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Cigna is on a roll — for now. The health insurance giant raised its 2026 financial outlook for the third time this year, driven by strong performance in its health insurance and specialty pharmacy divisions. But its pharmacy benefit manager, Express Scripts, is dragging on profits as it navigates a costly transition to a more transparent business model.
Cigna is riding a wave of profitability — but not without some turbulence. The company raised its 2026 financial outlook for the third time this year, reporting Q3 net income of $1.4 billion on $73.7 billion in revenue, beating analyst expectations. Its health insurance arm, Cigna Healthcare, covering 18.5 million people, was the standout performer, with adjusted operating income up 15% year over year, helped by premium hikes and improved efficiencies. The specialty pharmacy segment also shone, with earnings up 15% despite just 1% revenue growth, fueled by rising adoption of biosimilars and specialty generics.
The weak link? Express Scripts, Cigna's pharmacy benefit manager (PBM), saw adjusted operating income drop 22% year over year as it spends heavily to roll out "Signature" — a new, more transparent PBM model set to launch in 2028. The broader PBM industry is under fire, with new federal transparency rules and growing calls to restructure vertically integrated health conglomerates.
By the Numbers:
Why it matters: Cigna's results reflect a broader industry rebound after two tough years of runaway medical costs — but the PBM sector's mounting regulatory and structural pressures signal that the road ahead won't be smooth for health conglomerates.
