Cigna's insurance profit rises as Express Scripts earnings fall

What happened

The Cigna Group reported on Thursday 5 November that third-quarter revenue was up 6 percent to $73.7 billion, and it raised its full-year outlook in the same release. ^[1]

Shareholders' net income was $1.4 billion, down from $1.9 billion a year earlier, mainly because the 2025 quarter held an after-tax gain on a sale. Adjusted income from operations, the company's own measure that leaves out investment results, amortization of acquired intangibles and special items, was $2.1 billion in both quarters. ^[1]

Why it matters

The two segments moved in opposite directions. Cigna Healthcare, the insurance business, earned $1.19 billion before tax, up 15 percent, on adjusted revenue of $11.7 billion, up 9 percent. Evernorth, the pharmacy and care services business, earned $1.83 billion before tax, down 4 percent. ^{[1, 2]}

Express Scripts in transition

Inside Evernorth, Pharmacy Benefit Services, which includes Express Scripts, earned $765 million before tax, down 22 percent. The company said the drop mainly reflected large client contract renewals and strategic investments. Specialty and Care Services earned $1.06 billion, up 15 percent, helped by wider use of biosimilars, lower-cost copies of biologic drugs. ^{[1, 2]}

Chief Financial Officer Ann Dennison said 'This business is in a period of transition,' according to Healthcare Dive. The trade site reported that Express Scripts is spending to move to a new model called Signature, meant to be more transparent, which becomes broadly available in 2028. ^[2]

Healthcare Dive also reported, on Thursday 5 November, that the Labor Department had finalized a pharmacy benefit transparency rule late the month before. Chief Executive Brian Evanko said on the call that it is 'very unlikely that this rule will result in lower prescription drug spending,' though Cigna will comply. ^[2]

Customers gained and lost

Total customer relationships were 177.6 million on 30 September, down 6 percent from 31 December 2025. Pharmacy customers fell 5 percent to 117.7 million, which the company tied to expected client transitions and lower health plan membership. Behavioral care customers were down 19 percent after a government contract ended, with minimal effect on revenue or earnings, the company said. ^[1]

Medical customers were up 2 percent to 18.5 million, with growth in Middle and Select markets and lower membership in National Accounts. In April 2026 Cigna announced it would leave the Individual and Family Plans medical business on 1 January 2027. ^[1]

What settles it next

The company's 2026 outlook now has Cigna Healthcare earning at least $4.6 billion before tax, up $50 million from its prior projection. Evernorth is at least $6.9 billion, with no change listed. The medical care ratio, the share of premiums spent on medical costs, is projected at 84.2 percent plus or minus 25 basis points, a range narrowed by 50 (a basis point is 0.01 percentage point). ^[1]

Cigna also announced a $3 billion multi-year productivity effort at its Investor Day on Wednesday 30 September. The exit from individual plans takes effect Friday 1 January 2027. ^{[1, 3]}

Who it reaches

The Cigna Group (CI) is direct: the results are its own. CVS Health (CVS) is adjacent: Healthcare Dive reported on Wednesday 4 November that CVS plans to split in two. One company would hold Aetna and the Caremark pharmacy benefit manager, the other its retail pharmacies, by the first half of 2028. ^[4]