- Cigna skyrocketed up this year's Fortune 500 list to No. 13, up 52 spots from last year's report, the result of its merger with pharmacy benefit manager Express Scripts completed in late 2018.
- Fortune released its annual rankings based on the 2019 revenue of top-earning U.S. companies on Monday. Forty healthcare companies are in the top 500, about the same as the past few years.
- EHR vendor Cerner also made it on the list for the first time in its 40 years of operation. The Kansas City, Missouri-based company moved up 22 spots since last year's report to ring in at No. 498.
The 66th iteration of the Fortune 500 list once again illustrates the sheer size of the healthcare industry, a sector accounting for 18% of the nation's gross domestic product. Healthcare was only surpassed by the energy, financial and retail sectors in terms of number of companies on the list.
Cigna's rise illustrates the appeal of inorganic growth, and the trend of vertical integration among healthcare giants that has played out over the past few years. With the $67 billion acquisition finalized in December 2018, all major PBMs were combined with a payer, bringing the medical and pharmaceutical benefit in the same house in an attempt at greater cost savings.
The Express Scripts integration caused Cigna to surpass even its own internal expectations for revenue growth. The Bloomfield, Connecticut-based payer saw adjusted 2019 revenues of $140 billion, compared to its original predictions of $131 billion to $133 billion.
That's compared to Cigna's pre-Express Scripts yearly revenue of $49 billion in 2018.
All major U.S. commercial payers were in the top 50 of the list, except Humana, which came in at No. 52.
Fortune 500 healthcare companies
Providers have significantly lower revenue, and are correspondingly lower on the list than their payer counterparts. The hospital sector has dealt with strong headwinds over the past few years, including shrinking reimbursements and lower admissions.
Nashville-based hospital operator HCA Healthcare came in at No. 65, the highest health system on the list, followed by Tenet (No. 174), Community Health Systems (No. 241) and Universal Health Services (No. 281). That's about the same as last year's list.
Four healthcare companies are in the top 10 of the Fortune 500 list for 2020: payer, pharmacy benefit manager and retail pharmacy giant CVS Health; payer and health services behemoth UnitedHealth Group; pharmaceutical and medtech manufacturer McKesson; and drug wholesaler AmerisourceBergen. The four were in the top 10 last year as well, though in 2018 UnitedHealth and CVS were the only two healthcare companies among the top slots.