Cigna

RANK32

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.