Key Highlights

  • Revenue reached USD 4.2 billion, up 26% year over year, while adjusted EBITDA rose 42% to USD 228 million.
  • Earnings per share were USD 0.54, up 80% from the third quarter of last year and 20% sequentially.
  • Pharmacy Solutions Revenue grew 26% to USD 3.7 billion, and Provider Services revenue grew 31% to USD 481 million.
  • Leverage fell to 1.79 times, and full-year adjusted EBITDA guidance is now USD 850 million to USD 860 million.

Revenue and EBITDA Above Forecast

BrightSpring Health Services, Inc. (NASDAQ:BTSG) reported third-quarter 2026 revenue of USD 4.2 billion, up 26% from a year earlier, and adjusted EBITDA of USD 228 million, up 42%, both above its forecast. Earnings Per Share of USD 0.54 rose 80% year over year and 20% from the second quarter. Cash Flow from operations was USD 204 million.

Management said the results are consistent with the company's performance since going public in January 2024, with growth well into double digits over the past decade.

Segment Performance

Pharmacy Solutions revenue was USD 3.7 billion, up 26%, with segment EBITDA of USD 202 million, up 43%. Specialty and infusion revenue reached USD 3.2 billion, up 34%, on script growth of 29%, supported by branded limited distribution drugs, generics, value-added pharma services and mid-teens growth in both chronic and acute infusion. The company launched seven limited distribution drugs in the quarter, 19 year to date, and now supports 162 across dozens of manufacturers.

Provider Services revenue was USD 481 million, up 31%, with segment EBITDA of USD 79 million, up 30%. Home health demonstrated timely initiation of care of 99%. Management cited scale, procurement and contracting benefits, Operating Expense and Acquisition synergies and rapid Investment in AI automation across quality, documentation, medication review and hiring.

Updated 2026 Guidance

Guidance excludes the Community Living Business and any acquisitions not yet closed. Total revenue is projected at USD 15.9 billion to USD 16.125 billion, reflecting growth of 23.2% to 24.9%, including Pharmacy Solutions of USD 14.0 billion to USD 14.2 billion and Provider Services of USD 1.9 billion to USD 1.93 billion. Adjusted EBITDA is projected at USD 850 million to USD 860 million, growth of 37.6% to 39.3%, including about USD 35 million from the Amedisys and LHC asset acquisition.

The company projects over USD 700 million of operating cash flow, with EBITDA-to-operating-cash conversion near 80% and over USD 600 million of cash flow after capital expenditures and before Debt paydown and repurchases.

Total debt was about USD 2.2 billion and, net of USD 718 million of cash, net debt was USD 1.5 billion, for a Leverage ratio of 1.79 times. Leverage includes the effect of USD 120 million of share repurchases year to date. Management said it is evaluating its Capital Structure ahead of 2027 to support growth plans.

Management plans to provide full-year 2027 guidance on the fourth-quarter call, and said it currently anticipates 2027 organic adjusted EBITDA growth of at least 15% to 20%, with a broad base of growth drivers.

Growth Drivers to Follow

Management said its strategy aligns with demographic trends and a rising prevalence of certain health conditions, and that relationships with hospitals, physicians and other providers underpin its ability to capture demand. Items to track include limited distribution drug launches, infusion growth, the integration of acquired Assets and progress on leverage.