The companies on the Global 500 employ 70.2 million people, and their revenue represents more than one-third of the world’s GDP.

Fortune Global 500

With a combined revenue of $21 trillion and $2.1 trillion in profits, the 2026 Fortune 500 is the definitive list of America's largest companies.

Fortune 500

The 300 companies on this year’s list brought in over $12.5 trillion in revenue for the latest 12 months, with the median revenue figure at $24 billion.

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The corporations on our annual list of the world's 500 largest companies combined to generate $41.7 trillion in revenue over the past year.

Almost $20 trillion in revenue—and a record-breaking $1.87 trillion in profits. Introducing the 2025 Fortune 500, the definitive list of the biggest companies in America.

The 300 companies on this year’s list brought in over $12.6 trillion in revenue for the latest 12 months, with the median revenue figure at $22 billion.

The corporations on our annual list posted aggregate revenues of $41 trillion for the second year in a row.

Industries included in the sector are insurance and managed care, medical products and facilities, pharmacy services, and pharmaceutical companies.

Fortune Sector Leaders: Health Care

The Fortune 500, in its 70th year in 2024, ranks the biggest U.S. companies by revenue.

The 200 companies on this list are transforming industries from the inside out.

The corporations on our annual list of the world’s largest companies delivered a record $41 trillion in aggregate revenues.

G500-2023-Cardinal Health

This U.S. wholesale health-supply distributor is one of three such companies in the top 40 of the Global 500. Its revenue rose 11.6% last year, to $181 billion. 
<ul> 
 	<li>Ongoing litigation issues over the alleged role of Cardinal and other pharmaceutical distributors in the opioid crisis bled into the company’s 2022 financials; the company registered a $933 million loss in the fiscal year ended June 2022. But the company’s stock soared in calendar 2022, reflecting investors’ relief after Cardinal reached settlements in several opioid-related lawsuits. (The company did not admit wrongdoing in those settlements.)</li> 
 	<li>The pharmaceutical arm of the company performed well, with a 5% increase in profit year over year.</li> 
 	<li>CEO Mike Kaufmann was succeeded by former CFO Jason Hollar in September 2022.</li> 
</ul>

The 300 companies on this list are transforming industries from the inside out.

The Fortune 500, in its 69th year in 2023, ranks the biggest U.S. companies by revenue.

F500 2023-Cardinal Health

This wholesale health-supply distributor is one of three such companies in the top 20 of the Fortune 500. Its revenue rose 11.6% last year, to $181 billion. 
<ul> 
 	<li>Ongoing litigation issues over the alleged role of Cardinal and other pharmaceutical distributors in the opioid crisis bled into the company’s 2022 financials; the company registered a $933 million loss in the fiscal year ended June 2022. But the company’s stock soared in calendar 2022, reflecting investors’ relief after Cardinal reached settlements in several opioid-related lawsuits. (The company did not admit wrongdoing in those settlements.)</li> 
 	<li>The pharmaceutical arm of the company performed well, with a 5% increase in profit year over year.</li> 
 	<li>CEO Mike Kaufmann was succeeded by former CFO Jason Hollar in September 2022.</li> 
</ul>

Just as it dominates our economy, Big Tech now dominates Fortune’s annual ranking of corporate reputation.

World's Most Admired Companies

Aggregate sales hit $37.8 trillion last year—an increase of 19%, the highest annual growth rate in the list’s history.

Despite bringing in over $160 billion in revenue in 2021, Cardinal Health reported net income of just $611 million for the year. Litigation costs were one factor: One of several companies entangled in lawsuits over their alleged role in the opioid crisis, Cardinal in July 2021 agreed to pay $6.4 billion in settlements to help fund health care and drug-treatment programs. The company also agreed to settle a case with the Equal Employment Opportunity Commission involving racial harassment claims made by Black employees at one of its distribution centers, offering $1.45 million in settlements and agreeing to implement a range of policy changes. On the business-building front, Cardinal partnered with logistics startup Zipline to deliver products to pharmacies using autonomous aircraft.

This year’s Fortune 500 marks the 68th running of the list.

F500 2022 Cardinal Health

Despite bringing in over $160 billion in revenue in 2021, Cardinal Health reported net income of just $611 million for the year. Litigation costs were one factor: One of several companies entangled in lawsuits over their alleged role in the opioid crisis, Cardinal in July 2021 agreed to pay $6.4 billion in settlements to help pay for health care and drug-treatment programs. The company also agreed to settle a case with the Equal Employment Opportunity Commission involving racial harassment claims made by Black employees at one of its distribution centers, offering $1.45 million in settlements and agreeing to implement a range of policy changes. On the business-building front, Cardinal recently partnered with logistics startup Zipline to deliver products to pharmacies using autonomous aircraft.

After a year in which humanity leaned more heavily than ever on tech giants, see which companies topped Fortune's ranking of corporate reputation.

Total revenue for the world’s biggest companies fell 4.8% to $31.7 trillion this year—the first decline in half a decade.

G500-2021-030-Cardinal Health

The drug and medical supply company saw 5.1% sales growth last year (its fiscal year ended in June 2020) owing to the strength of its pharmaceutical distribution business. That was particularly true during the first half of 2020, as customers stocked up on medications at the onset of the pandemic. A manufacturer and distributor of the personal protective equipment that has been much in demand, Cardinal has seen both sales of these products and the cost of making and sourcing them increase in the past year. As with other drug wholesalers, Cardinal faces legal challenges over its alleged role in America’s opioid epidemic.

This year’s Fortune 500 marks the 67th running of the list.

F500-201-14-Cardinal Health

For an astounding 13th straight year, Apple claims the top spot in Fortune’s annual ranking of corporate reputation, based on a survey of almost 3,800 executives, directors, and analysts.

This year's Fortune Global 500 generated $33.3 trillion in revenues and $2.1 trillion in profits.

G500-2020-037-Cardinal-Health

The Ohio-based drug wholesaler, which counts CVS Health and Kroger as customers, saw revenues rise 6.4% in its 2019 fiscal year due to growth in its drug and specialty pharmaceutical distribution business—and despite the 2018 divestiture of part of its business in China. While depressed prices of generic medications and the cost of opioid-related litigation weighed on Cardinal’s bottom line, the company’s profits rebounded from 2018, when the company took a $1.4 billion impairment charge. Like its two large competitors, Cardinal faces thousands of lawsuits over its alleged role in the nation’s opioid epidemic. In February, states rejected a proposed $18 billion settlement with the nation’s three largest drug distributors.

This year's Fortune 500 marks the 66th running of the list.

F500-2020-016-Cardinal-Health

The Ohio-based drug wholesaler, which counts CVS Health and Kroger as customers, saw revenues rise 6.4% in its 2019 fiscal year due to growth in its drug and specialty pharmaceutical distribution business—and despite the 2018 divestiture of the business in China. While depressed prices of generic medications and the cost of opioid-related litigation weighed on Cardinal’s bottom line, the company’s profits rebounded from 2018, when the company took a $1.4 billion impairment charge. Like its two large competitors, Cardinal faces thousands of lawsuits over its alleged role in the nation’s opioid epidemic. In February, states rejected a proposed $18 billion settlement with the nation’s three largest drug distributors.

Here are the World's Most Admired Companies for 2019 as ranked in their industries. See who made the list.

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The world's 500 largest companies generated $31.2 trillion in revenues and $1.7 trillion in profits in 2014. Together, this year's Fortune Global 500 employ 65 million people worldwide and are represented by 36 countries.

This year's Fortune 500 marks the 61st running of the list. Wal-Mart claims the top spot again. See who made the list.

Global business is back. After limping through a worldwide financial crisis and economic slowdown, the 500 largest companies ranked by revenues shattered all sorts of performance records in 2013: They racked up combined revenues of $31.1 trillion, up 2.5% from 2012, and profits soared 27% to nearly $2 trillion. China’s 95 companies (up from 89 last year) posted $5.8 trillion in revenues. The U.S. has four fewer companies on the list than last year but remains (for now) the country leader, with 128 corporations on the list—including No. 1 Wal-Mart Stores—reporting $8.6 trillion in revenues. 

Wal-Mart stayed on top as its sales crept closer to half-a-trillion dollars. Apple moved into the top five. And UnitedHealth Group continued its steady climb. 

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Cardinal Health is a U.S. health care services and products company operating across over 30 countries as of 2025. The business provides customized solutions for hospitals, health care systems, pharmacies, surgery centers, clinical laboratories, and patients at home. The medical giant distributes generic and specialty pharmaceuticals, as well as medical, surgical, and laboratory products. Cardinal Health’s history dates back to 1971, in its founding as Cardinal Foods; in 1979, the company switched industries from food to health care, changing its name to Cardinal Distribution.

Q4 2026

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Cardinal Health (CAH): Company Profile, Stock Price, News, Rankings

legacy

Cardinal Health

cardinal health

Hello, and welcome to the Fourth Quarter Fiscal Year twenty twenty five Cardinal Health Incorporated Earnings Conference Call. My name is George. I'll be your coordinator of today's event. Please note that this conference is being recorded. For the duration of the call, your lines have been listen only mode.

However, you will have the opportunity to ask questions towards the end of the presentation. This could be done by pressing star one on your telephone keypad session. I'd like to hand the call over to your host today, Mr. Matt Sims, Vice President of Investor Relations, for you today's conference. Please go ahead, sir.

Good morning, and welcome to Cardinal Health fourth quarter fiscal twenty twenty five earnings conference call and thank you for joining us. With me today are Cardinal Health's CEO, Jason Hollar and our CFO, Aaron Ault. You can find this morning's earnings press release and investor presentation on the Investor Relations section of our website at ir.cardinalhealth.com. Since we will be making forward looking statements today, let me remind you that the matters addressed in these statements are subject to risks and uncertainties that could cause our actual results to differ materially from those projected or implied. Please refer to our SEC filings and the forward looking statements slide at the beginning of our presentation for a description of these risks and uncertainties.

Please note that during our discussion today, the comments will be on a non GAAP basis unless specifically called out as GAAP. GAAP to non GAAP reconciliations for all relevant periods can be found in the supporting schedules attached to our press release. For the Q and A portion of today's call, we kindly ask that you limit questions to one per participant so that we can try and give everyone an opportunity. With that, I will now turn the

call over to Jason. Thanks, Matt, and good morning, everyone. We closed fiscal twenty twenty five with momentum, delivering excellent fourth quarter results in what was a transformative year for Cardinal Health. Our consistent performance with all five operating segments delivering double digit profit growth for both the year and Q4 reflects the significant progress we've made against our strategic priorities. As we outlined at Investor Day, our strategy is clear and we continue to deliver on our commitments, reflecting disciplined execution across each of our operating segments.

Our relentless focus on driving simplification and operational efficiencies in our core, along with strategic investments for growth, are enabling us to evolve to meet the needs of our customers and drive long term value creation. Before I get into the specifics and Aaron takes us through the financials, I want to recognize the hard work and dedication of our teams around the world. Their commitment to our mission and our customers is essential to strengthening our position as healthcare's most trusted partner at a time when reliability, resiliency and access are more important than ever. Within Pharmaceutical and Specialty Solutions, our largest and most significant business, we continue to see robust pharmaceutical demand and strong underlying performance. Our path forward remains well defined and consistent.

Prioritize the growth and resiliency of this business by building upon our strong core foundation and further expanding in specialty as you saw in our press release this morning. We're thrilled to announce the acquisition of Solaris Health, the country's leading urology managed services organization. This greatly accelerates our progress in building the specialty alliances, multi specialty MSO platform, significantly expanding the reach of our urology alliance physician network. We see substantial opportunity ahead with Cardinal Health positioned as the multi specialty leader and I'll elaborate on this shortly. In GMPD, our improvement plan initiatives are driving results delivering $70,000,000 in profit for the fourth quarter.

The team continues to navigate the current environment to optimize our global footprint and increase supply chain resiliency for our customers. We see further opportunities ahead to continue to drive the GMPD improvement plan. Our differentiated growth businesses within other made substantial contributions this quarter capping off a year of meaningful momentum. The performance was broad based with strong growth across at home solutions, now including the acquisition of ADS, nuclear and precision health solutions and Optifreight Logistics. As we close out fiscal twenty twenty five and look ahead, we have great optimism in what we will achieve in fiscal twenty twenty six.

We continue to make strategic investments to optimize the business and position us for success. I'll dive deeper into these and other updates shortly, but we'll now turn it over to Aaron to take us through financials.

Thank you, Jason, and good morning. I am delighted to share more details on our Q4 financial results and the significant year that we have had at Cardinal Health. Here are some of the key financial headlines. At the enterprise level, we grew operating earnings 19% in the quarter and 15% on the year. We grew EPS by 13% in the quarter and over 9% on the year.

We delivered 2,500,000,000 of adjusted free cash flow in the year, dollars 500,000,000 ahead of our increased expectations from Investor Day. We invested nearly $550,000,000 in CapEx, returned to shareholders nearly $500,000,000 for our growing dividend, repurchased $750,000,000 of shares at an average price of $117 per share and completed four strategic acquisitions, Green Specialty and One plus At Home Solutions to drive our future growth. And we got all of this done in parallel with the previously announced customer contract expiration, a significant focus on cost mitigation, the onboarding of new customers and managing through regulatory uncertainty and the implementation of tariffs. Let's go through the Q4 results. Total company revenue was relatively flat at $60,200,000,000 on a reported basis.

Adjusting for the contract expiration, revenue at the enterprise level increased 21% versus the prior year led by strong demand across pharma and the growth businesses in other. Gross profit grew 17% to $2,200,000,000 with rate improving by approximately 50 basis points reflecting favorable product, customer and business mix. Gross profit growth again outpaced consolidated SG and A growth, which increased 16% to $1,500,000,000 in the quarter, primarily driven by the inclusion of our acquisitions of ION, GIA and ADS in our results. On an organic basis, SG and A increased a more modest 4% reflective of both our investing for the future and our continued focus on efficiency with GNPD and pharma in particular successfully executing against significant cost improvement projects. Overall, our efforts resulted in total company operating earnings of $719,000,000 up 19% versus last year.

Below the line, interest and other increased by $34,000,000 versus prior year to $44,000,000 due to acquisition related financing costs. Interest and other finished better than our expectations due to several factors, including the strong cash performance and the quarterly revaluation of our company's deferred compensation plan, which as a reminder is offset as an expense in corporate SG and A above the line. Our fourth quarter effective tax rate was 26.3%, 1.7 percentage points higher than the previous year and modestly higher than our expectations due to earnings mix at the state level and abroad. Fourth quarter average diluted shares outstanding were $240,000,000 2% lower than a year ago due to our share repurchase efforts earlier in the year. The net result was fourth quarter EPS of $2.08 growth of 13%.

One quick note on Q4 EPS. We acquired a majority position in GI Alliance and other physician support organizations in the back half of this year, culminating with our just announced acquisition of Solaris Health, which will not close until at least the '6. We have determined that the minority equity positions owned by physicians and management in GI Alliance, now part of the Specialty Alliance, represent a liability to Cardinal Health, whereas our Investor Day guidance assumed a non controlling interest reduction to EPS. As a result, we are showing a higher than expected EPS contribution from the Specialty Alliance in fiscal year twenty twenty five were approximately $05 more than anticipated. Moving on to our segment results, beginning with the Pharma segment on slide five.

Fourth quarter revenue was relatively flat at $55,400,000,000 Excluding the customer contract expiration, revenue increased a robust 22% driven by brand and specialty pharmaceutical sales growth from existing and new customers. This included approximately six percentage points of revenue growth from GLP-one sales. During Q4, as we have in prior quarters this year, we saw strong pharmaceutical demand across the entire business within brand, within specialty, within generics, and within consumer health. This strength came from both our largest existing customers and our new customers. Segment profit increased 11% to $535,000,000 in the fourth quarter, driven by contributions from our MSO platforms and brand and specialty products in particular.

This growth was partially offset by the customer contract expiration. At this point, I will repeat the point that we saw strong demand and volumes across the business. However, Q4 Pharma segment profit was a touch lighter than we expected due to the impact of a few individually immaterial expenses, including bad debt adjustments and the resolution of some routine contractual open items with customers and vendors. If not for these items, our results would have been above the midpoint of our Pharma profit guidance. Finally, we are pleased that our generics program continues to see positive performance, including strong volume growth and consistent market dynamics.

Turning to JMPD on slide six. Fourth quarter revenue grew 3% to $3,200,000,000 driven by volume growth from existing customers. As we saw last quarter, Cardinal Health brand continues to trend positively with over 6% revenue growth in The U. S. GNPD delivered Q4 segment profit of $70,000,000 its highest profit quarter driven by volume growth from existing customers and reflecting the team's notable progress against the GNPD improvement plan, particularly cost containment efforts.

While we continue to invest in the business and are pleased with the continued quarter by quarter significant improvements to profitability and cash flow presented by the segment, we have more work to do. The team also continued to make progress on mitigating tariff impacts, Jason will touch on shortly. Finishing with the growth businesses reported within other as seen on slide seven. Fourth quarter revenue increased 37% to $1,600,000,000 and segment profit increased 44% to $160,000,000 As we highlighted at Investor Day, these businesses are becoming an increasingly important part of our overall growth and this quarter was no exception. These growth businesses contributed over 40% of the growth in our enterprise operating earnings for the quarter.

Revenue and segment profit were driven by strong growth across all three businesses: At Home Solutions, including contributions from the ADS acquisition, Nuclean Precision Health Solutions and Optifreight Logistics. We closed the ADS acquisition at the start of the fourth quarter and are very pleased with the integration and synergy capture efforts. The At Home Solutions management team has a synergy realization plan which is specific and achievable with opportunities for over performance over time. All three businesses saw strong organic growth. These businesses continue to benefit from their leading value propositions, efficient operations and alignment with favorable long term secular trends.

Turning briefly to our full year enterprise commentary. Fiscal twenty twenty five revenue decreased 2% to $223,000,000,000 driven by the customer contract expiration. Excluding the contract expiration, full year revenue increased 18%. Gross margin increased 10% to $8,200,000,000 while SG and A increased 8% to $5,400,000,000 reflecting the acquisitions and our continued focus on driving operating leverage. Together, this resulted in fiscal twenty twenty five total operating earnings growth of 15% to $2,800,000,000 Below the line, interest and other increased to $174,000,000 primarily due to financing costs related to acquisitions.

Our annual effective tax rate finished at 23.3. Average diluted shares outstanding were $242,000,000 2% lower than a year ago due to share repurchases. The net result was fiscal twenty twenty five non GAAP EPS of $8.24 growth of over 9%, again despite the large customer contract expiration and our significant investments for future growth. Now before I turn to fiscal twenty twenty six, let's cover the balance sheet. For fiscal twenty twenty five, our ending cash balance was a robust $3,900,000,000 reflecting $2,500,000,000 of adjusted free cash flow driven by the strong performance of our businesses and a continued focus on working capital management across our management team.

This is an area of both further focus and further opportunity. Now let's look forward to our updated fiscal twenty twenty six guidance. Before I start, a reminder that our fiscal year twenty twenty six guidance does not yet include the benefit of Solaris Health. While we expect the acquisition to be slightly accretive to EPS within the first twelve months post close, as is our practice, we will update guidance following the close of that acquisition. Today, we are increasing our fiscal year twenty twenty six EPS guidance to a new range of $9.3 to $9.5 which reflects growth of 13% to 15%.

This is a $0.20 increase from the guidance provided at Investor Day, driven by the benefit to net earnings of the liability classification I referenced earlier, as well as increased contributions from Pharma and increased contributions from our other growth businesses. Slide 15 shows our updated fiscal twenty twenty six outlook for our segments. Beginning with Pharma, on revenue we continue to expect an increase of 11% to 13% as we annualize the new customer wins we had in fiscal year twenty twenty five in the 2026 resulting in an approximate $7,000,000,000 revenue tailwind. For Pharma segment profit, we are raising our guidance and now expect between 1113% growth. We are expecting 2% to 3% generics market volume growth and continued consistent market dynamics in our Red Oak enabled generics program.

In Specialty, we're expecting double digit revenue growth, including in our higher margin biopharma solutions business, where we expect at least 20% revenue growth fueled in part by the strong momentum in our Synexis hub that Jason will touch on shortly. We anticipate strong growth in our MSO platforms and increasing contributions from biosimilars. With respect to the MSO platforms, we can now confirm that Cardinal Health will be picking up distribution for the Specialty Alliance gastroenterology portfolio starting in April 2026. We've also begun transitioning the oncology distribution tied to Ion with the majority of volume shifting over during Q2 of this year consistent with the expiration of existing agreements. Additionally, with respect to the evolving policy environment, we remain confident in our resilient business model that creates tremendous value for The U.

S. Healthcare system. In terms of Pharma segment profit cadence, we anticipate first half growth to be a bit stronger than second half growth driven by the annualization of new customer wins from fiscal twenty twenty five and the acquisitions of GIA and ION. Nevertheless, Q3 will remain the highest dollar profit quarter as it has been in prior years. Moving on to GNPD.

On the top line, we are updating our guidance to growth between 24% aided by low single digit utilization growth as well as accretive Cardinal brand growth. On the bottom line, we continue to expect segment profit of at least $140,000,000 which continues to assume a net $50,000,000 to $75,000,000 headwind to our results in fiscal twenty twenty six from tariffs. While the tariff environment continues to evolve, we are not communicating any changes to our exposure or actions today. In addition to market growth and modest increases in Cardinal Health brand penetration, our results will continue to be aided by ongoing execution of simplification and cost optimization projects in our distribution operations, in our manufacturing operations and in our central functions. In terms of cadence, we expect GNPD segment profit to be weighted to the second half of the year as we've seen in both fiscal twenty twenty five and fiscal twenty twenty four driven by seasonality and the timing of tariff mitigation.

We expect this profit split to be roughly one third in the first half and two thirds in the second half, and Q4 should again be the high point of the year. Q2 is the quarter in which the earlier rounds of fiscal year twenty twenty five tariff expenses will be realized. As a result, that quarter may have the lowest profit in absolute dollar terms. Turning to our other growth businesses. We continue to expect robust revenue growth of 26% to 28% and profit growth of 25% to 27%, but on top of a higher jump off point relative to our Investor Day expectations.

This reflects contributions from ADF and continued strong demand overall. Altogether, we expect normalized profit growth of approximately 10% on an organic basis. In At Home Solutions, we will benefit from our ongoing distribution capacity expansions and automation efficiencies, double digit revenue growth and the integration of ADS' distribution volumes. In Nuclear, we expect above market core growth and approximately 20% growth from Pet and Theranostics, while investing in additional capacity to service the substantial pipeline in areas like oncology, urology and neurology. In Opticrate Logistics, the team will drive strong core volume growth as well as incremental growth driven by our expansion into the hospital pharmacy.

With the ADS acquisition having closed at the start of our Q4, our growth rates will be strongest in the first three quarters until we begin lapping the acquisition in Q4. Stepping back, we feel well positioned to deliver another strong year of operating earnings growth. Moving below the line, we expect interest and other of about $275,000,000 driven by a step up in interest expense from the annualization of our acquisition debt financing. Our interest expense guidance does not yet take into account the anticipated financing costs for our proposed acquisition of Solaris Health. Cardinal will fund the cash component of the purchase price through a relatively even mix of new bond financing and use of cash on hand.

We will provide more details upon closing, but recall that I commented that the deal should be slightly accretive in the first twelve months. We continue to expect our fiscal year twenty six effective tax rate to be in the range of 22% to 24%. As announced at Investor Day, our new baseline of annual share repurchases is $750,000,000 which we are confirming even with the assumed closure of the Solaris Health acquisition during the year. This leads to diluted weighted average shares outstanding between $238,000,000 and $240,000,000 for the year. Finally, we expect fiscal twenty twenty six adjusted free cash flow between $2,750,000,000 and $3,250,000,000 driven by our growing profit, improving working capital efficiency and lapping of the customer unwind last year.

Our strong cash flow generation will enable us to delever back to our targeted leverage range of 2.75x to 3.25x adjusted gross debt to EBITDA by the end of fiscal year twenty twenty six even with the Solaris acquisition. To close, fiscal year twenty twenty five was a terrific year showcasing the resilience and power of our enterprise. As we embark on building upon our growth, we are well positioned with strong cash flows and a robust balance sheet to support our strategic plans. We look forward to updating you on our progress throughout the year. With that, I will turn it back over to Jason.

Thanks, Aaron. Now let's take a closer look at our strategic progress across the businesses. Our Pharmaceutical and Specialty Solutions strategy centers on strengthening our core and expanding in Specialty, both of which are essential for unlocking long term value. Our execution of this strategy was evident in our strong fiscal twenty twenty five performance. Our focus on customer experience continues to be a key differentiator.

In fiscal twenty twenty five, as we previously confirmed, we successfully onboarded new customers contributing approximately $10,000,000,000 in new business and have made significant strides in streamlining and accelerating the onboarding process. Our sustained core distribution growth has allowed us to finalize our multiyear plan for expanding and modernizing our distribution footprint. We are making great progress on our multistate search for our new fully automated pharma distribution center as we announced at Investor Day. Our new consumer health logistics center, the first of its kind hub for consumer health and over the counter healthcare products, has successfully launched and is now fully operational. These strategic investments, along with the modernization of our core technology platforms, enhance the service and capabilities we can provide to customers and support our long term growth trajectory.

This includes our new ordering platform, Fantas HQ, where we continue to seamlessly migrate customers offering them new capabilities to create value for their business. Last month, we hosted our thirty third Annual Retail Business Conference, the largest in the industry, signaling our continued strong role as a trusted partner to retail pharmacies through our commitment to providing solutions, consultative support and advocacy. As an example, during this year's conference, we announced the formation of our One Voice initiative to support state advocacy efforts for independent pharmacies, reinforcing our commitment to their success and the vital role they play with patient care in their communities. Turning to specialty, which remains central to our long term growth strategy and was again a meaningful contributor for the quarter. We continue to see outside opportunities to drive significant value with a long runway for future growth ahead.

Today's announcement of the acquisition of Solaris Health and the recent momentum we've seen with the Specialty Alliance and Navista are clear indications that we are well positioned to grow the impact of our MSL platforms across three related high priority areas: autoimmune, urology, and oncology. These therapeutic areas continue to benefit from robust product pipelines and ongoing innovation efforts, but importantly in the areas of autoimmune and urology also provide diverse revenue streams for our MSO platform due to the breadth of ancillary services such as pathology and laboratory testing, administering anesthesia, and diagnostic imaging. In addition, Solaris Health further bolsters the strength and resiliency of this business model by adding scale and expanding our reach to patients and providers in new communities. As the nation's leading urology MSO, Solaris Health adds over seven fifty providers across 14 states to the Specialty Alliance led by Doctor. Jim Weber and solidifies our leadership in the urology therapeutic area.

Coupled with the acquisitions of Urology America, Potomac Urology, and most recently Academic Urology and Urogynecology, our Urology Alliance team will be better positioned to meet the comprehensive needs of community urologists and even more communities through the robust combined capabilities of the Specialty Alliance, Cardinal Health, and Specialty Networks. Our comprehensive suite of services empower physicians so that they can spend their time where it matters most, caring for patients with the absolute highest standards of care. In addition to Solaris Health, we continue to attract providers for our MSO platforms and we're pleased to add additional providers to Navista. Of note, the expansion of our MSO platforms, including the Specialty Alliance and Navista, positions us to support approximately 3,000 providers across 32 states following the completion of the Solaris Health transaction. Additionally, we have seen strong and growing demand across our upstream biopharma solutions businesses, expecting 20% revenue growth in fiscal twenty twenty six and beyond.

This includes our SYNNEXIS patient access business, where the team's excellent patient and provider experience is leading to 40 expected launches in calendar year 2025, growth of over 30% driven by our investments in product innovation and technology. This success is due to the implementation of our next generation hub that is digitizing and automating the patient support process, which combined with our team of experts is getting more patients on therapy faster, helping them stay on therapy longer and driving great feedback from our manufacturer partners. We plan to share more on this in the coming quarters. We've also seen momentum with Specialty Networks data insights platforms, PPS Analytics and Sonar. These platforms leverage advanced AI capabilities to abstract and curate patient information from unstructured data.

This enables the creation of a comprehensive three sixty degree patient view, empowering healthcare professionals to make clinically appropriate decisions for optimal patient outcomes. Specialty Networks platforms were recently launched into oncology and the strategy is resonating evidenced by the first signed oncology customer agreement this quarter. Turning to GMPD, which delivered operational and profit improvements in Q4 and fiscal twenty twenty five, reflecting the continued progress we're making against our improvement plan initiatives. In addition to our cost optimization efforts, we are also encouraged by the stronger growth of our Cardinal Health branded products with another quarter of strong volume growth in The United States. Our team continues to prioritize the execution of our plan focused on customer service, product availability and innovation of our product portfolio to meet the evolving needs of our customers.

During the quarter, we launched the Kendall DL MultiSystem, a multi parameter single patient use monitoring cable and leadwire system that enables the continuous monitoring of cardiac activity, blood oxygen level and temperature with one point of connection to simplify patient monitoring and drive efficiencies for providers. As it relates to further details about the impacts of tariffs, our views remain largely unchanged since Investor Day, supported by our proactive and aggressive implementation of mitigation actions to reduce the burden on our customers as much as possible. This includes increasing U. S. Manufacturing capacity, which is now our largest country of origin, proactively diversifying the supplier network and reducing our dependency on higher risk jurisdictions.

We've also implemented pricing adjustments as we previously communicated and continue to work with our customers to identify win win opportunities to help offset the impact of tariffs by growing Cardinal Health brand penetration. And now closing with our other businesses. With strong performance and execution across each of these three, momentum is accelerating and we continue to view these businesses as a high potential engine of growth. Nuclear and Precision Health Solutions continues to outpace the market, driven by our highly differentiated offerings, leading positioning and early investments. We are strategically expanding our PET cyclotron capacity in 11 key markets and enhancing our Center for Theranostics advancement to support a strong pipeline of products targeting oncology, urology and neurology.

We continue to see strong demand for Theranostics products, which grew revenue over 30% in fiscal twenty twenty five. Notably, the urology portfolio of products that we support, which includes both diagnostic and therapeutic PSMA drugs for prostate cancer, experienced even greater growth. Recently, we've seen momentum for certain radioligand therapies to move earlier in the regimen of treatment in advance of even chemotherapy, which is exciting for patients and a long term opportunity for our business. Furthermore, we are uniquely positioned to support our specialty strategy, benefiting from significant customer and product overlap in therapeutic areas like oncology as well as urology, where we are establishing a leading position. In At Home Solutions, our investments in distribution capacity and automation are yielding tangible results.

Q4 revenue grew nearly 50% and double digits on an organic basis, significantly outpacing the increase in our freight and warehousing costs. This includes strong growth in urology products, which grew revenue over 20% on the year. We are continuing our investments with a new state of the art distribution center on the West Coast planned to break ground in fiscal twenty twenty six. This facility, like our new facilities in Texas, South Carolina and Ohio, will leverage the latest robotics and technology to further enhance supply chain efficiency, quality and employee safety beyond the record levels we've seen to close this fiscal year. We anticipate continued growth fueled by the secular tailwinds in home health care and synergies from the full integration with ADS.

This integration positions us well to build on this year's momentum and manage through potential changes in the reimbursement environment. ADS excels in multichannel patient acquisition and user experience, leading to exceptional patient retention and customer satisfaction. Our strong operational foundation will support ADS and enable us to achieve greater growth and operating leverage. We've already begun transitioning the ADS volume into our DC network and we expect full conversion by the end of Q1. Optifreight Logistics continues to demonstrate its value, providing strategic logistics support to our customers as an extension of their teams.

Thanks to ongoing investments in our proprietary technology driven platform, TotalView Insights, we continue to see long term potential to deliver cost savings, transparency and operational efficiency for customers. Our efforts continue to resonate with the market with the renewal of some notable key contracts in Q4 as a direct reflection of our leading value proposition. In summary, I'm pleased with the progress and execution across all five of our operating segments. Our strong results speak to the strength of our foundation, the talent of our teams and the consistent demand for value we bring to the market. We've accelerated our momentum and are well positioned to carry it forward.

We'll wrap up in a moment and take your questions, which I know will include the current and anticipated regulatory environment. While this remains fluid, we continue to be confident in our resilient business model across the enterprise and continue to believe that policymakers and stakeholders are aligned with our goals of increasing access, affordability and innovation in healthcare. We are uniquely positioned to support these efforts with the products and services that are absolutely indispensable to our customers and patients. We work tirelessly to provide fantastic service and significant benefit for the margin we earn and are confident these capabilities will continue to be valued. As we enter fiscal twenty twenty six, we are operating from a position of strength.

We remain focused on executing our strategy, serving our customers and patients and delivering value creation and look forward to the year ahead. And with that, we will take your questions.

Thank you much, sir. Very first question today is coming from Lisa Gill calling from JPMorgan. Please go ahead.

Thanks very much. Good morning, and thanks for all the detail. I just have a numbers question. If I look at the updated guidance for the Pharmaceutical and Specialty Solutions division, it's up by 100 basis points. And Erin, I think you talked about $05 coming from the change in NCI, so that'd be about half of that. Can you talk about where

I'm very sorry, but it appears that her line just dropped. Okay. We'll just wait for her to dial back in. But so please go ahead, sir.

I'll proceed. Thank you. Lisa, thank you for the question. You're right to call out that we did raise our guide for the year by $0.20 and roughly half of that is tied to the liability classification and roughly half of that is tied to higher expectations for both Pharma and the other business. It's a higher percentage of a lower base in Pharma and the same percentage of a higher base in other.

And so we are pleased with what we saw in Q4. As you know, I took from Jason's and my comments on the demand we're seeing across the business and that's reflected in our raise to the guide. Next question please.

Yes, sir. Our next question will be coming from Alan Lutz of Bank of America. Please go ahead, sir.

Good morning, and thanks for taking the questions. One for Aaron. SG and A was up a bit quarter over quarter. And know there's a lot of moving pieces here. You just said the closing of ADS.

There's some R and D investments you talked about at the Investor Day. But can you talk about or frame the high level drivers of that quarterly step up? Then how we should think about SG and A heading into fiscal twenty twenty six? Thanks.

Really appreciate the question. First, I want to point out that we actually saw gross margin improvements as well. And so we're pleased with the benefits we're seeing really across the mix of the business, whether it's product, customer or part of the business. SG and A is really a story of us investing for the future, offset by extensive efforts to simplify and optimize our operating costs. But you're right, are making investments in technology, etcetera, that's hitting expense.

But I do want to point out that the vast majority of the increase in SG and A is tied to the inclusion of the recent acquisitions. And as you can imagine, when you have acquisitions, we also have synergy opportunities that develop over time. And so we see opportunity there as well. Next question, please.

Yes, sir. The next question will be coming from Elizabeth Anderson of Evercore ISI. Please go ahead.

Hey, guys. Good morning, and thanks so much for the question. Maybe just to follow-up on what Alan was asking. Can you just confirm that when you were talking about the things that moved the pharma numbers versus I think your expectations of above that high end of the AOI guide for 4Q, you just talked about bad debt and routine contractual items. That does not include those items do not include the things you called out in your Investor Day about like the consumer health logistics center, MSO investments.

And then two, could you maybe double click a little bit more on the pharma AOI guidance increase in sort of the specific drivers that kind of caused you to go from your prior guide of, you know, a month and a half ago to the new guide? Thanks.

Let me take it in reverse order. What I would observe is we are really pleased with the Pharma business performance in the fourth quarter and indeed for the entire year. And while the numbers came in a little bit lighter than what we had expected when we issued our updated guidance three weeks before the end of the fiscal year, the practical reality is we are seeing strong demand really across the business and that was why we were comfortable raising our guide for next year for Pharma as well. And then on your point about the what led to the Pharma results for Q4, there were a number of individually immaterial items like bad debt, some contract resolution points with vendors and suppliers that aren't terribly exceptional. They were individually immaterial and they all happened at our as we approach the year end.

And so I don't want people to read too much into it. What you should focus on is the we are seeing across the business, from a go forward perspective.

Yeah. And the only thing I'd add within that is, when you dive down deeper into all the different KPIs, metrics and operational performance of not only the pharma business, but the rest of the enterprise, it's reflective of these updates that we saw confidence in that. We have a lot of momentum exiting fiscal twenty twenty five that we expect to continue into fiscal twenty twenty six. And that increasing confidence allowed us to tweak that up just a little bit.

And Elizabeth, those items did not include the investments that you referenced either. Next question please.

Yes, sir. Next question is coming from Michael Cherny of Leerink Partners. Please go ahead. Your line is open, sir.

Good morning and thanks for taking the question. Maybe if I can just dive in a little bit on the gross profit performance in the quarter. You talked about the margin expansion. Obviously, some of that is mix driven because of MSOs. How are you thinking about the gross margin trajectory you're seeing within your core distribution business?

And what are some of the moving pieces particularly in the quarter that drove some of the performance if that did increase on an underlying basis?

We are very focused on driving profit improvement across the enterprise. And so we look at it on a total enterprise and total business segment perspective. And so while I'm not going to comment on the gross margin elements just to the core distribution business, I do want to point out that our emphasis on specialty distribution, which is a higher margin business growing double digits, our emphasis on the additional revenue streams coming out of our MSO acquisitions like Solaris. All of those things are helpful to our overall gross profit profile. And of course, we can't lose sight of the rapidly growing other parts of the business, the nuclear precision health, the at home, the Optifreeze, etcetera, those are also helping our overall profit profile. Next question, please.

The next question will be coming from Erin Wright calling from Morgan Stanley. Please go ahead.

Great. Thanks. So I'll switch to GMPD. And just more broadly, what are you seeing in terms of utilization trends across the segment? And then on the tariff front, I think you said no change to your expectations there.

But just speak to how maybe some of the mitigation efforts are playing out relative to your expectations on that front. You spoke a little bit about that quarterly cadence. Is that how you were thinking that it would play out for the year? And just can you kind of remind us, how meaningful of a component is some of the mitigation efforts around price increases across that segment? Thanks.

Sure. Yeah. Sure. Overall, there's not a lot of new news as it relates to the GMPD business overall, whether we're talking utilization that remains, relatively consistent. We've always said we're targeting, the overall market growth and then a little bit of extra as it relates to increasing the penetration of our Cardinal Health branded products and that's exactly what you saw in the quarter.

So not much is changing there within the tariff also not much is changing there. Absolutely there's some puts and takes in terms of the different changes to the tariff rates by country, but they've been relatively small in that regard. The overall aggregate gross impact as it relates to the tariffs remains in that around $450,000,000 that we've referenced before. We continue to anticipate that we can mitigate $250,000,000 to $300,000,000 of that. So up to two thirds of that we are working through operational mitigation actions that do not impact either us or our customers.

And it's that remainder then the 150,000,000 to $200,000,000 that we're working through part of that is included in this guidance. That remains also the same of that 50,000,000 to $75,000,000 And then the remainder is in the form of pricing that we only take as a last resort for those items that are under particular pressure and are unique to where it's sourced that we feel that's appropriate. So we'll continue to work that. What's really important is that when we had the incremental inflation three years ago or so three, four years ago, we it took us about three years to get to a run rate that was acceptable. As it relates to this, we're targeting trying to get our run rate to be back to much closer to parity as we exit fiscal twenty twenty six and we're making really good progress on that.

I'll turn it over to Aaron here to walk through a little bit more on the cadence as it relates to how to think about, all this over the course of fiscal twenty twenty six.

Sure. Thanks, Jason. Hi, Aaron. Look, Jason and I are really proud of what the GNPD team has accomplished this year. And for them to deliver a 70,000,000 profit number in Q4, is an excellent result for that business given how it's evolved over the last couple of years.

From a quarterly cadence perspective though, I do want to point out that in each of fiscal year twenty twenty four and 2025, they were very back half weighted years and that's what we anticipate happening again in fiscal year twenty twenty six. In my prepared remarks, I called out that we expect the profit to be roughly one third H1, two thirds H2. Q2 is probably going to be may well be the lowest low point from an absolute dollar perspective because of when we'll realize the impact from the early rounds of tariffs as well. And Q4, again, we expect to be the high point of the year. And so very similar profile to the last two years as we look from a cadence perspective as we look ahead. Next question, please.

We'll now go to Eric Percher of Nephron Research. Please go ahead.

Thank you. Question on Solaris. So I think at seven fifty providers, this is about double what you started with not so long ago. I know you've been adding. So I'd be interested to hear what they may be adding in terms of capabilities or opportunities versus what you're adding.

And then, Aaron, what what I'd ask you, I know we don't have accretion beyond the initial view, but what is your view on where accretion will ultimately come from relative to the MSO share versus distribution versus new revenue streams?

Okay. So let let me go ahead and start, and then Aaron can get clean up here afterwards. So really pleased with the the partnership and acquisition we see here with Solaris. It fits very well to what we laid out at Investor Day. You're right, Eric, that this is 750, providers, and you add it to the other recent acquisitions in urology for, you know, Urology America, Potomac Urology, and Academic Urology, Urogynecology.

Those combined to nearly a thousand providers with within urology. And and specifically, what what are we bringing, the Cardinal Health side, urology is a real sweet spot for this enterprise. When you think about our leadership and our strengths across the enterprise, so much of it, fits well within autoimmune and urology, which is why we laid out the strategy we did. Think Specialty Networks, you know, our first acquisition in the specialty space in quite some time, nearly, now, what, two years ago. They were born and their strength remains in urology while they're expanding quickly into other therapeutic areas like oncology.

Think about our nuclear business, long known for strength and leadership in oncology, but, urology is more and more an area of strength and growth. As you heard this quarter, we're growing our Theranostics business more than 30% and even faster in the urology space. At Home Solutions, it's a real strength. We have a key role within delivering those urology products to people's homes and then, of course, the the addition of all that. So we we really like, how it fits into our portfolio.

And with when you think about what they're bringing beyond 750 fantastic, specialty providers, especially physicians and providers throughout The United States, what they're able to bring is that very diverse revenue stream. So while there's a drug component spend, to this, it's pretty similar to the ratios we've talked about before. So this is an additional $1,000,000,000 of revenue and less than a third of that being in the drug spend. And so that real breadth of revenue and strength of providers fits nicely into the MSO structure that we have at GI Alliance. A lot of those capabilities will carry over.

This will be managed by a common leadership team. But having a very specific focus on the urology space to ensure that those physicians have the added attention and specialization they need for for their practices. So what did I now miss?

Let let me, offer up a couple additional insights. First, some data points for you, Eric. Jason called out the revenue for Solaris being about a billion and a half dollars. You know, from a modeling purpose for modeling purposes, you assume EBITDA of, call it, a $125,000,000. We've got some questions on purchase price.

Our cash out the door will be $1,900,000,000. As you see in our press release, that we get about a 75% stake. The enterprise value or transaction headline value is $2,400,000,000. And as we call that, we will, fund, our portion of that through a combination of cash on hand, you know, as well as some incremental, financing that will follow in coming days, and we expect to close it by the end of the year. Last thing I observed, really to build on Jason's point about accretion, it's coming from a couple of different places.

One, scale. Right? This is the fifth business now that is urology, MSO related. That'll be part of our portfolio. We have and we have efficiencies across the various businesses that are being added to the specialty alliance, the urology alliance, part of the specialty alliance.

And don't forget, there are also opportunities across the Cardinal portfolio as well. We started our acquisition efforts in support of our strategy by acquiring Specialty Networks, which had a very strong urology platform as well. Next question, please.

Yes, sir. Thank you. We'll now move to Kevin Caliendo of UBS. Please go ahead.

Hey, guys. Just wanna confirm one thing. On the the noncontrolling interest, is that being added back to AOI, or is that just 5¢ less below the line? I'm just trying to understand if it actually impacts the operating income, the change of accounting on this, actually changes the operating income increase in guide in the pharma segment or not. It was just unclear to me.

The liability classification, is exactly what we called it, so it will adjust.

But but no no direct impact to the, above the line operating income. Next question, please.

Yes, sir. Next question will be coming from George Hill from Deutsche Bank. Please go ahead.

Hey, guys. And I appreciate the question. Aaron, can you walk us through, I guess, two things I wanted to follow-up on, I think, was Kevin's question on the accounting treatment. And are there any marks on the liability that will run through the income statement in future periods? Kind of like what's the offset for the NCI going away?

And are you able to quantify the value of the assets from specialty networks, either from a revenue or earnings perspective that are being contributed to the new JV that you guys will own 75% off?

On your last point, specialty networks is not being contributed into the broader whole. It's a core part of our operation. And indeed, as we've highlighted on earlier calls, specialty networks has, become a much larger piece of the overall, you know, cardinal profile. If I could jump in there to make sure

I connect all the dots. Mike, when I was referencing what we bring to the relationship with Solaris Health, it's we bring these capabilities. We're not contributing anything to that business. It's it's the broader infrastructure of everything that we have as it relates to what specialty networks brings, which we bring for distribution, and what what we bring more broadly with the relationship with GI lines, is now the specialty lines going there.

Right. And then with respect to the liability classification, I think you just heard me call out that from an update to our overall guide perspective, we raised it by $0.20 and roughly half of that is tied to the liability classification, half of it is tied to our expectations for the underlying new business. You will see further details in our 10 ks, which we encourage you to take a look at. And if you have more questions on that, Matt and team are happy to take them. Next question, please.

Yes, sir. The next question will be from Daniel Grosslight of Citi. Please go ahead. Your line is open, sir.

Hi, guys. Thanks for taking the question. Can you talk about some of the potential pricing headwinds in Home Solutions? Particularly, I'm thinking about competitive bidding coming back maybe in a couple of years from now. Can you just help size what percent of your at home revenue is subject to competitive bidding and how you're thinking about, potential CGMs and pumps being included in that program? Thank you.

Cardinal Health (CAH) Q4 2025 Earnings Call Transcript

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