3 takeaways from Cigna’s 2025 earnings call

The Cigna Group reported strong 2025 financial results this morning, just a day after its settlement with federal regulators was announced. For the full year 2025, the company saw total revenue increase 11% to $274.9 billion compared with 2024. Adjusted earnings per share were $29.84 for 2025, representing 9% growth, and Cigna executives project it will be at least $30.25 per share for 2026.

Express Scripts, which sits within Cigna’s Evernorth division, saw adjusted 2025 revenue grow by 18%, which executives said was the result of growth from existing clients and new business. Specialty and care services experienced 14% revenue growth last year, which the company said was the result of volume growth, including increased adoption of biosimilars.

The company’s healthcare business, Cigna Healthcare, saw revenue decrease 11% for 2025 compared with 2024, mostly because of the impact of the Health Care Service Corporation acquisition of Cigna’s Medicare business. This transaction was completed in March 2025. Excluding the HCSC transaction, revenue increased 7% last year.

During a call with investors, Cigna executives focused on several critical issues facing the company and the industry: its settlement with the Federal Trade Commission, a transformation announced last year to move to a rebate-free model in pharmacy benefits, and a focus on patient affordability.

“We’ve been saying for some time that the pharmacy services space would go through a clearing event being driven by market innovation, legislation, or regulation,” David M. Cordani, CEO of The Cigna Group, said during the investor call. “Many of those forces converged this week, and the work we started in early 2025 and announced in the third quarter of 2025 with our new, innovative model is directly aligned with these forces.”

The FTC settlement

Yesterday, Express Scripts announced that it agreed to make big changes in how it operates to settle a lawsuit with the FTC, which the agency said would lower patients’ out-of-pocket costs for drugs such as insulin by up to $7 billion over 10 years. Some of the biggest changes will require Express Scripts to reimburse community pharmacists based on actual costs, increase transparency for plan sponsors and make sure members pay the lowest available cost for medication.

Related: Express Scripts agrees to reforms in settlement with FTC

The settlement will also require that its group purchasing organization, Ascent, be relocated within the United States instead of Switzerland. Cigna executives said during the call that this change could impact the company’s effective tax rate by up to 1% over time. During the question-and-answer session with analysts, the company said this was manageable against the company’s long-term earnings growth expectation of 10% to 14%.

The settlement “enhances the value we provide to customers and clients, all while we continue to strengthen our position and deliver on our long-term shareholder,” Cordani said. “We are squarely focused on driving affordability improvements and value for those we serve. We are steadfast in our focus on leaning in to lower healthcare costs and expanding access to quality care and medication, but doing so requires confronting the underlying cost drivers, including both the demand and the supply side.”

He talked about the need to address the chronic health conditions and conditions related to aging, as well as mental health conditions, which he said account for roughly 90% of total healthcare spending.

A rebate-free pharmacy benefit model

Cigna officials said during the call that the FTC settlement agreement aligns with Evernorth’s new rebate-free pharmacy benefit model, which was announced in October 2025. This approach will provide for the discounts negotiated with drug companies to be available upfront to patients. Cigna Healthcare will adopt this model for its fully insured lives beginning in 2027. It will become the standard model available for all Evernorth pharmacy benefits clients beginning in 2028.

Evernorth is also adopting a new reimbursement model that compensates pharmacies based on their cost for medications plus a dispensing fee, as well as providing additional reimbursement for clinical services they provide to patients. The new reimbursement model will be implemented across all in-network pharmacies starting in 2026.

This new approach changes how the company will be paid, Brian Evanko, president and chief operating officer, said during the call. “Securing better unit pricing for prescription drugs, administering benefits for plan sponsors and supporting patients with clinical safety checks and advanced clinical programs are the core values from the legacy model. They are in the new model that we’ve introduced. The primary difference is the way in which we’re compensated.”

He explained that there will be two primary ways they’ll be paid in the future: a core administration fee that is per member, per script that is delinked from the price of the drug, and a fee for clinical programs and other services. Executives stressed that despite the different revenue structure, they expect comparable levels of profitability and that the business’ long-term growth algorithm remains intact.

Evernorth’s focus on patient affordability

Both the FTC settlement and the company’s new model aim to address patient affordability in healthcare. The settlement will provide for patient access to more lower-priced medicines, including insulins, and include those medications across all standard formularies. It will cap the monthly cost of insulin at $25 and has set caps on out-of-pocket costs for other medication.

The new pharmacy benefit model includes guarantees that patients receive the lowest possible price on medications, whether through negotiated manufacturer prices, cash pay alternatives, or their copay structure.

Cigna, Cordani said, has also introduced other measures to address patient affordability, including $0 out-of-pocket options for some biosimilars. “In the coming years, there will be more than $100 billion of savings for the U.S. in the biosimilar space alone,” he said. He also pointed to the organization’s reductions in prior authorization.

“We see significant runway for additional growth in our specialty platforms in the future,” Evanko said. “This includes leveraging competition and the shift to more biosimilars and specialty generics, with expected launches and uptake across other drug classes such as oncology, bone, autoimmune, and inflammatory conditions, guided by a clear mission and vision that prioritizes improving healthcare and keeping the customer at the center.”

Officials said Cigna, in collaboration with Lilly and Novo Nordisk, last year expanded its patient assurance program to include GLP-1 medications for weight management to improve predictability and affordability. Copays for GLP-1 medications are capped at $25 for a 34-day supply. With these agreements, the weight loss drugs Wegovy and Zepbound are being added to the solution, and diabetes medications Ozempic and Rybelsus will return to the program.

When Trump Rx launches, Evernorth will be a pharmacy partner for the site. It will dispense EMD Serono’s fertility medications that will be offered through Trump Rx, including Gonal-f (follitropin alfa), Ovidrel (choriogonadotropin alfa), and Cetrotide (cetrorelix acetate).

Additionally, in November 2025, Cigna announced the launch of Clearity, a new copay-only health plan. It leverages AI-powered digital tools to provide upfront pricing, verified patient reviews, and a user-friendly digital experience. With this option, employers can choose from five plan design packages to support various cost-share strategies.