The Cigna Group
Health Care · Health Care Providers & Services
Structural: #2 US PBM by script volume behind $CVS Caremark, ahead of $UNH OptumRx; vertically integrated with Accredo specialty (largest US specialty pharmacy) and Evernorth Care Solutions. 3B cash, closed Q1 2025), capital structure is commercial-employer + PBM, not MA-utilization-exposed.
Selective on growth: walked from $HUM, walked from MA, used proceeds for buybacks.
(1) Evernorth scale insulates PBM from formulary pressure - 3 big PBMs control ~80% of scripts; (2) Specialty drug mix (Accredo) is the highest-margin script category and grows with biologics/GLP-1 pipeline; (3) Commercial book has lowest MLR volatility vs MA peers $UNH $HUM $ELV; (4) Buyback cadence funded by HCSC proceeds + FCF (~$10B/yr operating cash); (5) Trading at single-digit forward P/E vs managed-care historical average.
(1) PBM regulatory overhang - FTC interim report (2024) flagged rebate practices, bipartisan reform bills recurring; (2) Drug-pricing reform / IRA Medicare negotiation reduces rebate economics; (3) GLP-1 ($LLY $NVO) utilization spike pressures employer-plan MLR before formulary controls tighten; (4) Commercial enrollment growth is mid-single-digit, not a re-rating catalyst; (5) Express Scripts contract renewals (Centene, DoD) carry concentration risk.
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