# Cigna Connecticut insurance conglomerate whose Evernorth division contains **Express Scripts**, the second of the Big Three [[Pharmacy Benefit Managers]] (acquired 2018 for $67 billion, under long-tenured CEO David Cordani). Same vertical-integration logic as its peers — insurer plus PBM plus specialty/mail pharmacies — but for this KB its significance is as the **first mover in the PBM reckoning**. ## The FTC Settlement On February 4, 2026, Express Scripts became the first of the Big Three to settle the FTC's insulin-rebate case — one day after the PBM reform provisions were signed in the spending bill, a sequencing that marked the week the PBM era's terms changed. The settlement imposed no fines but required structural changes to the PBM model: rebate transparency and pass-through commitments the FTC valued at up to **$7 billion in patient out-of-pocket savings over ten years**, plus new revenue flowing to community pharmacies. The template now hangs over [[CVS Health]] (negotiating) and [[UnitedHealth Group]]'s OptumRx (still litigating) — and the no-fine, forward-looking structure is itself worth noting: even the landmark enforcement action against the designated villains of drug pricing extracted process changes, not penalties. ## The GLP-1 Differentiation Where [[CVS Health]]'s Caremark wielded exclusion in the GLP-1 wars (dropping Zepbound outright), Evernorth played accommodation: deals with both [[Eli Lilly]] and [[Novo Nordisk]] capping patient copays at $200/month for Zepbound and Wegovy, wrapped in home-delivery and pharmacist-support programs. Two strategies, same underlying fact — the PBM, not the manufacturer or the [[Most-Favored-Nation Drug Pricing Deals]], decides what the insured patient actually pays for the decade's defining drugs. ## Connections - [[Pharmacy Benefit Managers]] — Express Scripts; first FTC settler, February 2026 - [[CVS Health]] / [[UnitedHealth Group]] — Fellow Big Three; settlement template pending - [[Eli Lilly]] / [[Novo Nordisk]] — The $200 copay-cap deals - [[Big Pharma]] — Hub frame