Cigna Corp. is the fifth-largest health insurer in the U.S., serving more than 15 million lives nationwide. Roughly 80% of its members are enrolled in administrative services only (ASO) contracting arrangements. While Cigna largely covers employer groups, the insurer is working to build its individual and Medicare Advantage (MA) businesses. The insurer will expand its Affordable Care Act exchange offerings to 50 new counties in Georgia, Mississippi and North Carolina in 2023 and add three new states — Indiana, South Carolina and Texas — to its market. Cigna currently ranks 12th in national exchange enrollment, with 307,500 members. In the MA arena, Cigna ranks eighth nationally. For the 2023 plan year, the company is expanding its MA plans to 106 new counties and two new states — Kentucky and New York.
Cigna is also investing heavily in virtual and primary care. The company acquired MDLive, one of the largest telehealth platforms, in 2021. And on Nov. 7, 2022, Cigna invested $2.5 billion in primary care provider VillageMD, a subsidiary of Walgreens Boots Alliance, Inc. The deal also presents an opportunity for Evernorth, Cigna’s health care services division, to build out its analytics, population health and value-based contracting capabilities on a much larger scale, according to a Nov. 18 article in AIS’s Health Plan Weekly. “It pulls together the PBM services of Express Scripts, and the primary care of VillageMD, and the specialty care of Summit Health and even the urgent care of CityMD,” Michael Abrams, principal at Numerof & Associates, told Health Plan Weekly. “At some level, maybe this is kind of a bigger test to see whether all of these pieces can work together.”
Meanwhile, Evernorth’s Express Scripts — one of the “big three” pharmacy benefits managers — in October was selected as Centene Corp.’s new PBM for the bulk of its 21 million members. Cigna will face a one-year headwind that includes onboarding costs of about $200 million, according to a Nov. 10 article in AIS’s RADAR on Drug Benefits, as the two orgs will need to integrate their IT systems and reshuffle formularies and likely their rebate contracts with drug manufacturers. “Were Centene to have certain relationships with pharmaceutical companies, those would carry forward,” Steven Peskin, M.D., senior adviser at ADVI Health, told AIS. “They would not be changed by a change in pharmacy benefit administrator. On the other hand, they’ll lose all of what they had with the incumbent. In making this decision, no doubt there was very careful consideration of that.” Centene, which is switching to Express Scripts from CVS Health Corp.’s Caremark PBM, is the fourth-largest insurer in the U.S.
“[It] builds on Express Scripts’ track record as the partner of choice and will present growth opportunities to provide additional Evernorth health services over time,” Cigna CEO David Cordani said of the deal during the company’s third-quarter 2022 earnings call on Nov. 3. And while Evernorth as a whole had “solid top-line and bottom-line results,” Cordani pointed to Cigna’s U.S. commercial business performance as a standout, “leading us to once again raise our full-year outlook for medical customers.” The company projects full-year 2022 earnings of at least $179 billion.
*Cigna’s small group market makes up 1% of its total group risk enrollment.
SOURCE: AIS’s Directory of Health Plans as of December 2022; MMIT Analytics as of 4Q 2022.