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Fortune 500

The 300 companies on this year’s list brought in over $12.5 trillion in revenue for the latest 12 months, with the median revenue figure at $24 billion.

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G500-2023-Cigna

The insurer and health services company had a relatively slow year for revenue growth, but profits, at $6.7 billion, were up 24.3%. 
<ul> 
 	<li>Cigna has been working to expand “value-based” care models, which are designed to emphasize primary care and preventive medicine. To strengthen such care, Cigna entered into a strategic partnership with Walgreens-owned primary care provider VillageMD.</li> 
 	<li>Evernorth, Cigna’s service-provider arm, which also oversees the new VillageMD investment, has brought the company growth over recent years, and focuses on value-based care.</li> 
 	<li>Cigna Healthcare, the health-insurance benefits arm of the business, also expanded its margins and customer base.</li> 
</ul>

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The Fortune 500, in its 69th year in 2023, ranks the biggest U.S. companies by revenue.

F500 2023-Cigna Group

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G500 2022-30-Cigna

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This year’s Fortune 500 marks the 68th running of the list.

F500 2022 Cigna

Global health services company Cigna had an up-and-down year. Despite bringing on an additional 8.4 million customers in its pharmacy division in 2021 and an 8.5% rise in sales, Cigna’s profits plummeted by 36% from 2020, to $5.37 billion. After years of litigation, an appeals court rejected Cigna’s attempt to claim a $1.85 billion breakup fee from Anthem in the wake of a merger agreement that fell apart a few years ago.

This year’s group delivered stellar revenue and profit growth, but it underperformed the broader stock market.

100 Fastest-Growing Companies

Total revenue for the world’s biggest companies fell 4.8% to $31.7 trillion this year—the first decline in half a decade.

G500-2021-028-Cigna

If there’s one element you need to home in on to understand health insurer Cigna’s 2020 success, Evernorth is a pretty good place to start. The company climbed more than 50 spots on the Fortune 500 after completing its merger with pharmacy benefits manager Express Scripts. That sent its revenues skyrocketing—and then the pandemic hit. How did Cigna manage to deal with that buzz saw? The Evernorth subsidiary, which encompasses Express Scripts, brought in $30.6 billion in the first quarter of 2021 and moved to expand its plan memberships in five more states and 67 new counties. It doesn’t hurt that Evernorth acquired the virtual care platform MDLive at the beginning of 2021—at a time when telehealth demand is soaring.

This year’s Fortune 500 marks the 67th running of the list.

F500-2021-013-Cigna

Collectively, the ranked companies produced a three-year average shareholder return of 33%, vs. 19% for the S&P 500.

FGC 2021-Cigna

This year's Fortune Global 500 generated $33.3 trillion in revenues and $2.1 trillion in profits.

G500-2020-032-Cigna

Health insurer Cigna is enjoying a meteoric rise on the Global 500 this year, climbing 197 spots thanks to its merger with pharmacy benefits giant Express Scripts—yet another example of the trend toward "vertical integration" among large health care companies. The Express Scripts integration, completed in December 2018, fueled revenue growth that exceeded even Cigna’s own pre-merger expectations: Adjusted revenues for 2019 soared to $140 billion, compared with the $131 billion to $133 billion originally forecast.

This year's Fortune 500 marks the 66th running of the list.

F500-2020-013-Cigna

Health insurer Cigna ranked 65th on the Fortune 500 last year. This year? A meteoric rise to 13th, the result of its merger with pharmacy benefits giant Express Scripts—and another instance of the trend toward vertical integration among large health care companies. The Express Scripts integration, completed in December 2018, fueled revenue growth that exceeded even Cigna’s own pre-merger expectations: Adjusted revenues for 2019 soared to $140 billion, compared with the $131 to $133 billion originally forecast.

Collectively, the ranked companies produced a three-year average shareholder return of 19%, vs. 11% for the S&P 500.

Fastest-Growing-Companies-2020-59-Cigna

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Global business is back. After limping through a worldwide financial crisis and economic slowdown, the 500 largest companies ranked by revenues shattered all sorts of performance records in 2013: They racked up combined revenues of $31.1 trillion, up 2.5% from 2012, and profits soared 27% to nearly $2 trillion. China’s 95 companies (up from 89 last year) posted $5.8 trillion in revenues. The U.S. has four fewer companies on the list than last year but remains (for now) the country leader, with 128 corporations on the list—including No. 1 Wal-Mart Stores—reporting $8.6 trillion in revenues. 

Wal-Mart stayed on top as its sales crept closer to half-a-trillion dollars. Apple moved into the top five. And UnitedHealth Group continued its steady climb. 

Fastest-growing Companies

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With roots dating back to 1792, the Cigna Group is an insurance and related services company serving millions of clients in the United States. Its Evernorth Health Services branch offers pharmacy benefits, home delivery, distribution, management solutions for plans, and health care providers. Meanwhile, the company’s Cigna Healthcare segment provides medical, behavioral health, dental, and other products to customers. In 2023, the business underwent a rebrand; Cigna Corp. changed its name to the Cigna Group, and its two segments became the primary business units.

Q2 2026

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Cigna Group (CI): Company Profile, Stock Price, News, Rankings

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Cigna Group

cigna group

Ladies and gentlemen, thank you for standing by for The Cycna Group's First Quarter twenty twenty five Results Review. At this time, all callers are in a listen only mode. We will conduct a question and answer session later in the conference and review procedures on how to enter queue to ask questions at that time. If you should require assistance during the call, please press 0 on your touchtone phone. As a reminder, ladies and gentlemen, this conference, including the Q and A session, is being recorded.

We'll begin by turning the conference over to Ralph Please go ahead.

Great. Thank you, operator. Good morning, everyone. Thank you for joining today's call. I'm Ralph Jacoby, Senior Vice President of Investor Relations.

With me on the line this morning are David Cordani, The Cigna Group's Chairman and Chief Executive Officer Brian Ivankoe, President and Chief Operating Officer and Ann Dennison, Chief Financial Officer. In our remarks today, David, Brian and Ann will cover a number of topics, including our first quarter twenty twenty five financial results and our financial outlook for 2025. Following their prepared remarks, David, Brian and Anne will be available for Q and A. As noted in our earnings release, when describing our financial results, we use certain financial measures, including adjusted income from operations and adjusted revenues, which are not determined in accordance with accounting principles generally accepted in The United States, otherwise known as GAAP. A reconciliation of these measures to the most directly comparable GAAP measures, shareholders' net income and total revenues, respectively, is contained in today's earnings release, which is posted in the Investor Relations section of thesignagroup.com.

We use the term labeled adjusted income from operations and adjusted earnings per share on the same basis as our principal measures of financial performance.

be making some forward looking statements, including statements regarding our outlook for 2025 and future performance. These statements are subject to risks and uncertainties that could cause actual results to differ materially from our current expectations. A description of these risks and uncertainties is contained in the cautionary note to today's earnings release and in our most recent reports filed with the SEC. Regarding our results in the first quarter, we recorded net after tax special item charges of $229,000,000 or $0.84 per share. This included an after tax special item charge of $163,000,000 or $0.63 per share related to a strategic optimization program to further leverage the company's ongoing operational efficiency initiatives.

Additional details of the special items are included in our quarterly financial supplement. Additionally, please note that when we make prospective comments regarding financial performance, including our full year 2025 outlook, we will do so on a basis that includes the potential impact of future share repurchases and anticipated 2025 dividends. With that, I'll turn the call over to David.

Thanks, Ralph. Good morning, everyone, and thank you for joining today's call. We begin 2025 with momentum, and I'm pleased to report that in the first quarter, Cigna Group had strong results while we continue to focus on delivering on our commitments to build a better, more sustainable healthcare model. Joining me on the call is Brian Ivankoe, our President and Chief Operating Officer, and I also want to welcome Ann Dennison, our Chief Financial Officer. As you likely saw, Brian and Ann were named to these new roles in March.

With their announcement, we will be following an Evolve format for our call this morning. I'll share some brief comments and focus on our performance and how we're leading to address Evolving stakeholder needs. Then Brian will discuss key business drivers fueling our growth, and Ann will provide more detail on our financial results. And then we'll take your questions. To start today, I'm pleased to report that we delivered $65,500,000,000 in total revenue, and we grew adjusted earnings per share to $6.74 this quarter.

And we are also raising our full year EPS guidance estimate to at least $29.6 We delivered this performance in a dynamic environment, with forces of change going beyond tariffs and trade, significant geopolitical and evolving social impacts. At the Cigna Group, our market leading capabilities and flexible model has fueled our consistent track record of delivering differentiated value, innovating and smartly expanding our addressable markets, driving sustained long term growth even in the most disrupted environments. Whether measured over the last three, five or ten years, we've performed and delivered on our EPS growth algorithm. We've been able to deliver these competitively attractive results through a relentless approach to position our company to lead through the forces of change in healthcare. We all know the healthcare system is on an unsustainable trajectory.

Annual U. S. Healthcare expenditures now exceed $4,500,000,000,000 and society's growing needs are overwhelming the current system, which remains primarily oriented to providing interventions after someone becomes ill. All of these dynamics, particularly when matched against the current economic, geopolitical, and social environment, are driving strong demand for strategic partners that could help individuals, employers, governmental agencies, health plans, and integrated health care delivery systems achieve both their short and long term goals. The engines for converting these opportunities into differentiated results are our two growth platforms: EverNorth, our health services portfolio and Cigna Healthcare, our integrated benefits portfolio.

Together, the businesses across these platforms are leveraging the breadth of our core strengths and the power of our capabilities to create and capture more value than any one business could achieve alone. Importantly, we also continue to shape our portfolio with strategic acquisitions, partnerships, and divestitures. The recently completed sale of our Medicare business, HCSC, the last quarter is the most recent example that demonstrates our disciplined execution of our capital management strategy. Now, while we've long been on a path to evolve and drive continuous improvement, as we stepped into 2025, the forces of change in healthcare further strengthened our urgency and resolve, and in part fueled customer focused commitments and series of actions we announced earlier this year to address some of the most pressing challenges in healthcare in five key areas. First, access.

We are addressing the challenges customers and patients face in getting care and making our processes simpler and faster. Second is support, helping our customers and patients with enhanced resources to navigate the healthcare system with greater ease and peace of mind. Next is value, working to further lower costs for our customers and patients. Fourth is accountability, our promise to stand behind our commitments, specifically by tying our leadership compensation to improving customer and patient satisfaction. And finally, transparency.

We will publicly share our progress and improvements to serve our customers and patients as we go forward. These actions represent yet another significant commitment from the Cigna Group to build a better future, and I'm pleased we are already making good progress. Now to wrap up my comments. Against a backdrop that is dynamic and challenging, we are well positioned for a strong 2025. Our first quarter results underscore the momentum we're building and our resilience we continue to drive growth and invest for the long term.

And we are confident in our ability to sustainably deliver 10% to 14% compounded EPS growth over the strategic horizon, along with providing an attractive dividend. With that, I'll turn the call over to Brian.

Thank you, David. Before getting into our business performance, I'd like to share a few thoughts on the new roles that were announced in March for Anne and myself. I'm humbled and grateful to be named as President and COO of the Cigna Group. My new team's primary focus will be on driving profitable growth for the company, while making healthcare better for our primary stakeholders, most notably customers, patients, clients and healthcare professional partners. I'm also thrilled to pass the reins of our finance function over to Anne, who is an accomplished and strategic financial leader.

Over the past several weeks as I've transitioned to the new role, I have spent meaningful time meeting with a number of our clients and partners, and some key insights were reinforced through these engagements. First, our clients and partners consistently point to the attractive breadth and depth of our services and expertise across our Evernorth Health Services and Cigna Healthcare portfolio to solve their most pressing healthcare needs. For example, in Evernorth Specialty and Care Services businesses, representing about 30% of the company's income today, we have unique capabilities in this fast growing sector that others can't match. Last year, we delivered more than 8,000,000 prescriptions to over a million patients through our owned operational assets and capabilities, including safely mixing and preparing medications in sterile environments that take years to build and fully license. This business represents one of the company's top growth opportunities going forward in a space with high secular growth rates.

Specialty drugs are clinically intensive, serving a relatively small number of patients who rely on them. Our patients clearly value the experience enabled by our clinicians, pharmacists, nurses, both in their home and over the phone, as we see ninety seven percent patient satisfaction rates on interactions with our Accredo nurses. In Express Scripts, our pharmacy benefit services business, which also represents about 30% of the company's income, we are working tirelessly to lower prescription drug prices for more than 100,000,000 Americans, and we saved about $38,000,000,000 for our clients last year. Unlike our lower volume clinically intensive specialty pharmacy business, our PBS business features much higher prescription volumes, including low cost generics alongside the lower prices we negotiate for high list price branded drugs. For example, we will process over 2,000,000,000 prescriptions in Express Scripts this year with around 90% of these being cost effective generics.

And finally, in Cigna Healthcare, where we generate about 40 of the Cigna Group's income. My recent engagements with some of our U. S. Employer clients have underscored the value of our consultative client partnership model. This has been further advanced by improving customer outcomes through better unit costs, site of care optimization, and personalized clinical programs.

And we continue to generate net growth rates that are well above the market in our under 500 select segment, where we have now reached more than 3,000,000 customers. Finally, I'm proud of the way all of my colleagues at the Cigna Group care deeply about those we serve. Our clients and partners appreciate the expertise of our team and the passion that they bring to our work to improve healthcare for all. As out to the future, I'm very excited about the growth opportunities we see across our businesses, while we remain focused on building a more sustainable model for healthcare. Now, let me turn to the quarter and our business performance.

EverNorth earnings were in line with expectations and revenues grew by double digits, led by our strong pharmacy benefit services and specialty pharmacy capabilities. Within Cigna Healthcare, we achieved strong revenue performance across our U. S. Employer and international health businesses, driven by growth in our select segment customers and strong rate execution. We are also confident in our action plan to improve margins on our stop loss products, and we are pleased to see that the early indicators on 2025 stop loss performance are tracking to expectations.

Let me unpack these headlines more fully. Evernote's specialty and care services businesses drove very strong growth in the first quarter, with double digit growth rates in both revenue and normalized earnings. And this space continues to represent one of the fastest growing sectors in the industry. The specialty pharmacy market continues to grow at an attractive pace as new specialty drugs are introduced, existing medications are authorized for expanded indications, and biosimilars become more prevalent. We are pleased with the further increased adoption of our interchangeable Humira biosimilar, and this month we are taking another step forward with an interchangeable Stellara biosimilar, which will also be available to eligible patients for $0 out of pocket.

Turning to our pharmacy benefit services Turning pharmacy business, we drove attractive revenue growth of 14%, while balancing the need to continue investments for the long term. And while it's early into the 2026 selling season, we continue to see strong demand among existing and new clients. And we further increased investments in the

pharmacy benefits business to drive even greater transparency and savings and to make the healthcare system work better for customers and patients. We will soon be announcing enhancements to the patient experience with new flexible and personalized digital tools and capabilities. In Cigna Healthcare, our earnings exceeded expectations in the quarter, along with 9% revenue growth powered by strong rate execution.

We generated strong growth in our under 500 select segment with customers growing 9% year over year, well above industry growth. And we continue to see further headroom for future customer growth, given our market share is just 7% in this segment. And as David mentioned, we are laser focused on the actions we announced earlier this year to improve the customer experience within Cigna Healthcare. The response to our proactive commitments has been very positive with stakeholders appreciating the associated transparency and accountability. To bring it all together, I'd like to share one specific example of how we continue to lead through the rapidly changing environment with new innovations leveraging our differentiated capabilities.

The GLP-one drug class is on pace to be the number one drug trend driver for plans this year. In fact, for the average employer who provides access to GLP-1s for weight management, GLP-1s now represent about 3% of their total healthcare costs. And GLP-1s are now being prescribed beyond their original application for diabetes to include use for obesity and weight management, and more recently for sleep apnea, with additional indications on the horizon. These treatments have been called once in a generation, and we all know they're changing lives and changing healthcare. By 02/1930, we expect the market size to exceed $100,000,000,000 in The U.

S. Alone, and one in ten Americans is expected to be on a GLP-one medication. But the challenge of affordability, access and clinical coordination for GLP-1s in The US remains. Clients are looking for ways to manage the high cost of these medicines while ensuring appropriate use, and patients want to access these medications at an affordable price point and have a positive experience with the clinical support they need to achieve durable and impactful results. Our Encircle Rx solution provides a clinical program wrapper around the medication to help support sustainable and positive lifestyle changes for patients, as well as improve affordability and access for clients.

Encircle Rx now has approximately 9,000,000 members enrolled. Now, we're building on that success with the launch of additional innovations around GLP-one access and affordability, including our new and ReachRx solution, a high touch patient support clinical model enabled by pharmacies committed to enhance clinical care for dispensing GLP-one medicines. We also will offer a new specialized GLP-one pharmacy called InGUIDE, which will go live for patients and clients next month. The combination of our pharmacy solutions further strengthens our position as a leader and innovator in this space by solving pharmacy, client and patient challenges. As I wrap up my remarks, I'd like to reiterate a few points.

We had a strong start to the year across both EverNorth and Cigna Healthcare. Some of the notable headlines from the quarter's performance include favorable MCR performance in Cigna Healthcare leading to better than expected earnings, strong growth in Cigna Healthcare Select segment customers up 9% year over year. Within EverNorth, we posted double digit percentage growth in both revenue and normalized earnings within our high growth specialty and care services operating segment, and we had a strong start to the year in our pharmacy benefit services business, including double digit revenue growth. We delivered these strong results alongside making strategic investments for the longer term, including the customer and provider facing enhancements we committed to earlier this year. I'm excited by the numerous growth opportunities we have in the future and the enhancements we are making in order to improve the healthcare system for all.

Now, I'll turn it over to Anne to cover our financial performance and outlook in more detail.

Thank you, Brian, and good morning, everyone. I'm excited to join you for my first earnings call as the CFO of the Cigna Group. Since joining the company over a year ago, I have been inspired by the dedication and talent of our employees, which gives me confidence in our ability to deliver value for our patients and customers and to achieve attractive long term growth. I look forward to engaging with many of you over the coming months. As Brian mentioned, we started the year with a strong first quarter performance ahead of expectations.

Key consolidated financial highlights for the first quarter include revenue of $65,500,000,000 and adjusted earnings per share of $6.74 With the first quarter results, we are raising our full year 2025 adjusted earnings per share outlook to at least $29.6 This outlook reflects confidence in our businesses while maintaining a prudent view of the current environment. Now turning to our segment results. I will first comment on EverNorth. EverNorth continues to deliver strong results. First quarter twenty twenty five revenues grew to $53,700,000,000 while pretax adjusted earnings grew 5% to $1,400,000,000 in line with expectations.

Specialty and Care Services showed strong growth with revenue up 19% to $23,900,000,000 Normalizing for the impact of lower net investment income due to absence of the VillageMD dividend, pretax adjusted earnings were up 11% year over year. This performance reflects the continued demand for specialty drugs as well as increased adoption of biosimilars. Pharmacy benefit services also posted solid growth, reflecting strong client retention, expansion of existing relationships, and new business wins. Pretax adjusted earnings were up 4% to $544,000,000 as our innovative capabilities continue to drive value and savings for our patients, customers, and clients. Overall, we're pleased with Evernorth's first quarter results and confident about the long term growth outlook for the underlying businesses.

Turning to Cigna Healthcare. First quarter twenty twenty five revenues were $14,500,000,000 and pretax adjusted earnings were $1,300,000,000 The medical care ratio for the first quarter was 82.2%. On March 19, we completed the divestiture of our Medicare businesses to HCSC. This transaction closed about a month later than our financial planning assumptions. The timing of the closing modestly benefited our first quarter earnings, but had a greater impact on our medical care ratio as the Medicare businesses operate at a higher MCR compared to the rest of our portfolio.

An additional month equates to an increase of approximately 100 basis points to our MCR in the first quarter, which is included in our reported results. Excluding the impact of the later timing of the Medicare divestiture, the fundamental Cigna Healthcare adjusted earnings in MCR were both favorable to expectations. As previously noted, we anticipated medical cost trends in 2025 to remain elevated. Year to date, we have observed elevated trends consistent with our expectations in most categories, with some favorability in surgical activity and OB services. And finally, our stop loss performance is tracking in line with expectations, and we continue to assume an elevated full year MCR for this business, consistent with our commentary on the fourth quarter earnings call.

Overall, Cigna Healthcare delivered strong results in a dynamic operating environment. Before I comment on our 2025 outlook, as Ralph mentioned, in the first quarter we initiated a strategic optimization program to further advance the company's ongoing efficiency initiatives. These actions will continue to leverage our scale, technology and innovation to position us for sustainable long term growth. Now turning to our outlook for the full year 2025. We are increasing our full year 2025 expectation for consolidated adjusted income from operations to at least $29.6 per share.

This increase is primarily attributed to the incremental earnings contribution from our Medicare businesses, largely reflecting later timing of the divestiture. Regarding the cadence of earnings, we expect the second quarter adjusted earnings per share to be slightly below 25% of the full year outlook. Now turning to our 2025 outlook for each of our growth platforms. In EverNorth, we continue to expect full year 2025 pretax adjusted earnings of at least $7,200,000,000 and we expect Evernorth's second quarter pretax adjusted earnings seasonality to be similar to 2024. For Cigna Healthcare, we are increasing our full year 2025 pretax adjusted earnings outlook by $25,000,000 to at least $4,125,000,000 We expect the second quarter Cigna Healthcare adjusted earnings to be slightly above 25% of the full year outlook.

We continue to expect the full year medical care ratio within the range of 83.2% to 84.2%. Additionally, we expect our second quarter medical care ratio to be towards the low end of the full year range. Turning to our 2025 capital management position. Our debt to capitalization ratio was 43.1% as of March 31. We expect this ratio to be lower at year end as we balance our capital management strategy, including debt paydown, as we move through the year.

As of May 1, we have repurchased 8,200,000.0 shares of common stock for approximately $2,600,000,000 And we remain confident in our strong balance sheet and cash flow generation, we will continue our disciplined capital management approach to drive sustainable long term growth. Now to recap. Our first quarter twenty twenty five results reflect strong contributions and disciplined execution from both EverNorth and Cigna Healthcare. Our 2025 outlook reflects the sustained momentum and solid fundamentals of our growth platforms, which gives us confidence to increase our full year 2025 adjusted earnings outlook to at least $29.6 per share. And with that, we'll turn it over to the operator for the Q and A portion of the call.

Ladies and gentlemen, at this time if you do have a question, please press 1 on your touch tone phone. If someone asks your question ahead of you, you can remove yourself from the queue by pressing 2. Also, if you're using a speakerphone, please pick up your handset before pressing the buttons. One moment please for the first question. And our first question comes from Lisa Gill with JPMorgan.

Your line is open. You may ask your question.

Thanks very much and good morning. I wanted to start first with weight loss. You know, saw a competitor yesterday sign a deal with Novo. I'm just curious around what you're seeing on the opportunity to be able to negotiate a better price with either of the large GLP-one players in the marketplace. And then two, you talked about 9,000,000 people enrolled in the program, but can you talk about general coverage from an employer or ASO perspective?

Is there a big opportunity if we start to see materially better pricing? And then just lastly, David, I have to sneak this one in here. I just really would love to hear your thoughts on Arkansas and the legislation. And I believe you have a large pharmacy benefit relationship with one of the large employers in that state. So if you could give some color around that as well.

Lisa, good morning, David. You sure packed a lot in there. So let me ask Brian to take the first tranche of your questions, which I'll focus around the GLP-one space, and talk about what we're seeing in the market. You asked questions around what's happening with coverage, but more specifically, what's happening with innovation in the marketplace, both in terms of the access and the affordability. Then I'll come back on the Arkansas bill.

Thanks, David. Good morning, Lisa. So, if I step back and take a look at the GLP-one space and our position, we're really proud of the comprehensive approach that we're taking towards this market. So, that's represented by the combined suite of GLP-one programs that I referenced in my earlier comments, specifically around EncircleRx and ReachRx and in Guide. And we developed these programs really in response to some of the clear needs that were emerging around the market.

So most notably access, affordability, clinical safety, and longer term lifestyle changes. And we don't necessarily see formulary placement or choosing one drug over another in this class as being sufficient to generate the societal impact that these drugs can have. And it's important to keep in mind that we have multiple formularies, multiple network options available across our, EverNorth platform today. And some of these solutions are narrower in nature, some of them are broader. Now, it relates to specific drugs or manufacturers that we partner with, there are some principles that tend to guide us, whether for GLP-1s or for other drugs.

So, one principle is that competition tends to improve affordability over time. So, that competition can occur between manufacturers on a specific type of drug or between injectable versions and tablet versions. All those dynamics are a good thing over time. It allows us to negotiate lower net costs, which benefit both clients and patients. Another principle is that choice is good, all else equal.

And a final principle is to ensure that a resilient supply chain exists such that there's adequate supply of any drug class. So these principles apply across most drug classes, but are particularly important for GLP-1s. And we have a proven track record of being able to dynamically manage against this changing prescription drug landscape. So again, we're really proud of our comprehensive approach to the GLP-one market and the solutions that we've introduced that address access affordability, clinical safety and longer term lifestyle changes. In of coverage levels, what we're seeing in our EverNorth book of business is just north of 50% of our employers provide coverage for weight management.

That's relatively stable from where it was in 2024. In our Cigna Healthcare book of business, the percentage covering for weight management is lower. We're in the 15 to 20% range, and that's because we have a smaller average employer in our Cigna Healthcare book of business, and that percentage is also relatively stable from 2024 to 2025. So as net pricing comes down in this class, it should increase the percentage of employers who are interested in providing this benefit for their employees and their dependents. David, do you want to pick up on the last part of Lisa's question?

Sure. And again, before I pivot over to Arkansas, I'll just amplify two pieces. Lisa, first, as I think you very well know, back to coverage, part of your question, in The United States, Brian referenced the coverage levels. Broadly speaking, OECD countries outside The U. S.

Do not cover GLP-1s for weight management. So our country is in a different posture, and hence, as employers at that stable coverage level are increasingly looking for more value out of the coverage, including continuity of care, as there's a lot of fracturing in terms of the use of the medication starts and stops and starts and stops. Just wanted to amplify that. Back to the Arkansas bill. First, context wise for Arkansas.

Arkansas, for the broad Cigna Group portfolio, is a smaller market for us. Now, to the bill, two points before I get into the Arkansas bill. As an organization, we have and will continue to operate in an active and regulatory environment. That's something we have a long track record of demonstrated engagement in, participation in, and then evolving our business portfolio. Second, in that environment, we aggressively support evolution of both legislation and regulation around, for example, transparency, but transparency that's actionable, improving value and affordability, and importantly, maintaining or expanding choice versus constricting choice.

Specific to the Arkansas bill, we see it broadly speaking in opposition to these goals, where the posture of the bill picks and chooses winners in the state, uses inappropriately from our point of view licensure capabilities to limit choice, commerce, and free market, and the result of which, importantly, is going to be a decrease in access, a reduction in choice, an erosion in quality and continuity of care, and ultimately an increase in cost for citizens. So we oppose both the construct and the intent of the bill. Having said that, I'd reinforce that Arkansas is a relatively small market for the Cigna Group. Lisa, thank you for your question.

Thank you. Our next question comes from A. J. Rice with UBS. You may ask your question.

Hi everybody. Thanks for the comments about GLP-1s. I wonder if I could broaden it out a little bit. Obviously, there's a little bit more of an unsettled economic environment. I guess there's always some variability every time this year, but as you start to have discussions, obviously you're well into the PBM selling season and you're gearing up to talk about benefit design with your commercial clients, and the broader health care coverage.

What are you seeing in terms of where they're focused and things that they're asking you about? And I wondered in an unsettled economic environment, does that tend to drive more of that select market toward your product or does it make them pause on making a change like that?

Morning AJ, it's Brian. I'll take the question about the selling season and then I'll try to address your point about the smaller employers and some of the uncertainty in the economic environment right now. So maybe I'll start with the net results that we're expecting at this point in time for 2026 and then I'll unpack some of the market dynamics underneath. So within our Express Scripts pharmacy benefit services business, we're currently tracking toward mid-90s or better retention. That's a strong retention level consistent with what we've seen in prior years.

Within the Cigna Healthcare portfolio, still pretty early in the season for smaller employers, but we do have some good insights on the larger end of the market, specifically our national accounts business. And here we continue to view this market segment as one that will be a flat to shrinking market overall over time. And our strategy in the national account space is to maintain our current share. And at this point, we're not seeing anything unique for 2026 that would cause us to deviate from that general pattern. So maybe I'll spend just a minute or two on some of the dynamics, transpiring in the selling season to your question.

So I'd characterize this as an active season, both as we compete for potential 2026 new business, but also amongst our existing client base who are exploring the market. So in terms of some common themes, a few things I'd highlight. As we've discussed on prior calls, affordability continues to be a key area of focus for employers, particularly with the higher cost trend environment that we're experiencing. Now, this is driven in part by the wave of drug innovation, including specialty drugs and GLP-1s, along with continued growth in mental health spending. Now fortunately, significant strides we've taken in improving our own unit cost position in the Cigna Healthcare business has positioned us well to compete effectively on the unit cost dimension.

And you can see that manifesting itself in the strong growth that we're posting in the under 500 select segment. And of course, the Express Scripts pharmacy benefit services business, we continue to drive superior net cost outcomes for our clients, which allows us to retain and win not only employer, but also health plan and government clients in this business. And as we look at the composition of costs for an average employer, about 20% of the average employer's healthcare spend is now in specialty drugs, when you combine what's covered under the prescription and the medical benefits. And our Accredo specialty pharmacy business is very well positioned to address this need and to deliver strong cost and clinical outcomes. And finally, we continue to see interest in more precise and personalized solutions, both in the form of network configurations as well as clinical programs.

So some of our solutions to address this need on the network side include the Pathwell specialty offering as well as our Pathwell bone and joint program. On the clinical side, personalized programs are increasingly being demanded and we're meeting that need with programs like the inReach GLP-one clinical support program that I described earlier. And finally, well, we don't really typically talk about our Accredo specialty pharmacy in the context of the selling season, our patient base within Accredo continues to grow through a combination of Accredo being added as a network option and other companies PBMs, growth in our Express Scripts business, which leads to more Accredo patients and more existing Cigna Healthcare patients being prescribed specialty drugs. The second part of your question was more around the select segment under 500, the strong growth we've posted year to date of 9% customer growth year over year. I would say our solutions broadly are attracted to those employers because we have a funding agnostic approach that we use in terms of how we go to market, meaning if a client wants a fully insured offering, we'll allow them to have a fully insured offering.

If they would prefer a self funder, we call level funded where it's ASO with stop loss, that's also on the table for any employer that engages with us. So I think the consultative model has allowed us to be a net share taker in addition to the affordability improvements that we've made over time, independent of the economic environment that go to market strategy has proven beneficial to us. So, don't necessarily correlate the current economic uncertainty with the growth we've experienced, but we're pleased with the results we put up. Thanks for the question.

Thank you. Our next question comes from Justin Lake with Wolfe Research. You may ask your question.

Thanks. Good morning. I wanted to follow-up on the stop loss discussion. I was hoping you might be able to give us a little more detail in terms of what you're seeing in terms of cost trend in your commercial book, but specifically in the stop loss business relative to what you saw kind of pressure you in the fourth quarter? And then any early kind of feedback from the customer community as you're starting to work on getting that book repriced for 2026?

I know you're trying to target 100% getting it fully back in terms of the margin that you lost last year, but you've guided to something a little bit less than that. Curious how you're seeing that kind of run through. Thank you.

Justin, good morning. It's David. Let me ask Brian to start with the marketplace, our rate execution, continue working with our clients, etcetera. And then Ian will pick up from there and talk about the performance we saw in the first quarter. To bridge a part of your latter part of your comment, our plan and expectation is to recoup the margin through the 'twenty five and 'twenty six season.

So over the two year horizon, profitable book of business, less profitable than it's historically been. We'll recoup throughout the course of this year, largely in the second half and then recoup further in 2026. Brian, I ask you to talk about the selling season and the clients' reactions?

Sure, David. Good morning, Justin. So the headline I'd ask you to take away is that we're tracking to the stop loss margin improvement plan that we outlined during the fourth quarter call. Now kind of stepping back from that, our stop loss offerings are an important part of our U. S.

Employer portfolio within Cigna Healthcare. They work in complement with our other products and solutions for the employers who choose to employ a self funding with us. And the Stop Loss products provide employers with budgetary protection against unexpected large claim in activity for aggregate cost levels being unexpectedly high. And all of the Stop Loss business that we write is through an integrated offering with the employer where we also administer their overall medical benefits and we continue to see very strong market demand for these solutions. And we are the industry leader in this space.

Now, we noted in our fourth quarter call, we are working to improve the margin profile in this business over the course of the next two renewal cycles as David indicated, and we're confident in our ability to deliver against this. Now over the past few months, we've been able to make progress on this plan specifically by incorporating the revised cost structure in our later 2025 client renewals. And we've been able to execute this while preserving our typical client retention levels. So overall, the year to date '25 performance is tracking to the expectations that we had outlined for you during the fourth quarter call. And I'll turn it over to you if you want to elaborate on what we're seeing in the first quarter financials and the outlook specifically.

Sure. Thanks, Brian. So I'll start maybe first with trend utilization, what we're seeing more broadly and then talk about stop loss and specifically how the first quarter, has played out. So heading into 2025, we expect the trend to remain elevated. In the first quarter, trends remained elevated in most categories consistent with what we expected, so we continued to see elevation in the specialty and behavioral categories.

As I mentioned in my prepared remarks, we did see some moderation in surgical activity in OB services, but given it's early in the year, we've prudently maintained our MCR assumptions for the full year. Now specifically for stop loss, as a reminder, we've assumed a higher stop loss MCR for this year versus last year, consistent with what we said coming out of the fourth quarter. Stop loss is a cumulative product, and we are still very early in the year. The first quarter stop loss MCR reflects our expectation for the full year. So thus far, things are tracking to expectation based on the early indicators that we're monitoring and measure the performance of the business.

So taken altogether, as Brian said, performance is in line with our expectations for the stop loss book.

Thank you. Our next question comes from Charles Rhyee with TD Cowen. Your line is open. You may ask your question.

Yeah, thanks for taking the question. Just wanted to follow-up maybe on Arkansas for a second. What is the recourse for companies like Cigna and other companies that operate both PBMs and pharmacies, and in this case, mail order specialty pharmacy? Because I think, know, obviously, bigger question is perceptions of potential conflicts of interest of having these kind of entities joined together. And, you know, obviously, there's a lot of different proposals, both in Congress and across many states, trying to address this through things like greater transparency.

And I appreciate that you guys have been moving forward and trying to provide greater transparency, but what in your view are some of the more simple steps that could be done to maybe assuage some of these concerns about potential conflicts of interest that doesn't have to go all the way to what Arkansas has tried to do here? Then if I could just quickly add also, Qualen has launched biosimilars to LARA would be great. Thanks.

Good morning, Charles. It's David. I'm going to give you a directional tone to your question because I'm not trying to give you the specifics she may be looking for. First, as I mentioned to Lisa's question, we fundamentally think the bill is a flawed posture. The value creation is indisputable of what is being able to be delivered and supported and actually bridged your last comment and worked my way back.

If you think about the biosimilar success in terms of the interchangeable that we've been able to launch a break to market for Humira, that is enabled by the breadth of our portfolio and the breadth of our capabilities. It's been able to harness those, the result of which is significant savings for employers, health plans, or government latency clients in $0 out of pocket for a consumer. It's indisputable. Secondly, as an example, the capabilities Brian walked through around our GLP-one innovations, they are expressly enabled by harnessing the breadth of capabilities across our portfolio as opposed to dismantling those capabilities. So fundamentally, we disagree with the core tenet.

Now to your point, what can be done? Fact based engagement relative to what the problem statement is, how the marketplace works, and how ongoing innovation is being brought to market. Second, further amplifying and activating client's voice relative to maintaining choice as opposed to structurally removing choice. Third, as you articulated and I highlighted in my prior comments, embracing transparency. Transparency is something that the marketplace has and further leans into.

Cigna Group (CI) Q1 2025 Earnings Call Transcript

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