Hello, and welcome to the annual meeting of shareholders of The Cigna Group. Please note that today's meeting is being recorded by Broadridge. Recording of this meeting by any other person is strictly prohibited. After the formal adjournment of the meeting, there will be a question and answer session. It is now my pleasure to turn the meeting over to Mr. David Cordani, Chair and CEO of The Cigna Group.
Hello, everyone. Welcome to the Cigna Group's 2026 annual shareholder meeting. I'm David Cordani, Chair and CEO of the Cigna Group, and I'm pleased to be joined by our Board of Directors and our Enterprise Leadership Team. Today, I'll highlight our 2025 performance as we continue to deliver for our customers, patients, clients, and partners, and how we are intensifying our effort to help build a more sustainable and affordable healthcare model. Following my brief remarks, along with our Corporate Secretary, Andrea Nelson, we will conduct our formal meeting. I'll begin by reviewing our business and financial performance. In a dynamic 2025, the Cigna Group once again delivered on our performance track record while taking important steps to further prioritize the need of our customers and those patients we serve. In 2025, our company grew full-year total revenue to $275 billion, an increase of 11% year-over-year.
We achieved shareholders net income of $6 billion or $22.18 per share, and adjusted income from operations of $8 billion or $29.84 per share. We generated cash flow from operations of $9.8 billion, and we returned $5.2 billion to shareholders through dividends and share repurchase. We also took steps to further strengthen The Cigna Group by sharpening our company's focus on core services in our health benefit platform. Two examples from 2025 include our $3.5 billion investment in Shields Health Solutions to better serve the rapidly expanding number of individuals living with complex and chronic conditions, and completing the sale of our Medicare business for $4.9 billion to Health Care Service Corporation. We remain confident in the growth opportunities ahead, supported by our strong fundamentals and continued focus on our core health service and benefits platforms.
At the Cigna Group, we recognize that healthcare affordability affects everyone, including individuals, families, employers, and governmental organizations. We are steadfast in our focus on improving affordability and expanding access to high-quality care. Doing so requires confronting the underlying cost drivers of healthcare, including both demand and supply. Demand is growing rapidly as the population ages and instances of chronic disease continue to increase. Today, chronic disease and mental health conditions combined account for approximately 90% of healthcare spending in the United States. On the supply side, hospitals and drug companies and other organizations are delivering significant innovations. However, since 2000, for example, the cost of a hospital stay has increased more than 220%, and the median price of a new prescription drug in 2025 was approximately $390,000. This is up from about $2,000 just less than 20 years ago.
At the Cigna Group, we are working to serve as a counterweight to these pressures by innovating to improve affordability, expanding access to preventative care, and coordinating services around individual patient needs. In October, we became the first to introduce a rebate-free pharmacy benefit model as an alternative to the more complex post-purchase rebate process. This model creates greater affordability for people right at the pharmacy counter, saving them more than 30% on brand name drugs. We also continued to drive affordability in 2025 by leveraging competition and including the use of generic medications and increasingly biosimilars. For example, in 2025, we accelerated the adoption of biosimilars by offering a $0 out-of-pocket option for both Humira and Stelara biosimilars, saving patients thousands of dollars.
You can learn more about our efforts to make healthcare more affordable in our recently published Customer Transparency Report, which is available on the Cigna Group website. This report details our 2025 progress against each of the five public commitments to better we established last year. Create easier access to care, deliver better support for our customers and patients, provide better value, drive greater accountability, and expand transparency around the work we do. Our commitment to better extends to embracing our larger societal role as well. Over the past year, our colleagues stepped up in many ways to prioritize purpose along with our company's performance. For example, JUST Capital and CNBC once again ranked The Cigna Group number 1 among healthcare companies in their annual list of America's most just companies.
In conjunction with the Business Roundtable, we convened business and healthcare leaders to discuss strategies of addressing mental health issues and challenges, as well as opportunities amongst America's workforce. In addition, our colleagues volunteered nearly 114,000 hours across the globe. This represents an approximate 30% increase in volunteerism compared to 2024. Looking ahead, we know that meeting the highly personalized needs of our customers and patients requires an even more direct, personalized approach, a focus we now embed across our entire organization. We refer to this as our lead to one, which calls on our colleagues to lead the charge for better healthcare by focusing on the unique needs of our customers and patients, one person at a time.
The work our company has done over the past several years positions us with strengths and momentum to strategically and operationally, as well as financially deliver on our mission, which also made 2026 a natural point to identify the next CEO to lead The Cigna Group forward. As we announced in March, I will retire as the Chief Executive Officer of The Cigna Group effective July 1, and step into the role of Executive Chair. I will be succeeded as CEO by our current President and Chief Operating Officer, Brian Evanko. Brian has nearly 30 years of tenure with The Cigna Group, and his extensive experience across multiple parts of our organization make him ideally suited to lead the next era of growth for The Cigna Group and our impact.
In a moment, we'll turn to the next part of our meeting, but before I do that, I want to express my appreciation to our entire team around the world. Everything we accomplish at The Cigna Group is made possible through the passion and commitment to those we serve. I also want to thank our shareholders. As always, we appreciate your engagement, and we thank you for choosing to invest in The Cigna Group.
Thank you, David. Now I'd like to welcome Andrea Nelson, the Cigna Group's Corporate Secretary, to join David to begin the formal portion of our meeting.
Posted on the meeting website is a copy of the agenda and rules of conduct and procedure for today's meeting. We ask that participants please abide by these rules. I will now ask the Corporate Secretary to establish that this meeting has been duly called, that a quorum has been established, and also review the protocol for today's meeting.
Thank you, Mr. Chair. First, I would like to remind everyone that recording of this meeting is strictly prohibited. Mr. Chris Woods, a representative of Broadridge Financial Solutions, has been duly appointed as the Inspector of Election to tabulate the vote for today's meeting. The Inspector of Election has signed the necessary oath of office. The Cigna Group also received certain affidavits of mailing establishing that notice of this meeting, along with the Cigna Group's proxy statement and annual report, were mailed or made available on or about March 13th, 2026. These were shared with shareholders of record of the Cigna Group as of the close of business on the record date of February 23rd, 2026. The affidavits of mailing will be incorporated into the minutes of this meeting.
All shareholders of record at the close of business on the record date are entitled to vote at this annual meeting. In addition, based upon information provided by the Inspector of Election, I confirm that a quorum is present today to conduct The Cigna Group's 2026 annual meeting of shareholders. A representative from PricewaterhouseCoopers LLP is also present today. There are four items of formal business for presentation at today's meeting. The polls have been opened. Following presentation of the proposals, we will ask shareholders to conclude voting, read the preliminary voting report, and adjourn the meeting. A question-and-answer period will take place following adjournment. If you have already submitted a proxy by mail, by telephone, or electronically, you do not need to do anything further unless you desire to change your vote. The polls will close immediately prior to the preliminary voting report.
We will now proceed with the four proposals set forth in the agenda, each of which was detailed in The Cigna Group's proxy statement for this annual meeting. Because no other notices were submitted within the advanced notice period in The Cigna Group's bylaws, no nominations or proposals other than those in the proxy statement will be presented at this meeting.
On the basis of the Corporate Secretary's report, the meeting is duly convened, and we will now turn to the proposals to be voted on today. The proposals and the voting thresholds required for approval of each proposal are described in the proxy statement. Ms. Nelson, will you please present the first item of business?
Mr. Chair, the first item of business is the election of 12 director nominees, David Cordani, Brian Evanko, Eric Foss, Neesha Hathi, Michael Hennigan, George Kurian, Kathleen Mazzarella, Mark McClellan, Philip Ozuah, Kimberly Ross, Eric Wiseman, and Donna Zarcone, all for one-year terms expiring at the next annual meeting of shareholders or until their successors have been duly elected and qualified.
Ms. Nelson, would you present the second item of business?
The second item of business is the approval of the advisory resolution on executive compensation.
Ms. Nelson, would you present the third item of business?
The third item of business is the ratification of the appointment of PricewaterhouseCoopers LLP as the company's independent registered public accounting firm for the fiscal year ending December 31st, 2026.
Ms. Nelson, would you please present the fourth item of business?
The next item is a shareholder proposal submitted by John Chevedden. The shareholder proposal and supporting statement are set forth in the company's proxy statement. I would like to now recognize John Chevedden for a period of three minutes to present the proposal. Operator, please open the line for Mr. Chevedden.
Hello, this is John Chevedden. Proposal 4, shareholder right to act by written consent. Shareholders request the Board of Directors take the necessary steps to prevent written consent by the shareholders entitled to cast the minimum number of votes that would be necessary to authorize an action at a meeting at which all shareholders entitled to vote thereon were present and voting without any discrimination or restriction based on length of stock ownership. The Cigna statement next to this proposal is low quality. It is based on deception and distraction. The deception element raises the question of whether Cigna could ever conduct a so-called robust shareholder outreach campaign, as claimed in its statement next to this proposal. The beginning of the Cigna statement deceptively claims that Cigna shareholders have a right for 25% of Cigna shares to call for a special shareholder meeting. However, there's a big, fat material admission.
Cigna fails to mention that a significant block of Cigna shares are completely disqualified from calling for a special shareholder meeting. Thus, it could take 40% of the Cigna shares left standing after Cigna's disqualification clause to call for a special shareholder meeting. Shame on Cigna for citing the 25% figure five times without ever mentioning the disqualification clause firmly attached to it. There's a substantial block of Cigna shares that are completely disqualified from being part of the 25% figure. Cigna's argument is further flawed. Proposal 4 does not ask shareholders to choose between the shareholder right to act by written consent and the shareholder right to call a special shareholder meeting.
Shareholders are best served when they have both rights, and Cigna's current shareholder right to call for a special shareholder meeting is so weak that it creates the added incentive for Cigna shareholders to have a right to act by written consent, the topic of this proposal. Shame on Cigna for suggesting that Cigna shareholders limit themselves to one shareholder right when Cigna shareholders are entitled to two shareholder rights under state law. Cigna does not understand the right to act by written consent. Written consent is a shareholder right that requires the formal backing of a Cigna majority based on all shares outstanding. This majority support requirement in reality is much more than majority support because it is not economically possible to contact a significant percent of Cigna shares to get their formal backing.
Thus, for an issue to still get majority support based on all shares outstanding, under written consent, it could need 70% support from the Cigna shares that are economically possible to reach. The Cigna shares that are economically possible to reach are the Cigna shares that are the most informed and have the greatest incentive to cast an informed ballot. Please vote yes, shareholder right to act by written consent, proposal four.
Thank you, Mr. Chevedden.
Mr. Chevedden, thank you for taking time to join our meeting today.
There were no other proposals submitted in advance of the meeting.
That concluds the matters to be voted on as outlined in the notice of the annual meeting. Because no other proposals were submitted within the advanced notice period as set forth by the bylaws, no other business matters will be presented at this meeting. Shareholders may vote by clicking the button titled Voting on the meeting website. The polls are about to close, so if you wish to vote and have not done so yet, please do so now. I'll pause momentarily. I hereby declare the polls closed. At this time, I request the corporate secretary to read the preliminary vote report.
The Inspector of Election has preliminarily determined that the 12 director nominees have been elected as directors for terms expiring at the next annual meeting of shareholders, or until their successors have been duly elected and qualified. The advisory resolution on executive compensation has been approved. The appointment of PricewaterhouseCoopers as the company's independent registered public accounting firm for 2026 has been ratified, and the shareholder proposal regarding right to act by written consent has not received the majority support. The final voting results for this meeting will be reported on a Form 8-K filed with the SEC within four business days of this meeting.
I declare the formal meeting portion of the 2026 annual meeting of shareholders adjourned. At this time, we will transition to the question and answer portion of the meeting.
Thank you, Mr. Cordani. No questions were submitted in advance of the meeting. We will respond to questions submitted during the meeting on the investor relations section of our website within 30 days of this meeting. I will now turn the meeting back to Mr. Cordani.
That concludes the question and answer portion and brings the meeting to a close. We thank you for taking time to join us today.
The meeting has now concluded. Thank you for joining, and have a pleasant day.