Operating margins continue to reflect the initial clinical engagement activities that support the strong growth in patients we have realized this year, as well as the higher care activity patterns we have discussed. OptumRx revenues grew by 14%, approaching $29 billion, driven by the strength in our pharmacy care services offerings, as well as new customer wins. Script growth of nearly 7% reflects customer response to our innovative solutions, which focus on choice and lowest net cost. OptumInsight revenues grew by 35% to $5 billion. Revenue backlog of over $31 billion increased by more than $7 billion, in part due to the change healthcare combination. In addition, we recently announced a partnership to provide revenue cycle, analytics, and information technology services to a health system serving more than 400,000 people in the Midwest.
Turning to UnitedHealthcare, our commercial business added nearly 700,000 people through the third quarter. Further, selling season indications are tracking favorably, particularly in national accounts. So as ‘24 begins, we expect to grow to serve an additional 1 million people with commercial benefits. Within our public sector programs, we expect growth of nearly 1 million Medicare Advantage members this year. And looking to the year ahead, we’re encouraged by the consumer value, stability, and breadth of our offerings. And as always, we start with an expectation that we will outpace overall market growth. Our Medicaid performance remains strong as we support people and families through the redeterminations process. Our teams are really leaning in, speaking with 1,000s of consumers each day.
Through a comprehensive Outreach Program, we are helping people navigate the process and connecting them with the resources they need to retain or reinstate their health benefits or to help them find other affordable coverages. A significant majority of the people we engage with are able to retain or reinstate their coverage. Our capital capacities remain strong. For the first nine months of the year, adjusted cash flows from operations were at $22.4 billion or 1.3 times net income. And in that same timeframe, we returned over $11.5 billion to shareholders through dividends and share repurchases. As noted, given the strength of our business performance, this morning we have updated our ‘23 outlook for adjusted earnings to $24.85 to $25 per share.
And as we finish strongly in ‘23 and look forward to ‘24, we’re intensely focused on execution, while further expanding our capacity to serve more people, more deeply, and building the foundations to support our growth objectives for years to come. Now I’ll turn it back to Andrew.
Andrew Witty: Thanks John. Before opening up for questions, I’ll offer some preliminary observations about next year, while reserving most of this conversation for our investor conference on November 29th. Our businesses continue to build momentum, while maintaining flexibility and adaptability for an ever-changing landscape, even as we invest for the future. We’re focused on our strategic growth pillars and driving efficiencies throughout the enterprise at an accelerated pace. At this distance, analyst earnings estimates for 2024 reasonably reflect the performance view we expect to offer in November, with consensus near the upper end of our likely initial outlook range. Importantly, the growth we’re realizing today and our expanding capacity serve to further reinforce the confidence we have in our long-term 13% to 16% growth objective. And with that, I’ll now ask the operator to open up for questions.
Operator: The floor is now open for questions. [Operator Instructions] We’ll go first to Lisa Gill with JPMorgan.
Lisa Gill: Good morning, and thanks for the comments. I wanted to start with GLP-1s and really understand from two sides. One, when we think about rates for 2024, can you talk about what you’ve incorporated in rates around GLP-1s, especially around weight loss as we have new products coming to the market? And how do I think about that from the PBM side when we think about the services that you can wrap around that and sell from a PBM perspective?
Andrew Witty: Lisa, thanks so much for the question. In a second, I’ll ask Brian Thompson from UHC and Dr. Patrick Conway to respond to your comments in a little more detail. But let me just preface all of that. You know, the thing we’re most overall focused on in GLP-1 space is honestly the pricing. You know, we’re very positive about the potential for another tool in the toolbox to help folks manage their weight. We recognize that has potential benefits, but we’re struggling and frankly our clients are struggling with the list prices, which have been demanded of these products in the U.S., which are running at about 10 times the level of price which have been paid in Western Europe. So, overall, I’d say that is our focus, is to try and find a way to make this a sustainable and affordable space for our clients to support. With that said, let me ask Brian to give you a perspective from UHC and how they’ve incorporated this in their forward view?
Brian Thompson: Sure. Thanks for the question there, Lisa. First, to put in context GLP-1 is over 80% on the diabetic side. So as we think about weight loss, up to maybe 20% of our total spend and it’s largely performing in line with what we had planned as we went into ‘23. And we feel very confident and comfortable about how we’re looking at that going forward into ‘24. As you think about it, keep in mind, the vast majority of the coverage here is in our fee-based business, that’s our self-employed customers and that’s still at less than a third, around 30% of our book. As we look forward, are our customers considering to cover more or less? I would say it’s a mixed bag, some are seeking coverage albeit dissatisfied with the price points.
Some are backing off given the cost, but I wouldn’t really be directional one way or the other on whether or not we’re seeing more or less coverage on the weightless side as we look forward. But again, to Andrew’s point, beyond just getting to the obvious lower price points, we’re really trying to work with manufacturers to get to some aligned value-based constructs, getting pricing to a point where it’s based on outcomes and adherence levels, all the way to outright risk on utilization levels, and pairing those with therapies and programs that can put less reliance on lifelong adherence requirements like these drugs currently have. We’re not there yet. We’re optimistic, but we can get there, but clearly price point is a key barrier.
Andrew Witty: Brian, thanks so much. And Patrick, maybe from the — from OptumRx perspective, you could talk a little bit about the broader approaches we take?
Patrick Conway: Thank you. As Andrew said, our customers, payers, employers, people we serve are concerned about the prices of GLP-1s as set by manufacturers. OptumRx will continue to negotiate lower prices through discounts over time, be transparent with our customers, and implement clinical evidence-based guidelines so the right people get appropriate medicines. And as you alluded to, Lisa, obesity and cardiometabolic disease is a major public issue — health issue in the U.S. and across all of [Oxfam] (ph), we are developing and implementing comprehensive solutions of which medicines are only a part of on behalf of our clients and people we serve to drive better health outcomes for all and value to the health system.
Andrew Witty: Thanks, Patrick. And Lisa, thanks so much for the question. Next question, please, Jennifer.
Operator: Yes, we’ll go next to A.J. Rice with [UBS] (ph).
