BrightSpring Health Services NASDAQ: BTSG reported first-quarter 2026 results that management said reflected broad-based momentum across both the Pharmacy Solutions and Provider Services segments, alongside continued operating discipline and balance sheet improvement following the divestiture of its community living business.
Jon Rousseau, chief executive officer, told investors the company is “pleased with our first quarter financial results” and said BrightSpring is “on track to deliver the updated full year guidance provided today.”
Quarterly results and balance sheet update
For the quarter ended March 31, 2026, BrightSpring reported total revenue of $3.6 billion, up 26% year-over-year. Pharmacy Solutions revenue rose 25% to $3.2 billion, while Provider Services revenue increased 28% to $442 million.
Adjusted EBITDA increased 45% to $190 million, with an adjusted EBITDA margin of 5.3%, up 70 basis points from the prior-year quarter. Rousseau said margin expansion was “primarily driven by mix and operational efficiencies across the organization.” Adjusted EPS was $0.39, according to CFO Jennifer Phipps.
BrightSpring generated $123 million of cash flow from operations in the quarter, excluding fees related to the community living divestiture. Leverage improved to 2.27x as of March 31, down from 2.99x at Dec. 31, 2025. Phipps said net debt was approximately $1.7 billion as of quarter end.
Rousseau also discussed the recently completed sale of the community living business to Sevita, which closed March 30, 2026. He said the transaction resulted in net cash proceeds before tax of approximately $811 million and that proceeds will be used to strengthen the balance sheet, including debt paydown and cash availability. Phipps added that the sale involved $835 million of gross cash consideration and that about $100 million in taxes is expected to be paid in the second quarter of 2026.
Pharmacy Solutions: LDD adds, infusion growth, and IRA headwinds
Within Pharmacy Solutions, Phipps said specialty and infusion revenue was $2.6 billion, up 36% year-over-year, driven by factors including market adoption of existing limited distribution drugs (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.” Rousseau said the company added four exclusive and ultra-narrow LDDs in the quarter, bringing total LDDs to 153.
Home and community pharmacy revenue fell 9% year-over-year to $527 million. Phipps attributed the decline to an approximately $50 million impact from the Inflation Reduction Act (IRA), which she said was expected, along with BrightSpring’s decision to exit “uneconomic customers.” She said BrightSpring expects an IRA revenue impact of about $45 million in each remaining quarter of 2026, totaling approximately $175 million for the full year in home and community pharmacy.
In the Q&A, Phipps reiterated other revenue headwinds the company has discussed previously, including about $181 million in specialty and infusion related to the IRA, and about $250 million from brand-to-generic conversions.
Pharmacy Solutions profitability also improved. Segment gross profit was $301 million, up 48% year-over-year, and segment adjusted EBITDA was $169 million, up 46%, representing a 5.3% adjusted EBITDA margin, up about 70 basis points from a year earlier. Phipps cited “strong performance across the therapy portfolio, favorable mix, and fee for service” as contributors.
Management also discussed growth and operational efforts in infusion. Rousseau said the company posted “double-digit growth on both the acute side and the chronic specialty side,” describing chronic specialty as an area where BrightSpring has been “underweight” and sees opportunity. He said the company went live in early Q2 with a concierge program around IVIG and plans to build concierge programs around targeted therapy.
On PBM dynamics and private-label biosimilars, Rousseau said he did not believe BrightSpring has “a lot of exposure,” noting the company’s portfolio mix. He added in a later exchange that BrightSpring is not seeing “any big changes or big moves” in payer or PBM agreements and that trends have been “very consistent.”
Provider Services: home health growth and acquired branch integration
Provider Services revenue increased 28% to $442 million. Within the segment:
- Home health care revenue was $266 million, up 49% year-over-year, driven by “strong census growth, de novo expansion, preferred MA contracts, and ongoing successful integration of our acquired branches,” according to Phipps.
- Rehab revenue was $75 million, up 7%, supported by growth in persons served and hours billed in core neuro rehab, de novo additions, and expansion of the Rehab in Motion program.
- Personal care revenue was $102 million, up 4%, driven by modest growth in persons served and stable operations.
Phipps said acquired home health assets contributed $79 million of revenue and approximately $9 million in adjusted EBITDA during the quarter, adding that management was encouraged by integration progress. Rousseau said BrightSpring expects approximately $30 million of EBITDA contribution in year one from integrating acquired Amedisys and LHC branches in 2026.
Provider Services gross profit was $181 million, up 35% year-over-year, while segment adjusted EBITDA was $66 million, up 29%, representing a 14.9% adjusted EBITDA margin, up about 10 basis points from the prior year.
Quality metrics, operational initiatives, and 2026 guidance
Rousseau highlighted a range of quality and satisfaction metrics across service lines, including home health star ratings, hospice measures, rehab and personal care satisfaction scores, and pharmacy operational performance such as dispensing accuracy and specialty pharmacy adherence measures.
Management also described ongoing efforts to improve efficiency through process redesign, automation, and AI. Rousseau gave examples including automating infusion intake workflows and further centralizing order intake. He said BrightSpring’s internal AI team has grown to “over 20 people.”
For full-year 2026, Phipps provided updated guidance (for continuing operations, excluding the divested community living business and acquisitions not yet closed). BrightSpring expects:
- Total revenue 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).
- Total adjusted EBITDA of $795 million to $825 million, including approximately $30 million of expected contribution from the Amedisys and LHC assets acquisition.
Phipps said the company expects quarterly interest expense of approximately $35 million and, looking ahead, expects to deliver approximately $500 million of annual operating cash flow excluding community living-related cash flow impacts.
About BrightSpring Health Services NASDAQ: BTSG
BrightSpring Health Services NASDAQ: BTSG is a leading provider of home and community-based care and workforce solutions aimed at seniors, individuals with disabilities and those facing behavioral health challenges. The company's operations encompass a broad spectrum of services, including personal care, skilled nursing, therapy, habilitation and supported living, as well as specialized behavioral health programs delivered through both clinical and non-clinical channels.
Through its network of subsidiary brands, BrightSpring offers integrated care in the patient's home environment, fostering independence and improving quality of life.
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