Regulatory Scrutiny and Compliance: Cigna operates in a highly regulated industry, and changes in healthcare laws, policies, or increased enforcement by government agencies could negatively impact its operations, profitability, and business model.

Rising Healthcare Costs: Escalating medical and pharmacy costs, including new drug therapies and advanced medical technologies, could outpace Cigna's ability to manage or price its products effectively, leading to reduced margins and financial performance.

Intense Competition: The healthcare and insurance markets are highly competitive, with numerous players including other large insurers, PBMs, and new entrants. This competition could lead to pricing pressures, loss of market share, and increased spending on customer acquisition and retention.