UNH — UnitedHealth Group Incorporated

CVS Health is a vertically integrated healthcare company operating pharmacy benefit management (Caremark), retail pharmacies (9,000+ stores), health insurance (Aetna), and clinic-based care (MinuteClinic, Oak Street Health). The 2018 acquisition of Aetna for $69 billion transformed CVS from a pharmacy chain into a healthcare ecosystem player. CVS manages prescription drug benefits for tens of millions of Americans through Caremark and continues to expand primary care through Oak Street Health, acquired in 2023.

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.