Cigna’s Second Quarter Revenue Increased 25%

Cigna Group’s total revenue for second quarter 2024 was $60.5 billion, an increase of 25% compared with the second quarter of 2023. Company executives said this growth was primarily driven by significant growth in Evernorth Health Services.

David M. Cordani

“Our solutions continue to resonate well given our highly consultative approach to help clients choose the right set of solutions. Our proven capability to support the workforce and our innovative programs help keep costs down,” David M. Cordani, chairman and CEO of The Cigna Group, said during an investor call.

Evernorth accounts for about 60% of Cigna’s earnings and includes the pharmacy benefit services and the specialty and care services segments. Express Scripts, which provides pharmacy benefit services, accounts for about 30% of Cigna’s earnings.

For the three months that ended June 30, 2024, total adjusted revenue from pharmacy benefit services was $26.6 billion, up from $18.8 billion in the second quarter of 2023. The number of pharmacy customers at June 30, 2024, increased 24% from Dec. 31, 2023 to 122.5 million. Company officials said this is due to new sales and the continued expansion of relationships.

“While the needs of every client are unique, there are a few consistent themes across every discussion,” he said. “First continued focus on affordability, particularly like medications like GLP-1 coming to market. Next, an increased need of improved access and importantly coordination of behavioral health services. Third is mounting point solution fatigue and fourth, the opportunity and need for leverage of our longitudinal data and clinical programs to help keep people healthy and vital.”

Cordani said that pharmacy services continues to expand. Cigna and Evernorth, he said, are positioned to address the advances likely to come in the next few years in cancer, diseases that stem from diabetes and obesity and other conditions.

“The GLP-1 class of drugs is on tap to be the No. 1 pharmacy benefit trend driver for plans of all sizes this year,” Cordani said. “The impact has grown, with some forecasting nearly 10% of the U.S. population using GLP-1 drugs in the next 10 years or so. The implications rippling from these fast growing pharmaceutical trends across the entire healthcare system are undeniable.”

Increased attention has been on the GLP-1 drugs after semaglutide was approved as Wegovy and tirzepatide as Zepbound to treat obesity. They were first approved to treat diabetes. As more data becomes available about how GLP-1 therapies impact the metabolic system, demand and use is expected to skyrocket. Spending as a whole on the GLP-1 class of therapeutics is expected to grow by 378% to $8.1 billion by 2027, according to IQVIA Institute for Human Data Science. IQVIA expects two to five additional launches of GLP-1 therapies by 2027.

In March 2024, Evernorth introduced a financial guarantee for clients interested in covering GLP-1s therapies called EncircleRx. The program aims to give employers and health plans greater predictability and control of their GLP-1 spend. For patients, those who meet criteria for a GLP-1 drug are enrolled in a lifestyle modification program with behavior change support from an Omada Health care team.

Within oncology, Cordani mentioned the Express Scripts oncology benefit services, which will be available in 2025. The company is offering a new solution helps patients navigate the challenges of cancer care by providing a single oncology benefits integrating pharmacy, medical, and behavioral health treatments. “Our patient centered approach will help ensure the earliest possible detection guide individuals to high quality providers and coordinate care across clinical,” Cordani said.

Biosimilars to Grow Evernorth

Going forward, Cordani said during the investor call the company expects continued growth in Evernorth. He pointed to the company’s efforts to provide a private label Humira (adalimumab) biosimilar as part of this growth strategy.

Related: Evernorth to Offer Private Label Humira Biosimilar

Cigna’s affiliate private label pharmaceutical distributor, Quallent Pharmaceuticals, began shipping the Humira biosimilars at the end of June 2024. The private label biosimilars will be available as both high- and low-concentration interchangeable product, and eligible patients will have access to a $0 copay to those who are part of the company specialty pharmacy Accredo.

Eric Palmer

The company has already seen meaningful uptake of the Humira biosimilars, with a 20% share, Eric Palmer, executive vice president for Enterprise Strategy for The Cigna Group and president and CEO for Evernorth Health Services, said during the question-and-answer part of the investor call.

“Biosimilars are a really important opportunity to improve affordability of these high cost specialty medicines,” Palmer said. “We’re really well-positioned to help connect our clients and their customers with these therapies. Our approach here has been consistent and that we offer choice and value to a best align with our client’s needs.”

The private label business positions Cigna and Evernorth for the biosimilar market beyond Humira, Cordani said. “By 2030, we expect to see an additional $100 billion of annual specialty drug spend in the United States will be subject to biosimilar competition, and Accredo is well positioned to deliver a differentiated value for our clients, customers and patients,” he said.

Care Services Poised for Growth

Cordani said, the company’s care services businesses are set to expand into areas of increased demand, including behavioral, virtual and home care. Evernorth’s Specialty and Care Services revenue increased 18% in the second quarter compared with the second quarter of 2023.

Behavioral Care customers at June 30, 2024, were 23.8 million, but this was a decrease from last year due to non-renewal of supplemental behavioral coverage contracts. At the same time, Evernorth’s behavioral care group expanded to an additional seven states.

“We are seeing positive patient outcomes from our unique mission-matching capabilities based on individual needs and preferences, with fully 84% of patients experiencing clinically significant reductions in the depression and anxiety symptoms,” he said.

In March 2024, Evernorth launched an outpatient behavioral health practice as a way to expand access. Through this new service, patients can book an appointment online and are see a clinician within 72 hours.

Evernorth Behavioral Care Group launched with more than 1,000 licensed behavioral health clinicians who specialize in treating a wide range of behavioral conditions and can provide therapy for personal and social health concerns.

Evernorth Behavioral Care Group teamed up with The Cigna Group Ventures-backed Octave to accelerate the creation of this infrastructure and recruitment of clinicians.