The Cigna Group

The Cigna Group is an American health insurance and pharmacy services company that operates through two segments — Evernorth Health Services, one of the largest pharmacy benefit managers and specialty pharmacy platforms in the United States, and Cigna Healthcare, a national health benefits provider — generating $275 billion in revenue in fiscal 2025. The company serves more than 185 million customer relationships across over 30 markets, making it one of the handful of entities that sit at the intersection of medical benefits, pharmacy benefits, and specialty drug distribution in the American health care system.

This is a story about a company navigating a deliberate and self-imposed transformation of its largest revenue engine while betting that a faster-growing specialty pharmacy business can carry the earnings compounder forward. The Cigna Group of 2026 looks materially different from the Cigna of 2017: the $67 billion Express Scripts acquisition closed in December 2018 transformed a midsized health insurer into a health services conglomerate where pharmacy-related revenue now dwarfs the legacy medical business. The 2025 sale of the Medicare Advantage book to HCSC, the announced exit from the individual exchange business at end-2026, and the ongoing strategic review of eviCore all reflect a management team willing to prune where it cannot achieve differentiated scale. The central question the file turns on is whether the growth and margin profile of the specialty pharmacy and care services platform can offset the deliberate margin compression underway in the pharmacy benefit management business as the industry transitions from a rebate-based model to a transparent fee-for-service model.

The company trades at roughly 11.5 times trailing earnings and 8 times EBITDA — multiples that embed a skeptical view of the PBM transition and little credit for the specialty compounding story. Understanding whether that skepticism is warranted requires working through the structure of each business, the durability of the competitive position, and the signposts that would confirm or refute the bull case for specialty-led earnings growth.