BrightSpring Health Services (NASDAQ:BTSG) reported fourth-quarter and full-year 2025 results that management said exceeded the high end of the company’s guidance range for the year, driven by revenue growth, adjusted EBITDA expansion, and stronger cash flow generation. Executives also outlined key portfolio actions, including an expected first-quarter close for the company’s planned Community Living divestiture and the completed acquisition of home health assets from Amedisys and LHC in the fourth quarter.
Portfolio actions: Community Living sale and home health acquisition
Chief Executive Officer Jon Rousseau said BrightSpring expects its Community Living divestiture to close at the end of the first quarter of 2026, following Federal Trade Commission approval earlier in the year. The company expects net after-tax cash proceeds of approximately $715 million and intends to primarily use the funds to pay down debt.
Full-year and fourth-quarter 2025 results
For the fourth quarter of 2025, BrightSpring reported total revenue of $3.6 billion, up 29% year-over-year. Adjusted EBITDA was $184 million, up 41% year-over-year. Adjusted EPS was $0.33 for the quarter.
For the full year, BrightSpring reported total revenue of $12.9 billion, up 28% from 2024. Pharmacy Solutions revenue was $11.4 billion (up 31%), and Provider Services revenue was $1.5 billion (up 11%). Full-year adjusted EBITDA was $618 million, up 34%, with an adjusted EBITDA margin of 4.8%, up 20 basis points versus 2024. Adjusted EPS for the full year was $1.00.
CFO Jen Phipps noted that the company began recording Community Living in discontinued operations in the first quarter of 2025, and that results and 2026 guidance discussed on the call relate to continuing operations and exclude Community Living and any acquisitions not yet closed.
Cash flow and leverage
BrightSpring generated $232 million in cash flow from operations in the fourth quarter and $490 million in 2025, which Phipps said exceeded the company’s annual run-rate operating cash flow expectations. Net debt outstanding was approximately $2.5 billion as of December 31, 2025.
The company’s leverage ratio was 2.99x at year-end 2025, down from 4.16x at year-end 2024. Phipps said BrightSpring’s view of year-end 2025 leverage on a pro forma basis for the Community Living transaction was 2.6x. Over the longer term, management reiterated a leverage target of 2.5x or below, which Phipps said could be realized by mid-year at current trends, excluding acquisitions or other uses of cash.
Because of “various moving parts” related to the use of Community Living proceeds, Phipps said the company is not providing interest expense guidance at this time.
Segment performance: Pharmacy Solutions and Provider Services
In Pharmacy Solutions, fourth-quarter revenue was $3.2 billion, up 32% year-over-year. Within the segment, infusion and specialty revenue was $2.6 billion (up 43%), while home and community pharmacy revenue was $593 million (down 1%). Management attributed the home and community decline to divestitures tied to a customer bankruptcy and decisions to exit uneconomic customers; Phipps said the bankruptcy process is ongoing and that guidance contemplates a variety of scenarios, though she said the company does not anticipate changes to the year under any scenario.
Fourth-quarter Pharmacy Solutions gross profit was $255 million (up 25%), and adjusted EBITDA was $162 million (up 44%), with a 5.1% adjusted EBITDA margin, up about 40 basis points year-over-year. Total pharmacy script volume was 10.8 million, and management noted specialty and infusion script growth of 30% year-over-year in the quarter.
Rousseau highlighted limited distribution drug (LDD) momentum, stating the total LDD portfolio stood at 149, including five launches in the quarter and 24 total launches in 2025. The company expects 16 to 20-plus LDD launches over the next 12 to 18 months. Executives also discussed growth drivers in specialty pharmacy as multifactorial, citing brand LDD wins, brand-to-generic conversions, expanded fee-for-service activities, and hub services (with “over 30 hubs” where the company serves as a hub for pharmaceutical manufacturers).
In Provider Services, fourth-quarter revenue was $394 million, up 13% year-over-year. Home healthcare revenue was $217 million (up 19%), rehab revenue was $75 million (up 8%), and personal care revenue was $102 million (up 4%). Provider Services gross profit was $158 million (up 17%), and adjusted EBITDA was $64 million (up 16%), with a 16.4% adjusted EBITDA margin, up about 50 basis points year-over-year.
2026 guidance and key items discussed on the call
BrightSpring initiated 2026 guidance for continuing operations. The company expects:
- Total revenue of $14.45 billion to $15.0 billion (including Pharmacy Solutions revenue of $12.6 billion to $13.1 billion and Provider Services revenue of $1.85 billion to $1.9 billion)
- Total adjusted EBITDA of $760 million to $790 million, including an expected $30 million contribution from the Amedisys and LHC acquisition
Management discussed several factors affecting 2026 pharmacy revenue, including headwinds tied to the Inflation Reduction Act (IRA) and brand-to-generic conversions. Phipps quantified approximately $200 million of IRA-related revenue headwind in specialty and infusion, plus a combined specialty and infusion impact “a little over $400 million” between IRA and brand-to-generic conversions. She also cited approximately $175 million of IRA impact in home and community pharmacy revenue, describing total pharmacy revenue headwinds of about $600 million in 2026, while still expecting strong growth across business lines.
Executives said they expect sequential quarterly growth through 2026, noting that the first quarter is typically the lowest due to fewer days. Phipps also pointed to a generic launch expected in the second quarter that she said would increase margins throughout the year.
On the Amedisys and LHC asset margins, Rousseau said investor math implying high single-digit margins was “largely” correct based on the acquired business, and management said it plans to work toward BrightSpring’s higher margin profile over time, citing integration, technology investments, and standardizing platforms and systems as part of the process.
BrightSpring also announced it will host an investor day on March 17 to provide additional detail on business unit operations, end markets, and growth drivers, as well as the company’s long-term vision and strategy.
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.
