David Cordani
Chairman and Chief Executive Officer at The Cigna Group
Thanks Ralph. Good morning everyone and thank you for joining our call today. For the second quarter, we again delivered strong performance as we continue to build on our momentum. Today, I'll discuss our performance for the quarter and key strategic drivers of our growth, demonstrate how the strength and durable nature of our model is fueling our success. Then Brian will review additional details on our results and our outlook for the rest of the year, and we'll move to your questions. So, let's get started. For the second quarter, I'm pleased to report that Cigna Group delivered total revenue of $60.5 and adjusted earnings per share of $6.72.
We achieved these positive overall results in a dynamic environment and I'm proud of our team for continuing to focus on those we serve, ensuring that they get care they need, to get their medications at an affordable cost, and they get the support they need in order to make the best decisions about their health and vitality. All of this requires a relentless focus on innovation, disciplined execution, and a passionate commitment to our mission. During the quarter, our Evernorth Health Service businesses demonstrated continued strength with our market-leading specialty and pharmacy benefit services capabilities. Within Evernorth, I'll start with our accelerated growth specialty and care businesses, which provides specialty drugs for the treatment of complex and rare diseases, distribution of specialty pharmaceuticals as well as clinical programs to help clients improve health and vitality.
We saw strong growth in the quarter with adjusted income growing 12% year-over-year, reflecting continued demand for our services while we also continue to invest in broadening our offerings and expanding our reach. In Accredo, our specialty business, our growth continues to be fueled by secular tailwinds as well as Accredo's differentiated strength which makes us the market leader in the space. Biosimilars, for example, represent a force of change and a substantial opportunity for continued growth and impact. At the end of June, we began dispensing our interchangeable biosimilar for HUMIRA. Our program has $0 out-of-pocket cost for patients, saving them, on average, $3,500 per year. To deliver these savings, we have agreements in place with multiple manufacturers that will produce biosimilars for Evernorth pharmaceutical distributor, Quallent Pharmaceuticals.
Now the biosimilar opportunity goes well beyond HUMIRA. By 2030, we expect an additional $100 million of annual specialty drug spend in the US will be subject to biosimilar and generic competition. And Accredo is well subject to deliver differentiated value for our clients, customers and patients. In our care services businesses, we are continuing to grow and expand in key areas of increased demand, including behavioral health, virtual and home care. For example, the summer, we further expanded Evernorth behavioral care group to an additional seven states. We are seeing positive patient outcomes from our unique clinician matching capabilities based on individual needs and preferences with fully 84% of patients experiencing clinically significant reductions in the depression and anxiety symptoms.
Now shifting to Express Scripts, our foundational pharmacy benefit services businesses. We are seeing continued strong client demand given our breadth of clinical and supply chain expertise as well as our proven partnership orientation. This quarter, Express Scripts built on a long track record of innovating for those we serve with continued enhancements and new solutions. For example, given the high cost of GLP-1 drugs, we're continuing to continuing to see meaningful see meaningful interest from our clients in EnCircleRx, now with more than 2 million lives already enrolled. Our program starts with our longitudinal data to target patients who will most benefit from these medications and we will provide patients with resources to make lasting changes to help maximize the effectiveness of these medications, both in the short and long-term.
Another example of our innovation orientation is a recent announcement of Express Scripts oncology benefit services, which will be available in 2025. Our new solution helps patients navigate the challenges of cancer care by providing a single oncology benefit, integrating pharmacy, medical and behavioral health treatments. Our patient-centered approach will help to ensure the earliest possible detection guide individuals to high-quality providers and coordinate care across clinical teams. Now moving Cigna Healthcare, our health benefits platform, we continue to deliver solutions that create value to and better outcomes for clients and customers, coupled with highly competitive total cost of care. Similar to others in the industry and as we've anticipated, we are seeing increased utilization in our book of business. I would note that our results are largely in line with the elevated levels in our planning and pricing assumptions.
Our US Employer foundational growth business continues to perform in line with our expectations. Over this year, I've met with hundreds of clients across the US and globally. And while the needs of every client are unique, there are a few consistent themes across every discussion. First, continued focus on affordability, particularly in light medications like GLP-1 and gene therapies coming to market. Next, an increased need of improved access and importantly, coordination of behavioral health services. Third is mounting point solution fatigue. And fourth, the opportunity and need for leverage of our longitudinal data and clinical programs to help keep people healthy and vital.
Our solutions continue to resonate well given our highly consultative approach to help clients choose the right set clients, our proven capabilities to support their workforce and our innovative programs that help to keep costs down. As a result, we are further gaining share and continue to see outsized opportunities, for example, in our Select segment. Another capability of our US business to deliver integrated and tailored benefits for our clients and customers, our modular solutions that incorporate innovative services from Evernorth, including behavioral health, virtual care and pharmacy. Our Pathwell solution, which continues to drive exceptional value is a prime example. Pathwell specialty is another way we are reducing costs associated with specialty drug therapies while also providing improved care and clinical outcomes for patients.
With our Accredo nurses, nearly 50% of our Pathwell specialty patients who've transitioned their side of care now receive treatment in the comfort and convenience of their home. We are pleased with how the market continues to recognize the value we are delivering through solutions like Pathwell. Turning to our Medicare Advantage business, we continue to make great progress regarding the sale of this business, and I'm pleased that we remain on track to close in the first quarter of 2025 as planned. Next, I want to take a few minutes to talk about the current environment surrounding pharmacy benefit managers and the relative landscape. At the heart of this debate is the cost of pharmaceuticals.
As we previously discussed, a key force of change in healthcare is the surge of pharmacological innovation. For context, prescription drug coverage is the most frequently used care benefit, and on average, it's used 15 times per year per person, resulting in billions of prescriptions per year annually in the United States. Today, and for the foreseeable future, the most meaningful advances extending and improving quality of life will come through gene therapies, breakthrough and treatments for cancers and other conditions, as well as personalized medicines. In the US, for example, there are already more than 20 gene therapy and cell therapies available. However, there are nearly 1,000 more in the pipeline. Additionally, as we know, GLP-1s are growing rapidly, helping to treat diseases and complications that stem from obesity and diabetes.
This class of drug is on tap to be the number one pharmacy benefit trend driver for plans of all sizes this year. And the impact will grow, with some forecasting nearly 10% of the US population using GLP-1s in the next 10 years or sooner. The implications rippling from these fast-growing pharmaceutical trends across the entire healthcare system are undeniable. And one of the biggest unanswered questions is, how could society afford this continued trajectory? Our role is to negotiate with pharmaceutical manufacturers as well as pharmacies to ensure that individuals are able to access pharmacological innovations at a fair and affordable price. In fact, pharmacy benefit companies are the only part of the drug supply chain who work to drive costs down. To underscore this, new drugs coming to market with unsustainable prices in 2023, were up $300,000 on a median basis, up over 35% over 2022.
And last year, median brand drug price increases were greater than 5% more than the rate of inflation. Let me repeat this. Last year, the median annual price for new drugs coming to market was $300,000, up 35% over 2022. Meanwhile, in 2023, Express Scripts change in pace and cost sharing was relatively flat on average. Express Scripts' patients with employer-sponsored drug coverage pay, on average, $15 out-of-pocket for a 30-day supply. And for clients, Express Scripts delivered more than $38 billion in savings annually. Stepping back, our industry negotiations to drive these results can, at times, generate friction in the system. Friction that is spilled into and now has reached tightened levels in the political arena and media with industry winners and losers being declared at every report and every headline.
We believe that the facts and results and outcomes delivered to our clients, customers, and patients will rule the day. However, the environment calls on us to be more proactive. This means ensuring that what we do and the value we bring is more widely and better understood. And we continue to evolve our model to address legitimate pain points and opportunities. For example, in 2023, 1% of the patients in the United States experienced out-of-pocket costs above $2,000 a year. From our point of view, that's too many. We accept the responsibility to accelerate innovation to make medications more affordable, while continuing to improve health outcomes in finding solutions for every person we serve.
Make no doubt our team will continue to lean into the challenge for the benefit of our patients, clients, and the health care ecosystem and we are proud of the work that our team does every day and the role we play and the results we're able to achieve. Now, let me pause and summarize before transitioning to Brian. When you combine our compelling growth potential and strong execution focus, we have confidence in our ability to meet our 2024 and long-term growth targets. We have a proven track record of delivering differentiated value for those we serve by serve by innovating new solutions like EnCircleRx and our Pathwell suite as well as expanding meaningful partnerships.
As a result, in the second quarter, we delivered on our financial commitment with adjusted EPS of $6.72, and we remain on track to deliver our guidance for full year adjusted earnings per share of at least $28.40 for 2024. Further, our company has attractive sustainable growth opportunities over the long-term, and we remain on track to deliver average annual adjusted EPS growth of 10% 14% building on our track record of achieving 13% adjusted EPS growth over the last decade, all while we generate cumulative operating cash flow of $60 billion over the next five years, while continuing to meaningfully invest capital for the benefit of shareholders.
We also continue to make strategic investments in strengthening our capabilities in our foundational and accelerated growth business and remain focusing on harnessing the breadth of our capabilities of our organization to meet the evolving needs of those we serve. Overall, our strong performance through the first half of the year reflects the balance in our company portfolio and the significant value creation that positions us for sustained and differentiated growth.
With that, I'll turn it over to Brian.
