costs payable also include an estimate of the cost of services that will continue to be rendered after the financial statement date if the Company is obligated to pay for such services in accordance with contractual or regulatory requirements. Such estimates are developed using actuarial principles and assumptions which consider, among other things, historical and projected claim submission and processing patterns, assumed and historical medical cost trends, historical utilization of medical services, claim inventory levels, changes in Insured membership and product mix, seasonality and other relevant factors. The Company reflects changes in these estimates in benefit costs in the Company’s consolidated operating results in the period they are determined. Capitation costs represent contractual monthly fees paid to participating physicians and other medical providers for providing medical care, regardless of the volume of medical services provided to the Insured member. Amounts due under risk-sharing arrangements are based on the terms of the underlying contracts with the providers and consider claims experience under the contracts through the financial statement date. Within the Health Services segment, health care costs payable includes estimates of the Company’s obligations for medical care services that have been rendered by third parties on behalf of consumers for which the Company is contractually obligated to pay, but for which claims have either not yet been received, processed or paid.

The Company develops its estimate of IBNR using actuarial principles and assumptions that consider numerous factors. Of those factors, the Company considers the analysis of historical and projected claim payment patterns (including claims submission and processing patterns) and the assumed health care cost trend rate (the year-over-year change in per member per month health care costs) to be the most critical assumptions. In developing its IBNR estimate, the Company consistently applies these actuarial principles and assumptions each period, with consideration to the variability of related factors. There have been no significant changes to the methodologies or assumptions used to develop the Company’s estimate of IBNR in 2023.

The Company analyzes historical claim payment patterns by comparing claim incurred dates (i.e., the date services were provided) to claim payment dates to estimate “completion factors.” The Company uses completion factors predominantly to estimate the ultimate cost of claims incurred more than three months before the financial statement date. The Company estimates completion factors by aggregating claim data based on the month of service and month of claim payment and estimating the percentage of claims incurred for a given month that are complete by each month thereafter. For any given month, substantially all claims are paid within six months of the date of service, but it can take up to 48 months or longer after the date of service before all of the claims are completely resolved and paid. These historically-derived completion factors are then applied to claims paid through the financial statement date to estimate the ultimate claim cost for a given month’s incurred claim activity. The difference between the estimated ultimate claim cost and the claims paid through the financial statement date represents the Company’s estimate of claims remaining to be paid as of the financial statement date and is included in the Company’s health care costs payable. The completion factors the Company uses reflect judgments and possible adjustments based on data such as claim inventory levels, claim submission and processing patterns and, to a lesser extent, other factors such as changes in health care cost trend rates, changes in Insured membership and changes in product mix. If claims are submitted or processed on a faster (slower) pace than prior periods, the actual claims may be more (less) complete than originally estimated using the Company’s completion factors, which may result in reserves that are higher (lower) than the ultimate cost of claims.

Because claims incurred within three months before the financial statement date are less mature, the Company uses a combination of historically-derived completion factors and the assumed health care cost trend rate to estimate the ultimate cost of claims incurred for these months. The Company applies its actuarial judgment and places a greater emphasis on the assumed health care cost trend rate for the most recent claim incurred dates as these months may be influenced by seasonal patterns and changes in membership and product mix.

The Company’s health care cost trend rate is affected by changes in per member utilization of medical services as well as changes in the unit cost of such services. Many factors influence the health care cost trend rate, including the Company’s ability to manage benefit costs through product design, negotiation of favorable provider contracts and medical management programs, as well as the mix of the Company’s business. The health status of the Company’s Insured members, aging of the population and other demographic characteristics, advances in medical technology and other factors continue to contribute to rising per member utilization and unit costs. Changes in health care practices, inflation, new technologies, increases in the cost of prescription drugs (including specialty pharmacy drugs), direct-to-consumer marketing by pharmaceutical companies, clusters
of high-cost cases, claim intensity, changes in the regulatory environment, health care provider or member fraud and numerous other factors also contribute to the cost of health care and the Company’s health care cost trend rate.

For each reporting period, the Company uses an extensive degree of judgment in the process of estimating its health care costs payable. As a result, considerable variability and uncertainty is inherent in such estimates, particularly with respect to claims with claim incurred dates of three months or less before the financial statement date; and the adequacy of such estimates is highly sensitive to changes in assumed completion factors and the assumed health care cost trend rates. For each reporting period the Company recognizes the actuarial best estimate of health care costs payable considering the potential volatility in assumed completion factors and health care cost trend rates, as well as other factors. The Company believes its estimate of health care costs payable is reasonable and adequate to cover its obligations at December 31, 2023; however, actual claim payments may differ from the Company’s estimates. A worsening (or improvement) of the Company’s health care cost trend rates or changes in completion factors from those that the Company assumed in estimating health care costs payable at December 31, 2023 would cause these estimates to change in the near term, and such a change could be material.

Each quarter, the Company re-examines previously established health care costs payable estimates based on actual claim payments for prior periods and other changes in facts and circumstances. Given the extensive degree of judgment in this estimate, it is possible that the Company’s estimates of health care costs payable could develop either favorably (that is, its actual benefit costs for the period were less than estimated) or unfavorably. The changes in the Company’s estimate of health care costs payable may relate to a prior quarter, prior year or earlier periods. For a roll forward of the Company’s health care costs payable, see Note 8 ‘‘Health Care Costs Payable.’’ The Company’s reserving practice is to consistently recognize the actuarial best estimate of its ultimate liability for health care costs payable.
Other Insurance Liabilities
Other Insurance Liabilities

Unpaid Claims
Unpaid claims consist primarily of reserves associated with certain short-duration group disability and term life insurance contracts, including an estimate for IBNR as of the financial statement date. Reserves associated with certain short-duration group disability and term life insurance contracts are based upon the Company’s estimate of the present value of future benefits, which is based on assumed investment yields and assumptions regarding mortality, morbidity and recoveries from the U.S. Social Security Administration. The Company develops its estimate of IBNR using actuarial principles and assumptions which consider, among other things, contractual requirements, claim incidence rates, claim recovery rates, seasonality and other relevant factors. The Company discounts certain claim liabilities related to group long-term disability and life insurance waiver of premium contracts. The discount rates generally reflect the Company’s expected investment returns for the investments supporting all incurral years of these liabilities. The discount rates for retrospectively-rated contracts are set at contractually specified levels. The Company’s estimates of unpaid claims are subject to change due to changes in the underlying experience of the insurance contracts, changes in investment yields or other factors, and these changes are recorded in current and future benefits in the consolidated statements of operations in the period they are determined. The Company estimates its reserve for claims IBNR for life products largely based on completion factors. The completion factors used are based on the Company’s historical experience and reflect judgments and possible adjustments based on data such as claim inventory levels, claim payment patterns, changes in business volume and other factors. If claims are submitted or processed on a faster (slower) pace than historical periods, the actual claims may be more (less) complete than originally estimated using completion factors, which may result in reserves that are higher (lower) than required to cover future life benefit payments. There have been no significant changes to the methodologies or assumptions used to develop the Company’s estimate of unpaid claims IBNR in 2023. As of December 31, 2023, unpaid claims balances of $285 million and $834 million were recorded in other insurance liabilities and other long-term insurance liabilities, respectively. As of December 31, 2022, unpaid claims balances of $243 million and $1.1 billion were recorded in other insurance liabilities and other long-term insurance liabilities, respectively.

Substantially all life and disability insurance liabilities have been fully ceded to unrelated third parties through indemnity reinsurance agreements; however, the Company remains directly obligated to the policyholders.

Future Policy Benefits
Future policy benefits consist primarily of reserves for products for which the Company no longer solicits or accepts new customers, including limited payment pension and annuity contracts and long-term care insurance contracts. Contracts are grouped into cohorts by contract type and issue year. The liability for future policy benefits is adjusted for differences between actual and expected experience.

Reserves for limited payment pension and annuity contracts represent the Company’s estimate of the present value of future benefits to be paid to or on behalf of policyholders and are computed using actuarial principles that consider, among other
things, assumptions reflecting anticipated mortality and retirement experience. On an annual basis, or more frequently if necessary, the Company reviews mortality assumptions against both industry standards and its experience.

Reserves for long-term care insurance contracts represent the Company’s estimate of the present value of future benefits and settlement costs to be paid to or on behalf of policyholders less the present value of future net premiums. The Company’s estimate of the present value of future benefits under such contracts is based upon mortality, morbidity, lapse and interest rate assumptions. On an annual basis, or more frequently if necessary, the Company reviews its mortality, morbidity and lapse assumptions against its experience. Annually, or each time the assumptions are changed, the net premium ratio used to calculate the future policy benefit liability is updated to reflect actual experience, as well as the impact of any change in assumptions on the Company’s future cash flows.

The Company discounts its future policy benefit liability using a curve of spot rates derived from Single A rated fixed income instruments. At each reporting date, the Company will measure its liability for future policy benefits using both the current spot rate curve and the locked-in discount rate at each cohort’s inception. Any difference between the measured liabilities is recorded in other comprehensive income (loss).
Premium Deficiency Reserves
Premium Deficiency Reserves
The Company evaluates its short-duration insurance contracts to determine if it is probable that a loss will be incurred. A premium deficiency loss is recognized when it is probable that expected future claims, including maintenance costs (for example, direct costs such as claim processing costs), will exceed existing reserves plus anticipated future premiums and reinsurance recoveries. Anticipated investment income is not considered in the calculation of premium deficiency losses. For purposes of determining premium deficiency losses, contracts are grouped consistent with the Company’s method of acquiring, servicing and measuring the profitability of such contracts.
Policyholders' Funds
Policyholders’ Funds

Policyholders’ funds consist primarily of reserves for pension and annuity investment contracts and customer funds associated with certain health contracts. Reserves for such contracts are equal to cumulative deposits less withdrawals and charges plus interest credited thereon, net of experience-rated adjustments. Reserves for contracts subject to experience rating reflect the Company’s rights as well as the rights of policyholders and plan participants.
Policyholders’ funds liabilities that are expected to be paid within twelve months from the balance sheet date are classified as current on the consolidated balance sheets. Policyholders’ funds liabilities that are expected to be paid greater than twelve months from the balance sheet date are included in other long-term liabilities on the consolidated balance sheets.
Self-Insurance Liabilities
Self-Insurance Liabilities
The Company is self-insured for certain losses related to general liability, workers’ compensation and auto liability. The Company obtains third party insurance coverage to limit exposure from these claims. The Company is also self-insured for certain losses related to health and medical liabilities. The Company’s self-insurance accruals, which include reported claims and claims incurred but not reported, are calculated using standard insurance industry actuarial assumptions and the Company’s historical claims experience.
Foreign Currency Translation and Transactions
Foreign Currency Translation and Transactions

For non-U.S. dollar functional currency locations, (i) assets and liabilities are translated at end-of-period exchange rates, (ii) revenues and expenses are translated at average exchange rates in effect during the period and (iii) equity is translated at historical exchange rates. The resulting cumulative translation adjustments are included as a component of accumulated other comprehensive loss.
For U.S. dollar functional currency locations, foreign currency assets and liabilities are remeasured into U.S. dollars at end-of-period exchange rates, except for nonmonetary balance sheet accounts which are remeasured at historical exchange rates. Revenues and expenses are remeasured at average exchange rates in effect during each period, except for those expenses related to the nonmonetary balance sheet amounts which are remeasured at historical exchange rates. Gains or losses from foreign currency remeasurement are included in net income.
Revenue Recognition
Revenue Recognition

Health Care Benefits Segment
Health Care Benefits revenue is principally derived from insurance premiums and fees billed to customers. Revenue is recognized based on customer billings, which, in the Company’s Commercial business, reflect contracted rates per member and the number of covered members recorded in the Company’s records at the time the billings are prepared. Billings are generally sent monthly for coverage during the following month. Revenue related to the Company’s Government business is collected monthly from the U.S. federal government and various government agencies based on fixed payment rates and member eligibility.

The Company’s billings may be subsequently adjusted to reflect enrollment changes due to member terminations or other factors. These adjustments are known as retroactivity adjustments. In each period, the Company estimates the amount of future retroactivity and adjusts the recorded revenue accordingly. As information regarding actual retroactivity amounts becomes known, the Company refines its estimates and records any required adjustments to revenues in the period in which they arise.

Premium Revenue
Premiums are recognized as revenue in the month in which the enrollee is entitled to receive health care services. Premiums are reported net of an allowance for estimated terminations and uncollectible amounts. Additionally, premium revenue subject to the minimum medical loss ratio (“MLR”) rebate requirements of the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (as amended, collectively, the “ACA”) is recorded net of the estimated minimum MLR rebates for the current calendar year. Premiums related to unexpired contractual coverage periods (unearned premiums) are reported as other insurance liabilities on the consolidated balance sheets and recognized as revenue when earned.

Some of the Company’s contracts allow for premiums to be adjusted to reflect actual experience or the relative health status of Insured members. Such adjustments are reasonably estimable at the outset of the contract, and adjustments to those estimates are made based on actual experience of the customer emerging under the contract and the terms of the underlying contract.

The ACA established a permanent risk adjustment program to transfer funds from qualified individual and small group insurance plans with below average risk scores to plans with above average risk scores. Based on the risk of the Company’s qualified plan members relative to the average risk of members of other qualified plans in comparable markets, as defined by the ACA, the Company estimates its ultimate risk adjustment receivable (recorded in accounts receivable) or payable (recorded in accrued expenses) for the current calendar year and reflects the pro-rata year-to-date impact as an adjustment to premium revenue. As of December 31, 2023, the Company recorded an ACA risk adjustment payable of $1.2 billion. As of December 31, 2022, the Company’s ACA risk adjustment payable was not material.

Services Revenue
Services revenue relates to contracts that can include various combinations of services or series of services which generally are capable of being distinct and accounted for as separate performance obligations. The Health Care Benefits segment’s services revenue primarily consists of ASC fees received in exchange for performing certain claim processing and member services for ASC members. ASC fee revenue is recognized over the period the service is provided. Some of the Company’s administrative services contracts include guarantees with respect to certain functions, such as customer service response time, claim processing accuracy and claim processing turnaround time, as well as certain guarantees that a plan sponsor’s benefit claim experience will fall within a certain range. With any of these guarantees, the Company is financially at risk if the conditions of the arrangements are not met, although the maximum amount at risk typically is limited to a percentage of the fees otherwise payable to the Company by the customer involved. Each period the Company estimates its obligations under the terms of these guarantees and records its estimate as an offset to services revenues.
Accounting for Medicare Part D
Revenues include insurance premiums earned by the Company’s PDPs, which are determined based on the PDP’s annual bid and related contractual arrangements with the U.S. Centers for Medicare & Medicaid Services (“CMS”). The insurance premiums include a beneficiary premium, which is the responsibility of the PDP member, and can be subsidized by CMS in the case of low-income members, and a direct premium paid by CMS. Premiums collected in advance are initially recorded within other insurance liabilities and are then recognized ratably as revenue over the period in which members are entitled to receive benefits.

Revenues also include a risk-sharing feature of the Medicare Part D program design referred to as the risk corridor. The Company estimates variable consideration in the form of amounts payable to, or receivable from, CMS under the risk corridor, and adjusts revenue based on calculations of additional subsidies to be received from or owed to CMS at the end of the reporting year.

In addition to Medicare Part D premiums, the Company receives additional payments each month from CMS related to catastrophic reinsurance, low-income cost-sharing subsidies and coverage gap benefits. If the subsidies received differ from the amounts earned from actual prescriptions transferred, the difference is recorded in either accounts receivable, net or accrued expenses.

Health Services Segment

Pharmacy Solutions
The Health Services segment sells prescription drugs directly through its specialty and mail order pharmacy offerings and indirectly through the Company’s retail pharmacy network. The Company’s pharmacy benefit arrangements are accounted for in a manner consistent with a master supply arrangement as there are no contractual minimum volumes and each prescription is considered a separate purchasing decision and distinct performance obligation transferred at a point in time. PBM services performed in connection with each prescription claim are considered part of a single performance obligation which culminates in the fulfillment of prescription drugs.

The Company recognizes revenue using the gross method at the contract price negotiated with its clients when the Company has concluded it controls the prescription drug before it is transferred to the client plan members. The Company controls prescriptions fulfilled indirectly through its retail pharmacy network because it has separate contractual arrangements with those pharmacies, has discretion in setting the price for the transaction and assumes primary responsibility for fulfilling the promise to provide prescription drugs to its client plan members while also performing the related PBM services.

Revenues include (i) the portion of the price the client pays directly to the Company, net of any discounts earned on brand name drugs or other discounts and refunds paid back to the client (see “Drug Discounts” and “Guarantees” below), (ii) the price paid to the Company by client plan members for mail order prescriptions and the price paid to retail network pharmacies by client plan members for retail prescriptions (“retail co-payments”), and (iii) claims based administrative fees for retail pharmacy network contracts. Sales taxes are not included in revenues.

The Company recognizes revenue when control of the prescription drugs is transferred to customers, in an amount that reflects the consideration the Company expects to be entitled to receive in exchange for those prescription drugs. The Company has established the following revenue recognition policies for the Health Services segment:

•Revenues generated from prescription drugs sold by third party pharmacies in the Company’s retail pharmacy network and associated administrative fees are recognized at the Company’s point-of-sale, which is when the claim is adjudicated by the Company’s online claims processing system and the Company has transferred control of the prescription drug and completed all of its performance obligations.
•Revenues generated from prescription drugs sold by specialty and mail order pharmacies are recognized when the prescription drug is delivered to the client plan member. At the time of delivery, the Company has performed substantially all of its performance obligations under its client contracts and does not experience a significant level of returns or reshipments.

For contracts under which the Company acts as an agent or does not control the prescription drugs prior to transfer to the client plan member, revenue is recognized using the net method.
Drug Discounts
The Company records revenue net of manufacturers’ rebates earned by its clients based on their plan members’ utilization of brand-name formulary drugs. The Company estimates these rebates at period-end based on actual and estimated claims data and its estimates of the manufacturers’ rebates earned by its clients. The estimates are based on the best available data at period-end and recent history for the various factors that can affect the amount of rebates due to the client. The Company adjusts its rebates payable to clients to the actual amounts paid when these rebates are paid or as significant events occur. Any cumulative effect of these adjustments is recorded against revenues at the time it is identified. Adjustments generally result from contract changes with clients or manufacturers that have retroactive rebate adjustments, differences between the estimated and actual product mix subject to rebates, or whether the brand name drug was included in the applicable formulary. The effect of adjustments between estimated and actual manufacturers’ rebate amounts has not been material to the Company’s operating results or financial condition.

Guarantees
The Company also adjusts revenues for refunds owed to clients resulting from pricing guarantees and performance against defined service and performance metrics. The inputs to these estimates are not subject to a high degree of subjectivity or volatility. The effect of adjustments between estimated and actual pricing and performance refund amounts has not been material to the Company’s operating results or financial condition.

Walk-In Medical Clinics
For services provided by the Company’s walk-in medical clinics, revenue recognition occurs for completed services provided to patients, with adjustments taken for third party payor contractual obligations and patient direct bill historical collection rates.

Primary Care Capitated Revenue
Capitated revenue related to the Company’s primary care operations consists primarily of capitated fees for medical services it provides under capitated or capitation arrangements directly made with various Medicare Advantage managed care payors or CMS. Under the risk contracts, the Company receives from the third-party payor a fixed payment per patient per month for a defined patient population, and the Company is then responsible for providing, managing and paying for healthcare services for that patient population, including those not provided by the Company. The Company recognizes revenue using the gross method as the Company is the principal in arranging, providing and controlling the managed healthcare services provided to the defined patient population. The Company considers all contracts with customers (enrolled patients) as a single performance obligation to stand ready to provide healthcare services. This performance obligation is satisfied over time as the Company stands ready to fulfill its obligation to enrolled patients.

In-Home Health Evaluations
Revenue generated from IHEs relates to the assessments performed either within the patient’s home, virtually or at a healthcare provider facility as well as certain in-home clinical evaluations performed by the Company’s mobile network of providers. Revenue is recognized when the IHEs are submitted to customers on a daily basis. Submission to the customer occurs after the IHEs are completed and coded, a process which may take one to several days after completion of the evaluation. The pricing for the IHEs is generally based on a fixed transaction fee, which is directly linked to the usage of the service by the customer during a distinct service period. Customers are invoiced for evaluations performed each month and remit payment accordingly. Each IHE represents a single performance obligation for which revenue is recognized at a point in time when control is transferred to the customer upon submission of the completed and coded evaluation.

Pharmacy & Consumer Wellness Segment

Retail Pharmacy
The Company’s retail drugstores recognize revenue at the time the customer takes possession of the merchandise. For pharmacy sales, each prescription claim is its own arrangement with the customer and is a performance obligation, separate and distinct from other prescription claims under other retail network arrangements. Revenues are adjusted for refunds owed to third party payers resulting from pricing guarantees and performance against defined value-based service and performance metrics. The inputs to these estimates are not subject to a high degree of subjectivity or volatility. The effect of adjustments between estimated and actual pricing and performance refund amounts has not been material to the Company’s operating results or financial condition.

Revenue from Company gift cards purchased by customers is deferred as a contract liability until goods or services are transferred. Any amounts not expected to be redeemed by customers (i.e., breakage) are recognized based on historical redemption patterns.
Customer returns are not material to the Company’s operating results or financial condition. Sales taxes are not included in revenues.

Loyalty and Other Programs
The Company’s customer loyalty program, ExtraCare®, consists of two components, ExtraSavingsTM and ExtraBucks® Rewards. ExtraSavings are coupons that are recorded as a reduction of revenue when redeemed as the Company concluded that they do not represent a promise to the customer to deliver additional goods or services at the time of issuance because they are not tied to a specific transaction or spending level.

ExtraBucks Rewards are accumulated by customers based on their historical spending levels. Thus, the Company has determined that there is an additional performance obligation to those customers at the time of the initial transaction. The Company allocates the transaction price to the initial transaction and the ExtraBucks Rewards transaction based upon the relative standalone selling price, which considers historical redemption patterns for the rewards. Revenue allocated to ExtraBucks Rewards is recognized as those rewards are redeemed. At the end of each period, unredeemed ExtraBucks Rewards are reflected as a contract liability.

The Company also offers a subscription-based membership program, ExtraCare PlusTM, under which members are entitled to a suite of benefits delivered over the course of the subscription period, as well as a promotional reward that can be redeemed for future goods and services. Subscriptions are paid for on a monthly or annual basis at the time of or in advance of the Company delivering the goods and services. Revenue from these arrangements is recognized as the performance obligations are satisfied.

Long-term Care
Revenue is recognized when control of the promised goods or services is transferred to customers in an amount that reflects the consideration the Company expects to be entitled to receive in exchange for those goods or services. Each prescription claim represents a separate performance obligation of the Company, separate and distinct from other prescription claims under customer arrangements. A significant portion of long-term care revenue from sales of pharmaceutical and medical products is reimbursed by the federal Medicare Part D program and, to a lesser extent, state Medicaid programs. The Company monitors its revenues and receivables from these reimbursement sources, as well as long-term care facilities and other third party insurance payors, and reduces revenue at the revenue recognition date to properly account for the variable consideration due to anticipated differences between billed and reimbursed amounts. Accordingly, the total revenues and receivables reported in the Company’s consolidated financial statements are recorded at the amount expected to be ultimately received from these payors.

Patient co-payments associated with Medicare Part D, certain state Medicaid programs, Medicare Part B and certain third party payors typically are not collected at the time products are delivered or services are rendered, but are billed to the individuals as part of normal billing procedures and subject to normal accounts receivable collections procedures.
Contract Balances
Contract liabilities primarily represent the Company’s obligation to transfer additional goods or services to a customer for which the Company has received consideration, and include ExtraBucks Rewards and unredeemed Company gift cards. The consideration received remains a contract liability until goods or services have been provided to the customer. In addition, the Company recognizes breakage on Company gift cards based on historical redemption patterns.
Cost of Products Sold
Cost of Products Sold

The Company accounts for cost of products sold as follows:

Health Services Segment
Cost of products sold includes: (i) the cost of prescription drugs sold during the reporting period directly through the Company’s specialty and mail order pharmacies and indirectly through the Company’s retail pharmacy network, (ii) the cost of care provided within the Company’s primary care centers, (iii) direct operating costs associated with generating revenues related to services provided, including fees paid to clinicians for performing IHEs, (iv) administrative service fees paid to the Pharmacy & Consumer Wellness segment for specialty and mail order pharmacy fulfillment services and (v) shipping and handling costs.

The cost of prescription drugs sold component of cost of products sold includes: (i) the cost of the prescription drugs purchased from manufacturers or distributors and shipped to members in clients’ benefit plans from the Company’s mail order pharmacies, net of any volume-related or other discounts (see “Vendor Allowances and Purchase Discounts” below) and (ii) the cost of prescription drugs sold (including retail co-payments) through the Company’s retail pharmacy network under contracts where the Company is the principal, net of any volume-related or other discounts.

The cost of care provided within the Company’s costs of products sold includes the costs incurred to operate the primary care centers and care model. These costs consist of care team and patient support employee-related costs, occupancy costs, patient transportation, medical supplies, insurance, fees paid to specialists and other operating costs.

Pharmacy & Consumer Wellness Segment
Cost of products sold includes: the cost of merchandise sold during the reporting period, including the costs of prescription drugs sold through its retail pharmacies, net of any volume-related or other discounts, the related purchasing costs, warehousing and delivery costs (including depreciation and amortization), the operating costs of the Company’s specialty and mail order pharmacy fulfillment operations and inventory losses.
Vendor Allowances and Purchase Discounts
Vendor Allowances and Purchase Discounts

The Company accounts for vendor allowances and purchase discounts as follows:

Health Services Segment
The Health Services segment receives purchase discounts on pharmaceutical products purchased. Contractual arrangements with vendors, including manufacturers, wholesalers and retail pharmacies, normally provide for the Health Services segment to receive purchase discounts from established list prices in one, or a combination, of the following forms: (i) a direct discount at the time of purchase, (ii) a discount for the prompt payment of invoices or (iii) when products are purchased indirectly from a manufacturer (e.g., through a wholesaler or retail pharmacy), a discount (or rebate) paid subsequent to dispensing. These rebates are recognized when prescriptions are dispensed and are generally calculated and billed to manufacturers within 30 days of the end of each completed quarter. Historically, the effect of adjustments resulting from the reconciliation of rebates recognized to the amounts billed and collected has not been material to the Company’s operating results or financial condition. The Company accounts for the effect of any such differences as a change in accounting estimate in the period the reconciliation is completed. The Health Services segment also receives additional discounts under its wholesaler contracts if it exceeds contractually defined purchase volumes. In addition, the Health Services segment receives fees from pharmaceutical manufacturers for administrative services. Purchase discounts and administrative service fees are recorded as a reduction of cost of products sold.

Pharmacy & Consumer Wellness Segment
Vendor allowances received by the Pharmacy & Consumer Wellness segment reduce the carrying cost of inventory and are recognized in cost of products sold when the related inventory is sold, unless they are specifically identified as a reimbursement of incremental costs for promotional programs and/or other services provided. Amounts that are directly linked to advertising commitments are recognized as a reduction of advertising expense (included in operating expenses) when the related advertising commitment is satisfied. Any amounts received in excess of the actual cost incurred also reduce the carrying cost of inventory. The total value of any upfront payments received from vendors that are linked to purchase commitments is initially deferred. The deferred amounts are then amortized to reduce cost of products sold over the life of the contract based upon sales volume. The total value of any upfront payments received from vendors that are not linked to purchase commitments is also initially deferred. The deferred amounts are then amortized to reduce cost of products sold on a straight-line basis over the life
of the related contract. The total amortization of these upfront payments was not material to the Company’s consolidated financial statements in any of the periods presented.
Advertising Costs
Advertising Costs
Advertising costs, which are reduced by the portion funded by vendors, are expensed when the related advertising takes place. Net advertising costs, which are included in operating expenses, were $985 million, $745 million and $707 million in 2023, 2022 and 2021, respectively.
Stock-Based Compensation
Stock-Based Compensation
Stock-based compensation is measured at the grant date based on the fair value of the award and is recognized as expense over the requisite service period of the stock award (generally three to five years) using the straight-line method.
Income Taxes
Income Taxes

The Company accounts for income taxes under the asset and liability method, which requires the recognition of deferred tax assets and liabilities for the expected future tax consequences of events that have been included in the consolidated financial statements. Under this method, deferred tax assets and liabilities are determined on the basis of the differences between the consolidated financial statements and tax basis of assets and liabilities using enacted tax rates in effect for the year or years in which the differences are expected to reverse. The effect of a change in the tax rates on deferred tax assets and liabilities is recognized in income in the period that includes the enactment date of such change.

The Company recognizes deferred tax assets to the extent that it believes these assets are more likely than not to be realized. In making such a determination, the Company considers all available positive and negative evidence, including future reversals of existing taxable temporary differences, projected future taxable income, tax planning strategies, and the Company’s recent operating results. The Company establishes a valuation allowance when it does not consider it more likely than not that a deferred tax asset will be recovered.

The Company records uncertain tax positions on the basis of a two-step process whereby (1) the Company determines whether it is more likely than not that the tax positions will be sustained on the basis of the technical merits of the position and (2) for those tax positions that meet the more-likely-than-not recognition threshold, the Company recognizes the largest amount of tax benefit that is more than 50% likely to be realized upon ultimate settlement with the related tax authority.

Interest and/or penalties related to uncertain tax positions are recognized in the income tax provision.
Measurement of Defined Benefit Pension and Other Postretirement Employee Benefit Plans
Measurement of Defined Benefit Pension and Other Postretirement Employee Benefit Plans

The Company sponsors defined benefit pension plans (“pension plans”) and other postretirement employee benefit plans (“OPEB plans”) for its employees and retirees. The Company recognizes the funded status of its pension and OPEB plans on the consolidated balance sheets based on the year-end measurements of plan assets and benefit obligations. When the fair value of plan assets are in excess of the plan benefit obligations, the amounts are reported in other current assets and other assets. When the fair value of plan benefit obligations are in excess of plan assets, the amounts are reported in accrued expenses and other long-term liabilities based on the amount by which the actuarial present value of benefits payable in the next twelve months included in the benefit obligation exceeds the fair value of plan assets. The net periodic benefit income for the Company’s pension and OPEB plans do not contain a service cost component as these plans have been frozen for an extended period of time. Non-service cost components of pension and postretirement net periodic benefit income are included in other income in the consolidated statements of operations.
Earnings per Share
Earnings per Share

Earnings per share is computed using the treasury stock method. The Company calculates basic earnings per share based on the weighted average number of common shares outstanding for the period. See Note 16 ‘‘Earnings Per Share’’ for additional information.
Shares Held in Trust
Shares Held in Trust
The Company maintains grantor trusts, which held approximately one million shares of its common stock at both December 31, 2023 and 2022. These shares are designated for use under various employee compensation plans. Since the Company holds these shares, they are excluded from the computation of basic and diluted shares outstanding.
VIEs
VIEs

The Company has various investments that are considered VIEs. The Company does not have a future obligation to fund losses or debts on behalf of these investments; however, it may voluntarily contribute funds. In evaluating whether the Company is the primary beneficiary of a VIE, the Company considers several factors, including whether the Company has (a) the power to direct the activities that most significantly impact the VIE’s economic performance and (b) the obligation to absorb losses and the right to receive benefits that could potentially be significant to the VIE.

VIEs - Primary Beneficiary

Red Oak Sourcing, LLC (“Red Oak”)
In 2014, the Company and Cardinal Health, Inc. (“Cardinal”) established Red Oak, a generic pharmaceutical sourcing entity in which the Company and Cardinal each own 50%. The Red Oak arrangement had an initial term of ten years. In 2021, the Red Oak arrangement was amended to extend the initial term an additional five years, for a total term of 15 years. Under this arrangement, the Company and Cardinal contributed their sourcing and supply chain expertise to Red Oak and agreed to source and negotiate generic pharmaceutical supply contracts for both companies through Red Oak; however, Red Oak does not own or hold inventory on behalf of either company. No physical assets (e.g., property and equipment) were contributed to Red Oak by either company, and minimal funding was provided to capitalize Red Oak. The Company has determined that it is the primary beneficiary of this VIE because it has the ability to direct the activities of Red Oak. Consequently, the Company consolidates Red Oak in its consolidated financial statements within the Pharmacy & Consumer Wellness segment.

Cardinal is required to pay the Company quarterly payments, which began in October 2014 and will extend through June 2029. As milestones are met, the quarterly payments increase. The Company received $183 million from Cardinal during each of the years ended December 31, 2023, 2022 and 2021. The payments reduce the Company’s carrying value of inventory and are recognized in cost of products sold when the related inventory is sold.

Physician Groups
The Company has entered into management and/or administrative services agreements with affiliated physician practice organizations (the “Physician Groups”). Physician Groups employ healthcare providers, contract with managed care payors and deliver healthcare services to patients in the markets that the Company serves. Oak Street Health, MSO LLC (“OSH MSO”), a wholly owned subsidiary of the Company, provides management services to the Physician Groups. Activities include but are not limited to operational support of the centers, marketing, information technology infrastructure and the sourcing and managing of health plan contracts. The Company concluded that it has variable interests in the Physician Groups on the basis of its administrative service agreement, which includes the reimbursement of costs and a management fee payable to the Company from the Physician Groups for the management services provided, which are eliminated in consolidation. The Physician Groups are considered VIEs as additional support is needed to finance their operations. Neither shareholders, employees nor their designees have the individual power to direct the activities of the Physician Groups that significantly impact its economic performance. The success or failure of OSH MSO in performing the activities impacting the growth of patients and management of healthcare services of the Physicians Groups’ patient base is significant to the economic performance of the Physician Groups. Therefore, the Company is the primary beneficiary of the Physician Groups and, consequently, consolidates the Physician Groups in its consolidated financial statements within the Health Services segment.
There are no restrictions on the Physician Groups’ assets or on the settlement of its liabilities. The assets of the Physician Groups are all current and can be used to settle obligations of the Company. The Physician Groups are included in the Company’s obligated group; thus, creditors of the Company have recourse to the assets owned by the Physician Groups. There
are no liabilities for which creditors of the Physician Groups do not have recourse to the general credit of the Company. There are no restrictions placed on the retained earnings or net income of the Physician Groups with respect to potential dividend payments.

Physician Owned Entities
The Company’s consolidated VIEs include certain IHE related physician practices that require an individual physician to legally own the equity interests as certain state laws and regulations prohibit non-physician owned business entities from practicing medicine or employing licensed healthcare providers. The Company determined it was the primary beneficiary of these VIEs as it has the obligation to absorb the losses from and direct the activities of these operations. As a result, these VIEs are consolidated and any noncontrolling interest is not presented. The carrying amount of these VIEs’ assets and liabilities are not material to the consolidated balance sheets.

Accountable Care Organizations (“ACOs”)
The Company is the sole member of certain ACOs which are considered VIEs. CMS offers a Medicare Shared Savings Program (“MSSP”) to ACOs where the goal of the program is to reward the ACO participants when specific quality metrics are met and expenditures are lowered. The MSSPs have different risk models where the ACOs can either share in both savings and losses or share in only the savings. The governance structure of the VIEs does not provide the Company with the ultimate decision-making authority to direct the activities that most significantly impact the VIEs’ economic performance. For certain ACO VIEs, the Company is ultimately liable for losses incurred or is required to secure and have sole authority over all aspects of the repayment of any shared losses incurred in the program in exchange for a higher percentage of savings and, accordingly, the Company is taking on the risk to absorb losses, resulting in a financial responsibility to ensure that these VIEs operate as designed. For these VIEs, the Company has determined it is the primary beneficiary and therefore consolidates the results of these ACOs. The carrying amount of these VIEs’ assets and liabilities are not material to the consolidated balance sheets.

VIEs - Other Variable Interest Holder
The Company has invested in certain VIEs for which it has determined that it is not the primary beneficiary, consisting of the following:

•Hedge fund and private equity investments - The Company invests in hedge fund and private equity investments in order to generate investment returns for its investment portfolio supporting its insurance businesses.
•Real estate partnerships - The Company invests in various real estate partnerships, including those that construct, own and manage low-income housing developments. For the low income housing development investments, substantially all of the projected benefits to the Company are from tax credits and other tax benefits.

The Company is not the primary beneficiary of these VIEs because the nature of the Company’s involvement with the activities of these VIEs does not give the Company the power to direct the activities that most significantly impact their economic performance. The Company records the amount of its investment in these VIEs as long-term investments on the consolidated balance sheets and recognizes its share of each VIE’s income or losses in net income. The Company’s maximum exposure to loss from these VIEs is limited to its investment balances as disclosed below and the risk of recapture of previously recognized tax credits related to the real estate partnerships, which the Company does not consider significant.
Related Party Transactions
Related Party Transactions

The Company has an equity method investment in SureScripts, LLC (“SureScripts”), which operates a clinical health information network. The Company utilizes this clinical health information network in providing services to its client plan members and retail customers. The Company expensed fees for the use of this network of $59 million, $60 million and $52 million in the years ended December 31, 2023, 2022 and 2021, respectively. The Company’s investment in and equity in the earnings of SureScripts for all periods presented is immaterial.
The Company has an equity method investment in Heartland Healthcare Services, LLC (“Heartland”), which previously operated LTC pharmacies. During the year ended December 31, 2023, Heartland ceased operations. Heartland paid the Company $35 million, $87 million and $79 million for pharmaceutical inventory purchases during the years ended December 31, 2023, 2022 and 2021, respectively. Additionally, the Company performed certain collection functions for Heartland and then transferred those customer cash collections to Heartland. The Company’s investment in and equity in the earnings of Heartland for all periods presented is immaterial.

During the years ended December 31, 2022 and 2021, the Company made charitable contributions of $25 million and $50 million, respectively, to the CVS Health Foundation, a non-profit entity that focuses on health, education and community involvement programs. The charitable contributions were recorded as operating expenses in the consolidated statements of operations within the Corporate/Other segment for the years ended December 31, 2022 and 2021. The Company did not make any charitable contributions to the CVS Health Foundation during the year ended December 31, 2023.
Discontinued Operations
Discontinued Operations
In connection with certain business dispositions completed between 1995 and 1997, the Company retained guarantees on store lease obligations for a number of former subsidiaries, including Linens ‘n Things and Bob’s Stores, each of which subsequently filed for bankruptcy. The Company’s loss from discontinued operations includes lease-related costs that the Company believes it will likely be required to satisfy pursuant to these lease guarantees.
New Accounting Pronouncements Recently Adopted and Not Yet Adopted
New Accounting Pronouncements Recently Adopted

Targeted Improvements to the Accounting for Long-Duration Insurance Contracts
In August 2018, the Financial Accounting Standards Board (“FASB”) issued ASU 2018-12, Targeted Improvements to the Accounting for Long-Duration Contracts (Topic 944) (the “long-duration insurance standard”). This standard requires the Company to review cash flow assumptions for its long-duration insurance contracts at least annually and recognize the effect of changes in future cash flow assumptions in net income. This standard also requires the Company to update discount rate assumptions quarterly and recognize the effect of changes in these assumptions in other comprehensive income. The rate used to discount the Company’s liability for future policy benefits will be based on an estimate of the yield for an upper-medium grade fixed-income instrument with a duration profile matching that of the Company’s liabilities. In addition, this standard changes the amortization method for deferred acquisition costs and requires additional disclosures regarding the long duration insurance contract liabilities in the Company’s interim and annual financial statements.

The Company adopted this accounting standard on January 1, 2023, using the modified retrospective transition method as of January 1, 2021, also referred to as the “transition date”, for changes to its liabilities for future policy benefits, deferred acquisition costs and VOBA intangible asset. Upon adoption, the Company recorded a transition date net adjustment to reduce accumulated other comprehensive income (loss) by $986 million ($766 million after-tax) with a corresponding increase to its liability for future policy benefits, the majority of which is included within other insurance liabilities and other long-term liabilities on the consolidated balance sheets. The transition date net adjustment was a result of updating the rate used to discount the liabilities to reflect the yield for an upper-medium grade fixed-income instrument compared to the Company’s expected investment yield under the historical guidance. The Company was not required to record an adjustment to retained earnings on the transition date. Prior period financial information subsequent to the transition date has been revised to reflect the adoption of the long-duration insurance standard.
New Accounting Pronouncements Not Yet Adopted

Segment Reporting
In November 2023, the FASB issued ASU 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures. This standard requires the Company to disclose significant segment expenses that are regularly provided to the CODM and are included within each reported measure of segment operating results. The standard also requires the Company to disclose the total amount of any other items included in segment operating results which were not deemed to be significant expenses for separate disclosure, along with a qualitative description of the composition of these other items. In addition, the standard also requires disclosure of the CODM’s title and position, as well as detail on how the CODM uses the reported measure of segment operating results to evaluate segment performance and allocate resources. The standard also aligns interim segment reporting disclosure requirements with annual segment reporting disclosure requirements. The Company adopted the standard on January 1, 2024 for fiscal year reporting and the standard will be effective for interim reporting periods in fiscal years beginning after December 15, 2024, with early adoption permitted. The standard requires retrospective application to all prior periods presented. While the standard requires additional disclosures related to the Company’s reportable segments, the standard did not have any impact on the Company’s consolidated operating results, financial condition or cash flows as of the date of adoption.

Income Taxes
In December 2023, the FASB issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures. The standard requires the Company to provide further disaggregated income tax disclosures for specific categories on the effective
tax rate reconciliation, as well as additional information about federal, state/local and foreign income taxes. The standard also requires the Company to annually disclose its income taxes paid (net of refunds received), disaggregated by jurisdiction. The standard is effective for fiscal years beginning after December 15, 2024, with early adoption permitted. The standard is to be applied on a prospective basis, although optional retrospective application is permitted. While the standard will require additional disclosures related to the Company’s income taxes, the standard is not expected have any impact on the Company’s consolidated operating results, financial condition or cash flows.
v3.24.0.1
Significant Accounting Policies (Tables)
 12 Months Ended
Dec. 31, 2023
Accounting Policies [Abstract]  
Schedule of Reconciliation of Cash and Cash Equivalents
The following is a reconciliation of cash and cash equivalents on the consolidated balance sheets to total cash, cash equivalents and restricted cash on the consolidated statements of cash flows as of December 31, 2023, 2022 and 2021:
In millions202320222021
Cash and cash equivalents$8,196 $12,945 $9,408 
Restricted cash (included in other current assets)90 144 3,065 
Restricted cash (included in other assets)239 216 218 
Total cash, cash equivalents and restricted cash in the consolidated statements of cash flows$8,525 $13,305 $12,691 
Schedule of Accounts Receivable, Net Accounts receivable, net was composed of the following at December 31, 2023 and 2022:
In millions20232022
Trade receivables$11,908 $8,983 
Vendor and manufacturer receivables15,711 12,395 
Premium receivables3,714 2,676 
Other receivables3,894 3,449 
   Total accounts receivable, net (1)
$35,227 $27,503 
_____________________________________
(1)Includes accounts receivable of $227 million which were accounted for as assets held for sale and were included in assets held for sale on the consolidated balance sheet at December 31, 2022. See Note 2 ‘‘Acquisitions, Divestitures and Asset Sales’’ for additional information.
Rollforward of Deferred Acquisition Costs
The following is a roll forward of deferred acquisition costs for the years ended December 31, 2023 and 2022:
In millions20232022
Deferred acquisition costs, beginning of the period$1,219 $879 
Capitalizations548 564 
Amortization expense(265)(224)
Deferred acquisition costs, end of the period$1,502 $1,219 
Schedule of Property and Equipment
Property and equipment consisted of the following at December 31, 2023 and 2022:
In millions20232022
Land$1,958 $1,996 
Building and improvements4,571 4,545 
Fixtures and equipment11,024 12,978 
Leasehold improvements6,511 6,238 
Software9,818 8,843 
Total property and equipment33,882 34,600 
Accumulated depreciation and amortization(20,699)(21,483)
Property and equipment, net (1)
$13,183 $13,117 
_____________________________________
(1)Includes property and equipment of $244 million which were accounted for as assets held for sale and were included in assets held for sale on the consolidated balance sheet at December 31, 2022. See Note 2 ‘‘Acquisitions, Divestitures and Asset Sales’’ for additional information.
Schedule of Disaggregation of Revenue
The following table disaggregates the Company’s revenue by major source in each segment for the years ended December 31, 2023, 2022 and 2021:
In millionsHealth Care
Benefits		Health
Services		Pharmacy &
Consumer
Wellness		Corporate/
Other		Intersegment
Eliminations		Consolidated
Totals
2023
Major goods/services lines:
Pharmacy$— $180,710 $92,111 $— $(49,369)$223,452 
Front Store— — 22,458 — — 22,458 
Premiums99,144 — — 48 — 99,192 
Net investment income (loss)765 (1)(5)394 — 1,153 
Other5,737 6,134 2,199 9 (2,558)11,521 
Total$105,646 $186,843 $116,763 $451 $(51,927)$357,776 
Health Services distribution channel:
Pharmacy network (1)
$112,718 
Mail & specialty (2)
67,992 
Net investment income (loss)(1)
Other6,134 
Total$186,843 
2022
Major goods/services lines:
Pharmacy$— $166,793 $83,480 $— $(45,154)$205,119 
Front Store— — 22,780 — — 22,780 
Premiums85,274 — — 56 — 85,330 
Net investment income (loss)476 — (44)406 — 838 
Other5,600 2,783 2,380 68 (2,431)8,400 
Total$91,350 $169,576 $108,596 $530 $(47,585)$322,467 
Health Services distribution channel:
Pharmacy network (1)
$102,968 
Mail & specialty (2)
63,825 
Other2,783 
Total$169,576 
In millionsHealth Care
Benefits		Health
Services		Pharmacy &
Consumer
Wellness		Corporate/
Other		Intersegment
Eliminations		Consolidated
Totals
2021
Major goods/services lines:
Pharmacy$— $150,646 $77,886 $— $(43,913)$184,619 
Front Store— — 21,315 — — 21,315 
Premiums76,064 — — 68 — 76,132 
Net investment income586 — 17 596 — 1,199 
Other5,469 3,246 2,402 57 (2,328)8,846 
Total$82,119 $153,892 $101,620 $721 $(46,241)$292,111 
Health Services distribution channel:
Pharmacy network (1)
$96,834 
Mail & specialty (2)
53,812 
Other3,246 
Total$153,892 
_____________________________________________
(1)Health Services pharmacy network is defined as claims filled at retail and specialty retail pharmacies, including the Company’s retail pharmacies and LTC pharmacies. Effective January 1, 2023, pharmacy network also includes activity associated with Maintenance Choice®, which permits eligible client plan members to fill their maintenance prescriptions through mail order delivery or at a CVS pharmacy retail store for the same price as mail order. Maintenance Choice activity was previously reflected in mail & specialty. Segment financial information has been revised to reflect these changes.
(2)Health Services mail & specialty is defined as specialty mail claims inclusive of Specialty Connect® claims picked up at a retail pharmacy, as well as mail order and specialty claims fulfilled by the Pharmacy & Consumer Wellness segment. Effective January 1, 2023, mail & specialty excludes Maintenance Choice activity, which is now reflected within pharmacy network. Segment financial information has been revised to reflect these changes.
Schedule of Receivables and Contract Liabilities from Contracts with Customers
The following table provides information about receivables and contract liabilities from contracts with customers as of December 31, 2023 and 2022:
In millions20232022
Trade receivables (included in accounts receivable, net)$11,908 $8,983 
Contract liabilities (included in accrued expenses)149 71 
Below is a summary of such changes:
In millions20232022
Contract liabilities, beginning of period$71 $87 
Rewards earnings and gift card issuances357 340 
Redemption and breakage(363)(356)
Acquired contract liabilities109 — 
Other(25)— 
Contract liabilities, end of period$149 $71 
Schedule of Variable Interest Entities
Physician Groups VIE assets and liabilities included on the consolidated balance sheet at December 31, 2023 were as follows:

In millions2023
Total assets$1,515 
Total liabilities1,503 
Other variable interest holder VIE assets included in long-term investments on the consolidated balance sheets at December 31, 2023 and 2022 were as follows:
In millions20232022
Hedge fund investments$859 $589 
Private equity investments840 707 
Real estate partnerships319 241 
Total$2,018 $1,537 
Schedule of Adjustments Resulting from Applying New Accounting Standard
The following summarizes changes in the balances of long-duration insurance liabilities as a result of the adoption of the long-duration insurance standard effective January 1, 2021:
In millionsLarge Case
Pensions		Long-Term
Care		Other
Balance at December 31, 2020, net of reinsurance$3,224$1,142$480
Add: Reinsurance recoverable——274
Balance at December 31, 20203,2241,142754
Change in discount rate assumptions60455344
Removal of shadow adjustments in accumulated other comprehensive income(181)——
Adjusted balance at January 1, 20213,6471,695798
Less: Reinsurance recoverable——308
Adjusted balance at January 1, 2021, net of reinsurance$3,647$1,695$490

Impact of New Long-Duration Insurance Contracts Standard on Financial Statement Line Items
As a result of applying the long-duration insurance standard using a modified retrospective method, the following adjustments were made to amounts reported in the consolidated statement of operations for the years ended December 31, 2022 and 2021:
Impact of Change in Accounting Policy
In millionsAs Reported
December 31, 2022		AdjustmentsAdjusted
December 31, 2022
Consolidated Statement of Operations:
Operating costs:
Health care costs$71,281$(208)$71,073
Total operating costs314,721(208)314,513
Operating income7,7462087,954
Income before income tax provision5,6282085,836
Income tax provision1,463461,509
Net income4,1651624,327
Net income attributable to CVS Health4,1491624,311
Net income per share attributable to CVS Health:
Basic$3.16 $0.13 $3.29 
Diluted$3.14 $0.12 $3.26 
Impact of Change in Accounting Policy
In millionsAs Reported
December 31, 2021		AdjustmentsAdjusted
December 31, 2021
Consolidated Statement of Operations:
Operating costs:
Health care costs$64,260$(72)$64,188
Operating expenses37,066(45)37,021
Total operating costs278,918(117)278,801
Operating income13,19311713,310
Income before income tax provision10,42011710,537
Income tax provision2,522262,548
Net income7,898917,989
Net income attributable to CVS Health7,910918,001
Net income per share attributable to CVS Health:
Basic$6.00 $0.07 $6.07 
Diluted$5.95 $0.07 $6.02 
As a result of applying the long-duration insurance standard using a modified retrospective method, the following adjustments were made to amounts reported in the consolidated balance sheet as of December 31, 2022:
Impact of Change in Accounting Policy
In millionsAs Reported
December 31, 2022		AdjustmentsAdjusted
December 31, 2022
Consolidated Balance Sheet:
Other current assets$2,685$(49)$2,636
Total current assets65,682(49)65,633
Intangible assets, net24,7544924,803
Total assets228,275—228,275
Health care costs payable10,406(264)10,142
Other insurance liabilities1,140(51)1,089
Total current liabilities69,736(315)69,421
Deferred income taxes3,8801364,016
Other long-term insurance liabilities6,108(273)5,835
Other long-term liabilities6,732(2)6,730
Total liabilities156,960(454)156,506
Retained earnings56,14525356,398
Accumulated other comprehensive loss(1,465)201(1,264)
Total CVS Health shareholders’ equity71,01545471,469
Total shareholders’ equity71,31545471,769
Total liabilities and shareholders’ equity228,275—228,275
As a result of applying the long-duration insurance standard using a modified retrospective method, the following adjustments were made to amounts reported in the consolidated statement of cash flows for the years ended December 31, 2022 and 2021:
Impact of Change in Accounting Policy
In millionsAs Reported
December 31, 2022		AdjustmentsAdjusted
December 31, 2022
Consolidated Statement of Cash Flows:
Reconciliation of net income to net cash provided by operating activities:
Net income$4,165$162$4,327
Adjustments required to reconcile net income to net cash provided by operating activities:
Depreciation and amortization4,247(23)4,224
Deferred income taxes(2,075)46(2,029)
Change in operating assets and liabilities, net of effects from acquisitions:
Other assets(566)75(491)
Health care costs payable and other insurance liabilities1,247(255)992
Other liabilities6,468(5)6,463
Impact of Change in Accounting Policy
In millionsAs Reported
December 31, 2021		AdjustmentsAdjusted
December 31, 2021
Consolidated Statement of Cash Flows:
Reconciliation of net income to net cash provided by operating activities:
Net income$7,898$91$7,989
Adjustments required to reconcile net income to net cash provided by operating activities:
Depreciation and amortization4,512(26)4,486
Deferred income taxes(428)26(402)
Change in operating assets and liabilities, net of effects from acquisitions:
Other assets(3)(27)(30)
Health care costs payable and other insurance liabilities169(68)101
Other liabilities2,85242,856
v3.24.0.1
Acquisitions, Divestitures and Asset Sales (Tables)
 12 Months Ended
Dec. 31, 2023
Business Combination and Asset Acquisition [Abstract]  
Schedule of Fair Value of Consideration Transferred
The fair value of the consideration transferred on the date of acquisition consisted of the following:
In millions
Cash$9,579 
Fair value of replacement equity awards for pre-combination services (3.9 million shares) (1)
118 
Effective settlement of pre-existing relationship (2)
(29)
Total consideration transferred$9,668 
_____________________________________________
(1)The fair value of the replacement equity awards issued by the Company was determined as of the Oak Street Health Acquisition Date. The fair value of the awards attributed to pre-combination services of $118 million is included in the consideration transferred and the fair value of the awards attributed to post-combination services of $165 million has been, or will be, included in the Company’s post-combination financial statements as compensation costs.
(2)The purchase price included $29 million of effectively settled liabilities the Company owed to Oak Street Health from their pre-existing relationship.
The fair value of the consideration transferred on the date of acquisition consisted of the following:
In millions
Cash$7,450 
Fair value of replacement equity awards for pre-combination services (3.2 million shares) (1)
14 
Effective settlement of pre-existing relationship (2)
(111)
Total consideration transferred$7,353 
_____________________________________________
(1)The fair value of the replacement equity awards issued by the Company was determined as of the Signify Health Acquisition Date. The fair value of the awards attributed to pre-combination services of $14 million is included in the consideration transferred and the fair value of the awards attributed to post-combination services of $167 million has been, or will be, included in the Company’s post-combination financial statements as compensation costs.
(2)The purchase price included $111 million of effectively settled liabilities the Company owed to Signify Health from their pre-existing relationship.
Summary of Estimated Fair Values of Assets Acquired and Liabilities Assumed The following table summarizes the estimated fair values of the assets acquired and liabilities assumed at the date of acquisition:
In millions
Cash and cash equivalents$201 
Investments168 
Accounts receivable1,143 
Other current assets46 
Property and equipment180 
Operating lease right-of-use assets316 
Goodwill7,213 
Intangible assets4,233 
Other long-term assets7 
Total assets acquired13,507 
Health care costs payable 1,098 
Other current liabilities444 
Operating lease liabilities (current and long-term)378 
Debt (current and long-term)1,028 
Deferred income taxes796 
Other long-term liabilities 29 
Total liabilities assumed3,773 
Noncontrolling interests66 
Total consideration transferred$9,668 
The transaction has been accounted for using the acquisition method of accounting which requires, among other things, the assets acquired and liabilities assumed to be recognized at their fair values at the date of acquisition. The following table summarizes the fair values of the assets acquired and liabilities assumed at the date of acquisition:
In millions
Cash and cash equivalents$376 
Accounts receivable190 
Other current assets (including restricted cash of $28)
147 
Property and equipment25 
Goodwill5,909 
Intangible assets1,920 
Other long-term assets23 
Total assets acquired8,590 
Other current liabilities606 
Debt (current and long-term)346 
Deferred income taxes259 
Other long-term liabilities 26 
Total liabilities assumed1,237 
Total consideration transferred$7,353 
Summary of the Valuation of Goodwill Allocated to Business Segments The preliminary valuation of goodwill was allocated to the Company’s business segments as follows:
In millions
Health Services$6,936 
Pharmacy & Consumer Wellness156 
Health Care Benefits121 
Total goodwill$7,213 
Goodwill was allocated to the Company’s business segments as follows:
In millions
Health Services$3,406 
Health Care Benefits2,473 
Pharmacy & Consumer Wellness30 
Total goodwill$5,909 
Summary of Fair Values and Weighted Average Useful Lives for Intangible Assets Acquired
The following table summarizes the fair values and weighted average useful lives for intangible assets acquired in the Oak Street Health Acquisition:
In millions, except weighted average useful lifeGross
Fair Value		Weighted
Average Useful
Life (years)
Customer relationships (1)
$3,620 19.9
Technology143 3.0
Trademark (definite-lived)470 8.0
Total intangible assets$4,233 18.0
_____________________________________________
(1) The substantial majority of the customer relationships intangible asset relates to relationships with health plan payors.
The following table summarizes the fair values and weighted average useful lives for intangible assets acquired in the Signify Health Acquisition:
In millions, except weighted average useful lifeGross
Fair Value		Weighted
Average Useful
Life (years)
Customer relationships$1,810 16.7
Technology 50 3.0
Trademark (definite-lived)60 5.0
Total intangible assets$1,920 16.0
v3.24.0.1
Restructuring Program (Tables)
 12 Months Ended
Dec. 31, 2023
Restructuring and Related Activities [Abstract]  
Schedule of Change in Severance and Employee-related Restructuring Charge Liability
The following table shows the change in the severance and employee-related restructuring charge liability during the year ended December 31, 2023:

In millions2023
Restructuring charge liability, beginning of the period$— 
Restructuring charges344 
Payments(194)
Restructuring charge liability, end of the period$150 
v3.24.0.1
Investments (Tables)
 12 Months Ended
Dec. 31, 2023
Investments [Abstract]  
Schedule of Total Investments
Total investments at December 31, 2023 and 2022 were as follows:
20232022
In millionsCurrentLong-termTotalCurrentLong-termTotal
Debt securities available for sale$3,131 $18,582 $21,713 $2,718 $17,562 $20,280 
Mortgage loans128 1,183 1,311 55 989 1,044 
Other investments— 3,254 3,254 5 2,562 2,567 
Total investments (1)
$3,259 $23,019 $26,278 $2,778 $21,113 $23,891 
_____________________________________________
(1)Includes long-term investments of $17 million which were accounted for as assets held for sale and were included in assets held for sale on the consolidated balance sheet at December 31, 2022. See Note 2 ‘‘Acquisitions, Divestitures and Asset Sales’’ for additional information.
Schedule of Debt Securities Available For Sale
Debt securities available for sale at December 31, 2023 and 2022 were as follows:
In millionsGross
Amortized
Cost		Allowance
for Credit
Losses		Net
Amortized
Cost		Gross
Unrealized
Gains		Gross
Unrealized
Losses		Fair
Value
December 31, 2023   
Debt securities:   
U.S. government securities$2,071 $— $2,071 $19 $(54)$2,036 
States, municipalities and political subdivisions2,219 — 2,219 31 (35)2,215 
U.S. corporate securities10,156 — 10,156 133 (446)9,843 
Foreign securities2,593 — 2,593 41 (122)2,512 
Residential mortgage-backed securities862 — 862 8 (60)810 
Commercial mortgage-backed securities1,066 — 1,066 9 (100)975 
Other asset-backed securities3,294 — 3,294 26 (18)3,302 
Redeemable preferred securities21 — 21 — (1)20 
Total debt securities (1)
$22,282 $— $22,282 $267 $(836)$21,713 
December 31, 2022
Debt securities:
U.S. government securities$2,074 $— $2,074 $— $(182)$1,892 
States, municipalities and political subdivisions2,393 — 2,393 8 (129)2,272 
U.S. corporate securities9,838 (3)9,835 26 (903)8,958 
Foreign securities2,780 (1)2,779 15 (244)2,550 
Residential mortgage-backed securities845 — 845 1 (89)757 
Commercial mortgage-backed securities1,172 — 1,172 1 (155)1,018 
Other asset-backed securities2,940 — 2,940 6 (136)2,810 
Redeemable preferred securities25 — 25 — (2)23 
Total debt securities (1)
$22,067 $(4)$22,063 $57 $(1,840)$20,280 
_____________________________________________
(1)Investment risks associated with the Company’s experience-rated products generally do not impact the Company’s consolidated operating results. At December 31, 2023, debt securities with a fair value of $592 million, gross unrealized capital gains of $10 million and gross unrealized capital losses of
$28 million, and at December 31, 2022, debt securities with a fair value of $609 million, gross unrealized capital gains of $3 million and gross unrealized capital losses of $59 million were included in total debt securities, but support experience-rated products. Changes in net unrealized capital gains (losses) on these securities are not reflected in accumulated other comprehensive loss.
Schedule of Amortized Cost and Fair Value of Debt Securities by Contractual Maturity
The amortized cost and fair value of debt securities at December 31, 2023 are shown below by contractual maturity. Actual maturities may differ from contractual maturities because securities may be restructured, called or prepaid, or the Company intends to sell a security prior to maturity.
In millions Amortized
Cost		Fair
Value
Due to mature: 
Less than one year$1,244 $1,230 
One year through five years7,563 7,390 
After five years through ten years4,302 4,204 
Greater than ten years3,951 3,802 
Residential mortgage-backed securities862 810 
Commercial mortgage-backed securities1,066 975 
Other asset-backed securities3,294 3,302 
Total$22,282 $21,713 
Schedule of Debt Securities In An Unrealized Capital Loss Position
Summarized below are the debt securities the Company held at December 31, 2023 and 2022 that were in an unrealized capital loss position, aggregated by the length of time the investments have been in that position:
Less than 12 monthsGreater than 12 monthsTotal
In millions, except number of securitiesNumber
of
 Securities		Fair
Value		Unrealized
Losses		Number
of
 Securities		Fair
Value		Unrealized
Losses		Number
of
 Securities		Fair
Value		Unrealized
Losses
December 31, 2023
Debt securities:  
U.S. government securities74 $194 $2 280 $891 $52 354 $1,085 $54 
States, municipalities and political subdivisions95 181 1 455 733 34 550 914 35 
U.S. corporate securities576 672 14 4,120 5,602 432 4,696 6,274 446 
Foreign securities160 243 4 964 1,407 118 1,124 1,650 122 
Residential mortgage-backed securities33 97 1 461 517 59 494 614 60 
Commercial mortgage-backed securities44 94 2 287 581 98 331 675 100 
Other asset-backed securities196 449 4 443 867 14 639 1,316 18 
Redeemable preferred securities4 2 — 8 18 1 12 20 1 
Total debt securities1,182 $1,932 $28 7,018 $10,616 $808 8,200 $12,548 $836 
December 31, 2022
Debt securities:
U.S. government securities519 $1,620 $164 35 $191 $18 554 $1,811 $182 
States, municipalities and political subdivisions859 1,370 95 196 322 34 1,055 1,692 129 
U.S. corporate securities5,193 6,537 622 1,479 1,822 281 6,672 8,359 903 
Foreign securities1,168 1,715 147 403 592 97 1,571 2,307 244 
Residential mortgage-backed securities452 464 39 91 257 50 543 721 89 
Commercial mortgage-backed securities288 611 69 187 381 86 475 992 155 
Other asset-backed securities1,008 1,893 88 391 694 48 1,399 2,587 136 
Redeemable preferred securities13 18 2 2 5 — 15 23 2 
Total debt securities9,500 $14,228 $1,226 2,784 $4,264 $614 12,284 $18,492 $1,840 
The maturity dates for debt securities in an unrealized capital loss position at December 31, 2023 were as follows:
 Supporting experience-
rated products		Supporting remaining
products		Total
In millionsFair
Value		Unrealized
Losses		Fair
Value		Unrealized
Losses		Fair
Value		Unrealized
Losses
Due to mature:      
Less than one year$15 $— $1,057 $16 $1,072 $16 
One year through five years128 3 4,504 226 4,632 229 
After five years through ten years87 7 1,925 172 2,012 179 
Greater than ten years137 14 2,090 220 2,227 234 
Residential mortgage-backed securities9 1 605 59 614 60 
Commercial mortgage-backed securities15 2 660 98 675 100 
Other asset-backed securities12 1 1,304 17 1,316 18 
Total$403 $28 $12,145 $808 $12,548 $836 
Schedule of Activity in Mortgage Loan Portfolio
The Company’s mortgage loans are collateralized by commercial real estate. During the years ended December 31, 2023 and 2022, the Company had the following activity in its mortgage loan portfolio:
In millions20232022
New mortgage loans$342 $356 
Mortgage loans fully repaid43 178 
Mortgage loans foreclosed— — 
At December 31, 2023 scheduled mortgage loan principal repayments were as follows:
In millions
2024$128 
2025123 
2026179 
2027229 
2028300 
Thereafter352 
Total$1,311 
Schedule of Mortgage Loan Amortized Cost and Credit Quality Indicator
Based upon the Company’s assessments at December 31, 2023 and 2022, the amortized cost basis of the Company’s mortgage loans within each credit quality indicator by year of origination was as follows:

Amortized Cost Basis by Year of Origination
In millions, except credit quality indicator20232022202120202019PriorTotal
December 31, 2023
1$— $— $— $— $— $11 $11 
2 to 4302 346 225 35 11 343 1,262 
5 and 6— — 13 — — 19 32 
7— — 6 — — — 6 
Total$302 $346 $244 $35 $11 $373 $1,311 
December 31, 2022
1$— $— $— $— $15 $15 
2 to 4326 247 36 11 402 1,022 
5 and 6— — — — 7 7 
7— — — — — — 
Total$326 $247 $36 $11 $424 $1,044 
Schedule of Net Investment Income
Sources of net investment income for the years ended December 31, 2023, 2022 and 2021 were as follows:
In millions202320222021
Debt securities$841 $702 $634 
Mortgage loans59 51 55 
Other investments796 448 381 
Gross investment income1,696 1,201 1,070 
Investment expenses(46)(43)(47)
Net investment income (excluding net realized capital gains or losses)1,650 1,158 1,023 
Net realized capital gains (losses) (1)
(497)(320)176 
Net investment income (2)
$1,153 $838 $1,199 
_____________________________________________
(1)Net realized capital losses include yield-related impairment losses on debt securities of $152 million and are net of the reversal of previously recorded credit-related impairment losses on debt securities of $3 million in the year ended December 31, 2023. Net realized capital losses include yield-related impairment losses on debt securities of $143 million and credit-related impairment losses on debt securities of $13 million in the year ended December 31, 2022. Net realized capital gains are net of yield-related impairment losses on debt securities of $42 million for the year ended December 31, 2021. There were no credit-related impairment losses on debt securities in the year ended December 31, 2021.
(2)Net investment income includes $34 million, $35 million and $38 million for the years ended December 31, 2023, 2022 and 2021, respectively, related to investments supporting experience-rated products.
Schedule of Proceeds and Related Gross Realized Capital Gains and Losses From the Sale of Debt Securities
Excluding amounts related to experience-rated products, proceeds from the sale of available-for-sale debt securities and the related gross realized capital gains and losses in the years ended December 31, 2023, 2022 and 2021 were as follows:
In millions202320222021
Proceeds from sales$5,031 $4,243 $3,572 
Gross realized capital gains9 24 72 
Gross realized capital losses420 177 14 
v3.24.0.1
Fair Value (Tables)
 12 Months Ended
Dec. 31, 2023
Fair Value Disclosures [Abstract]  
Schedule of Fair Value, Assets and Liabilities Measured on Recurring Basis Financial assets measured at fair value on a recurring basis on the consolidated balance sheets at December 31, 2023 and 2022 were as follows:
In millionsLevel 1Level 2Level 3Total
December 31, 2023    
Cash and cash equivalents$2,174 $6,022 $— $8,196 
Debt securities:    
U.S. government securities2,013 23 — 2,036 
States, municipalities and political subdivisions— 2,215 — 2,215 
U.S. corporate securities— 9,814 29 9,843 
Foreign securities— 2,512 — 2,512 
Residential mortgage-backed securities— 810 — 810 
Commercial mortgage-backed securities— 975 — 975 
Other asset-backed securities— 3,302 — 3,302 
Redeemable preferred securities— 20 — 20 
Total debt securities2,013 19,671 29 21,713 
Equity securities194 — 79 273 
Total$4,381 $25,693 $108 $30,182 
December 31, 2022    
Cash and cash equivalents (1)
$6,902 $6,049 $— $12,951 
Debt securities:
U.S. government securities1,860 32 — 1,892 
States, municipalities and political subdivisions— 2,272 — 2,272 
U.S. corporate securities— 8,897 61 8,958 
Foreign securities— 2,542 8 2,550 
Residential mortgage-backed securities— 757 — 757 
Commercial mortgage-backed securities— 1,018 — 1,018 
Other asset-backed securities— 2,810 — 2,810 
Redeemable preferred securities— 23 — 23 
Total debt securities1,860 18,351 69 20,280 
Equity securities116 — 60 176 
Total$8,878 $24,400 $129 $33,407 
_______________________________________
(1)Includes cash and cash equivalents of $6 million which were accounted for as assets held for sale and were included in assets held for sale on the consolidated balance sheet at December 31, 2022. See Note 2 ‘‘Acquisitions, Divestitures and Asset Sales’’ for additional information.
Schedule of Changes in Level 3 Financial Assets
The changes in the balances of Level 3 financial assets during the year ended December 31, 2023 were as follows:
In millionsCommercial mortgage-backed securitiesU.S.
corporate
securities		Foreign
securities		Equity
securities		Total
Beginning balance$— $61 $8 $60 $129 
Net realized and unrealized capital losses:
Included in earnings — (8)— (2)(10)
Included in other comprehensive income— 1 — — 1 
Purchases13 5 — 23 41 
Sales— (1)— (2)(3)
Transfers out of Level 3, net(13)(29)(8)— (50)
Ending balance$— $29 $— $79 $108 
The changes in the balances of Level 3 financial assets during the year ended December 31, 2022 were as follows:
In millionsStates,
municipalities
 and political
subdivisions		U.S.
corporate
securities		Foreign
securities		Other asset-
backed
securities		Equity
securities		Total
Beginning balance$5 $38 $10 $3 $55 $111 
Net realized and unrealized capital losses:
Included in earnings— (8)— (1)(9)
Included in other comprehensive loss— (5)(2)(2)— (9)
Purchases— 36 — 30 29 95 
Sales(5)— — (2)(23)(30)
Settlements— — — — — — 
Transfers out of Level 3, net— — — (29)— (29)
Ending balance$— $61 $8 $— $60 $129 
The total gross transfers into (out of) Level 3 during the years ended December 31, 2023 and 2022 were as follows:
In millions20232022
Gross transfers into Level 3$— $— 
Gross transfers out of Level 3(50)(29)
Net transfers out of Level 3$(50)$(29)
Schedule of Carrying Value and Fair Value By Level of Fair Value Hierarchy
The carrying value and estimated fair value classified by level of fair value hierarchy for financial instruments carried on the consolidated balance sheets at adjusted cost or contract value at December 31, 2023 and 2022 were as follows:
Carrying
Value		 Estimated Fair Value
In millionsLevel 1Level 2Level 3Total
December 31, 2023
Assets: 
Mortgage loans$1,311 $— $— $1,274 $1,274 
Equity securities (1)
534 N/AN/AN/AN/A
Liabilities:
Investment contract liabilities:
With a fixed maturity1 — — 1 1 
Without a fixed maturity312 — — 279 279 
Long-term debt61,410 58,451 — — 58,451 
December 31, 2022
Assets:
Mortgage loans$1,044 $— $— $978 $978 
Equity securities (1)
411 N/AN/AN/AN/A
Liabilities:
Investment contract liabilities:
With a fixed maturity3 — — 3 3 
Without a fixed maturity332 — — 305 305 
Long-term debt (2)
52,257 47,653 — — 47,653 
______________________________________
(1)It was not practical to estimate the fair value of these cost-method investments as it represents shares of unlisted companies. See Note 1 ‘‘Significant Accounting Policies’’ for additional information regarding the valuation of cost method investments.
(2)Includes long-term debt of $3 million which was accounted for as liabilities held for sale and was included in liabilities held for sale on the consolidated balance sheet at December 31, 2022. See Note 2 ‘‘Acquisitions, Divestitures and Asset Sales’’ for additional information.
Schedule of Fair Value of Separate Accounts by Major Category of Investment
Separate Accounts financial assets at December 31, 2023 and 2022 were as follows:
December 31, 2023December 31, 2022
In millionsLevel 1Level 2Level 3TotalLevel 1Level 2Level 3Total
Cash and cash equivalents$2 $166 $— $168 $2 $154 $— $156 
Debt securities558 1,949 — 2,507 712 1,965 — 2,677 
Common/collective trusts— 529 — 529 — 480 — 480 
Total (1)
$560 $2,644 $— $3,204 $714 $2,599 $— $3,313 
_____________________________________
(1)Excludes $46 million of other receivables and $85 million of other payables at December 31, 2023 and 2022, respectively.
The following table shows the fair value of assets, by major investment category, supporting Separate Accounts as of December 31, 2023 and 2022:
In millions20232022
Cash and cash equivalents$168 156 
Debt securities:
U.S. government securities573 717 
States, municipalities and political subdivisions28 27 
U.S. corporate securities1,632 1,667 
Foreign securities202 201 
Residential mortgage-backed securities51 41 
Commercial mortgage-backed securities6 6 
Other asset-backed securities15 18 
Total debt securities2,507 2,677 
Common/collective trusts529 480 
Total (1)
$3,204 $3,313 
_____________________________________________
(1)Excludes $46 million of other receivables and $85 million of other payables at December 31, 2023 and 2022, respectively.
v3.24.0.1
Goodwill and Other Intangibles (Tables)
 12 Months Ended
Dec. 31, 2023
Goodwill and Intangible Assets Disclosure [Abstract]  
Summary of Changes in Carrying Amount of Goodwill
Below is a summary of the changes in the carrying amount of goodwill by segment for the years ended December 31, 2023 and 2022:
In millionsHealth Care
Benefits		Health
Services		Pharmacy &
Consumer
Wellness		Total
Balance at December 31, 2021$45,130 $23,615 $10,376 $79,121 
Divestitures
(971)— — (971)
Balance at December 31, 202244,159 23,615 10,376 78,150 
Segment realignment(109)109 — — 
Acquisitions2,594 10,342 186 13,122 
Balance at December 31, 2023$46,644 $34,066 $10,562 $91,272 
Summary of Intangible Assets
The following table is a summary of the Company’s intangible assets as of December 31, 2023 and 2022:
In millions, except weighted average lifeGross
Carrying
Amount		Accumulated
Amortization		Net
Carrying
Amount		Weighted
Average
Life (years)
2023
Trademarks (indefinite-lived)$10,498 $— $10,498 N/A
Customer contracts/relationships and covenants not to compete26,784 (12,241)14,543 14.2
Technology1,253 (1,104)149 3.0
Provider networks4,203 (1,072)3,131 20.0
Value of Business Acquired 590 (201)389 20.0
Other838 (314)524 9.3
Total$44,166 $(14,932)$29,234 14.5
2022
Trademarks (indefinite-lived)$10,498 $— $10,498 N/A
Customer contracts/relationships and covenants not to compete21,206 (10,668)10,538 13.3
Technology1,060 (1,060)— — 
Provider networks4,203 (862)3,341 20.0
Value of Business Acquired 590 (174)416 20.0
Other302 (264)38 12.4
Total (1)
$37,859 $(13,028)$24,831 13.9
_____________________________________
(1)Includes intangible assets of $28 million which were accounted for as assets held for sale and were included in assets held for sale on the consolidated balance sheet at December 31, 2022. See Note 2 ‘‘Acquisitions, Divestitures and Asset Sales’’ for additional information.
Schedule of Projected Annual Amortization Expense for Intangible Assets for Next Five Years The projected annual amortization expense for the Company’s intangible assets for the next five years is as follows:
In millions
2024$2,011 
20251,964 
20261,687 
20271,580 
20281,306 
v3.24.0.1
Leases (Tables)
 12 Months Ended
Dec. 31, 2023
Leases [Abstract]  
Summary of the Components of Net Lease Cost and Supplemental Cash Flow Information
The following table is a summary of the components of net lease cost for the years ended December 31, 2023, 2022 and 2021:
In millions202320222021
Operating lease cost$2,532 $2,579 $2,633 
Finance lease cost:
Amortization of right-of-use assets84 79 62 
Interest on lease liabilities73 68 62 
Total finance lease costs157 147 124 
Short-term lease costs22 27 25 
Variable lease costs635 610 604 
Less: sublease income(63)(61)(59)
Net lease cost$3,283 $3,302 $3,327 

Supplemental cash flow information related to leases for the years ended December 31, 2023, 2022 and 2021 was as follows:
In millions202320222021
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows paid for operating leases$2,756 $2,689 $2,714 
Operating cash flows paid for interest portion of finance leases73 68 62 
Financing cash flows paid for principal portion of finance leases70 62 50 
Right-of-use assets obtained in exchange for lease obligations:
Operating leases1,132 591 1,254 
Finance leases(4)232 278 
Supplemental Balance Sheet Information
Supplemental balance sheet information related to leases as of December 31, 2023 and 2022 is as follows:
In millions, except remaining lease term and discount rate20232022
Operating leases:
Operating lease right-of-use assets (1)
$17,252$17,928
Current portion of operating lease liabilities$1,741$1,699
Long-term operating lease liabilities16,03416,839
Total operating lease liabilities (2)
$17,775$18,538
Finance leases:
Property and equipment, gross$1,604$1,608
Accumulated depreciation(375)(284)
Property and equipment, net$1,229$1,324
Current portion of long-term debt$66$59
Long-term debt1,3251,406
Total finance lease liabilities$1,391$1,465
Weighted average remaining lease term (in years)
Operating leases11.412.2
Finance leases17.319.4
Weighted average discount rate
Operating leases4.5 %4.4 %
Finance leases5.0 %4.9 %
_____________________________________________
(1)Includes operating lease right-of-use assets of $56 million which were accounted for as assets held for sale and were included in assets held for sale on the consolidated balance sheet at December 31, 2022. See Note 2 ‘‘Acquisitions, Divestitures and Asset Sales’’ for additional information.
(2)Includes current portion of operating lease liabilities of $21 million and long-term operating lease liabilities of $39 million which were accounted for as liabilities held for sale and were included in liabilities held for sale on the consolidated balance sheet at December 31, 2022. See Note 2 ‘‘Acquisitions, Divestitures and Asset Sales’’ for additional information.
Maturities of Operating Lease Liabilities
The following table summarizes the maturity of lease liabilities under finance and operating leases as of December 31, 2023:
In millionsFinance
Leases
Operating
Leases (1)
Total
2024$143 $2,716 $2,859 
2025138 2,559 2,697 
2026130 2,369 2,499 
2027127 2,181 2,308 
2028124 2,024 2,148 
Thereafter1,446 11,004 12,450 
Total lease payments (2)
2,108 22,853 24,961 
Less: imputed interest(717)(5,078)(5,795)
Total lease liabilities$1,391 $17,775 $19,166 
_____________________________________________
(1)Future operating lease payments have not been reduced by minimum sublease rentals of $289 million due in the future under noncancelable subleases.
(2)The Company leases pharmacy and clinic space from Target Corporation. Amounts related to such finance and operating leases are reflected above. Pharmacy lease amounts due in excess of the remaining estimated economic life of the buildings of approximately $2.1 billion are not reflected in this table since the estimated economic life of the buildings is shorter than the contractual term of the pharmacy lease arrangement.
Maturities of Finance Lease Liabilities
The following table summarizes the maturity of lease liabilities under finance and operating leases as of December 31, 2023:
In millionsFinance
Leases
Operating
Leases (1)
Total
2024$143 $2,716 $2,859 
2025138 2,559 2,697 
2026130 2,369 2,499 
2027127 2,181 2,308 
2028124 2,024 2,148 
Thereafter1,446 11,004 12,450 
Total lease payments (2)
2,108 22,853 24,961 
Less: imputed interest(717)(5,078)(5,795)
Total lease liabilities$1,391 $17,775 $19,166 
_____________________________________________
(1)Future operating lease payments have not been reduced by minimum sublease rentals of $289 million due in the future under noncancelable subleases.
(2)The Company leases pharmacy and clinic space from Target Corporation. Amounts related to such finance and operating leases are reflected above. Pharmacy lease amounts due in excess of the remaining estimated economic life of the buildings of approximately $2.1 billion are not reflected in this table since the estimated economic life of the buildings is shorter than the contractual term of the pharmacy lease arrangement.
v3.24.0.1
Health Care Costs Payable (Tables)
 12 Months Ended
Dec. 31, 2023
Health Care and Other Insurance Liabilities [Abstract]  
Information about Incurred and Paid Health Care Claims Development
The information about incurred and paid health care claims development for the year ended December 31, 2022 is presented as required unaudited supplemental information.
In millionsIncurred Health Care Claims,
Net of Reinsurance
For the Years Ended December 31,
Date of Service20222023
(Unaudited)
2022$69,185 $68,540 
202382,362 
Total$150,902 
In millionsCumulative Paid Health Care Claims,
Net of Reinsurance
For the Years Ended December 31,
Date of Service20222023
(Unaudited)
2022$59,570 $68,363 
202372,175 
Total$140,538 
All outstanding liabilities for health care costs payable prior to 2022, net of reinsurance171 
Total outstanding liabilities for health care costs payable, net of reinsurance$10,535 
Schedule of Liability for Unpaid Claims and Claims Adjustment Expense
The reconciliation of the December 31, 2023 health care net incurred and paid claims development tables to the health care costs payable liability on the consolidated balance sheet were as follows:
In millionsDecember 31, 2023
Short-duration health care costs payable, net of reinsurance$10,535 
Reinsurance recoverables5 
Insurance lines other than short duration217 
Other non-insurance health care costs payable1,292 
Total health care costs payable$12,049 
Components of Change in Health Care Costs Payable
The following table shows the components of the change in health care costs payable during the years ended December 31, 2023, 2022 and 2021:
In millions202320222021
Health care costs payable, beginning of period $10,142 $8,678 $7,936 
Less: Reinsurance recoverables5 8 10 
Less: Impact of discount rate on long-duration insurance reserves (1)
8 — — 
Health care costs payable, beginning of period, net10,129 8,670 7,926 
Acquisition, net1,098 — — 
Add: Components of incurred health care costs
  Current year86,639 71,399 64,631 
  Prior years(685)(654)(788)
Total incurred health care costs (2)
85,954 70,745 63,843 
Less: Claims paid
  Current year75,529 61,640 56,323 
  Prior years9,585 7,646 6,792 
Total claims paid85,114 69,286 63,115 
Add: Premium deficiency reserve— — 16 
Health care costs payable, end of period, net12,067 10,129 8,670 
Add: Reinsurance recoverables5 5 8 
Add: Impact of discount rate on long-duration insurance reserves (1)
(23)8 — 
Health care costs payable, end of period$12,049 $10,142 $8,678 
_____________________________________
(1)Reflects the difference between the current discount rate and the locked-in discount rate on long-duration insurance reserves which is recorded within accumulated other comprehensive loss on the consolidated balance sheets. Refer to Note 1 ‘‘Significant Accounting Policies’’ for further information related to the adoption of the long-duration insurance contracts accounting standard.
(2)Total incurred health care costs for the years ended December 31, 2023, 2022 and 2021 in the table above exclude $83 million, $79 million and $58 million, respectively, of benefit costs recorded in the Health Care Benefits segment that are included in other insurance liabilities on the consolidated balance sheets and $210 million, $249 million and $271 million, respectively, of benefit costs recorded in the Corporate/Other segment that are included in other insurance liabilities on the consolidated balance sheets. The incurred health care costs for the year ended December 31, 2021 also exclude $16 million for premium deficiency reserves related to the Company’s Medicaid products.
v3.24.0.1
Other Insurance Liabilities and Separate Accounts (Tables)
 12 Months Ended
Dec. 31, 2023
Insurance [Abstract]  
Schedule of Changes in Liability for Future Policy Benefits
The following tables show the components of the change in the liability for future policy benefits, which is included in other insurance liabilities and other long-term insurance liabilities on the consolidated balance sheets, during the years ended December 31, 2023 and 2022:
2023
In millionsLarge Case
Pensions		Long-Term
Care
Present value of expected net premiums (1)
Liability for future policy benefits, beginning of period - current discount rate$300 
Beginning liability for future policy benefits at original (locked-in) discount rate$302 
Effect of changes in cash flow assumptions— 
Effect of actual variances from expected experience10 
Adjusted beginning liability for future policy benefits - original (locked-in) discount rate312 
Interest accrual (using locked-in discount rate)15 
Net premiums (actual)(39)
Ending liability for future policy benefits at original (locked-in) discount rate288 
Effect of changes in discount rate assumptions5 
Liability for future policy benefits, end of period - current discount rate$293 
Present value of expected future policy benefits
Liability for future policy benefits, beginning of period - current discount rate$2,253 $1,566 
Beginning liability for future policy benefits at original (locked-in) discount rate$2,425 $1,613 
Effect of changes in cash flow assumptions— — 
Effect of actual variances from expected experience(3)8 
Adjusted beginning liability for future policy benefits - original (locked-in) discount rate2,422 1,621 
Issuances8 — 
Interest accrual (using locked-in discount rate)97 82 
Benefit payments (actual)(276)(71)
Ending liability for future policy benefits at original (locked-in) discount rate2,251 1,632 
Effect of changes in discount rate assumptions(112)8 
Liability for future policy benefits, end of period - current discount rate$2,139 $1,640 
Net liability for future policy benefits$2,139 $1,347 
Less: Reinsurance recoverable— — 
Net liability for future policy benefits, net of reinsurance recoverable$2,139 $1,347 
_____________________________________________
(1)The present value of expected net premiums is equivalent to the present value of expected gross premiums for the long-term care insurance contracts as net premiums are set equal to gross premiums.
2022
In millionsLarge Case
Pensions		Long-Term
Care
Present value of expected net premiums (1)
Liability for future policy benefits, beginning of period - current discount rate$389 
Beginning liability for future policy benefits at original (locked-in) discount rate$323 
Effect of changes in cash flow assumptions(15)
Effect of actual variances from expected experience18 
Adjusted beginning liability for future policy benefits - original (locked-in) discount rate326 
Interest accrual (using locked-in discount rate)16 
Net premiums (actual)(40)
Ending liability for future policy benefits at original (locked-in) discount rate302 
Effect of changes in discount rate assumptions(2)
Liability for future policy benefits, end of period - current discount rate$300 
Present value of expected future policy benefits
Liability for future policy benefits, beginning of period - current discount rate$3,034 $1,991 
Beginning liability for future policy benefits at original (locked-in) discount rate$2,650 $1,480 
Effect of changes in cash flow assumptions— 99 
Effect of actual variances from expected experience(44)18 
Adjusted beginning liability for future policy benefits - original (locked-in) discount rate2,606 1,597 
Issuances4 — 
Interest accrual (using locked-in discount rate)106 80 
Benefit payments (actual)(291)(64)
Ending liability for future policy benefits at original (locked-in) discount rate2,425 1,613 
Effect of changes in discount rate assumptions(172)(47)
Liability for future policy benefits, end of period - current discount rate$2,253 $1,566 
Net liability for future policy benefits$2,253 $1,266 
Less: Reinsurance recoverable— — 
Net liability for future policy benefits, net of reinsurance recoverable$2,253 $1,266 
_____________________________________________
(1)The present value of expected net premiums is equivalent to the present value of expected gross premiums for the long-term care insurance contracts as net premiums are set equal to gross premiums.
The amount of undiscounted expected gross premiums and expected future benefit payments for long-duration insurance liabilities as of December 31, 2023 and 2022 were as follows:
In millions20232022
Large case pensions
Expected future benefit payments$3,266$3,539
Expected gross premiums——
Long-term care
Expected future benefit payments$3,224$3,265
Expected gross premiums414437
The weighted-average interest rate used in the measurement of the long-duration insurance liabilities as of December 31, 2023 and 2022 were as follows:
20232022
Large case pensions
Interest accretion rate4.20%4.20%
Current discount rate4.93%5.24%
Long-term care
Interest accretion rate5.11%5.11%
Current discount rate5.08%5.39%

The weighted-average durations (in years) of the long-duration insurance liabilities as of December 31, 2023 and 2022 were as follows:
20232022
Large case pensions7.37.4
Long-term care12.112.6
Roll Forward of Policyholders' Funds
The following table shows the components of the change in policyholders’ funds related to long-duration insurance contracts, which are included in policyholders’ funds and other long-term liabilities on the consolidated balance sheets, during the years ended December 31, 2023 and 2022:
In millions, except weighted average crediting rate20232022
Policyholders’ funds, beginning of the period$345$522
Deposits received—13
Policy charges(2)(2)
Surrenders and withdrawals(35)(31)
Interest credited911
Change in net unrealized gains (losses)39(148)
Other(24)(20)
Policyholders’ funds, end of the period$332$345
Weighted average crediting rate4.32%4.72%
Net amount at risk$— $— 
Cash surrender value$313 $339 
Schedule of Fair Value of Separate Accounts by Major Category of Investment
Separate Accounts financial assets at December 31, 2023 and 2022 were as follows:
December 31, 2023December 31, 2022
In millionsLevel 1Level 2Level 3TotalLevel 1Level 2Level 3Total
Cash and cash equivalents$2 $166 $— $168 $2 $154 $— $156 
Debt securities558 1,949 — 2,507 712 1,965 — 2,677 
Common/collective trusts— 529 — 529 — 480 — 480 
Total (1)
$560 $2,644 $— $3,204 $714 $2,599 $— $3,313 
_____________________________________
(1)Excludes $46 million of other receivables and $85 million of other payables at December 31, 2023 and 2022, respectively.
The following table shows the fair value of assets, by major investment category, supporting Separate Accounts as of December 31, 2023 and 2022:
In millions20232022
Cash and cash equivalents$168 156 
Debt securities:
U.S. government securities573 717 
States, municipalities and political subdivisions28 27 
U.S. corporate securities1,632 1,667 
Foreign securities202 201 
Residential mortgage-backed securities51 41 
Commercial mortgage-backed securities6 6 
Other asset-backed securities15 18 
Total debt securities2,507 2,677 
Common/collective trusts529 480 
Total (1)
$3,204 $3,313 
_____________________________________________
(1)Excludes $46 million of other receivables and $85 million of other payables at December 31, 2023 and 2022, respectively.
Roll Forward of Separate Accounts
The following table shows the components of the change in Separate Accounts liabilities during the years ended December 31, 2023 and 2022:
In millions20232022
Separate Accounts liability, beginning of the period$3,228 $5,087 
Premiums and deposits860 853 
Surrenders and withdrawals(9)(581)
Benefit payments(938)(947)
Investment earnings100 (1,130)
Net transfers from general account7 9 
Other2 (63)
Separate Accounts liability, end of the period$3,250 $3,228 
Cash surrender value, end of the period$2,181 $2,087 
v3.24.0.1
Borrowings and Credit Agreements (Tables)
 12 Months Ended
Dec. 31, 2023
Debt Disclosure [Abstract]  
Summary of Company's Borrowings
The following table is a summary of the Company’s borrowings as of December 31, 2023 and 2022:
In millions20232022
Short-term debt
Commercial paper$200 $— 
Long-term debt
2.8% senior notes due June 2023
— 1,300 
4% senior notes due December 2023
— 414 
3.375% senior notes due August 2024
650 650 
2.625% senior notes due August 2024
1,000 1,000 
3.5% senior notes due November 2024
750 750 
5% senior notes due December 2024 (1)
299 299 
4.1% senior notes due March 2025
950 950 
3.875% senior notes due July 2025
2,828 2,828 
5% senior notes due February 2026
1,500 — 
2.875% senior notes due June 2026
1,750 1,750 
3% senior notes due August 2026
750 750 
3.625% senior notes due April 2027
750 750 
6.25% senior notes due June 2027
372 372 
1.3% senior notes due August 2027
2,250 2,250 
4.3% senior notes due March 2028
5,000 5,000 
5% senior notes due January 2029
1,000 — 
3.25% senior notes due August 2029
1,750 1,750 
5.125% senior notes due February 2030
1,500 — 
3.75% senior notes due April 2030
1,500 1,500 
1.75% senior notes due August 2030
1,250 1,250 
5.25% senior notes due January 2031
750 — 
1.875% senior notes due February 2031
1,250 1,250 
2.125% senior notes due September 2031
1,000 1,000 
5.25% senior notes due February 2033
1,750 — 
5.3% senior notes due June 2033
1,250 — 
4.875% senior notes due July 2035
652 652 
6.625% senior notes due June 2036
771 771 
6.75% senior notes due December 2037
533 533 
4.78% senior notes due March 2038
5,000 5,000 
6.125% senior notes due September 2039
447 447 
4.125% senior notes due April 2040
1,000 1,000 
2.7% senior notes due August 2040
1,250 1,250 
5.75% senior notes due May 2041
133 133 
4.5% senior notes due May 2042
500 500 
4.125% senior notes due November 2042
500 500 
5.3% senior notes due December 2043
750 750 
4.75% senior notes due March 2044
375 375 
5.125% senior notes due July 2045
3,500 3,500 
3.875% senior notes due August 2047
1,000 1,000 
5.05% senior notes due March 2048
8,000 8,000 
4.25% senior notes due April 2050
750 750 
5.625% senior notes due February 2053
1,250 — 
5.875% senior notes due June 2053
1,250 — 
6% senior notes due June 2063
750 — 
Finance lease liabilities1,391 1,465 
Other309 314 
Total debt principal62,160 52,753 
Debt premiums186 200 
Debt discounts and deferred financing costs(736)(696)
61,610 52,257 
Less:
Short-term debt (commercial paper)(200)— 
Current portion of long-term debt(2,772)(1,778)
Long-term debt (1)
$58,638 $50,479 
__________________________________________
(1)Includes long-term debt of $3 million which was accounted for as liabilities held for sale and was included in liabilities held for sale on the consolidated balance sheet at December 31, 2022. See Note 2 ‘‘Acquisitions, Divestitures and Asset Sales’’ for additional information.
Schedule of Maturities of Long-Term Debt
The following is a summary of the Company’s required repayments of long-term debt principal due during each of the next five years and thereafter, as of December 31, 2023:
In millions
2024$2,705 
20253,785 
20264,008 
20273,379 
20285,007 
Thereafter41,685 
Subtotal60,569 
Commercial paper200 
Finance lease liabilities (1)
1,391 
Total debt principal$62,160 
_____________________________________________
(1)See Note 7 ‘‘Leases’’ for a summary of maturities of the Company’s finance lease liabilities.
v3.24.0.1
Pension Plans and Other Postretirement Benefits (Tables)
 12 Months Ended
Dec. 31, 2023
Retirement Benefits [Abstract]  
Schedule of Changes in Benefit Obligations
The following tables outline the change in pension benefit obligation and plan assets over the specified periods:
In millions20232022
Change in benefit obligation:
Benefit obligation, beginning of year$4,740 $6,009 
Interest cost231 132 
Actuarial loss (gain)145 (1,011)
Benefit payments(380)(387)
Settlements— (3)
Benefit obligation, end of year4,736 4,740 
Change in plan assets:
Fair value of plan assets, beginning of year5,346 6,677 
Actual return on plan assets389 (968)
Employer contributions24 27 
Benefit payments(380)(387)
Settlements— (3)
Fair value of plan assets, end of year5,379 5,346 
Funded status$643 $606 
Schedule of Changes in Plan Assets
The following tables outline the change in pension benefit obligation and plan assets over the specified periods:
In millions20232022
Change in benefit obligation:
Benefit obligation, beginning of year$4,740 $6,009 
Interest cost231 132 
Actuarial loss (gain)145 (1,011)
Benefit payments(380)(387)
Settlements— (3)
Benefit obligation, end of year4,736 4,740 
Change in plan assets:
Fair value of plan assets, beginning of year5,346 6,677 
Actual return on plan assets389 (968)
Employer contributions24 27 
Benefit payments(380)(387)
Settlements— (3)
Fair value of plan assets, end of year5,379 5,346 
Funded status$643 $606 
Schedule of Assets (Liabilities) Recognized in Balance Sheet
The assets (liabilities) recognized on the consolidated balance sheets at December 31, 2023 and 2022 for the defined benefit pension plans consisted of the following:
In millions20232022
Noncurrent assets reflected in other assets$856 $827 
Current liabilities reflected in accrued expenses(24)(24)
Noncurrent liabilities reflected in other long-term liabilities(189)(197)
Net assets$643 $606 
Schedule of Net Periodic Benefit Cost (Income)
The components of net periodic benefit cost (income) for the years ended December 31, 2023, 2022 and 2021 are shown below:
In millions202320222021
Components of net periodic benefit cost (income):
Interest cost$231 $132 $110 
Expected return on plan assets(326)(309)(317)
Amortization of net actuarial loss1 3 5 
Settlement losses— 1 16 
Net periodic benefit cost (income)$(94)$(173)$(186)
Weighted Average Assumptions Used in Determining Benefit Obligations and Net Benefit Costs
The Company determined its benefit obligation based on the following weighted average assumptions as of December 31, 2023 and 2022:
20232022
Discount rate5.0 %5.2 %

The Company determined its net periodic benefit cost (income) based on the following weighted average assumptions for the years ended December 31, 2023, 2022 and 2021:
202320222021
Discount rate5.1 %2.3 %1.8 %
Expected long-term rate of return on plan assets6.3 %4.8 %4.8 %
Schedule of Changes in Fair Value of Plan Assets
Pension plan assets with changes in fair value measured on a recurring basis at December 31, 2023 were as follows:
In millionsLevel 1Level 2Level 3Total
Cash and cash equivalents$12 $69 $— $81 
Debt securities:
    U.S. government securities518 4 — 522 
    States, municipalities and political subdivisions— 94 — 94 
    U.S. corporate securities— 2,649 — 2,649 
    Foreign securities— 106 — 106 
    Residential mortgage-backed securities— 17 — 17 
    Commercial mortgage-backed securities— 9 — 9 
    Other asset-backed securities— 8 — 8 
    Redeemable preferred securities— 1 — 1 
Total debt securities518 2,888 — 3,406 
Equity securities:
    U.S. domestic150 — — 150 
    International34 — — 34 
Total equity securities184 — — 184 
Other investments:
    Real estate— — 290 290 
    Common/collective trusts (1)
— 405 — 405 
    Derivatives— (14)— (14)
Total other investments— 391 290 681 
Total pension investments (2)
$714 $3,348 $290 $4,352 
_____________________________________________
(1)The assets in the underlying funds of common/collective trusts consist of $114 million of equity securities and $291 million of debt securities.
(2)Excludes $314 million of other receivables as well as $461 million of private equity limited partnership investments and $252 million of hedge fund limited partnership investments as these amounts are measured at NAV per share or an equivalent and are not subject to leveling within the fair value hierarchy.
Pension plan assets with changes in fair value measured on a recurring basis at December 31, 2022 were as follows:
In millionsLevel 1Level 2Level 3Total
Cash and cash equivalents$7 $81 $— $88 
Debt securities:
    U.S. government securities566 4 — 570 
    States, municipalities and political subdivisions— 102 — 102 
    U.S. corporate securities— 2,611 — 2,611 
    Foreign securities— 101 — 101 
    Residential mortgage-backed securities— 6 — 6 
    Commercial mortgage-backed securities— 1 — 1 
    Other asset-backed securities— 11 — 11 
    Redeemable preferred securities— 1 — 1 
Total debt securities566 2,837 — 3,403 
Equity securities:
    U.S. domestic133 — — 133 
    International43 — — 43 
Total equity securities176 — — 176 
Other investments:
    Real estate— — 325 325 
    Common/collective trusts (1)
— 307 — 307 
Total other investments— 307 325 632 
Total pension investments (2)
$749 $3,225 $325 $4,299 
_____________________________________________
(1)The assets in the underlying funds of common/collective trusts consist of $104 million of equity securities and $203 million of debt securities.
(2)Excludes $390 million of other receivables as well as $432 million of private equity limited partnership investments and $225 million of hedge fund limited partnership investments as these amounts are measured at NAV per share or an equivalent and are not subject to leveling within the fair value hierarchy.
Schedule of Change in Level 3 Plan Assets
The changes in the balances of Level 3 pension plan assets during the year ended December 31, 2023 were as follows:
In millionsReal estate
Beginning balance$325 
Actual return on plan assets(23)
Purchases, sales and settlements(12)
Transfers out of Level 3— 
Ending balance$290 

The changes in the balances of Level 3 pension plan assets during the year ended December 31, 2022 were as follows:

In millionsReal estate
Beginning balance$378 
Actual return on plan assets21 
Purchases, sales and settlements(74)
Transfers out of Level 3— 
Ending balance$325 
Schedule of Expected Future Benefits Payments
The Company estimates the following future benefit payments, which are calculated using the same actuarial assumptions used to measure the pension benefit obligation as of December 31, 2023:
In millions
2024$393 
2025388 
2026384 
2027380 
2028378 
2029-20331,746 
The Company estimates the following future benefit payments, which are calculated using the same actuarial assumptions used to measure the accumulated other postretirement benefit obligation as of December 31, 2023:
In millions
2024$12 
202512 
202612 
202712 
202812 
2029-203358 
v3.24.0.1
Income Taxes (Tables)
 12 Months Ended
Dec. 31, 2023
Income Tax Disclosure [Abstract]  
Schedule of Income Tax Provision
The income tax provision consisted of the following for the years ended December 31, 2023, 2022 and 2021:
In millions202320222021
Current:
Federal$2,819 $2,803 $2,285 
State662 735 665 
3,481 3,538 2,950 
Deferred:
Federal(537)(1,526)(282)
State(139)(503)(120)
(676)(2,029)(402)
Total$2,805 $1,509 $2,548 
Schedule of Effective Income Tax Rate Reconciliation
The following table is a reconciliation of the statutory income tax rate to the Company’s effective income tax rate for the years ended December 31, 2023, 2022 and 2021:
202320222021
Statutory income tax rate21.0 %21.0 %21.0 %
State income taxes, net of federal tax benefit3.7 3.2 4.1 
Legal charges— 3.4 — 
Basis difference upon disposition of subsidiary— 1.6 — 
Prior year refunds and unrecognized tax benefits— (2.6)(1.2)
Other0.4 (0.7)0.3 
Effective income tax rate25.1 %25.9 %24.2 %
Schedule of Deferred Tax Assets and Liabilities
The following table is a summary of the components of the Company’s deferred income tax assets and liabilities as of December 31, 2023 and 2022:
In millions20232022
Deferred income tax assets:
Lease and rents$5,059 $5,242 
Legal charges1,205 1,260 
Inventory94 103 
Employee benefits168 153 
Bad debts and other allowances606 480 
Net operating loss and capital loss carryforwards409 266 
Deferred income62 66 
Insurance reserves356 319 
Investments56 293 
Other372 335 
Valuation allowance(385)(532)
Total deferred income tax assets (1)
8,002 7,985 
Deferred income tax liabilities:
Retirement benefits112 92 
Lease and rents4,469 4,639 
Depreciation and amortization7,732 7,139 
Total deferred income tax liabilities12,313 11,870 
Net deferred income tax liabilities$4,311 $3,885 
_____________________________________________
(1)Includes deferred income tax assets of $131 million which were accounted for as assets held for sale and were included in assets held for sale on the consolidated balance sheet at December 31, 2022. See Note 2 ‘‘Acquisitions, Divestitures and Asset Sales’’ for additional information.
Schedule of Unrecognized Tax Benefits Rollforward
A reconciliation of the beginning and ending balance of unrecognized tax benefits in 2023, 2022 and 2021 is as follows:
In millions202320222021
Beginning balance$446 $782 $768 
Additions based on tax positions related to the current year2 5 3 
Additions based on tax positions related to prior years46 42 52 
Reductions for tax positions of prior years(24)(166)(33)
Expiration of statutes of limitation(34)(4)(1)
Settlements— (213)(7)
Ending balance$436 $446 $782 
v3.24.0.1
Stock Incentive Plans (Tables)
 12 Months Ended
Dec. 31, 2023
Share-Based Payment Arrangement [Abstract]  
Summary of Stock-Based Compensation The following table is a summary of stock-based compensation for the years ended December 31, 2023, 2022 and 2021:
In millions202320222021
Restricted stock units and performance stock units
$497 $369 $404 
Stock options and stock appreciation rights (“SARs”) (1)
91 78 80 
Total stock-based compensation (2)
$588 $447 $484 
_____________________________________________
(1)Includes the Employee Stock Purchase Plan (“ESPP”).
(2)Total stock-based compensation for the year ended December 31, 2023 included $71 million and $72 million of post-combination expense associated with replacement equity awards granted in connection with the Oak Street Health and Signify Health acquisitions, respectively.
Restricted Stock Unit and Performance Stock Unit Activity
The following table is a summary of the restricted stock unit and performance stock unit activity for the year ended December 31, 2023:
In thousands, except weighted average grant date fair valueUnitsWeighted Average
Grant Date
Fair Value
Outstanding at beginning of year, nonvested12,681 $80.25 
Granted (1)
13,918 $71.06 
Vested (2)
(7,346)$71.46 
Forfeited(2,259)$71.78 
Outstanding at end of year, nonvested16,994 $77.65 
_____________________________________________
(1)Includes 3.9 million and 1.8 million restricted stock replacement equity awards granted in connection with the Oak Street Health and Signify Health acquisitions, respectively.
(2)Vested performance stock units have been included at target level performance. Based on actual performance, the number of restricted stock units and performance stock units vested during the year ended December 31, 2023 was 7.8 million.
Summary of Stock Option and SAR Activity
The following table is a summary of stock option and SAR activity that occurred for the years ended December 31, 2023, 2022 and 2021:
In millions202320222021
Cash received from stock options exercised (including ESPP)
$277 $551 $549 
Payments for taxes for net share settlement of equity awards
181 370 168 
Intrinsic value of stock options and SARs exercised
31 118 105 
Fair value of stock options and SARs vested
227 219 224 
Schedule of Valuation Assumptions
The fair value of each stock option is estimated using the Black-Scholes option pricing model based on the following assumptions at the time of grant:
202320222021
Dividend yield (1)
3.27 %2.18 %2.68 %
Expected volatility (2)
28.15 %27.34 %27.10 %
Risk-free interest rate (3)
3.55 %2.46 %1.13 %
Expected life (in years) (4)
5.96.36.3
Weighted-average grant date fair value$21.78 $24.15 $14.57 
_____________________________________________
(1)The dividend yield is based on annual dividends paid and the fair market value of CVS Health Corporation stock at the grant date.
(2)The expected volatility is estimated based on the historical volatility of CVS Health Corporation’s daily stock price over a period equal to the expected life of each option grant after adjustments for infrequent events such as stock splits.
(3)The risk-free interest rate is selected based on yields from U.S. Treasury zero-coupon issues with a remaining term equal to the expected term of the options being valued.
(4)The expected life represents the number of years the options are expected to be outstanding from grant date based on historical option or SAR holder exercise experience.
Schedule of Stock Options and Stock Appreciation Rights Award Activity
The following table is a summary of the Company’s stock option and SAR activity for the year ended December 31, 2023:
In thousands, except weighted average exercise price and remaining contractual termSharesWeighted
Average
Exercise
 Price		Weighted
Average
Remaining
Contractual
Term		Aggregate
Intrinsic
Value
Outstanding at beginning of year15,040 $73.15 
Granted (1)
4,595 $63.06 
Exercised(1,652)$50.03 
Forfeited(624)$76.74 
Expired(2,233)$102.47 
Outstanding at end of year15,126 $68.13 5.21$203,645 
Exercisable at end of year7,785 $63.64 3.35130,509 
Vested at end of year and expected to vest in the future14,793 $67.95 5.14201,439 
_____________________________________________
(1)Includes 1.4 million stock option replacement equity awards granted in connection with the Signify Health acquisition.
Schedule ESPP Valuation Assumptions
The following table is a summary of the assumptions used to value the ESPP awards for the years ended December 31, 2023, 2022 and 2021:
202320222021
Dividend yield (1)
1.54 %1.12 %1.34 %
Expected volatility (2)
25.61 %23.54 %25.27 %
Risk-free interest rate (3)
5.17 %1.42 %0.08 %
Expected life (in years) (4)
0.50.50.5
Weighted-average grant date fair value$14.26 $16.25 $12.55 
_____________________________________________
(1)The dividend yield is calculated based on semi-annual dividends paid and the fair market value of CVS Health Corporation stock at the grant date.
(2)The expected volatility is estimated based on the historical volatility of CVS Health Corporation’s daily stock price over the previous six month period.
(3)The risk-free interest rate is selected based on the Treasury constant maturity interest rate whose term is consistent with the expected term of ESPP purchases (i.e., six months).
(4)The expected life is based on the semi-annual purchase period.
v3.24.0.1
Shareholders' Equity (Tables)
 12 Months Ended
Dec. 31, 2023
Equity [Abstract]  
Share Repurchase Programs
The following share repurchase programs have been authorized by the Board:
In billions
Authorization Date
AuthorizedRemaining as of
December 31, 2023
November 17, 2022 (“2022 Repurchase Program”)$10.0 $10.0 
December 9, 2021 (“2021 Repurchase Program”)10.0 4.5 
Schedule of Regulatory Requirements The combined statutory net income for the years ended and estimated combined statutory and capital surplus at December 31, 2023, 2022 and 2021 for the Company’s insurance and HMO subsidiaries were as follows:
In millions202320222021
Statutory net income
$2,757 $2,851 $3,302 
Estimated statutory capital and surplus
16,961 15,503 14,879 
Statutory Accounting Practices Disclosure At December 31, 2023, these amounts were as follows:
In millions
Estimated minimum statutory surplus required by regulators$9,011 
Investments on deposit with regulatory bodies684 
Estimated maximum dividend distributions permitted in 2024 without prior regulatory approval3,098 
v3.24.0.1
Other Comprehensive Income (Loss) (Tables)
 12 Months Ended
Dec. 31, 2023
Other Comprehensive Income (Loss), Net of Tax [Abstract]  
Schedule of Accumulated Other Comprehensive Income (Loss)
Shareholders’ equity included the following activity in accumulated other comprehensive income (loss) in 2023, 2022 and 2021:
At December 31,
In millions202320222021
Net unrealized investment gains (losses):
Beginning of year balance$(1,519)$798 $1,214 
Adoption of new accounting standard ($0, $0 and $181 pretax) (1)
— — 140 
Other comprehensive income (loss) before reclassifications ($612, $(3,021) and $(644) pretax)
603 (2,556)(530)
Amounts reclassified from accumulated other comprehensive income (loss) ($566, $315 and $(32) pretax) (2)
487 239 (26)
Other comprehensive income (loss)1,090 (2,317)(556)
End of year balance(429)(1,519)798 
Change in discount rate on long-duration insurance reserves:
Beginning of period balance219 (651)— 
Adoption of new accounting standard ($0, $0 and $(1,166) pretax) (1)
— — (906)
Other comprehensive income (loss) before reclassifications ($(92), $1,126, and $328 pretax)
(67)870 255 
Other comprehensive income (loss)(67)870 255 
End of period balance152 219 (651)
Foreign currency translation adjustments:
Beginning of year balance— — 7 
Other comprehensive loss before reclassifications— — (7)
Other comprehensive loss— — (7)
End of year balance— — — 
Net cash flow hedges:
Beginning of year balance239 222 248 
Other comprehensive income before reclassifications ($25, $38 and $0 pretax)
19 28 — 
Amounts reclassified from accumulated other comprehensive income ($(19), $(15) and $(34) pretax) (3)
(14)(11)(26)
Other comprehensive income (loss)5 17 (26)
End of year balance244 239 222 
Pension and other postretirement benefits:
Beginning of year balance(203)(35)(55)
Other comprehensive income (loss) before reclassifications ($(81), $(229) and $20 pretax)
(61)(170)15 
Amounts reclassified from accumulated other comprehensive loss ($0, $3 and $6 pretax) (4)
— 2 5 
Other comprehensive income (loss) (61)(168)20 
End of year balance(264)(203)(35)
Total beginning of year accumulated other comprehensive income (loss)(1,264)334 1,414 
Adoption of new accounting standard (1)
— — (766)
Total other comprehensive income (loss)967 (1,598)(314)
Total end of year accumulated other comprehensive income (loss)$(297)$(1,264)$334 
_______________________________________
(1)Reflects the adoption of ASU 2018-12, Targeted Improvements to the Accounting for Long-Duration Contracts (Topic 944) during the year ended December 31, 2021. See Note 1 ‘‘Significant Accounting Policies’’ for additional information.
(2)Amounts reclassified from accumulated other comprehensive income (loss) for specifically identified debt securities are included in net investment income in the consolidated statements of operations.
(3)Amounts reclassified from accumulated other comprehensive income for specifically identified cash flow hedges are included within interest expense in the consolidated statements of operations. The Company expects to reclassify $15 million, net of tax, in net gains associated with its cash flow hedges into net income within the next 12 months.
(4)Amounts reclassified from accumulated other comprehensive loss for specifically identified pension and other postretirement benefits are included in other income in the consolidated statements of operations.
v3.24.0.1
Earnings Per Share (Tables)
 12 Months Ended
Dec. 31, 2023
Earnings Per Share [Abstract]  
Reconciliation of Basic and Diluted Earnings (Loss) Per Share
The following is a reconciliation of basic and diluted earnings per share for the years ended December 31, 2023, 2022 and 2021:
In millions, except per share amounts202320222021
Numerator for earnings per share calculation:
Net income attributable to CVS Health$8,344 $4,311 $8,001 
Denominator for earnings per share calculation:
Weighted average shares, basic1,285 1,312 1,319 
Restricted stock units and performance stock units3 6 6 
Stock options and SARs2 5 4 
Weighted average shares, diluted1,290 1,323 1,329 
Earnings per share:
Basic$6.49 $3.29 $6.07 
Diluted$6.47 $3.26 $6.02 
v3.24.0.1
Reinsurance (Tables)
 12 Months Ended
Dec. 31, 2023
Reinsurance Disclosures [Abstract]  
Schedule of Reinsurance Recoverables
Reinsurance recoverables (recorded as other current assets or other assets on the consolidated balance sheets) at December 31, 2023 and 2022 were as follows:
In millions20232022
Reinsurer
Hartford Life and Accident Insurance Company$1,314 $1,549 
Lincoln Life & Annuity Company of New York480 385 
VOYA Retirement Insurance and Annuity Company — 159 
Fresenius Medical Care Reinsurance Company (Cayman) Ltd. 54 102 
Resolution Life Group Holdings Ltd.35 — 
All Other115 55 
Total$1,998 $2,250 
Schedule of Effects of Reinsurance
Direct, assumed and ceded premiums earned for the years ended December 31, 2023, 2022 and 2021 were as follows:
In millions202320222021
Direct$99,753 $85,670 $76,320 
Assumed350 432 492 
Ceded(911)(772)(680)
Net premiums$99,192 $85,330 $76,132 

The impact of reinsurance on benefit costs for the years ended December 31, 2023, 2022 and 2021 was as follows:
In millions202320222021
Direct$86,738 $71,357 $64,339 
Assumed223 379 398 
Ceded(714)(663)(549)
Net benefit costs$86,247 $71,073 $64,188 
v3.24.0.1
Segment Reporting (Tables)
 12 Months Ended
Dec. 31, 2023
Segment Reporting [Abstract]  
Summarized Financial Information Of Segments
The impact of these items on segment financial information for the years ended December 31, 2022 and 2021 is reflected in the “Adjustments” lines of the table included on the next page.
Year Ended December 31, 2022
In millionsHealth Care
Benefits		Health
Services		Pharmacy &
Consumer
Wellness		Corporate/
Other
Intersegment
Eliminations (1)
Consolidated
Totals
Total revenues, as previously reported$91,409 $169,236 $106,594 $530 $(45,302)$322,467 
Adjustments(59)340 2,002 — (2,283)— 
Total revenues, as adjusted$91,350 $169,576 $108,596 $530 $(47,585)$322,467 
Adjusted operating income (loss), as previously reported$5,984 $7,356 $6,705 $(1,785)$(728)$17,532 
Adjustments354 (575)(174)172 728 505 
Adjusted operating income (loss), as adjusted$6,338 $6,781 $6,531 $(1,613)$— $18,037 

Year Ended December 31, 2021
In millionsHealth Care
Benefits		Health
Services		Pharmacy &
Consumer
Wellness		Corporate/
Other
Intersegment
Eliminations (1)
Consolidated
Totals
Total revenues, as previously reported$82,186 $153,022 $100,105 $721 $(43,923)$292,111 
Adjustments(67)870 1,515 — (2,318)— 
Total revenues, as adjusted$82,119 $153,892 $101,620 $721 $(46,241)$292,111 
Adjusted operating income (loss), as previously reported$5,012 $6,859 $7,623 $(1,471)$(711)$17,312 
Adjustments98 (367)(363)(164)711 (85)
Adjusted operating income (loss), as adjusted$5,110 $6,492 $7,260 $(1,635)$— $17,227 
_____________________________________________
(1)Intersegment revenue eliminations relate to intersegment revenue generating activities that occur between the Health Care Benefits segment, the Health Services segment, and/or the Pharmacy & Consumer Wellness segment. Prior to January 1, 2023, intersegment adjusted operating income eliminations occurred when members of the Health Services segment's clients enrolled in Maintenance Choice elected to pick up maintenance prescriptions at one of the Company’s retail pharmacies instead of receiving them through the mail. When this occurred, both the Health Services and Pharmacy & Consumer Wellness segments recorded the adjusted operating income on a stand-alone basis. Effective January 1, 2023, the adjusted operating income associated with such transactions is reported only in the Pharmacy & Consumer Wellness segment, therefore no adjusted operating income elimination is required. Segment financial information has been recast to reflect this change.
The following is a reconciliation of financial measures of the Company’s segments to the consolidated totals:
In millionsHealth Care
Benefits
Health
Services (1)
Pharmacy &
Consumer
Wellness		Corporate/
Other
Intersegment
Eliminations (2)
Consolidated
Totals
2023:
Revenues from external customers$104,800 $174,018 $77,748 $57 $— $356,623 
Intersegment revenues81 12,826 39,020 — (51,927)— 
Net investment income (loss)765 (1)(5)394 — 1,153 
Total revenues105,646 186,843 116,763 451 (51,927)357,776 
  Adjusted operating income (loss) 5,577 7,312 5,963 (1,318)— 17,534 
Depreciation and amortization1,572 880 1,549 365 — 4,366 
2022:
Revenues from external customers90,798 157,968 72,739 124 — 321,629 
Intersegment revenues76 11,608 35,901 — (47,585)— 
Net investment income (loss)476 — (44)406 — 838 
Total revenues 91,350 169,576 108,596 530 (47,585)322,467 
  Adjusted operating income (loss) 6,338 6,781 6,531 (1,613)— 18,037 
Depreciation and amortization1,579 519 1,889 237 — 4,224 
2021:
Revenues from external customers81,457 143,912 65,418 125 — 290,912 
Intersegment revenues76 9,980 36,185 — (46,241)— 
Net investment income586 — 17 596 — 1,199 
Total revenues82,119 153,892 101,620 721 (46,241)292,111 
  Adjusted operating income (loss) 5,110 6,492 7,260 (1,635)— 17,227 
Depreciation and amortization1,811 505 1,955 215 — 4,486 
_____________________________________________
(1)Total revenues of the Health Services segment include approximately $13.7 billion, $12.6 billion and $11.6 billion of retail co-payments for 2023, 2022 and 2021, respectively. See Note 1 ‘‘Significant Accounting Policies’’ for additional information about retail co-payments.
(2)Intersegment revenue eliminations relate to intersegment revenue generating activities that occur between the Health Care Benefits segment, the Health Services segment, and/or the Pharmacy & Consumer Wellness segment.
Reconciliation Of Consolidated Operating Income to Adjusted Operating Income
The following is a reconciliation of consolidated operating income to adjusted operating income for the years ended December 31, 2023, 2022 and 2021:
In millions202320222021
Operating income (GAAP measure)$13,743 $7,954 $13,310 
Amortization of intangible assets (1)
1,905 1,785 2,233 
Net realized capital (gains) losses (2)
497 320 (176)
Acquisition-related transaction and integration costs (3)
487 — 132 
Restructuring charges (4)
507 — — 
Office real estate optimization charges (5)
46 117 — 
Loss on assets held for sale (6)
349 2,533 — 
Opioid litigation charges (7)
— 5,803 — 
Gain on divestiture of subsidiaries (8)
— (475)— 
Store impairments (9)
— — 1,358 
Goodwill impairment (10)
— — 431 
Acquisition purchase price adjustment outside of measurement period (11)
— — (61)
Adjusted operating income$17,534 $18,037 $17,227 
_____________________________________________
(1)The Company’s acquisition activities have resulted in the recognition of intangible assets as required under the acquisition method of accounting which consist primarily of trademarks, customer contracts/relationships, covenants not to compete, technology, provider networks and value of business acquired. Definite-lived intangible assets are amortized over their estimated useful lives and are tested for impairment when events indicate that the carrying value may not be recoverable. The amortization of intangible assets is reflected in the Company’s GAAP consolidated statements of operations in operating expenses within each segment. Although intangible assets contribute to the Company’s revenue generation, the amortization of intangible assets does not directly relate to the underwriting of the Company’s insurance products, the services performed for the Company’s customers or the sale of the Company’s products or services. Additionally, intangible asset amortization expense typically fluctuates based on the size and timing of the Company’s acquisition activity. Accordingly, the Company believes excluding the amortization of intangible assets enhances the Company’s and investors’ ability to compare the Company’s past financial performance with its current performance and to analyze underlying business performance and trends. Intangible asset amortization excluded from the related non-GAAP financial measure represents the entire amount recorded within the Company’s GAAP financial statements, and the revenue generated by the associated intangible assets has not been excluded from the related non-GAAP financial measure. Intangible asset amortization is excluded from the related non-GAAP financial measure because the amortization, unlike the related revenue, is not affected by operations of any particular period unless an intangible asset becomes impaired or the estimated useful life of an intangible asset is revised.
(2)The Company’s net realized capital gains and losses arise from various types of transactions, primarily in the course of managing a portfolio of assets that support the payment of insurance liabilities. Net realized capital gains and losses are reflected in the consolidated statements of operations in net investment income within each segment. These capital gains and losses are the result of investment decisions, market conditions and other economic developments that are unrelated to the performance of the Company’s business, and the amount and timing of these capital gains and losses do not directly relate to the underwriting of the Company’s insurance products, the services performed for the Company’s customers or the sale of the Company’s products or services. Accordingly, the Company believes excluding net realized capital gains and losses enhances the Company’s and investors’ ability to compare the Company’s past financial performance with its current performance and to analyze underlying business performance and trends.
(3)In 2023, the acquisition-related transaction and integration costs relate to the acquisitions of Signify Health and Oak Street Health. In 2021, the acquisition-related integration costs relate to the acquisition of Aetna. The acquisition-related transaction and integration costs are reflected in the Company’s GAAP consolidated statements of operations in operating expenses within the Corporate/Other segment.
(4)In 2023, the restructuring charges are primarily comprised of severance and employee-related costs, asset impairment charges and a stock-based compensation charge. During the second quarter of 2023, the Company developed an enterprise-wide restructuring plan intended to streamline and simplify the organization, improve efficiency and reduce costs. In connection with the development of this plan and the recently completed acquisitions of Signify Health and Oak Street Health, the Company also conducted a strategic review of its various transformation initiatives and determined that it would terminate certain initiatives. The restructuring charges are reflected within the Corporate/Other segment.
(5)In 2023 and 2022, the office real estate optimization charges primarily relate to the abandonment of leased real estate and the related right-of-use assets and property and equipment in connection with the planned reduction of corporate office real estate space in response to the Company’s new flexible work arrangement. The office real estate optimization charges are reflected in the Company’s GAAP consolidated statements of operations in operating expenses within the Health Care Benefits, Corporate/Other and Health Services segments.
(6)In 2023 and 2022, the loss on assets held for sale relates to the LTC reporting unit within the Pharmacy & Consumer Wellness segment. During 2022, the Company determined that its LTC business was no longer a strategic asset and committed to a plan to sell it, at which time the LTC business met the criteria for held-for-sale accounting and its net assets were accounted for as assets held for sale. The carrying value of the LTC business was determined to be greater than its estimated fair value less costs to sell and, accordingly, the Company recorded a loss on assets held for sale during 2022. During the first quarter of 2023, a loss on assets held for sale was recorded to write down the carrying value of the LTC business to the Company’s best estimate of the ultimate selling price which reflected its estimated fair value less costs to sell. As of September 30, 2023, the Company determined the LTC business no longer met the criteria for held-for-sale accounting and, accordingly, the net assets associated with the LTC business were reclassified to held and used at their respective fair values. During 2022, the loss on assets held for sale also relates to the Company’s Thailand business, which was included in the Commercial Business reporting unit in the Health Care Benefits segment. The sale of the Thailand business closed in the second quarter of 2022, and the ultimate loss on the sale was not material.
(7)In 2022, the opioid litigation charges relate to agreements to resolve substantially all opioid claims against the Company by certain states and governmental entities. The opioid litigation charges are reflected within the Corporate/Other segment.
(8)In 2022, the gain on divestiture of subsidiaries represents the pre-tax gain on the sale of bswift, which the Company sold in November 2022, and the pre-tax gain on the sale of PayFlex, which the Company sold in June 2022. The gains on divestitures are reflected as a reduction of operating expenses in the Company’s GAAP consolidated statement of operations within the Health Care Benefits segment.
(9)In 2021, the store impairment charge relates to the write down of operating lease right-of-use assets and property and equipment in connection with the planned closure of approximately 900 retail stores between 2022 and 2024. The store impairment charge is reflected within the Pharmacy & Consumer Wellness segment.
(10)In 2021, the goodwill impairment charge relates to an impairment of the remaining goodwill of the LTC reporting unit within the Pharmacy & Consumer Wellness segment.
(11)In 2021, the Company received $61 million related to a purchase price working capital adjustment for an acquisition completed during the first quarter of 2020. The resolution of this matter occurred subsequent to the acquisition accounting measurement period and is reflected in the Company’s GAAP consolidated statement of operations as a reduction of operating expenses within the Health Care Benefits segment.
v3.24.0.1
Significant Accounting Policies - Narrative (Details)
shares in Millions, people in Millions, patient in Millions, $ in Millions
 1 Months Ended 3 Months Ended 12 Months Ended
Jan. 31, 2024
state
Dec. 31, 2022
USD ($)
shares
Dec. 31, 2021
USD ($)
store
shares
Sep. 30, 2021
USD ($)
Dec. 31, 2023
USD ($)
store
clinic
people
patient
state
business
Segment
shares
Dec. 31, 2022
USD ($)
shares
Dec. 31, 2021
USD ($)
store
shares
Significant Accounting Policies [Line Items]              
Number of pharmacy plan members | people         108    
Number of patients served per year (more than) | patient         1    
Number of businesses acquired | business         2    
Number of reportable segments | Segment         4    
Depreciation         $ 2,500 $ 2,400 $ 2,300
Office real estate optimization charges   $ 117     46 117 0
Store impairments         0 0 $ 1,358
Number of stores, planned closure | store             900
Goodwill impairment         0 0 $ 431
Impairment of intangible assets, indefinite-lived         0 0 0
Premium deficiency reserve   0     0 0  
Self insurance liabilities   1,100     1,100 1,100  
ACA risk adjustment payable   $ 0     $ 1,200 0  
Pharmacy rebate period         30 days    
Advertising costs         $ 985 $ 745 $ 707
Treasury shares held in trust (in shares) | shares   1 1   1 1 1
Charitable contribution to CVS Health Foundation         $ 0 $ 25 $ 50
Client Health Information Network Services, Fees Expensed              
Significant Accounting Policies [Line Items]              
Transactions with related party         59 60 52
Pharmaceutical Inventory Purchases, Payments Received              
Significant Accounting Policies [Line Items]              
Transactions with related party         35 87 79
Health Insurance Product Line              
Significant Accounting Policies [Line Items]              
Premium deficiency reserve   $ 0 $ 16     0 16
Other Insurance Liabilities              
Significant Accounting Policies [Line Items]              
Liability for unpaid claims   243     285 243  
Liability for future policy benefits   334     393 334  
Other Long-Term Insurance Liabilities              
Significant Accounting Policies [Line Items]              
Liability for unpaid claims   1,100     834 1,100  
Liability for future policy benefits   $ 4,700     $ 4,600 $ 4,700  
Long-Term Care Reporting Unit              
Significant Accounting Policies [Line Items]              
Goodwill impairment       $ 431      
Minimum              
Significant Accounting Policies [Line Items]              
Period after date of service a claim is paid         6 months    
Award vesting period         3 years    
Minimum | Buildings, building improvements and leasehold improvements              
Significant Accounting Policies [Line Items]              
Useful life of property plant and equipment         1 year    
Minimum | Fixtures, equipment and internally developed software              
Significant Accounting Policies [Line Items]              
Useful life of property plant and equipment         3 years    
Maximum              
Significant Accounting Policies [Line Items]              
Lease renewal term         5 years    
Period after date of service a claim is paid         48 months    
Award vesting period         5 years    
Maximum | Buildings, building improvements and leasehold improvements              
Significant Accounting Policies [Line Items]              
Useful life of property plant and equipment         40 years    
Maximum | Fixtures, equipment and internally developed software              
Significant Accounting Policies [Line Items]              
Useful life of property plant and equipment         10 years    
Pharmacy & Consumer Wellness              
Significant Accounting Policies [Line Items]              
Number of retail locations (more than) | store         9,000    
Store impairments     $ 1,400       $ 1,400
Number of stores, planned closure | store     900       900
Health Services              
Significant Accounting Policies [Line Items]              
Number of walk-in medical clinics (more than) | clinic         1,000    
Number of primary care medical clinics | clinic         204    
Health Care Benefits              
Significant Accounting Policies [Line Items]              
Number of people served (more than) | people         35    
Number of states in which the Company has entered the individual public health insurance exchange | state         12    
Health Care Benefits | Subsequent Event              
Significant Accounting Policies [Line Items]              
Additional number of states in which the Company entered the individual public health insurance exchange | state 5            
v3.24.0.1
Significant Accounting Policies - Cash and Cash Equivalents, Restricted Cash and Cash Equivalents (Details) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Accounting Policies [Abstract]        
Cash and cash equivalents $ 8,196 $ 12,945 $ 9,408  
Restricted cash (included in other current assets) 90 144 3,065  
Restricted cash (included in other assets) 239 216 218  
Total cash, cash equivalents and restricted cash in the consolidated statements of cash flows $ 8,525 $ 13,305 $ 12,691 $ 11,043
v3.24.0.1
Significant Accounting Policies - Accounts Receivable (Details) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Accounts, Notes, Loans and Financing Receivable [Line Items]    
Trade receivables $ 11,908 $ 8,983
Vendor and manufacturer receivables 15,711 12,395
Premium receivables 3,714 2,676
Other receivables 3,894 3,449
Accounts receivable, net 35,227 27,276
Total accounts receivable, net   27,503
Allowance for credit losses $ 343 333
Disposal Group, Held-for-sale, Not Discontinued Operations    
Accounts, Notes, Loans and Financing Receivable [Line Items]    
Total accounts receivable, net   $ 227
v3.24.0.1
Significant Accounting Policies - Deferred Acquisition Costs (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Movement Analysis of Deferred Policy Acquisition Costs [Roll Forward]    
Deferred acquisition costs, beginning of the period $ 1,219 $ 879
Capitalizations 548 564
Amortization expense (265) (224)
Deferred acquisition costs, end of the period $ 1,502 $ 1,219
v3.24.0.1
Significant Accounting Policies - Property and Equipment (Details) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Property, Plant and Equipment [Line Items]    
Total property and equipment $ 33,882 $ 34,600
Accumulated depreciation and amortization (20,699) (21,483)
Property and equipment, net 13,183 12,873
Property and equipment, net   13,117
Disposal Group, Held-for-sale, Not Discontinued Operations    
Property, Plant and Equipment [Line Items]    
Property and equipment, net   244
Land    
Property, Plant and Equipment [Line Items]    
Total property and equipment 1,958 1,996
Building and improvements    
Property, Plant and Equipment [Line Items]    
Total property and equipment 4,571 4,545
Fixtures and equipment    
Property, Plant and Equipment [Line Items]    
Total property and equipment 11,024 12,978
Leasehold improvements    
Property, Plant and Equipment [Line Items]    
Total property and equipment 6,511 6,238
Software    
Property, Plant and Equipment [Line Items]    
Total property and equipment $ 9,818 $ 8,843
v3.24.0.1
Significant Accounting Policies - Disaggregation of Revenue (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Disaggregation of Revenue [Line Items]      
Revenues $ 356,623 $ 321,629 $ 290,912
Net investment income (loss) 1,153 838 1,199
Total revenues 357,776 322,467 292,111
Pharmacy      
Disaggregation of Revenue [Line Items]      
Revenues 223,452 205,119 184,619
Front Store      
Disaggregation of Revenue [Line Items]      
Revenues 22,458 22,780 21,315
Premiums      
Disaggregation of Revenue [Line Items]      
Revenues 99,192 85,330 76,132
Other      
Disaggregation of Revenue [Line Items]      
Revenues 11,521 8,400 8,846
Operating Segments | Health Care Benefits      
Disaggregation of Revenue [Line Items]      
Revenues 104,800 90,798 81,457
Net investment income (loss) 765 476 586
Total revenues 105,646 91,350 82,119
Operating Segments | Health Care Benefits | Pharmacy      
Disaggregation of Revenue [Line Items]      
Revenues 0 0 0
Operating Segments | Health Care Benefits | Front Store      
Disaggregation of Revenue [Line Items]      
Revenues 0 0 0
Operating Segments | Health Care Benefits | Premiums      
Disaggregation of Revenue [Line Items]      
Revenues 99,144 85,274 76,064
Operating Segments | Health Care Benefits | Other      
Disaggregation of Revenue [Line Items]      
Revenues 5,737 5,600 5,469
Operating Segments | Health Services      
Disaggregation of Revenue [Line Items]      
Revenues 174,018 157,968 143,912
Net investment income (loss) (1) 0 0
Total revenues 186,843 169,576 153,892
Operating Segments | Health Services | Pharmacy network      
Disaggregation of Revenue [Line Items]      
Total revenues 112,718 102,968 96,834
Operating Segments | Health Services | Mail choice      
Disaggregation of Revenue [Line Items]      
Total revenues 67,992 63,825 53,812
Operating Segments | Health Services | Other      
Disaggregation of Revenue [Line Items]      
Total revenues 6,134 2,783 3,246
Operating Segments | Health Services | Pharmacy      
Disaggregation of Revenue [Line Items]      
Revenues 180,710 166,793 150,646
Operating Segments | Health Services | Front Store      
Disaggregation of Revenue [Line Items]      
Revenues 0 0 0
Operating Segments | Health Services | Premiums      
Disaggregation of Revenue [Line Items]      
Revenues 0 0 0
Operating Segments | Health Services | Other      
Disaggregation of Revenue [Line Items]      
Revenues 6,134 2,783 3,246
Operating Segments | Pharmacy & Consumer Wellness      
Disaggregation of Revenue [Line Items]      
Revenues 77,748 72,739 65,418
Net investment income (loss) (5) (44) 17
Total revenues 116,763 108,596 101,620
Operating Segments | Pharmacy & Consumer Wellness | Pharmacy      
Disaggregation of Revenue [Line Items]      
Revenues 92,111 83,480 77,886
Operating Segments | Pharmacy & Consumer Wellness | Front Store      
Disaggregation of Revenue [Line Items]      
Revenues 22,458 22,780 21,315
Operating Segments | Pharmacy & Consumer Wellness | Premiums      
Disaggregation of Revenue [Line Items]      
Revenues 0 0 0
Operating Segments | Pharmacy & Consumer Wellness | Other      
Disaggregation of Revenue [Line Items]      
Revenues 2,199 2,380 2,402
Corporate/ Other | Corporate/ Other      
Disaggregation of Revenue [Line Items]      
Revenues 57 124 125
Net investment income (loss) 394 406 596
Total revenues 451 530 721
Corporate/ Other | Corporate/ Other | Pharmacy      
Disaggregation of Revenue [Line Items]      
Revenues 0 0 0
Corporate/ Other | Corporate/ Other | Front Store      
Disaggregation of Revenue [Line Items]      
Revenues 0 0 0
Corporate/ Other | Corporate/ Other | Premiums      
Disaggregation of Revenue [Line Items]      
Revenues 48 56 68
Corporate/ Other | Corporate/ Other | Other      
Disaggregation of Revenue [Line Items]      
Revenues 9 68 57
Intersegment Eliminations      
Disaggregation of Revenue [Line Items]      
Net investment income (loss) 0 0 0
Total revenues (51,927) (47,585) (46,241)
Intersegment Eliminations | Pharmacy      
Disaggregation of Revenue [Line Items]      
Revenues (49,369) (45,154) (43,913)
Intersegment Eliminations | Front Store      
Disaggregation of Revenue [Line Items]      
Revenues 0 0 0
Intersegment Eliminations | Premiums      
Disaggregation of Revenue [Line Items]      
Revenues 0 0 0
Intersegment Eliminations | Other      
Disaggregation of Revenue [Line Items]      
Revenues $ (2,558) $ (2,431) $ (2,328)
v3.24.0.1
Significant Accounting Policies - Receivables and Contract Balances (Details) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Accounting Policies [Abstract]      
Trade receivables (included in accounts receivable, net) $ 11,908 $ 8,983  
Contract liabilities (included in accrued expenses) $ 149 $ 71 $ 87
v3.24.0.1
Significant Accounting Policies - Contract Balances (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Change in Contract with Customer, Liability [Roll Forward]    
Contract liabilities, beginning of period $ 71 $ 87
Rewards earnings and gift card issuances 357 340
Redemption and breakage (363) (356)
Acquired contract liabilities 109 0
Other (25) 0
Contract liabilities, end of period $ 149 $ 71
v3.24.0.1
Significant Accounting Policies - Variable Interest Entities (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2014
Variable Interest Entity [Line Items]        
Total assets $ 249,728 $ 228,275    
Total liabilities 173,092 156,506    
Long-term investments 23,019 21,096    
Variable Interest Entity, Primary Beneficiary, Red Oak Sourcing, LLC        
Variable Interest Entity [Line Items]        
VIE, ownership percentage       50.00%
Initial contractual term (in years)       10 years
Amended contract extension term     5 years  
Amended contract term (in years)     15 years  
Proceeds from VIE 183 183 $ 183  
Variable Interest Entity, Primary Beneficiary, Physicians Groups        
Variable Interest Entity [Line Items]        
Total assets 1,515      
Total liabilities 1,503      
Variable Interest Entity, Not Primary Beneficiary        
Variable Interest Entity [Line Items]        
Long-term investments 2,018 1,537    
Variable Interest Entity, Not Primary Beneficiary | Hedge fund investments        
Variable Interest Entity [Line Items]        
Long-term investments 859 589    
Variable Interest Entity, Not Primary Beneficiary | Private equity investments        
Variable Interest Entity [Line Items]        
Long-term investments 840 707    
Variable Interest Entity, Not Primary Beneficiary | Real estate partnerships        
Variable Interest Entity [Line Items]        
Long-term investments $ 319 $ 241    
v3.24.0.1
Significant Accounting Policies - New Accounting Pronouncements Recently Adopted (Details) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Jan. 01, 2021
Significant Accounting Policies [Line Items]      
Reduction to accumulated other comprehensive income (loss) $ 297 $ 1,264  
Adoption of new accounting standard, adjustment      
Significant Accounting Policies [Line Items]      
Reduction to accumulated other comprehensive income (loss)   $ (201)  
Accounting Standards Update 2018-12 | Adoption of new accounting standard, adjustment      
Significant Accounting Policies [Line Items]      
Liability for future policy benefits     $ 986
Reduction to accumulated other comprehensive income (loss), before tax     986
Liability for future policy benefits, after tax     766
Reduction to accumulated other comprehensive income (loss)     $ 766
v3.24.0.1
Significant Accounting Policies - Changes in Balances of Long-duration Insurance Liabilities (Details) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Large Case Pensions        
Present value of expected future policy benefits        
Balance at December 31, 2020, net of reinsurance $ 2,139 $ 2,253   $ 3,647
Add: Reinsurance recoverable 0 0   0
Effect of changes in cash flow assumptions   0 $ 0  
Liability for future policy benefits, end of period - current discount rate 2,139 2,253 3,034 3,647
Large Case Pensions | As Reported        
Present value of expected future policy benefits        
Balance at December 31, 2020, net of reinsurance       3,224
Add: Reinsurance recoverable       0
Liability for future policy benefits, beginning of period - current discount rate       3,224
Large Case Pensions | Change in discount rate assumptions        
Present value of expected future policy benefits        
Effect of changes in cash flow assumptions       604
Large Case Pensions | Removal of shadow adjustments in accumulated other comprehensive income        
Present value of expected future policy benefits        
Effect of changes in cash flow assumptions       (181)
Long-Term Care        
Present value of expected future policy benefits        
Balance at December 31, 2020, net of reinsurance 1,347 1,266   1,695
Add: Reinsurance recoverable 0 0   0
Effect of changes in cash flow assumptions   0 99  
Liability for future policy benefits, end of period - current discount rate $ 1,640 $ 1,566 $ 1,991 1,695
Long-Term Care | As Reported        
Present value of expected future policy benefits        
Balance at December 31, 2020, net of reinsurance       1,142
Add: Reinsurance recoverable       0
Liability for future policy benefits, beginning of period - current discount rate       1,142
Long-Term Care | Change in discount rate assumptions        
Present value of expected future policy benefits        
Effect of changes in cash flow assumptions       553
Long-Term Care | Removal of shadow adjustments in accumulated other comprehensive income        
Present value of expected future policy benefits        
Effect of changes in cash flow assumptions       0
Other        
Present value of expected future policy benefits        
Balance at December 31, 2020, net of reinsurance       490
Add: Reinsurance recoverable       308
Liability for future policy benefits, end of period - current discount rate       798
Other | As Reported        
Present value of expected future policy benefits        
Balance at December 31, 2020, net of reinsurance       480
Add: Reinsurance recoverable       274
Liability for future policy benefits, beginning of period - current discount rate       754
Other | Change in discount rate assumptions        
Present value of expected future policy benefits        
Effect of changes in cash flow assumptions       44
Other | Removal of shadow adjustments in accumulated other comprehensive income        
Present value of expected future policy benefits        
Effect of changes in cash flow assumptions       $ 0
v3.24.0.1
Significant Accounting Policies - Adjustments Resulting From Applying New Accounting Standard (Details) - USD ($)
$ / shares in Units, $ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Condensed Consolidated Statement of Operations:        
Health care costs $ 86,247 $ 71,073 $ 64,188  
Operating expenses 39,832 38,212 37,021  
Costs and Expenses 344,033 314,513 278,801  
Operating income 13,743 7,954 13,310  
Income before income tax provision 11,173 5,836 10,537  
Income tax provision 2,805 1,509 2,548  
Net income 8,368 4,327 7,989  
Net income attributable to CVS Health $ 8,344 $ 4,311 $ 8,001  
Net income per share attributable to CVS Health:        
Basic (in dollars per share) $ 6.49 $ 3.29 $ 6.07  
Diluted (in dollars per share) $ 6.47 $ 3.26 $ 6.02  
Condensed Consolidated Balance Sheet:        
Other current assets $ 3,151 $ 2,636    
Total current assets 67,858 65,633    
Intangible assets, net 29,234 24,803    
Total assets 249,728 228,275    
Health care costs payable   10,142    
Other insurance liabilities 1,141 1,089    
Total current liabilities 79,189 69,421    
Deferred income taxes 4,311 4,016    
Other long-term insurance liabilities 5,459 5,835    
Other long-term liabilities 6,211 6,730    
Total liabilities 173,092 156,506    
Retained earnings 61,604 56,398    
Accumulated other comprehensive loss (297) (1,264)    
Total CVS Health shareholders’ equity 76,461 71,469    
Total shareholders’ equity 76,636 71,769 $ 74,841 $ 69,701
Total liabilities and shareholders’ equity 249,728 228,275    
Condensed Consolidated Statement of Cash Flows:        
Depreciation and amortization 4,366 4,224 4,486  
Deferred income taxes (676) (2,029) (402)  
Other assets (510) (491) (30)  
Health care costs payable and other insurance liabilities 394 992 101  
Other liabilities $ 1,540 6,463 2,856  
As Reported        
Condensed Consolidated Statement of Operations:        
Health care costs   71,281 64,260  
Operating expenses     37,066  
Costs and Expenses   314,721 278,918  
Operating income   7,746 13,193  
Income before income tax provision   5,628 10,420  
Income tax provision   1,463 2,522  
Net income   4,165 7,898  
Net income attributable to CVS Health   $ 4,149 $ 7,910  
Net income per share attributable to CVS Health:        
Basic (in dollars per share)   $ 3.16 $ 6.00  
Diluted (in dollars per share)   $ 3.14 $ 5.95  
Condensed Consolidated Balance Sheet:        
Other current assets   $ 2,685    
Total current assets   65,682    
Intangible assets, net   24,754    
Total assets   228,275    
Health care costs payable   10,406    
Other insurance liabilities   1,140    
Total current liabilities   69,736    
Deferred income taxes   3,880    
Other long-term insurance liabilities   6,108    
Other long-term liabilities   6,732    
Total liabilities   156,960    
Retained earnings   56,145    
Accumulated other comprehensive loss   (1,465)    
Total CVS Health shareholders’ equity   71,015    
Total shareholders’ equity   71,315    
Total liabilities and shareholders’ equity   228,275    
Condensed Consolidated Statement of Cash Flows:        
Depreciation and amortization   4,247 $ 4,512  
Deferred income taxes   (2,075) (428)  
Other assets   (566) (3)  
Health care costs payable and other insurance liabilities   1,247 169  
Other liabilities   6,468 2,852  
Adoption of new accounting standard, adjustment        
Condensed Consolidated Statement of Operations:        
Health care costs   (208) (72)  
Operating expenses     (45)  
Costs and Expenses   (208) (117)  
Operating income   208 117  
Income before income tax provision   208 117  
Income tax provision   46 26  
Net income   162 91  
Net income attributable to CVS Health   $ 162 $ 91  
Net income per share attributable to CVS Health:        
Basic (in dollars per share)   $ 0.13 $ 0.07  
Diluted (in dollars per share)   $ 0.12 $ 0.07  
Condensed Consolidated Balance Sheet:        
Other current assets   $ (49)    
Total current assets   (49)    
Intangible assets, net   49    
Total assets   0    
Health care costs payable   (264)    
Other insurance liabilities   (51)    
Total current liabilities   (315)    
Deferred income taxes   136    
Other long-term insurance liabilities   (273)    
Other long-term liabilities   (2)    
Total liabilities   (454)    
Retained earnings   253    
Accumulated other comprehensive loss   201    
Total CVS Health shareholders’ equity   454    
Total shareholders’ equity   454   $ (766) [1]
Total liabilities and shareholders’ equity   0    
Condensed Consolidated Statement of Cash Flows:        
Depreciation and amortization   (23) $ (26)  
Deferred income taxes   46 26  
Other assets   75 (27)  
Health care costs payable and other insurance liabilities   (255) (68)  
Other liabilities   $ (5) $ 4  
[1] Reflects the adoption of Accounting Standards Update (“ASU”) 2018-12, Targeted Improvements to the Accounting for Long-Duration Contracts (Topic 944) during the year ended December 31, 2021. See Note 1 ‘‘Significant Accounting Policies’’ for additional information.
v3.24.0.1
Acquisitions, Divestitures and Asset Sales - Narrative (Details)
$ / shares in Units, member in Thousands, $ in Millions
 1 Months Ended 3 Months Ended 8 Months Ended 9 Months Ended 12 Months Ended
Jun. 02, 2023
USD ($)
May 01, 2023
USD ($)
Feb. 21, 2023
USD ($)
Feb. 28, 2023
USD ($)
Nov. 30, 2022
USD ($)
Jun. 30, 2022
USD ($)
Mar. 31, 2023
USD ($)
Mar. 31, 2022
USD ($)
member
Dec. 31, 2023
USD ($)
Dec. 31, 2023
USD ($)
Dec. 31, 2023
USD ($)
Dec. 31, 2022
USD ($)
Dec. 31, 2021
USD ($)
May 02, 2023
USD ($)
$ / shares
Mar. 29, 2023
USD ($)
$ / shares
May 31, 2022
member
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]                                
Proceeds from debt $ 4,900 $ 5,000 $ 6,000 $ 6,000                        
Intangible asset amortization since acquisition date                     $ 1,905 $ 1,785 $ 2,233      
Stock-based compensation expense since acquisition date                     588 447 484      
Loss on assets held for sale                     349 2,533 0      
Gain (loss) on sale of subsidiaries                     0 475 $ 0      
Disposal Group, Disposed of by Sale, Not Discontinued Operations | International Health Care Renewal Rights                                
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]                                
Number of international health care members, renewal rights sold | member                               200
Health Care Benefits | Disposal Group, Disposed of by Sale, Not Discontinued Operations | bswift LLC                                
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]                                
Proceeds from divestiture of subsidiary         $ 735                      
Gain (loss) on sale of subsidiaries                       250        
Health Care Benefits | Disposal Group, Disposed of by Sale, Not Discontinued Operations | Payflex                                
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]                                
Proceeds from divestiture of subsidiary           $ 775                    
Gain (loss) on sale of subsidiaries                       225        
Health Care Benefits | Disposal Group, Disposed of by Sale, Not Discontinued Operations | Thailand Business                                
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]                                
Loss on assets held for sale               $ 41                
Number of medical members | member               266                
Pharmacy & Consumer Wellness | Disposal Group, Held-for-sale, Not Discontinued Operations | Omnicare Long-Term Care Business                                
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]                                
Loss on assets held for sale             $ 349         $ 2,500        
Oak Street Health Inc.                                
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]                                
Percentage of voting interests acquired                           100.00%    
Cash to be received by shareholders in acquisition (in dollars per share) | $ / shares                           $ 39.00    
Deferred income taxes                           $ 796    
Revenue since acquisition date                 $ 2,100              
Operating income (losses) since acquisition date                 (520)              
Intangible asset amortization since acquisition date                 193              
Stock-based compensation expense since acquisition date                 $ 71              
Transaction costs                     77          
Signify Health, Inc.                                
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]                                
Percentage of voting interests acquired                             100.00%  
Cash to be received by shareholders in acquisition (in dollars per share) | $ / shares                             $ 30.50  
Deferred income taxes                             $ 259  
Revenue since acquisition date                   $ 797            
Operating income (losses) since acquisition date                   123            
Intangible asset amortization since acquisition date                   106            
Stock-based compensation expense since acquisition date                   $ 72            
Goodwill deductible for income tax purposes                             $ 1,700  
Transaction costs                     $ 37          
v3.24.0.1
Acquisitions, Divestitures and Asset Sales - Schedule of Fair Value of Consideration Transferred (Details) - USD ($)
shares in Millions, $ in Millions
May 02, 2023
Mar. 29, 2023
Oak Street Health Inc.    
Business Acquisition [Line Items]    
Cash $ 9,579  
Effective settlement of pre-existing relationship (29)  
Total consideration transferred 9,668  
Oak Street Health Inc. | Pre-combination services    
Business Acquisition [Line Items]    
Fair value of replacement equity awards for pre-combination services $ 118  
Replacement equity awards for pre-combination services (in shares) 3.9  
Oak Street Health Inc. | Post-combination services    
Business Acquisition [Line Items]    
Fair value of replacement equity awards for pre-combination services $ 165  
Signify Health, Inc.    
Business Acquisition [Line Items]    
Cash   $ 7,450
Effective settlement of pre-existing relationship   (111)
Total consideration transferred   7,353
Signify Health, Inc. | Pre-combination services    
Business Acquisition [Line Items]    
Fair value of replacement equity awards for pre-combination services   $ 14
Replacement equity awards for pre-combination services (in shares)   3.2
Signify Health, Inc. | Post-combination services    
Business Acquisition [Line Items]    
Fair value of replacement equity awards for pre-combination services   $ 167
v3.24.0.1
Acquisitions, Divestitures and Asset Sales - Schedule of Estimated Fair Values of Assets Acquired and Liabilities Assumed (Details) - USD ($)
$ in Millions
Dec. 31, 2023
May 02, 2023
Mar. 29, 2023
Dec. 31, 2022
Dec. 31, 2021
Business Acquisition [Line Items]          
Goodwill $ 91,272     $ 78,150 $ 79,121
Oak Street Health Inc.          
Business Acquisition [Line Items]          
Cash and cash equivalents   $ 201      
Investments   168      
Accounts receivable   1,143      
Other current assets (including restricted cash)   46      
Property and equipment   180      
Operating lease right-of-use assets   316      
Goodwill   7,213      
Intangible assets   4,233      
Other long-term assets   7      
Total assets acquired   13,507      
Health care costs payable   1,098      
Other current liabilities   444      
Operating lease liabilities (current and long-term)   378      
Debt (current and long-term)   1,028      
Deferred income taxes   796      
Other long-term liabilities   29      
Total liabilities assumed   3,773      
Noncontrolling interests   66      
Total consideration transferred   $ 9,668      
Signify Health, Inc.          
Business Acquisition [Line Items]          
Cash and cash equivalents     $ 376    
Accounts receivable     190    
Other current assets (including restricted cash)     147    
Property and equipment     25    
Goodwill     5,909    
Intangible assets     1,920    
Other long-term assets     23    
Total assets acquired     8,590    
Other current liabilities     606    
Debt (current and long-term)     346    
Deferred income taxes     259    
Other long-term liabilities     26    
Total liabilities assumed     1,237    
Total consideration transferred     7,353    
Restricted cash     $ 28    
v3.24.0.1
Acquisitions, Divestitures and Asset Sales - Summary of the Valuation of Goodwill Allocated to Business Segments (Details) - USD ($)
$ in Millions
Dec. 31, 2023
May 02, 2023
Mar. 29, 2023
Dec. 31, 2022
Dec. 31, 2021
Business Acquisition [Line Items]          
Goodwill $ 91,272     $ 78,150 $ 79,121
Health Services          
Business Acquisition [Line Items]          
Goodwill 34,066     23,615 23,615
Pharmacy & Consumer Wellness          
Business Acquisition [Line Items]          
Goodwill 10,562     10,376 10,376
Health Care Benefits          
Business Acquisition [Line Items]          
Goodwill $ 46,644     $ 44,159 $ 45,130
Oak Street Health Inc.          
Business Acquisition [Line Items]          
Goodwill   $ 7,213      
Oak Street Health Inc. | Health Services          
Business Acquisition [Line Items]          
Goodwill   6,936      
Oak Street Health Inc. | Pharmacy & Consumer Wellness          
Business Acquisition [Line Items]          
Goodwill   156      
Oak Street Health Inc. | Health Care Benefits          
Business Acquisition [Line Items]          
Goodwill   $ 121      
Signify Health, Inc.          
Business Acquisition [Line Items]          
Goodwill     $ 5,909    
Signify Health, Inc. | Health Services          
Business Acquisition [Line Items]          
Goodwill     3,406    
Signify Health, Inc. | Pharmacy & Consumer Wellness          
Business Acquisition [Line Items]          
Goodwill     30    
Signify Health, Inc. | Health Care Benefits          
Business Acquisition [Line Items]          
Goodwill     $ 2,473    
v3.24.0.1
Acquisitions, Divestitures and Asset Sales - Summary of Fair Values and Weighted Average Useful Lives for Intangible Assets Acquired (Details) - USD ($)
$ in Millions
May 02, 2023
Mar. 29, 2023
Oak Street Health Inc.    
Business Acquisition [Line Items]    
Gross Fair Value $ 4,233  
Weighted Average Useful Life (years) 18 years  
Oak Street Health Inc. | Customer Relationships    
Business Acquisition [Line Items]    
Gross Fair Value $ 3,620  
Weighted Average Useful Life (years) 19 years 10 months 24 days  
Oak Street Health Inc. | Technology    
Business Acquisition [Line Items]    
Gross Fair Value $ 143  
Weighted Average Useful Life (years) 3 years  
Oak Street Health Inc. | Trademarks    
Business Acquisition [Line Items]    
Gross Fair Value $ 470  
Weighted Average Useful Life (years) 8 years  
Signify Health, Inc.    
Business Acquisition [Line Items]    
Gross Fair Value   $ 1,920
Weighted Average Useful Life (years)   16 years
Signify Health, Inc. | Customer Relationships    
Business Acquisition [Line Items]    
Gross Fair Value   $ 1,810
Weighted Average Useful Life (years)   16 years 8 months 12 days
Signify Health, Inc. | Technology    
Business Acquisition [Line Items]    
Gross Fair Value   $ 50
Weighted Average Useful Life (years)   3 years
Signify Health, Inc. | Trademarks    
Business Acquisition [Line Items]    
Gross Fair Value   $ 60
Weighted Average Useful Life (years)   5 years
v3.24.0.1
Restructuring Program - Narrative (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Restructuring and Related Activities [Abstract]      
Restructuring charges $ 507 $ 0 $ 0
Severance and employee-related costs 344    
Asset impairment charges 152    
Stock-based compensation charge $ 11    
v3.24.0.1
Restructuring Program - Change in Severance and Employee-related Restructuring Charge Liability (Details)
$ in Millions
 12 Months Ended
Dec. 31, 2023
USD ($)
Supplemental Unemployment Benefits, Severance Benefits [Roll Forward]  
Restructuring charge liability, beginning of the period $ 0
Restructuring charges 344
Payments (194)
Restructuring charge liability, end of the period $ 150
v3.24.0.1
Investments - Total Investments Schedule (Details) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Total Investments [Line Items]    
Current $ 3,259 $ 2,778
Long-term 23,019 21,096
Long-term   21,113
Total 26,278 23,891
Disposal Group, Held-for-sale, Not Discontinued Operations    
Total Investments [Line Items]    
Long-term   17
Debt securities available for sale    
Total Investments [Line Items]    
Current 3,131 2,718
Long-term 18,582  
Long-term   17,562
Total 21,713 20,280
Mortgage loans    
Total Investments [Line Items]    
Current 128 55
Long-term 1,183  
Long-term   989
Total 1,311 1,044
Other investments    
Total Investments [Line Items]    
Current 0 5
Long-term 3,254  
Long-term   2,562
Total $ 3,254 $ 2,567
v3.24.0.1
Investments - Narrative (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Debt Securities, Available-for-sale [Line Items]    
Investments related to 2012 contract conversion $ 307 $ 331
Residential mortgage-backed securities    
Debt Securities, Available-for-sale [Line Items]    
Weighted average duration of securities 5 years 10 months 24 days  
Commercial mortgage-backed securities    
Debt Securities, Available-for-sale [Line Items]    
Weighted average duration of securities 5 years 4 months 24 days  
Other asset-backed securities    
Debt Securities, Available-for-sale [Line Items]    
Weighted average duration of securities 1 year  
v3.24.0.1
Investments - Debt Securities (Details) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Debt Securities, Available-for-sale [Line Items]    
Gross Amortized Cost $ 22,282 $ 22,067
Allowance for Credit Losses 0 (4)
Net Amortized Cost 22,282 22,063
Gross Unrealized Gains 267 57
Gross Unrealized Losses (836) (1,840)
Fair Value 21,713 20,280
U.S. government securities    
Debt Securities, Available-for-sale [Line Items]    
Gross Amortized Cost 2,071 2,074
Allowance for Credit Losses 0 0
Net Amortized Cost 2,071 2,074
Gross Unrealized Gains 19 0
Gross Unrealized Losses (54) (182)
Fair Value 2,036 1,892
States, municipalities and political subdivisions    
Debt Securities, Available-for-sale [Line Items]    
Gross Amortized Cost 2,219 2,393
Allowance for Credit Losses 0 0
Net Amortized Cost 2,219 2,393
Gross Unrealized Gains 31 8
Gross Unrealized Losses (35) (129)
Fair Value 2,215 2,272
U.S. corporate securities    
Debt Securities, Available-for-sale [Line Items]    
Gross Amortized Cost 10,156 9,838
Allowance for Credit Losses 0 (3)
Net Amortized Cost 10,156 9,835
Gross Unrealized Gains 133 26
Gross Unrealized Losses (446) (903)
Fair Value 9,843 8,958
Foreign securities    
Debt Securities, Available-for-sale [Line Items]    
Gross Amortized Cost 2,593 2,780
Allowance for Credit Losses 0 (1)
Net Amortized Cost 2,593 2,779
Gross Unrealized Gains 41 15
Gross Unrealized Losses (122) (244)
Fair Value 2,512 2,550
Residential mortgage-backed securities    
Debt Securities, Available-for-sale [Line Items]    
Gross Amortized Cost 862 845
Allowance for Credit Losses 0 0
Net Amortized Cost 862 845
Gross Unrealized Gains 8 1
Gross Unrealized Losses (60) (89)
Fair Value 810 757
Commercial mortgage-backed securities    
Debt Securities, Available-for-sale [Line Items]    
Gross Amortized Cost 1,066 1,172
Allowance for Credit Losses 0 0
Net Amortized Cost 1,066 1,172
Gross Unrealized Gains 9 1
Gross Unrealized Losses (100) (155)
Fair Value 975 1,018
Other asset-backed securities    
Debt Securities, Available-for-sale [Line Items]    
Gross Amortized Cost 3,294 2,940
Allowance for Credit Losses 0 0
Net Amortized Cost 3,294 2,940
Gross Unrealized Gains 26 6
Gross Unrealized Losses (18) (136)
Fair Value 3,302 2,810
Redeemable preferred securities    
Debt Securities, Available-for-sale [Line Items]    
Gross Amortized Cost 21 25
Allowance for Credit Losses 0 0
Net Amortized Cost 21 25
Gross Unrealized Gains 0 0
Gross Unrealized Losses (1) (2)
Fair Value 20 23
Supporting experience- rated products    
Debt Securities, Available-for-sale [Line Items]    
Gross Unrealized Gains 10 3
Gross Unrealized Losses (28) (59)
Fair Value $ 592 $ 609
v3.24.0.1
Investments - Debt Securities by Maturity (Details) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Amortized Cost    
Less than one year $ 1,244  
One year through five years 7,563  
After five years through ten years 4,302  
Greater than ten years 3,951  
Net Amortized Cost 22,282 $ 22,063
Fair Value    
Less than one year 1,230  
One year through five years 7,390  
After five years through ten years 4,204  
Greater than ten years 3,802  
Total 21,713 20,280
Residential mortgage-backed securities    
Amortized Cost    
Debt securities, maturity, without single maturity date 862  
Net Amortized Cost 862 845
Fair Value    
Debt securities, maturity, without single maturity date 810  
Total 810 757
Commercial mortgage-backed securities    
Amortized Cost    
Debt securities, maturity, without single maturity date 1,066  
Net Amortized Cost 1,066 1,172
Fair Value    
Debt securities, maturity, without single maturity date 975  
Total 975 1,018
Other asset-backed securities    
Amortized Cost    
Debt securities, maturity, without single maturity date 3,294  
Net Amortized Cost 3,294 2,940
Fair Value    
Debt securities, maturity, without single maturity date 3,302  
Total $ 3,302 $ 2,810
v3.24.0.1
Investments - Unrealized Loss Position (Details)
$ in Millions
Dec. 31, 2023
USD ($)
security
Dec. 31, 2022
USD ($)
security
Number of Securities    
Number of Securities, Less than 12 months | security 1,182 9,500
Number of Securities, Greater than 12 months | security 7,018 2,784
Number of Securities | security 8,200 12,284
Fair Value    
Fair Value, Less than 12 months $ 1,932 $ 14,228
Fair Value, Greater than 12 months 10,616 4,264
Fair Value 12,548 18,492
Unrealized Losses    
Unrealized Losses, Less than 12 months 28 1,226
Unrealized Losses, Greater than 12 months 808 614
Unrealized Losses $ 836 $ 1,840
U.S. government securities    
Number of Securities    
Number of Securities, Less than 12 months | security 74 519
Number of Securities, Greater than 12 months | security 280 35
Number of Securities | security 354 554
Fair Value    
Fair Value, Less than 12 months $ 194 $ 1,620
Fair Value, Greater than 12 months 891 191
Fair Value 1,085 1,811
Unrealized Losses    
Unrealized Losses, Less than 12 months 2 164
Unrealized Losses, Greater than 12 months 52 18
Unrealized Losses $ 54 $ 182
States, municipalities and political subdivisions    
Number of Securities    
Number of Securities, Less than 12 months | security 95 859
Number of Securities, Greater than 12 months | security 455 196
Number of Securities | security 550 1,055
Fair Value    
Fair Value, Less than 12 months $ 181 $ 1,370
Fair Value, Greater than 12 months 733 322
Fair Value 914 1,692
Unrealized Losses    
Unrealized Losses, Less than 12 months 1 95
Unrealized Losses, Greater than 12 months 34 34
Unrealized Losses $ 35 $ 129
U.S. corporate securities    
Number of Securities    
Number of Securities, Less than 12 months | security 576 5,193
Number of Securities, Greater than 12 months | security 4,120 1,479
Number of Securities | security 4,696 6,672
Fair Value    
Fair Value, Less than 12 months $ 672 $ 6,537
Fair Value, Greater than 12 months 5,602 1,822
Fair Value 6,274 8,359
Unrealized Losses    
Unrealized Losses, Less than 12 months 14 622
Unrealized Losses, Greater than 12 months 432 281
Unrealized Losses $ 446 $ 903
Foreign securities    
Number of Securities    
Number of Securities, Less than 12 months | security 160 1,168
Number of Securities, Greater than 12 months | security 964 403
Number of Securities | security 1,124 1,571
Fair Value    
Fair Value, Less than 12 months $ 243 $ 1,715
Fair Value, Greater than 12 months 1,407 592
Fair Value 1,650 2,307
Unrealized Losses    
Unrealized Losses, Less than 12 months 4 147
Unrealized Losses, Greater than 12 months 118 97
Unrealized Losses $ 122 $ 244
Residential mortgage-backed securities    
Number of Securities    
Number of Securities, Less than 12 months | security 33 452
Number of Securities, Greater than 12 months | security 461 91
Number of Securities | security 494 543
Fair Value    
Fair Value, Less than 12 months $ 97 $ 464
Fair Value, Greater than 12 months 517 257
Fair Value 614 721
Unrealized Losses    
Unrealized Losses, Less than 12 months 1 39
Unrealized Losses, Greater than 12 months 59 50
Unrealized Losses $ 60 $ 89
Commercial mortgage-backed securities    
Number of Securities    
Number of Securities, Less than 12 months | security 44 288
Number of Securities, Greater than 12 months | security 287 187
Number of Securities | security 331 475
Fair Value    
Fair Value, Less than 12 months $ 94 $ 611
Fair Value, Greater than 12 months 581 381
Fair Value 675 992
Unrealized Losses    
Unrealized Losses, Less than 12 months 2 69
Unrealized Losses, Greater than 12 months 98 86
Unrealized Losses $ 100 $ 155
Other asset-backed securities    
Number of Securities    
Number of Securities, Less than 12 months | security 196 1,008
Number of Securities, Greater than 12 months | security 443 391
Number of Securities | security 639 1,399
Fair Value    
Fair Value, Less than 12 months $ 449 $ 1,893
Fair Value, Greater than 12 months 867 694
Fair Value 1,316 2,587
Unrealized Losses    
Unrealized Losses, Less than 12 months 4 88
Unrealized Losses, Greater than 12 months 14 48
Unrealized Losses $ 18 $ 136
Redeemable preferred securities    
Number of Securities    
Number of Securities, Less than 12 months | security 4 13
Number of Securities, Greater than 12 months | security 8 2
Number of Securities | security 12 15
Fair Value    
Fair Value, Less than 12 months $ 2 $ 18
Fair Value, Greater than 12 months 18 5
Fair Value 20 23
Unrealized Losses    
Unrealized Losses, Less than 12 months 0 2
Unrealized Losses, Greater than 12 months 1 0
Unrealized Losses $ 1 $ 2
v3.24.0.1
Investments - Unrealized Loss Position Maturities (Details) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Fair Value    
Less than one year $ 1,072  
One year through five years 4,632  
After five years through ten years 2,012  
Greater than ten years 2,227  
Fair Value 12,548 $ 18,492
Unrealized Losses    
Less than one year 16  
One year through five years 229  
After five years through ten years 179  
Greater than ten years 234  
Unrealized Losses 836 1,840
Residential mortgage-backed securities    
Fair Value    
Debt securities, maturity, without single maturity date, fair value 614  
Fair Value 614 721
Unrealized Losses    
Debt securities, maturity, without single maturity date, unrealized losses 60  
Unrealized Losses 60 89
Commercial mortgage-backed securities    
Fair Value    
Debt securities, maturity, without single maturity date, fair value 675  
Fair Value 675 992
Unrealized Losses    
Debt securities, maturity, without single maturity date, unrealized losses 100  
Unrealized Losses 100 155
Other asset-backed securities    
Fair Value    
Debt securities, maturity, without single maturity date, fair value 1,316  
Fair Value 1,316 2,587
Unrealized Losses    
Debt securities, maturity, without single maturity date, unrealized losses 18  
Unrealized Losses 18 $ 136
Supporting experience- rated products    
Fair Value    
Less than one year 15  
One year through five years 128  
After five years through ten years 87  
Greater than ten years 137  
Fair Value 403  
Unrealized Losses    
Less than one year 0  
One year through five years 3  
After five years through ten years 7  
Greater than ten years 14  
Unrealized Losses 28  
Supporting experience- rated products | Residential mortgage-backed securities    
Fair Value    
Debt securities, maturity, without single maturity date, fair value 9  
Unrealized Losses    
Debt securities, maturity, without single maturity date, unrealized losses 1  
Supporting experience- rated products | Commercial mortgage-backed securities    
Fair Value    
Debt securities, maturity, without single maturity date, fair value 15  
Unrealized Losses    
Debt securities, maturity, without single maturity date, unrealized losses 2  
Supporting experience- rated products | Other asset-backed securities    
Fair Value    
Debt securities, maturity, without single maturity date, fair value 12  
Unrealized Losses    
Debt securities, maturity, without single maturity date, unrealized losses 1  
Supporting remaining products    
Fair Value    
Less than one year 1,057  
One year through five years 4,504  
After five years through ten years 1,925  
Greater than ten years 2,090  
Fair Value 12,145  
Unrealized Losses    
Less than one year 16  
One year through five years 226  
After five years through ten years 172  
Greater than ten years 220  
Unrealized Losses 808  
Supporting remaining products | Residential mortgage-backed securities    
Fair Value    
Debt securities, maturity, without single maturity date, fair value 605  
Unrealized Losses    
Debt securities, maturity, without single maturity date, unrealized losses 59  
Supporting remaining products | Commercial mortgage-backed securities    
Fair Value    
Debt securities, maturity, without single maturity date, fair value 660  
Unrealized Losses    
Debt securities, maturity, without single maturity date, unrealized losses 98  
Supporting remaining products | Other asset-backed securities    
Fair Value    
Debt securities, maturity, without single maturity date, fair value 1,304  
Unrealized Losses    
Debt securities, maturity, without single maturity date, unrealized losses $ 17  
v3.24.0.1
Investments - Mortgage Loans (Details) - Commercial Real Estate - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Mortgage Loans on Real Estate [Line Items]    
New mortgage loans $ 342 $ 356
Mortgage loans fully repaid 43 178
Mortgage loans foreclosed $ 0 $ 0
v3.24.0.1
Investments - Mortgage Loans Credit Ratings Indicator (Details) - Commercial Real Estate - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Mortgage Loans on Real Estate [Line Items]    
Mortgage loans $ 1,311 $ 1,044
2023    
Mortgage Loans on Real Estate [Line Items]    
Mortgage loans 302  
2022    
Mortgage Loans on Real Estate [Line Items]    
Mortgage loans 346 326
2021    
Mortgage Loans on Real Estate [Line Items]    
Mortgage loans 244 247
2020    
Mortgage Loans on Real Estate [Line Items]    
Mortgage loans 35 36
2019    
Mortgage Loans on Real Estate [Line Items]    
Mortgage loans 11 11
Prior    
Mortgage Loans on Real Estate [Line Items]    
Mortgage loans 373 424
1    
Mortgage Loans on Real Estate [Line Items]    
Mortgage loans 11 15
1 | 2023    
Mortgage Loans on Real Estate [Line Items]    
Mortgage loans 0  
1 | 2022    
Mortgage Loans on Real Estate [Line Items]    
Mortgage loans 0 0
1 | 2021    
Mortgage Loans on Real Estate [Line Items]    
Mortgage loans 0 0
1 | 2020    
Mortgage Loans on Real Estate [Line Items]    
Mortgage loans 0 0
1 | 2019    
Mortgage Loans on Real Estate [Line Items]    
Mortgage loans 0 0
1 | Prior    
Mortgage Loans on Real Estate [Line Items]    
Mortgage loans 11 15
2 to 4    
Mortgage Loans on Real Estate [Line Items]    
Mortgage loans 1,262 1,022
2 to 4 | 2023    
Mortgage Loans on Real Estate [Line Items]    
Mortgage loans 302  
2 to 4 | 2022    
Mortgage Loans on Real Estate [Line Items]    
Mortgage loans 346 326
2 to 4 | 2021    
Mortgage Loans on Real Estate [Line Items]    
Mortgage loans 225 247
2 to 4 | 2020    
Mortgage Loans on Real Estate [Line Items]    
Mortgage loans 35 36
2 to 4 | 2019    
Mortgage Loans on Real Estate [Line Items]    
Mortgage loans 11 11
2 to 4 | Prior    
Mortgage Loans on Real Estate [Line Items]    
Mortgage loans 343 402
5 and 6    
Mortgage Loans on Real Estate [Line Items]    
Mortgage loans 32 7
5 and 6 | 2023    
Mortgage Loans on Real Estate [Line Items]    
Mortgage loans 0  
5 and 6 | 2022    
Mortgage Loans on Real Estate [Line Items]    
Mortgage loans 0 0
5 and 6 | 2021    
Mortgage Loans on Real Estate [Line Items]    
Mortgage loans 13 0
5 and 6 | 2020    
Mortgage Loans on Real Estate [Line Items]    
Mortgage loans 0 0
5 and 6 | 2019    
Mortgage Loans on Real Estate [Line Items]    
Mortgage loans 0 0
5 and 6 | Prior    
Mortgage Loans on Real Estate [Line Items]    
Mortgage loans 19 7
7    
Mortgage Loans on Real Estate [Line Items]    
Mortgage loans 6 0
7 | 2023    
Mortgage Loans on Real Estate [Line Items]    
Mortgage loans 0  
7 | 2022    
Mortgage Loans on Real Estate [Line Items]    
Mortgage loans 0 0
7 | 2021    
Mortgage Loans on Real Estate [Line Items]    
Mortgage loans 6 0
7 | 2020    
Mortgage Loans on Real Estate [Line Items]    
Mortgage loans 0 0
7 | 2019    
Mortgage Loans on Real Estate [Line Items]    
Mortgage loans 0 0
7 | Prior    
Mortgage Loans on Real Estate [Line Items]    
Mortgage loans $ 0 $ 0
v3.24.0.1
Investments - Mortgage Loan Principal Repayments (Details) - Commercial Real Estate
$ in Millions
Dec. 31, 2023
USD ($)
Mortgage Loans on Real Estate [Line Items]  
2024 $ 128
2025 123
2026 179
2027 229
2028 300
Thereafter 352
Total $ 1,311
v3.24.0.1
Investments - Net Investment Income (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Schedule of Investment Income, Reported Amounts, by Category [Line Items]      
Gross investment income $ 1,696 $ 1,201 $ 1,070
Investment expenses (46) (43) (47)
Net investment income (excluding net realized capital gains or losses) 1,650 1,158 1,023
Net realized capital gains (losses) (497) (320) 176
Net investment income 1,153 838 1,199
Yield-related impairment loss 152 143 42
Credit-related impairment loss (reversal of loss) (3) 13 0
Supporting experience- rated products      
Schedule of Investment Income, Reported Amounts, by Category [Line Items]      
Net investment income 34 35 38
Debt securities      
Schedule of Investment Income, Reported Amounts, by Category [Line Items]      
Gross investment income 841 702 634
Mortgage loans      
Schedule of Investment Income, Reported Amounts, by Category [Line Items]      
Gross investment income 59 51 55
Other investments      
Schedule of Investment Income, Reported Amounts, by Category [Line Items]      
Gross investment income $ 796 $ 448 $ 381
v3.24.0.1
Investments - Realized Gains (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Investments [Abstract]      
Proceeds from sales $ 5,031 $ 4,243 $ 3,572
Gross realized capital gains 9 24 72
Gross realized capital losses $ 420 $ 177 $ 14
v3.24.0.1
Fair Value - Measurement on a Recurring Basis (Details) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities $ 21,713 $ 20,280
U.S. government securities    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 2,036 1,892
States, municipalities and political subdivisions    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 2,215 2,272
U.S. corporate securities    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 9,843 8,958
Foreign securities    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 2,512 2,550
Residential mortgage-backed securities    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 810 757
Commercial mortgage-backed securities    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 975 1,018
Other asset-backed securities    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 3,302 2,810
Redeemable preferred securities    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 20 23
Recurring    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Financial liabilities measured at fair value on a recurring basis 0 0
Cash and cash equivalents 8,196 12,951
Debt securities 21,713 20,280
Equity securities 273 176
Total 30,182 33,407
Recurring | Disposal Group, Held-for-sale, Not Discontinued Operations    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Cash and cash equivalents   6
Recurring | Level 1    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Cash and cash equivalents 2,174 6,902
Debt securities 2,013 1,860
Equity securities 194 116
Total 4,381 8,878
Recurring | Level 2    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Cash and cash equivalents 6,022 6,049
Debt securities 19,671 18,351
Equity securities 0 0
Total 25,693 24,400
Recurring | Level 3    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Cash and cash equivalents 0 0
Debt securities 29 69
Equity securities 79 60
Total 108 129
Recurring | U.S. government securities    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 2,036 1,892
Recurring | U.S. government securities | Level 1    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 2,013 1,860
Recurring | U.S. government securities | Level 2    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 23 32
Recurring | U.S. government securities | Level 3    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 0 0
Recurring | States, municipalities and political subdivisions    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 2,215 2,272
Recurring | States, municipalities and political subdivisions | Level 1    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 0 0
Recurring | States, municipalities and political subdivisions | Level 2    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 2,215 2,272
Recurring | States, municipalities and political subdivisions | Level 3    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 0 0
Recurring | U.S. corporate securities    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 9,843 8,958
Recurring | U.S. corporate securities | Level 1    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 0 0
Recurring | U.S. corporate securities | Level 2    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 9,814 8,897
Recurring | U.S. corporate securities | Level 3    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 29 61
Recurring | Foreign securities    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 2,512 2,550
Recurring | Foreign securities | Level 1    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 0 0
Recurring | Foreign securities | Level 2    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 2,512 2,542
Recurring | Foreign securities | Level 3    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 0 8
Recurring | Residential mortgage-backed securities    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 810 757
Recurring | Residential mortgage-backed securities | Level 1    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 0 0
Recurring | Residential mortgage-backed securities | Level 2    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 810 757
Recurring | Residential mortgage-backed securities | Level 3    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 0 0
Recurring | Commercial mortgage-backed securities    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 975 1,018
Recurring | Commercial mortgage-backed securities | Level 1    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 0 0
Recurring | Commercial mortgage-backed securities | Level 2    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 975 1,018
Recurring | Commercial mortgage-backed securities | Level 3    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 0 0
Recurring | Other asset-backed securities    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 3,302 2,810
Recurring | Other asset-backed securities | Level 1    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 0 0
Recurring | Other asset-backed securities | Level 2    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 3,302 2,810
Recurring | Other asset-backed securities | Level 3    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 0 0
Recurring | Redeemable preferred securities    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 20 23
Recurring | Redeemable preferred securities | Level 1    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 0 0
Recurring | Redeemable preferred securities | Level 2    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities 20 23
Recurring | Redeemable preferred securities | Level 3    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Debt securities $ 0 $ 0
v3.24.0.1
Fair Value - Changes in Level 3 Financial Assets (Details) - Recurring - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Fair Value, Assets Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]    
Beginning balance $ 129 $ 111
Net realized and unrealized capital losses:    
Included in earnings (10) (9)
Included in other comprehensive income (loss) 1 (9)
Purchases 41 95
Sales (3) (30)
Settlements   0
Gross transfers out of level 3 (50) (29)
Ending balance 108 129
Commercial mortgage-backed securities    
Fair Value, Assets Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]    
Beginning balance 0  
Net realized and unrealized capital losses:    
Included in earnings 0  
Included in other comprehensive income (loss) 0  
Purchases 13  
Sales 0  
Gross transfers out of level 3 (13)  
Ending balance 0 0
States, municipalities and political subdivisions    
Fair Value, Assets Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]    
Beginning balance 0 5
Net realized and unrealized capital losses:    
Included in earnings   0
Included in other comprehensive income (loss)   0
Purchases   0
Sales   (5)
Settlements   0
Gross transfers out of level 3   0
Ending balance   0
U.S. corporate securities    
Fair Value, Assets Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]    
Beginning balance 61 38
Net realized and unrealized capital losses:    
Included in earnings (8) (8)
Included in other comprehensive income (loss) 1 (5)
Purchases 5 36
Sales (1) 0
Settlements   0
Gross transfers out of level 3 (29) 0
Ending balance 29 61
Foreign securities    
Fair Value, Assets Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]    
Beginning balance 8 10
Net realized and unrealized capital losses:    
Included in earnings 0 0
Included in other comprehensive income (loss) 0 (2)
Purchases 0 0
Sales 0 0
Settlements   0
Gross transfers out of level 3 (8) 0
Ending balance 0 8
Other asset-backed securities    
Fair Value, Assets Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]    
Beginning balance 0 3
Net realized and unrealized capital losses:    
Included in earnings  
Included in other comprehensive income (loss)   (2)
Purchases   30
Sales   (2)
Settlements   0
Gross transfers out of level 3   (29)
Ending balance   0
Equity securities    
Fair Value, Assets Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]    
Beginning balance 60 55
Net realized and unrealized capital losses:    
Included in earnings (2) (1)
Included in other comprehensive income (loss) 0 0
Purchases 23 29
Sales (2) (23)
Settlements   0
Gross transfers out of level 3 0 0
Ending balance $ 79 $ 60
v3.24.0.1
Fair Value - Narrative (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Change in unrealized capital losses included in OCI associated with Level 3 financial assets $ 9 $ 9
Level 3 | Recurring    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Gross transfers into Level 3 0 0
Gross transfers out of Level 3 50 29
Level 3 | Recurring | Separate Accounts, financial assets    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Gross transfers into Level 3 0 0
Gross transfers out of Level 3 $ 0 $ 0
v3.24.0.1
Fair Value - Gross Transfers Into (Out of) Level 3 (Details) - Recurring - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Net transfers out of Level 3 $ (50) $ (29)
Level 3    
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]    
Gross transfers into Level 3 0 0
Gross transfers out of Level 3 (50) (29)
Net transfers out of Level 3 $ (50) $ (29)
v3.24.0.1
Fair Value - Carrying Value and Fair Value Classified by Level (Details) - Nonrecurring - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Carrying Value    
Assets:    
Mortgage loans $ 1,311 $ 1,044
Equity securities 534 411
Liabilities:    
Investment contract liabilities with a fixed maturity 1 3
Investment contracts liabilities without a fixed maturity 312 332
Long-term debt 61,410 52,257
Carrying Value | Disposal Group, Held-for-sale, Not Discontinued Operations    
Liabilities:    
Long-term debt   3
Estimated Fair Value    
Assets:    
Mortgage loans 1,274 978
Liabilities:    
Investment contract liabilities with a fixed maturity 1 3
Investment contracts liabilities without a fixed maturity 279 305
Long-term debt 58,451 47,653
Level 1 | Estimated Fair Value    
Assets:    
Mortgage loans 0 0
Liabilities:    
Investment contract liabilities with a fixed maturity 0 0
Investment contracts liabilities without a fixed maturity 0 0
Long-term debt 58,451 47,653
Level 2 | Estimated Fair Value    
Assets:    
Mortgage loans 0 0
Liabilities:    
Investment contract liabilities with a fixed maturity 0 0
Investment contracts liabilities without a fixed maturity 0 0
Long-term debt 0 0
Level 3 | Estimated Fair Value    
Assets:    
Mortgage loans 1,274 978
Liabilities:    
Investment contract liabilities with a fixed maturity 1 3
Investment contracts liabilities without a fixed maturity 279 305
Long-term debt $ 0 $ 0
v3.24.0.1
Fair Value - Separate Accounts Fair Value (Details) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Fair Value, Separate Account Investment [Line Items]      
Separate accounts assets $ 3,250 $ 3,228  
Separate accounts liabilities 3,250 3,228 $ 5,087
Recurring      
Fair Value, Separate Account Investment [Line Items]      
Separate accounts assets 3,204 3,313  
Recurring | Other Receivables      
Fair Value, Separate Account Investment [Line Items]      
Separate accounts assets 46    
Recurring | Other Payables      
Fair Value, Separate Account Investment [Line Items]      
Separate accounts liabilities   85  
Recurring | Cash and cash equivalents      
Fair Value, Separate Account Investment [Line Items]      
Separate accounts assets 168 156  
Recurring | Debt securities      
Fair Value, Separate Account Investment [Line Items]      
Separate accounts assets 2,507 2,677  
Recurring | Common/collective trusts      
Fair Value, Separate Account Investment [Line Items]      
Separate accounts assets 529 480  
Recurring | Level 1      
Fair Value, Separate Account Investment [Line Items]      
Separate accounts assets 560 714  
Recurring | Level 1 | Cash and cash equivalents      
Fair Value, Separate Account Investment [Line Items]      
Separate accounts assets 2 2  
Recurring | Level 1 | Debt securities      
Fair Value, Separate Account Investment [Line Items]      
Separate accounts assets 558 712  
Recurring | Level 1 | Common/collective trusts      
Fair Value, Separate Account Investment [Line Items]      
Separate accounts assets 0 0  
Recurring | Level 2      
Fair Value, Separate Account Investment [Line Items]      
Separate accounts assets 2,644 2,599  
Recurring | Level 2 | Cash and cash equivalents      
Fair Value, Separate Account Investment [Line Items]      
Separate accounts assets 166 154  
Recurring | Level 2 | Debt securities      
Fair Value, Separate Account Investment [Line Items]      
Separate accounts assets 1,949 1,965  
Recurring | Level 2 | Common/collective trusts      
Fair Value, Separate Account Investment [Line Items]      
Separate accounts assets 529 480  
Recurring | Level 3      
Fair Value, Separate Account Investment [Line Items]      
Separate accounts assets 0 0  
Recurring | Level 3 | Cash and cash equivalents      
Fair Value, Separate Account Investment [Line Items]      
Separate accounts assets 0 0  
Recurring | Level 3 | Debt securities      
Fair Value, Separate Account Investment [Line Items]      
Separate accounts assets 0 0  
Recurring | Level 3 | Common/collective trusts      
Fair Value, Separate Account Investment [Line Items]      
Separate accounts assets $ 0 $ 0  
v3.24.0.1
Goodwill and Other Intangibles - Goodwill (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Goodwill [Roll Forward]    
Balance, beginning of the period $ 78,150 $ 79,121
Segment realignment 0  
Acquisitions 13,122  
Balance, end of the period 91,272 78,150
Disposal Group, Disposed of by Sale, Not Discontinued Operations    
Goodwill [Roll Forward]    
Divestitures   (971)
Health Care Benefits    
Goodwill [Roll Forward]    
Balance, beginning of the period 44,159 45,130
Segment realignment (109)  
Acquisitions 2,594  
Balance, end of the period 46,644 44,159
Health Care Benefits | Disposal Group, Disposed of by Sale, Not Discontinued Operations    
Goodwill [Roll Forward]    
Divestitures   (971)
Health Services    
Goodwill [Roll Forward]    
Balance, beginning of the period 23,615 23,615
Segment realignment 109  
Acquisitions 10,342  
Balance, end of the period 34,066 23,615
Health Services | Disposal Group, Disposed of by Sale, Not Discontinued Operations    
Goodwill [Roll Forward]    
Divestitures   0
Pharmacy & Consumer Wellness    
Goodwill [Roll Forward]    
Balance, beginning of the period 10,376 10,376
Segment realignment 0  
Acquisitions 186  
Balance, end of the period $ 10,562 10,376
Pharmacy & Consumer Wellness | Disposal Group, Disposed of by Sale, Not Discontinued Operations    
Goodwill [Roll Forward]    
Divestitures   $ 0
v3.24.0.1
Goodwill and Other Intangibles - Narrative (Details) - USD ($)
$ in Millions
 3 Months Ended 12 Months Ended
Sep. 30, 2021
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Goodwill [Line Items]        
Goodwill impairment   $ 0 $ 0 $ 431
Goodwill   91,272 78,150 79,121
Cumulative goodwill impairments   6,600 6,600  
Amortization of intangible assets   $ 1,905 $ 1,785 2,233
Long-Term Care Reporting Unit        
Goodwill [Line Items]        
Goodwill impairment $ 431      
Goodwill       $ 0
v3.24.0.1
Goodwill and Other Intangibles - Intangible Assets (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Other Intangible Assets[Line Items]    
Indefinite-lived intangible assets, Trademarks $ 10,498 $ 10,498
Finite-lived intangible assets, accumulated amortization (14,932) (13,028)
Intangible assets, gross 44,166 37,859
Intangible assets, net $ 29,234 24,803
Intangible assets, net   $ 24,831
Weighted Average Life (years) 14 years 6 months 13 years 10 months 24 days
Disposal Group, Held-for-sale, Not Discontinued Operations    
Other Intangible Assets[Line Items]    
Intangible assets, net   $ 28
Customer contracts/relationships and covenants not to compete    
Other Intangible Assets[Line Items]    
Finite-lived intangible assets, gross carrying amount $ 26,784 21,206
Finite-lived intangible assets, accumulated amortization (12,241) (10,668)
Finite-lived intangible assets, net carrying amount $ 14,543 $ 10,538
Weighted Average Life (years) 14 years 2 months 12 days 13 years 3 months 18 days
Technology    
Other Intangible Assets[Line Items]    
Finite-lived intangible assets, gross carrying amount $ 1,253 $ 1,060
Finite-lived intangible assets, accumulated amortization (1,104) (1,060)
Finite-lived intangible assets, net carrying amount $ 149 $ 0
Weighted Average Life (years) 3 years 0 years
Provider networks    
Other Intangible Assets[Line Items]    
Finite-lived intangible assets, gross carrying amount $ 4,203 $ 4,203
Finite-lived intangible assets, accumulated amortization (1,072) (862)
Finite-lived intangible assets, net carrying amount $ 3,131 $ 3,341
Weighted Average Life (years) 20 years 20 years
Value of Business Acquired    
Other Intangible Assets[Line Items]    
Finite-lived intangible assets, gross carrying amount $ 590 $ 590
Finite-lived intangible assets, accumulated amortization (201) (174)
Finite-lived intangible assets, net carrying amount $ 389 $ 416
Weighted Average Life (years) 20 years 20 years
Other    
Other Intangible Assets[Line Items]    
Finite-lived intangible assets, gross carrying amount $ 838 $ 302
Finite-lived intangible assets, accumulated amortization (314) (264)
Finite-lived intangible assets, net carrying amount $ 524 $ 38
Weighted Average Life (years) 9 years 3 months 18 days 12 years 4 months 24 days
v3.24.0.1
Goodwill and Other Intangibles - Future Amortization Expense (Details)
$ in Millions
Dec. 31, 2023
USD ($)
Finite-Lived Intangible Assets, Net, Amortization Expense, Fiscal Year Maturity [Abstract]  
2024 $ 2,011
2025 1,964
2026 1,687
2027 1,580
2028 $ 1,306
v3.24.0.1
Leases - Narrative (Details)
$ in Millions
 3 Months Ended 12 Months Ended
Dec. 31, 2022
USD ($)
Dec. 31, 2021
USD ($)
store
Dec. 31, 2023
USD ($)
Dec. 31, 2022
USD ($)
Dec. 31, 2021
USD ($)
store
Operating Leased Assets [Line Items]          
Office real estate optimization charges $ 117   $ 46 $ 117 $ 0
Number of stores, planned closure | store         900
Store impairment charges     0 $ 0 $ 1,358
Operating lease right-of-use asset          
Operating Leased Assets [Line Items]          
Office real estate optimization charges 71   $ 20    
Pharmacy & Consumer Wellness          
Operating Leased Assets [Line Items]          
Number of stores, planned closure | store   900     900
Number of stores, annual planned closures for closure period | store   300      
Store impairment charges   $ 1,400     $ 1,400
Pharmacy & Consumer Wellness | Operating lease right-of-use asset          
Operating Leased Assets [Line Items]          
Store impairment charges   1,100      
Operating lease, right-of-use asset, fair value   356     356
Distribution centers and Corporate offices | Minimum          
Operating Leased Assets [Line Items]          
Operating lease term (in years)     15 years    
Finance lease term (in years)     15 years    
Distribution centers and Corporate offices | Maximum          
Operating Leased Assets [Line Items]          
Operating lease term (in years)     25 years    
Finance lease term (in years)     25 years    
Equipment | Minimum          
Operating Leased Assets [Line Items]          
Operating lease term (in years)     3 years    
Finance lease term (in years)     3 years    
Equipment | Maximum          
Operating Leased Assets [Line Items]          
Operating lease term (in years)     10 years    
Finance lease term (in years)     10 years    
Property and equipment          
Operating Leased Assets [Line Items]          
Office real estate optimization charges $ 44   $ 18    
Property and equipment | Pharmacy & Consumer Wellness          
Operating Leased Assets [Line Items]          
Store impairment charges   261      
Property and equipment, fair value   $ 185     $ 185
v3.24.0.1
Leases - Summary of the Components of Net Lease Cost (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Leases [Abstract]      
Operating lease cost $ 2,532 $ 2,579 $ 2,633
Finance lease cost:      
Amortization of right-of-use assets 84 79 62
Interest on lease liabilities 73 68 62
Total finance lease costs 157 147 124
Short-term lease costs 22 27 25
Variable lease costs 635 610 604
Less: sublease income (63) (61) (59)
Net lease cost $ 3,283 $ 3,302 $ 3,327
v3.24.0.1
Leases - Supplemental Cash Flow Information (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Cash paid for amounts included in the measurement of lease liabilities:      
Operating cash flows paid for operating leases $ 2,756 $ 2,689 $ 2,714
Operating cash flows paid for interest portion of finance leases 73 68 62
Financing cash flows paid for principal portion of finance leases 70 62 50
Right-of-use assets obtained in exchange for lease obligations:      
Operating leases 1,132 591 1,254
Finance leases $ (4)    
Finance leases   $ 232 $ 278
v3.24.0.1
Leases - Supplemental Balance Sheet Information (Details) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Operating leases:    
Operating lease right-of-use assets $ 17,252 $ 17,872
Operating lease right-of-use assets   17,928
Current portion of operating lease liabilities 1,741 1,678
Current portion of operating lease liabilities   1,699
Long-term operating lease liabilities 16,034 16,800
Long-term operating lease liabilities   16,839
Total operating lease liabilities 17,775 18,538
Finance leases:    
Property and equipment, gross 1,604 1,608
Accumulated depreciation $ (375) $ (284)
Finance Lease, Right-of-Use Asset, Statement of Financial Position [Extensible Enumeration] Property and equipment, net Property and equipment, net
Property and equipment, net $ 1,229 $ 1,324
Current portion of long-term debt 66 59
Long-term debt 1,325 1,406
Total finance lease liabilities $ 1,391 $ 1,465
Weighted average remaining lease term (in years)    
Operating leases 11 years 4 months 24 days 12 years 2 months 12 days
Finance leases 17 years 3 months 18 days 19 years 4 months 24 days
Weighted average discount rate    
Operating leases 4.50% 4.40%
Finance leases 5.00% 4.90%
Disposal Group, Held-for-sale, Not Discontinued Operations    
Operating leases:    
Operating lease right-of-use assets   $ 56
Current portion of operating lease liabilities   21
Long-term operating lease liabilities   $ 39
v3.24.0.1
Leases - Maturities of Operating and Finance Lease Liabilities (Details) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Finance Leases    
2024 $ 143  
2025 138  
2026 130  
2027 127  
2028 124  
Thereafter 1,446  
Total lease payments 2,108  
Less: imputed interest (717)  
Total finance lease liabilities 1,391 $ 1,465
Operating Leases    
2024 2,716  
2025 2,559  
2026 2,369  
2027 2,181  
2028 2,024  
Thereafter 11,004  
Total lease payments 22,853  
Less: imputed interest (5,078)  
Total operating lease liabilities 17,775 $ 18,538
Total    
2024 2,859  
2025 2,697  
2026 2,499  
2027 2,308  
2028 2,148  
Thereafter 12,450  
Total lease payments 24,961  
Less: imputed interest (5,795)  
Total lease liabilities 19,166  
Future noncancelable subleases, future minimum payments 289  
Leases, amount due in excess of remaining estimated economic life $ 2,100  
v3.24.0.1
Health Care Costs Payable - Incurred and Paid Health Care Claims Development (Details) - Health Insurance Product Line - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Claims Development [Line Items]    
Incurred Health Care Claims, Net of Reinsurance $ 150,902  
Cumulative Paid Health Care Claims, Net of Reinsurance 140,538  
All outstanding liabilities for health care costs payable prior to 2022, net of reinsurance 171  
Total outstanding liabilities for health care costs payable, net of reinsurance 10,535  
2022    
Claims Development [Line Items]    
Incurred Health Care Claims, Net of Reinsurance 68,540 $ 69,185
Cumulative Paid Health Care Claims, Net of Reinsurance 68,363 $ 59,570
2023    
Claims Development [Line Items]    
Incurred Health Care Claims, Net of Reinsurance 82,362  
Cumulative Paid Health Care Claims, Net of Reinsurance $ 72,175  
v3.24.0.1
Health Care Costs Payable - Narrative (Details)
$ in Millions
 12 Months Ended
Dec. 31, 2023
USD ($)
Liability for Claims and Claims Adjustment Expense [Line Items]  
Decrease in prior years' healthcare costs payable $ 685
Health Care Benefits  
Liability for Claims and Claims Adjustment Expense [Line Items]  
Liabilities for IBNR plus expected development on reported claims $ 8,700
v3.24.0.1
Health Care Costs Payable - Liability for Unpaid Claims and Claims Adjustment Expense (Details) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Short-duration Insurance Contracts, Reconciliation of Claims Development to Liability [Line Items]        
Reinsurance recoverables $ 5      
Other non-insurance health care costs payable 1,292      
Total health care costs payable 12,049      
Health Insurance Product Line        
Short-duration Insurance Contracts, Reconciliation of Claims Development to Liability [Line Items]        
Total outstanding liabilities for health care costs payable, net of reinsurance 10,535      
Reinsurance recoverables 5 $ 5 $ 8 $ 10
Insurance lines other than short duration $ 217      
Total health care costs payable   $ 10,142    
v3.24.0.1
Health Care Costs Payable - Components of Change in Health Care Costs Payable (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Liability for Unpaid Claims and Claims Adjustment Expense [Roll Forward]      
Health care costs payable, beginning of period $ 10,142    
Acquisition, net 1,098    
Add: Components of incurred health care costs      
Current year 86,639    
Prior years (685)    
Total incurred health care costs 85,954    
Less: Claims paid      
Current year 75,529    
Prior years 9,585    
Total claims paid 85,114    
Add: Premium deficiency reserve 0 $ 0  
Health care costs payable, end of period, net 12,067    
Add: Reinsurance recoverables 5    
Add: Impact of discount rate on long-duration insurance reserves (23)    
Health care costs payable, end of period 12,049    
Health care costs payable, end of period   10,142  
Premium deficiency reserve 0 0  
Health Care Benefits      
Less: Claims paid      
Benefit costs recorded in other insurance liabilities 83 79 $ 58
Corporate/ Other      
Less: Claims paid      
Benefit costs recorded in other insurance liabilities 210 249 271
Health Insurance Product Line      
Liability for Unpaid Claims and Claims Adjustment Expense [Roll Forward]      
Health care costs payable, beginning of period 10,142    
Health care costs payable, beginning of period 10,142 8,678 7,936
Less: Reinsurance recoverables 5 8 10
Less: Impact of discount rate on long-duration insurance reserves 8 0 0
Health care costs payable, beginning of period, net 10,129 8,670 7,926
Acquisition, net   0 0
Add: Components of incurred health care costs      
Current year   71,399 64,631
Prior years   (654) (788)
Total incurred health care costs   70,745 63,843
Less: Claims paid      
Current year   61,640 56,323
Prior years   7,646 6,792
Total claims paid   69,286 63,115
Add: Premium deficiency reserve   0 16
Health care costs payable, end of period, net   10,129 8,670
Add: Reinsurance recoverables $ 5 5 8
Add: Impact of discount rate on long-duration insurance reserves   8 0
Health care costs payable, end of period   10,142  
Health care costs payable, end of period   10,142 8,678
Premium deficiency reserve   $ 0 $ 16
v3.24.0.1
Other Insurance Liabilities and Separate Accounts - Changes in Liability for Future Policy Benefits (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Present value of expected future policy benefits        
Effect of changes in discount rate assumptions $ (23)      
Large Case Pensions        
Present value of expected future policy benefits        
Liability for future policy benefits, beginning of period - current discount rate 2,253 $ 3,034    
Beginning liability for future policy benefits at original (locked-in) discount rate 2,425 2,650    
Effect of changes in cash flow assumptions   0 $ 0  
Effect of actual variances from expected experience   (3) (44)  
Adjusted beginning liability for future policy benefits - original (locked-in) discount rate   2,422 2,606  
Issuances 8 4    
Interest accrual (using locked-in discount rate) 97 106    
Benefit payments (actual) (276) (291)    
Ending liability for future policy benefits at original (locked-in) discount rate 2,251 2,425    
Effect of changes in discount rate assumptions (112) (172)    
Liability for future policy benefits, end of period - current discount rate 2,139 2,253    
Net liability for future policy benefits 2,139 2,253    
Less: Reinsurance recoverable 0 0   $ 0
Net liability for future policy benefits, net of reinsurance recoverable 2,139 2,253   3,647
Long-Term Care        
Present value of expected net premiums        
Liability for future policy benefits, beginning of period - current discount rate 300 389    
Beginning liability for future policy benefits at original (locked-in) discount rate 302 323    
Effect of changes in cash flow assumptions   0 (15)  
Effect of actual variances from expected experience   10 18  
Adjusted beginning liability for future policy benefits - original (locked-in) discount rate   312 326  
Interest accrual (using locked-in discount rate) 15 16    
Net premiums (actual) (39) (40)    
Ending liability for future policy benefits at original (locked-in) discount rate 288 302    
Effect of changes in discount rate assumptions 5 (2)    
Liability for future policy benefits, end of period - current discount rate 293 300    
Present value of expected future policy benefits        
Liability for future policy benefits, beginning of period - current discount rate 1,566 1,991    
Beginning liability for future policy benefits at original (locked-in) discount rate 1,613 1,480    
Effect of changes in cash flow assumptions   0 99  
Effect of actual variances from expected experience   8 18  
Adjusted beginning liability for future policy benefits - original (locked-in) discount rate   1,621 $ 1,597  
Issuances 0 0    
Interest accrual (using locked-in discount rate) 82 80    
Benefit payments (actual) (71) (64)    
Ending liability for future policy benefits at original (locked-in) discount rate 1,632 1,613    
Effect of changes in discount rate assumptions 8 (47)    
Liability for future policy benefits, end of period - current discount rate 1,640 1,566    
Net liability for future policy benefits 1,347 1,266    
Less: Reinsurance recoverable 0 0   0
Net liability for future policy benefits, net of reinsurance recoverable $ 1,347 $ 1,266   $ 1,695
v3.24.0.1
Other Insurance Liabilities and Separate Accounts - Undiscounted Expected Gross Premiums and Expected Future Benefit Payments (Details) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Large Case Pensions    
Liability for Future Policy Benefit, Activity [Line Items]    
Expected future benefit payments $ 3,266 $ 3,539
Expected gross premiums 0 0
Long-Term Care    
Liability for Future Policy Benefit, Activity [Line Items]    
Expected future benefit payments 3,224 3,265
Expected gross premiums $ 414 $ 437
v3.24.0.1
Other Insurance Liabilities and Separate Accounts - Weighted-average Interest Rates and Durations (Details)
Dec. 31, 2023
Dec. 31, 2022
Large Case Pensions    
Liability for Future Policy Benefit, Activity [Line Items]    
Interest accretion rate 4.20% 4.20%
Current discount rate 4.93% 5.24%
Weighted-average duration of long-duration insurance liabilities 7 years 3 months 18 days 7 years 4 months 24 days
Long-Term Care    
Liability for Future Policy Benefit, Activity [Line Items]    
Interest accretion rate 5.11% 5.11%
Current discount rate 5.08% 5.39%
Weighted-average duration of long-duration insurance liabilities 12 years 1 month 6 days 12 years 7 months 6 days
v3.24.0.1
Other Insurance Liabilities and Separate Accounts - Roll Forward of Policyholders' Funds (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Policyholder Account Balance [Roll Forward]    
Policyholders’ funds, beginning of the period $ 345 $ 522
Deposits received 0 13
Policy charges (2) (2)
Surrenders and withdrawals (35) (31)
Interest credited 9 11
Change in net unrealized gains (losses) 39 (148)
Other (24) (20)
Policyholders’ funds, end of the period $ 332 $ 345
Weighted average crediting rate 4.32% 4.72%
Net amount at risk $ 0 $ 0
Cash surrender value $ 313 $ 339
v3.24.0.1
Other Insurance Liabilities and Separate Accounts - Separate Account Assets (Details) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Fair Value, Separate Account Investment [Line Items]      
Separate accounts assets $ 3,250 $ 3,228  
Separate accounts liabilities 3,250 3,228 $ 5,087
Recurring      
Fair Value, Separate Account Investment [Line Items]      
Separate accounts assets 3,204 3,313  
Other Receivables | Recurring      
Fair Value, Separate Account Investment [Line Items]      
Separate accounts assets 46    
Other Payables | Recurring      
Fair Value, Separate Account Investment [Line Items]      
Separate accounts liabilities   85  
Cash and cash equivalents | Recurring      
Fair Value, Separate Account Investment [Line Items]      
Separate accounts assets 168 156  
Debt securities | Recurring      
Fair Value, Separate Account Investment [Line Items]      
Separate accounts assets 2,507 2,677  
Debt securities | U.S. government securities | Recurring      
Fair Value, Separate Account Investment [Line Items]      
Separate accounts assets 573 717  
Debt securities | States, municipalities and political subdivisions | Recurring      
Fair Value, Separate Account Investment [Line Items]      
Separate accounts assets 28 27  
Debt securities | U.S. corporate securities | Recurring      
Fair Value, Separate Account Investment [Line Items]      
Separate accounts assets 1,632 1,667  
Debt securities | Foreign securities | Recurring      
Fair Value, Separate Account Investment [Line Items]      
Separate accounts assets 202 201  
Mortgage-backed securities | Residential mortgage-backed securities | Recurring      
Fair Value, Separate Account Investment [Line Items]      
Separate accounts assets 51 41  
Mortgage-backed securities | Commercial mortgage-backed securities | Recurring      
Fair Value, Separate Account Investment [Line Items]      
Separate accounts assets 6 6  
Other asset-backed securities | Recurring      
Fair Value, Separate Account Investment [Line Items]      
Separate accounts assets 15 18  
Common/collective trusts | Recurring      
Fair Value, Separate Account Investment [Line Items]      
Separate accounts assets $ 529 $ 480  
v3.24.0.1
Other Insurance Liabilities and Separate Accounts - Roll Forward of Separate Accounts (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Separate Account, Liability [Roll Forward]    
Separate Accounts liability, beginning of the period $ 3,228 $ 5,087
Premiums and deposits 860 853
Surrenders and withdrawals (9) (581)
Benefit payments (938) (947)
Investment earnings 100 (1,130)
Net transfers from general account 7 9
Other 2 (63)
Separate Accounts liability, end of the period 3,250 3,228
Cash surrender value, end of the period $ 2,181 $ 2,087
v3.24.0.1
Borrowings and Credit Agreements - Schedule of Borrowings (Details) - USD ($)
$ in Millions
Dec. 31, 2023
Jun. 02, 2023
Feb. 21, 2023
Dec. 31, 2022
Debt Instrument [Line Items]        
Commercial Paper $ 200     $ 0
Long-term debt 60,569      
Finance lease liabilities 1,391     1,465
Total debt principal 62,160     52,753
Debt premiums 186     200
Debt discounts and deferred financing costs (736)     (696)
Long-term debt and lease obligation 61,610     52,257
Current portion of long-term debt (2,772)     (1,778)
Long-term debt $ 58,638     50,476
Long-term debt       $ 50,479
Finance Lease, Liability, Statement of Financial Position [Extensible Enumeration] Long-term debt     Long-term debt
Senior Notes | 2.8% senior notes due June 2023        
Debt Instrument [Line Items]        
Debt interest rate 2.80%      
Long-term debt $ 0     $ 1,300
Senior Notes | 4% senior notes due December 2023        
Debt Instrument [Line Items]        
Debt interest rate 4.00%      
Long-term debt $ 0     414
Senior Notes | 3.375% senior notes due August 2024        
Debt Instrument [Line Items]        
Debt interest rate 3.375%      
Long-term debt $ 650     650
Senior Notes | 2.625% senior notes due August 2024        
Debt Instrument [Line Items]        
Debt interest rate 2.625%      
Long-term debt $ 1,000     1,000
Senior Notes | 3.5% senior notes due November 2024        
Debt Instrument [Line Items]        
Debt interest rate 3.50%      
Long-term debt $ 750     750
Senior Notes | 5% senior notes due December 2024        
Debt Instrument [Line Items]        
Debt interest rate 5.00%      
Long-term debt $ 299     299
Senior Notes | 5% senior notes due December 2024 | Disposal Group, Held-for-sale, Not Discontinued Operations        
Debt Instrument [Line Items]        
Long-term debt       3
Senior Notes | 4.1% senior notes due March 2025        
Debt Instrument [Line Items]        
Debt interest rate 4.10%      
Long-term debt $ 950     950
Senior Notes | 3.875% senior notes due July 2025        
Debt Instrument [Line Items]        
Debt interest rate 3.875%      
Long-term debt $ 2,828     2,828
Senior Notes | 5% senior notes due February 2026        
Debt Instrument [Line Items]        
Debt interest rate 5.00%   5.00%  
Long-term debt $ 1,500     0
Senior Notes | 2.875% senior notes due June 2026        
Debt Instrument [Line Items]        
Debt interest rate 2.875%      
Long-term debt $ 1,750     1,750
Senior Notes | 3% senior notes due August 2026        
Debt Instrument [Line Items]        
Debt interest rate 3.00%      
Long-term debt $ 750     750
Senior Notes | 3.625% senior notes due April 2027        
Debt Instrument [Line Items]        
Debt interest rate 3.625%      
Long-term debt $ 750     750
Senior Notes | 6.25% senior notes due June 2027        
Debt Instrument [Line Items]        
Debt interest rate 6.25%      
Long-term debt $ 372     372
Senior Notes | 1.3% senior notes due August 2027        
Debt Instrument [Line Items]        
Debt interest rate 1.30%      
Long-term debt $ 2,250     2,250
Senior Notes | 4.3% senior notes due March 2028        
Debt Instrument [Line Items]        
Debt interest rate 4.30%      
Long-term debt $ 5,000     5,000
Senior Notes | 5% senior notes due January 2029        
Debt Instrument [Line Items]        
Debt interest rate 5.00% 5.00%    
Long-term debt $ 1,000     0
Senior Notes | 3.25% senior notes due August 2029        
Debt Instrument [Line Items]        
Debt interest rate 3.25%      
Long-term debt $ 1,750     1,750
Senior Notes | 5.125% senior notes due February 2030        
Debt Instrument [Line Items]        
Debt interest rate 5.125%   5.125%  
Long-term debt $ 1,500     0
Senior Notes | 3.75% senior notes due April 2030        
Debt Instrument [Line Items]        
Debt interest rate 3.75%      
Long-term debt $ 1,500     1,500
Senior Notes | 1.75% senior notes due August 2030        
Debt Instrument [Line Items]        
Debt interest rate 1.75%      
Long-term debt $ 1,250     1,250
Senior Notes | 5.25% senior notes due January 2031        
Debt Instrument [Line Items]        
Debt interest rate 5.25% 5.25%    
Long-term debt $ 750     0
Senior Notes | 1.875% senior notes due February 2031        
Debt Instrument [Line Items]        
Debt interest rate 1.875%      
Long-term debt $ 1,250     1,250
Senior Notes | 2.125% senior notes due September 2031        
Debt Instrument [Line Items]        
Debt interest rate 2.125%      
Long-term debt $ 1,000     1,000
Senior Notes | 5.25% senior notes due February 2033        
Debt Instrument [Line Items]        
Debt interest rate 5.25%   5.25%  
Long-term debt $ 1,750     0
Senior Notes | 5.3% senior notes due June 2033        
Debt Instrument [Line Items]        
Debt interest rate 5.30% 5.30%    
Long-term debt $ 1,250     0
Senior Notes | 4.875% senior notes due July 2035        
Debt Instrument [Line Items]        
Debt interest rate 4.875%      
Long-term debt $ 652     652
Senior Notes | 6.625% senior notes due June 2036        
Debt Instrument [Line Items]        
Debt interest rate 6.625%      
Long-term debt $ 771     771
Senior Notes | 6.75% senior notes due December 2037        
Debt Instrument [Line Items]        
Debt interest rate 6.75%      
Long-term debt $ 533     533
Senior Notes | 4.78% senior notes due March 2038        
Debt Instrument [Line Items]        
Debt interest rate 4.78%      
Long-term debt $ 5,000     5,000
Senior Notes | 6.125% senior notes due September 2039        
Debt Instrument [Line Items]        
Debt interest rate 6.125%      
Long-term debt $ 447     447
Senior Notes | 4.125% senior notes due April 2040        
Debt Instrument [Line Items]        
Debt interest rate 4.125%      
Long-term debt $ 1,000     1,000
Senior Notes | 2.7% senior notes due August 2040        
Debt Instrument [Line Items]        
Debt interest rate 2.70%      
Long-term debt $ 1,250     1,250
Senior Notes | 5.75% senior notes due May 2041        
Debt Instrument [Line Items]        
Debt interest rate 5.75%      
Long-term debt $ 133     133
Senior Notes | 4.5% senior notes due May 2042        
Debt Instrument [Line Items]        
Debt interest rate 4.50%      
Long-term debt $ 500     500
Senior Notes | 4.125% senior notes due November 2042        
Debt Instrument [Line Items]        
Debt interest rate 4.125%      
Long-term debt $ 500     500
Senior Notes | 5.3% senior notes due December 2043        
Debt Instrument [Line Items]        
Debt interest rate 5.30%      
Long-term debt $ 750     750
Senior Notes | 4.75% senior notes due March 2044        
Debt Instrument [Line Items]        
Debt interest rate 4.75%      
Long-term debt $ 375     375
Senior Notes | 5.125% senior notes due July 2045        
Debt Instrument [Line Items]        
Debt interest rate 5.125%      
Long-term debt $ 3,500     3,500
Senior Notes | 3.875% senior notes due August 2047        
Debt Instrument [Line Items]        
Debt interest rate 3.875%      
Long-term debt $ 1,000     1,000
Senior Notes | 5.05% senior notes due March 2048        
Debt Instrument [Line Items]        
Debt interest rate 5.05%      
Long-term debt $ 8,000     8,000
Senior Notes | 4.25% senior notes due April 2050        
Debt Instrument [Line Items]        
Debt interest rate 4.25%      
Long-term debt $ 750     750
Senior Notes | 5.625% senior notes due February 2053        
Debt Instrument [Line Items]        
Debt interest rate 5.625%   5.625%  
Long-term debt $ 1,250     0
Senior Notes | 5.875% senior notes due June 2053        
Debt Instrument [Line Items]        
Debt interest rate 5.875% 5.875%    
Long-term debt $ 1,250     0
Senior Notes | 6% senior notes due June 2063        
Debt Instrument [Line Items]        
Debt interest rate 6.00% 6.00%    
Long-term debt $ 750     0
Other Debt Obligations        
Debt Instrument [Line Items]        
Long-term debt $ 309     $ 314
v3.24.0.1
Borrowings and Credit Agreements - Debt Maturities (Details) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Long-term Debt, Fiscal Year Maturity [Abstract]    
2024 $ 2,705  
2025 3,785  
2026 4,008  
2027 3,379  
2028 5,007  
Thereafter 41,685  
Subtotal 60,569  
Commercial Paper 200 $ 0
Finance lease liabilities 1,391 1,465
Total debt principal $ 62,160 $ 52,753
v3.24.0.1
Borrowings and Credit Agreements - Short-term Borrowings (Details) - USD ($)
 1 Months Ended 12 Months Ended
Jun. 02, 2023
May 02, 2023
May 01, 2023
Feb. 21, 2023
Feb. 28, 2023
Dec. 31, 2023
Dec. 31, 2022
Short-term Debt [Line Items]              
Short-term debt           $ 200,000,000 $ 0
Proceeds from debt $ 4,900,000,000   $ 5,000,000,000 $ 6,000,000,000 $ 6,000,000,000    
Federal Home Loan Bank advances maximum amount available           1,000,000,000  
Commercial Paper              
Short-term Debt [Line Items]              
Short-term debt           $ 200,000,000 0
Short-term debt, weighted average interest rate           4.31%  
Line of Credit | Back-Up Credit Facilities              
Short-term Debt [Line Items]              
Short-term debt           $ 0 0
Commitment fee percentage           0.03%  
Line of Credit | Revolving Credit Facility, Expiring May 16, 2025              
Short-term Debt [Line Items]              
Maximum borrowing capacity           $ 2,500,000,000  
Debt instrument term           5 years  
Line of Credit | Revolving Credit Facility, Expiring May 11, 2026              
Short-term Debt [Line Items]              
Maximum borrowing capacity           $ 2,500,000,000  
Debt instrument term           5 years  
Line of Credit | Revolving Credit Facility, Expiring May 16, 2027              
Short-term Debt [Line Items]              
Maximum borrowing capacity           $ 2,500,000,000  
Debt instrument term           5 years  
Loans Payable | 364-day Term Loan Agreement              
Short-term Debt [Line Items]              
Debt instrument term     364 days        
Debt face amount     $ 5,000,000,000        
Proceeds from debt   $ 5,000,000,000          
Debt interest rate   6.20%          
Federal Home Loan Bank Advances              
Short-term Debt [Line Items]              
Short-term debt           $ 0 $ 0
v3.24.0.1
Borrowings and Credit Agreements - Long-term Borrowings (Details) - USD ($)
 1 Months Ended 12 Months Ended
Oct. 20, 2023
Jul. 21, 2023
Jun. 02, 2023
May 02, 2023
May 01, 2023
Feb. 21, 2023
Feb. 28, 2023
Sep. 30, 2022
Aug. 31, 2022
May 31, 2022
Dec. 31, 2021
Aug. 31, 2021
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Debt Instrument [Line Items]                              
Proceeds from debt     $ 4,900,000,000   $ 5,000,000,000 $ 6,000,000,000 $ 6,000,000,000                
Redeemed principal amount                         $ 3,166,000,000 $ 4,211,000,000 $ 10,254,000,000
Premium paid in excess of debt principal                     $ 80,000,000 $ 332,000,000      
Write off of deferred debt issuance cost                     8,000,000 26,000,000      
Debt extinguishment fees                     1,000,000 5,000,000      
Loss on early extinguishment of debt                     $ 89,000,000 $ 363,000,000 $ 0 $ 0 $ 452,000,000
Senior Notes | 5% senior notes due January 2029                              
Debt Instrument [Line Items]                              
Debt face amount     $ 1,000,000,000                        
Debt interest rate     5.00%                   5.00%    
Senior Notes | 5.25% senior notes due January 2031                              
Debt Instrument [Line Items]                              
Debt face amount     $ 750,000,000                        
Debt interest rate     5.25%                   5.25%    
Senior Notes | 5.3% senior notes due June 2033                              
Debt Instrument [Line Items]                              
Debt face amount     $ 1,250,000,000                        
Debt interest rate     5.30%                   5.30%    
Senior Notes | 5.875% senior notes due June 2053                              
Debt Instrument [Line Items]                              
Debt face amount     $ 1,250,000,000                        
Debt interest rate     5.875%                   5.875%    
Senior Notes | 6% senior notes due June 2063                              
Debt Instrument [Line Items]                              
Debt face amount     $ 750,000,000                        
Debt interest rate     6.00%                   6.00%    
Senior Notes | 5% senior notes due February 2026                              
Debt Instrument [Line Items]                              
Debt face amount           $ 1,500,000,000                  
Debt interest rate           5.00%             5.00%    
Senior Notes | 5.125% senior notes due February 2030                              
Debt Instrument [Line Items]                              
Debt face amount           $ 1,500,000,000                  
Debt interest rate           5.125%             5.125%    
Senior Notes | 5.25% senior notes due February 2033                              
Debt Instrument [Line Items]                              
Debt face amount           $ 1,750,000,000                  
Debt interest rate           5.25%             5.25%    
Senior Notes | 5.625% senior notes due February 2053                              
Debt Instrument [Line Items]                              
Debt face amount           $ 1,250,000,000                  
Debt interest rate           5.625%             5.625%    
Senior Notes | 3.5% senior notes due July 2022                              
Debt Instrument [Line Items]                              
Debt interest rate                   3.50%          
Redeemed principal amount                   $ 1,500,000,000          
Senior Notes | 2.75% senior notes due November 2022                              
Debt Instrument [Line Items]                              
Debt interest rate                 2.75%            
Redeemed principal amount                 $ 1,000,000,000            
Senior Notes | 2.75% senior notes due December 2022                              
Debt Instrument [Line Items]                              
Debt interest rate               2.75%              
Redeemed principal amount               $ 1,250,000,000              
Senior Notes | 4.75% senior notes due December 2022                              
Debt Instrument [Line Items]                              
Debt interest rate               4.75%              
Redeemed principal amount               $ 399,000,000              
Senior Notes | 3.7% senior notes due 2023                              
Debt Instrument [Line Items]                              
Debt interest rate                     3.70%       3.70%
Aggregate principal of debt extinguished                     $ 2,300,000,000        
Senior Notes | 4.3% senior notes due 2028                              
Debt Instrument [Line Items]                              
Debt interest rate                       4.30%      
Aggregate principal of debt extinguished                       $ 2,000,000,000      
Convertible Debt | 0% convertible senior notes due March 2026                              
Debt Instrument [Line Items]                              
Repurchase price of convertible senior notes, as a percent of principal       100.00%                      
Conversion of convertible senior notes with cash $ 3,000,000 $ 917,000,000                          
Convertible Debt | 0% convertible senior notes due March 2026 | Oak Street Health Inc.                              
Debt Instrument [Line Items]                              
Debt face amount         $ 920,000,000                    
Debt interest rate         0.00%                    
v3.24.0.1
Pension Plans and Other Postretirement Benefits - Narrative (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Defined Benefit Plan Disclosure [Line Items]      
Defined contribution plan, employer contributions $ 581 $ 567 $ 552
Pension Plan      
Defined Benefit Plan Disclosure [Line Items]      
Employer contributions 24 27 78
Multiemployer plans, plan contributions 19 20 19
Benefit obligation 4,736 4,740 6,009
Net periodic benefit cost $ (94) (173) (186)
Pension Plan | Equity securities      
Defined Benefit Plan Disclosure [Line Items]      
Target investment allocations 12.00%    
Pension Plan | Debt securities      
Defined Benefit Plan Disclosure [Line Items]      
Target investment allocations 77.00%    
Pension Plan | Real estate investment      
Defined Benefit Plan Disclosure [Line Items]      
Target investment allocations 5.00%    
Pension Plan | Private equity investments      
Defined Benefit Plan Disclosure [Line Items]      
Target investment allocations 3.00%    
Pension Plan | Hedge fund investments      
Defined Benefit Plan Disclosure [Line Items]      
Target investment allocations 3.00%    
Other Postretirement Benefits      
Defined Benefit Plan Disclosure [Line Items]      
Multiemployer plans, plan contributions $ 60 62 60
Benefit obligation 155 159  
Net periodic benefit cost $ 6 $ 4 $ 4
v3.24.0.1
Pension Plans and Other Postretirement Benefits - Benefit Obligations and Plan Assets (Details) - Pension Plan - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Change in benefit obligation:      
Benefit obligation, beginning of year $ 4,740 $ 6,009  
Interest cost 231 132 $ 110
Actuarial loss (gain) 145 (1,011)  
Benefit payments (380) (387)  
Settlements 0 (3)  
Benefit obligation, end of year 4,736 4,740 6,009
Change in plan assets:      
Beginning balance 5,346 6,677  
Actual return on plan assets 389 (968)  
Employer contributions 24 27 78
Benefit payments (380) (387)  
Settlements 0 (3)  
Ending balance 5,379 5,346 $ 6,677
Funded status 643 606  
Assets (liabilities) recognized on the consolidated balance sheet      
Noncurrent assets reflected in other assets 856 827  
Current liabilities reflected in accrued expenses (24) (24)  
Noncurrent liabilities reflected in other long-term liabilities (189) (197)  
Net assets $ 643 $ 606  
v3.24.0.1
Pension Plans and Other Postretirement Benefits - Net Periodic Benefit Cost (Income) (Details) - Pension Plan - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Components of net periodic benefit cost (income):      
Interest cost $ 231 $ 132 $ 110
Expected return on plan assets (326) (309) (317)
Amortization of net actuarial loss 1 3 5
Settlement losses 0 1 16
Net periodic benefit cost (income) $ (94) $ (173) $ (186)
v3.24.0.1
Pension Plans and Other Postretirement Benefits - Weighted Average Assumptions Used (Details)
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Assumptions used to determine benefit obligations      
Discount rate 5.00% 5.20%  
Assumptions used to determine net benefit costs      
Discount rate 5.10% 2.30% 1.80%
Expected long-term rate of return on plan assets 6.30% 4.80% 4.80%
v3.24.0.1
Pension Plans and Other Postretirement Benefits - Fair Value of Pension Plan Assets (Details) - Pension Plan - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets $ 5,379 $ 5,346 $ 6,677
Total Fair Value, Inputs, Level 1, 2 and 3      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 4,352 4,299  
Total Fair Value, Inputs, Level 1, 2 and 3 | Cash and cash equivalents      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 81 88  
Total Fair Value, Inputs, Level 1, 2 and 3 | Debt securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 3,406 3,403  
Total Fair Value, Inputs, Level 1, 2 and 3 | U.S. government securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 522 570  
Total Fair Value, Inputs, Level 1, 2 and 3 | States, municipalities and political subdivisions      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 94 102  
Total Fair Value, Inputs, Level 1, 2 and 3 | U.S. corporate securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 2,649 2,611  
Total Fair Value, Inputs, Level 1, 2 and 3 | Foreign securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 106 101  
Total Fair Value, Inputs, Level 1, 2 and 3 | Residential mortgage-backed securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 17 6  
Total Fair Value, Inputs, Level 1, 2 and 3 | Commercial mortgage-backed securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 9 1  
Total Fair Value, Inputs, Level 1, 2 and 3 | Other asset-backed securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 8 11  
Total Fair Value, Inputs, Level 1, 2 and 3 | Redeemable preferred securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 1 1  
Total Fair Value, Inputs, Level 1, 2 and 3 | Total equity securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 184 176  
Total Fair Value, Inputs, Level 1, 2 and 3 | U.S. domestic      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 150 133  
Total Fair Value, Inputs, Level 1, 2 and 3 | International      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 34 43  
Total Fair Value, Inputs, Level 1, 2 and 3 | Other investments      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 681 632  
Total Fair Value, Inputs, Level 1, 2 and 3 | Real estate      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 290 325  
Total Fair Value, Inputs, Level 1, 2 and 3 | Common/collective trusts      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 405 307  
Total Fair Value, Inputs, Level 1, 2 and 3 | Derivatives      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets (14)    
Level 1      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 714 749  
Level 1 | Cash and cash equivalents      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 12 7  
Level 1 | Debt securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 518 566  
Level 1 | U.S. government securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 518 566  
Level 1 | States, municipalities and political subdivisions      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 0 0  
Level 1 | U.S. corporate securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 0 0  
Level 1 | Foreign securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 0 0  
Level 1 | Residential mortgage-backed securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 0 0  
Level 1 | Commercial mortgage-backed securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 0 0  
Level 1 | Other asset-backed securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 0 0  
Level 1 | Redeemable preferred securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 0 0  
Level 1 | Total equity securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 184 176  
Level 1 | U.S. domestic      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 150 133  
Level 1 | International      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 34 43  
Level 1 | Other investments      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 0 0  
Level 1 | Real estate      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 0 0  
Level 1 | Common/collective trusts      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 0 0  
Level 1 | Derivatives      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 0    
Level 2      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 3,348 3,225  
Level 2 | Cash and cash equivalents      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 69 81  
Level 2 | Debt securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 2,888 2,837  
Level 2 | U.S. government securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 4 4  
Level 2 | States, municipalities and political subdivisions      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 94 102  
Level 2 | U.S. corporate securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 2,649 2,611  
Level 2 | Foreign securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 106 101  
Level 2 | Residential mortgage-backed securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 17 6  
Level 2 | Commercial mortgage-backed securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 9 1  
Level 2 | Other asset-backed securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 8 11  
Level 2 | Redeemable preferred securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 1 1  
Level 2 | Total equity securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 0 0  
Level 2 | U.S. domestic      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 0 0  
Level 2 | International      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 0 0  
Level 2 | Other investments      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 391 307  
Level 2 | Real estate      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 0 0  
Level 2 | Common/collective trusts      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 405 307  
Level 2 | Derivatives      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets (14)    
Level 2 | Common/collective trusts, Equity Securities      
Defined Benefit Plan Disclosure [Line Items]      
Plan assets, investment within plan asset category, amount 114 104  
Level 2 | Common/collective trusts, Debt Securities      
Defined Benefit Plan Disclosure [Line Items]      
Plan assets, investment within plan asset category, amount 291 203  
Level 3      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 290 325  
Level 3 | Cash and cash equivalents      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 0 0  
Level 3 | Debt securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 0 0  
Level 3 | U.S. government securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 0 0  
Level 3 | States, municipalities and political subdivisions      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 0 0  
Level 3 | U.S. corporate securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 0 0  
Level 3 | Foreign securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 0 0  
Level 3 | Residential mortgage-backed securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 0 0  
Level 3 | Commercial mortgage-backed securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 0 0  
Level 3 | Other asset-backed securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 0 0  
Level 3 | Redeemable preferred securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 0 0  
Level 3 | Total equity securities      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 0 0  
Level 3 | U.S. domestic      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 0 0  
Level 3 | International      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 0 0  
Level 3 | Other investments      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 290 325  
Level 3 | Real estate      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 290 325 $ 378
Level 3 | Common/collective trusts      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 0 0  
Level 3 | Derivatives      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 0    
Fair Value Measured at Net Asset Value Per Share | Other receivables      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 314 390  
Fair Value Measured at Net Asset Value Per Share | Private equity investments      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets 461 432  
Fair Value Measured at Net Asset Value Per Share | Hedge fund investments      
Defined Benefit Plan Disclosure [Line Items]      
Fair value of plan assets $ 252 $ 225  
v3.24.0.1
Pension Plans and Other Postretirement Benefits - Changes in Level 3 Pension Plan Assets (Details) - Pension Plan - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Change in plan assets:    
Beginning balance $ 5,346 $ 6,677
Ending balance 5,379 5,346
Level 3    
Change in plan assets:    
Beginning balance 325  
Ending balance 290 325
Real estate | Level 3    
Change in plan assets:    
Beginning balance 325 378
Actual return on plan assets (23) 21
Purchases, sales and settlements (12) (74)
Transfers out of Level 3 0 0
Ending balance $ 290 $ 325
v3.24.0.1
Pension Plans and Other Postretirement Benefits - Defined Benefit Plans Expected Benefit (Details)
$ in Millions
Dec. 31, 2023
USD ($)
Pension Plan  
Defined Benefit Plan Disclosure [Line Items]  
2024 $ 393
2025 388
2026 384
2027 380
2028 378
2029-2033 1,746
Other Postretirement Benefits  
Defined Benefit Plan Disclosure [Line Items]  
2024 12
2025 12
2026 12
2027 12
2028 12
2029-2033 $ 58
v3.24.0.1
Income Taxes - Income Tax Provision (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Current:      
Federal $ 2,819 $ 2,803 $ 2,285
State 662 735 665
Total current taxes 3,481 3,538 2,950
Deferred:      
Federal (537) (1,526) (282)
State (139) (503) (120)
Total deferred income taxes (676) (2,029) (402)
Total $ 2,805 $ 1,509 $ 2,548
v3.24.0.1
Income Taxes - Effective Tax Rate Reconciliation (Details)
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Income Tax Disclosure [Abstract]      
Statutory income tax rate 21.00% 21.00% 21.00%
State income taxes, net of federal tax benefit 3.70% 3.20% 4.10%
Legal charges 0.00% 3.40% 0.00%
Basis difference upon disposition of subsidiary 0.00% 1.60% 0.00%
Prior year refunds and unrecognized tax benefits 0.00% (2.60%) (1.20%)
Other 0.40% (0.70%) 0.30%
Effective income tax rate 25.10% 25.90% 24.20%
v3.24.0.1
Income Taxes - Deferred Tax Assets and Liabilities (Details) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Deferred income tax assets:    
Lease and rents $ 5,059 $ 5,242
Legal charges 1,205 1,260
Inventory 94 103
Employee benefits 168 153
Bad debts and other allowances 606 480
Net operating loss and capital loss carryforwards 409 266
Deferred income 62 66
Insurance reserves 356 319
Investments 56 293
Other 372 335
Valuation allowance (385) (532)
Total deferred income tax assets 8,002 7,985
Deferred income tax liabilities:    
Retirement benefits 112 92
Lease and rents 4,469 4,639
Depreciation and amortization 7,732 7,139
Total deferred income tax liabilities 12,313 11,870
Net deferred income tax liabilities $ 4,311 3,885
Disposal Group, Held-for-sale, Not Discontinued Operations    
Deferred income tax assets:    
Total deferred income tax assets   $ 131
v3.24.0.1
Income Taxes - Narrative (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Income Tax Disclosure [Abstract]      
Valuation allowance $ 385 $ 532  
Net operating loss and capital loss carryforwards 409 266  
Income tax penalties and interest expense 31 29 $ 40
Income tax penalties and interest accrued 134 $ 112  
Unrecognized tax benefits that would impact effective tax rate $ 330    
v3.24.0.1
Income Taxes - Unrecognized Tax Benefits (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Reconciliation of Unrecognized Tax Benefits, Excluding Amounts Pertaining to Examined Tax Returns [Roll Forward]      
Beginning balance $ 446 $ 782 $ 768
Additions based on tax positions related to the current year 2 5 3
Additions based on tax positions related to prior years 46 42 52
Reductions for tax positions of prior years (24) (166) (33)
Expiration of statutes of limitation (34) (4) (1)
Settlements 0 (213) (7)
Ending balance $ 436 $ 446 $ 782
v3.24.0.1
Stock Incentive Plans - Narrative (Details) - USD ($)
$ / shares in Units, $ in Millions
 12 Months Ended
May 02, 2023
Mar. 29, 2023
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]          
Shares of common stock received for each restricted stock unit granted (in shares)     1    
Shares issued employee stock purchase plan (in shares)     3,000,000    
Average purchase price of shares purchased (in dollars per share)     $ 70.99    
Restricted stock units and performance stock units          
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]          
Compensation not yet recognized, other than options     $ 790    
Compensation not yet recognized, period for recognition     2 years 1 month 6 days    
Vested in period, fair value     $ 525 $ 328 $ 406
Performance stock units          
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]          
Award vesting period     3 years    
Employee Stock Option          
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]          
Award vesting period     4 years    
Compensation not yet recognized, period for recognition     2 years    
Compensation not yet recognized, options     $ 58    
Expected to vest (in shares)     7,000,000    
Stock options granted through 2018          
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]          
Expiration period     7 years    
Stock options granted subsequent to 2018          
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]          
Expiration period     10 years    
Stock Appreciation Rights (SARs)          
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]          
Award vesting period     3 years    
Expiration period     10 years    
Employee Stock          
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]          
Number of shares authorized (in shares)     60,000,000    
Number of shares available for grant (in shares)     26,000,000    
Offering period     6 months    
Purchase price of common stock percent     90.00%    
Minimum          
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]          
Award vesting period     3 years    
Maximum          
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]          
Award vesting period     5 years    
Oak Street Health Inc. | Pre-combination services          
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]          
Replacement equity awards for pre-combination services (in shares) 3,900,000        
Signify Health, Inc. | Pre-combination services          
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]          
Replacement equity awards for pre-combination services (in shares)   3,200,000      
CVS Health 2017 Incentive Compensation Plan          
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]          
Number of shares authorized (in shares)     58,000,000    
Number of shares available for grant (in shares)     11,000,000    
Oak Street Health Plan          
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]          
Number of shares authorized (in shares)     7,000,000    
Signify Plan          
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]          
Number of shares authorized (in shares)     9,000,000    
v3.24.0.1
Stock Incentive Plans - Stock-Based Compensation Expense (Details) - USD ($)
$ in Millions
 8 Months Ended 9 Months Ended 12 Months Ended
Dec. 31, 2023
Dec. 31, 2023
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]          
Stock-based compensation expense     $ 588 $ 447 $ 484
Oak Street Health Inc.          
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]          
Stock-based compensation expense $ 71        
Signify Health, Inc.          
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]          
Stock-based compensation expense   $ 72      
Restricted stock units and performance stock units          
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]          
Stock-based compensation expense     497 369 404
Stock options and stock appreciation rights (“SARs”)          
Share-based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]          
Stock-based compensation expense     $ 91 $ 78 $ 80
v3.24.0.1
Stock Incentive Plans - Restricted Stock Unit and Performance Stock Unit Activity (Details)
shares in Thousands
 12 Months Ended
Dec. 31, 2023
$ / shares
shares
Restricted stock units and performance stock units  
Units  
Unvested at beginning of period (in shares) 12,681
Granted (in shares) 13,918
Vested (in shares) (7,346)
Forfeited (in shares) (2,259)
Unvested at end of period (in shares) 16,994
Weighted average grant date fair value (in dollars per share)  
Unvested at beginning of year (in dollars per share) | $ / shares $ 80.25
Granted (in dollars per share) | $ / shares 71.06
Vested (in dollars per share) | $ / shares 71.46
Forfeited (in dollars per share) | $ / shares 71.78
Unvested at end of year (in dollars per share) | $ / shares $ 77.65
Restricted stock units and performance stock units vested if actual payout rates are applied (in shares) 7,800
Restricted stock units | Oak Street Health Inc.  
Units  
Granted (in shares) 3,900
Restricted stock units | Signify Health, Inc.  
Units  
Granted (in shares) 1,800
v3.24.0.1
Stock Incentive Plans - Stock Option and SAR Activity (Details) - USD ($)
$ / shares in Units, shares in Thousands, $ in Thousands
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Cash received from stock options exercised (including ESPP) $ 277,000 $ 551,000 $ 549,000
Payments for taxes for net share settlement of equity awards 181,000 370,000 168,000
Stock options and stock appreciation rights (“SARs”)      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Cash received from stock options exercised (including ESPP) 277,000 551,000 549,000
Payments for taxes for net share settlement of equity awards 181,000 370,000 168,000
Intrinsic value of stock options and SARs exercised 31,000 118,000 105,000
Fair value of stock options and SARs vested $ 227,000 $ 219,000 $ 224,000
Shares      
Shares, Outstanding at beginning of year (in shares) 15,040    
Shares granted (in shares) 4,595    
Shares exercised (in shares) (1,652)    
Shares forfeited (in shares) (624)    
Shares expired (in shares) (2,233)    
Shares, Outstanding at end of year (in shares) 15,126 15,040  
Weighted Average Exercise  Price      
Outstanding at beginning of year (in dollars per share) $ 73.15    
Granted (in dollars per share) 63.06    
Exercised (in dollars per share) 50.03    
Forfeited (in dollars per share) 76.74    
Expired (in dollars per share) 102.47    
Outstanding at end of year (in dollars per share) $ 68.13 $ 73.15  
Additional Disclosures      
Weighted average contractual term, outstanding at end of year 5 years 2 months 15 days    
Aggregate Intrinsic value outstanding at end of year $ 203,645    
Shares exercisable at end of year (in shares) 7,785    
Weighted average exercise price exercisable at end of year (in dollars per share) $ 63.64    
Weighted average remaining contractual term exercisable at end of year 3 years 4 months 6 days    
Aggregate intrinsic value exercisable at end of year $ 130,509    
Shares vested at end of year and expected to vest in the future (in shares) 14,793    
Weighted average exercise price vested at end of year and expected to vest in the future (in dollars per share) $ 67.95    
Weighted average remaining contractual term vested at end of year and expected to vest in the future 5 years 1 month 20 days    
Aggregate intrinsic value vested at end of year and expected to vest in the future $ 201,439    
Employee Stock Option | Signify Health, Inc.      
Shares      
Shares granted (in shares) 1,400    
v3.24.0.1
Stock Incentive Plans - Valuation Assumptions (Details) - $ / shares
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Stock Options      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Dividend yield 3.27% 2.18% 2.68%
Expected volatility 28.15% 27.34% 27.10%
Risk-free interest rate 3.55% 2.46% 1.13%
Expected life (in years) 5 years 10 months 24 days 6 years 3 months 18 days 6 years 3 months 18 days
Weighted-average grant date fair value (in dollars per share) $ 21.78 $ 24.15 $ 14.57
Employee Stock      
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]      
Dividend yield 1.54% 1.12% 1.34%
Expected volatility 25.61% 23.54% 25.27%
Risk-free interest rate 5.17% 1.42% 0.08%
Expected life (in years) 6 months 6 months 6 months
Weighted-average grant date fair value (in dollars per share) $ 14.26 $ 16.25 $ 12.55
v3.24.0.1
Shareholders' Equity - Share Repurchases (Details) - USD ($)
shares in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Nov. 17, 2022
Dec. 09, 2021
Equity, Class of Treasury Stock [Line Items]          
Stock repurchased during the period (in shares)     0.0    
2022 Repurchase Program          
Equity, Class of Treasury Stock [Line Items]          
Stock repurchase program, authorized amount       $ 10,000,000,000.0  
Stock repurchase program, remaining authorized repurchase amount $ 10,000,000,000.0        
2021 Repurchase Program          
Equity, Class of Treasury Stock [Line Items]          
Stock repurchase program, authorized amount         $ 10,000,000,000.0
Stock repurchase program, remaining authorized repurchase amount $ 4,500,000,000        
Stock repurchased during the period (in shares) 22.8 34.1      
Stock repurchased during period, value $ 2,000,000,000 $ 3,500,000,000      
v3.24.0.1
Shareholders' Equity - Accelerated Share Repurchases (Details) - 2021 Repurchase Program - USD ($)
$ / shares in Units, shares in Millions, $ in Billions
Jan. 04, 2024
Jan. 04, 2023
Jan. 04, 2022
Feb. 28, 2023
Feb. 28, 2022
Morgan Stanley | Subsequent Event          
Equity, Class of Treasury Stock [Line Items]          
ASR agreement, amount $ 3.0        
Payments for ASR, amount $ 3.0        
ASR percent of notional amount received in shares 85.00%        
Shares repurchased under ASR agreement (in shares) 31.4        
Share price (in dollars per share) $ 81.19        
ASR, maximum amount of shares received or delivered 73.9        
ASR, shares to be received at the end of program as a percent of notional amount 15.00%        
Citibank, N.A.          
Equity, Class of Treasury Stock [Line Items]          
ASR agreement, amount   $ 2.0   $ 2.0  
Payments for ASR, amount   $ 2.0      
ASR percent of notional amount received in shares   80.00%      
Shares repurchased under ASR agreement (in shares)   17.4   5.4  
Share price (in dollars per share)   $ 92.19      
Transfer of shares to treasury stock value   $ 1.6      
ASR, shares to be received at the end of program as a percent of notional amount       20.00%  
Citibank, N.A. | Forward Contracts          
Equity, Class of Treasury Stock [Line Items]          
Forward contract, notional amount   $ 0.4      
Barclays Bank          
Equity, Class of Treasury Stock [Line Items]          
ASR agreement, amount     $ 1.5   $ 1.5
Payments for ASR, amount     $ 1.5    
ASR percent of notional amount received in shares     80.00%    
Shares repurchased under ASR agreement (in shares)     11.6   2.7
Share price (in dollars per share)     $ 103.34    
Transfer of shares to treasury stock value     $ 1.2    
ASR, shares to be received at the end of program as a percent of notional amount         20.00%
Barclays Bank | Forward Contracts          
Equity, Class of Treasury Stock [Line Items]          
Forward contract, notional amount     $ 0.3    
v3.24.0.1
Shareholders' Equity - Dividends (Details) - $ / shares
Jan. 01, 2024
Dec. 31, 2023
Sep. 30, 2023
Jun. 30, 2023
Mar. 31, 2023
Dec. 31, 2022
Sep. 30, 2022
Jun. 30, 2022
Mar. 31, 2022
Dividends Payable [Line Items]                  
Cash dividend declared (in dollars per share)   $ 0.605 $ 0.605 $ 0.605 $ 0.605 $ 0.55 $ 0.55 $ 0.55 $ 0.55
Quarterly dividends declared, percent increase   10.00%              
Forecast                  
Dividends Payable [Line Items]                  
Cash dividend declared (in dollars per share) $ 0.665                
v3.24.0.1
Shareholders' Equity - Regulatory Requirements (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Statutory Accounting Practices [Line Items]      
Estimated minimum statutory surplus required by regulators $ 9,011    
Investments on deposit with regulatory bodies 684    
Estimated maximum dividend distributions permitted in 2024 without prior regulatory approval 3,098    
Insurance and HMO      
Statutory Accounting Practices [Line Items]      
Statutory net income 2,757 $ 2,851 $ 3,302
Estimated statutory capital and surplus 16,961 $ 15,503 $ 14,879
Dividends paid $ 1,900    
v3.24.0.1
Shareholders' Equity - Noncontrolling Interests (Details) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Equity [Abstract]    
Noncontrolling interests $ 175 $ 300
v3.24.0.1
Other Comprehensive Income (Loss) (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Changes in Accumulated Other Comprehensive Income (Loss) by Component        
Beginning of year balance $ 71,769 $ 74,841 $ 69,701  
Other comprehensive income (loss) 967 (1,598) (314)  
End of year balance 76,636 71,769 74,841  
Adoption of new accounting standard, adjustment        
Changes in Accumulated Other Comprehensive Income (Loss) by Component        
Beginning of year balance 454   (766) [1]  
End of year balance   454    
AOCI Including Portion Attributable to Noncontrolling Interest        
Changes in Accumulated Other Comprehensive Income (Loss) by Component        
Beginning of year balance (1,264) 334 1,414  
End of year balance (297) (1,264) 334  
AOCI Including Portion Attributable to Noncontrolling Interest | Adoption of new accounting standard, adjustment        
Changes in Accumulated Other Comprehensive Income (Loss) by Component        
Beginning of year balance 0 0 (766)  
End of year balance   0 0  
Net unrealized investment gains (losses)        
Changes in Accumulated Other Comprehensive Income (Loss) by Component        
Beginning of year balance (1,519) 798 1,214  
Other comprehensive income (loss) before reclassifications, net of tax 603 (2,556) (530)  
Amounts reclassified from accumulated other comprehensive income (loss), net of tax 487 239 (26)  
Other comprehensive income (loss) 1,090 (2,317) (556)  
End of year balance (429) (1,519) 798  
Other comprehensive income (loss) before reclassifications, pre-tax 612 (3,021) (644)  
Amounts reclassified from accumulated other comprehensive income (loss), pre-tax 566 315 (32)  
Net unrealized investment gains (losses) | Adoption of new accounting standard, adjustment        
Changes in Accumulated Other Comprehensive Income (Loss) by Component        
Beginning of year balance 0 0 140  
End of year balance   0 0  
Adoption of new accounting standard, pre-tax   0 0 $ 181
Change in discount rate on long-duration insurance reserves        
Changes in Accumulated Other Comprehensive Income (Loss) by Component        
Beginning of year balance 219 (651) 0  
Other comprehensive income (loss) before reclassifications, net of tax (67) 870 255  
Other comprehensive income (loss) (67) 870 255  
End of year balance 152 219 (651)  
Other comprehensive income (loss) before reclassifications, pre-tax (92) 1,126 328  
Change in discount rate on long-duration insurance reserves | Adoption of new accounting standard, adjustment        
Changes in Accumulated Other Comprehensive Income (Loss) by Component        
Beginning of year balance 0 0 (906)  
End of year balance   0 0  
Adoption of new accounting standard, pre-tax   0 0 $ (1,166)
Foreign currency translation adjustments        
Changes in Accumulated Other Comprehensive Income (Loss) by Component        
Beginning of year balance 0 0 7  
Other comprehensive income (loss) before reclassifications, net of tax 0 0 (7)  
Other comprehensive income (loss) 0 0 (7)  
End of year balance 0 0 0  
Net cash flow hedges        
Changes in Accumulated Other Comprehensive Income (Loss) by Component        
Beginning of year balance 239 222 248  
Other comprehensive income (loss) before reclassifications, net of tax 19 28 0  
Amounts reclassified from accumulated other comprehensive income (loss), net of tax (14) (11) (26)  
Other comprehensive income (loss) 5 17 (26)  
End of year balance 244 239 222  
Other comprehensive income (loss) before reclassifications, pre-tax 25 38 0  
Amounts reclassified from accumulated other comprehensive income (loss), pre-tax (19) (15) (34)  
Amount expected to be reclassified 15      
Pension and other postretirement benefits        
Changes in Accumulated Other Comprehensive Income (Loss) by Component        
Beginning of year balance (203) (35) (55)  
Other comprehensive income (loss) before reclassifications, net of tax (61) (170) 15  
Amounts reclassified from accumulated other comprehensive income (loss), net of tax 0 2 5  
Other comprehensive income (loss) (61) (168) 20  
End of year balance (264) (203) (35)  
Other comprehensive income (loss) before reclassifications, pre-tax (81) (229) 20  
Amounts reclassified from accumulated other comprehensive income (loss), pre-tax $ 0 $ 3 $ 6  
[1] Reflects the adoption of Accounting Standards Update (“ASU”) 2018-12, Targeted Improvements to the Accounting for Long-Duration Contracts (Topic 944) during the year ended December 31, 2021. See Note 1 ‘‘Significant Accounting Policies’’ for additional information.
v3.24.0.1
Earnings Per Share (Details) - USD ($)
$ / shares in Units, shares in Millions, $ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Numerator for earnings per share calculation:      
Net income attributable to CVS Health, basic $ 8,344 $ 4,311 $ 8,001
Net income attributable to CVS Health, diluted $ 8,344 $ 4,311 $ 8,001
Denominator for earnings per share calculation:      
Weighted average shares, basic (in shares) 1,285 1,312 1,319
Weighted average shares, diluted (in shares) 1,290 1,323 1,329
Earnings per share:      
Basic (in dollars per share) $ 6.49 $ 3.29 $ 6.07
Diluted (in dollars per share) $ 6.47 $ 3.26 $ 6.02
Stock options and SARs      
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]      
Antidilutive securities excluded from computation of EPS (in shares) 8 4 7
Denominator for earnings per share calculation:      
Effect of dilutive securities (in shares) 2 5 4
Restricted stock units and performance stock units      
Denominator for earnings per share calculation:      
Effect of dilutive securities (in shares) 3 6 6
v3.24.0.1
Reinsurance - Narrative (Details) - Subsequent Event
 1 Months Ended
Jan. 31, 2024
reinsurance_agreement
Ceded Credit Risk [Line Items]  
Number of reinsurance contracts entered into 2
Term of reinsurance agreements with unrelated issuer 4 years
v3.24.0.1
Reinsurance - Reinsurance Recoverables (Details) - USD ($)
$ in Millions
Dec. 31, 2023
Dec. 31, 2022
Ceded Credit Risk [Line Items]    
Total reinsurance recoverables $ 1,998 $ 2,250
Hartford Life and Accident Insurance Company    
Ceded Credit Risk [Line Items]    
Total reinsurance recoverables 1,314 1,549
Lincoln Life & Annuity Company of New York    
Ceded Credit Risk [Line Items]    
Total reinsurance recoverables 480 385
VOYA Retirement Insurance and Annuity Company    
Ceded Credit Risk [Line Items]    
Total reinsurance recoverables 0 159
Fresenius Medical Care Reinsurance Company (Cayman) Ltd.    
Ceded Credit Risk [Line Items]    
Total reinsurance recoverables 54 102
Resolution Life Group Holdings Ltd.    
Ceded Credit Risk [Line Items]    
Total reinsurance recoverables 35 0
All Other    
Ceded Credit Risk [Line Items]    
Total reinsurance recoverables $ 115 $ 55
v3.24.0.1
Reinsurance - Effects of Reinsurance (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Net Premiums      
Direct $ 99,753 $ 85,670 $ 76,320
Assumed 350 432 492
Ceded (911) (772) (680)
Net premiums 99,192 85,330 76,132
Net Benefit Costs      
Direct 86,738 71,357 64,339
Assumed 223 379 398
Ceded (714) (663) (549)
Net benefit costs $ 86,247 $ 71,073 $ 64,188
v3.24.0.1
Commitments and Contingencies (Details)
$ in Millions
 1 Months Ended 12 Months Ended
Dec. 31, 2022
USD ($)
Aug. 31, 2022
USD ($)
Dec. 31, 2023
USD ($)
lease
Dec. 31, 2022
USD ($)
Dec. 31, 2021
USD ($)
Jun. 30, 2023
state
Commitments and Contingencies Disclosure [Abstract]            
Guarantor obligations, maximum exposure     $ 300      
Contractual obligations underlying the guaranteed benefits $ 941   $ 834 $ 941    
Guarantor obligations, number of leases | lease     63      
Loss Contingencies [Line Items]            
Opioid litigation charges     $ 0 $ 5,803 $ 0  
Settlement Framework            
Loss Contingencies [Line Items]            
Legal settlement awarded to other party 4,300          
Attorneys' fees and costs $ 625          
Legal settlement, period of payment 10 years     10 years    
Number of states that elected to join the settlement | state           45
Number of states under separate settlement agreements | state           4
Settlement Framework | Tribal Entities            
Loss Contingencies [Line Items]            
Legal settlement awarded to other party $ 113          
Attorneys' fees and costs $ 16          
Legal settlement, period of payment 10 years     10 years    
Settlement Framework and Other Opioid-Related Claims            
Loss Contingencies [Line Items]            
Opioid litigation charges       $ 5,300    
Federal Court in Ohio Judgment | Pending Litigation            
Loss Contingencies [Line Items]            
Legal settlement awarded to other party   $ 651        
Legal settlement, period of payment   15 years        
v3.24.0.1
Segment Reporting - Narrative (Details) - Segment
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Segment Reporting [Abstract]      
Number of operating segments 3    
US Federal Government | Customer Concentration Risk | Revenues      
Concentration Risk [Line Items]      
Concentration risk, percent 19.00% 18.00% 17.00%
v3.24.0.1
Segment Reporting - Retrospective Adjustments to Segment Composition (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Segment Reporting, Other Significant Reconciling Item [Line Items]      
Total revenues $ 357,776 $ 322,467 $ 292,111
Adjusted operating income 17,534 18,037 17,227
Operating Segments | Health Care Benefits      
Segment Reporting, Other Significant Reconciling Item [Line Items]      
Total revenues 105,646 91,350 82,119
Adjusted operating income 5,577 6,338 5,110
Operating Segments | Health Services      
Segment Reporting, Other Significant Reconciling Item [Line Items]      
Total revenues 186,843 169,576 153,892
Adjusted operating income 7,312 6,781 6,492
Operating Segments | Pharmacy & Consumer Wellness      
Segment Reporting, Other Significant Reconciling Item [Line Items]      
Total revenues 116,763 108,596 101,620
Adjusted operating income 5,963 6,531 7,260
Corporate/ Other | Corporate/ Other      
Segment Reporting, Other Significant Reconciling Item [Line Items]      
Total revenues 451 530 721
Adjusted operating income (1,318) (1,613) (1,635)
Intersegment Eliminations      
Segment Reporting, Other Significant Reconciling Item [Line Items]      
Total revenues (51,927) (47,585) (46,241)
Adjusted operating income $ 0 0 0
As Previously Reported      
Segment Reporting, Other Significant Reconciling Item [Line Items]      
Total revenues   322,467 292,111
Adjusted operating income   17,532 17,312
As Previously Reported | Operating Segments | Health Care Benefits      
Segment Reporting, Other Significant Reconciling Item [Line Items]      
Total revenues   91,409 82,186
Adjusted operating income   5,984 5,012
As Previously Reported | Operating Segments | Health Services      
Segment Reporting, Other Significant Reconciling Item [Line Items]      
Total revenues   169,236 153,022
Adjusted operating income   7,356 6,859
As Previously Reported | Operating Segments | Pharmacy & Consumer Wellness      
Segment Reporting, Other Significant Reconciling Item [Line Items]      
Total revenues   106,594 100,105
Adjusted operating income   6,705 7,623
As Previously Reported | Corporate/ Other | Corporate/ Other      
Segment Reporting, Other Significant Reconciling Item [Line Items]      
Total revenues   530 721
Adjusted operating income   (1,785) (1,471)
As Previously Reported | Intersegment Eliminations      
Segment Reporting, Other Significant Reconciling Item [Line Items]      
Total revenues   (45,302) (43,923)
Adjusted operating income   (728) (711)
Adjustments      
Segment Reporting, Other Significant Reconciling Item [Line Items]      
Total revenues   0 0
Adjusted operating income   505 (85)
Adjustments | Operating Segments | Health Care Benefits      
Segment Reporting, Other Significant Reconciling Item [Line Items]      
Total revenues   (59) (67)
Adjusted operating income   354 98
Adjustments | Operating Segments | Health Services      
Segment Reporting, Other Significant Reconciling Item [Line Items]      
Total revenues   340 870
Adjusted operating income   (575) (367)
Adjustments | Operating Segments | Pharmacy & Consumer Wellness      
Segment Reporting, Other Significant Reconciling Item [Line Items]      
Total revenues   2,002 1,515
Adjusted operating income   (174) (363)
Adjustments | Corporate/ Other | Corporate/ Other      
Segment Reporting, Other Significant Reconciling Item [Line Items]      
Total revenues   0 0
Adjusted operating income   172 (164)
Adjustments | Intersegment Eliminations      
Segment Reporting, Other Significant Reconciling Item [Line Items]      
Total revenues   (2,283) (2,318)
Adjusted operating income   $ 728 $ 711
v3.24.0.1
Segment Reporting - Reconciliation of Financial Measures of Segments to Consolidated Totals (Details) - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Segment Reporting Information [Line Items]      
Revenues from external customers $ 356,623 $ 321,629 $ 290,912
Net investment income (loss) 1,153 838 1,199
Total revenues 357,776 322,467 292,111
Adjusted operating income (loss) 17,534 18,037 17,227
Depreciation and amortization 4,366 4,224 4,486
Operating Segments | Health Care Benefits      
Segment Reporting Information [Line Items]      
Revenues from external customers 104,800 90,798 81,457
Net investment income (loss) 765 476 586
Total revenues 105,646 91,350 82,119
Adjusted operating income (loss) 5,577 6,338 5,110
Depreciation and amortization 1,572 1,579 1,811
Operating Segments | Health Services      
Segment Reporting Information [Line Items]      
Revenues from external customers 174,018 157,968 143,912
Net investment income (loss) (1) 0 0
Total revenues 186,843 169,576 153,892
Adjusted operating income (loss) 7,312 6,781 6,492
Depreciation and amortization 880 519 505
Copayments 13,700 12,600 11,600
Operating Segments | Pharmacy & Consumer Wellness      
Segment Reporting Information [Line Items]      
Revenues from external customers 77,748 72,739 65,418
Net investment income (loss) (5) (44) 17
Total revenues 116,763 108,596 101,620
Adjusted operating income (loss) 5,963 6,531 7,260
Depreciation and amortization 1,549 1,889 1,955
Intersegment Eliminations      
Segment Reporting Information [Line Items]      
Intersegment revenues (51,927) (47,585) (46,241)
Net investment income (loss) 0 0 0
Total revenues (51,927) (47,585) (46,241)
Adjusted operating income (loss) 0 0 0
Depreciation and amortization 0 0 0
Intersegment Eliminations | Health Care Benefits      
Segment Reporting Information [Line Items]      
Intersegment revenues 81 76 76
Intersegment Eliminations | Health Services      
Segment Reporting Information [Line Items]      
Intersegment revenues 12,826 11,608 9,980
Intersegment Eliminations | Pharmacy & Consumer Wellness      
Segment Reporting Information [Line Items]      
Intersegment revenues 39,020 35,901 36,185
Corporate/ Other | Corporate/ Other      
Segment Reporting Information [Line Items]      
Revenues from external customers 57 124 125
Net investment income (loss) 394 406 596
Total revenues 451 530 721
Adjusted operating income (loss) (1,318) (1,613) (1,635)
Depreciation and amortization $ 365 $ 237 $ 215
v3.24.0.1
Segment Reporting - Reconciliation from Operating Income to Adjusted Operating Income (Details)
$ in Millions
 3 Months Ended 12 Months Ended
Dec. 31, 2022
USD ($)
Dec. 31, 2023
USD ($)
Dec. 31, 2022
USD ($)
Dec. 31, 2021
USD ($)
store
Segment Reporting [Abstract]        
Operating income (GAAP measure)   $ 13,743 $ 7,954 $ 13,310
Amortization of intangible assets   1,905 1,785 2,233
Net realized capital (gains) losses   497 320 (176)
Acquisition-related integration costs   487 0 132
Restructuring charges   507 0 0
Office real estate optimization charges $ 117 46 117 0
Loss on assets held for sale   349 2,533 0
Opioid litigation charges   0 5,803 0
Gain on divestiture of subsidiaries   0 (475) 0
Store impairments   0 0 1,358
Goodwill impairment   0 0 431
Acquisition purchase price adjustments outside of measurement period   0 0 (61)
Adjusted operating income   $ 17,534 $ 18,037 $ 17,227
Number of stores, planned closure | store       900
v3.24.0.1
Label Element Value
Accounting Standards Update [Extensible Enumeration] us-gaap_AccountingStandardsUpdateExtensibleList Accounting Standards Update 2018-12 [Member]