Cigna Delivers Strong Second Quarter 2019 Results, Raises Revenue And Earnings Outlook

Cigna Corporation (NYSE: CI) has reported strong second quarter 2019 results led by the Health Services and Integrated Medical segments.

“As Cigna accelerates our focus on whole person health, our strong second quarter results reflect the value we deliver to customers and clients, and our consistent execution in a dynamic environment,” said David M. Cordani, President and Chief Executive Officer. “We continue to invest in innovative, customer-centric solutions to improve affordability and personalization for those we serve.”

Total revenues for second quarter 2019 were $38.8 billion. Adjusted revenues¹ were $34.4 billion and reflect strong contributions from each of Cigna's ongoing businesses.

Shareholders’ net income for second quarter 2019 was $1.41 billion, or $3.70 per share, compared with $0.81 billion, or $3.29 per share, for second quarter 2018.

Cigna's adjusted income from operations² for second quarter 2019 was $1.64 billion, or $4.30 per share, compared with $0.96 billion, or $3.89 per share, for second quarter 2018. This reflects strong earnings contributions led by the Health Services and Integrated Medical segments.

Reconciliations of total revenues to adjusted revenues¹ and of shareholders’ net income to adjusted income from operations² are provided below.

CONSOLIDATED HIGHLIGHTS

The following table includes highlights of results and reconciliations of total revenues to adjusted revenues¹ and shareholders’ net income to adjusted income from operations²:

Consolidated Financial Results (dollars in millions):
			Three Months Ended												Six Months Ended
				June 30,						March 31,					June 30,
				2019			2018					2019				2019
Total Revenues			$	38,819		$	11,480				$	37,946			$	76,765
Net Realized Investment Losses (Gains) from Equity Method Investments1				6			20					(28)				(22)
Special Items and Transitioning Client Contributions1				(4,450)								(4,489)				(8,939)
Adjusted Revenues1			$	34,375		$	11,500				$	33,429			$	67,804
Consolidated Earnings, net of taxes
Shareholders’ Net Income			$	1,408		$	806				$	1,368			$	2,776
Net Realized Investment (Gains) Losses2				(13)			22					(38)				(51)
Amortization of Other Acquired Intangible Assets2				572			18					564				1,136
Special Items and Transitioning Client Contributions1,2				(327)			109					(396)				(723)
Adjusted Income from Operations2			$	1,640		$	955				$	1,498			$	3,138
Shareholders’ Net Income, per share			$	3.70		$	3.29				$	3.56			$	7.26
Adjusted Income from Operations2, per share			$	4.30		$	3.89				$	3.90			$	8.20

• Cigna’s second quarter results reflect strong revenue and earnings growth, as we deepened customer relationships, delivered strong medical and pharmacy cost performance, and continued innovation across our businesses. Second quarter 2019 adjusted income from operations² also included a $45 million benefit from the favorable resolution of a tax matter.

• Year to date through July 31, 2019, the Company repurchased 6.2 million shares of common stock for approximately $1.1 billion.

• The debt to capitalization ratio decreased to 47.2% at June 30, 2019, from 50.9% at December 31, 2018.

• The SG&A expense ratio⁵ was 9.0% for second quarter 2019, a significant decrease from 23.5% for second quarter 2018, driven by business mix changes resulting from the Express Scripts combination and the health insurance tax suspension.

CUSTOMER RELATIONSHIPS

The following table summarizes our medical customers and overall customer relationships:

Customer Relationships (in thousands):
		As of the Periods Ended
		June 30,						March 31,			December 31,
		2019			2018			2019			2018
Commercial		14,026			13,850			14,016			13,982
Government		1,382			1,390			1,405			1,407
International Markets		1,589			1,550			1,572			1,572
Total Medical Customers6		16,997			16,790			16,993			16,961
Pharmacy6		75,171			8,794			74,935			73,230
Behavioral Care		28,577			27,069			28,046			27,215
Dental		17,077			16,506			17,122			16,544
Medicare Part D		3,266			771			3,302			3,295
International Markets Supplemental Policies6,7		12,500			12,197			12,576			12,569
Group Disability and Life Covered Lives6		15,400			15,300			15,200			14,800
Total Customer Relationships		168,988			97,427			168,174			164,614

• The total medical customer base⁶ at second quarter 2019 was 17 million, an organic increase of 36,000 customers year to date and 207,000 over second quarter 2018 driven by growth in the Select and Middle Market segments, partially offset by a decline in National Accounts.

• The pharmacy customer base⁶ at second quarter 2019 was 75 million, an organic increase of 1.9 million customers year to date, driven by strong new commercial sales.

• Pharmacy⁶ and Medicare Part D customers in the first and second quarter 2019 and fourth quarter 2018 include customers gained through the completion of the Express Scripts combination on December 20, 2018.

HIGHLIGHTS OF SEGMENT RESULTS

See Exhibit 1 for a reconciliation of adjusted income (loss) from operations² to shareholders’ net income.

Health Services

This segment includes a broad range of pharmacy services, including benefits management, specialty pharmacy services, clinical solutions, home delivery, and health management services.

Financial Results (dollars in millions):
		Three Months Ended										Six Months Ended
		June 30,							March 31,			June 30,
			2019			2018				2019				2019
Adjusted Revenues1		$	23,537		$	1,113			$	22,460		$		45,997
Adjusted Income from Operations, Pre-Tax2		$	1,162		$	77			$	994		$		2,156
Adjusted Margin, Pre-Tax8			4.9%			6.9%				4.4%				4.7%

• Cigna completed the combination with Express Scripts on December 20, 2018. Accordingly, contributions from the Express Scripts business are reflected in the Health Services segment results for the first half of 2019, and are not reflected in second quarter 2018 results.

• Growth in second quarter 2019 adjusted revenues¹ and adjusted income from operations, pre-tax² over second quarter 2018 were driven by the combination with Express Scripts.

• Second quarter 2019 adjusted income from operations, pre-tax² and adjusted margin, pre-tax⁸ reflect organic growth in adjusted pharmacy script volumes as well as strong performance in specialty pharmacy care.

• Health Services fulfilled 294 million adjusted pharmacy scripts⁹ in second quarter 2019, and 292 million adjusted pharmacy scripts⁹ in first quarter 2019.

Integrated Medical

This segment includes Cigna’s U.S. Commercial and Government businesses that provide comprehensive medical solutions to clients and customers. U.S. Commercial products and services include medical, pharmacy, behavioral health, dental, vision, health advocacy programs and other products and services to insured and self-insured customers. Government solutions include Medicare Advantage, Medicare Supplement, and Medicare Part D plans for seniors, Medicaid plans, and individual health insurance coverage both on and off the public exchanges.

Financial Results (dollars in millions):
		Three Months Ended										Six Months Ended
		June 30,							March 31,			June 30,
			2019			2018				2019				2019
Adjusted Revenues1		$	8,968		$	8,170			$	9,195		$		18,163
Adjusted Income from Operations, Pre-Tax2		$	990		$	915			$	1,170		$		2,160
Adjusted Margin, Pre-Tax8			11.0%			11.2%				12.7%				11.9%

• Second quarter 2019 adjusted revenues¹ increased 10% relative to second quarter 2018, driven by Commercial customer growth and deepening of relationships, as well as premium increases consistent with underlying cost trends.

• Second quarter 2019 adjusted income from operations, pre-tax² and adjusted margin, pre-tax⁸ reflect strong medical and specialty contributions and continued effective medical cost management.

• Adjusted income from operations, pre-tax² for second quarter 2019, first quarter 2019, and second quarter 2018 included favorable net prior year reserve development on a pre-tax basis of $28 million, $50 million and $20 million, respectively.

• The medical care ratio⁵ (“MCR”) of 81.6% for second quarter 2019 reflects continued effective execution in our commercial and government businesses. The second quarter 2019 MCR increased relative to second quarter 2018, as expected, driven by the inclusion of the Express Scripts Medicare Part D business, the pricing effect of the health insurance tax suspension, and a higher MCR in our individual medical business.

• Integrated Medical net medical costs payable¹⁰ was approximately $2.64 billion at June 30, 2019, $2.51 billion at June 30, 2018 and $2.43 billion at December 31, 2018.

International Markets

This segment includes supplemental health, life and accident insurance products and health care coverage in our international markets, as well as health care benefits for globally mobile employees of multinational organizations.

Financial Results (dollars in millions, policies and customers in thousands):
		Three Months Ended									Six Months Ended
			June 30,				March 31,				June 30,
			2019			2018			2019			2019
Adjusted Revenues1,7		$	1,389		$	1,344		$	1,394		$	2,783
Adjusted Income from Operations, Pre-Tax2		$	207		$	203		$	206		$	413
Adjusted Margin, Pre-Tax8			14.9%			15.1%			14.8%			14.8%
			As of the Periods Ended
			June 30,				March 31,				December 31,
			2019			2018			2019			2018
International Markets Supplemental Policies6,7			12,500			12,197			12,576			12,569
International Markets Medical Customers6			1,589			1,550			1,572			1,572

• Excluding the impact of foreign currency movements, second quarter 2019 adjusted revenues^1,7 grew 8% over second quarter 2018 reflecting continued business growth.

• Second quarter 2019 adjusted income from operations, pre-tax² and adjusted margin, pre-tax⁸ reflect continued business growth and a favorable loss ratio, partially offset by unfavorable foreign currency impacts.

Group Disability and Other Operations

This segment includes Cigna’s Group Disability and Life business which offers group long-term and short-term disability, and group life, accident, voluntary and specialty insurance products and services. Additionally, this segment includes Corporate Owned Life Insurance (“COLI”) and the Company’s run-off operations.

Financial Results (dollars in millions):
		Three Months Ended									Six Months Ended
			June 30,				March 31,				June 30,
			2019			2018			2019			2019
Adjusted Revenues1		$	1,309		$	1,282		$	1,296		$	2,605
Adjusted Income from Operations, Pre-Tax2		$	149		$	161		$	84		$	233
Adjusted Margin, Pre-Tax8			11.4%			12.6%			6.5%			8.9%

• Second quarter 2019 adjusted income from operations, pre-tax² and adjusted margin, pre-tax⁸ reflect solid disability and life performance as well as the impact of the run-off businesses.

Corporate

Corporate reflects interest expense, as well as amounts not allocated to operating segments and includes intersegment eliminations.

Financial Results (dollars in millions):
		Three Months Ended										Six Months Ended
			June 30,					March 31,				June 30,
			2019			2018				2019			2019
Adjusted (Loss) from Operations, Pre-Tax2		$	(453)		$	(80)			$	(490)		$	(943)

• Second quarter 2019 adjusted loss from operations, pre-tax² increased relative to second quarter 2018 as a result of higher interest expense associated with the financing of the combination with Express Scripts.

2019 OUTLOOK

Cigna's outlook for full year 2019 consolidated adjusted income from operations^2,3,4 is in the range of $6.34 billion to $6.46 billion, or $16.60 to $16.90 per share. Cigna’s outlook excludes the impact of additional prior year reserve development of medical costs and potential effects of any future share repurchase⁴.

(dollars in millions, except where noted and per share amounts)		Projection for Full-Year Ending				Change from Prior
		December 31, 2019				Projection
2019 Consolidated Operating Metrics
Adjusted Income from Operations 2,3,4		$	6,340 to 6,460		$	+ 60 to 100
Adjusted Income from Operations, per share 2,3,4		$	16.60 to 16.90		$	+ 0.25 to 0.35
Adjusted Revenues 1,3		$	136,000 to 137,000		$	+ 2,500 to 3,500
SG&A Expense Ratio 5			less than 10%			improved > 25 bps at the midpoint
Adjusted Tax Rate 11			23% to 24%			- 50 bps
2019 Segment-Level Operating Metrics
Adjusted Income from Operations, Pre-Tax 2,3,4
Health Services		$	5,050 to 5,200
Integrated Medical		$	3,780 to 3,850		$	+ 50 to 80
Adjusted Pharmacy Scripts – Health Services 9			1.21 to 1.23 billion			+ 40 million
Medical Customer Growth 6			~ 200,000 customers			- 150,000 customers at the midpoint
Medical Care Ratio 5			80.5% to 81.5%
Medical Cost Trend 12			3.5% to 4.5%

2020 OUTLOOK

Health Services’ projected 2020 retention rate for the 2019 selling season for pharmacy services is now in the range of 97% to 98%, an increase of 50 bps from the midpoint of our previous expectations. Health Services’ adjusted pharmacy scripts ⁹ are expected to grow 25 to 35 million scripts organically in 2020.

The foregoing statements represent the Company’s current estimates of Cigna's 2019 consolidated and segment adjusted income from operations^2,3,4 and other key metrics as of the date of this release. Actual results may differ materially depending on a number of factors. Investors are urged to read the Cautionary Note Regarding Forward-Looking Statements included in this release. Management does not assume any obligation to update these estimates.

This quarterly earnings release and the Quarterly Financial Supplement are available on Cigna’s website in the Investor Relations section (http://www.cigna.com/aboutcigna/investors). Management will be hosting a conference call to review second quarter 2019 results and discuss full year 2019 outlook beginning today at 8:30 a.m. ET. A link to the conference call is available in the Investor Relations section of Cigna's website located at https://www.cigna.com/aboutcigna/investors/events/index.page.

The call-in numbers for the conference call are as follows:

Live Call 
(888) 324-7575 (Domestic) 
(210) 234-0013 (International) 
Passcode: 8012019

Replay 
(800) 272-5965 (Domestic) 
(402) 220-9721 (International)

It is strongly suggested you dial in to the conference call by 8:15 a.m. ET.

Read the complete results and notes here in PDF format.

Notes:
1.		At the consolidated level, the measure “adjusted revenues” is not determined in accordance with accounting principles generally accepted in the United States (GAAP) and should not be viewed as a substitute for the most directly comparable GAAP measure, “total revenues.” We define adjusted revenues as total revenues excluding revenue contributions from transitioning pharmacy benefit management clients, Anthem Inc. and Coventry Health Care, Inc. (the “transitioning clients”), net realized investment results from equity method investments, and special items. We exclude these items from this measure because they are not indicative of past or future underlying performance of the business. See Exhibit 1 for a reconciliation of consolidated adjusted revenues to total revenues.
2.		Adjusted income (loss) from operations is defined as shareholders’ net income (loss) excluding the following adjustments: earnings contributions from transitioning clients, net realized investment results, amortization of acquired intangible assets, and special items. Special items are identified in Exhibit 1 of this earnings release. Adjusted income (loss) from operations is measured on an after-tax basis for consolidated results and on a pre-tax basis for segment results.
		Adjusted income (loss) from operations is a measure of profitability used by Cigna’s management because it presents the underlying results of operations of Cigna’s businesses and permits analysis of trends in underlying revenue, expenses and shareholders’ net income. This consolidated measure is not determined in accordance with GAAP and should not be viewed as a substitute for the most directly comparable GAAP measure, shareholders’ net income. See Exhibit 1 for a reconciliation of adjusted income from operations to shareholders’ net income.
		Effective in the fourth quarter of 2018, Cigna updated its segments. Refer to our Current Report on Form 8-K filed with the Securities and Exchange Commission on January 23, 2019 and our Annual Report on Form 10-K for the year ended December 31, 2018 for additional information and prior period results on the historic and new segment bases.
3.		Management is not able to provide a reconciliation of adjusted income from operations to shareholders’ net income (loss) or adjusted revenues to total revenues on a forward-looking basis because we are unable to predict, without unreasonable effort, certain components thereof including (i) future net realized investment results (from equity method investments with respect to adjusted revenues) and (ii) future special items. These items are inherently uncertain and depend on various factors, many of which are beyond our control. As such, any associated estimate and its impact on shareholders’ net income could vary materially.
4.		The Company’s outlook excludes the potential effects of any share repurchases or business combinations that may occur after the date of this earnings release.
5.		Operating ratios are defined as follows:
		Medical care ratio represents medical costs as a percentage of premiums for all U.S. commercial risk products, including medical, pharmacy, dental, stop loss and behavioral products provided through guaranteed cost or experience-rated funding arrangements, as well as Medicare Advantage, Medicare Part D, Medicare Supplement, Medicaid, and individual on and off-exchange products, within our Integrated Medical segment. SG&A expense ratio represents enterprise selling, general and administrative expenses excluding special items and expenses from transitioning clients, as a percentage of adjusted revenue at a consolidated level.
6.		Customer relationships are defined as follows:
		Total medical customers includes individuals in our Integrated Medical and International Markets segments who meet any one of the following criteria: are covered under a medical insurance policy, managed care arrangement, or service agreement issued by Cigna; have access to Cigna's provider network for covered services under their medical plan; or have medical claims and services that are administered by Cigna. Pharmacy customer relationships excludes transitioning clients. International Markets policies exclude International Markets medical customers included in total medical customers. Group Disability and Life covered lives are estimated.
7.		Cigna owns a 50% noncontrolling interest in its China joint venture. Cigna's 50% share of the joint venture’s earnings is reported in Fees and Other Revenues using the equity method of accounting under GAAP. As such, the adjusted revenues and policy counts for the International Markets segment do not include the China joint venture.
8.		Adjusted margin, pre-tax, is calculated by dividing adjusted income (loss) from operations, pre-tax by adjusted revenues for each segment.
9.		For Health Services adjusted pharmacy scripts, 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. Adjusted pharmacy scripts guidance does not include script volumes associated with transitioning clients. Outlook for organic adjusted pharmacy script growth of 25 to 35 million scripts in 2020 excludes volumes expected to be insourced from OptumRx under the terms of the transition services agreement.
10.		Medical costs payable within the Integrated Medical segment are presented net of reinsurance and other recoverables. The gross medical costs payable balance was $2.88 billion as of June 30, 2019, $2.70 billion as of December 31, 2018, and $2.75 billion as of June 30, 2018. The Integrated Medical days claims payable was 40.1 days at June 30, 2019, 40.7 days at December 31, 2018 and 43.4 days at June 30, 2018.
11.		The measure “adjusted tax rate” is not determined in accordance with GAAP and should not be viewed as a substitute for the most directly comparable GAAP measure, “consolidated effective tax rate.” We define adjusted tax rate as the consolidated income tax rate applicable to the Company’s pre-tax income excluding net realized investment results, amortization of acquired intangible assets, special items, and transitioning clients. Management is not able to provide a reconciliation to the consolidated effective tax rate on a forward-looking basis because we are unable to predict, without unreasonable effort, certain components thereof including (i) future net realized investment results and (ii) future special items.
12.		Medical cost trend includes all U.S. commercial employer funding arrangements.