Cigna is a health services and insurance company built around two core businesses: Evernorth Health Services and Cigna Healthcare. Evernorth is the larger earnings contributor and operates two main businesses. The first is Pharmacy Benefit Services (PBS), run under the Express Scripts brand, which manages prescription drug benefits for insurers, employers, unions, and government programs — adjudicating retail pharmacy claims, negotiating drug prices and rebates with manufacturers, and operating home delivery pharmacies. The second is Specialty and Care Services, anchored by Accredo Specialty Pharmacy, which dispenses and provides clinical support for high-cost specialty drugs used to treat rare and chronic diseases, alongside CuraScript SD, a specialty drug distributor serving hospitals and physician offices. Cigna Healthcare is Cigna's health insurance business, covering U.S. employers, ACA exchange individuals, and international markets through medical, dental, behavioral, and stop-loss insurance, as well as administrative services for self-funded employers. Cigna sold its Medicare Advantage business in early 2025, making Cigna Healthcare entirely employer-focused. Evernorth PBS earns fees for managing pharmacy benefits, and is transitioning away from spread pricing and rebate retention toward a fully fee-based, rebate-free model ahead of federal legislation requiring 100% rebate pass-through by 2028. Cigna Healthcare earns premiums on insured plans, bearing medical cost risk measured by the Medical Care Ratio, and earns administrative fees on self-funded plans. Cigna is prioritizing growth in specialty pharmacy, where Specialty and Care Services has grown from roughly a quarter to over a third of enterprise earnings in three years, driven by rising specialty drug utilization and biosimilar adoption.