Cigna

Revenue and cash flows are anchored by recurring PBM scripts and commercial ASO fees, which are more predictable than government MA plans. 2024 revenue was 247.1 billion dollars; Q1 through Q3 2025 updates showed continued growth and reaffirmed full‑year adjusted EPS of at least 29.60. Our TTM free cash flow estimate through Q3 2025 is about 7.4 billion dollars based on the most recent four quarters.

Offsetting this stability, medical cost ratios in stop‑loss have been elevated, producing quarterly noise; and regulatory actions could alter PBM margins with limited notice. Netting these, we view predictability as solid, though not in the class of pure toll‑booths like card networks.