By Sy Mukherjee
May 16, 2019

Hello, readers!

I’m heading to the west coast for the next few weeks (don’t worry—we’ll still be in your inbox, just from the other side of the country). But a short one today as I make the trek.

As luck would have it, Fortune released the latest Fortune 500 rankings this morning (the 65th running of the list), so there’s no lack of fascinating material for our readers to peruse. And, as usual, health care holds strong sway on this litany of America’s largest public companies by revenue.

Some opening thoughts from my colleague and our dear leader Fortune editor-in-chief Clifton Leaf: “Each year, it seems, America’s biggest companies look more and more like a set of matryoshka dolls; companies that a generation ago would have been seen as corporate titans now appear as if they could be swallowed up as midday snacks by the real behemoths. That’s one of the takeaways from this year’s Fortune 500 ranking—the 65th running of the list: The big are getting bigger, and the rich are getting richer.”

The same theme plays out in health care companies on the 500 specifically. For instance, as Cliff notes, “CVS, for its part, has combined with Aetna to become the health industry’s biggest platypus: a drugstore-insurer-pharmacy benefit manager-walk-in clinic.” CVS’ 2018 revenues stood just shy of $195 billion, landing it the number 8 spot.

Other companies ranking in the top 100 span the gamut from insurers (UnitedHealth Group at #6, Anthem, Humana, and Centene all in the top 75) to pharma companies (Johnson & Johnson and Pfizer, at #37 and #61 spots, respectively) to drug distributors (McKesson and AmerisourceBergen at #7 and #10).

It shouldn’t come as a surprise that an industry that’s, literally, critical to the preservation of human life ranks so prominently when it comes to revenue generation. What’s more intriguing is the way these companies are attempting to preserve their competitive advantages (especially in the case of insurers, who have very different strategies—some favor consolidation while others are laying down the gauntlet in markets that competitors have left).

Back with more tomorrow, and read on for the day’s news.

Sy Mukherjee
@the_sy_guy
sayak.mukherjee@fortune.com

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