Cigna Corp. is the fifth-largest health insurer in the U.S., serving more than 15 million lives nationwide. More than 80% of its members are enrolled in administrative services only (ASO) contracting arrangements. While Cigna largely covers employer groups, the insurer is working to expand its individual and Medicare Advantage (MA) business, bringing its Affordable Care Act exchange plans to 79 new counties in 2021 while also expanding its MA reach to 80 new counties for the 2021 plan year. The push to expand into these markets may be partially fueled by the nationwide job losses caused by the COVID-19 pandemic, as Cigna’s overall membership is down 8.7% from 4Q19.
While the pandemic may have caused Cigna’s insurance segment to take a hit, the company has been able to beat market expectations due to its growing health services portfolio, rebranded as Evernorth in September 2020. The Evernorth umbrella includes Express Scripts, which Cigna acquired in a landmark 2018 deal; Accredo Health Group, a specialty pharmacy unit; and eviCore, a medical benefits management company. In addition to Express Scripts, Cigna also offers PBM services under its Cigna Health and Life Insurance Company (CHLIC) branding. Cigna posted $40.8 billion in revenue in 3Q20, with industry analysts pointing out Evernorth’s high script volumes and better-than-expected margins, according to a Nov. 6 article in AIS’s Health Plan Weekly.
Analysts also pointed to Express Scripts’ burgeoning relationship with Prime Therapeutics, the PBM jointly owned by 18 Blue Cross and Blue Shield affiliates, as a reason for the boost. In addition to an agreement that allows Express Scripts to negotiate with drug manufacturers on Prime’s behalf, a 2020 deal between the PBMs gives Prime’s Blues plans the option to use Express Scripts for mail order and specialty pharmacy services.
*Cigna’s small group market makes up less than 1% of its total group risk enrollment.
SOURCE: DHP, AIS’s Directory of Health Plans; MMIT Analytics. Subscribers can read the Health Plan Weekly article here: https://bit.ly/3pqmpHj. Read more about Express Scripts’ relationship with Prime Therapeutics here: https://prn.to/3ae9P7D.