Cigna

Moat components and indicative scores: cost advantage 80/100, switching costs 75/100, efficient scale 85/100, intangible assets 60/100, network effects 45/100. We weight them 35 percent, 25 percent, 15 percent, 15 percent, and 10 percent respectively to reach a blended 76. Evernorth’s Express Scripts is one of the Big 3 PBMs alongside CVS Caremark and OptumRx, a market structure where the top three handle roughly 80 percent of claims and the top six over 90 percent.

Scale confers purchasing leverage with manufacturers, pharmacy network rate advantages, and operational efficiency in claims processing and specialty distribution. The industry’s concentrated structure also exhibits efficient‑scale dynamics that deter new entrants.

These are durable advantages but not unassailable: enforcement actions and legislative reforms could compress or reallocate economics. Switching costs for jumbo employers and health plans are meaningful due to data migration, formulary and clinical program rebuilds, and contracting, which helps client stickiness.

Intangibles exist in brands (Express Scripts, Accredo) and deep datasets, but we discount them given political risk to PBM models. Network effects are weaker than in pure payment networks: value scales with utilization but can be reset by policy. Overall, we see a real moat tempered by regulatory fragility.