The Cigna Group

The Cigna Group is an American health care services and insurance company that administers pharmacy benefits for over 100 million Americans, operates one of the country's largest specialty pharmacies, and provides medical coverage to approximately 18 million people, generating $274.9 billion in total revenue in fiscal 2025. Through its Evernorth Health Services segment — home to Express Scripts and Accredo — and its Cigna Healthcare medical benefits segment, the company sits at the intersection of pharmaceutical supply-chain management and health insurance, touching roughly 185 million customer relationships across more than 30 markets.

This is a story about a company deliberately narrowing its focus to compete on pharmacy services at a moment when its core pharmacy benefit management (PBM) business model faces the most consequential regulatory reset in a generation. In 2025, Cigna sold its Medicare business, and in 2026 it announced an exit from the individual exchange market and a strategic review of its eviCore prior-authorization unit — all while launching a rebate-free, fully transparent PBM model called Signature that it intends as the industry's new standard. The central question the file turns on is whether Signature can preserve PBM economics while satisfying the political demand for transparency, or whether the transition will reveal that a meaningful portion of the legacy profit pool was the opacity itself.

The broader enterprise has momentum. Specialty pharmacy — the fastest-growing piece, now contributing roughly 35% of company income — benefits from secular tailwinds in biologic drug spending and biosimilar adoption that are largely independent of the PBM debate. Cigna Healthcare is generating attractive returns after shedding its Medicare exposure. And management has telegraphed confidence with a $30.35 adjusted EPS guide for 2026, an active buyback, and a leadership transition that keeps institutional knowledge in the executive chair. The question is how much of the PBM uncertainty the current multiple already discounts — and what combination of execution and external events would move it.