The Cigna Group (CI) TD Cowen 46th Annual Health Care Conference summary

Financial performance and outlook

• Delivered steady results for 2025, meeting expectations and differentiating in the market.

• Confident in achieving at least $3.25 EPS in 2026 and maintaining a 10%-14% long-term EPS growth rate.

• Cash flow from operations expected to be at least $9 billion in 2026, with a focus on reducing debt-to-capital ratio to 40%.

• Share repurchases are expected to be back half weighted in 2026, with more normal activity resuming in 2027 as debt repayments subside.

• Potential upside in guidance could come from favorable medical cost trends, higher volumes, or faster biosimilar penetration.

Strategic initiatives and investments

• Launched a new rebate-free PBM model in October, receiving strong client interest and aligning with PBM reform and transparency requirements.

• Investing approximately $300 million per year through 2027 to support the new model, focusing on technology and recontracting with manufacturers.

• The rebate-free model features upfront, transparent discounts and a flat administrative fee, aiming to reduce unpredictability and improve patient affordability.

• Expansion of Price Assure and integration with platforms like GoodRx to guarantee lowest prices and enhance benefit compliance.

• Specialty and care services are guided to the high end of long-term growth targets, driven by biosimilar adoption and the Shields investment.

Market positioning and regulatory response

• Positioned ahead of the market in PBM reform, transparency, and pass-through requirements, with proactive compliance to FTC settlement and appropriations bill.

• Engaged in productive negotiations with drug manufacturers and pharmacies to support the new model and expand discounts.

• Targeting 50% of clients to transition to the new transparent model by 2028, including commercial employers and labor unions.

• Opposes legislative efforts to separate managed care from PBMs, citing concerns over reduced choice and increased costs.

• Specialty pharmacy strategy includes expanding into provider-to-patient channels via Shields, leveraging synergies with existing distribution capabilities.