BrightSpring Health Services, Inc. Q3 FY2025 Earnings Call

Good afternoon. Thank you for participating in today's conference call. My name is David Deuchler with Investor Relations for BrightSpring. I'm joined on today's call by Jon Rousseau, Chief Executive Officer; and Jen Phipps, Chief Financial Officer. Earlier today, BrightSpring released financial results for the quarter ended September 30, 2025. 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 as well as our quarterly report on Form 10-Q that will be filed with the SEC, including the specific risk factors and uncertainties discussed in our Form 10-K and Form 10-Q. Such factors may be updated from time to time in our periodic filings with the SEC, and we do not undertake any duty to update any forward-looking statements, except as required by law. During the call, we will use non-GAAP financial measures when talking about the company's financial performance and financial condition. You can find additional information on these non-GAAP measures and reconciliations of our non-GAAP financial measures to their 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. And with that, I will turn the call over to Jon Rousseau, Chief Executive Officer.

Good afternoon, everyone, and thank you for joining BrightSpring's Third Quarter 2025 Earnings Call. First off, I would like to thank all of our BrightSpring employees in the field and in administrative support roles who make a real impact for patients and people every day. I'm grateful for their continued dedication and commitment to providing high-quality and compassionate care and services to the individuals we serve. BrightSpring is a leading health services provider in home and community settings in large and growing pharmacy and provider markets, and we believe a scaled platform in home and community health care differentiates and positions us well for the future. Today, we reported third quarter financial results that are in line with the preliminary financial results we announced on October 20. The third quarter exceeded our expectations and our ongoing commitment to high-value and high-quality services, operational execution, and continuous improvement, all hallmarks of our company culture, have driven the financial results so far this year. Before discussing BrightSpring's third quarter performance, I would like to remind you that the company's financial results and 2025 guidance pertain to the continuing operations and do not include results from the Community Living business. At this time, we now expect the Community Living divestiture transaction to close in the first quarter of 2026, which remains subject to final federal regulatory approvals and typical closing conditions. For the third quarter, BrightSpring revenue grew approximately 28%, and adjusted EBITDA grew approximately 37% versus last year's comparable quarter. Total company revenue was $3.3 billion, with Pharmacy Solutions revenue of $3.0 billion, increasing 31% year-over-year and provider services revenue of $367 million, increasing 9% year-over-year. Total company adjusted EBITDA of $160 million in the quarter grew 37% compared to the same period last year, driven by strength across the businesses. EBITDA margin for the company was 4.8%, which grew approximately 30 basis points compared to the third quarter of last year and up 30 basis points versus the second quarter. Margin expansion was primarily driven by disciplined operating expense management and a modest revenue mix shift within pharmacy with greater contribution from generics. On cash flow, the company realized over $100 million of cash flow from operations in the third quarter, and leverage declined to 3.3x at the end of the quarter sooner than previously communicated expectations with an updated goal of 3x by year-end as is and below 3x pro forma for both the Amedisys and LHC Home Health branch acquisitions and the Community Living sale. The company continues to deliver growth, reflective of each business line executing on our internal goals. Given the third quarter update today and current expectations for the fourth quarter of 2025, we are increasing total revenue and adjusted EBITDA guidance for 2025. A week ago, in the October 20 release, we increased our adjusted EBITDA guidance to a range of $605 million to $615 million, which compares to $590 million to $605 million communicated in August following our second quarter results. As a reminder, this 2025 guidance excludes Community Living and any M&A activity not yet closed. We continue to expect the Amedisys and LHC branches to close later this quarter and expect this to be immaterial to our 2025 results. We look forward to having the Amedisys and LHC colleagues join BrightSpring, and Jen will discuss BrightSpring's third quarter financial results and 2025 outlook in more detail shortly. At BrightSpring, we're focused on quality and continuous improvement in our people and services to deliver comparatively low-cost, timely, and attentive patient-centric care to complex populations. Quality and patient satisfaction scores across our service lines in the third quarter remained at very high levels. In home health, 94% of our branches are at four stars or greater with timely initiation of care at an industry-leading level of 99%. In hospice, we continue to be a top 5% ranked hospice program in the U.S. with a CAHPS overall hospice rating of 89%, up from 85% in the second quarter. Overall, hospice quality index scores and the number of visits we provide patients per month on average remain well above the national average. In rehab, our patient satisfaction scores remain exceptionally high. And in personal care, we have strong internal client records and quality indicator audit scores, along with a satisfaction score of 4.54 out of 5. In infusion, our patient satisfaction score was approximately 95%, and our discharge rate due to completion of therapy was stable at 96%. Home & Community Pharmacy demonstrated 99.5% order completeness and on-time delivery of 97.2%. In Specialty Pharmacy, our medication possession ratio remains much higher than the national average at approximately 95%, and we have a time to first fill of 3.7 days. Our company continues to demonstrate high levels of execution and customer satisfaction across service lines. Turning to the company's financial results by segment. Total Pharmacy Solutions revenue grew 31% in the third quarter, and adjusted EBITDA grew 42% versus the prior year, with total pharmacy census growth facilitating total pharmacy script volume of $10.8 million in the quarter. Though script volumes demonstrated strong growth in both specialty and infusion with over 30% script growth in the subsegment, total pharmacy volumes declined 1% versus the prior year due to the majority of scripts being in Home & Community Pharmacy and a decline in the Home & Community Pharmacy total scripts dispensed due to divestitures associated with the customer that previously declared bankruptcy as well as flu season beginning later in 2025 as compared to 2024, operational decisions made to exit specific uneconomic customers, and a difficult comparison to last year when we added the same aforementioned customer in the third quarter. In the specialty and infusion business, revenue grew 42% year-over-year, which exceeded expectations. The performance in specialty and infusion was driven by limited distribution drug launches, generic drug utilization from conversions over the past year, strong commercial execution from the team, and excellent patient service. Specialty scripts grew approximately 40% in the third quarter, driven by strength in both brand limited distribution drugs and generics. We ended Q3 with 144 limited distribution drugs, including five limited distribution drug launches in the quarter. Through the end of October, our limited distribution drug portfolio has now expanded to 145 therapies, and we continue to expect 16 to 18 additional limited distribution drug launches over the next 12 to 18 months. We are honored and proud to have been chosen as a preferred specialty pharmacy partner for these new therapies that are being utilized to treat a range of cancers and rare orphan diseases. We work diligently to deliver high-quality care to patients and gain the trust of manufacturers, prescribing physicians, and patients to support long-term therapy innovation and growth. Within Infusion, performance in the quarter was in line with expectations, driven by solid double-digit volume growth and continued benefit from operational improvements and procurement initiatives to streamline the business and improve profitability with strong year-over-year EBITDA growth well into the double digits. Our strategy is a broad-based one in terms of both acute and chronic therapies. We remain excited about the acute market where we believe there exists a multibillion-dollar market where our leadership team can leverage best practices and scale the business in new geographic markets efficiently. We also remain constructive on our ability to expand chronic infused therapy offerings as we look to innovate delivery to patients living with chronic disease. In Home & Community Pharmacy, revenue performance in the quarter was in line with our expectations, and we continue to optimize the go-to-market strategy and customer mix to ensure profitable growth in attractive and targeted end markets. Under a new and expanded leadership team, we continue to implement operational initiatives to augment efficiency with year-over-year EBITDA up outside of several unusual items in the quarter. Over time, we expect to continue to expand our presence in target markets with industry-leading operational processes, quality, and efficiency. Turning to the Provider segment. We are pleased by the performance across each of our service lines in the third quarter. Provider revenue grew 9% year-over-year, and segment adjusted EBITDA grew 16% with a segment adjusted EBITDA margin in the quarter of 16.5%, up approximately 90 basis points year-over-year. Home health care, which represents about 50% of the revenue in the provider segment and is comprised of home health, hospice, and primary care, grew 12% year-over-year. The home health care business continues to perform very well, driven by strong quality metrics and patient satisfaction scores, ongoing operational investments and advancements, de novo expansions, and preferred provider Medicare Advantage contracts are continuing to advance. Average daily census in home health care was 29,592 in the third quarter, representing a 3% increase year-over-year with hospice increasing approximately 15% year-over-year in the quarter. In the third quarter, home health settings in five states were awarded accreditation by the Accreditation Commission for Health Care, or ACHC, reflecting compliance with ACHC standards and CMS' conditions of participation, highlighting our commitment to providing safe and high-quality care to patients. Home-based primary care also delivered solid growth in the quarter. We believe primary care at home remains a large opportunity as we continue to build out the business, particularly as it relates to the benefits of our integrated services and ACO and SNP payment models, which we continue to make steady progress on. Moving to rehab care, which represented approximately 20% of provider revenue in the third quarter, growth was 9% year-over-year, underpinned by 11% growth in person served and approximately 17% growth in hours billed in the core neuro rehab services. We have continued to see a long history of performance and positive momentum in the rehab business and the expansion of our rehab into ALS and home settings with Part B rehab for seniors is now ongoing as we went live in the quarter with a key milestone and integrated home health and rehab offering in ALS. In personal care, which represented approximately 30% of provider revenue in the third quarter, revenue grew 6%. Personal care growth, operations, and performance remained very steady, including solid growth in person served. Overall, we continue to realize and see many benefits from our high-value services in targeted markets with one integrated and coordinated enterprise. Finally, we are excited to announce that we will be hosting an Investor Day on March 17 in Louisville. We look forward to the opportunity to review our company strategy with the investment community, discuss each of our service lines, and outline the prospects for each in the years to come. To close, we are pleased with BrightSpring's operating performance and financial results in the third quarter and the progress we have made so far in 2025, and we look forward to entering 2026 from a position of strength with continuing investments for long-term differentiation and sustainable growth across the organization. With that, I'll turn the call over to Jen.

Thank you, Jon. Before I discuss our financial results for the third quarter of 2025, I'd like to remind you that in the first quarter of this year, we began to record the Community Living business in discontinued operations as indicated in the press release and 10-Q to adhere to accounting standards required on an interim basis. As such, all BrightSpring financial results and forecasts that I will discuss are related to continuing operations and exclude Community Living. Management believes the presentation of the non-GAAP financials from continuing operations is a useful reflection of our current business performance. In the third quarter of 2025, total company revenue was $3.3 billion, representing 28% growth from the prior year period. Pharmacy Solutions segment revenue in the quarter was $3.0 billion, achieving 31% year-over-year growth. Within the Pharmacy segment, Infusion and Specialty revenue was $2.4 billion, representing growth of 42% from prior year and Home & Community Pharmacy revenue was $590 million, which was approximately flat year-over-year. In the Provider Services segment, we reported revenue of $367 million in the third quarter, which represented 9% growth compared to the prior year. Within the Provider Services segment, Home Healthcare reported $188 million in revenue, growing 12% versus last year. Rehab revenue was $76 million, growing 9% versus last year, and Personal Care revenue was $102 million, representing growth of 6% year-over-year. Moving down the P&L, third quarter company gross profit was $392 million, representing growth of 21% compared with the third quarter of last year. Adjusted EBITDA for the total company was $160 million in the third quarter, an increase of 37% compared to the third quarter of 2024. Adjusted EPS for the total company was $0.30 for the third quarter. In the third quarter, continuous lean automation and efficiency programs at the company contributed to growth and margin improvement, and we anticipate additional improvements in the fourth quarter from ongoing operational initiatives. Further, we have seen a positive impact in the third quarter and into Q4 from our targeted growth investments, including in recent home health volume, hospice volume, rehab volume, and an accelerating infusion volume and growth in limited distribution drugs and generics in the specialty oncology and rare and orphan therapy business. Turning back to segment performance in the third quarter, Pharmacy Solutions gross profit was $246 million, growing 30% compared with the third quarter of last year. Adjusted EBITDA for Pharmacy Solutions was $141 million for the third quarter, an increase of 42% compared to last year, representing an adjusted EBITDA margin of 4.8%, which was up approximately 40 basis points versus last year. Provider Services gross profit was $146 million, growing 9% versus the third quarter of last year. Adjusted EBITDA for Provider Services was $61 million for the third quarter, growing 16% versus last year, representing an adjusted EBITDA margin of 16.5%, up approximately 90 basis points versus last year. Not included in the company's reported adjusted EBITDA of $160 million, as previously stated, Community Living's adjusted EBITDA was an additional $40 million in the quarter, an increase of 18% from the prior year in this business. On a total company basis, cash flow from operations was $108 million in the third quarter. We continue to expect to deliver over $300 million of annual run rate operating cash flow in 2025, and we remain focused on improving our leverage ratio towards our year-end goal of below 3.0x pro forma for both the pending home health acquisition and the Community Living divestiture. Our adjusted EBITDA growth, combined with our cash flow generation during the quarter has led to a leverage ratio at September 30 of 3.3x. Longer term, with continued growth, execution, and cash flow generation, we remain on track towards a leverage target of 2.5x, which at current trends could be realized by mid or later next year, excluding acquisitions or other uses of cash. As of September 30, net debt outstanding was approximately $2.5 billion. As mentioned previously, in January, we expect to receive approximately $715 million of net cash proceeds from the $835 million of gross cash consideration in the pending Community Living sale. As a reminder, net interest expense includes interest income related to cash flow hedges due to our three received variable pay fixed interest rate swap agreements that we have in place, which matured on September 30, 2025. As part of our process to monitor and address risks, during the quarter, we entered into two three-year interest rate hedges, which are additional to the one-year extension that was entered into during the first quarter, providing stability to our interest rate risk through September 2028. Prior to any proceeds from the pending Community Living divestiture, quarterly interest expense is still expected to be approximately $43 million, including approximately $1.2 million of interest expense related to the TEU instrument. Turning to guidance for 2025, 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 $12.5 billion to $12.8 billion, including Pharmacy Solutions revenue of $11.05 billion to $11.3 billion and provider services revenue of $1.45 billion to $1.5 billion. This revenue range reflects 24.1% to 27.1% growth over full year 2024, excluding Community Living in both years. Total adjusted EBITDA is expected to be in the range of $605 million to $615 million for full year 2025. This would reflect 31.5% to 33.7% growth over full year 2024, excluding Community Living in both years. I will now turn it back to Jon.

Thanks, Jen. Thank you for your time today to go through BrightSpring's Third quarter 2025 results. We will now open up the call for questions. Operator?

And our first question comes from A.J. Rice of UBS.

I have a question and a follow-up. Regarding the timing of new drug launches, you previously mentioned 16 to 18 launches over an 18-month period. Earlier this year, you indicated that this pace had accelerated to roughly a year. Today, you noted that you still expect 16 to 18 launches over the next 12 to 18 months. I'm trying to clarify if the pace of relevant new drug launches is increasing or if it remains consistent. If it is increasing, is the pipeline still quite strong?

A.J., how are you? Thanks for the question. I think the pipeline remains unchanged, just given the magnitude of it, both in the next year and over the next five to seven years on the brand side. We have had probably one of our strongest years in terms of brand wins going back several years; it's been robust, but this year has been a very good year. So we've seen some therapies come to market sooner, and we've been in a good position to be a partner on most all of those therapies. So it has been a good year, a little bit ahead of expectations, but we still expect a similar number of the 15 to 18 over the next year, 1.5 years. Nothing's really been pulled forward that would affect the future. Some things happen a little bit sooner, but the pipeline remains robust as we go bottoms up drug by drug, we still feel confident in that pace going forward.

Okay. In your prepared comments about the pending transaction, you mentioned the Amedisys and LHC branch acquisitions. Has what you're looking to buy changed at all? Can you provide any specifics on whether it is significantly larger than what you initially considered or in what other ways the deals have evolved?

Yes. There's always been some of the divested branches were LHC, but it's been the minority. So I think we've just more or less said Amedisys in the past. It is the significant majority of those branches as United was working through all of its final agreements with the FTC, the universe did increase a little bit, not dramatically at all, but a little bit. So there's been a handful more branches that have been included in the group in the past couple of months, and we do expect that transaction to close in the quarter.

Do you have any early read on whether it will be accretive to '26? I know you said it would be neutral this year. Is it meaning any significant accretion next year? Or is it neutral? Or how should we think about it?

I think accretion is a fair comment, yes.

And our next question comes from David Larsen of BTIG.

Congratulations on a great quarter. Can you talk about the sources of accretion for like the Amedisys transaction or quite frankly, any transaction, where do you drive the incremental margin and profit from, please?

We're limited on what we can disclose about this transaction due to our agreements with the other party. It’s fair to say that we aim to integrate the operations as seamlessly as possible. We have a great partner, which has allowed us to communicate effectively with the other side to ensure we execute this to the best of our abilities. We're very excited and optimistic about applying some of our practices, payer contracts, IT, technology, and people practices to the organization. It's been well run, which is something we find very encouraging, and we look forward to maintaining that consistency. We're also open to any beneficial synergies that might enhance growth and efficiency, as we plan to retain all employees. If there are any additional synergies in technology or similar areas that we can leverage from past acquisitions, we will definitely be looking to implement those.

Okay. That's very helpful. And then I think I'm calculating an EBITDA per script increase of 32% year-over-year. Is that correct? That sounds high, which is good, obviously. Just any color around sort of the sustainability of that growth rate and what some of the key drivers there would be?

Yes, I believe that is correct. It's likely just slightly higher on a per script adjusted EBITDA basis from a pharmacy standpoint. The changes are mainly due to the mix. We experienced higher growth in specialty and specialty scripts, which yield our highest gross profit and adjusted EBITDA. As Jon noted in his prepared remarks, we saw over 40% growth in specialty scripts during the quarter, resulting in a mix impact related to that.

Great. And one more quick one. Can you just remind me, as a drug launches biosimilar or goes generic, how much of an earnings lift is there typically in terms of margin per drug?

David, that's not really information that we reference. But when a drug goes generic, I think it's common knowledge that there are more manufacturers and that reduces the procurement cost. And overall, the price of the drug comes down pretty dramatically. But net-net, that's a very positive thing for all stakeholders and everybody in the industry. But really as a function of a lot more manufacturers typically able to provide the drug, you see a dynamic there, which is favorable to all stakeholders.

And our next question comes from Charles Rhyee of TD Cowen.

Jon and Jen, just wanted to ask, obviously, in one of the big competitors in community and pharmacy would be Omnicare and they declared bankruptcy. Just curious to what do you think of that as an opportunity to pick up incremental share? What kind of overlap in the markets are you there? And is that an opportunity to enter into new markets? Or is skilled nursing really maybe not that attractive to keep expanding into first?

I don't believe that we have any significant concerns about that situation. It seems to be tied more to past litigation rather than our operational performance. Our primary focus remains on our customers and key markets, particularly in areas such as assisted living, behavioral health, and hospice, which account for the majority of our Home & Community Pharmacy EBITDA. Regarding the script growth this quarter, we saw remarkable increases in hospice, infusion, and specialty pharmacy, all experiencing double-digit growth. On the skilled nursing facility side, there are a few factors at play that may continue for the next couple of quarters, but these do not impact our EBITDA. We secured a significant customer last Q3, but that customer has since gone bankrupt, and we are in the process of unwinding operations at some of those locations. With the new leadership team, we have taken a closer look at our customer base and made proactive decisions to avoid potential payment issues or unprofitable accounts, which has been productive. Moreover, the flu season started later this year, affecting customer dynamics. Despite losing that major customer, our overall business remains strong due to growth in other markets and our commitment to operational efficiencies. This is a transitional phase that may affect the next quarter or two, mainly related to the timing of that one customer. Importantly, we continue to see growth in key areas that enhance our EBITDA, and we are optimistic about the long-term prospects of Home Community Pharmacy. Their EBITDA increased this quarter, and I’m very enthusiastic about the operational automation and AI efficiency initiatives underway with the new team. Overall, the business is performing well, particularly when comparing last Q3 to this Q3. Home & Community scripts represent 77% of our pharmacy scripts, which illustrates our year-over-year growth. In our key service lines, we have seen exceptional performance, and we intend to focus on driving growth in Home & Community through targeted markets and ongoing improvements in operations and automation.

That's helpful. Just one follow-up on LDDs. Obviously, the FDA, I think there's been some concerns about the pace of drug approvals. I know that there were relatively fewer drug approvals in the first half of this year. Just curious what you're seeing, if you're starting to see that pick up, if that causes any concerns for you in terms of sort of the LDDs you have on deck in terms of timing?

We haven't seen any impact. Our performance on the LDD side has really kind of been a record year and the pipeline is as big as ever.

And our next question comes from Kieran Ryan of Deutsche Bank.

This is Kieran Ryan on for Pito. Apologies if I missed something on this, but I was wondering if you could kind of provide a little more color on the breakout of the pharmacy guidance between SEC and infusion and Home & Community, but with a focus on kind of what it implies for SEC and infusion. I just wanted to see if maybe a little bit of the potential slowdown there in 4Q, if that was kind of related to your comments on how it's been kind of a record year on the branded side and maybe that's normalizing a little bit.

We don't see a slowdown. We updated our revenue guidance, and you can expect strong year-over-year growth, particularly in Q4. From a pharmacy revenue perspective, we have increased our guidance largely due to the specialty and infusion business, driven by ongoing strong growth in prescriptions. Additionally, regarding margins and EBITDA, we have raised our guidance to account for further efficiencies from the operational projects we discussed earlier, including those in infusion, home, and community pharmacy, and we anticipate those efforts will gain momentum in Q4 as well.

Got it. That's helpful. And then if you could just provide maybe a quick update on what you're seeing within M&A pipeline and kind of your priorities there. I know it's mostly focused on the tuck-in style deals, but just a quick refresher there would be helpful.

Yes, that's right. Nothing imminent outside of that other than obviously the Amedisys, LHC transaction. So as we've been working through the Community Living divestiture and then the Amedisys, LHC branch acquisition, we have just been focused on really small deals and target attractive geographies that are highly accretive. And that will probably continue at least for another quarter or so. There's nothing imminent in terms of anything sizable, but our M&A strategy will remain primarily focused on accretive tuck-ins in target geographies and probably a little bit more activity in deals of a little bit higher size, call it, in the $3 million to $10 million of EBITDA range. Those might start to get more focus again as we get past these two transactions into next year. We remain open and flexible to something interesting, a little bit larger, but certainly nothing transformational that's on our radar screen whatsoever right now. We really like our current strategy and where our organic growth is and where the balance sheet is.

And our next question comes from Brian Tanquilut of Jefferies.

Congrats on the quarter. Jon, maybe as I think about generics really quickly since you touched on that in your prepared remarks, anything you can share with us in terms of the cadence of upcoming patent expirations in your portfolio and also the dynamics in terms of the margin ramp? Like what is the runway for margin ramping on a per script basis for a new generic launch?

Yes. I think some of the information, Brian, we've laid out publicly remains the same. We expect numerous more brand to generic conversions over the next couple of years, including a more significant one probably at the end of Q1 next year. And we expect similar overall dynamics in these conversions that we've seen and experienced in the past and over the past 10 years. So our ability to partner with manufacturers and win innovative new brand therapies, the very strong growth in our fee-for-service business in that business, and then the steady stream of these brand to generics really all underpinned by our service levels and commercial team and efforts I think really remains very consistent as we look out still over the next five years. So, I think the information that we've put out there publicly and in our slide deck remains our current view.

Got it. And then, Jon, just on the delay on the Community Living divestiture, anything you can share in terms of what that is or what caused that? And just anything we should be on the lookout for to get that closed?

Yes. No, nothing unusual. Unfortunately, these processes can just take time these days. The recent government shutdown wasn't overly helpful. But we remain very optimistic that this will close in Q1. There were a handful of markets that the buyer needed to work through with the FTC, which is ongoing and seems very straightforward and is well down the path. So we expect that to occur in Q1.

And our next question comes from Ann Hynes of Mizuho.

Great. Just anything on the Washington front that we should be on the lookout in the next coming months, especially with a potential health care bill going through Congress at the end of December?

Yes, Ann, there hasn't been anything particularly significant from our standpoint regarding that matter. It has remained fairly steady over the past few months. The home health rule is expected to be released soon, although it might face some delays because of the government shutdown. Historically, with strong industry advocacy, we anticipate a reduction in the proposed cuts in the final rule. Even though any cuts won't have a significant impact on us at this time, given the percentage of revenue and EBITDA that business represents, we can easily adapt to any rate changes. It’s essential that these critical services receive adequate funding going forward, so we will continue to advocate for that, educate where possible, and look forward to collaborating with CMS on aligned solutions. Concerning the IRA, we're pleased that CMS has instructed payers to factor in the IRA for their 2026 pricing. We're also encouraged by our advocacy efforts and have many supporters in Congress and the administration who recognize the unique effects of the IRA on LTC pharmacies. There are bills in the House and one upcoming in the Senate. Nonetheless, a lot is happening in Washington until the year's end. Regardless of the outcomes, we believe our internal mitigation plans, combined with the overall strength of our enterprise, position us effectively. Thus, there have been no significant updates since how we previously communicated about this.

And our next question comes from Matthew Gillmor of KeyBanc.

I wanted to drill down on the EBITDA guidance raise. You raised the outlook a bit more than the beat on the quarter. From Jennifer's comments, it sounds like that reflects the combination of core performance and then pulling through some efficiency efforts. Was that about the components of the change?

That is correct, yes.

Okay. And then as a quick follow-up, I think in the past you've talked about being conservative with the value-based care accruals, but you have some potential shared savings to go get. I just wanted to see if there's been any change in thinking there, if there's still some potential to pull through some shared savings at some point later in the year.

Yes. I think at this point, we've gained clarity that we will get some shared savings there. But that after receiving news about last year here just very recently, looks to be probably a little bit of opportunity there that will be realized.

And our next question comes from Joanna Gajuk of Bank of America.

So, I guess a couple of follow-ups. So, first, I appreciate the comments around the acquisition of the assets from Amedisys and LHC will be accretive next year. But anything else we should be thinking about heading into next year in terms of any high-level tailwinds and headwinds? I'll stop here.

Yes, Joanna, there's been consistent performance throughout the year, and we expect that to continue. Each service line has been doing well individually. Recently, our efforts in infusion over the past 18 months are starting to yield positive results, which we're excited about for next year. Hospice is also performing excellently, with a rate increase expected in the fourth quarter. Momentum in limited distribution drugs and specialty conversions is strong, along with positive developments in home health, including the acquisition of divested branches and automation initiatives. We achieved the best admissions month in September for home health, backed by a new sales leadership team. We are on track to have our biggest customer win quarter ever in home and community pharmacy, which is exciting. Jen mentioned our significant investments in lean continuous improvement and efficiency, and we are pushing forward in those areas. We have a new CTO building an internal AI team and working with external vendors for AI implementations. From both growth and efficiency perspectives, we continue to make progress. Our balance sheet has improved, reducing leverage from about 3.64x to 3.31x in just a quarter. We previously anticipated year-end leverage at around 3.5x, but now we believe it will be around 3.0x, especially with the upcoming Community Living sale. We expect to be well below 3x leverage when that transaction closes. Additionally, we have been discussing $300 million in operating cash flow, but we now estimate it could be around $375 million, with free cash flow before debt amortization likely between $260 million and $270 million. Our focus on the balance sheet and cash flow has been very positive.

And if I may a couple of follow-ups. So on this comment about infusion, right, you sound very excited about this, and I guess you've been growing it nicely. But as we think about the pharmacy segment, I guess, in totality or maybe the specialty infusion, but the Pharmacy segment, the revenue is going to grow more than 25% this year, right? So how should we think about your ability to kind of grow on top of this fast growing into next year?

From an infusion perspective, as they continue to grow at a rapid pace, we don't anticipate any significant changes to their growth rate. However, we do expect the infusion segment to accelerate, which should give us a favorable boost heading into next year.

And our next question comes from Erin Wright of Morgan Stanley.

A couple of questions. First one is kind of bigger picture. Just can you speak to kind of some of the future opportunities across kind of pharmacy solutions and specifically kind of specialty pharmacy? The focus has been on oncology, but can you speak to rare disease or other areas and also the opportunity around some of those value-added manufacturer biopharma services and the respective margins associated with some of those opportunities evolving over time?

Yes, thank you, Erin. Everything you mentioned is accurate. We do actively engage in rare and orphan therapies, many of which are in the oncology sector. This is certainly a priority for us, both within and outside oncology, and we plan to continue focusing on it. Our fee-for-service business, including data agreements, clinical hubs, and various pharmaceutical programs, has shown significant growth over the past couple of years and has become an important contributor to our EBITDA. We anticipate continued growth, with additional program launches expected next year. On the infusion side, we are aiming to expand both acute and chronic therapies. The acute market is substantial, valued in the billions, and while some companies have pulled back due to operational challenges, we are fully committed to this area and saw good results in Q3, which contributed greatly to our growth rate. We are also focusing on tailored programs for chronic therapies, particularly with select distribution drugs. In our Home & Community Pharmacy segment, there are substantial growth opportunities in assisted living, IBD, behavioral hospice, and PACE markets, and we are excited about pursuing those. Overall, we are concentrating on improving processes and efficiency across all our pharmacies by implementing automation and AI to enhance our operational efficiency and maximize our scale. Overall, we see multiple growth drivers in each segment, consistently emphasizing process and automation, which makes us optimistic about the upcoming year and beyond.

Okay. Great. And then can you speak to what percentage of the portfolio is now more directly tied to drug pricing dynamics with potential MFN pricing as well as you spoke to IRA earlier, which we spoke to, I think, at length before. But what percentage of the book would be branded therapeutics that would be potentially exposed?

Yes. So the fee-for-service part of what we do is still the minority, the far minority. But as we've talked about before, we do our best to drive generic utilization for the industry, which is positive and good for all stakeholders. We also have a lot of our therapies, for example, in acute, which is immune from any of this discussion, too. So if you look across the breadth of our portfolio, branded GP is not the majority just given the diversification of what we do. And then as it relates to things like DTC, our pharmacy services are really to complex and high acuity patients and often very local with significant clinical support needs. So they really don't lend themselves to DTC.

And our next question comes from Stephen Baxter of Wells Fargo.

Obviously, the sequential progress you made on margins in the pharmacy business has been really notable. It sounds like you're expecting that to continue in the fourth quarter based on the guidance that you've given. And then broadly, you're describing kind of the conditions around further progress on LDDs and further the generic dynamics continuing in 2026. I guess how do we think about the trajectory of margins exiting this year and opportunity for further improvement in 2026?

Yes. From a guidance perspective, we expect margins in Q4 to be higher than what we've seen in the past few quarters. Q4 is typically our highest margin quarter for various reasons. We anticipate continued growth in our different businesses and a diverse mix of products, which will lead to slightly higher margins in Q4, resulting in a slightly elevated annual perspective as noted in the guidance.

I would say that from an enterprise perspective, when we consider margins, a lot of our ongoing efforts in lean operations and efficiency initiatives will support growth in higher-margin areas as our provider segment expands. Many of our acquisitions bring synergies that lead to increased margins. We are committed to maintaining efficiency while delivering the best quality possible, which we can leverage to form better partnerships with payers for enhanced rates. Margins are fundamentally influenced by our mix, but there are deliberate efforts throughout the organization to ensure we operate smoothly and efficiently.

And our next question comes from Larry Solow of CJS Securities.

Great job on another successful quarter. I really appreciate the insights shared. Overall, things sound positive. Jon, as we look ahead three to five years, I understand you might provide more information in March. However, while the 30% or even 40% volume growth this quarter is impressive, it might not be sustainable. You've mentioned that double-digit growth in Pharmacy Solutions is likely going forward, and that seems feasible. But regarding growth rates, can we maintain the rapid 25% to 30% levels? The Street appears to be adjusting expectations to low double digits for the next few years. Where do we think we might land? Is it closer to that low double-digit growth, or is there a chance we can sustain growth above that? Any insights on this would be appreciated.

It's a valid question that we consider deeply. Over the past decade, our compound annual growth rate has been about 15%, even exceeding that in recent years. This success stems from various factors, as we have developed a platform that we believe is well positioned for future growth across different environments. The slight growth in our corporate segment this quarter, along with the growth we've seen this year, can be attributed to our continued investments for the future, such as establishing an AI team and hiring experienced individuals from the technology sector. We plan to persist with these investments, focusing on new marketers and enhancing our development teams. While it's challenging to predict specific growth rates over the next four to five years, we are confident that we will achieve growth next year that exceeds our historical average. For most of our businesses, except perhaps personal care, we aim for growth of 20% or more. Our approach is grounded in quality, operational efficiency, and advocating for our services to improve patient outcomes and reduce costs in the industry. We set ambitious targets, and although some businesses may occasionally exceed those targets while others might not meet them, we maintain high standards. We are optimistic about the markets we operate in and believe that we will see acceleration from more integrated care within our platform. We are beginning to integrate some ALS offerings, which have been well received, and we expect continued scaling in primary care and value-based contracting. Our growth strategy distinguishes between core growth—achieving clear objectives for each business over 1, 3, and 5-year timelines—and strategic growth, which includes initiatives like home-based primary care, value-based care contracts, and integrated offerings that leverage AI products. As we move forward, we feel we are in a strong position for the upcoming year. We have gained valuable insights from Q1 and remain optimistic about expanding our platform by leveraging the various businesses we operate, driving strategic growth, and fostering operational and technological innovations throughout the organization.

Great. I appreciate that color. Really helpful. Just quickly, on the bankruptcy in Home & Community, is that actually a little bit of a drag on EBITDA in this quarter, maybe for the next couple?

No, we don't expect it to be whatsoever. So that was announced in the last quarter. I think based on the strength of our platform and our diversification, it was a nonevent for us in Q2. We talked about that. I only mention it because that's part of the reason why the home and community scripts had a tough year-over-year comp just given we were coming on to that contract last Q3, and now we're kind of going off. And so that's that. But really attractive growth within all of our pharmacy businesses and the ones that matter the most across specialty infusion, hospice, behavioral, etc. So, and in Home & Community Pharmacy, we're seeing right now, our pipeline has us looking at our biggest customer signing in three to four years. So things are moving in a really good direction. And one of the things surely we will talk about at the Investor Day is how much automation and process innovation is going into that pharmacy business today, which is going to be extremely constructive.

We have no further questions at this time. I'd like to turn it back to Jon Rousseau for closing remarks.

Yes. Thank you for the time today, everybody. We appreciate the interest in the company. Thank you for all the questions, and we look forward to talking with you again in another quarter. Have a great rest of the day.

This concludes today's conference call. Thank you for participating, and you may now disconnect.