UPDATED: Feb. 5 at noon ET
Cigna's top brass said that the company has anticipated a "clearing event" in the pharmacy benefit management industry, and that its new model aligns with regulators' push toward greater transparency.
CEO David Cordani told investors Thursday on the company's earnings call that between the newly-passed PBM reforms and Cigna's decision to settle a case over insulin prices with the Federal Trade Commission, it seems that inflection point has been reached.
"We've been saying for some time that the pharmacy services space would go through a clearing event, be it driven by market innovation, legislation or regulation," Cordani said. "When you step back, many of those forces converged this week."
He said that legislators and regulators have put an emphasis on transparency in their efforts to retool the way PBMs work, and Express Scripts' new model is in that arena, too. It's a transparent and fee-based model that eschews the more traditional approaches like rebates and spread pricing.
Both patients and plan sponsors have sought greater transparency and a deeper understand of pharmacy expenses as costs continue to rise. CFO Brian Evanko said that early feedback from stakeholders around the new model has been positive.
Cigna intends to have the new model live for all of its fully insured plans by 2027, and to see at least 50% of Evernorth's clients transition over by the end of 2028, Evanko said.
"Our innovation squarely goes in that direction, and we are excited and confident to lead the way for the industry," Cordani said.
Cordani said with the the new model's rollout ramping up, the company does not anticipate a change in the margin profile for its pharmacy business, and that its broader "growth algorithm" over time is still set. Evanko said that while the company generally expects profitability on par with prior models, the sources of that profit will likely shift as part of the new approach.
Under the FTC settlement, Cigna agreed to adopt a number of changes that would inject greater transparency into its standard benefit offering. Cordani said the new PBM model is Express Scripts' standard offering moving forward, and that it plans to "support aggressive adoption."
However, the PBM does still have the flexibility to offer more traditional rebates or pass-through models if that's what clients prefer, so there will be choices available in the market, he said.
"We will support this with marketing dollars because we are convicted and believe that this is the future of pharmacy benefit services for the benefit of consumers as well as clients as well as community pharmacists," Cordani said. "We will lean in and support the aggressive adoption of this, but choice will still be in the marketplace."
PUBLISHED: Feb. 5 at 7:30 a.m. ET
Cigna posted $1.2 billion in profit for the fourth quarter of 2025, down slightly from the prior year but still enough to surpass Wall Street analysts' predictions.
By comparison, Cigna reported $1.4 billion in profit for the fourth quarter of 2024. Full-year profits were up, however, climbing from 2024's haul of $3.4 billion to just shy of $6 billion in 2025.
Revenues in the quarter were $72.5 billion, also beating Wall Street's expectations, according to Zacks Investment Research. Cigna brought in $65.6 billion in revenue for the prior-year quarter, according to the earnings report released Thursday morning.
For the full year, revenues were $274.9 billion, up from $247.1 billion in 2024.
"In 2025, we expanded access and support, lowered costs, and improved transparency for our customers and patients," said David Cordani, chairman and CEO of The Cigna Group, in the press release. "As we enter the new year, we are well‑positioned to build on this momentum, fueled by our innovations that leverage our diversified businesses and track record of strong financial performance."
Much like its peers, Cigna continued to feel the sting of elevated costs in the fourth quarter, reporting a medical loss ratio (MLR) of 88%. In the fourth quarter of 2024, its MLR was 87.9%, Cigna said. Full-year MLR was 84.4% in 2025, up from 83.2% in 2024, and Cigna said rising cost in the individual and family plans unit was the key driver.
Revenue at Cigna Healthcare, the company's insurance arm, declined from $13.3 billion in the fourth quarter of 2024 to $11.2 billion in the fourth quarter of 2025. Full-year revenues were also down, decreasing from $52.9 billion in 2024 to $47.2 billion in 2025.
Cigna said the main factor in this decrease was the sale of its Medicare Advantage business to Health Care Service Corporation, a deal that closed in March.
The insurer had 18.1 million members as of Dec. 31, down slightly from 19.1 million at the end of 2024. Cigna said this decline was again largely attributable to the HCSC sale.
At Evernorth, however, revenues rose significantly year over year, increasing from a $53.7 billion haul in the fourth quarter of 2024 to $63.1 billion in the fourth quarter of 2025. Full-year revenues were $234.95 billion, up from $202.2 billion in 2024.
Cigna said the results at Evernorth reflect strong growth for both its pharmacy benefit management services and its specialty care division. The company had 123.6 million pharmacy customers as of Dec. 31, up from 118.3 million at the end of 2024.
For 2026, Cigna said it expects to bring in at least $280 billion in revenue and $30.25 in earnings per share.