I guess I'll say good morning. I don't know, I lost track of time. Good morning, everyone. Thanks so much for joining the Bank of America healthcare conference. My name is Joanna Gajuk. I cover healthcare facilities and managed care here at B of A. It's my pleasure now to host a session with BrightSpring, a very diversified company. There's a lot, I guess, things to cover here. With us today, we have Jon Rousseau, the CEO, and Jen Phipps, who's the CFO. I guess we decided to go right into Q&A. Unless, Jon, you have any prepared remarks, but I'm happy to just go right into the questions.
Thank you, Joanna. Good afternoon, everybody. We're happy to go right into questions.
Sure. Yeah. Q1 was actually a very good quarter, right? You guys beat and then you raised your guidance by even more, right? It seems like it's really the specialty pharmacy that continues to outperform. Can you kind of walk us through the sources of outperformance in terms of, was there any specific therapies or anything specifically that happened in the quarter that kind of drove that upside? It sounds like it's going to continue for the rest of the year.
Yeah, thank you. Thank you, Joanna. Q1, we were pleased with the quarter. I guess maybe there you go. Maybe first thing of note is really looking back over nine years, almost 10 years now, we have had a mid-teens EBITDA CAGR in the organization, along with a mid-teens growth CAGR on the top line. That growth has been really broad-based historically. Our focus has been continuing to try to execute against that, consistent with our historical practice. What has driven the company historically, which is continuing to still drive performance, is, first off, our volume growth, which is really underpinned by our quality across all of our service lines. Number two, efficiencies that we have been able to drive through the organization, which are based off our scaled platform. Then third, historically and continuing today, we have been able to drive accretive tuck-in M&A.
All of those themes continue to play out into Q1. We're pleased with the breadth across the organization. BrightSpring is a home and community-focused provider and pharmacy platform. We continue to see strong demand for our services in home and community settings. Our focus is to really be the most qualified, scaled national provider of home and community healthcare in the U.S. We think with our quality and the cost savings that we drive, that's a very strong value proposition. We're pleased with those markets and the dynamics around them. Within the company, the provider business had another very solid quarter. We were around 10% growth year- over- year, even on fewer days in the quarter compared to last year. On the pharmacy side, we did experience very solid growth in our oncology, in our growing rare and orphan business from a specialty pharmacy perspective.
That continues to be underpinned by our strong service levels with all of our partners, our payer partners, and our manufacturing partners. The ability to service more brands that are coming to market, and then the ability to drive generic utilization as well. Generics are good for everybody, and we help really drive generic conversion. And then our growing fee-for-service business, where we partner with the manufacturers around data and hub programs, etc. We have continued to see the benefits of participating in markets that we feel are attractive and innovative, where more and more solutions and more and more growth is evident across our home and community settings in markets like oncology. We have been able to build a franchise position in these markets over a long period of time, which is helping facilitate our growth and our penetration and very collaborative relationships across really all stakeholders.
Right. On pharmacy, if I may, the specialty infusion pharmacy piece grew 30% every year for the last three years, right? It sounds like it is on track to grow a comparable number this year. Is that sustainable growth? Can you kind of break into the components of it? What is really driving the 30% growth?
Within specialty oncology, it's certainly a larger market. Thankfully, there continues to be a lot of innovation in that market for patients, with life-saving new therapies that continue to come to market. We are pleased with our ability to partner with biotech and manufacturers as they bring these incredible therapies to market and help drive penetration and support of them through their patient base. Really making sure that patients receive the service levels as best possible to help drive their outcomes is of central importance to us. Over time, inevitably, some brands ultimately keep converting to generic drugs. We try to help be an effective partner in that process too, driving generic utilization. The market itself within oncology and then rare and orphan disease in that specific specialty market is very innovative.
We continue to leverage our quality, our relationships with payers and manufacturers, our data services, and our customer support solutions like our hub. We leverage all elements of this to continue to drive growth in the business. It remains a dynamic market where more and more solutions keep coming to bear for patients in these markets, which are driving terrific outcomes overall. We are pleased to be a solution on the generic side as well. We continue to see those dynamics playing out for the foreseeable future. We just continue to try to be the best partners we can across the market.
Maybe you can flesh out a little bit more about this innovation and the growth and kind of talk about the LDDs and your success rate there. I guess it sounds like I know the answer in terms of just the quality and offering that you have for these manufacturers, but maybe kind of flesh out a little bit more and also in terms of just maybe specifics in terms of the pipeline or how many more, I guess, you expect this year into next year of these.
Yeah. We continue to see a really strong pipeline of products that are coming to market. We believe that there will be 12-18 products that come to market that we'll participate in over the next 18 months. We continue to win those at a rate of about one LDD drug per month. There continues to be innovation in this space, as Jon has mentioned, and we see that being a dynamic that continues for a while in this space.
Great. Thank you for that. When I look at the guidance, when you exclude the community living asset that you're selling, the guidance, because you started, Jon, with talking about long-term growth in the more like in the teens, right? I guess this guidance kind of implies more like a 25% EBITDA growth year- over- year, right? Can you kind of flash out in terms of how much of that growth is organic versus acquisitions? You also mentioned part of your algo is acquisitions.
There's a little bit of acquisitions growth in there. Last year, we executed on, yeah, I got to look again, eight or nine more smaller tuck-in acquisitions. Those would be very accretive, lower multiple, where we could bring some of our operational capabilities and quality performance to bear and tuck those folks into our infrastructure and give them a nice longer-term home and help to improve those operations. That's something that we can do on a very regular basis. We did acquire a hospice asset in Florida. That was another situation where we were able to help them from an operational perspective and really continue to drive that quality forward. Hospice is a great example of where we are just an unquestioned performer from a quality perspective at the top end of the market. That was really the only one of a little bit more significance last year.
That was helpful as that and some of the other smaller tuck-ins rolled in this year. The majority has been organic. As I mentioned, we really focus on these home and community markets across the board, whether on the provider side in home health, hospice, rehab, or whether on the pharmacy side. This is pharmacy going to the customer, the building, and the patient wherever they are. If that's a nursing home, if that's assisted living, if that's somebody in a behavioral group home, somebody at home on hospice or home health, somebody with an infusion need or somebody with an oncology or other specialty therapeutic need, we go to them.
We continue to see a strong value proposition for that and a strong demand around services in those settings for these channels and these therapies that we've targeted for a long period of time and really built out a formidable set of capabilities to make sure that we execute to really high service levels. We have seen in particular more significant organic growth, I would say, in the last year and a half or two years. Our focus is looking at every one of our markets. How can we continue to drive market share that's based on quality, that's based on efficiency, and being the biggest advocate and educator we can for referral sources and patients out there?
Maybe just building on that, can you kind of walk us through? Because yeah, there are a lot of different service lines you guys provide under the BrightSpring hood, so to speak. Can you walk us through different service lines and what's the organic growth outlook for those? Because I guess you're exiting the one that has the slowest growth in terms of community leaving. Can you kind of flesh out these other services? How are you thinking about organic growth there?
Yeah. What really ties the organization together is the fact, again, that we focus on these home and community markets where we think we can deliver very high-quality services in preferred settings, which really results in a lower cost for the entire healthcare system. On the provider side of our business, it's home health, it's rehab, it's hospice. We think about home health. That's about a 5-6% growth market. We've been able to, I think, with our quality underpinnings, grow that market and more than that around sort of 8-12%, call it organically. That's our goal. Hospice, very similar. Rehab, very similar. These are 5-7% markets where there's more and more of a need for more of these services.
We have had the ability, again, I think based on our quality and our execution, to grow at rates that have been higher than that. I would say right around double digits, low double digits is what our long-term goals are. If we can grow at rates a little bit higher than that, like we have at certain times, say in the mid-teens, certainly we will try to do that. These are incredibly valuable services that people really appreciate in their home. They really drive down costs and hospitalizations. We are pretty passionate about trying to drive as much awareness for those services as we can and reach those levels of growth. Our community living business, which right now is pending divestiture, very proud of that business. We feel like we run that business as well as anybody that is typically a more acute behavioral population.
In that business, our quality and audit scores are 50% better than industry average. It's just been years and years and years of investing in quality and compliance in that population and that business. As we just looked at our portfolio, behavioral with that population was a little bit less core in terms of where we have evolved over time, really focusing more on highly clinical services to seniors and specialty populations. It was just trying to focus our organization as much as we can towards those populations on the pharmacy side, our home and community pharmacy business. This is where we're serving. We go to skilled nursing facilities, senior living communities, people in their home on hospice or home health, drug treatment centers, people in behavioral group homes. We can be anywhere in the United States with our footprint of pharmacies within three hours.
This has been a business that's been built out over 30 years. We'll do about 40 million scripts this year. It's one of the 10 or 12 biggest pharmacies in the U.S. This is where we take very customized patient and service setting specific programs to individuals, very high quality scores and service levels. In that business, it really, Joanna, is going to depend on your end market. You look at assisted living, you look at skilled, you look at hospice, you look at home health. What are those markets growing at? That's a business that if we can grow consistently in the mid-single- digits, potentially higher, we've been growing scripts and volume in the double digits here more recently. That would be something that we think is a win and very achievable. Infusion is a terrific market. A lot of very innovative therapies still coming out.
Infusion is a market that we think for us has a lot more potential. We would hope as we get into the back half of this year and the future years, we could grow that at double digits. You have our specialty oncology and rare and orphan business, which has been growing at a faster clip than the market just due to the new brands coming onto the market and our ability to be a partner in those brands with manufacturers and our ability to continue to drive utilization of generics when they become available.
I guess the one always question that we get is, what's the value of having all these service lines under one roof? Can you give us some examples of where there's either some synergies or revenue synergies, cost synergies, or any other reason why you have all these different business lines together?
Yeah, I think there's some hidden benefits that probably a lot of folks don't appreciate at first blush. First off, just given our scale, we're able to leverage that scale in a lot of our procurement efforts. Jen has played a lead role in that over the past eight years, but we have a very, I think, sophisticated and advanced procurement program in our company. Certainly having scale across hundreds of different types of products that we're buying, including on the drug side, has been helpful for us. The other thing that, I think we're able to do that at a level where you wouldn't be able to execute against that procurement if we were several other independent companies.
Another area that I think is probably a little bit less evident is just the ability as a management team to work across all of these businesses on a regular basis, leveraging hopefully the strengths of best practices in HR, in IT and technology, in sales and marketing, in quality and compliance, in government relations. The ability to drive those enterprise best practices down through each one of the businesses is something that we have really focused on. I think all of our service lines have really benefited from that. You get into, I would say, referral opportunities or integrated care opportunities today. There are large numbers of patients within our provider side of our business that also receive their pharmacy services from us. We think that's a better experience.
It's an opportunity for us to deliver multiple services to the same patient to streamline their experience, to better coordinate care. As you look forward, there's many more of those that we're excited about. We're moving on. One example of that would be our home-based primary care. Think house calls. These are nurse practitioners, sometimes doctors going to people in their home in an assisted living facility, and you are the doctor taking primary care of the patient. We find that that results in a much better outcome by being there, by stepping in front of unnecessary issues. We have found that with our primary care in these home settings, we reduce hospitalizations by 50%. If you are the primary caregiver, the ability to help coordinate all of their multiple services is an opportunity.
You look at assisted living, all of assisted living, they need pharmacy services, they need home health, they need rehab, they need primary care in their building. We are very uniquely positioned to be a one-stop solution for settings like that. Another area that we're continuing to make some progress on is offering our continued care meds in the home program. That's a program where combined with home health, we reduce hospitalizations for individuals in their home by 70% by having home health combined with med management right where they are. These are opportunities that I think could be significantly bigger in the future, all to the benefit of patients through integrated care. We're really excited about those.
At the consult data level, you target what, 6% EBITDA margins, right? How can you really get there if specialty pharmacy is growing the fastest, but that's the lowest EBITDA margin as a percent, right? How do you plan to kind of get to that 6%?
Yeah. We continue to look at lean opportunities, technology to leverage our scale. As every new volume that we're bringing in across all of our different businesses, we're focused on how can we scale that across our business. We've been very successful at that. We also are looking at opportunities to expand margins within each of the different business lines. Certainly from a specialty standpoint, the generic dynamic has been helpful, and we see that playing out and continuing across the next couple of years.
Maybe we switch gears a little bit to some of the recent topics, policy, but I guess before we go there, something else I want to ask you, the Inflation Reduction Act, right? There are some positives, there are some negatives for you, right? Pharmacy is a big business for you. Maybe walk us through those things because there are the lower drug prices over time, right? There is the impact to long-term care pharmacy business that you outlined, but there is also the Part D redesign. There are a lot of different moving pieces. Maybe walk us through those items and then how they impact the company.
Sure. So really, I think probably two elements there. Number one, we certainly applaud CMS for trying to ensure that as many people as possible have access to their medications, their therapies, which in many cases are life-changing. That is certainly something we are focused on all the time is making sure people receive the medications that they need and they get the support and services they need to manage most effectively through their condition and remain at home as much as they can. Elements of the IRA, which help to reduce the out-of-pocket, those have been helpful. I think really helpful for a certain amount of patients in general. The second element of that, there are at this point, I think 25 drugs on the IRA list, brand drugs on the IRA list in 2026 and 2027.
That really for us is a question around our home and community pharmacy. That is a much more broad-based pharmacy, which is serving patients with a number of those drugs. Our view of this is certainly as CMS and others have said, the focus of any of this regulation or lawmaking was never about the pharmacies. The pharmacies are the last mile to the home, extremely low margin. You have got to be highly efficient. You have got to drive scale. You have got to have customized service programs to drive that scale. The last mile to the home, driving medication reconciliation, keeping people out of the hospital, lowering costs, that is what the pharmacies do.
As we've talked to people in Washington, DC, over the past year about IRA, they to a person for everybody we've talked to have clearly said, "We do not want the pharmacies to be impacted by anything in IRA. They shouldn't be." There are conversations around the ability to ensure that that occurs, but those are fluid and those are ongoing. I would say we're hopeful, but in any environment, given the drivers we've had historically of volume, of quality, of efficiency and scale, and of accretive M&A that brings value to our new partners, we would be confident that we can continue to do well in varying environments and in varying settings. There's still some unknowns for that and how it plays out over time. Again, I think our quality and our scale serves us well there.
Pharmacies are very much viewed as the last mile solution and partner, doing a lot of great things in the value chain.
Another topic related to pharmacy business, right, is the tariffs on potentially on drugs. There could be other items, but I guess the ones on drugs are more topical and more, I guess, impactful to the company. Maybe walk us through that, the impact of brand versus the generics. Obviously, you make a spread on the brand. I guess would that kind of just flow through and, I guess, higher dollars as you make that spread? The generic dynamic, I guess, would be a little bit different. Maybe walk us through if that was to happen, right? We do not know exactly when it is going to happen and how it is going to look, but just in theory, right, like how this would flow through your business if the cost of drugs were going up.
Yeah. Maybe I'll start from a branded perspective. The WAC, which is the cost that we pay, is typically tied. The price that we're reimbursed from an AWP perspective is tied and linked to that. When you think about brand inflation, that happens very quickly. We would expect that your dollar impact from a gross profit perspective could actually increase while gross margins stay the same. That's typically, if you think about the brand and price inflation, probably the best correlation and what we would typically expect to see. As it relates to generics, we've spent a lot of time thinking about and understanding where our drugs are coming from.
As we've worked through that, we know that about 50% of our drugs are purchased or manufactured actually within the United States, or the majority of that 50% is within the United States, a little bit in Canada. Based on everything we know, we would obviously not expect tariffs to be impactful there. We really do not have a significant concentration across any of the other countries as we look at the generics. 10% from India, 10% from China, 10% from Europe. I think the balance is we've got listed in other across various different countries. As you know, manufacturers have lots of opportunities. We're having conversations with manufacturers, with wholesalers to understand how they're going to react to tariffs if they would come into place.
We feel good about the supply that at least in the short- term already resides in the United States, whether it is in our pharmacies or at the wholesalers or at the manufacturers. That gives us a little bit of confidence in the balance of the year as we are thinking through what that impact would look like. As it goes on, we are having conversations with PBMs, and everyone is just trying to understand that. We are monitoring it closely at this point. We certainly do not have any rule changes. I think generics, I think the president has an appreciation that there are sometimes generic shortages. We hear different things about how generics could be impacted differently than brands. We are monitoring that closely, and we will obviously react quickly. We would expect manufacturers, they are already starting to talk about how they are going to change their manufacturing patterns.
We certainly, across generics, have the opportunity to buy from different manufacturers than we buy today. We will be monitoring and quickly working through all of those things as things come to bear.
As you said, Joanna, these things are just unknowns, right? These are unknowns in the external environment. I think, as Jen highlighted, our scale and some of our capabilities as an organization, I think they do position us to be more agile in terms of we have many different partners from a supply chain perspective, great partners. These are elements and capabilities that we think would be helpful and come to bear in situations compared to smaller pharmacies who, frankly, probably need more help in protection.
Regardless of what the topic is, our team is always trying to actively educate on the Hill and with policymakers to make sure they understand what the pharmacies do in the value chain, the value that they bring, and how all of these various mechanisms play out amongst the parties in the value chain and making sure that this last mile to the home is always considered.
I know in the past, you benefited sometimes from forward buying of inventory. It would be something also that you could do if you see how there's going to be a spike in so-and-so tariff or whatever might happen. Is there something that you're considering as a mitigation strategy?
Yeah. So again, at this time, with no specific tariff policies or dates out there, we're not actively pursuing those. Those are opportunities that I think most any company will try to take advantage of should the need or the situation arise. At this point in time, we're not actively working on things like that.
All right. Maybe switching gears because we already have time. The company targets a leverage of three times. Can you walk us through how you're going to get there? Is it mostly EBITDA growth? Is it that paydown? I mean, obviously now you're waiting for some profits coming through, so that will help. Any other comments you're making how you're going to get to that target?
Yeah, Jen, you can chime in here, but it's both. I think both organic growth and healthy operating cash flow and free cash flow will allow us to get there. We'll be down at range of our desired range by, I think, by this year and then working towards our long-term goal of X and Y in the future. Jen, you can maybe just hit those a little bit more.
Yeah. This last quarter, we posted leverage. We were under four times leverage, and we are working our way down. We have good line of sight to being, excluding community living, to being at about 3.5 times leverage by the end of this year based on the cash generation that we expect, the growth that we expect. As you know, and we've talked a little bit about, we do have the community living divestiture. We would expect that to close by the end of this year. We believe that when you put the cash to the debt or you were to use it for some M&A, we would get down to about three times leverage by the end of the year, which we think is very beneficial and in line with what we had talked to investors at the time of the IPO.
With community living in about three and a half, when the divestiture hopefully goes through, you're now in the three to three-two range.
All right. Sounds good. You mentioned M&A part of the story, so I just want to touch base on the two. Is there any preference in terms of the assets? Is it like home health or hospice or is it something else? I mean, it sounds like you're also doing some things maybe in pharmacy a little bit, but it sounds like that's less about acquisitions, maybe building out pharmacies and such. Maybe talk about the priorities for M&A.
Yeah. Markets we've completed and would look at for M&A would be really in provider. It would be the more clinical home health, hospice, rehab, and maybe some home-based primary care. It's mostly smaller providers there. Then on the pharmacy side, if just given our scale, synergies there are more helpful. Some small pharmacy tuck-ins or at some point in the near future. Look, we've really held off on infusion for the last couple of years, at some point in the future, potentially infusion, but mostly home health, hospice, rehab, and then maybe some tuck-ins on home and community if the multiple's right. At some point here in the near future, some reasonably sized infusion would be all things that we would consider. That's really consistent with the last three, four years.
Great. This is all the time we have. Thank you so much, everyone. Thanks, Jon and Jen.
Thank you, Joanna. Thank you.