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Founded in 1974, BrightSpring Health Services provides home and community-based health services for patients in need of specialized or chronic care. Formerly known as Phoenix Parent Holdings, the company services over 400,000 people daily with home health care, hospice care, pharmacy therapy management, and more. BrightSpring Health Services also offers infused, injectable, and oral medication services and rehabilitation services, including physical, speech, and occupational therapy.

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BrightSpring Health Services (BTSG): Company Profile, Stock Price, News, Rankings

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BrightSpring Health Services

brightspring health services

Hello, and thank you for standing by. Welcome to BrightSpring Health Services, Inc. first quarter 2026 earnings conference call. I would now like to hand the conference over to David Deuchler. Please go ahead.

Good morning. Thank you for participating in today's conference call. My name is David Deuchler with Investor Relations at BrightSpring. I'm joined on today's call by Jon Rousseau, Chief Executive Officer, and Jen Phipps, Chief Financial Officer. Earlier today, BrightSpring released financial results for the quarter ended March 31st, 2026. A copy of the press release and presentation is available on the company's investor relations website. Please note that today's discussion will include certain forward-looking statements that reflect our current assumptions and expectations, including those related to our future financial performance and industry market conditions. Such forward-looking statements are not guarantees of future performance. These forward-looking statements are subject to risks and uncertainties that could cause actual results to differ materially from our expectations.

We encourage you to review the information in today's press release and presentation, as well as our quarterly report on Form 10-Q that will be filed with the SEC, including specific risk factors and uncertainties discussed in our Form 10-K and Form 10-Q. Such factors may be updated from time to time in our periodic filings with the SEC, and we do not undertake any duty to update any forward-looking statements except as required by law. During the call, we will use non-GAAP financial measures when talking about the company's financial performance and financial condition. You can find additional information on these non-GAAP measures and reconciliations of our non-GAAP financial measures to the most directly comparable GAAP financial measures to the extent available without unreasonable effort in today's earnings press release and presentation, which again, are available on our Investor Relations website.

This webcast is being recorded and will be available for replay on our Investor Relations website. With that, I will now turn the call over to Jon Rousseau, Chief Executive Officer.

Good morning, everyone, and thank you for joining BrightSpring's first quarter 2026 earnings call. I'd like to start by thanking everyone at BrightSpring who drives our mission forward and makes a lasting impact every day. We're grateful for their hard work and commitment, enabling us to deliver high quality and timely care to patients. Before we speak to first quarter performance, a few key messages and takeaways from our Investor Day in March and why we are optimistic about the company's prospects in the years ahead. BrightSpring is a national leader in home and community health services, serving complex patients in the healthcare system. We deliver high-quality services at significant scale with a disciplined operating model that focuses on patient and provider outcomes. Throughout our service lines, that focus on quality care underpins commercial efforts supporting sustainable growth.

Our organizational culture of continuous improvement and best practice sharing will continue to enable operations that expand the impact we're making in providing comparatively lower cost services for complex patients across the country. In pharmacy solutions, the growth outlook is healthy, with the specialty and infusion businesses continuing to deliver impressive script growth and patient satisfaction scores. We continue to see strong volume performance from both brand LDDs and generics, and we added four exclusive and ultra-narrow LDDs to our portfolio in the first quarter, bringing our total number of LDDs to 153. Infusion represents one of our larger geographic expansion opportunities looking forward, covering today about 1/3 of the country on the acute side and half the country in chronic specialty.

Home and community pharmacy is looking to drive organic, profitable growth in assisted living, behavioral, hospice, PACE, skilled nursing, and other markets, supported by investments in automation across our national pharmacy footprint. On the provider side, in our home healthcare businesses, we continue to expect organic growth to be underpinned by market share gains from high-quality services and scaled market development and clinical support teams that we continue to invest in. In 2026, we are integrating the acquired Amedisys and LHC branches and expect approximately $30 million of EBITDA contribution in year one. We are continuously looking to innovate services and associated operational processes to drive outcomes and growth, with numerous payer agreements and partnerships that reflect this.

In palliative and hospice, the strength of our quality results and our patient-centric approach positions us well in a market that remains significantly underutilized, with only half of eligible patients receiving such valuable care today. Rehab continues to deliver consistent growth in home and community settings with excellent clinical outcomes as we continue to expand in the senior setting through Rehab in Motion in assisted living facilities. Home-based primary care and value-based care initiatives, while still in earlier stages, produce meaningful reductions in hospitalization, help coordinate other needed services, and represent significant potential for future growth as we scale. BrightSpring is firmly positioned on the right side of the most important trends in healthcare to address system and patient needs with a differentiated enterprise and a unique set of assets that deliver real solutions to patients, providers, and payers alike. With that context, let me turn to the first quarter.

As a reminder, the company's financial results in 2026 guidance pertain to continuing operations and do not include results from the divested community living business, nor the impact of any future closed acquisitions. We completed the sale of community living to Sevita on March 30th, 2026, which resulted in net cash proceeds before tax of approximately $811 million. The proceeds from this transaction will be used to further strengthen the balance sheet, including both debt paydown and cash availability. Overall, we are pleased with our first quarter financial results with total company revenue of $3.6 billion that grew 26% year-over-year. Pharmacy solutions revenue of $3.2 billion and provider services revenue of $442 million represented 25% and 28% growth respectively.

First quarter 2026 adjusted EBITDA of $190 million grew 45% year-over-year with an adjusted EBITDA margin of 5.3%, a 70 basis point improvement year-over-year. Margin expansion was primarily driven by mix and operational efficiencies across the organization. On cash flow, the company realized $123 million of cash flow from operations in the quarter, excluding fees from the community living divestiture. Leverage was 2.27x as of March 31st, 2026, which declined from 2.99x as of December 31st, 2025. Pro forma leverage on March 31st was 2.40x when factoring in cash taxes associated with the community living proceeds that will be paid in Q2. Performance in the quarter was driven by a high quality of care and patient satisfaction.

In home health, over 91% of our branches are four stars or greater. We have an industry-leading timely initiation of care of greater than 99%. In Q1, 65 home health locations were named a best home health provider by U.S. News & World Report. In hospice, quality measures remain well above national average with significantly more visits provided, a top 5% ranked hospice program in the U.S., and a CAHPS overall hospice rating of 87%. In rehab, patient satisfaction scores are at 98% with outpatient and 97% with home and community rehab. In personal care, we have a client satisfaction score of 4.6 out of 5, consistent with the fourth quarter. On the pharmacy side, in home and community, dispensing accuracy was 99.99%. Order completeness was 99%, on-time delivery was 96%.

In infusion, our patient satisfaction score was 94%. 97% of discharges were due to completion of therapy. Importantly, we saw recent improvements in both acute and specialty turnaround times near internal goals aimed at best in class. Specialty pharmacy demonstrated a consistently high medication possession ratio of 92.1% in the quarter, along with time to first bill of 4.6 days, both much better than national average. I'd like to close by emphasizing that BrightSpring's continued focus on serving large and growing markets, providing high-quality care for patients, building and leveraging scale, and institutionalizing a disciplined operating model are what collectively differentiate the company. We serve expanding populations of high acuity individuals with solutions delivered in the home or community settings that consistently improve clinical outcomes while reducing total cost of care.

We are deliberate in our corporate strategy, and we use our platform scale to generate operational efficiencies while deploying best practices across our pharmacy and provider service lines, equipping them with the resources and capabilities they need to execute and grow. We believe this approach and model is what creates durable value and the most positive impact for all of our stakeholders. BrightSpring's first quarter saw broad-based momentum across both the pharmacy and provider segments that reflected execution on our operating and growth priorities, which we laid out at our Investor Day in March. We feel good about the performance of the business through the first three months and are on track to deliver the updated full year guidance provided today. With that, I'll turn the call over to Jen.

Thank you, Jon. Before I discuss our financial results for the first quarter of 2026, I'd like to remind you that in the first quarter of 2025, we began to record the community living business and discontinued operations, as indicated in the press release in 10-Q, to adhere to accounting standards required on an interim basis. As such, all BrightSpring financial results and forecasts that I will discuss are related to continuing operations and exclude community living and any acquisitions that have not yet closed. Management believes the presentation of the non-GAAP financials from continuing operations is a useful reflection of our current business performance. In the first quarter of 2026, the total company revenue was $3.6 billion, representing 26% growth from the prior year period. Pharmacy Solutions segment revenue in the quarter was $3.2 billion, achieving 25% year-over-year growth.

Within the pharmacy segment, specialty and infusion revenue was $2.6 billion, representing growth of 36% from prior year. Which was driven by strength in specialty and market adoption of existing LDDs, new LDD wins, brand to generic conversions, and generic utilization, growth in fee for service programs, including hubs and service agreements, and strong commercial execution. Infusion showed solid volume growth and operational metrics driven by process improvements. Home and community pharmacy revenue was $527 million, representing a decline of 9% year-over-year due to an approximately $50 million impact from the IRA, which was expected, along with our decision to exit any uneconomic customers, both of which we have previously discussed and came in line with our expectations.

We expect to see a revenue impact from the IRA of approximately $45 million for each of the remaining quarters of 2026, totaling a home and community pharmacy revenue impact of approximately $175 million for the full year of 2026. In the provider services segment, we reported revenue of $442 million in the first quarter, which represented 28% growth compared to the prior year. Within the provider services segment, home health care reported $266 million in revenue, growing 49% versus last year, with strong census growth, de novo expansion, preferred MA contracts, and ongoing successful integration of our acquired branches. The acquired assets contributed $79 million of revenue and approximately $9 million in adjusted EBITDA in the first quarter.

We are encouraged with how well the integration process is going and are optimistic about the performance for the year. Rehab revenue was $75 million, growing 7% versus last year, with momentum in person served and hours billed in core neuro rehab, de novo additions, and continued expansion in our Rehab in Motion program. Personal care revenue was $102 million, representing growth of 4% year-over-year, driven by modest growth in person served and stable operations. Moving down the P&L, first quarter company gross profit was $482 million, representing growth of 43% compared with the first quarter of last year. adjusted EBITDA for the total company was $190 million in the first quarter, an increase of 45% compared to the first quarter of 2025.

Adjusted EPS for the total company was $0.39 in the first quarter. The company's profitability growth and margins in the first quarter benefited from the performance dynamics Jon discussed and the impact of investment initiatives to drive operational improvement across the organization. Throughout 2026, we expect targeted commercial strategies and our operational and procurement initiatives to support both investment and growth from best practices deployment in operations, streamlining, and ongoing efficiencies realized. Turning to segment performance in the first quarter, Pharmacy Solutions gross profit was $301 million, growing 48% compared with the first quarter of last year. Adjusted EBITDA for Pharmacy Solutions was $169 million for the first quarter, an increase of 46% compared to last year, representing an adjusted EBITDA margin of 5.3%, which was up approximately 70 basis points versus last year.

Strong performance across the therapy portfolio, favorable mix, and fee for service contributed to profitability performance. Provider Services gross profit was $181 million, growing 35% versus the 1st quarter of last year. Adjusted EBITDA for Provider Services was $66 million for the first quarter, growing 29% versus last year, representing an adjusted EBITDA margin of 14.9%, up approximately 10 basis points versus last year. On a total company basis, cash flow from operations was $123 million in the first quarter. Recall that the discontinued operations cash flow are included in total company reports. As we look forward to the balance of the year, excluding community living related cash flow impact, we expect to deliver approximately $500 million of annual operating cash flow.

Our adjusted EBITDA growth, combined with our cash flow generation during the quarter, led to a leverage ratio of 2.27x as of March 31st, 2026. This cash flow and leverage profile provides the company with some additional flexibility in capital allocation and capital structure as we move throughout the year. As of March 31st, net debt outstanding was approximately $1.7 billion. As Jon mentioned, we received approximately $811 million of net cash proceeds before tax from the $835 million gross cash consideration for community living. Approximately $100 million in taxes is expected to be paid out in the second quarter of 2026. We will remain active in evaluating options for the existing term loan and the appropriate capital structure for the company over the coming months in light of continued strong operating performance.

We expect quarterly interest expense to be approximately $35 million. Turning to guidance for 2026, which excludes the community living business as well as any acquisitions that have not yet closed. Total revenue is expected to be in the range of $14.725 billion-$15.225 billion, including Pharmacy Solutions revenue of $12.85 billion-$13.3 billion and Provider Services revenue of $1.875 billion-$1.925 billion. This revenue range reflects 14.1%-17.9% growth over full year 2025, excluding community living in both years. Total adjusted EBITDA is now expected to be in the range of $795 million-$825 million for full year 2026.

This would reflect 28.7%-33.6% growth over full year 2025, excluding community living in both years. Included in total adjusted EBITDA is expected contribution from the Amedisys and LHC assets acquisition of approximately $30 million. I will now turn it back to Jon.

Thanks, Jen, and thank you for your time today to go through BrightSpring's first quarter 2026 results. We'll now open up the call for questions. Operator?

Thank you. Ladies and gentlemen, Our first question comes from the line of Ann Hynes with Mizuho. Your line is open.

Good morning. Thank you. I just wanna talk about some of the growth initiatives hitting the P&L this year, especially with infusion. I know that's been a big focus for the company, expanding the chronic portfolio. Can you just let us know how that's going, what the growth rate is, maybe what drug classes you're focused on?

Good morning, Ann. Hope you're doing well. You know, I think, pretty characteristically, we saw broad-based growth across the organization on both the provider and the pharmacy side. You know, provider obviously had a bit of a tailwind there from closing of the home health branches. Notwithstanding that, you know, we saw really good growth. One of the reasons we had a little outperformance on the home health branches that were acquired was the step-up in admissions we were able to drive, with them being under our roof for three to four months. It was a nice quarter across the company in terms of volume growth. On the pharmacy side, you know, the ramp-up of existing LDDs, the launching of new LDDs and, you know, focused growth around driving generic utilization led to good growth within our Onco360 and CareMed business.

I'd point out within that business, you know, quite a few of our LDDs under CareMed now are outside of oncology and, you know, that's been intentional. Not only did we see script growth rates over 30%, but we saw continued growth rate in, you know, the number of new account, new prescriber accounts that we're into, as we not only continue to invest in more reps, particularly on the West Coast, but then also get into some therapeutic states in addition and beyond oncology, as we've continued to focus not only on oncology but, you know, any other therapeutic area of interest. Specifically within infusion, you know, we did see double-digit growth on both the acute side and the chronic specialty side. You know, I think as we've mentioned before, we've been underweight on chronic specialty, we think that's an opportunity.

We did go live in early Q2 with a concierge program around IVIG, and our thoughts are to build out, and we are building out concierge programs around targeted therapy. It was a productive quarter with solid double-digit growth across both of those areas within infusion.

Great. Thank you. Just for a follow-up, obviously, your leverage is at a nice point after the repayment of debt. I guess, one, would you be interested in larger M&A? If you would be, what would be a leverage you would be comfortable going back up to for the right asset?

Yeah. You know, it's. I know Jen, in particular, very pleased with the balance sheet, but we all are. You know, I think we've sort of said under 3x mid-2s is our longer-term target where we'd always like to be. I think you'll continue to see us act the way we have historically, you know, with a disciplined approach. You know, I think in, you know, if you look at least at the last seven years, there's been two transactions that have, you know, really worked out well for us that have been a little bit more sizable. The original home health and hospice acquisition of Abode, which gave us critical mass there, and then this most recent one here with the LHC and Amedisys assets. You know, I think we do have a little bit more flexibility, obviously, we will continue to try to make sure we look at anything that makes the most sense in the long term, you know, across the organization.

I think our bread and butter will continue to be geographical expansion with tuck-ins in our current businesses that allow us maybe to get into some new markets more quickly and where it makes sense or where you need licensure or a CON, et cetera. You know, I think deals in that sort of mid-range or five-10 are probably easier to do. You know, as we look at our pipeline right now, nothing too different than historically. You know, whatever we do, you know, will continue to be very measured. Yes, we would like to stay within that target leverage range, you know, with anything that could come up. I would say, you know, at least for now, certainly a historically very consistent view and strategy as we look out, at least probably through the next couple of quarters.

Our next question comes from the line of David Larsen with BTIG. Your line is open.

Hey. Congratulations on another excellent beat and raise quarter. Can you maybe talk a little bit about the overall Medicare environment and how this is impacting your business? Like some of the health plans obviously are talking about high trend pressure on margins. I think you had talked a bit about the potential for getting into some value-based care arrangements in Medicare that could be a benefit to you. Just sort of general thoughts on the overall Medicare landscape and how this is affecting you would be very helpful. Thank you.

Yeah, sure. Yeah. Hey, David. Good morning. You know, we've just seen consistency on the Medicare side this year, you know, no major changes. You know, on the pharmacy side, you know, from a Part D perspective, you know, we've continued to, I think, be a partner in driving costs down there in terms of generic utilization over time. You know, on infusion, we continue to press in D.C. with the industry and the associations around, you know, some of the fixes for the Cures Act to provide much greater access for Medicare patients, beneficiaries being able to receive very valuable home infusion in their own home instead of the hospital. That has a massive potential benefit for the program. We continue to be optimistic that at some point, you know, that, you know, that change and that update can be addressed and can be implemented. You know, on the provider side, you know, on home health and hospice, you know, we've been pleased with where those rates have shaken out over the last six months.

You know, nothing too different that we've seen organizationally in the last even six months. You know, I would say as it relates to value-based care, you know, we continue to make some progress there. We're gonna be applying to this new LEAD ACO Program that's in the works. Applications are due in May and, you know, we'll see how that goes. Hopefully, we make it. That business we continue to invest in with some really good people even here recently that we've added to the business. Yeah, I would say operationally, being able to serve these patients across skilled nursing assistant living in the home with a, with a house calls model is not the easiest thing to do in the world, and we've been focused on doing that extremely well with really good quality outcomes.

I think we've really achieved that over the last couple of years, and our focus now is on really trying to scale it. You know, we're looking to next gen ACO programs in addition to the one we're in. You know, we had a successful year there last year. We've never been as positive about, you know, the ability to reduce cost in very desirable care settings as we are today. You know, that will continue to be a passion for us internally in terms of how we can take care of more folks in their own home in a value-based care model with the most proximal and intimate services possible.

You know, we're leaning in and building out that hub as much as we can to provide oversight in the in-between time and trying to apply AI to all of our data and analytics to be as proactive as we can and as smart as we can with our care approaches. You know, nothing too different as we sit here today on the Medicare front writ large in terms of traditional, you know, payment programs. I think there are, you know, real opportunities for the program in terms of what we can provide for it in terms of cost reduction in the future across quite a few of our businesses, and we will continue to be passionate about leaning into that.

Great. Then just one quick follow-up. Jen, I thought that we had been talking about $600 million of revenue headwind in 2026 coming from a combination of IRA community, IRA specialty infusion, and then also brand to generic conversions. Is that correct? You obviously beat my revenue estimate by a lot in the quarter, so you're certainly overcoming that really well. Just sort of an update there would be helpful on how that's tracking relative to expectations. Thank you.

Yeah, that's correct. Thank you so much for the question. We did obviously talk about the IRA impact in home and community because it was really obvious from a revenue standpoint. That is consistent, and we're tracking towards our expected numbers in all of those areas. Just as a reminder, that is about $175 million in, which we talked about a little bit earlier in the call, in home and community related to IRA for the full year IRA, of about $181 million in specialty and infusion and brand to generic conversions of about $250 million.

Okay, great, great quarter. Thanks very much. Appreciate it.

Our next question comes from the line of Charles Rhyee with TD Cowen. Your line is open.

Thanks for taking the questions, and congrats on the results. Maybe Jen, just to quickly follow up there. Besides the revenue headwind, are we still looking at $15 million of mitigated sort of headwind on the EBITDA line? That hasn't changed?

Okay, perfect. Then, you know, I don't think you gave sort of what the specialty script growth in the quarter was and was just curious, you know, what that number was and what maybe healthcare, home and community rev growth ex Genesis was as well?

Our specialty and infusion script growth in the quarter year-over-year was approximately 30% year-over-year growth. Specialty was a little bit higher with infusion in the mid-teens. Specialty was higher than that total infusion in the mid-teens in terms of their script growth. Really strong growth, you know, across both of those business lines. Home and community ex, you know, the uneconomic customers did see modest script growth in the mid-single digits.

Got it. That's helpful. Maybe just one last question. You know, we're seeing a lot of commentary from PBMs. They're really trying to push, you know, sort of their own label biosimilars. There's kind of discussion of how much more competitive they're getting or at least trying to steer patients into their own kind of, sort of captive pharmacies. Would like to understand, you know, sort of how much exposure you have to some of those dynamics. If that's something that you're seeing. If so, you know, what do you do to help kind of get around that? Thanks.

Yeah. I think, Charles, just given our history and product portfolio today, I don't think we have a lot of exposure there. You tend to see more of that on injectables. If you look at our infusion business, you know, still today, the majority is acute. We look to be growing on the chronic side, and we are, you know, but more from an infusible standpoint, you know, versus a subQ or an injectable standpoint. You know, we don't have a lot of concentration internally that would have biosimilar risk. On the Onco360 and CareMed side, the predominant form factor is oral solid. I think we feel good about that. You know, last little thing on LTC, we are proud of the performance in the quarter on home community pharmacy.

You know, we've really put just a top-notch team in there over the past year. They're doing a great job, particularly from an operational perspective, and then with our focus on some of these, you know, attractive end markets. Excluding IRA, you know, that business was up in profitability in the quarter year-over-year. You know, our hope and goal is in Q2, even with IRA, we're gonna have a really strong up quarter versus last year. Some nice momentum there too. I just wanted to add that.

Thank you. Our next question comes from the line of Joanna Gajuk with Bank of America. Your line is open.

Oh, hi, good morning. Thanks so much for taking the questions. Maybe on the infusion, if I may. Thanks for the color in terms of you guys growing, you know, double digits in both segments. As it relates to that business, can you give us an update on is it, you know, the quote, I guess, is coming from these 20 or so LDDs. Last time, we spoke, you said, you know, you had these LDDs, but you were not really participating. It sounds like you executing on this already, or that's still kind of in front of you?

Yeah. I think what we said last time is, you know, we had won three LDDs, and we had access to 20-plus more historically. At this point, we've won five LDDs in the last six months, we've won a couple more. You know, none of those are of the exclusive or ultra narrow one- or two-category as in Onco360 and CareMed. That's our goal. Nonetheless, nice wins. I would say, you know, as we kind of put specialty programs in place, you know, you have to win access to the drug, then, obviously, you have to execute on a number of operational initiatives and programs to pull those drugs through in the market. You know, we do such a good job of that on the Onco360 and the CareMed side with all of our wraparound programs, data services agreements, you know, hubs that we provide for patients as well. You know, we're building that out on the infusion side.

You know, we launched IG Connect in the quarter, which is a concierge program now for all IG referrals. You know, we'll look to do that for each one of these LDDs in the future and really have a focus on it to be able to customize that experience for, you know, both the manufacturer and the patient. You know, we are seeing some growth there. You know, but Joanna, I think we're probably in the early stages of a several year, you know, growth focus in LDDs and infusion like we've had, you know, over at ONCO and CareMed for the past decade. Nice continued progress with manufacturers on the infusion side and, you know, we will continue to focus on the pull-through and the programs in the future.

If I may, that was a follow-up. My question was actually about the gross profit per script, which was impressive. It was up, you know, 50% in this quarter year-over-year and sequentially over Q2. How much is from these new LDD launches, new product launches versus the generic conversions? You know, I'm asking because just thinking going forward, how much more room, I guess, is there left on that metric? Thank you.

Yeah. I don't know that we would expect to see, you know, too much more continued gains in GP per script. I mean, I think just stability there would be very good. Overall, there were four principal drivers for the tick up there. You know, number one was the disproportionate growth on the specialty infusion side, you know, in that business, with its gross profit per script. Second was, you know, we did have really healthy growth in both brands and generics, but the brand to generic mix shift there in the quarter relative from a volume perspective was additive to GP per script. You know, third is, you know, from a purchasing perspective, you know, we leverage our scale as much as we can and, you know, we're committed to all of our partners in the supply chain and have, I think, very constructive and long-standing relationships there that are really healthy on the supply side.

What we did from a purchasing standpoint has been helpful in the quarter again. Then, you know, really last, you know, but maybe even not least, fee for service, you know, that's a high gross profit margin business that we have with our hubs and our, and our service agreements. Every time you launch a brand, you know, you typically get some good fee for service, commercial business out of that too. Those were the four factors that were all contributing to the gross profit per script change.

Please stand by for our next question. Our next question comes from the line of Jared Haase with William Blair & Company. Your line is open.

Thanks for taking the questions. You know, maybe I'll pack two here into one, just as it relates to the margin in the quarter. You know, one thing I wanted to clarify was just the mix comment in regards to margin expansion that you showed in the first quarter. I think all else being equal, you know, we typically assume sort of rapid growth in specialty, particularly on the branded side, could be a bit dilutive to the overall margin profile. Just wanted to make sure I kind of understood what was going on there and if the mix dynamic had more to do with generics. I guess rolling that forward, how should we think about sort of the cadence of margins for the rest of the year?

You know, I think we typically would model margins building sequentially, but your guidance sort of implies fuller margins that are consistent with what you showed in the first quarter. Just wanted to kind of make sure we're understanding the expectation there as well.

Yeah, good morning, Jared. Jen, maybe you can take the outlook for the year, but I think we would expect some consistency for sure. You know, on the GP side, you know, you've got the percent margin versus the dollar margin, and I think it was the mix shift that we saw that helped probably proportionally on the dollar margin side versus the percent margin, if you're tracking with me there. Jen.

For the rest of the year, I do think we have, you know, the potential for slight build. Those things are gonna be, you know, based on our guidance range, you know, we have a range of 5.2%-5.6% margins that we would expect for the year. The things that we are working on is continued leverage of scale. We have a number of operational initiatives that we are building in place. Then from a mix standpoint, as we think about the mix within each portfolio, as Jon mentioned, we're working to drive, for example, chronic therapies within infusion. As we, you know, as we execute on those, I think we have the potential for, you know, slight margin expansion, but largely consistent with what we saw in Q1.

Thank you. Our next question comes from the line of A.J. Rice with UBS.

Hi, everybody. Just maybe picking up on the comment that Jen just made. I know operational efficiencies have been an ongoing part of your strategy, and you're attributing part of the 70 basis points of margin improvement you saw year-to-year to operational efficiencies. Can you just maybe update us on some of the specific areas of focus and any AI-related applications you're looking at there?

Good morning, A.J. Rice. Excuse me. I mean, I think as we've said before, you know, we did a nice job offsetting some of this IRA impact in Q1 in home and community pharmacy. Some really nice efforts there from procurement over the past year, but then also in operations with some automation tools and order intake and revenue cycle in particular. You know, currently working on something in infusion around order intake as well. You know, just to give everybody a tangible example because it can be a little ethereal sometimes. You get a five-inch thick patient packet in intake and infusion. It takes somebody two hours to enter the relevant information in the system, you know, working on an agent that can do that in two seconds.

You know, that would be an example of streamlining workflow of which we have, you know, nine or 10 different projects going on internally in the organization. You know, as you look at the home health and hospice side, we've invested a lot in portals. There can literally be 85 different portals that hospitals will send their, you know, put their patients into upon discharge. You've got to connect to all of them. So we've done a ton of work there over the last two years, connecting into all the portals. You still have to go earn the referral with your clinical liaison, you've got to be in the game by accepting the referral in the portal. We've done a ton of work there.

I think we have evidence of improvement and success in our admissions from doing that. Then, I think, you know, a last example would be in order intake and home health. You know, we've done a really nice job centralizing that. You know, as some of these assets come over from Amedisys and Optum, they were not centralized and, you know, we're seeing some real benefit there already out of the gates. So, you know, continue to invest in that team. I mean, Jen, we're up to over 20 people in our internal AI team now, and, you know, it seems like the more we get into it, the more opportunities you find. But, you know, that's gonna continue to be a real focus for us.

You know, there's another, you know, I hesitate to say, but, you know, we've got a pretty strong bogey for cost to fill reduction in home community pharmacy in Q2, and then more in Q3 and Q4 that we have to hit, and a lot of them are tied to these OpEx initiatives, which are, which are underpinned by, you know, some technology systems and automation. Working hard at it, you know, we are, we are seeing things proceed along the intended path as of now.

Okay, that's great. maybe just conceptually also ask you about biosimilars. Obviously, you know, you've benefited from tremendous new pacing of new LDD launches and so forth. I'm also curious about the pace of biosimilars, how the biosimilars coming to market has emerged. Do you see that as still the opportunity you thought it was a two years ago, or is there aspects about it that either make you more optimistic or a little more cautious about what that pipeline looks like and what it might mean for you?

I think as we sit here today, you know, we do not see, you know, much biosimilar risk just based on our current portfolio and the revenue in GP that we have from it. I think conceptually over time, you know, there's an opportunity for us to participate in that more, you know, from a baseline of it's all upside. I think that's how we're thinking about it. I think a lot of that is to be determined. You know, if you think about our portfolio today, you know, we have our oncology products, we have our other rare and orphan and LDDs, you know, that are oral injectable. We have our infusible products, you know, that, you know, we're leaning into from an LDD standpoint.

You know, those are kind of our three swim lanes of our primary products today from a specialty standpoint. You know, we are looking just more broadly at the specialty world, you know, any other LDDs or any other just attractive products and, you know, thinking if it makes sense to us to participate in any other areas. You know, I think we will continue to try to refine our strategic assessment of your exact question this year. I do think that there could be opportunities there. And, you know, we don't have any near and present risks in that area today. You know, hopefully, as we lean into this more, you know, could be a fourth or fifth swim lane in time.

Thank you. Our next question comes from the line of Sean Dodge with BMO Capital Markets. Your line is open.

Thanks. Good morning. Maybe just going back to the operational initiatives again. Jon, you gave some specific examples of what you're working on there. If we think about, I know those were a driver of some of the margin improvement we saw last year. You're continuing to work on those this year. How should we think about the expected contribution from those in 2026 maybe relative to what you saw in 2025? The savings or benefits from those, do you expect to be greater this year than last? Then of all of the margin leverage you talked about, where do these efficiency initiatives rank in terms of kind of the amount of EBITDA they're driving? Is this kind of pretty close to the generics, or is this kind of a distant second?

Yeah. Jen, maybe you can sort of tackle onto this question. You know, what we have internally, I would say is a program that's been consistent over time. I think we mentioned at Investor Day, you know, we've even more formalized, you know, call it continuous improvement, if you will, you know, into a real Lean Six Sigma training program throughout the organization. White, Green, Black Belt you can get, and we've really formalized that. I think it is very much in our culture, just constantly looking for the next thing. I think our data says that we've got over 700 projects that we've completed, you know, in the process improvement arena in the last five-plus years, that it's generated, you know, nine figures of savings, of which, you know, a ton of it we've reinvested back into our people and, you know, into IT and technology systems.

You know, over the past several years, we've just had, you know, I would say, meaningful savings that have been either investment and/or EBITDA contributors each year into the organization. I mean, look, first and foremost, we are always going to try to drive growth through a focus on the top line. I mean, the three things that have driven the company over the past nine years now that we talk about a lot are volume growth, operational efficiency, and accretive M&A. You know, we will continue to try to drive each one of those in the future. The volume growth, you know, whether it's on the pharmacy side with LDD wins, trying to maximize, you know, generic conversions or whether it's on the provider side with patient volume growth, will always be first and foremost, and I would say, you know, the biggest contributor. You know, we certainly try to complement that. Jen, anything else?

No, I would agree. I think the volume underpinned by our high-quality services has always been our very highest focus. You know, as Jon mentioned, the strength of our portfolio of our company really is, you know, at the core of our DNA, is leveraging our scale through smart procurement activities, continuing to build. We think there's a continuous, you know, opportunity for that in terms of, you know, focus on execution in those areas. As Jon mentioned, we have a lot of people we've been, you know, training just out in the field, hundreds of people that have gone through, you know, our White Belt and Green Belt, you know, trainings, but also making sure that as we scale, that we're going back and leveraging that in our procurement initiatives. I think that'll continue to be an important contributor as well, as the volume.

Okay, great. You mentioned before one of the other kind of growth areas within pharmacy being the fee for service business. Just anything you can share around kind of the scale of that business now, how much is that contributing and what do you kind of see the longer run opportunity being with fee for service specifically?

Yeah, I mean, it's, I think we've got 31 hub programs today, you know, probably more service agreements than that. You know, it's growing in the 40%-50% range year over year. You know, it's certainly not the majority of our, of our GP contribution, you know, within our specialty business, you know, but it's, you know, it's no longer $5 million or $10 million either. You know, it's, you know, you know, I hesitate to get into too many details, but, you know, it's a, it's a, it's a meaningful part of the business that's really important to us. You know, I think philosophically is an example of how we try to, you know, deepen our relationships as much as we can with manufacturers wherever we can be helpful.

Thank you. Our next question comes from the line of Whit Mayo with Leerink Partners. Your line is open.

Hey, thanks. Jon, I was just wondering if you have market share data with your specialty business. Just wondering if you know what your oncology share is today versus maybe one to two, three years ago.

Yeah, it's tricky, Whit. I mean, it's a great question. You know, we do have some of this, you know, obviously drug by drug. You know, as we talk about a lot, you know, a proxy would be generally half of the revenue of specialty drugs goes through the SP channel. You know, what is your share from there? You know, we do feel that our share continues to increase almost by definition. You know, if you're an exclusive with a manufacturer or in an ultra-narrow network, say, of two pharmacies, you know, by definition, you're gonna get, you know, 100% or, you know, 50%, 60%, 70% market share of that specific drug. As more drugs have gone exclusive and ultra-narrow, just given the service that we've been able to provide, you know, that will tick up your market share.

You know, you do have to go drug by drug ultimately. If the trend is towards more LDDs, in particular EDs and ultra narrows, you know, we would be seeing a greater share there over time. On the generic side, you know, we do try to get in front of it. You know, we try to be, you know, in the offices well in front of a generic launch, communicating and educating and building out that brand volume. You know, I think we'd like to believe our performance on the conversion side is really strong. You know, we can do a little bit more work, you know, on those market shares. You don't have perfect visibility on it, obviously, we do feel like it is continuing to ebb up.

That's helpful. Corporate cost was up maybe a little bit more than we thought. I mean, I know you guys are making a lot of investments this year. You've been quite vocal about that. Jen, what do you have in your plan for the full year for corporate?

Yeah, great question, Whit. If you look at versus Q4, our corporate costs are not up quite as much as they would appear to be year-over-year, as we had been making additional investments in different activities, throughout 2025 as well. I would say, you know, I do expect a small tick-up through the remainder of the year as we think about some additional projects that we have in the pipeline from an IT perspective and other things. I would say not a significant tick-up at this time is our best view.

Thank you. Ladies and gentlemen, due to the interest of time, we ask that you now limit yourself to one question only. Please stand by for our next question. Our next question comes from the line of Matthew Gillmor with KeyBanc. Your line is open.

Thanks. Hey, thanks for the question. Maybe picking up on some of the generic conversion comments. You had mentioned that utilization was strong. I wanted to see if you could provide a broader comment on the landscape for generic conversions and how you're performing relative to that opportunity.

Yeah. I would just say, you know, just very consistent there, you know, in terms of the last really five years. You know, we've got a broad portfolio, you know, across drugs and, and brands and generics across the organization. So, you know, so it's really fluid in terms of what's coming in and what's coming out with new brand launches and conversions. You know, the market's real dynamic. From a generic standpoint, you know, the playbook, you know, remains the same. We've continued to invest in the sales force, and we've continued to try to invest in our manufacturing partners as well, not only branded, but generic, to be able to, you know, have access to the supply where needed as well.

You know, I would just say it's, you know, it's a strategy that we continue to try to refine over time. It's multifaceted, you know, in terms of being able to execute against it. You know, as we look out to the next, you know, two years in particular and then another five years, you know, there's still a healthy stream of, you know, of drugs that will be coming up on their patent expiration date and converting generics. You know, we're always looking to grow our product portfolio in the, in the most broad and holistic way possible across all therapy types.

Thank you. Our next question comes from the line of Brian Tanquilut with Jefferies. Your line is open.

Hey, good morning, and congrats. Jon, maybe just a question on the business, right, as it relates to the defensiveness of it or how do you think it could be resilient against any PBM moves in light of the challenges the PBM industry is facing and also some of the stuff we found out yesterday from your peer, where the PBMs and the payers are trying to move drugs away from non-PBM-owned specialty pharmacies. Just curious how you're thinking about the strategy around defending the moat of your business. Thanks.

I mean, we do as best we can to try to partner with everybody. I mean, we have really longstanding relationships, and I think healthy partnerships with everybody across the value chain. I mean, I think it starts with our quality. You know, we really invest in quality like crazy. I think hopefully our scale is extremely helpful, too. You know, look, on the Medicare side, there's rules and, you know, any willing provider, you know, for example, you know, we're big believers that in patient choice and member choice, and they should be able to receive the provider that they want. You know, we try to be a high-quality provider, and we try to provide, you know, the best service possible to everybody's members out there. You know, I think we try to be really thoughtful about where we participate in terms of, you know, what therapeutic areas specifically.

Thank you. Our next question comes from the line of Larry Solow with CJS Securities. Your line is open.

BrightSpring Health Services Q1 2026 Earnings Call Transcript | Fortune

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BrightSpring Health Services (BTSG) Q1 2026 Earnings Call Transcript

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