Cigna primarily provides pharmacy benefit management and health insurance services. Its PBM and specialty pharmacy services, which were greatly expanded by its 2018 merger with Express Scripts, are mostly sold to health insurance plans and employers. Its largest PBM contract is with the Department of Defense, and it recently won a multiyear deal with top-tier insurer Centene. In health insurance and other benefits, Cigna primarily serves employers through self-funding arrangements, and the company operates mostly in the US with 16 million US and 2 million international medical members covered as of December 2025.