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1、Connecting for a Healthier FutureTHE CIGNA GROUP 2022 ANNUAL REPORTOUR MISSIONTo improve the health and vitality of those we serveDAVID M.CORDANICHAIRMAN AND CHIEF EXECUTIVE OFFICER,THE CIGNA GROUPConnecting for a Healthier FutureGood health drives good results.This is an unmistakable conclusion fro
2、m our collective experiences over the past few years.With good health,individuals are happier and more fulfilled,companies and organizations thrive,and our communities are stronger.Without it,challenges and uncertainties can feel insurmountable.Recognizing the foundational role of good health in our
3、 society at every level,we are doubling down to do even more.In 2022,we launched the Evernorth Vitality Index1 to better understand the factors influencing an individuals ability to not just survive but to thrive.We evolved our mission clarifying that the reason we exist is to improve the health and
4、 vitality of those we serve.And we set a bold goal to increase the health of the lives we touch.2 THE CIGNA GROUP 2022 ANNUAL REPORTOur vision for the health care system is built on the vitality of every individual and every community,and this means delivering on the promise of:Personalized,digital-
5、first health care access and experiences at scale;Advanced care models for conditions,diseases and episodes with superior value;and Seamlessly connected pharmacy,medical and behavioral health services.This is what we are working toward by harnessing the capabilities within our company and convening
6、others through relationships with our partners.It is also what drives and fuels the passion of our more than 70,000 co-workers around the world.We all recognize the inevitable day each of us,or a loved one,will need to turn to the health care system with our own health challenge.Given the level of t
7、alent,capabilities and expertise we possess as a company,we view it as both our responsibility and our privilege to ensure the health care system responds by keeping good health and,therefore,vitality in reach for everyone.We will continue to support the health and vitality of customers,patients,cli
8、ents and communities in ways that drive all of us forward in connecting for a healthier future.Our results and progressTo fulfill these commitments,we have continued to strengthen and evolve our capabilities,and we also have refreshed our brands to reflect the unique value we bring with our broad po
9、rtfolio.The Cigna Group is the new name of our corporation,and we bring our mission and vision to life through our two growth platforms,Evernorth Health Services and Cigna Healthcare.Guided by our durable strategic growth framework,we leverage our platforms as we work each and every day to fulfill o
10、ur promises to our key stakeholders.In 2022,both Evernorth Health Services and Cigna Healthcare delivered strong value for the benefit of our customers,patients,clients and partners,and,as a result,we achieved strong financial results for our investors.Our company:Grew total revenues to$180.5 billio
11、n.2 Achieved shareholders net income of$6.7 billion,or$21.30 per share,and adjusted income from operations of$7.3 billion.2,3 Returned$9 billion to shareholders via a combination of share repurchases and dividends.23 THE CIGNA GROUP 2022 ANNUAL REPORTEVERNORTH HEALTH SERVICES Evernorth Health Servic
12、es performed well in 2022 with its Pharmacy Benefits Services,Specialty Pharmacy and Evernorth Care businesses providing market-leading innovation and affordability.Throughout 2022,Evernorth Health Services continued to drive a digital-first approach to care with MDLIVE serving as the engine for vir
13、tual care.Last year alone,total MDLIVE patient visits grew by approximately 20 percent,4 including substantial growth in the virtual primary care program we introduced.Today,MDLIVE offers virtual primary,urgent,behavioral and dermatological care,which is expanding access,enhancing experiences and im
14、proving affordability for customers.Evernorth Health Services pharmacy solutions are also increasing the value of each dollar spent on medication and driving to the lowest net cost while ensuring quality outcomes.The highest therapy completion rates in the market are a key part of this success.This
15、applies to specialty and gene therapy costs,which comprise as much as half of total drug spending5 even though specialty drugs are used by less than 2 percent of the population.Biosimilars offer growing opportunities to lower costs for patients,clients and partners,and our leading specialty pharmacy
16、 capabilities give us a differentiated position to create value.Today,approximately 7 percent of our specialty drug spend has a biosimilar or generic equivalent on the market,and this will likely increase to more than 25 percent by 2026.4 Over time,we believe this will translate to a$100 billion mar
17、ket opportunity.6 And we expect to manage almost$30 billion of this market opportunity,driving significant savings for patients and clients as more biosimilar equivalents come to market.4 As a result of the value Evernorth Health Services is generating for the benefit of those we serve,we continue t
18、o be a partner of choice across health care and have established significant new relationships with Kaiser Permanente7 and Centene.8Pharmacy BenefitsHome Delivery PharmacySpecialty Pharmacy DistributionCare Delivery and Management Solutions4 THE CIGNA GROUP 2022 ANNUAL REPORTCIGNA HEALTHCARECigna He
19、althcare,our benefits portfolio,includes our U.S.Commercial,U.S.Government and International Health businesses.Together,these businesses are delivering products and services that meet the needs of employers of all sizes as well as individuals.In U.S.Commercial,we drove strong growth,demonstrating ho
20、w much clients appreciate our in-depth expertise and consultative approach,as well as the continued progress we are making with affordability.We are committed to being a differentiated partner of choice in helping individuals and their companies thrive in a time when employees increasingly are looki
21、ng to their employers for health and well-being needs.Our U.S.Government business provides an important growth opportunity for our company,and,in 2022,we continued to support individuals with plans for their personal health and well-being needs,for their lifestyle,and that fit within their budget.We
22、 continued our progress in strengthening our offerings as well as our work doubling the size of our Medicare Advantage provider network over the past two years.4,9 In our Individual and Family Plans business in 2022,we maintained our long-standing and continued commitment to participating in the ACA
23、 exchange marketplace,expanding our footprint and capabilities that provide positive experiences for those we serve.Our International Health business contributed strong revenue and earnings in 2022.In addition,we completed the divestiture of our life,accident and supplemental benefits businesses acr
24、oss seven markets.We will continue to sharpen our focus on meeting the health and well-being needs in attractive growth markets and for the globally mobile.Throughout the year,our Cigna Healthcare segment continued to find more ways of delivering value in the wake of COVID-19 as individuals and empl
25、oyers looked not only for medical benefits they were looking for ways to increase their overall vitality.U.S.CommercialU.S.GovernmentInternational Health5 THE CIGNA GROUP 2022 ANNUAL REPORTCROSS-COMPANY COLLABORATIONEvernorth Health Services and Cigna Healthcare have delivered impactful results on t
26、heir own.And,when they work together,they accelerate innovation and create new solutions for our clients and customers by leveraging our entire suite of capabilities,including our longitudinal portfolio of data.Our Cigna Pathwell program is a prime example.Cigna Pathwell Specialty connects patients
27、with convenient,quality and affordable options for drug infusions through Cigna Healthcares provider network.The newest Cigna Pathwell program,Cigna Pathwell Bone&Joint,connects patients to Cigna Healthcares provider network,as well as its personalized benefit designs,physical therapy options(both v
28、irtually and in person),behavioral health services and peer support.Through Evernorth Health Services analytics,our team can predict potential surgeries up to a year in advance and offer holistic care while also decreasing unnecessary surgeries that can drive up costs.When surgery is necessary,the m
29、embers benefits will cover the procedure at low-to-no cost from admission to discharge.10Another example of the power of our cross-company collaboration is a new multi-year strategic relationship with VillageMD.11 Through VillageMD,we are transforming how care is accessed,delivered and coordinated f
30、or better health outcomes and affordability.Operating more than 250 primary care practices across 22 markets,VillageMD is one of the largest independent primary care groups in the United States.VillageMD physicians and patients partner closely with Cigna Healthcare and also benefit from Evernorth He
31、alth Services,including real-time data and clinical insights at the point of diagnosis,enhanced virtual care options through MDLIVE,and dedicated pathways to specialty care and condition management capabilities.6 THE CIGNA GROUP 2022 ANNUAL REPORTWhen Evernorth Health Services and Cigna Healthcare w
32、ork together,they accelerate innovation and create new solutions for our clients and customers.7 THE CIGNA GROUP 2022 ANNUAL REPORT7 THE CIGNA GROUP 2022 ANNUAL REPORTMaking an impactOur commitment to improve the health and vitality of those we serve guides how we operate our businesses,as well as h
33、ow we engage and support our communities.We are honored by the recognition our efforts have earned,including being listed on the Dow Jones Sustainability Indices for a sixth consecutive year12 and ranking No.1 within health care among Americas Most JUST companies by JUST Capital and CNBC.13In 2022,w
34、e continued to make strides across the four pillars of our environmental,social and governance framework:Healthy Environment,Healthy Society,Healthy Workforce and Healthy Company.HEALTHY ENVIRONMENTWe see an inextricable link between the health of our environment and peoples health.This has spurred
35、our commitment to do more.In 2022,we signed the RE100 global corporate renewable energy initiative and pledged to transition to 100 percent renewable electricity by 2030.In addition,we see an opportunity to measure the positive impact on the environment with a number of ways we are advancing our bus
36、iness.Telemedicine can help to reduce the carbon footprint of health care by reducing emissions because patients do not need to travel for care.Our continued investment in virtual care is one important way we will support a healthy environment.8 THE CIGNA GROUP 2022 ANNUAL REPORTHEALTHY SOCIETY Reco
37、gnizing that some communities face greater challenges than others in supporting the health of their citizens,we maintain our long-standing focus on reducing disparities,addressing social determinants of health and creating a more sustainable health care system.We continue to advance our Building Equ
38、ity and Equality Program,a five-year commitment to accelerate our health equity and DE&I efforts,and are particularly encouraged by innovative opportunities to address racial disparities in pre-term births.By working with health care providers and convening services that include free home delivery o
39、f prenatal vitamins,transportation for medical appointments,nutrition and emotional support,we aim to reduce disparities in pregnancy-related complications among African American women in Baltimore,Houston and Memphis,where we have launched our pre-term birth program.We partner with providers to thi
40、nk beyond the clinical setting to best support the holistic care of their patients.We reward value-based providers to screen for social needs and make appropriate referrals for support and to identify health disparities impacting their patient population and develop an action plan to close gaps.We a
41、re also working to embed health equity into our culture,systems,policies and practices.Starting in 2021,we reviewed all our existing and new medical coverage policies through a health equity lens and,as a result,made changes to our policies that put us on the forefront of driving advancements in equ
42、itable access to care.The commitment to our leadership role in making a positive impact in our communities is core to our business and embraced by our co-workers.Dr.Luis Torres is a shining example,among so many others across our company,of co-workers personally dedicated to making a difference.Dr.T
43、orres worked to drive policy change addressing health equity for racial and social justice when representing The Cigna Group during the CEO Action for Racial Equity fellowship in 2022.14HEALTHY WORKFORCEWithin our company,we support transparency as we advance an inclusive culture honoring the unique
44、 talents and perspectives of our co-workers.Last year,we published our full-year 2021 Diversity Scorecard Report,reinforcing our commitment and progress in creating an environment where members of our team are able to bring their best selves to work,leaving us better able to serve the diverse needs
45、of our customers,clients and communities.159 THE CIGNA GROUP 2022 ANNUAL REPORTOur Diversity,Equity&Inclusion(DE&I)Council continued to provide valuable leadership in guiding our DE&I strategy,helping us strengthen our approaches within our company and in our communities.Caring deeply about our cust
46、omers,patients and co-workers is a value ingrained in our culture,and we are proud of the many ways our team brings this to life,including through our Community Ambassador Fellowship Program.Each year,we select up to 15 employees who receive paid leave and additional support to work with a nonprofit
47、 partner in addressing health and well-being needs.Our 2022 class of ambassador fellows worked on projects such as humanitarian and psychological support for refugees,help for adult survivors of childhood abuse,education around addiction,and the creation of equitable opportunities for high school st
48、udents.We are encouraged by the impact we are seeing with our wide-ranging approach and are pleased to be recognized among DiversityIncs Top 50 Companies for Diversity for a fifth year in a row.16We also understand the added challenges that many of our employees have faced over the past few years,an
49、d we have worked to increase the support we provide them.We initially offered emergency time off in 2021,and as the Omicron variant of COVID-19 spread rapidly at the beginning of 2022,we extended that benefit for our employees.In addition to increased flexibility,we also expanded our caregiver leave
50、 program to include care for grandparents and grandchildren in addition to children,spouses and parents with a serious health condition.HEALTHY COMPANYWe have a deep and long-held commitment to strong governance as well as ethical and resilient business practices.The strength of our Board of Directo
51、rs contributes meaningfully to upholding these commitments.Approximately 70 percent of our directors have served on our Board for fewer than six years,which demonstrates how we continue to bring new and relevant perspectives and skill sets into our company.Throughout 2022,our Board composition excee
52、ded the S&P benchmarks on median age,tenure,gender and ethnic diversity.Our company is purposeful about whom we work with as we seek suppliers that share our values and are committed to operating in a responsible manner.We continue to make progress in creating and supporting a diverse supplier base,
53、and we are honored by the National Minority Supplier Development Council as being among the Forefront 50 corporations showing leadership in creating greater economic access and equity for systematically excluded entrepreneurs of color.1710 THE CIGNA GROUP 2022 ANNUAL REPORTBuilding for the future202
54、2 was a strong year of performance,growth and positive impact for our company.With Evernorth Health Services and Cigna Healthcare,we demonstrated that we are serving the needs of our customers,clients and partners,and we expect to deliver another year of customer and earnings growth in 2023.2 We are
55、 making a defining difference in health care,and we are committed to building on our momentum by taking on new challenges where we are positioned to lead.It is a profound privilege to lead more than 70,000 colleagues around the world who demonstrate personal dedication to our refreshed mission to im
56、prove the health and vitality of those we serve.Im inspired by the way they guide patients to the care they need,work with employers in supporting their people and always seek more ways we can help.Each and every day,we are bringing to life our vision of a better future,built on the vitality of ever
57、y individual and every community.DAVID M.CORDANIChairman and Chief Executive OfficerThe Cigna Group 11 THE CIGNA GROUP 2022 ANNUAL REPORT2022 AT A GLANCE Innovating New Partnerships Created a new strategic collaboration with Centene to make prescription medications more accessible and affordable for
58、 20 million Centene health plan members beginning in 2024.8 Entered into a new strategic partnership with VillageMD to accelerate value-based care services across the country.11 Announced five-year collaboration with Kaiser aimed at delivering increased convenience,affordability and expanded access
59、to high-quality care for its members.712 THE CIGNA GROUP 2022 ANNUAL REPORTDelivering Value Transforming the care experience for patients with complex conditions with the launch of Cigna Pathwell,a new,industry-leading suite of cost-saving products.10 Accredo,our specialty pharmacy,was awarded URACs
60、 Rare Disease Pharmacy Center of Excellence designation.18 Named a 2023 Best Medicare Advantage Plan company in Alabama and Tennessee by U.S.News&World Report.19 Driving affordability for patients and employers through the adoption of biosimilars.20 13 THE CIGNA GROUP 2022 ANNUAL REPORT13 THE CIGNA
61、GROUP 2022 ANNUAL REPORTExpanding Coverage Expanded virtual primary care offerings through MDLIVE for patients with chronic conditions via personalized care plans and remote monitoring capabilities.21 Doubled the size of Medicare Advantage provider network over the past two years,including significa
62、ntly increasing the number of available specialists.4,9 Expanded ACA offerings in three new states Texas,Indiana and South Carolina and 50 new counties.22 14 THE CIGNA GROUP 2022 ANNUAL REPORTInvesting in Our Future Repurchased$3.5 billion of common stock through accelerated stock repurchase agreeme
63、nts.23 Completed$5.4 billion sale of life,accident and supplemental benefits businesses in six international markets to Chubb.24$450 million capital investment in Cigna Ventures,the strategic venture fund of The Cigna Group,to drive continuous health care transformation,innovation and growth.2515 TH
64、E CIGNA GROUP 2022 ANNUAL REPORT15 THE CIGNA GROUP 2022 ANNUAL REPORTWe are transforming the ecosystem of health.Advancing better health for all.Our approach is rooted in our drive to make the health care system well-functioning,sustainable and equitable.The approach is structured around four interc
65、onnected pillars that underscore our mission to improve the health and vitality of those we serve.The following are some 2022 highlights within each pillar.16 THE CIGNA GROUP 2022 ANNUAL REPORTHealthy Society Our businesses further aligned our products and services with value-based care models,lever
66、aging integrated benefits,managing drug costs through innovation,expanding digital offerings and applying a health equity focus to coverage policy development.26 The Cigna Group and the Cigna Foundation supported nearly$54 million in combined charitable giving,27 including more than$16.5 million tow
67、ard the following focus areas:health and well-being;education and workforce development;community and social issues;military,veterans and first responders;disaster relief;global and trending causes;employee programs;and the Foundations signature programs:Building Equity and Equality Program,Cigna Sc
68、holars,and Healthier Kids For Our Future.27 Employees dedicated their time and talent to various causes,equating to more than$2.8 million in volunteer-engagement value.27,28 The Cigna Foundation,in partnership with The New York Life Foundation and E4E Relief,received a Gold Halo award from Engage fo
69、r Good.The award recognizes the Brave of Heart Fund,which supports frontline health care workers,as the 2022 best COVID-19 Initiative.2917 THE CIGNA GROUP 2022 ANNUAL REPORTHealthy Workforce Expanded our caregiver leave program,which allows up to four weeks of paid leave to enable employees to care
70、for a family member with a serious health condition,to include care for grandparents and grandchildren in addition to children,spouses and parents.This program will be expanded to eight weeks in 2023.26 Honored by Business Group on Health as Best Employer for Health and Well-being.30 Published our f
71、ull-year 2021 Diversity Scorecard Report,which reflected a goal-oriented approach for progress in three key areas:colleagues,clinical and communities.15 Ranked#24 on DiversityIncs Top 50 Companies For Diversity,a nine-place jump forward from 2021.16 Awarded“2022 Best Places to Work for LGBTQ+Equalit
72、y”by the Human Rights Campaign Foundation.3118 THE CIGNA GROUP 2022 ANNUAL REPORTHealthy Environment Continued to work toward achieving our operational sustainability targets,including reducing our Scope 1 and 2 greenhouse gas emissions,striving for carbon neutrality,sourcing renewable electricity,a
73、nd reducing water consumption and waste generation.26 Launched digital ID cards,and encouraged customers to go paperless where feasible by providing them with the option to receive paperless statements,submit claims online,use direct deposit and view plan information through myC and the myCigna app.
74、3219 THE CIGNA GROUP 2022 ANNUAL REPORTHealthy Company Evolved our ESG governance,developed a new ESG framework and maintained ESG leadership:Member of Dow Jones Sustainability Index for both the World and North America for the sixth consecutive year.12 Named one of Americas Most JUST Companies for
75、the third year by JUST Capital and CNBC,including#1 in the Health Care Providers industry and#16 overall in the JUST 100.13 Top 1%in EcoVadis,improving to a Platinum Medal sustainability rating over Gold in 2021.33 Upgraded to AA in MSCI ESG Ratings,representing industry leadership.34 Made significa
76、nt progress toward our goal to achieve$1 billion in annual diverse supplier spend by 2025,resulting in being recognized with the Forefront 50 honor by the National Minority Supplier Development Council,which acknowledges companies that are leading the way to create greater economic access and equity
77、 for systematically excluded entrepreneurs of color.1720 THE CIGNA GROUP 2022 ANNUAL REPORT$180.5 billion adjusted revenues,representing growth of 4%2,32.2 millionrelationships with health care providers,clinics and facilities4$8.7 billioncash flow from operations270,000+employees committed to chang
78、ing peoples lives for the better$7.3 billionadjusted income from operations2,3300,000+mental and behavioral health care providers427.4 millionshares repurchased for$7.6 billion in 2022230 countries and jurisdictions$23.27adjusted earnings per share2,3189 million+customer relationships2Paid a quarter
79、ly dividend of$1.12 per share in 2022,increased by 10%for 20232 The information provided is as of December 31,2022,except where otherwise noted.All information subject to change.21 THE CIGNA GROUP 2022 ANNUAL REPORT21 THE CIGNA GROUP 2022 ANNUAL REPORTCorporate Board of DirectorsEXECUTIVE COMMITTEED
80、avid M.Cordani,ChairEric J.Foss Elder GrangerKathleen M.MazzarellaKimberly A.RossEric C.WisemanDonna F.ZarconeAUDIT COMMITTEEKimberly A.Ross,ChairWilliam J.DeLaneyNeesha HathiDonna F.ZarconeCOMPLIANCE COMMITTEEElder Granger,ChairGeorge KurianMark B.McClellanBoard of DirectorsDAVID M.CORDANIChairman
81、and Chief Executive Officer,The Cigna GroupWILLIAM J.DELANEYFormer Chief Executive Officer,Sysco Corporation,a food marketing and distribution companyERIC J.FOSSFormer Chair,President and Chief Executive Officer,Aramark,a provider of food services,facilities management and uniform servicesRETIRED MA
82、J.GEN.ELDER GRANGER,M.D.President and Chief Executive Officer,THE 5Ps LLC,a health care,education and leadership consulting firmNEESHA HATHIHead of Wealth and Advice Solutions,The Charles Schwab Corporation,a financial services companyGEORGE KURIANChief Executive Officer,NetApp,Inc.,a cloud-led,data
83、-centric software companyKATHLEEN M.MAZZARELLAChair,President and Chief Executive Officer,Graybar Electric Company,Inc.,a North American distributor of electrical,communications and data networking products and provider of related supply chain management and logistics servicesMARK B.MCCLELLAN,M.D.,P
84、H.D.Director,Duke-Robert J.Margolis,M.D.,Center for Health PolicyKIMBERLY A.ROSSFormer Chief Financial Officer,Baker Hughes Company,an energy technology companyERIC C.WISEMANLead Independent Director,The Cigna Group Former Executive Chair,President and Chief Executive Officer,VF Corporation,an appar
85、el and footwear companyDONNA F.ZARCONEFormer President and Chief Executive Officer,The Economic Club of Chicago,a civic and business leadership organization22 THE CIGNA GROUP 2022 ANNUAL REPORTExecutive OfficersDAVID M.CORDANIChairman and Chief Executive Officer,The Cigna GroupCHARLES G.BERGPresiden
86、t,U.S.Government Business and Senior Advisor,Cigna HealthcareDAVID J.BRAILER,M.D.,PH.D.Executive Vice President,Chief Health Officer,The Cigna GroupNOELLE K.EDERExecutive Vice President and Global Chief Information Officer,The Cigna GroupBRIAN C.EVANKOExecutive Vice President and Chief Financial Off
87、icer,The Cigna GroupNICOLE S.JONESExecutive Vice President and General Counsel,The Cigna GroupEVERETT NEVILLEExecutive Vice President,Solutions and Corporate Development,The Cigna GroupERIC P.PALMERPresident and Chief Executive Officer,Evernorth Health ServicesCYNTHIA RYANExecutive Vice President,Ch
88、ief Human Resources Officer,The Cigna GroupJASON D.SADLERPresident,International Health,Cigna HealthcarePAUL A.SANFORDExecutive Vice President,Operations,The Cigna GroupMICHAEL W.TRIPLETTPresident,U.S.Commercial,Cigna HealthcareOther OfficersKARI KNIGHT STEVENSSenior Vice President,Chief Counsel and
89、 Corporate Secretary,The Cigna GroupTIMOTHY D.BUCKLEYSenior Vice President and Treasurer,The Cigna GroupMARY T.AGOGLIA HOELTZELSenior Vice President,Tax and Chief Accounting Officer,The Cigna GroupCORPORATE GOVERNANCE COMMITTEEDonna F.Zarcone,ChairWilliam J.DeLaneyElder GrangerMark B.McClellanFINANC
90、E COMMITTEEEric J.Foss,ChairNeesha HathiKathleen M.MazzarellaKimberly A.RossPEOPLE RESOURCES COMMITTEEKathleen M.Mazzarella,ChairEric J.FossGeorge Kurian23 THE CIGNA GROUP 2022 ANNUAL REPORTDIRECT STOCK PURCHASE PLANShareholders can automatically reinvest their annual dividends and make optional cas
91、h purchases of common shares.For information on these services,please contact:Computershare150 Royall St.Suite 101 Canton,MA 02021Toll-free:800.760.8864;TDD:800.952.9245Outside the United States,U.S.territories and Canada:201.680.6578;TDD:201.680.6610Website: ACCOUNT ACCESSYou can access your shareh
92、older account online through the Computershare website, by calling 800.760.8864.DIRECT DEPOSIT OF DIVIDENDSDirect deposit of dividends provides a prompt,efficient way to have your dividends electronically deposited into your checking or savings account.It avoids the possibility of lost or delayed di
93、vidend checks.The deposit is made electronically on the payment date.For more information and an enrollment authorization form,contact Computershare at 800.760.8864 or,if outside the United States,U.S.territories and Canada,at 201.680.6578.You can access your account online through the Computershare
94、 website, AGENCYBy regular mail:ComputersharePO Box 43006Providence,RI 02940-3006By overnight delivery:Computershare150 Royall St.Suite 101 Canton,MA 02021Toll-free:800.760.8864;TDD:800.952.9245Outside the United States,U.S.territories and Canada:201.680.6578;TDD:201.680.6610Website: ANNUAL MEETINGT
95、he Annual Meeting of Shareholders will be held virtually on Wednesday,April 26,2023,at 9:30 a.m.ET.Information regarding how to attend will be included in the proxy materials for the Annual Meeting.Proxies and proxy statements have been made available to shareholders of record as of the close of bus
96、iness on Tuesday,March 7,2023.As of December 31,2022,the number of shareholders of record was 28,205.FINANCIAL INFORMATIONThe Cigna Groups Form 10-K,Form 10-Qs,quarterly earnings releases and other SEC filings are available online at TheCignaG.OFFICES900 Cottage Grove RoadBloomfield,CT 06002860.226.
97、6000One Express WaySt.Louis,MO 63121314.996.0900Two Liberty Place1601 Chestnut StreetPhiladelphia,PA 19192-1550 215.761.1000 STOCK LISTINGThe Cigna Groups common stock is listed on the New York Stock Exchange.The ticker symbol is CI.THE CIGNA GROUP ONLINETo access online information about The Cigna
98、Group,our products and our services,visit TheCignaG.24 THE CIGNA GROUP 2022 ANNUAL REPORTUNITED STATESSECURITIES AND EXCHANGE COMMISSIONWashington,D.C.20549FORM 10-K(Mark One)ANNUAL REPORT PURSUANT TO SECTION 13 OR 15(d)OF THE SECURITIES EXCHANGE ACT OF 1934For the fiscal year ended December 31,2022
99、ORTRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d)OF THE SECURITIES EXCHANGE ACT OF 1934For the transition period from _ to _Commission file number 001-38769The Cigna Group(Exact name of registrant as specified in its charter)Delaware82-4991898(State or other jurisdiction of incorporation or organi
100、zation)(I.R.S.Employer Identification No.)900 Cottage Grove Road,Bloomfield,Connecticut06002(Address of principal executive offices)(Zip Code)(860)226-6000Registrants telephone number,including area codeSecurities registered pursuant to Section 12(b)of the Act:Title of each classTrading Symbol(s)Nam
101、e of each exchange on which registeredCommon Stock,Par Value$0.01CINew York Stock Exchange,Inc.Securities registered pursuant to Section 12(g)of the Act:NONEYesNoIndicate by check mark if the registrant is a well-known seasoned issuer,as defined in Rule 405 of the Securities Act.Indicate by check ma
102、rk if the registrant is not required to file reports pursuant to Section 13 or Section 15(d)of the Act.Indicate by check mark whether the registrant(1)has filed all reports required to be filed by Section 13 or 15(d)of the Securities Exchange Act of 1934 during the preceding 12 months(or for such sh
103、orter period that the registrant was required to file such reports),and(2)has been subject to such filing requirements for the past 90 days.Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulati
104、on S-T during the preceding 12 months(or for such shorter period that the registrant was required to submit such files).Indicate by check mark whether the registrant is a large accelerated filer,an accelerated filer,a non-accelerated filer,a smaller reporting company or an emerging growth company.Se
105、e the definitions of large accelerated filer,accelerated filer,smaller reporting company and emerging growth company in Rule 12b-2 of the Exchange Act.Large accelerated filerAccelerated filerNon-accelerated filer Smaller reporting companyEmerging growth companyIf an emerging growth company,indicate
106、by check mark if the registrant has elected not to use the extended transition period for complying with any new or revised financial accounting standards provided pursuant to Section 13(a)of the Exchange Act.Indicate by check mark whether the registrant has filed a report on and attestation to its
107、managements assessment of the effectiveness of its internal control over financial reporting under Section 404(b)of the Sarbanes-Oxley Act(15 U.S.C.7262(b)by the registered public accounting firm that prepared or issued its audit report.If securities are registered pursuant to Section 12(b)of the Ac
108、t,indicate by check mark whether the financial statements of the registrant included in the filing reflect the correction of an error to previously issued financial statements.Indicate by check mark whether any of those error corrections are restatements that required a recovery analysis of incentiv
109、e-based compensation received by any of the registrants executive officers during the relevant recovery period pursuant to 240.10D-1(b).Indicate by check mark whether the registrant is a shell company(as defined in Rule 12b-2 of the Act).The aggregate market value of the voting stock held by non-aff
110、iliates of the registrant as of June 30,2022 was approximately$82.8 billion.As of January 31,2023,297,059,973 shares of the registrants Common Stock were outstanding.DOCUMENTS INCORPORATED BY REFERENCEPart III of this Form 10-K incorporates by reference information from the registrants definitive pr
111、oxy statement related to the 2023 annual meeting of shareholders.TABLE OF CONTENTS FREQUENTLY REQUESTED 10-K INFORMATION PageRisk Factors33Executive Overview53Key Transactions and Business Developments56Liquidity and Capital Resources58Critical Accounting Estimates63Segment Information134Revenues by
112、 Product Type137 PageCautionary Statement PART I Item 1.Business .1 Overview .1 Evernorth Health Services .3 Cigna Healthcare.11 Other Operations .17Investment Management .18Strategic Investments .18Digital,Data and Technology .19Human Capital Management .20Environmental,Social and Governance .21 Mi
113、scellaneous.21 Regulation .21Item 1A.Risk Factors .33Item 1B.Unresolved Staff Comments .48Item 2.Properties .48Item 3.Legal Proceedings .48Item 4.Mine Safety Disclosures.48Information about our Executive Officers .49PART II Item 5.Market for Registrants Common Equity,Related Stockholder Matters and
114、Issuer Purchases of Equity Securities .50Item 6.Reserved .51Item 7.Managements Discussion and Analysis of Financial Condition and Results of Operations .52Item 7A.Quantitative and Qualitative Disclosures about Market Risk .75Item 8.Financial Statements and Supplementary Data .76Item 9.Changes in and
115、 Disagreements with Accountants on Accounting and Financial Disclosure .138Item 9A.Controls and Procedures .138Item 9B.Other Information .138Item 9C.Disclosure Regarding Foreign Jurisdictions that Prevent Inspections .138 PART III Item 10.Directors,Executive Officers and Corporate Governance .139 A.
116、Directors of the Registrant .B.Executive Officers of the Registrant .C.Code of Ethics and Other Corporate Governance Disclosures .D.Delinquent Section 16(a)Reports .Item 11.Executive Compensation .139Item 12.Security Ownership of Certain Beneficial Owners and Management and Related Stockholder Matte
117、rs .140Item 13.Certain Relationships and Related Transactions,and Director Independence .140Item 14.Principal Accountant Fees and Services .140 PART IV Item 15.Exhibits and Financial Statement Schedules .141Item 16.Form 10-K Summary .149Signatures .150Index to Financial Statement Schedules .FS-1Exhi
118、bitsCAUTIONARY NOTE REGARDING FORWARD-LOOKING STATEMENTSThis Annual Report on Form 10-K contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995.Forward-looking statements are based on The Cigna Groups current expectations and projections about f
119、uture trends,events and uncertainties.These statements are not historical facts.Forward-looking statements may include,among others,statements concerning future financial or operating performance,including our ability to improve the health and vitality of those we serve;future growth,business strate
120、gy and strategic or operational initiatives;economic,regulatory or competitive environments,particularly with respect to the pace and extent of change in these areas and the impact of developing inflationary and interest rate pressures;financing or capital deployment plans and amounts available for
121、future deployment;our prospects for growth in the coming years;strategic transactions;the impact of the Inflation Reduction Act(as defined below);expectations related to our CMS(as defined below)Star Ratings and Medicare Advantage Capitation Rates;and other statements regarding The Cigna Groups futu
122、re beliefs,expectations,plans,intentions,liquidity,cash flows,financial condition or performance.You may identify forward-looking statements by the use of words such as believe,expect,project,plan,intend,anticipate,estimate,predict,potential,may,should,will or other words or expressions of similar m
123、eaning,although not all forward-looking statements contain such terms.Forward-looking statements are subject to risks and uncertainties,both known and unknown,that could cause actual results to differ materially from those expressed or implied in forward-looking statements.Such risks and uncertainti
124、es include,but are not limited to:our ability to achieve our strategic and operational initiatives;our ability to adapt to changes in an evolving and rapidly changing industry;our ability to compete effectively,differentiate our products and services from those of our competitors and maintain or inc
125、rease market share;price competition,inflation and other pressures that could compress our margins or result in premiums that are insufficient to cover the cost of services delivered to our customers;the potential for actual claims to exceed our estimates related to expected medical claims;our abili
126、ty to develop and maintain satisfactory relationships with physicians,hospitals,other health service providers and with producers and consultants;our ability to maintain relationships with one or more key pharmaceutical manufacturers or if payments made or discounts provided decline;changes in the p
127、harmacy provider marketplace or pharmacy networks;changes in drug pricing or industry pricing benchmarks;our ability to invest in and properly maintain our information technology and other business systems;our ability to prevent or contain effects of a potential cyberattack or other privacy or data
128、security incident;the scale,scope and duration of the COVID-19 pandemic and its potential impact on our business,operating results,cash flows or financial condition;political,legal,operational,regulatory,economic and other risks that could affect our multinational operations,including currency excha
129、nge rates;risks related to strategic transactions and realization of the expected benefits of such transactions,as well as integration or separation difficulties or underperformance relative to expectations;dependence on success of relationships with third parties;risk of significant disruption with
130、in our operations or among key suppliers or third parties;potential liability in connection with managing medical practices and operating pharmacies,onsite clinics and other types of medical facilities;the substantial level of government regulation over our business and the potential effects of new
131、laws or regulations or changes in existing laws or regulations;uncertainties surrounding participation in government-sponsored programs such as Medicare;the outcome of litigation,regulatory audits and investigations;compliance with applicable privacy,security and data laws,regulations and standards;
132、potential failure of our prevention,detection and control systems;unfavorable economic and market conditions,including the risk of a recession or other economic downturn and resulting impact on employment metrics,stock market or changes in interest rates and risks related to a downgrade in financial
133、 strength ratings of our insurance subsidiaries;the impact of our significant indebtedness and the potential for further indebtedness in the future;unfavorable industry,economic or political conditions;credit risk related to our reinsurers;as well as more specific risks and uncertainties discussed i
134、n Part I,Item 1A Risk Factors and Part II,Item 7 Managements Discussion and Analysis of Financial Condition and Results of Operations of this Form 10-K and as described from time to time in our future reports filed with the Securities and Exchange Commission(the SEC).You should not place undue relia
135、nce on forward-looking statements,which speak only as of the date they are made,are not guarantees of future performance or results and are subject to risks,uncertainties and assumptions that are difficult to predict or quantify.The Cigna Group undertakes no obligation to update or revise any forwar
136、d-looking statement,whether as a result of new information,future events or otherwise,except as may be required by law.PART IItem 1.BUSINESSOVERVIEWThe Cigna Group,together with its subsidiaries,is a global health company.On February 13,2023,we changed our corporate name from Cigna Corporation to Th
137、e Cigna Group.We will not distinguish between our prior and current corporate name and will refer to our current corporate name throughout this Annual Report on Form 10-K.As such,unless expressly indicated or the context requires otherwise,the terms Company,we,us,and our in this document refer to Th
138、e Cigna Group,a Delaware corporation,and,where appropriate,its subsidiaries.On February 13,2023,we also changed the name of our Evernorth segment to Evernorth Health Services.We will not distinguish between our prior and current segment name and will refer to our current segment name throughout this
139、 Annual Report on Form 10-K.Our common stock continues to be listed with,and trades on,the New York Stock Exchange under the ticker symbol CI.Our Purpose and Mission The Cigna Group is a global health company committed to a better future built on the vitality of every individual and every community.
140、Our employees are trailblazers,relentlessly partnering and innovating solutions for better health.This captures who we are today and who we aspire to be in the future.We are undergoing a revolution in health.Our Pathways to GrowthIn order to turn the differentiated value we deliver to our customers,
141、patients,clients,communities and investors into attractive,sustained growth,we will continue to cultivate our portfolio of businesses so that it can continue to deliver the foundational and accelerated growth and cross-enterprise leverage we expect today and in the future.Foundational:Mature,scaled
142、businesses contributing steady,predictable growth.Accelerated:High-growth businesses in very attractive markets.Cross-Enterprise Leverage:Working together to create even greater value.How We WinDeep clinical expertise across pharmacy,medical and behavioral.Robust data and insights supporting care wi
143、th greater precision and personalization.Focus on developing innovative solutions addressing needs of customers,patients and clients.Partnering with others to accelerate innovation and achieve greater impact.Consultative approach driven by an experienced and talented team.The last couple of years ha
144、ve reoriented every person,every organization and every community toward a deeper relationship with health.We believe that achieving both health and vitality for those we serve must fuel the actions of our over 70,000 colleagues around the world,each and every day.We have two growth platforms:Everno
145、rth Health Services and Cigna Healthcare.Evernorth Health Services is our pharmacy,care and benefits solution that is highly attractive to our clients and partners because of the depth of its capabilities and expertise.Evernorth Health Services also enables us to deepen existing relationships across
146、 our entire book of business.Cigna Healthcare is the health benefits provider of The Cigna Group,serving customers and clients for our U.S.Commercial,U.S.Government and International Health operating segments,and it allows us to harness our partnership relationship with physicians to deliver afforda
147、ble and coordinated health care to employers and individuals.Together,Evernorth Health Services and Cigna Healthcare provide a strong and diverse foundation that allows us to capitalize on growth opportunities by leading with our strengths medical and pharmacy solutions and then expanding those rela
148、tionships by addressing additional client needs and innovating and delivering new services and solutions.To transform the differentiated value we deliver to our customers,patients,clients,communities and investors into attractive,sustained growth,we continue to cultivate our portfolio of businesses
149、with the goal of consistently delivering the foundational growth,accelerated growth and opportunity for cross-enterprise leverage we expect today and in the future.When considering our broad portfolio of businesses,we have strong foundational businesses that will continue to grow.These businesses of
150、ten serve as the key entry point for clients with either a 1pharmacy relationship,a medical relationship or both.We also have a variety of accelerated growth businesses,both scaled and emerging,which build upon our foundational relationships or provide exposure to adjacent high-growth areas.Our cros
151、s-enterprise leverage provides us with an opportunity to unlock even more value as the combined power of the franchise is unleashed.The Cigna Groups employees are champions for the people we serve and over the past decade,our focus has shifted to helping individuals and families thrive by offering s
152、olutions to prevent and better manage health challenges.When sickness or disability do occur,we support our customers by offering broad choices to help them best access high quality,affordable,whole person care.We see three primary ways to help individuals maintain,improve or recover their physical
153、or mental health:1)behavioral and lifestyle changes with health coaches helping individuals set and meet health goals;2)affordable,effective medication options with access to our leading pharmacy services improving health and driving affordability;and 3)targeted medical and surgical interventions wi
154、th a clear and proven strategy around partnerships and value-based care quality programs,powered by data and analytics and aligned incentives.We maximize use of evidence-based care,while delivering best-in-class service for our customers with acute and chronic conditions through enhanced real-time i
155、nsights across an expanded platform with industry-leading solutions to support care decisions.Our portfolio of offerings solves diverse challenges across the health care system.We offer a differentiated set of pharmacy,medical,behavioral,dental and supplemental products and services,primarily throug
156、h two growth platforms:Evernorth Health Services and Cigna Healthcare.Our capabilities include:1)a broad portfolio of solutions and services,some of which can be offered on a stand-alone basis;2)integrated behavioral,medical and pharmacy management solutions;3)leading specialty pharmacy,clinical and
157、 care management expertise;and 4)advanced analytics that help us engage more meaningfully with individuals,the plan sponsors we serve and our provider partners.We differentiate ourselves in the market through a number of capabilities.We improve whole-person health,in body and mind by treating physic
158、al and behavioral health together to improve outcomes and by providing early behavioral and lifestyle interventions.We make it easier to access quality care by improving navigation at every step in a patients health journey and by meeting customers wherever they are-virtually,digitally and in home.W
159、e connect care for the most pressing conditions by closing gaps between hospitals,primary care providers,specialists and other health care providers.We also develop personalized treatment paths across every dimension of care.We continue to build upon our network of value-based provider arrangements
160、for better customer experiences,better overall health outcomes and greater affordability,with a significant number of our eligible customers aligned to our Accountable Care programs nationally.We make medicine more affordable by reducing costs from start to finish,including those related to drug acc
161、ess,delivery and treatment and by identifying appropriate medication alternatives.We partner and innovate to enable us to deliver differentiated value and broaden our reach in new geographies or through the introduction of new solutions and offerings.Our key to success revolves around how deeply we
162、care about our customers,patients and co-workers.We intend to create a better future together by innovating and adapting,acting with speed and purpose,partnering,collaborating and keeping our promises.Information about SegmentsWe present the financial results of our businesses in the following segme
163、nts(see Executive Overview section of the Management Discussion and Analysis of Financial Condition and Results of Operations(MD&A)located in Part II,Item 7 of this Form 10-K for a Financial Summary):Evernorth Health Services includes a broad range of coordinated and point solution health services a
164、nd capabilities,as well as those from partners across the health care system,in Pharmacy Benefits,Home Delivery Pharmacy,Specialty Pharmacy,Distribution and Care Delivery and Management Solutions,which are provided to health plans,employers,government organizations and health care providers.Within E
165、vernorth Health Services,Pharmacy Benefits and Home Delivery Pharmacy are foundational growth businesses and Specialty Pharmacy,Distribution,and Care Delivery and Management Solutions are accelerated growth businesses.Cigna Healthcare includes the U.S.Commercial,U.S.Government and International Heal
166、th operating segments,which provide comprehensive medical and coordinated solutions to clients and customers.Within Cigna Healthcare,U.S.Commercial and International Health are our foundational growth businesses and U.S.Government is our accelerated growth business.2Other Operations comprises the re
167、mainder of our business operations,which includes certain ongoing businesses and exiting businesses.Our ongoing businesses include our continuing business,corporate-owned life insurance(COLI),and our run-off businesses.Our run-off businesses include(i)guaranteed minimum death benefit(GMDB)and guaran
168、teed minimum income benefit(GMIB)business,(ii)settlement annuity business and(iii)individual life insurance and annuity and retirement benefits businesses.Our exiting businesses include our interest in a joint venture in Trkiye,which was sold to our partner in December 2022,the international life,ac
169、cident and supplemental benefits businesses sold on July 1,2022 and the Group Disability and Life business sold on December 31,2020.On July 1,2022,the Company completed the sale of its life,accident and supplemental benefits businesses in six countries(Hong Kong,Indonesia,New Zealand,South Korea,Tai
170、wan and Thailand)to Chubb INA Holdings,Inc.(Chubb)for approximately$5.4 billion in cash(the Chubb transaction)(see Note 4 to the Consolidated Financial Statements included in Part II,Item 8 of this Form 10-K).Corporate reflects amounts not allocated to operating segments,including net interest expen
171、se(defined as interest on corporate debt less net investment income on investments not supporting segment and other operations),certain litigation matters,expense associated with our frozen pension plans,charitable contributions,operating severance,certain overhead and enterprise-wide project costs
172、and intersegment eliminations for products and services sold between segments.Other InformationThe financial information included in this Form 10-K for the fiscal year ended December 31,2022 is in conformity with accounting principles generally accepted in the United States of America(GAAP)unless ot
173、herwise indicated.In the segment discussions that follow,we use the terms adjusted revenues and pre-tax adjusted income(loss)from operations to describe segment results.See Note 24 to the Consolidated Financial Statements of this Form 10-K for definitions of those terms.Industry rankings and percent
174、ages set forth herein are for the year ended December 31,2022,unless otherwise indicated.In addition,statements set forth in this document concerning our rank or position in an industry or particular line of business have been developed internally based on publicly available information unless other
175、wise noted.Cigna Holding Company(formerly Cigna Corporation)was incorporated in Delaware in 1981.Halfmoon Parent,Inc.was incorporated in Delaware in March 2018.Halfmoon Parent,Inc.was renamed Cigna Corporation and Cigna Holding Company became its subsidiary concurrent with the consummation of the co
176、mbination with Express Scripts on December 20,2018.Cigna Corporation was renamed The Cigna Group in February 2023.You can access our website at http:/ to learn more about our company.We make annual,quarterly and current reports and proxy statements and amendments to those reports available,free of c
177、harge through our website as soon as reasonably practicable after we electronically file these materials with,or furnish them to,the Securities and Exchange Commission(SEC).We also use our website as a means of disclosing material information and for complying with our disclosure obligations under t
178、he SECs Regulation FD(Fair Disclosure).Important information,including news releases,analyst presentations and financial information regarding The Cigna Group is routinely posted on our website.Accordingly,investors should monitor the Investor Relations portion of our website,in addition to followin
179、g our press releases,SEC filings and public conference calls and webcasts.The information contained on,or that may be accessed through,our website is neither incorporated by reference into nor a part of this report.See also Code of Ethics and Other Corporate Governance Disclosures in Part III,Item 1
180、0 of this Form 10-K for additional information regarding the availability of our Codes of Ethics on our website.Intellectual Property RightsWe hold a variety of trademarks and service marks used throughout our businesses.We also use patents to protect our proprietary technological advances and to di
181、fferentiate ourselves in the market.The Cigna Group companies hold over 320 United States patents.We are not substantially dependent on any single patent or group of related patents.We are not aware of any facts that could materially impact the continuing use of any of our intellectual property.EVER
182、NORTH HEALTH SERVICESEvernorth Health Services includes a broad range of coordinated and point solution health services and capabilities,as well as those from partners across the health care system,in Pharmacy Benefits,Home Delivery Pharmacy,Specialty Pharmacy,Distribution and Care Delivery and Mana
183、gement Solutions,which are provided to health plans,employers,government organizations and health care providers.These offerings are also integrated into our Cigna Healthcare solutions to span the total health care delivery system,further 3reducing the total cost of care for our clients and customer
184、s.In 2022,Evernorth Health Services reported adjusted revenues of$140.3 billion and pre-tax adjusted income from operations of$6.1 billion.On February 13,2023,we changed the name of our Evernorth segment to Evernorth Health Services.We will not distinguish between our prior and current segment name
185、and will refer to our current segment name throughout this Annual Report on Form 10-K.HOW WE WINEvernorth Health Services accelerates delivery of comprehensive,connected solutions to create value and meet the diverse needs of health plans,employers,health care providers and government organizations
186、by:Partnering in unconventional ways to solve complex problems across a fragmented health care ecosystem,fueled by data and expertise that drives purposeful innovationCreating flexible solutions tailored to client needs,using Evernorth Health Services combined strengths and capabilities,as well as s
187、trategic partnerships,to deliver:better,more efficient care for patients;better experiences for clients,providers and customers;and enhanced choices for clients and customers through our open architecture modelEvaluating medicines,digital therapeutics and other health solutions for efficacy,adherenc
188、e,value and price to assist clients in selecting a cost-effective formularyOffering home delivery,virtual and in-person care,and specialty customer-centric solutions that meet the needs of our clients and customers in ways that unlock greater value and better health services while providing better a
189、nd specialized clinical careDelivering more affordable solutions that provide more discounts and drive risk-sharing and value-based carePromoting the use of generics and lowest-cost,clinically effective brands of medications4The following chart depicts a high-level summary of our principal products
190、and services in this segment with definitions on subsequent pages.Principal Products&ServicesBrands/SubsidiariesKey RelationshipsPrimary CompetitorsDriving Foundational GrowthPharmacy Benefits Express Scripts PBM,myMatrixx,Care Continuum,Express Scripts MedRx ManagementSM,Embarc Benefit Protection,F
191、amilyPathSM,Advanced Utilization Management,Enhanced Fraud,Waste&Abuse,Ascent Health Services,Econdisc,SaveOnSP,Inside Rx,Evernorth Wholesale MarketplaceSM,Value-Based Programs(Express Scripts SafeGuardRx,Express Scripts Patient Assurance),National Preferred Formulary,Advanced Opioid Management,Scre
192、enRxClients,Customers,Health Care Providers,Consultants,Health Plans,Commercial and Government Payors,Self-paying Customers,Pharmacy ProvidersHealth Plans,Independent Pharmacy Benefit Managers(PBMs),Managed Care PBMs,Third-Party Benefit Administrators,Group Purchasing Organizations,Clinical Solution
193、s and Health Care Data Analytics CompaniesHome Delivery PharmacyExpress Scripts PharmacyClients,Customers,Health Care ProvidersIndependent PBMs,Managed Care PBMs,Retail PharmaciesDriving Accelerated GrowthSpecialty PharmacyAccredo,Freedom Fertility Pharmacy,Therapeutic Resource CenterClients,Custome
194、rs,Health Care Providers,Specialty Drug DistributorsSpecialty PharmaciesDistributionCuraScript SDClinics,HospitalsSpecialty Drug DistributorsCare Delivery and Management SolutionsEvernorth Care Group,Evernorth Care Services,Evernorth Care Solutions,Evernorth Direct Health,Evernorth Home-Based Care,e
195、viCore Healthcare,MDLIVE,Evernorth Behavioral Health,inMyndSM,Health Connect 360,RationalMed,Evernorth Digital Health FormularySM,Evernorth Labs,Trend Central,HealthPredictSM,MediCUBE,ScriptVisionClients,Customers,Health Care ProvidersManaged Care Organizations,Care Delivery and Care Management Solu
196、tions Providers,Third-Party Benefit Administrators,Health Care Data Analytics CompaniesPrincipal Products&ServicesPharmacy Benefits.Express Scripts Pharmacy dispenses approximately 1.6 billion adjusted prescriptions(1)annually to members of pharmacy plans managed by our Express Scripts PBM.We drive
197、high-quality,cost-effective care through prescription drug utilization and cost management services.We support our clients plan design selections to deliver balanced affordability,choice,simplicity and convenience.We focus our solutions to align with our clients service,care and cost management need
198、s.As a result,we believe we deliver better care,healthier outcomes,higher customer satisfaction and a more affordable prescription drug benefit.We dispense drug claims via Express Scripts Pharmacy,Accredo and our retail networks by integrating retail network pharmacy administration,benefit design co
199、nsultation,drug utilization review,drug formulary management and pharmacy fulfillment services.We administer payments to retail networks and bill benefits costs to our clients through our end-to-end adjudication services.Drug Utilization Review Program.When pharmacies submit claims for prescription
200、drugs to us,we review them electronically in real time for health and safety.We then alert the dispensing pharmacy of any detected issues.Clients may also choose to enroll in programs that result in communications about potential therapy concerns being sent to prescribers after the initial claim sub
201、mission.Benefits Design Consultation.We consult with our clients on how best to structure and leverage the pharmacy benefit to meet plan objectives for affordable access to the prescription medications customers need to stay healthy and to ensure the safe and effective use of those medications.myMat
202、rixx.myMatrixx is a unique PBM with an exclusive focus on workers compensation.We combine high-touch customer service with clinical expertise and state-of-the-art business intelligence systems to deliver simplified solutions and positive outcomes.myMatrixx leverages Express Scripts robust pharmacy n
203、etwork and provides a smooth and personalized experience for clients and injured workers.5(1)Non-specialty network scripts filled through 90-day programs and home delivery scripts are multiplied by three.All other network and specialty scripts are counted as one script.Medical Drug Management.We off
204、er a comprehensive range of services and guaranteed savings for managing medically billed specialty drugs.Our solutions apply utilization management,site of care management and claims prepayment review to effectively reduce wasteful spend,while providing services tailored to customers ensuring safet
205、y and healthier outcomes.We also offer Express Scripts MedRx Management,a suite of solutions and consultative services for medical rebates contracting,medically-billed drug preferencing and value-based contracting.Embarc Benefit Protection.Embarc shields clients and members from the high costs of li
206、fe-saving gene therapies,so that customers who need treatment can get it.Additionally,the program provides access to quality,cost-effective in-network providers and support from a dedicated gene therapy case management team.FamilyPath.FamilyPath is raising the bar for fertility health by providing m
207、ore comprehensive and more flexible coverage and proactive care for growing families,including expanded medical and pharmacy benefit management;access to vetted provider and lab networks;and dedicated Fertility Advisors to proactively support and guide customers.Retail Network Pharmacy Administratio
208、n.We contract with retail pharmacies to provide prescription drugs to customers of the pharmacy benefit plans we manage.We negotiate with pharmacies throughout the United States to discount drug prices provided to customers and manage national and regional networks responsive to client preferences r
209、elated to cost containment,convenience of access for customers and network performance.We also manage networks of pharmacies customized for or under direct contract with specific clients and have contracted with pharmacy provider networks to comply with the Center for Medicare and Medicaid Services(
210、CMS)access requirements for the federal Medicare Part D prescription drug program(Medicare Part D).All retail pharmacies in our network communicate with us online and in real-time to process prescription drug claims.Drug Formulary Management.Formularies are lists of drugs with designations that may
211、be used to determine drug coverage,customer out-of-pocket costs and communicate plan preferences in competitive drug categories.Our formulary management services support clients in establishing formularies that assist customers and physicians in choosing clinically-appropriate,cost-effective drugs a
212、nd prioritize access,safety and affordability.We administer specific formularies on behalf of our clients,including standard formularies developed and offered by Express Scripts and custom formularies in which we play a more limited role.Most of our clients select standard formularies,governed by ou
213、r National Pharmacy&Therapeutics Committee,which is comprised of a panel of independent physicians and pharmacists in active clinical practice representing a variety of specialties and practice settings,typically with major academic affiliations.In making formulary recommendations,this committee con
214、siders only the drugs safety and efficacy and not the cost of the drug,including any negotiated manufacturer discount or rebate arrangement.This process is designed to ensure the clinical recommendation is not affected by our financial arrangements.We fully comply with this committees clinical recom
215、mendations regarding drugs that must be included or excluded from the formulary based on their assessment of safety and efficacy.Advanced Utilization Management.These programs include prior authorization,drug quantity management and step therapy designed to decrease client spend on pharmacy.Enhanced
216、 Fraud,Waste&Abuse.We help plan sponsors identify potential problem customers and prescribers with unusual or excessive utilization patterns.The program is designed to help identify outliers and situations of abnormal use or prescribing patterns by analyzing types of prescriptions,refill patterns an
217、d pharmacy utilization.Administration of Group Purchasing Organizations.We operate various group purchasing organizations that negotiate pricing for the purchase of pharmaceuticals and formulary rebates with pharmaceutical manufacturers on behalf of their participants.They also provide various admin
218、istrative services to their participants including management and reporting.Copay Solutions.Our first-to-market innovative copay solutions help customers afford their medications,protect plan design preferences and achieve lower trend.Our partnership with SaveOnSP on the first non-essential health b
219、enefits copay assistance solution has driven significant savings by targeting high-cost,high-volume drugs.SaveOnSP recommends plan design and coverage changes for certain drugs,enabling maximum savings and reducing plan and client costs.As manufacturer programs and regulations change,this aggressive
220、 solution adapts,delivering lower specialty plan cost and enhanced customer support.Inside Rx.Inside Rx is a prescription medication savings program that offers eligible self-paying customers discounts on many brand and generic medications.This program is not insurance but offers savings at more tha
221、n 60,000 participating retail pharmacies(including all major chains)in the United States and Puerto Rico.The program also offers discounts on prescription medications through private label solutions.Inside Rx earns a small fee from our supply chain partners every time a customer fills a prescription
222、 via the program.This lets us provide access to our savings card at no cost to the customer.Evernorth Wholesale Marketplace.Evernorth Wholesale Marketplace offers a suite of flexible,private label solutions including but not limited to Wholesale Marketplace Drug Formulary Management services,Retail
223、Network Programs,Value-Based Solutions,Medical Rebate Programs and Utilization Management Policies.These offerings are captured under either our drug formulary administrative service arrangements or our formulary processing arrangements.As the needs of the market evolve,we will continue to partner w
224、ith clients and develop additional offerings that align with their goals and objectives.6Value-Based Programs.Express Scripts SafeGuardRx.We offer a solution platform aimed at therapy classes that pose budgetary threats and clinical challenges to customers.Our solutions are designed to keep our clie
225、nts ahead of the drug cost curve while providing customers the personalized care and access they need.These solutions are offered throughout our pharmacy benefit management services and include,but are not limited to care for:cardiovascular,diabetes,hepatitis,HIV,inflammatory conditions,neurological
226、,multiple sclerosis,oncology,pulmonary,rare conditions and weight management.Innovative programs,such as Express Scripts SafeGuardRx,combine utilization management,formulary management,specialized care from our Therapeutic Resource Centers and financial savings,to help us to change the market in key
227、 categories.These services optimize the safe and appropriate dispensing of therapeutic agents,minimize waste and improve clinical and financial outcomes.Express Scripts Patient Assurance Program.This program addresses affordability challenges for customers managing their diabetes and cardiovascular
228、conditions by providing a lower,fixed,out-of-pocket cost directly to the customer.Express Scripts negotiates additional discounts to reduce customer cost share without increasing plan cost,and applies those discounts at the point of service.By making the cost of medication affordable and predictable
229、,the Express Scripts Patient Assurance Program improves medication adherence,driving better customer outcomes and lower downstream medical costs for the plan.Home Delivery Pharmacy.Evernorth Health Services offers free standard shipping of medications nationwide,usually in a 90-day supply,directly t
230、o the customers home and allows for automatic refills on eligible medications and unrestricted telephone access to over 4,000 customer care advocates and specially trained pharmacists to answer customer questions.Our differentiated practice of pharmacy,coupled with our advanced automated dispensing
231、technology,results in safer and more accurate pharmacy operations when compared to retail pharmacies,convenient access to maintenance medications and better management of our clients drug costs through operating efficiencies and generic substitutions.Our research shows that Express Scripts Pharmacy
232、achieves a higher level of therapeutic interventions,better adherence,more cost savings and a consistently higher Net Promoter Score(marketplace NPS)compared to retail pharmacies.The Home Delivery Pharmacy operations consist of ten home delivery pharmacies and four high-volume automated dispensing p
233、harmacies located throughout the United States.Our high-volume automated dispensing pharmacies are located in Arizona,Indiana,Missouri and New Jersey.Specialty Pharmacy.Specialty medications are primarily characterized as high-cost medications for the treatment of complex and rare diseases.These med
234、ications broadly include those with frequent dosing adjustments,intensive clinical monitoring,the need for customer training,specialized product administration requirements or medications limited to certain specialty pharmacy networks by manufacturers.The front-end of our pharmacy is organized into
235、Therapeutic Resource Centers,where pharmacists focus their practice of pharmacy by condition,which offers customers a more personalized experience while providing enhanced clinical care.Through a combination of assets and capabilities,we work to provide an enhanced level of predictable care and ther
236、apy management for customers taking specialty medications,leading to increased visibility and improved outcomes for payors and custom programs for biopharmaceutical manufacturers.The launch of biosimilars to blockbuster specialty therapies provides competition and an opportunity to drive down costs
237、for both customers and clients.We work closely with clients to efficiently support each benefit design to improve affordability.Accredo is focused on dispensing injectable,infused,oral and inhaled drugs that require a higher level of clinical service and support than traditional pharmacies typically
238、 offer.Accredo supports successful outcomes for customers and reduces waste for clients through specialty trained clinicians,a nationwide footprint and a network of in-home nursing services,reimbursement and customer assistance programs and biopharmaceutical services.Drug manufacturers may select Ac
239、credo for exclusive dispensing of highly specialized therapies.Freedom Fertility Pharmacy is dedicated exclusively to supporting customers undergoing fertility treatment.Accredo and Freedom Fertility Pharmacy serve customers within a pharmacy benefit plan administered by Express Scripts PBM,as well
240、as customers in plans administered by other PBMs and health plans.Our Specialty Pharmacy operations consist of 33 specialty pharmacies.Distribution.CuraScript SD is a specialty distributor of pharmaceuticals and medical supplies(including injectable and infusible pharmaceuticals and medications to t
241、reat specialty and rare or orphan diseases)directly to health care providers,clinics and hospitals in the United States for office or clinic administration.Through this business,we provide distribution services primarily to office and clinic-based physicians who treat customers with chronic diseases
242、 and regularly order costly specialty pharmaceuticals.This business provides competitive pricing on pharmaceuticals and medical supplies,operates three distribution centers and ships most products overnight within the United States;it also provides distribution capabilities 7to Puerto Rico and Guam.
243、It is a contracted supplier with most major group purchasing organizations and leverages our distribution platform to operate as a third-party logistics provider for several pharmaceutical companies.Care Delivery and Management Solutions.We offer clinical programs to help our clients drive better wh
244、ole-person health outcomes through our Care Delivery(virtual care,in-home care,physical primary care)and Care Management(behavioral health services and health coaching capabilities)offerings.eviCore.eviCore healthcare is a medical benefits management organization that is a leading provider of soluti
245、ons that ensure customers receive optimal treatment at the right site of care by leveraging our team of medical professionals,evidence-based guidelines and innovative technologies to deliver affordable care.eviCore provides integrated solutions for key clinical diagnostic areas such as advanced imag
246、ing,cardiology and gastroenterology,as well as longitudinal areas such as musculoskeletal,oncology and post-acute care.eviCore contracts with health plans to promote the appropriate use of health care services by the customers they serve.In certain instances,this occurs through capitated risk arrang
247、ements,when we assume the financial obligation for the cost of health care services provided to eligible customers covered by eviCore healthcare management programs.MDLIVE.MDLIVE virtual care services provide flexibility for the customer to access a network of virtual care providers for preventative
248、 and routine primary care and wellness,urgent care,dermatology care,behavioral health care needs and chronic condition management beginning with hypertension.Behavioral health.Our behavioral health solutions simplify the complicated treatment landscape by assisting members to the right level of care
249、 at the right time,in the right place-from start to finish.Our predictive analytics models proactively identify customers who need support so that we can engage them early and provide the appropriate care,leveraging our extensive provider network including in-person providers,virtual providers and d
250、igital tools.inMynd.Our Evernorth inMynd Behavioral Health and inMyndRx solutions provide access to expert guidance and support for anxiety,depression,insomnia,ADHD,narcolepsy,Alzheimers and select mood stabilizing medications.These solutions include providing access to individualized support and ed
251、ucational resources,condition-specific care through our Neuroscience Therapeutic Resource Centers and digital Cognitive Behavioral Therapy program when applicable.Health Connect 360.This program is a transformational,outcomes-based,clinical management model that bridges pharmacy,medical,lab and biom
252、etric data to develop insights and deliver personalized health care clinical support.Clinical outcomes and quality metrics are tailored to meet client needs.RationalMed.RationalMed improves customer health and safety by integrating medical,pharmacy and laboratory claims data to initiate changes and
253、correct errors in care,lowering both medical and prescription drug costs.Evernorth Digital Health Formulary.Through the Evernorth Digital Health Formulary,we evaluate,procure,implement and manage digital health solutions on behalf of clients,alleviating administrative burden and ensuring clinical ef
254、fectiveness,data security,user-friendly experiences and financial value.Cigna Pathwell Specialty.Cigna Pathwell Specialty is designed to address one of our clients top health care cost drivers-specialty drugs-enabling clients to reinvest in their employees,making health care more affordable.This new
255、 solution controls specialty spending across the medical and pharmacy benefits by integrating pharmacy network and care coordination for customers who need our support the most.Evernorth Intelligence Solutions.By bringing together world-class talent,multi-disciplinary expertise and advanced data and
256、 analytics,we unlock actionable insights to help drive greater affordability,simplicity,predictability and growth.We work together with our clients and partners to create dynamic solutions,services and platforms that guide better decisions and improved performance(see Business-Digital,Data and Techn
257、ology section of this Form 10-K for further information).Evernorth Labs.We accelerate innovation through increased collaboration with clients,customers and partners to develop solutions for launch in their businesses.With our Labs,which are state-of-the-art research facilities and shared spaces for
258、collaboration,ideation and innovation,we gather with our clients and industry leaders to solve the toughest challenges in the health care system,including:better managing the most complex and expensive disease states,such as oncology;improving care access and delivery,such as worksite,home and virtu
259、al care;and planning for emerging trends,such as artificial intelligence,and industry disruptors,such as COVID-19.Data,advanced analytics and platforms.We use advanced predictive modeling to shape solutions that help decrease health care fragmentation,drive optimized care coordination,reduce key cos
260、t drivers and improve health outcomes.In-depth trend analysis helps us to identify and effectively address challenges like opioid abuse,COVID-19 and other emerging health crises.We use market surveillance and forecasting to pinpoint and proactively address cost drivers.Our platform strategy as a ser
261、vice gives clients the tools to build successful businesses in a flexible,customizable way:Trend Central provides access to key performance indicators to help plan sponsors reduce costs and work towards healthier outcomes;HealthPredict produces high customer-level risk scores,to show the highest val
262、ue opportunities for proactive intervention;MediCUBE gives our academic detailing pharmacists the analytical power to identify ways to save plans from significant unnecessary spend and improve quality metrics;and ScriptVision provides a suite of real-time,data-driven capabilities that empower physic
263、ians to make the best 8prescribing choices,including ePrescribing(including controlled substances),real-time prescription benefit information,electronic prior authorizations,clinical care messages such as drug interactions and high-risk medication alerts and data on customer adherence rates.Customer
264、sWe provide products and services in the Evernorth Health Services segment to clients and customers,as described below.Also described below are our significant clients.Clients.We provide services to managed care organizations,health insurers,third-party administrators,employers,union-sponsored benef
265、it plans,workers compensation plans,government health programs,providers,clinics,hospitals and others.We provide services to a majority of customers in our Cigna Healthcare segment.Customers.Prescription drugs are dispensed to patients connected to the service offerings we provide to clients.Prescri
266、ption drugs are dispensed primarily through networks of retail pharmacies under non-exclusive contracts with us and via home delivery from Express Scripts Pharmacy and specialty drug fulfillment pharmacies.The Department of Defense(DoD)TRICARE Pharmacy Program is the military health care program ser
267、ving active-duty service customers,National Guard and Reserve customers and retirees,as well as their dependents.Under this contract,we provide online claims adjudication,home delivery services,specialty pharmacy clinical services,claims processing and contact center support and other services criti
268、cal to managing pharmacy trend.In 2021,the DoD awarded Express Scripts a seven-year pharmacy program contract beginning January 1,2023.Under the new contract,Express Scripts will provide enhanced specialty care and expanded care coordination capabilities,while continuing to support current pharmacy
269、operations,through 2029.Revenues from this contract are significant to the segment.In 2019,Express Scripts and Prime Therapeutics LLC(Prime)entered into an agreement effective on April 1,2020 to deliver improved choice and affordability for Primes clients and their customers by enhancing retail phar
270、macy networks and pharmaceutical manufacturer value.In 2022,Prime and Express Scripts agreed to extend this relationship through 2025.In 2021,the relationship with Prime was expanded to include the option for Primes plans to access the Accredo specialty pharmacy and Express Scripts home delivery in-
271、network pharmacies.Revenues from these contracts are significant to the segment.In October 2022,Evernorth Health Services and Centene Corporation(Centene)announced a multi-year agreement effective January 2024 to manage pharmacy benefit services and make prescription medications more accessible and
272、affordable for Centenes approximately 20 million customers.In addition to greater savings on prescription drugs,Centene customers will also have access to Express Scripts extensive national network of retail pharmacies.CompetitionThe health care industry has undergone periods of substantial consolid
273、ation and may continue to consolidate in the future.Many of the largest managed care organizations now also own health services businesses that compete with Evernorth Health Services in the verticals in which we participate.We believe the primary competitive factors in the industry include the abili
274、ty to:negotiate with retail pharmacies to ensure our retail pharmacy networks meet the needs of our clients and customers;provide home delivery and specialty pharmacy services;negotiate discounts and rebates on prescription drugs with drug manufacturers;navigate the complexities of government-reimbu
275、rsed business including Medicare,Medicaid and the public exchanges;manage cost and quality of specialty drugs;and use the information we obtain about drug utilization patterns and consumer behavior to reduce costs for our clients and customers and assess the level of service we provide.Managed Care
276、PBMs.CVS Caremark(owned by CVS Health Corporation(CVS),Humana Inc.(Humana),IngenioRx(owned by Elevance Health Inc.(Elevance),OptumRx(owned by UnitedHealth Group Inc.(UnitedHealth)and Prime Therapeutics(owned by a collection of Blue Cross/Blue Shield Plans)compete with us on a variety of products and
277、 in various regions throughout the United States.Independent PBMs.MedImpact,Navitus Health Solutions,Elixir(owned by Rite Aid Corporation)and many other regional PBMs compete with us on a variety of products across the United States.Pharmacies.CVS,Walgreens Boots Alliance,Inc.,WalMart,Inc.,Rite Aid,
278、Kroger and other independent pharmacies compete with us for the delivery of prescription drug needs to our customers.In addition,many PBMs own and operate home delivery and specialty pharmacies including CVS,OptumRx,Walgreens,Humana and Elixir.New entrants continue to emerge,including Amazon Pharmac
279、y,Capsule and Hims.Third-Party Benefits Administrators.Third parties that specialize in claim adjudication and benefit administration,such as SS&C Health,are direct competitors.With the emergence of alternative benefit models through private exchanges,the competitive landscape also includes brokers,
280、health plans and consultants.Some of these competitors may deploy greater financial,marketing and technological resources than we do and new market entrants,including strategic alliances aimed at 9modifying the current health care delivery models or entering the prescription drug sector from another
281、 sector of the health care industry,may increase competition as barriers to entry are relatively low.For example,GoodRx is an entrant focused on serving the uninsured and underinsured in the cash pay pharmacy administration space.Care Delivery and Management Solutions.OptumHealth,NaviHealth and Land
282、mark(UnitedHealth);Beacon,Aspire and CareMore(owned by Elevance);CVSs HealthHubs and MinuteClinics;CenterWell Home Health(Humana);Community and Bayless(Centene);VillageMD,Teladoc,Doctor on Demand,MeMD,WalmartHealth and AmazonCare are among the companies that compete with us in this market.Clinical S
283、olutions and Health Care Data Analytics Companies.Optum(owned by UnitedHealth),Elevance,Magellan Health and Apixio(owned by Centene Corporation),HealthHelp,Cotiviti and Inovalon are among the companies that compete with us in this market.OperationsSales and Account Management.Our sales and account m
284、anagement teams market and sell pharmacy benefit management solutions and are supported by client service representatives,clinical pharmacy managers and benefit analysis consultants.These teams work with clients to develop innovative strategies that put medicine within reach of customers while helpi
285、ng health benefit providers improve access to and affordability of prescription drugs.Supply Chain.Our supply chain contracting and strategy teams negotiate and manage pharmacy retail network contracts,pharmaceutical and wholesaler purchasing contracts and manufacturer rebate contracts.As our client
286、s continue to experience increased cost trends,our supply chain teams develop innovative solutions such as our Express Scripts SafeGuardRx platform and preferred pharmacy networks to combat these cost increases.In addition,our Formulary Consulting team,consisting of pharmacists and financial analyst
287、s,provides services to our clients to support formulary decisions,benefit design consultation and utilization management programs.Clinical Support.Our staff of highly trained health care professionals provides clinical support for our pharmacy,medical and behavioral customers.Our services include ac
288、cess to:Support for the individual and their caregivers from crisis care in their most vulnerable moments to stabilization and returning back to work and life for all involvedComprehensive behavioral health offerings including network access,utilization management and coordination of care to treat c
289、onditions ranging from depression and anxiety to substance use,autism and eating disordersCondition-specific specialized customer care through our Therapeutic Resource Center facilities staffed with specialist pharmacists,nurses and other cliniciansClinical development and operational support for ou
290、r pharmacy benefit management services by our clinical solutions staff of pharmacists and physicians who conduct a wide range of activities including:identifying emerging medication-related safety issues and alerting physicians,clients and customers(as appropriate);providing drug information service
291、s;managing formulary;identifying and closing gaps in care;and developing utilization management,safety(drug utilization review)and other clinical interventionsSuppliersWe maintain an inventory of brand-name and generic pharmaceuticals in our home delivery and specialty pharmacies.Our specialty pharm
292、acies also carry biopharmaceutical products to meet the needs of our customers,including pharmaceuticals for the treatment of rare or chronic diseases;if a drug is not in our inventory,we can generally obtain it from a supplier within a reasonable amount of time.We purchase pharmaceuticals either di
293、rectly from manufacturers or through authorized wholesalers.Evernorth Health Services uses one wholesaler more than others in the industry,but holds contracts with other wholesalers if needs for an alternate source arise.Generic pharmaceuticals are generally purchased directly from manufacturers.Key
294、 Transactions and Business DevelopmentsSee the Executive Overview-Key Transactions and Business Developments section of our MD&A located in Part II,Item 7 of this Form 10-K for discussion of key developments impacting this segment.10CIGNA HEALTHCARECigna Healthcare includes the U.S.Commercial,U.S.Go
295、vernment and International Health operating segments,which provide comprehensive medical and coordinated solutions to clients and customers.Within Cigna Healthcare,U.S.Commercial and International Health are our foundational growth businesses and U.S.Government is our accelerated growth business.In
296、2022,Cigna Healthcare reported adjusted revenues of$45.0 billion and pre-tax adjusted income from operations of$4.1 billion.HOW WE WINClinical programs to support the highest-quality health outcomes and customer experiencesPartnership with high-performing providers,emphasizing value over volume of s
297、ervicesDifferentiated approach to understanding clients and responding to evolving workforce needs to improve employee productivity and drive more consistent performanceInnovative coordinated benefit solutions that deliver value for our customers,clients and partnersTechnology and data analytics pow
298、ering actionable insights and promoting solutions to improve health and vitality with greater precision and personalizationTalented,experienced and caring people who work as consultative partners in aligning client and customer needs to our solutions and putting those we serve at the center of all w
299、e doBy offering a mix of services and medical insurance products to employers,groups and individuals along with specialty products,we improve the quality of care,lower costs and help customers achieve better health outcomes.Many of these products are available on a standalone basis,but we believe th
300、ey create additional value and savings when integrated with a Cigna Healthcare-administered health plan.11The following chart depicts a high-level summary of our principal products and services in this segment,with definitions on subsequent pages.Principal Products&ServicesMajor Brand(s)GeographyFun
301、ding Solution(s)(1)Market Segment(s)Primary Distribution Channel(s)Primary CompetitorsU.S.Commercial MedicalManaged CareCigna HealthcareNationwideGC,ER,ASOU.S.CommercialBrokers,Private Exchanges,DirectNational Insurers,Local Healthplans,Third-Party Administrators(TPAs)Preferred Provider Organization
302、(PPO)National Insurers,Local Healthplans,TPAsConsumer-DrivenNational Insurers,Local HealthplansU.S.Government MedicalIndividual and Family PlansCigna Healthcare16 states(2)GCU.S.GovernmentPublic Exchanges,Brokers,DirectNational Insurers,Local Healthplans,Provider-led PlansMedicare AdvantageCigna Hea
303、lthcare29 states(3)&District of ColumbiaGCDirect,BrokersNational Insurers,Local Healthplans,Provider-led PlansMedicare Stand Alone Prescription Drug PlansCigna Healthcare,Express ScriptsNationwideGC,ASODirect,BrokersNational InsurersMedicare SupplementCigna Healthcare48 states(4)&District of Columbi
304、aGCBrokers,Direct,Private ExchangesNational InsurersSpecialty Products and ServicesStop-LossCigna HealthcareNationwideGCU.S.CommercialBrokers,DirectNational Insurers,Specialty CompaniesCost ContainmentCigna HealthcareGC,ER,ASOU.S.CommercialNational Insurers,Specialty CompaniesConsumer Health Engagem
305、entCigna HealthcareGC,ER,ASOU.S.Commercial,U.S.GovernmentNational Insurers,Specialty CompaniesPharmacy ManagementCigna HealthcareGC,ER,ASOU.S.Commercial,U.S.GovernmentIndependent PBMs,Managed Care PBMsBehavioral HealthCigna HealthcareGC,ER,ASOU.S.Commercial,U.S.GovernmentNational Insurers,Specialty
306、CompaniesDentalCigna Dental CareGC,ER,ASOU.S.Commercial,U.S.GovernmentDental Insurers,National Insurers(1)Our three funding solutions include administrative services only(ASO),insured-guaranteed cost(GC)and insured-experience-rated(ER)arrangements.(2)AZ,CO,FL,GA,IL,KS,MO,MS,NC,PA,TN,UT&VA.Effective
307、January 1,2023,also includes IN,SC&TX.(3)AL,AR,AZ,CO,CT,DE,FL,GA,IL,KS,MD,MO,MS,NC,NJ,NM,OH,OK,OR,PA,SC,TN,TX,UT,VA,VT&WA.Effective January 1,2023,also includes KY&NY.(4)All states except MA&NY.12Principal Products&ServicesMajor Brand(s)GeographyFunding Solution(s)Market Segment(s)Primary Distributi
308、on Channel(s)Primary CompetitorsInternational Health Products and ServicesGlobal Health CareCigna Global Health Benefits,Cigna Global Individual HealthWorldwide(except as limited by applicable law)GC,ER,ASOInternational HealthBrokers,DirectGlobal insurersLocal Health CareCigna Healthcare,ManipalCign
309、a,CignaCMBChina,Middle East,Singapore,Hong Kong,Spain,United Kingdom,IndiaGlobal insurers and local non-U.S.insurersPrincipal Products&ServicesU.S.Commercial MedicalManaged Care Plans are offered through our insurance companies,Health Maintenance Organizations(HMOs)and TPA companies.HMO,LocalPlus,Ne
310、twork and Open Access Plus plans use meaningful cost-sharing incentives to encourage the use of in-network versus out-of-network health care providers.The national provider network for Managed Care Plans is smaller than the national network used with the PPO plan product line.PPO Plans feature a net
311、work with broader provider access than the Managed Care Plans.Consumer-Driven Products are typically paired with a high-deductible medical plan and offer customers a tax-advantaged way to pay for eligible health care expenses.These products,consisting of health savings accounts,health reimbursement
312、accounts and flexible spending accounts,encourage customers to play an active role in managing their health and health care costs.U.S.Government MedicalIndividual and Family Plans are Patient Protection and Affordable Care Act(ACA)compliant exclusive provider organization(EPO)or HMO plans marketed t
313、o individuals under age 65 who do not have access to health care coverage through an employer or government program such as Medicare or Medicaid.Customers receive comprehensive health care benefits and have access to a local network of health care providers who have been selected with cost and quali
314、ty in mind.Medicare Advantage Plans allow Medicare-eligible customers to receive health care benefits,including prescription drugs,through a managed care health plan such as our coordinated care plans.Our Medicare Advantage Plans include HMO and PPO plans marketed to individuals and qualified employ
315、er groups.A significant portion of our Medicare Advantage customers receive medical care from our value-based models that focus on developing highly engaged physician networks,aligning payment incentives to improve health outcomes and using timely and transparent data sharing.Medicare Stand-Alone Pr
316、escription Drug(Part D)Products provide a number of prescription drug plan options,as well as service and information support to Medicare-eligible individuals or individuals through a qualified employer group.Our stand-alone plans offer the coverage of Medicare combined with the flexibility to selec
317、t a product that provides enhanced benefits and a formulary that aligns with the individuals needs.Eligible customers benefit from broad network access and enhanced service intended to promote adherence,wellness and affordability.Medicare Supplement Plans provide Medicare-eligible customers with fed
318、erally standardized Medigap-style plans.Customers may select among the various plans with specific plan options to meet their unique needs and may visit,without the need for a referral,any health care provider or facility that accepts Medicare throughout the United States.Specialty Products and Serv
319、icesStop-Loss insurance coverage is offered to self-insured clients whose group health plans are administered by Cigna Healthcare.Stop-loss insurance provides reimbursement for claims in excess of a predetermined amount for individuals,the entire group,or both.Cost Containment Programs are designed
320、to contain the cost of covered health care services and supplies.These programs reduce out-of-network utilization and costs,protect customers from balance billing and educate customers regarding the availability of lower cost in-network services.In addition,under these programs we negotiate discount
321、s with out-of-network providers,review provider bills and recover overpayments.We charge fees for providing or arranging for these services.These programs may be administered by third-party vendors that have contracted with Cigna Healthcare.13Consumer Health Engagement services are offered to custom
322、ers covered under plans administered by Cigna Healthcare or by third-party administrators.These services consist of an array of health management,disease management and wellness services.Our Medical Management programs include case,specialty and utilization management and a 24/7 Health Information l
323、ine which ensures around the clock access to a medical professional.Our Health Advocacy program services include early intervention in the treatment of chronic conditions and an array of health and wellness coaching.We administer incentives programs designed to encourage customers to engage in healt
324、h improvement activities.Pharmacy Management services and benefits can be combined with our medical offerings.The comprehensive suite of pharmacy management services are available to clients and customers through our integration with Evernorth Health Services capabilities.Behavioral Health services
325、consist of a broad national network of behavioral health providers which includes one of the largest virtual networks in the United States,behavioral health specialty case and utilization management,a crisis intervention line accessible anytime,employee assistance programs and work/life programs.We
326、integrate our programs and services with medical and pharmacy programs to facilitate customized,holistic care as well as to provide resources that increase resiliency and address non-medical factors that affect overall well-being.Dental solutions include dental HMO plans,dental PPO plans,exclusive d
327、ental provider organization plans,traditional dental indemnity plans and a dental discount program.Employers and other groups can purchase our products on either an insured or self-insured basis as standalone products or in conjunction with medical products.Additionally,individual customers can purc
328、hase insured dental PPO plans as standalone products or in conjunction with individual medical policies.International HealthGlobal Health Care products and services include insurance and administrative services for medical,dental,pharmacy,vision and life,accidental death and dismemberment and disabi
329、lity risks.We are a leading provider of products and services that meet the needs of multinational employers,intergovernmental and nongovernmental organizations and globally mobile individuals with a focus on keeping employees healthy and productive.The employer benefits products and services are of
330、fered through guaranteed cost,experience-rated and administrative services only funding solutions,while individuals purchase guaranteed cost coverage.Local Health Care products and services include medical,dental,pharmacy and vision as well as life coverage.The customers of local health care busines
331、ses are employers and individuals located in specific countries where the products and services are purchased.These employer services can similarly be funded through a range of options;individuals purchase on a guaranteed cost basis.Revenues:Premiums and FeesASO.Plan sponsors(i.e.,employers,unions a
332、nd other groups)self-fund all claims,but may purchase stop-loss insurance to limit exposure.We collect fees from plan sponsors for providing access to our participating provider network and for other services and programs including:claims administration;behavioral health services;disease management;
333、utilization management;cost containment;dental and pharmacy benefit management.Approximately 85%of our U.S.Commercial medical customers are in ASO arrangements.Insured.GC and ER.In most states,individual and group insurance premium rates must be approved by the applicable state regulatory agency(typically a department of insurance).State or federal laws may restrict or limit the use of rating meth