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Text: I'm Alexis Jones, Lead Principal for Investor Relations.
In our remarks today, David and Brian will cover a number of topics, including Cigna's third quarter 2021 financial results, as well as an update on our financial outlook for 2021.
We use term labeled adjusted income from operations and adjusted earnings per share on the same basis as our principal measures of financial performance.
Before turning the call over to David, I will cover a few items pertaining to our financial results and disclosures.
Regarding our results, in the third quarter, we recorded an after-tax special item benefit of $35 million or $0.10 per share for integration and transaction related costs.
Additionally, please note that when we make prospective comments regarding financial performance, including our full-year 2021 outlook, we will do so on a basis that includes the potential impact of future share repurchases and anticipated 2021 dividend and does not assume any impact from any business combinations or divestitures that may occur after today, such as our recently announced planned divestiture of life accident and supplemental benefits businesses outside of the U.S., which we expect to close in 2022.
So, let's jump in.
During the quarter, we delivered adjusted revenue of $44 billion and adjusted earnings per share of $5.73 per share, all while continuing to reinvest back in our business to fund growth, expansion and ongoing innovation, and we continue to return significant value to our shareholders.
These results reinforce we are delivering for our customers, our patients, clients provider partners, as well as for you, our shareholders.
With our high performing health service portfolio and sharp focus on executing our strategy, we are confident in our ability to continue driving growth and are again raising our full-year 2001 guidance for adjusted earnings per share and revenue.
Our performance is strong considering the ongoing impact of the pandemic on medical costs, as well as the higher claims we've experienced among the special enrollment period or SEP customers within our individual business.
As it relates to our MCR in the quarter, our commercial business did improve from the second quarter to the third quarter and our Medicare Advantage business also improved sequentially.
We continue to execute a series of actions in 2021 and 2022 to further improve our MCR, and Brian will walk through this in more detail in a few moments.
Separately, in early October we also announced an agreement with Chubb to sell our life, accident and supplemental benefits business in our International Markets platform in seven countries for $5.75 billion.
We expect to realize about $5.4 billion in net after-tax proceeds and complete the transaction in 2022 following regulatory approvals.
Guided by our strategy and similar to our 2020 divestiture of our Group Insurance business, this transaction unlocks the value of a best-in-class leading asset, while also enabling us to even more sharply focus our business on health and well-being services.
So overall, our performance for the quarter reflects our clear strategy and strong execution and delivering attractive results and importantly, our ongoing commitment to prioritize and support the evolving health and well-being needs of those we serve.
Now, I'll walk through some additional detail for our Evernorth in U.S. Medical businesses.
A year ago, we launched Evernorth to the marketplace as our health service platform, focused on servicing health plans, employers, government organizations and healthcare providers.
Since that time, Evernorth has established itself with unique partnerships and innovative services that are resonating with multiple buyer groups.
Our Evernorth pharmacy and our medical offerings through our U.S. medical platform are the two primary gateways through which most of our clients and customers form their base relationship with us.
Wrapping around these two exceptionally strong platforms are our additional suites of innovative health services Evernorth, including benefits management, care solutions and intelligent solutions.
These help us to expand and deepen existing relationships.
In the third quarter, Evernorth retained and expanded our relationship with the Department of Defense TRICARE pharmacy program and we did seven-year contracts.
It's our privilege to serve almost 10 million active duty service members, retirees and their families.
Evernorth will continue supporting TRICARE pharmacy operations including specialty pharmacy services, military pharmacy claims and retail network pharmacies.
The new contract also allows for expansion of specialty and care coordination services through 2029.
As we look to the balance of the year and into 2022, Evernorth will continue to grow revenue and earnings.
Turning to our U.S. medical platform.
In U.S. commercial, our teams are leveraging and deploying the innovative solutions from Evernorth to expand our service offerings and address the evolving needs of our clients and customers.
For example, in our U.S. commercial platform, we are leveraging Evernorth and the live capabilities to expand virtual care options for our customers through their employers, with primary, urgent, behavioral and dermatology care as part of these value-based arrangements during virtual visits and the live physicians are leveraging our Evernorth Intelligence capabilities, enabling them to provide more connected and coordinated experience, and we continue to expand our capabilities with MDLIVE as we recently launched a virtual first health plan for employers.
Another great example of Evernorth in U.S. commercial partnering to bring more value to our health plan clients is a new arrangement we have with University of Pittsburgh Medical Center Health plan.
We will make in network care available to UPMC customers who live, work or travel outside the network service area.
UPMC has been an Evernorth pharmacy client for 16 years and this agreement illustrates how we are collaborating across our enterprise to deliver greater affordability and differentiated value for health plan clients.
We are pleased how the market continues to recognize the value we're delivering through our broad suite of solutions and as such, we continue to grow through both our U.S. commercial and Evernorth platforms.
Within Medicare Advantage, consistent with our strategy, we continue to grow in our existing markets and are expanding into new geographies.
Our progress is further supported by our overall value of our offerings.
For 2022 calendar year, 89% of our Medicare Advantage customers will be in four star or greater plans nationally.
This is the highest level we've ever achieved and it marks the fifth year in a row we've improved our STARS performance.
And in our individual and family plan business, we've driven strong growth in this year, increasing customers by 47% through the third quarter.
A substantial portion of this growth did come from the extended special enrollment period.
And as I previously noted, some of the MCR impact in the third quarter was driven by the medical costs among those we added during the outpaced SEP growth.
We do expect this will moderate in 2022.
We are positioning ourselves to build on this momentum in the individual family plan business by expanding our addressable markets, again as we enter in three new states and 93 new counties in 2022.
These new markets offer the potential to reach an additional 1.5 million customers.
The continued strength of our results and the growth we are generating through the execution of our strategy gives us confidence we will deliver against our commitments in 2021.
We will deliver earnings per share in line with our long-term targets and revenue growth well above our long-term targets for yet another year.
We will also deliver earnings per share within our long-term target range in 2022.
Specifically for 2021, we are committed to delivering our increased guidance for full-year adjusted earnings per share of at least $20.35.
For full year 2021, we remain on track for generating at least $7.5 billion of cash flow from operations and we expect to return more than $7 billion to shareholders in 2021 through dividends and share repurchase.
Looking into 2022, we expect to grow earnings per share by at least 10% off of our increased 2021 guidance of at least $20.35 per share.
We anticipate a number of tailwinds, including core growth in our business and additional contribution from margin expansion in our U.S. medical business as we drive pricing actions, execute affordability and efficiency initiatives and benefit from the return of Medicare risk adjustment revenue to more normalized levels.
We're also expecting year-over-year headwind as we plan for net investment income to be more in line with historical levels.
And of course, the rate and pace of ongoing strategic investments will vary from year to year.
In short, 2022 will be another strong year for Cigna.
Now to briefly summarize.
As we demonstrated through the quarter and throughout 2021, we are delivering for our customers, patients, clients and provider partners as they experience the ongoing challenges of the pandemic.
We are also taking significant value-enhancing actions such as divesting a portion of our international business, returning substantial amounts of capital to our shareholders and continuing to strategically invest in our capabilities and strategic partnerships, all of which position us to continue to advance our long-term growth agenda and continue to deliver shareholder value.
Today, I will review key aspects of Cigna's third quarter results, including the ongoing impact of COVID-19 on our business and I will discuss our updated outlook for the full year.
During the quarter, total medical costs were higher than our expectations within our U.S. Medical segment, driven largely by the impact of the Delta variant in our U.S. commercial business and increased medical costs for special enrollment period customers in our U.S. individual business.
Importantly, I would remind you that approximately 80% of our revenues are from service-based businesses that are not significantly exposed to medical cost fluctuations.
Our balanced portfolio and multiple levers for value creation resulted in Cigna's overall revenue and earnings exceeding our third quarter expectations.
This strong third quarter performance coupled with capital deployment activities led to an increased outlook for full year 2021, which I will discuss shortly.
Now turning to enterprise results.
Key consolidated financial highlights in third quarter 2021 include adjusted revenue growth of 9% to $44.3 billion, adjusted earnings growth of 20% to $1.9 billion after tax, and adjusted earnings-per-share growth of 30% to $5.73.
Results in the third quarter reflect strong top and bottom line growth with contributions across all of our businesses with overall performance above our expectations.
I'll now discuss our segment level results and will then provide an update on the details of our outlook as well as our capital positioning.
Regarding our segments, I'll first comment on Evernorth.
Third quarter 2021 adjusted revenues grew 13% to $33.6 billion.
Adjusted pharmacy script volume increased 8% to 411 million scripts and adjusted pre-tax earnings grew 7% to $1.5 billion compared to third quarter 2020.
Evernorth's strong results in the quarter were driven by organic growth, including strong volumes in retail and specialty pharmacy along with ongoing efforts to improve affordability for the benefit of our clients, customers and patients and deepening of existing relationships, partially offset by significant strategic investments to support ongoing growth, including our virtual care platform and technology capabilities.
Overall, Evernorth continues to create differentiated value for clients and customers, while driving overall revenue and earnings growth that exceeded our original expectations through the first three quarters of 2021.
Turning to U.S. Medical.
Third quarter adjusted revenues were $10.5 billion and adjusted pre-tax earnings were approximately $1 billion.
Overall, our U.S. Medical earnings exceeded our expectations during the third quarter, reflecting the impact of favorable net investment income and increased specialty contributions, partially offset by higher claim costs due to the net impact of COVID-19 and increased medical costs for special enrollment period customers in our individual business.
The net effect of these claim cost impacts produced a medical care ratio of 84.4% in the third quarter.
Looking ahead, we are actively managing overall medical costs and our MCR with the range of actions, including continuing to leverage our insights from our strong data and analytics capabilities to address key drivers and identify opportunities such as guiding customers to more effective and efficient sites of care, continued disciplined in our pricing and rate actions and we're also continuing to promote preventative care and access to behavioral services to provide meaningful support to patients and moderate overall medical costs over the longer-term.
Turning to membership, w ended the quarter with 17 million total medical customers, an increase of approximately 368,000 customers year-to-date.
In U.S. Medical, the year-to-date customer growth was driven by net growth in select and new markets within U.S. commercial and continued organic growth in Medicare Advantage and Individual within U.S. government.
In our international markets business, third quarter adjusted revenues were $1.6 billion and adjusted pre-tax earnings were $250 million.
These results were in line with our expectations.
Corporate and Other operations delivered a third quarter adjusted loss of $275 million.
Overall, Cigna's broad portfolio of services continues to serve the needs of our customers and clients.
Cigna remains committed to delivering value for all of our stakeholders, leveraging our well-positioned businesses.
Now turning to our updated outlook for full year 2021.
We are raising our adjusted earnings per share guidance for full-year 2021 to at least $20.35 per share, reflecting the strength of the quarter, the favorable impact of our year-to-date share repurchase and acknowledgment of the ongoing fluidity of the broader environment.
This represents earnings per share growth of at least 10% from 2020, consistent with our long-term earnings per share growth range of 10% to 13%, even with the ongoing challenges associated with COVID-19 and while having significantly increased our dividend in 2021.
As we look forward, it is clear that COVID-19 will continue to have an impact in the fourth quarter and in 2022.
And as time progresses, COVID-related impacts and the ongoing performance of the business are becoming more intertwined.
Therefore, we no longer believe it constructive to continue to quantify the impact of COVID-19.
These dynamics are fully contemplated in our 2021 expectation for adjusted earnings per share of at least $20.35 and our 2022 expectation for earnings per share growth of at least 10% off this 2021 guidance.
We now expect full-year 2021 consolidated adjusted revenues of at least one $172 billion, representing growth of at least 11% from 2020, when adjusting for the divestiture of our Group Disability and Life business.
I would note this revenue growth rate significantly exceeds our projected long-term average annual growth goal of 6% to 8% and represents a third consecutive year of significant revenue outperformance since our combination with Express Scripts in late 2018.
I will now discuss our 2021 outlook for our segments.
For Evernorth, we continue to expect full-year 2021 adjusted earnings of at least $5.8 billion, representing growth of at least 8% over 2020, reflecting the significant value we create for our customers and clients.
For U.S. Medical, we continue to expect full-year 2021 adjusted earnings of at least $3.5 billion.
Underlying this updated outlook, we now expect the 2021 medical care ratio to be in the range of 84% to 84.5%, which includes our expectations for elevated medical costs for Individual special enrollment period customers.
Regarding total medical customers, we continue to expect 2021 growth of at least 350,000 customers.
Now, moving to our 2021 capital management position and outlook.
We expect our businesses to continue to drive strong cash flows and returns on capital even as we continue reinvesting to support long-term growth and innovation.
For full-year 2021, we continue to expect at least $7.5 billion of cash flow from operations, reflecting the strong capital efficiency of our well-performing businesses.
Year-to-date, as of November 3, 2021, we have repurchased 26.5 million shares for $6.3 billion and we now expect full-year 2021 weighted average shares of approximately 342 million shares.
This includes the impact of the $2 billion accelerated share repurchase that we announced in the third quarter.
On October 27th, we declared a $1 per share dividend payable on December 22nd to shareholders of record as of December 7th.
Our balance sheet and cash flow outlook remains, benefiting from our highly efficient service-based orientation that drives strategic flexibility, strong margins and attractive returns on capital.
So now to recap.
Results in the third quarter reflect strong top and bottom line growth with solid contributions across our businesses.
Cigna has shown the ability to deliver value through dynamic environments with our breadth of businesses and multiple earnings levers we continue to support our customers, clients and coworkers and deliver on our financial commitments.
We now expect 2021 full-year adjusted earnings of at least $20.35 per share, representing growth of at least 10% from 2020 consistent with our long-term earnings per share growth rate range of 10% to 13%, and we expect to grow 2022 adjusted earnings per share at least 10% off our raised 2021 guidance.

user
cigna sees ‍​fy 2021 adjusted rev to be at least $172 bln.
‍​qtrly earnings per share $4.80; qtrly adjusted earnings per share $5.73.
sees ‍​fy 2021 adjusted revenues to be at least $172 billion; sees fy 2021 consolidated adjusted income from operations at least $6.96 billion.
‍​adjusted income from operations for 2021 is now projected to be at least $20.35 per share.
‍​medical care ratio of 84.4% for q3 2021 compares to 82.6% for q3 2020.
sees ‍​fy 2021 medical care ratio of 84.0% to 84.5%.

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