BrightSpring Health Services (BTSG) Wells Fargo 21st Annual Healthcare Conference summary

Pharmacy growth drivers

• Pharmacy EBITDA growth accelerated from 6%-8% in 2022-24 to nearly 40% in 2025 and over 40% in H1 2026.

• Specialty growth came from new and previously won limited-distribution drugs (LDDs), generic conversions, and manufacturer fee-for-service work.

• Infusion volumes grew across acute and targeted chronic services; home and community pharmacy benefited from profitable core volume and operational efficiencies.

• Q1 price appreciation on inventory is a recurring seasonal benefit; excluding it, Q2 gross profit per script increased QoQ.

• Gross profit per script is treated as an output; priority is sustainable growth in total gross profit dollars and EBITDA, including lower-per-script business lines.

Specialty drugs and generic conversions

• Oncology and rare/orphan drugs are moving toward exclusive and ultranarrow pharmacy networks; service quality, time-to-first-fill, satisfaction, and adherence support manufacturer relationships.

• Drugs typically take 2-3 years to fully ramp; growth continued from some drugs launched in 2021, with visibility into the portfolio and wins 12-18 months ahead.

• Generic conversion preparation focuses on building branded-drug volume, then rapidly converting patients; conversion can reach almost 100% early in launch, followed by sales-force-led volume growth.

• Generic price step-downs historically play out over 5-10 years; volume growth, improved manufacturer pricing, new LDDs, fee-for-service growth, and new launches help offset the pressure.

• The 2027 generic conversions are expected later in the year, with more of their impact falling in 2028; 2026 POMALYST conversion largely reached run-rate in Q1.

IRA effects and investment priorities

• 2027 IRA revenue and EBITDA impact is expected to be half the 2026 impact before further mitigation; 2026 offsets reduced the EBITDA impact to $15 million.

• Enhanced dispensing fees under negotiation could further mitigate IRA effects across both the 2026 and later drug cohorts.

• Spending includes permanent sales-force additions and temporary or one-time IT, systems, and AI initiatives; investments are assessed for ROI and long-term EBITDA growth.