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• Cigna is like UnitedHealth Group for health and pharmacy services.
• Cigna is like CVS Health for health insurance and prescription plans.

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• Health Insurance Plans: Provides a range of medical, dental, behavioral health, and vision insurance plans for employers, individuals, and government programs.
• Pharmacy Benefits Management (PBM): Manages prescription drug programs for health plans and employers, encompassing formulary development, claims processing, and drug cost management.
• Specialty Pharmacy Services: Dispenses and supports high-cost, complex medications for chronic and rare diseases, often integrating clinical management and patient education.
• Health Services and Care Management: Offers virtual care, chronic condition management, and other clinical programs designed to improve health outcomes and enhance patient well-being.

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Major Customer Categories for Cigna:

1. Employers (Commercial Market): This is a foundational customer segment for Cigna Healthcare. Cigna provides health, dental, vision, life, and disability insurance plans, as well as health and well-being programs, to employers of all sizes – from small businesses to large national corporations. These employers purchase Cigna's offerings to provide benefits to their employees and their families.

2. Other Health Plans, Third-Party Administrators (TPAs), and Benefit Sponsors: Through its Evernorth Health Services segment (which includes Express Scripts for pharmacy benefits management), Cigna provides a wide range of services. Clients in this category include other health plans (which may be public or private companies), large self-insured employers, labor unions, and other organizations that administer health benefits. These clients leverage Evernorth's capabilities for services like PBM, specialty pharmacy, and care delivery solutions.

3. Government Entities: Cigna contracts with federal and state governments to provide health services to various populations. This includes participation in government-sponsored programs such as Medicare Advantage (contracting with the Centers for Medicare & Medicaid Services - CMS) and managed care services for state Medicaid programs. While not "public companies," these government agencies represent significant institutional customers.

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• Pfizer Inc. (PFE)
• Merck & Co., Inc. (MRK)
• Johnson & Johnson (JNJ)
• Eli Lilly and Company (LLY)
• AbbVie Inc. (ABBV)
• Bristol Myers Squibb Company (BMY)

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David M. Cordani, Chairman and Chief Executive Officer

Mr. Cordani has served as Chief Executive Officer of The Cigna Group since 2009 and President since 2008, assuming the additional role of Chairman of the Board in January 2022. He joined Cigna in 1991 and has held various senior leadership roles, including Chief Operating Officer and President of Cigna Healthcare. Before joining Cigna, he was with Coopers & Lybrand, a predecessor firm of PricewaterhouseCoopers. Under his leadership, Cigna acquired Express Scripts in 2018, a deal valued at approximately $67.5 billion. Mr. Cordani earned a Bachelor's degree from Texas A&M University and an MBA from the University of Hartford.

Ann Dennison, Executive Vice President and Chief Financial Officer

Ms. Dennison was named Executive Vice President and Chief Financial Officer of The Cigna Group, effective March 31, 2025. She joined Cigna in early 2024 as Deputy CFO. Prior to her tenure at Cigna, Ms. Dennison served as Executive Vice President and Chief Financial Officer at Nasdaq. She also previously held the position of Managing Director and Head of Financial Reporting at Goldman Sachs.

Brian Evanko, President and Chief Operating Officer

Mr. Evanko was named President and Chief Operating Officer of The Cigna Group, effective March 31, 2025, with responsibility for all business lines. He previously served as Chief Financial Officer of The Cigna Group since 2021 and as President and Chief Executive Officer of Cigna Healthcare from January 2024. Mr. Evanko joined Cigna in 1998 and has held numerous financial and operational leadership roles across the company's U.S. and international businesses, including positions in Hong Kong and Singapore. He holds a bachelor's degree in actuarial science from Pennsylvania State University and serves on the Board of Directors for TriNet.

Nicole Jones, Executive Vice President, Chief Administrative Officer, and General Counsel

Ms. Jones oversees all legal, regulatory, compliance, and government affairs, and communications functions for Cigna. Her responsibilities are expanding to include the company's enterprise marketing division. Ms. Jones has been with Cigna since 2011.

Everett Neville, Executive Vice President, Strategy and Business Development

Mr. Neville is responsible for mapping the long-term growth strategy for Cigna, overseeing strategy, corporate development, business development, and Cigna Ventures. A pharmacist by training, he joined Express Scripts 16 years ago.

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The key risks to Cigna's business include regulatory changes and political pressures, intense competition, and data security risks.

1. Regulatory Changes and Political Pressures: Cigna operates within a heavily regulated healthcare industry, making it susceptible to significant impacts from changes in laws, regulations, and government policies. This includes legislative reforms, executive actions related to rebates, reporting, and pharmacy benefit management (PBM) practices, which could prohibit certain pricing models like spread pricing and rebates, leading to potential profit headwinds for the company. The ongoing political debates over healthcare subsidies and their influence on insurance premiums also pose a considerable risk, as shifts in policy could adversely affect Cigna's competitive position, cash flows, and overall financial results.
2. Intense Competition: Cigna faces a highly competitive environment within the global healthcare and insurance sectors. The company competes with major players such as Aetna, UnitedHealth Group, Humana, Anthem, and CVS Caremark. Failure to effectively compete, differentiate its products and services, or maintain and increase market share could materially impact Cigna's results of operations, financial position, and cash flows.
3. Data Security Risks and Cyberattacks: As a large global health company, Cigna handles sensitive personal information and data for its clients and customers, making it a target for cyberattacks and other privacy or data security incidents. A robust cybersecurity program is crucial to protect its systems and operations. Any interruption in business or loss of access to data resulting from a security breach could adversely affect Cigna's operations and its ability to meet customer demands, potentially leading to reputational damage, litigation, fines, and penalties.

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Emerging Threats to Cigna (CI)

• Big Tech and Retailers' Entry into Healthcare: Companies like Amazon and Walmart are aggressively expanding their direct healthcare offerings, posing a significant emerging threat. Amazon's initiatives, including Amazon Clinic (virtual care), Amazon Pharmacy, and its acquisition of One Medical (primary care), create direct-to-consumer and direct-to-employer alternatives. These services can bypass traditional health insurers and pharmacy benefit managers (PBMs) like Cigna's Evernorth, potentially eroding market share in pharmacy services, virtual care, and primary care navigation. Similarly, Walmart's expansion of Walmart Health clinics, offering primary care, dental, and behavioral health services, often at lower costs, provides alternative, integrated care options that could disrupt traditional care delivery and insurance models.
• Intensified Regulatory Scrutiny and Legislative Action on PBMs: Cigna's Evernorth segment, a major Pharmacy Benefit Manager, faces increasing bipartisan scrutiny and potential legislative reforms. Emerging legislative proposals aim to increase transparency, delink PBM compensation from drug prices, and regulate other aspects of their business model. Such changes could significantly impact Evernorth's profitability and force a fundamental shift in its operational model, potentially opening the door for new, disruptive PBM models or direct drug procurement methods that bypass the traditional PBM structure.

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Evernorth Health Services

• Pharmacy Benefit Management (PBM):
  • In the U.S., the pharmacy benefit management market was valued at approximately USD 419.14 billion in 2024 and is projected to reach around USD 1,041.11 billion by 2034. Another estimate places the U.S. market size at USD 555.84 billion in 2024.
  • Globally, the pharmacy benefit management market is estimated at USD 670.19 billion in 2025 and is forecasted to reach approximately USD 1,474.64 billion by 2034.
• Specialty Pharmacy Services:
  • The addressable specialty pharmacy market in the U.S. is identified as over USD 400 billion.

Cigna Healthcare

• Comprehensive Medical Plans and Healthcare Solutions:
  • The global healthcare services market was valued at USD 13.31 trillion in 2024 and is projected to reach USD 22.57 trillion by 2032. North America was the largest region in the healthcare services market in 2024.

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Cigna (CI) is anticipated to drive future revenue growth over the next 2-3 years through several key strategies and market dynamics:

1. Expansion and Performance of Evernorth Health Services: Cigna's Evernorth Health Services segment, which includes pharmacy benefit management (PBM), specialty pharmacy (Express Scripts and Accredo), and care services, is consistently highlighted as a primary growth engine. The company expects continued strong specialty volume growth, growth from existing client relationships, and new business wins within this segment. Notably, the increased adoption of biosimilars and the launch of a new rebate-free pharmacy benefit model are expected to contribute significantly, with the new model aiming to transition 50% of its business by 2028 and becoming a growth driver by 2028.
2. Customer Growth and Rate Execution in Cigna Healthcare: Cigna's commercial health insurance business, particularly the "under 500 Select segment," has demonstrated strong customer growth, well above industry averages, with ample headroom for future expansion given Cigna's current market share in this area. Additionally, strong rate execution and disciplined pricing actions within Cigna Healthcare plans are expected to continue driving revenue growth and help manage medical costs.
3. Strategic Innovations and Product Development: Cigna is actively pursuing innovative solutions to address significant healthcare challenges. This includes the introduction of the industry's first financial guarantee for GLP-1 medications through Express Scripts by Evernorth to help manage rising costs associated with cardiodiabesity. The company is also integrating advanced technologies, such as covering Heartflow's AI-powered Plaque Analysis platform, to enhance service offerings. These strategic initiatives are designed to improve value, cost transparency, and support for customers, thereby fostering long-term growth.
4. Demographic Tailwinds: The global increase in the aging population and the rising prevalence of chronic diseases are expected to drive higher healthcare utilization. This demographic shift is anticipated to increase the demand for Cigna's integrated solutions across its Evernorth and Cigna Healthcare platforms, leading to an expansion of its member base and premium revenues.

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Share Repurchases

• Cigna has actively engaged in share repurchases, with approximately $7.0 billion spent on buybacks in 2024.
• As of December 2023, the Board of Directors approved a $10 billion increase in share repurchase authorization, bringing the total authority to $11.3 billion. As of December 31, 2024, the total share repurchase authority was $10.3 billion.
• The company plans to use the majority of proceeds from the sale of its Medicare businesses, expected to close in the first quarter of 2025, for further share repurchases.

Share Issuance

• No significant dollar amount for large-scale share issuance to raise capital was identified; shares are issued under the Cigna Long-Term Incentive Plan for employee compensation, with no further grants available outside this plan.

Outbound Investments

• In March 2022, Cigna announced an additional $450 million investment in Cigna Ventures, its corporate venture fund focused on health tech startups, bringing the total commitment to $700 million.
• In 2020, Cigna sold its Group Life and Disability insurance business to New York Life for $6.3 billion.
• In November 2024, Cigna confirmed it is not pursuing a combination with Humana Inc. and remains focused on strategic, financially attractive acquisitions.

Capital Expenditures

• Cigna's capital expenditures averaged $1.304 billion annually from fiscal year-end 2020 to 2024.
• Capital expenditures peaked in December 2023 at $1.573 billion.
• The company reported capital expenditures of $1.4 billion in 2024 and expects to deploy approximately $1.4 billion in capital expenditures in 2025, primarily funded by operating cash flows.