CVS — CVS Health Corporation

UnitedHealth Group is the largest health insurance company in the US, serving tens of millions of members through UnitedHealthcare. The company also operates Optum, a diversified health services platform spanning pharmacy benefits, care delivery, and health technology.

Humana is one of the largest health insurance companies in the United States with a dominant position in Medicare Advantage, the privately managed version of Medicare. Humana serves over 5 million Medicare Advantage members and benefits from the secular trend of Baby Boomers aging into Medicare eligibility. The company is heavily focused on value-based care through its CenterWell (formerly Conviva) primary care clinic network and home health services. Humana's earnings are highly sensitive to Medicare Advantage reimbursement rates set by CMS.

The Cigna Group is a global healthcare services and insurance company serving employers, government programs, and individuals. Cigna operates two primary segments: Evernorth Health Services (pharmacy benefits management via Express Scripts, specialty pharmacy, and care solutions) and Cigna Healthcare (commercial health insurance). Express Scripts is one of the three dominant PBMs in the U.S., processing hundreds of millions of prescriptions annually. Cigna divested its Medicare Advantage, Medicare Supplement, and Part D businesses to HCSC in 2024.

McKesson is one of the three dominant U.S. pharmaceutical distributors alongside AmerisourceBergen (Cencora) and Cardinal Health, distributing branded and generic drugs, medical supplies, and specialty pharmaceuticals to pharmacies, hospitals, and clinics. As a distributor, McKesson's margins are thin but volumes are enormous. The company also operates oncology specialty distribution and has a growing presence in oncology practice management through The US Oncology Network.