Lance Glinn:

Welcome in to another episode of the Inside the ICE House podcast. Today we are joined by Brian Evanko, president and COO of The Cigna Group. Brian, thanks so much for joining us Inside the ICE House.

Brian Evanko:

Thanks for hosting us, Lance.

Lance Glinn:

So, Brian, I want to start on a topic that I think is most prominent with consumers of all kinds these days, and that's affordability. You've said in the past that affordability is the number one challenge in our healthcare system. And frankly, that's kind of hard to argue with right now. Healthcare spending in the US has recently been hovering around 17 to 18% of GDP among the highest in the world. A stat like that, I think, really underscores how complex this issue of affordability is. But from your perspective, just first and foremost, as we get the conversation started, what does that stat, what does this affordability issue tell you about where the system stands today?

Brian Evanko:

Yeah, I appreciate the question, Lance. Affordability is far and away the number one challenge we have in the American healthcare system right now. And it's been building over a long period of time. I like to think of it in two frames, demand and supply.

So basic economic principles here, but apply them to the healthcare system. When you think about demand for healthcare services in the US, there are a few forces really driving that upward. So one is the aging of the population. This has been a long-term secular trend in America. That creates more and more demand for healthcare services. Secondly, we've got more and more chronic diseases across the US. So right now, if you look at all the spend in American healthcare, about 85% of it is attached to chronic diseases. And that's becoming a greater burden between aging, behavioral dynamics, et cetera, here in the US.

On top of that, we've got a culture that essentially wants healthcare on demand. America's a little different than most countries. Many other countries ration healthcare or they have waiting lists for healthcare. We don't really have that in the US. If you want healthcare, you get healthcare. So all those forces create insatiable demand for services. Then on the supply side, and when I say, "Supply," here, I'm talking about hospitals, doctors, drug companies, device manufacturers.

Lance Glinn:

Those who provide the healthcare.

Brian Evanko:

Yeah. Everyone that's providing or rendering the care that the demand side is consuming. So on the supply side, what you've got is new supply coming online constantly, but at very high prices. So as an example, drug innovation, it's been a great thing for America for a long time. New drugs coming to market, sometimes curing diseases that weren't curable before. But the average cost of new drugs is really high. So last year, the median list price of a new drug was $370,000 in the US. That stat is startling-

Lance Glinn:

Insane, yeah.

Brian Evanko:

... isn't it? So new drugs come to market, but at really high prices. Similarly, device manufacturers, new scanners, new imaging techniques. Those are constantly being brought to market, but at higher prices than the old equipment. And they get consumed by doctors, hospitals, physician groups. And as a result of that, they're using those. That adds cost to the supply side. And then you've got other dynamics like consolidation in hospitals and health systems. So acquisitions. Typically, what happens is hospital or health system buys another one and then raises the price after the acquisition's done. And so that adds cost to the supply side.

So when you put those forces together, demand growing, supply, pricing going up, the combination of that is driving the affordability challenge that we have right now. And so what we try to do at The Cigna Group is find ways to mitigate those forces and try to keep costs down by putting the customer at the center of all of it. But it's a real challenge because of the complexity of all those forces working together.

Lance Glinn:

And so you have all these forces, right? You said the supply and demand. Would you say just overall the system as it stands today is just under really an incredible amount of pressure?

Brian Evanko:

Well, right now, when you look at the combined forces I just described between demand and supply, it's creating rates of growth annually that are near all time highs. So we're seeing '23, '24, '25, '26 being really high cost trend years in terms of the year-over-year growth in the healthcare system, which leads to the need for new solutions and new approaches. And a lot of that comes back to how do you get customers front and center, taking more control of their health to drive to better, more affordable outcomes.

Lance Glinn:

And so where do you see the biggest opportunities for improvement? Is it how we pay for care? Is it how it's delivered? Is it maybe how we manage conditions before they become that level of catastrophe? Where do you see the biggest improvements that could happen to take some of that pressure off of the system and ultimately bring down costs?

Brian Evanko:

If I were to highlight maybe just a few to keep it simple.

Lance Glinn:

Sure. Because I'm sure we could do a whole podcast, just that question alone.

Brian Evanko:

So take prescription drugs. That's a good example of one. So if you look at all the prescriptions in America, about 90% of those are generics. And in the US, we actually have better pricing on generics than the rest of the world. Most people don't realize that. They think that drug costs are high for everything, but 90% of all the prescriptions are generics. We have better pricing than almost every other country. And that's because of competitive forces over long periods of time that have driven that.

But the 10% that are brand drugs, America pays way more than the rest of the world on that 10%. So if we can find ways to reduce that 10% in terms of the cost structure of that, or moving those drugs to generics or biosimilars, it brings tremendous affordability benefits. So an example of that last year, Humira, which is a very popular anti-inflammatory drug, biosimilars were available for the first time. We introduced a $0 patient out of pocket and it saves $200 million for the patients we cover just in the year or two since that's been available. So that's an example of one where if we can shift the volume from the high cost brand drugs over into the much more affordable generics and biosimilars, it's a real win for everyone except for the drug company that had the brand originally.

So that's an example of something we're working constructively with the administration on as well is how do we drive more volume into these more cost-effective prescription drug solutions. And then a second area is exactly where you started with your question of our system is really a sick care system today, meaning most of healthcare is reactive in nature. Once you get sick, once you have a problem, it gets fixed. Whether that's with a prescription drug, whether that's with a hospital intervention, but we need more and more upstream intervention, whether that's behavioral activity, whether that's better diagnostics and preventive care, whether that's diet and exercise, we need much more of that over time to influence the downstream costs that are so prevalent today. So those are two examples of areas that we're very focused on, driving more affordable prescription drugs, and then also making sure that we get more involved upstream and help our customers and patients be healthier.

Lance Glinn:

Now I do want to focus a little bit on Cigna as a whole, operates obviously in a very highly competitive healthcare industry, an industry that I'm sure you know could often feel overwhelming for consumers at times. From your perspective though, what truly sets Cigna apart from other players in the industry and makes it a preferred global health company for millions of consumers?

Brian Evanko:

Yeah, so we serve over a hundred million individuals around the world and have three growth platforms be the way to think of us. So in our services business, we have a scaled specialty pharmacy. So here, think of clinically intensive, high cost interventions required. We serve about a million people around the US with really complicated prescription drug needs through our specialty pharmacy. That's about 30% of our company.

We also have pharmacy benefit services business where we serve about a hundred million people and provide them with prescription drug access, the vast majority of which are the generics that I talked about earlier in our conversation. That's about 30% of our company. And then in our Cigna Healthcare business, which is our health benefits, so here you can think of health insurance, you can think of self-funded plans for employers. That's about 40% of the company. There we provide comprehensive packages, so your typical medical plan designs along with prescription drugs and mental health services and that sort of a thing.

So what sets us apart though to get to the core of your question is our focus on the individual. So we always start customer first, patient first, and then work back from that to say, "What's the business model that we need to wrap around that?" And good example of that's in our pharmacy benefit services business where we were the first to bring a $25 cap on insulin monthly through our patient assurance program. I made reference to the $0 out of pocket for Humira biosimilars. We had a $0 Stelara biosimilar brought to market this year. Another example of that where we're trying to put the patient first and then work backward into the business model that wraps around that.

And then more recently in October, we introduced the first rebate-free pharmacy benefit services model in the US. So what that's meant to do is put the patient at the center by saying, "The patient will always get the best possible price," and then work back from that to say, "What does it mean for the way we engage with pharmacies in our network? What does it mean for the way we engage with employers? What does it mean for the way that we engage with the drug companies?" But all of that was centered around the customer or the patient first because we think it's critically important to build that trust and be a real advocate and a partner to them in their healthcare journey, given the complexity of the system, because the system is not working for everyone. It works for a lot of people, but it's not working for everyone.

Lance Glinn:

And we're going to talk about that pharmacy benefit model just a little bit later in our conversation. Now healthcare today, like industries across the business landscape, as I'm sure you know, has transformed from what it was even just five years ago. It's completely different for a number of reasons, right? Technology, consumer expectations, right? Things like convenience, transparency, efficiencies. Those are things that people want at a... I mean, they've always wanted it, but they want it now at a much greater scale. And there are technology pieces that allow it to come at much greater scale now than say, "Five years ago." But how is Cigna adapting again over the last, let's use that five years to meet those rising and often ever evolving expectations from consumers because they've changed over the last five years, they're going to change over the next five years. How does Cigna adapt to meet them?

Brian Evanko:

Yeah. It comes back to what we were just talking about in terms of putting the customer or the patient at the center. The modalities with which people want to actually engage the healthcare system, they vary quite a bit. So some people really prefer face-to-face interactions with their doctor. They want to call into our contact centers and talk to someone. Other people don't want anything to do with that, and they want to do everything digitally and virtually. And so we have the capabilities to do any of those, but making sure we understand at an individual level how we personalize services for people is extraordinarily important to the future.

And we've been investing significantly in data, advanced analytics and AI capabilities because we see the winners and losers in the healthcare system being separated over time by who's really good at doing that. Who's really good at personalizing making it relevant for Lance as opposed to Brian because we're going to need different things. And so at the end of the day, investments we're making are designed to really put the customer or the patient first and in the center and then work backward to our business model.

Lance Glinn:

I mentioned transparency. I mentioned affordability in the first few questions. And in late 2025, Evernorth, the Health Services Division of Cigna announced the rebate-free pharmacy benefit model that we obviously just mentioned that addresses, among other things, that transparency and that affordability. You spoke a little bit to how it differs from previous models, but I guess my question is, what inspired this change? Why now to introduce something like this and bring it to the consumer?

Brian Evanko:

There were a few things that drove this, Lance. So first of all, again, starting with the patient, so we have across our entire Evernorth pharmacy benefit services business, about 80% of our patients have $250 or less per year of out of pocket spending. So I would argue that's working for that 80%, but the other 20% have greater than $250 per year, and some of them have thousands of dollars out of pocket. And one of the challenges with that is if you're in a high deductible plan, you're often exposed to the list price that their drug company set, which is really high, as opposed to the negotiated discount price that we're able to essentially secure for the balance of our book of business.

And so for certain patients, they end up paying a higher out of pocket than what we actually are able to negotiate if they were in a copay oriented style plan. And so what this model does is it says, "The patient will never pay more than our best price that we're able to negotiate with the drug company for the drug." And so it puts the patient first and again, works back from that and it gets rid of rebates altogether because rebates have become a term that no one likes to talk about here in American healthcare. But we're stepping over all of that and saying, "You know what? At the end of the day, what patients want is the best possible price. They want transparency in their healthcare. They want to be able to understand where the dollars are going." And our employers who are often paying for the majority of the healthcare bill wants something simple, predictable. And this model allows them to have a monthly fee that's very simple to understand. It doesn't have variability and it's just a fixed fee.

So it's simple for the patient because they get the best possible price. It's simple for the employer because they have a fixed monthly fee. And the other thing that's important here is the network side of the solution, meaning all of the pharmacies, they get paid on acquisition cost, plus a fee depending on how complicated the prescription is. And so it's really putting, again, the patient first and then working backwards to what our business model needs to be across all the different stakeholders that are in this solution.

Lance Glinn:

You noted earlier in our conversation that the brand name drugs, they really only make up about 10% of prescriptions, but account for almost what, 90%, close to that of actual spending. How does this rebate free model specifically address that drastic imbalance? Because it is a drastic imbalance and really make those high cost medications a lot more accessible to consumers.

Brian Evanko:

Yeah, you're exactly right. So the last stat I saw was 10% of all the prescriptions are branded. It's 88% of the dollars.

Lance Glinn:

Wow, that's crazy.

Brian Evanko:

So that's where all the money is. And that's where the battleground has been between pharmacy benefit services companies like us and the drug companies that are manufacturing the drugs on those because that's where they make all their money. The drug companies are making all their money in that space, and you see it with direct to consumer advertising, right? The average American watches 16 hours of-

Lance Glinn:

You see them all the time.

Brian Evanko:

... drug company advertising.

Lance Glinn:

All the time. No matter what you're watching too, they're popping up all the time.

Brian Evanko:

And that's 16 hours a year is watching those commercials, more time than they spend with their doctor on average. So you kind of stop and think about that. So what our pharmacy benefit services rebate free model that we were referencing earlier is seeking to do is to drive knowledge to the patient to get them the most affordable solution for their specific situation. So oftentimes what the brand drug companies are trying to do is protect against the patients moving to a cheaper alternative because it's in their best interest to keep them in the higher cost one. And so this model is designed to provide transparency to individuals. So you can have a much more cheaper clinically equivalent solution over here in a generic or a biosimilar or sometimes even a brand drug that's basically providing the same clinical efficacy, but it's cheaper. So that's part of the solution here is to try to tackle that challenge.

Lance Glinn:

And you mentioned in a previous answer too about the impact it has on sort of local pharmacies. And local pharmacies are often really the first point of care for a lot of people. Sometimes they're the point of care that people frequent the most, right? Going every few weeks, every couple months to obviously refill prescriptions, so on and so forth. How does this, and you sort of touched on it a couple questions ago, but if you could dive a little bit further, how does this new approach really help these pharmacies thrive while still obviously improving patient care?

Brian Evanko:

Yeah. It's a big challenge, especially in rural America where there may only be one pharmacy for 10, 20, 30 miles, a lot different than sitting here in New York where there's-

Lance Glinn:

Where there's every single corner.

Brian Evanko:

But in much of America, that is the challenge. And oftentimes those pharmacies are struggling with their own economics to stay afloat. And so what this model does is it says, "We will pay you the acquisition cost for you to secure the drugs as the local pharmacy, plus you'll get a fee that will vary depending on the clinical complexity of the drug." So if it's a low cost, simple, generic, a pill form like the one I take for maintenance every day, they'll get the acquisition cost of that plus a small fee just for the service of dispensing it and making sure that it's clinically appropriate.

If it's a much more complicated drug that gets dispensed where they have to spend time with the patient, making sure that it's being administered properly, or if it's a self-injectable where they have to make sure that it's getting injected at the right time and all that sort of thing, then they'll get a higher fee on top of the acquisition cost. But that's designed to make sure that those pharmacies can essentially thrive and stay engaged with our patients and make sure that they are not losing money on the prescription drugs that they're dispensing on our behalf.

Lance Glinn:

So we talked about this pharmacy benefit model, but in May of last year, Evernorth addressed the high price of GLP-1s, which are of course in the news and have been for the last few years by launching a new benefit option to limit patient monthly costs to no more than $200 for the medications, for no more than $200 a month for the medications. Affordability. Look, we talked about only one piece of the puzzle, a big piece of the puzzle, but only one piece of the puzzle, but things like choice and consistency obviously matter too. How is Cigna making the GLP-1 experience simpler and more transparent for patients, allowing those who want them to have more convenient access to them?

Brian Evanko:

Yeah. So there's a few different things we're doing in the GLP-1 space. And I think this is indicative of broader trends in prescription drug space. It's just, to your point, it's kind of captured the public's attention because of the impact it's having.

Lance Glinn:

And there's so many-

Brian Evanko:

Yes, and they're now-

Lance Glinn:

... popping all over again.

Brian Evanko:

... so many, right? And so you've got the injectables, now we have tablets that are starting to become approved by the FDA, which is a good thing because over time in the drug space, more competition leads to lower net costs, which it's beneficial for patients. And so the list prices on these drugs that the drug companies set oftentimes are really high. So typically $1,000 a month, maybe even more, which if you think about that, it's not affordable for most Americans to be paying that sort of money.

And originally the GLP-1s were designed for diabetes, but what the FDA realizes they could be used for weight management, and that's what's really hit in the public over the last two to three years in particular. So we've been able to use the power of all the demand aggregation that I referenced to negotiate pretty good discounts from the drug companies off of those high list prices that I made reference to. And then to your point earlier this year, we introduced a program where it caps the monthly cost at $200 for individuals, which provides much greater access and availability to individuals because that's obviously a much more affordable price point than $1,000 or more per month. But importantly, we wrap all of that with clinical programs because part of the challenge is people will start taking the drugs and then they'll drop off after three months or six months and then the weight will come back. Or they'll micro dose, meaning they're not taking that recommended amount because they're trying to ration the pills over a period of time-

Lance Glinn:

Because they don't want to spend as much.

Brian Evanko:

Exactly. And on all those dynamics suboptimize the health outcomes that we're seeking. So we've put programs in place. One is called Encircle that's designed to ensure adherence to the right treatment protocol, and it's designed to make sure that diet and exercise are wrapped around it as well because part of the benefits here are long-lasting if you stay adherent to the protocol.

And importantly, all the drugs that we administer in GLP-1 space are FDA approved because you'd see sometimes on TV, compounded versions, which add to that complexity of the adherence challenge as well as whether people are actually taking the right dose of the right chemicals and that sort of thing. So all of our drugs are FDA approved. So there's a clinical safety component to our program that's really important that adds to the lifestyle aspect and ultimately helps people take the weight off, keep the weight off and get the benefits that these drugs are meant to deliver.

Lance Glinn:

So, Brian, you've spent decades at Cigna moving through different roles, different geographies, gaining a deep understanding of the business across the US and international waters as well. Healthcare. Look, we talked about it earlier. It's complex, constantly evolving. We just talked about GLP-1s. You said, "Originally for diabetes. Then the weight loss aspect came to play. People have to evolve on that." You've experienced really healthcare, the healthcare industry all over. How would you just describe your leadership philosophy now in guiding Cigna through the shifts that the industry undergoes, especially when it comes to balancing innovation, while balancing affordability, consumer trust, long-term sustainability, and all the other things that are sort of put together to make sure that the organization runs smoothly and effectively on a daily basis.

Brian Evanko:

Yeah, there's a lot in that question, Lance. But you're right, I've been at the company for 27 plus years. I've worked in all of our different businesses. I've lived in three different countries, saw healthcare systems all around the world, and we operate in over 30 countries around the world. There's no right healthcare system. I'll start there. So every country has its challenges with healthcare. So as much as we criticize the American system, every country has challenges. But one thing that's for sure here, and this applies, whether it's my career, whether it's to our business, is you can't accept the status quo. You have to be willing to self-disrupt. You have to be willing to take a risk and lead in the market.

And again, in my career, that's taking career risks and roles that maybe I don't know how they're going to go. In our business, it's things like the pharmacy benefit services model we introduced in October. That's a risk because not every employer may want that model. So those are risks that we're introducing. We're not sure exactly how everything will play out, but you have to take calculated risks. And in the American healthcare system, we can't accept the status quo. We have to drive change and disruption, even if we're not exactly sure what that looks like. And so as long as it's pointed in the right direction, as long as the probability is on your side, then you want to go. And so I think taking those calculated risks is something that I believe is extremely important and our company also does.

Lance Glinn:

And so when you talk about needing to take calculated risks, needing to adapt to change, needing to transform, as the industry transforms, what's your approach to leading a team through that transformation? Because it's one thing for you to make a decision on your career, take a job that you're not really sure how it's going to go, but you could see the path towards even greater success if you do it. But when you're leading a team, a bunch of group of people to also take that transformation with you and to take that jump with you, what's that process like in rallying the troops essentially and making sure that everyone's on the same page and still aligned on the ultimate bigger goal?

Brian Evanko:

Yeah. It's a great question. It's really important too, especially when you have a large organization like ours. So a couple things I'd point to. One is the importance of clarity of the mission and the clarity of the vision that you're trying to cast for the organization.

So I started earlier with an answer talking about putting the patient first, customer first. That's a rallying cry for our organization. So even though we serve many employers, we serve many health plans, we serve many government agencies, those ultimately are intermediaries to the patient and the individual. So our organization is squarely focused on making sure that healthcare experiences for individuals are as strong as possible, as transparent as possible, and drive satisfaction to the degree that we seek to.

So at the end of the day, starting with that as the anchor point, people can rally around that, and you can envision what I can do in my job to help make that happen. And so that's been a really important part for us is having the mission orientation because everyone that works for us that comes in, they want to know they're doing something that's helping, that's improving healthcare, not protecting the status quo, not making things worse for people. So that's really important.

The second thing is authenticity of leadership. So I know I don't have all the answers and being vulnerable with people and not to the point where they're losing confidence in me, but having the authenticity to say, "I'm not sure how this is all going to go, but here are the things I do know." So having a little bit of a I know this, I believe this, I don't know this framework oftentimes helps people, and they want to follow as a result of that. So those are a couple things that I've found that have worked over the years.

Lance Glinn:

And I think you'd agree with me, nothing has really brought more widespread change across industries, not just healthcare, but across industries and the broader business landscape than AI, and I can assume it's impacted the healthcare industry just as much. Broadly first, to start on that topic, where do you see AI having the biggest immediate impact for a company like Cigna?

Brian Evanko:

Yeah. So we're embracing AI and moving quickly relative to the power it can have on the healthcare system because we see it as there's the internet, there are mobile phones, now there's AI. There's AI. It's that big the way we see it. But in the healthcare space, you have to be really thoughtful about clinical applications because especially Generative AI, we still does hallucinate in some instances, and we can't have the risk of a bad clinical outcome as a result of that.

So we're going at a very measured pace for clinical applications. We're going at a very fast pace for things that are more back office in nature. So take our contact centers, we've been able to actually remove a lot of calls that historically would have come in by using AI upstream, getting people answers through our virtual AI assistants and our chatbots and that sort of thing.

Lance Glinn:

Different agent sources.

Brian Evanko:

Yeah, exactly. Yeah. So that's helped to take calls out of the system. We've been able to now get better first call resolution because when our agents are on the phone with an individual, they can get answers much more rapidly with AI tools that we put in an agentic fashion. So that sort of thing has helped quite a bit to take cost out of the back office. It's also helped us with risk prediction. So we've been able to now more accurately forecast who will have high costs next year. And as a result of that, we can use it for not only underwriting, but we can also use it to get our doctors and nurses engaged with those people before the situation starts to become really acute in terms of their healthcare. So those are examples of ways that we're using it. And then in the clinical domain over time, we see it as really helping to provide that personalized medicine solution that I was making reference to earlier.

And then other companies, the healthcare system obviously are using AI as well for the benefit of patients. So I see this as a big part of the breakthrough to make healthcare more personalized and more relevant for each and every American.

Lance Glinn:

And what do you see as the right balance between that automation and human touch? Because I think that's a question that has really impacted a lot of the leaders that I talk to across industries. It's you obviously want to inject AI of some sort into your organization, but you also need to understand that sometimes people don't want to talk to AI. They want to talk to a real person, or sometimes people want to have the assurance that a real person is looking after their information or looking after a question that they ask. So where do you see that good balance between automation and human touch?

Brian Evanko:

Yeah, you're exactly right. In the healthcare system, it'll never be 100% digital. There's just too many things that need to happen on a face-to-face basis. So as an example, in our specialty pharmacy I referenced earlier, we have 600 home infusion nurses that go into people's homes and assist them when they infuse drugs into their bodies because they have complicated clinical situations. So that's an example of one where you can't digitize-

Lance Glinn:

AI can't do that. Nope.

Brian Evanko:

Yeah, it can't do that. And you've got other situations where surgeries need to happen at hospitals and things like that. So for that reason, we're trying to digitize things that people want to have digitized, but also keep the other things the way that they should be in terms of face-to-face interaction. And as I said earlier, there are some people that actually don't want a digital experience, even if it could be made digital and-

Lance Glinn:

They just want the tried and true face-to-face method.

Brian Evanko:

Exactly. So we're going to have all those modalities available, but it kind of starts with what could be before what should be as you think about digital AI versus traditional face-to-face.

Lance Glinn:

And look, personalization, you mentioned in a previous answer, personalization requires data, data requires trust at the end of the day. How is Cigna addressing privacy concerns while also using AI to deliver that more personalized care that you spoke to a few questions ago, right? Customers obviously want to feel confident their information is secure. How does Cigna ensure that to be the case?

Brian Evanko:

Yeah. I mean, we have a very large organization that's focused on information protection, and not just from a cyber standpoint, but from a privacy standpoint, because healthcare is one of the most personal things in anyone's life. So as a result of that, we take that extraordinarily seriously. And to your point, make sure that the data that we have on an individual isn't shared with other parties without the consent of the individual. So that's something that we take very seriously, but it's a critical part of making those experiences more personalized over time is having longitudinal data on an individual. And so the more of that we can get, the better. So we're also making investments and connecting data from providers to patients to the health plans as well to make sure that that information can flow, because oftentimes people will change doctors and sometimes the medical records don't actually move. And as a result of that, you end up with suboptimal situations. So we're making investments and trying to connect those pipes, but in a way that's not breaching privacy.

Lance Glinn:

Absolutely. So, Brian, as we come towards the end of our conversation, I want to focus on the future in our last couple of questions. So as we record here in January, with 2026 obviously still young, pretty much the full year still ahead of us at this point, what does success look like for Cigna over the next 11 or so months?

Brian Evanko:

First and foremost, it's the continuation of the journey we've been on to improve the customer and patient experience. So we made a series of commitments right around a year ago. We called them our commitments to better. So we stepped out from the industry and said, "We've been listening hard to what's happening in the environment, and we know we need to make the healthcare system better, better access, better affordability, more transparency of information."

And so we introduced a series of commitments in both our Cigna healthcare business and our Evernorth business that were designed to say, "We're going to do these things to make the healthcare system better voluntarily." And we spent over a hundred million dollars last year bringing those commitments to life. Additionally, working in partnership with the President Trump administration have been able to have a nice public private partnership emerge. So in June of last year, we introduced a series of commitments to make the prior authorization process work better in combination with the Department of Health and Human Services.

And then in September, we introduced a partnership with a drug manufacturer called EMD Serono to bring fertility medicines to the US at a lower price. So again, putting the patient first in all of these to make the healthcare system better. And I would expect '26, 2026, we'll have a series of similar things that we do to introduce to make the healthcare system work better for individuals. So I start there as opposed to saying, "Financial results or anything along the lines of that," because if we make the healthcare system work better for people, ultimately the financials will follow, the shareholder value will follow, but we're very focused on that first and foremost here in 2026.

Lance Glinn:

And look, over the years, we've obviously seen Cigna grow. And when you think about the next chapter, when you think five years from now, or I guess now four years from now, when we're talking again in 2030, what will success look like for the company? What does Cigna's next chapter look like?

Brian Evanko:

We'll continue to invest in our core businesses, but first and foremost, around the customer and around the patients. So I believe we'll get to a point where we're not only known for providing good prices, good administration, and good clinical programs, but we're also known for having a differentiated customer and patient experience. That's, I think, the next leg for us because I don't think if you ask today, everyone would say that.

Lance Glinn:

Sure.

Brian Evanko:

They would say, "We have good pricing relative to the competitors." They would say, "We have great clinical programs." They would say, "We administer benefits fine," but having a differentiated customer experience I think is the next chapter for our company. And I look forward to talking about that with you when it happens.

Lance Glinn:

Well, Brian, I appreciate the conversation today. I appreciate all that you and that The Cigna Group are doing for patients and customers. Thanks so much for joining us Inside the ICE House.

Brian Evanko:

Thank you, Lance. I enjoyed it.