Ladies and gentlemen, good morning and welcome to the CVS Health Fourth Quarter and Full Year 2020 Earnings Conference Call. At this time, all participants are in a listen-only mode. A question-and-answer session will follow CVS Health's prepared remarks at which point we will review instructions on how to ask your questions. As a reminder, today's conference is being recorded. I would now like to turn the call over to Valerie Haertel, Senior Vice President of Investor Relations for CVS Health. Please go ahead.

Thank you and good morning everyone. Welcome to the CVS Health fourth quarter and full year 2020 earnings call. I'm Valerie Haertel, Senior Vice President of Investor Relations for CVS Health. I am joined this morning by Karen Lynch, President and CEO; and Eva Boratto, Executive Vice President and CFO. Following our prepared remarks we'll host a question and answer session that will include Jon Roberts, Chief Operating Officer and Alan Lotvin, President of Caremark. Our press release and slide presentation have been posted to our website along with our annual report on form 10-K that we filed with the SEC this morning. During this call we will make certain forward-looking statements reflecting our current views related to our future financial performance, future events, industry and market conditions as well as the expected consumer benefits of our products and services and our financial projections. Our forward-looking statements are subject to significant risks and uncertainties that could cause actual results to differ materially from what may be indicated in them. We strongly encourage you to review the information in the reports we file with the SEC regarding these risks and uncertainties in particular those that are described in the cautionary statement concerning forward-looking statements and risk factors section in this morning's earnings press release and included in our form 10-K. During this call we will use non-GAAP financial measures when talking about the company's performance and financial condition. In accordance with SEC regulations you can find a reconciliation of these non-GAAP measures to the comparable GAAP measures in this morning's earnings press release and the reconciliation document posted on the investor relations portion of our website. Today's call is being broadcast on our website where it will be archived for one year. Now I would like to turn the call over to Karen.

Thank you Valerie and good morning everyone, and thank you for joining our call today. Before we begin, I'd like to acknowledge Larry Merlo's leadership. He set a bold path for CVS Health to change the healthcare industry in this country. Larry did an incredible job bringing together our unique assets and establishing the foundation for our future. Our transformation over the last decade has enabled us to become the nation's leading diversified health services company. As one of the most trusted brands in America, our presence in communities across the country allows us to meet consumers where they are and becoming bigger part of their everyday health. Our unparalleled capabilities, reach, and relationship with over a hundred million people uniquely positions us to support them for every meaningful moment of health throughout their lifetime. These are unprecedented times, and our purpose to help people on their path to better health has never been more important. CVS colleagues are on the front lines every day helping millions of Americans with COVID testing and vaccines in home and virtual care services and face-to-face care in our CVS locations. We understand our responsibility to support our customers, members, and communities during these difficult times and we are delivering. I am proud of the nearly 300,000 colleagues on the CVS Health team and all that we've achieved in this past year. Turning to performance, our strong results in 2020 show that both our strategy and business model are working. We exceeded our earnings commitments while delivering 6% year-over-year adjusted EPS growth. We grew revenue 4.5% to achieve adjusted revenues of $268 billion. We delivered continued strong growth in our PBM and government services business, once again achieving solid results in Medicare Advantage. We generated strong cash flow from operations of nearly $16 billion…

Thanks Karen and good morning everyone. As Karen stated our strong performance across the enterprise continued in the fourth quarter as we executed on our strategy during this challenging time. For the full year we delivered $7.50 adjusted earnings per share and importantly achieved over $900 million of integration synergies above the high end of our expectations. We've hit the 2021 run rate and the synergies are fully embedded in the business. During the quarter we generated $3.6 billion of cash from operations bringing our full year to $15.9 billion which is above the high end of our expectations and we paid down $2.5 billion of net debt in the quarter exiting the year at a low four times leverage ratio. Since the close of the Aetna transaction we have paid down more than $12.2 billion in net debt and remain on track with our low three times leverage ratio goal in 2022. We maintained our dividend while we also invested in our enterprise to support our colleagues and customers during the pandemic and to accelerate future growth. Looking at our fourth quarter results by segment our Healthcare Benefits segment total adjusted revenues increased 9.6% year-over-year driven by membership growth in our government products and the reinstatement of the HIF. Adjusted revenues exclude the ACA risk quarter payment received during the fourth quarter. Adjusted operating income was $153 million in line with our expectations largely reflecting the planned COVID-19 related investments benefiting customers, testing and treatment costs and the divestitures of the Aetna PDP and our workers comp business. Total membership increased about 140,000 sequentially with Medicaid membership up about 90,000 as states continue to respond to the COVID-19 pandemic by suspending eligibility redeterminations. Additionally, our Medicare portfolio continues to show growth with strong Medicare Advantage and [Med sub-membership] growth…

[Operator Instructions] And we will take our first question from Lisa Gill with JPMorgan. Please go ahead.

We will take our next question from Robert Jones with Goldman. Please go ahead.

And we will move next with Ricky Goldwasser with Morgan Stanley. Please go ahead.

And we'll take our next question from Charles Rhyee with Cowen. Please go ahead.

We will move next with Matt Borsch with BMO. Please go ahead.

And we'll take our next question from Michael Cherny of Bank of America. Please go ahead.

We will move next with Lance Wilkes with Bernstein. Please go ahead.

And we will take our last question from A.J. Rice with Credit Suisse. Please go ahead.

[indiscernible]. I would like to thank everyone for our call this morning. As you can see we've made measurable and important progress on our strategy as a health services company, we're starting 2021 with strong momentum and we are accelerating our pace of progress to drive our consumer-centric approach and I do again want to thank all of our employees for their strong performance. With that I'll say thank you for joining us today.

Thanks everyone.

This concludes today's CVS Health fourth quarter and full year 2020 Earnings Call and Webcast. You may disconnect your line at this time. Have a wonderful day.