BrightSpring Health Services, Inc.

Hello, and thank you for standing by. Welcome to Bright Spring Health Services, Inc. First Quarter 2026 Earnings Conference Call. At this time, all participants are on a listen-only mode. After the speaker's presentation, there will be a question and answer session. To ask the question during the session, you will need to press star 11 on your telephone. You will then hear an automatic message advising your hand is raised. To withdraw your question, please press star 11 again. We ask that you limit yourself to one question and one follow-up. I would now like to hand the conference over to David Deichler. Please go ahead.

Good morning. Thank you for participating in today's conference call. My name is David Deichler with Investor Relations at Bright Spring. I'm joined on today's call by John Rousseau, Chief Executive Officer, and Jen Fitz, Chief Financial Officer. Earlier today, Bright Spring 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 and 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 and 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 conditions. 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 John Rousseau, Chief Executive Officer.

Good morning, everyone, and thank you for joining Bright Spring's first quarter of 2026 earnings call. I'd like to start by thanking everyone at Bright Spring 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. Bright Spring 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 one-third 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 and 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 and Medicis 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. Bright Spring 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 Civita 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 pay down 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 2.27 times as of March 31, 2026, which declined from 2.99 times as of December 31, 2025. Proforma leverage on March 31 was 2.40 times 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%. And in Q1, 65 home health locations were named a best home health provider by US News and World Report. In hospice, quality measures remain well above national average, with significantly more visits provided, a top 5% ranked hospice program in the US, 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%, and on-time delivery was 96%. And in infusion, our patient satisfaction score was 94%. 97% of discharges were due to completion of therapy, and importantly, we saw recent improvements in both acute and specialty turnaround times near internal goals aimed at best in class. And specialty pharmacy demonstrated a consistently high medication possession ratio of 92.1% in the quarter, along with time to first fill of 4.6 days, both much better than national average. I'd like to close by emphasizing that Bright Springs' 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. Bright Springs' 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, John. 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 and 10Q, to adhere to accounting standards required on an interim basis. As such, all Bright Spring 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 solution 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 to 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 John 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 first 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% of 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 2.27 times as of March 31, 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 John 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 to $15.225 billion including pharmacy solutions revenue of $12.85 billion to $13.3 billion, and provider services revenue of $1.875 billion to $1.925 billion. This revenue range reflects 14.1% to 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 to $825 million for full year 2026. This would reflect 28.7% to 33.6% growth over full year 2025, excluding community living in both years. Included in total adjusted EBITDA is expected contribution from the emeticists and LHC assets acquisition of approximately $30 million. I will now turn it back to John.

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

Thank you. Ladies and gentlemen, as a reminder to ask the question, please press star 11 on your telephone, then wait for your name to be announced. To withdraw your question, please press star 11 again. Please limit yourself to one question and one follow-up. Please stand by while we compile the Q&A roster. Our first question comes from the line of Anne Hines with Mizzou. Your line is open.

Good morning. Thank you. I just want to 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?

Yeah. Good morning, Anne. I hope you're doing well. I think pretty characteristically, we saw broad-based growth across the organization on both the provider and the pharmacy side. Provider obviously had a bit of a tailwind there from closing of the home health branches, but notwithstanding that, 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. So 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. And so 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 beyond oncology and as we've continued to focus not only on oncology, but, you know, any other therapeutic area of interest. Specifically within infusion then, you know, we did see double-digit growth on both the acute side and the chronic specialty side. So, you know, I think as we've mentioned before, we've been underweight on chronic specialty, so 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. So, it was a productive quarter with solid double-digit growth across both of those areas within infusion.

Great. Thank you. And just for a follow-up, obviously, your leverage is at a nice point after the repayment of debts. If you, or I guess one, would you be interested in large M&A? And 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. And, you know, I think we've sort of said under three times, mid twos 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 Omedesis assets, But, you know, I think we do have a little bit more flexibility, obviously, but 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 and where it makes sense or where you need licensure or CON, et cetera. You know, I think deals in that sort of mid-range or five to 10 are probably easier to do. But, you know, as we look at our pipeline right now, nothing too different than historically. And, you know, whatever we do, you know, we'll continue to be very measured. And yes, we would like to stay within that target leverage range, you know, with anything that could come up. But 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.

Thank you. Our next question comes from the line of David Larson 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. And 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. 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, and we continue to be optimistic that at some point, 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. So, 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 going to be applying to this new lead ACO program that's in the works. Applications are due in May, and We'll see how that goes. Hopefully we make it. But that business, we continue to invest in with some really good people, even here recently that we've added to the business. And I would say operationally, being able to serve these patients across skilled nursing assisted living and in the home 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. And so, you know, we're looking to next-gen ACO programs in addition to the one we're in. We had a successful year there last year, and we've never been as positive about, you know, the ability to reduce costs in very desirable care settings as we are today. So, you know, that will continue to be a passion for us internally and 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. 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. Nothing too different as we sit here today on the Medicare front writ large in terms of traditional payment programs. But I think there are 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. And 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? And 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, but 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... of about 181 million in specialty and infusion, and brand to generic conversions of about 250 million.

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

Thank you. Our next question comes from the line of Charles Rhee with TD Cohen. Your line is open.

Yeah, 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?

That is correct.

Okay, perfect. And 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 health care, home and community rev growth ex genesis was as well.

Yeah, so 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. So specialty was higher than that total infusion in the mid-teens in terms of their script growth. So really strong growth across both of those business lines. Home and community X, the uneconomic customers, did see modest script growth in the mid-single digits.

Got it. That's helpful. And then maybe just one last question. You know, we're seeing a lot of commentary from PBMs, and they're really trying to push, you know, sort of their own label biosimilars. And so there's kind of discussion of how much more competitive they're getting or at least trying to steer patients into their own sort of captive pharmacies. We'd like to understand, you know, sort of how much exposure you have to some of those dynamics and if that's something that you're seeing. And 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 products. And if you look at our infusion business, you know, still today, the majority is acute, but we look to be growing on the chronic side and we are, you know, but more from an infusible standpoint, you know, versus a sub-Q or an injectable standpoint. So, you know, we just, we don't have a lot of concentration internally that would have biosimilar risk. And on the Onco316 CareMed side, the predominant form factor is oral solids. So, I think we feel good about that. You know, last little thing on LTC, we were 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 and, you know, excluding IRA, you know, that business was up in profitability in the quarter year over year. And, you know, our hope and goal is in Q2, even with IRA, we're going to have a really strong up quarter versus last year. So some nice momentum there, too. I just wanted to add that.

I appreciate that. Thanks a lot, guys.

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

Oh, hi. Good morning. Thanks so much for taking the questions. So maybe on the infusion, if I may, so thanks for the color in terms of you guys growing double digits in both segments. And as it relates to that business, can you give us an update? And is it, you know, the quote, I guess, is coming from these 20 or so LDDs. So last time you said, you know, you had these LDDs, but you were not really participating. So it sounds like you're 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. So we've won a couple more. You know, none of those are of the exclusive or ultra narrow. One or two category is in Onco 360 and CareMed. So that's our goal. But nonetheless, nice wins. And, you know, I would say, you know, as we kind of put specialty programs in place, you know, you have to win access to the drug and 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, hubs that we provide for patients as well. So we're building that out on the infusion side. We launched IG Connect in the quarter, which is a concierge program now for all IG referrals. And 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 both the manufacturer and the patient. So we are seeing some growth there. You know, but Joanne, I think we're probably in the early stages of a several year, you know, growth focus and LVDs and infusion like we've had, you know, over at Onco and CareMed for the past decade. But but 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.

And if I may, so 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 the in this quarter, you'll be and sequentially, obviously, too. So how much is from DC new LED launches new product launches versus the generic conversions? And, you know, I'm asking, because just thinking going for 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 too much more continued gains in GP per script. I mean, I think just stability there would be very good. But overall, there were four principal drivers for the tick up there. Number one was the disproportionate growth on the specialty infusion side 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 longstanding relationships there that are really healthy on the supply side. And what we did from a purchasing standpoint has been helpful in the quarter again. And then really last, but maybe even not least, fee-for-service. That's a high gross profit margin business that we have with our hubs and our service agreements. And every time you launch a brand, you typically get some good fee-for-service commercial business out of that too. And so those were the four factors that we're all contributing to. to the gross profit per script change.

Thank you.

Please stand by for our next question. Our next question comes from the line of Jerry House with William Blair and Company. Your line is open.

Taking the questions, maybe I'll pack two here into one just as it relates to the margin in the quarter. One thing I wanted to clarify was just a mixed comment in regards to margin expansion that you showed in the first quarter. I think all else being equal, we typically assume sort of rapid growth and specialty, particularly on the branded side, could be a bit dilutive to the overall margin profile. So just wanted to make sure I kind of understood what was going on there and if the mixed dynamic had more to do with generics And then 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 all your margins that are consistent with what you showed in the first quarter. So 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'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?

Yeah, no. So for the rest of the year, I do think we have, you know, the potential for slight bills. Those things are going to be um you know you know based on our guidance range you know we have a range of 5.2 to 5.6 margins that we would expect for the year and the things that we are we are working on is continued leverage of scale uh we have a number of operational initiatives that we are we are building in place and then from a mixed standpoint as we think about the mix within each portfolio so as john mentioned we're working to drive for example chronic therapies within infusion. And so 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 AJ Rice.

Hi, everybody. Just maybe picking up on the 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?

Yeah, good morning, AJ. Excuse me. Yeah, look, I mean, I think as we've said before, you know, we did a nice job offsetting some of this IRA impact in Q1 and 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, but you get a five-inch thick patient packet and intake and infusion and take 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 ten different projects going on. internally in the organization um 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 hospice that hospitals will send their you know put their patients into upon discharge and you've got to connect to all of them and 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 but 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. And then I think a last example would be in order intake and home health. We've done a really nice job centralizing that. As some of these assets come over from and Optum, they were not centralized. And, you know, we're seeing some real benefit there already out of the gates. And so, you know, continue to invest in that team. I mean, Jen, we're up to over 20 people on 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 going to continue to be a real focus for us You know, there are, 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 underpinned by, you know, some technology systems and automation. So working hard at it, but, you know, we are seeing things proceed along the intended path as of now.

Okay, that's great. And 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. But I'm also curious about the pace of biosimilars, how biosimilars come into market has emerged. Do you see that as still the opportunity you thought it was a couple 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?

Yeah, 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 and GP that we have from it. So I think conceptually over time, you know, there's an opportunity for us to participate in that more. um you know from a baseline of it's all upside and i think that's how that's how we're thinking about it so um but you know 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 that are oral injectable we have our infusible products you know that you know we're leaning into from an ldd standpoint Those are kind of our three swim lanes of our primary products today from a specialty standpoint. We are looking just more broadly at the specialty world, any other LDDs or any other just attractive products, and thinking if it makes sense to us to participate in any other areas. So I think we will continue to try to refine our strategic assessment of your exact question this year. But 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. So, you know, hopefully as we lean into this more, you know, it could be a fourth or fifth swim lane in time. Okay. All right. Thanks so much.

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

yeah thanks uh good morning um maybe just going back to the uh the operational initiatives again um john you gave some specific examples of what you're working on there uh but if we think about i know those were a driver of some of the margin improvement we saw last year uh you're continuing to work on those this year how should we think about um the expected contribution from those in 26 maybe relative to what you saw in 25 um the savings or benefits from those you expect to be greater this year than last and 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 tack on to this question. But, 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, We've even more formalized, call it continuous improvement, if you will, into a real Lean Sigma training program throughout the organization. White, green, black belt you can get. And we've really formalized that. So 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 in the process improvement arena in the last five plus years that has generated nine figures of savings, of which a ton of it we've reinvested back into our people and into IT and technology systems. So over the past several years, we've just had, 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. And we will continue to try to drive each one of those in the future. So 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, but 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. And then, you know, as John 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 John mentioned, we have a lot of people we've been training just out in the field, hundreds of people that have gone through our White Belt and Green Belt trainings, but also making sure that as we scale that we're going back and leveraging that in our procurement initiatives. And I think that'll continue to be an important contributor as well as the volume.

Okay, great. And then 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, I think we've got 31 hub programs today, probably more service agreements than that. You know, it's growing in the 40 to 50% range year over year. You know, it's certainly not the majority of our GP contribution, you know, within our specialty business, you know, but it's, you know, it's no longer 5 or 10 million either. So, you know, it's, you know, I hesitate to get into too many details, but You know, it's a meaningful part of the business that's really important to us. And, 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.

Okay, great. Thanks and congratulations.

Thank you. Our next question comes from Alana Whitmayo with Leary Partners. Your line is open.

Hey, thanks. John, 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. And we do have some of this, obviously, drug by drug. As we talk about a lot, a proxy would be generally half of the revenue of specialty drugs goes through the SP channel. And then, you know, what is your share from there? You know, we, 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 going to get, you know, a hundred or, you know, 50, 60, 70% market share of that specific drug. So as more drugs have gone exclusive and ultra narrow, just given the service that we've been able to provide, you know, that will pick up your market share. You know, you do have to go drug by drug ultimately. But 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. And then 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. So, you know, I think we'd like to believe our performance on the conversion side is really strong. But, 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, but we do feel like it is continuing to ebb up.

That's helpful. Corporate costs was up maybe a little bit more than we thought. 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. So 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 pickup 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. But I would say not a significant pickup at this time is our best view.

Okay, thanks.

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 Gilmore with KeyBank. Your line is open.

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 brands and generics across the organization. And 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. The market's real dynamic. But from a generic standpoint, the playbook 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 have access to the supply where needed as well. So I would just say it's a strategy that we continue to try to refine over time. It's multifaceted in terms of being able to execute against it. And as we look out to the next two years in particular and then another five years, there's still a healthy stream of drugs that will be coming up on their patent expiration date and converting generics. But We're always looking to grow a product portfolio in the most broad and holistic way possible across all therapy types.

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

Hey, good morning and congrats. John, maybe just a question on the business, right? Is it related to the defensiveness of it or how do you think it could be resilient against any PBM moves in light of the challenges that 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. So just curious how you're thinking about the strategy around defending the both of your business.

Thanks. Yeah, 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. And, you know, look on the Medicare side, there's rules and, you know, any willing provider, you know, for example, but, you know, we're big believers that inpatient choice and member choice, and they should be able to receive the provider that they want. So, you know, we try to be a high quality provider and we try to provide, um you know the best service possible to to everybody's members out there and 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 solo with cjs securities your line is open

Great. Good morning. Congrats. Also on the good quarter. Just quickly on the pharmacy solutions, that grew about 25% in the quarter. The kind of midpoint of guidance sort of mid-teens, is the difference going forward, is that an increase in IRA and more branded conversions, or is it a little sense of conservatism, or what kind of drives a little bit of a slowdown there?

Jen, you want to hit that?

Yeah, so I would say, you know, it really is related more to the year over year growth and the quarterly sequential growth we saw in 2025. So really, as we think about the remainder of the quarters, while we do expect sequential growth, both in terms of revenue and EBITDA, we see that as being much more balanced in terms of quarter over quarter growth.

Thank you. Our next question comes from the line of Stephen Baxter with Wells Fargo. Your line is open.

Yeah, hey, thanks for the question. I just want to follow up on some of the kind of the efficiency conversations we've been having today. I guess specifically looking at the pharmacy business, you've held SG&A in a really tight range for the past couple of years, and I think you've gotten leverage on SG&A, I think, in all 20 quarters that we have in our model. As we look at this quarter specifically, it looks like SG&A stepped up like $40 million sequentially or something like 40% quarter over quarter. So we'd love to just understand a little bit better, like what is driving that sequential increase? Is there anything that's, you know, one time or kind of unusual to flag? And then as we think about, you know, what this money is actually being spent on, how to think about like kind of the growth profile or the returns that you'd expect to get on this kind of what seems like pretty meaningful platform spend over time. Thanks.

Yeah, so maybe I'll start, and John, if there's anything else you want to add. So from a Q1 perspective, there were a number of investments we've talked about in terms of IT and other areas. Those were certainly contributors from a cost perspective in the quarter. But we also continue to invest for growth in terms of sales force across our different businesses, a number of other areas. So we've talked about, you know, as we're investing, we're always thinking about how can those investments drive growth next year and two years and three years from now? So we did have a number of investments there. There certainly were commissions and other things that related to the strong sales growth and other areas that did drive that. But I would say the largest impact were those investments, including into our sales force and other areas throughout in the quarter.

Thank you. Our next question comes from the line of Aaron Wright with Morgan Stanley. Your line is open.

Thanks for squeezing me in. So I hate to belabor the topic, but just since we're getting a lot of inbound questions on it, I just wanted to dig into the PBM dynamic just a little bit more on private label. It just seems more dedicated to sub-Q, but are you seeing any changes in reimbursement now on the infusion side versus sub-Q? And when you when the sub-Q does launch and how do you kind of think about the scope of the private label right now? Does it broaden at all over time, just given some of the traction that they've seen so far? And I guess, how do you think about the relationship with payers and PBMs and any potential conflicts of interest that could arise? And I don't think you give a generic penetration rate, but like what percentage of that, you know, could be exposed to some of this competition over time? I'm just trying to reconcile with that. Thanks.

Yeah, I think as it relates to any of the private label stuff, we just don't have a lot of volume or exposure to those sort of relevant products or situations today. And anything we're seeing or experiencing from a payer or PBM standpoint, I would just say is very consistent. We're not We're not seeing any big changes or big moves as it relates to our agreements or our products.

Thank you. Ladies and gentlemen, I'm showing no further questions in the queue. That concludes today's conference call. Thank you for your participation. You may now disconnect.