All right, good afternoon. Hopefully, David Zervos gave us some optimism. I love his term, optimism, and we're all buying the S&P ETF. Our next company is Option Care Health, one of the largest, if not the largest, provider of infusion services in the U.S. Joining us this afternoon are John Rademacher, the company's President and CEO, and Nicole Maggio, the company's Senior Vice President and Corporate Controller. Nicole, I'll pass it to you first for a safe harbor, and then I'll pass it to John.
You guys are the fortunate people to get to hear this in person for once. Today we'll be using forward-looking statements, which are based on our current assumptions and expectations. These assumptions and expectations are subject to risks and uncertainties, which could cause actual results to differ from our expectations. We'll also be using non-GAAP measures as we go through our commentary. We encourage you to review our financial statements as filed with the SEC for more details on the risks and uncertainties and non-GAAP measures.
Awesome. That's it. We're done, right? Yeah. John, let's start with a brief introduction of what Option Care Health does, what your businesses are all about, and then maybe just a little bit of a state of the union and what's going on, you know, how you're feeling about things right now.
Great. Thanks, Brian. Thanks for inviting us. What a great conference. So far, Option Care Health is the nation's largest provider of home and alternate site infusion therapy. On an annual basis, we serve over 300,000 unique patients. It runs across various therapeutic categories, everything from IV antibiotics to the most sophisticated rare and orphan products that are in the marketplace. We have about 8,000 team members. We're licensed in all 50 states. We have over 90 pharmacies that compound, dispense, and distribute the product. Of the 8,000 team members, over 4,000 are clinicians. That's nurses, pharmacists, pharmacy technicians, dietitians, physicians, nurse practitioners that are part of that model. Our focus is around providing extraordinary care to those patients. With that size and scale, it gives us an opportunity to have consistency in the way that we are helping to support clinical outcomes.
That focus and consistency across the 50 states allows us to have a really high level of care. We think of ourselves as being high quality care at an appropriate cost in a setting in which the patients want to receive that. We're on the right side of the cost quality equation. We continue to work upstream with biopharma manufacturers to help support products as they're moving into channel support. We're capturing the market demand through the relationships that we have cultivated with the referral sources, whether it's in a hospital with hospital discharge planners, case managers, hospitalists, and/or with physician practices, clinics, as we're looking at capturing the demand across the acute and chronic portfolio.
John, maybe let's take a step back. Where we are, we see a lot of private equity activity in home infusion or infusion as a whole. There's just a lot of capital chasing the space, right? Maybe if you can walk us through what's compelling about infusion and what drives the growth there for the space.
I think it goes back to where I started. If you're thinking about how are you a solution to the healthcare system and some of the challenges that exist in the high cost of care, what we offer, that high quality of care at an appropriate cost, is something that drives that market demand. If you're a payer that is focusing around your medical loss ratio and thinking about the total cost of care, and you can have equal or better quality at a lower cost, you're trying to utilize those services. We think that there's going to be continued high utility for the products and services that we offer, but also a level of interest to help drive down that total cost of care.
You also see that in this space, especially with some of the higher priced products in the chronic space, there's a lot of interest in trying to find alternative ways to meet the needs of those patients and follow them on a longitudinal basis to deliver better outcomes. All of those things, certainly home infusion as an industry, the alternate site as a step down from that, helps to facilitate both that better quality and lower cost thesis that everyone's after.
Maybe I'll pass it to Nicole. As I think about the growth rate of the business, I think in the past you guys have quoted a high single digit organic top line growth outlook, low double digit adjusted EBITDA growth outlook. When we think about the drivers in the industry, is it still supportive of those expectations? Maybe for you too, John, if you want to chime in on that.
Yeah, you know, I'd say over the medium term, we still don't have any changes to our overall growth algorithm. Again, that high single digit growth comes from a combination of low single digit acute growth, which, again, we've typically performed above market to be closer to the mid single digits, combined with the faster growing low double digit chronic growth. We continue to see that as the organic growth formula for the revenue line. We do continue to see a lot of innovation and continued new disease prevalence, as well as new products that are coming out that, you know, with our relationships with pharma, we are in a position to be able to partner with them to help commercialize and to reach those patient cohorts.
On the gross profit line, we have said that given the mix shift towards chronic, again, just growing faster than acute, we do expect a slightly slower clip than revenue, just impact on the gross margin rate. That's why we've always focused on the gross profit dollar growth. Even though there are some lower gross profit margins on those chronic products, they do come with those higher revenue dollars and do offer a very attractive gross margin contribution. The bottom line, we have continued to invest in our infrastructure and continue to believe that we can leverage the investments that we've made and to be able to grow leveragedly to get that adjusted EBITDA up to double digits. Also, we have started disclosing adjusted EPS starting this year.
We do expect that to grow at a slightly higher clip given the cash generation of the business and our ability to deploy capital.
The only other thing I'd add to that, Brian, is, you know, even with the scale that we have today and the market presence that we have the privilege to serve the patients, there still is market share that we can take within that. This is a business that requires hustle. It is around reach and frequency. It's being able to support patients in those local markets. We use that national scale as a competitive advantage to make certain that we're driving efficiency and effectiveness. You win at a local level. There still is opportunity for us to continue to focus around our execution at those local market levels, developing and deepening the partnerships there.
We think there's opportunity to grow not only in that we see volume growth in the therapeutic categories that we're supporting, but also opportunities to take share given the performance of the business and the investments that we've made.
Since you both touched on drugs and new therapies coming down the pike, one of the things that we get asked a lot is, what does the portfolio look like today and what are the economics for some key drugs? I mean, John, you and I were just chatting about Stelara earlier, as an example, right? How should investors think about the mix of drugs that you have, maybe any big chunks of risk or exposures to think of and why you're not worried about the outlook for the drugs that you have in the pipeline and the portfolio and what the pipeline looks like?
Yeah, look, there's always going to be innovation in the drug delivery aspect of it. I mean, the goal of pharma is to create a little white pill that you take with water. There's different steps along that path. In the time Nicole and I have been with the organization for 10 years, there's always going to be that change in the portfolio and the formulary that we're able to provide through those cycles. However, there is high utility. There is a robust pipeline of infused and injectable drugs that require healthcare professional oversight. We work upstream with manufacturers to help support the commercialization of those products and be a channel partner for them through that process. We still see that even within the portfolio that we have today, we have broad diversity across the different therapies and therapeutic categories that allows us sustainability and durability across that.
We think we're well positioned. We like the platform from a clinical standpoint. We like the capability set that we have within the pharmacy infrastructure, the clinical competencies that we can bring into supporting either new therapies that are entering in the marketplace or supporting patients as they're transitioning out of an IV to a subcutaneous that requires a healthcare professional, or even we provide subcutaneous that is self-injectable as part of our pharmacy infrastructure. We think that there's opportunities to continue to grow and to continue to support these different disease states and therapeutic categories.
John, just to double click on that, right? One of the questions that we get a lot from investors is the idea that a lot of the drugs in the pipeline are subcutaneous and subinfused. Do you worry about that or some of the conversions that are happening with infused drugs to subQ? Does Option Care Health have a place for the future of pharmaceuticals?
Yeah, when you think of the pharmacy infrastructure that we have and the clinical capabilities that are existing in the organization, we are well positioned to continue to support patients through that process. Our pharmacies can dispense through that. We hear the same questions just around the therapies that are coming down the pipeline. There are still a significant number that are IV and injectables that require healthcare professional oversight. We will continue to capitalize on our position in support of those. There are ones that have IV induction dose that require the IV to kind of activate, and then they start to move towards subcutaneous.
When you think of the disease states that we're managing, the ability to follow a patient on a longitudinal basis and make certain that adherence is high, that they're following the care plan effectively, that we're able to capture insights and data and provide that back to the care team, whether it's the prescribing physician or others through that process. We think there's a meaningful role that we can play to help support not only people managing to live their best life with a chronic condition, to help monitor and support that through the process, and to continue to make certain that as an organization, we have the infrastructure to support those conversions to subcutaneous and be able to continue to support those patients. We're well equipped to be able to do that.
This is part of what we've lived through over the past 10 years. We've had a number of drugs come into our portfolio and subsequently leave, again, Radicava, the KINR2 that we called out a few years back. We have a dynamic portfolio and it will continue to shift. It's nothing that is foreign to us based on what we've seen over the past 10 years.
That makes sense. Maybe, Nicole, if I may just focus on Stelara. I know there's not a discussion in Option Care Health without Stelara coming up. We've seen a shift in the economics for that drug, and it's been an important topic here, right? If you could just walk us through the expected impact for 2025 from that change to reimbursement or the margins of Stelara and what we should expect the carryover impact would be to 2026, given some of the moves that you've made on inventory management.
Sure. Again, we're not giving 2026 today, so don't everybody get excited. I guess on 2025, we've outlined that we expected it to be $60 million-$70 million when we gave our guidance back in January. It's continuing to pattern out as we expect. The couple of things that we have been getting questions on are especially the inventory that we were able to build at the end of the year, which muted the impact in Q1. We've always looked for opportunities to buy ahead of price increases. Nothing that should have been surprising and was part of our calculus when we came out with that $60 million-$70 million. Where that patterns out into 2026, we're just not in a position to give that guidance yet. We've outlined a number of factors that will impact that. Most importantly, our Stelara census. That Stelara census is driven by conversions to biosimilars.
Really just started seeing the uptick in those in Q2, as well as which biosimilar they are converting to. A lot of next-gen drugs that are coming out, Tremfya, Skyrizi, and whether or not those patients decide to transition to one of those therapies instead. All of that additionally will play into our negotiations with Janssen, which, similar to last year, we enter into in the back half of the year. The only non-variable to the equation is the IRA pricing, which was announced last summer. 66% reduction. That's no new news there, but something that we are monitoring closely. The impact will be determined by what our census looks like at the end of the year. Anything else you'd add on that, John?
No. Again, there's been a lot of conversation around Stelara, needless to say, you know, from that standpoint. As an organization, I think we've just demonstrated the clinical capabilities of our enterprise by our ability to execute around that. Most of Stelara in today's format is self-administered. It is on the self-administered drug list. We had worked closely with Janssen, who is a great partner of ours, to identify a unique cohort of patients that required healthcare professional oversight in order to support, whether they had dexterity challenges, comorbidities, and/or cognitive impairment that prevented them from self-administering. I think it speaks in droves around just the clinical capabilities of the enterprise and our ability to capitalize on opportunities that are before us. We're continuing to look for ways for us to manage that effectively.
Chronic inflammatory disease as a category and all of the different products is a meaningful part of our value proposition and what we can bring into the marketplace. I think, as Nicole said, there's a bunch of variables that we're working and managing through at this point in time. I think it's a little disingenuous to try to distill the business down to just a single factor. As we demonstrated in 2025, even with the $60 million-$70 million of headwind that we felt that we called out on that, we've grown through that, right? The business continues to grow through that.
As we're trying to be thoughtful around the way that we're articulating, we want to make certain that we are talking about the full breadth of the capability sets that Option Care Health, as well as the other therapies that will help mute any headwinds that we're feeling or give us a tailwind to help us to capitalize on the incredible position that we have with the infrastructure. We're going to continue to work through that and continue to partner with Janssen and continue to work with the biosim manufacturers through that process.
When we're ready to disclose that and bring that forward, we'll do it with a level of conviction and confidence that you've seen for an organization that has done nothing other than delivered on 22 straight quarters of delivering on what they've committed to as an enterprise, even with the different headwinds and tailwinds that we've had to work through.
John, maybe just a follow-up on that. As we think about some of your disclosures and drug classes and specific therapies that you guys have in the portfolio, anything else we need to be looking out for where, you know, just for investors to feel confident that you don't have another Stelara issue staring down the company?
Yeah, you know, we have been transparent to say, look, Stelara was unique in the sense of that small cohort of patients and the partnership that we had with Janssen to be able to develop a unique service for these patients. Our branded pharmaceuticals that, again, most of the other products kind of fall into, they move more back towards the traditional of those are the lower margin products that are within our portfolio because as a branded manufacturer and an innovator into the marketplace, you don't have to necessarily share a lot of the value with the channel partners through that. We have disclosed that there is no other product that is more than 5%. We don't have kind of a concentration of exposure.
The other things that we've called out are chronic inflammatory disease across all of the spectrum is a meaningful contributor, but there are various products in various forms of either biosim, you know, competition, et cetera, and, you know, Ig as a category as well. That is in a very biosimilar type of status with all of the different fractionators having different products in there. We don't feel like there's concentrated exposure. We like the breadth of the product portfolio. I think our ability and what we've been able to demonstrate on the acute side of the house of being able to be very responsive to market changes and competitive exits, et cetera, just emboldens us in our confidence that we've got breadth of portfolio, breadth of formulary, and we don't have that concentration that we're concerned about internally or as we're trying to articulate externally to our investor base.
Since you mentioned biosimilars, how do you feel about biosimilars as a category? Do you still believe that it's an opportunity for upside going forward? Is it a category you're excited about or should we think of that as a risk?
In its normal form, it is an opportunity. As I said, normally with a branded pharmaceutical, those are on the lower end of the margin scale only because the innovators don't have to share that aspect. Once you get biosimilars into the marketplace, it creates a competitive dynamic that you would expect in the sense of both the innovator has to put some incentive to try to hold their census, as well as the biosimilar manufacturers are coming in and trying to help channel partners get motivated to move their product into the marketplace. In most instances, those are very favorable for us. Much like you see in a generic environment, it just allows us more leverage to get the best acquisition cost moving forward.
The interesting thing, again, not dwelling on Stelara, it's just Stelara is a little bit of an inverse in the sense of because of the uniqueness of the program that we were able to create with Janssen, it actually operated more as a biosim in that branded state and is now moving back towards kind of a more consistent model on that. That is the one nuance that we'll call out. That's why we've been highlighting it and being as transparent as possible without giving up competitive intelligence through that process.
With biosimilar events, as they typically play out, as entrants come into the market, that reference price takes a glide path that normally takes, again, every biosimilar event is a little bit different on the timeframe, but it normally takes some time for that reference price to compress. With the one we were, the drug we were just talking about, you know, they know the end of the movie is there for January 1st. That's why this one is behaving a little bit differently.
That makes sense. Maybe I'll shift gears a little bit. John, you introduced a strategy on the advanced practitioner model as a way to tap into Medicare fee-for-service. I mean, you and I have known each other for a long time. It feels like we've always talked about the opportunity for Medicare to cover infusion, but it still hasn't materialized. It's a good way to tap into that market. How are you thinking about the remaining runway or the runway for that strategy? What's the rollout going to look like over the next two to three years for you guys?
Yeah, we're always looking to provide the broadest access as possible. When you look at the depth of our market access from the commercial payer standpoint, we have over 800 payer relationships, over 1,400 contracts. We're broad in that market access. That one missing piece, I think, for everyone in home infusion really sits around Medicare fee-for-service and kind of the limited benefit for Medicare beneficiaries. We've been working in Washington with bipartisan support to try to get that to get advanced and moving ahead. Washington, as everyone knows, trying to move things in today's environment is a little bit difficult, even though you've got some bipartisan support associated with that. We're always going to push for that legislative fix because we think that there's an opportunity to save the U.S. government and CMS a significant amount of dollars through that as the commercial payers have realized.
The advanced practitioner model, that APM and the way that we've looked at it, we think is additive to kind of our overarching strategy. Again, knowing that servicing patients in the home is at the core of what we do, utilizing our infusion suites under the practice of pharmacy is an extension of that to make us easier and for those patients that are out doing activities of daily living. Expanding access through the advanced practitioner model, either to expand access for Medicare beneficiaries that can participate in the programs through that form and/or where we can find opportunities to help reduce the out-of-pocket for patients, even on some of the commercial plans. We'll use that advanced practitioner model in order to do that.
What that also allows us to do is have a deepening relationship from the clinical standpoint with the advanced practitioner to help develop the care plans to follow patient longitudinally, to provide a higher level of medical oversight for some of the more complex patients. When you think of some of the emerging therapies like Alzheimer's and other aspects that may require some additional oversight, this allows us expansion and the ability to look for additive ways to leverage our clinical competencies and deepen those relationships with pharma manufacturers. We look at it as a market access play. We look at it as a clinical outcome play. We look at it as an opportunity to differentiate ourselves with manufacturers who want that higher level of clinical oversight because of some of the complexity of their therapies.
Now, it makes a lot of sense. Shifting gears here, we saw CVS kind of walk away from a lot of their infusion businesses. That's obviously been a tailwind for you guys. How do we think about just the investments that you're making to fund future growth coming out of that sort of tailwind that you're seeing this year?
Yeah, I mean, we're a built-for-purpose home infusion company. We've been investing in home infusion for the last 10 years, and that's in people, process, technology, and facilities that allows us to capitalize on what we think is a unique model and a unique platform. We are well positioned and have capacity, and we've been able to demonstrate this past year, even with an unanticipated exit of a major competitor, our ability to capture that market demand and sweat the assets and utilize the facilities and take that capacity, I think just demonstrates some of the flexibility and the dynamic nature of the platform, but also our ability to respond to some of those market needs. As a business, our first priority is to make certain we're investing into the business for growth.
On a CapEx standpoint, on an annual basis, we've continued to invest in the business through that process, and we think we're well positioned to do that. There is care and feeding of just maintaining facilities and relocating where necessary or expanding where opportunities present itself. We think we're in a really strong position on that. The other thing that has done is it's deepened our relationship in those local markets. I think it's also increased the importance of Option Care Health to the payer community because when you think of the cost of a bed day, when you think of how they're trying to manage their medical loss ratios and our ability to support patients that are stable enough to be discharged from the hospital, but be able to move them to the home in a much more cost-effective manner, that is of high value to the payer community.
That opportunity for us to partner more deeply to make certain that we're extracting fair value for the value that we're delivering and to continue to be part of their solution as they're thinking about medical loss ratio, all of these just make us or put us in a better position for that dialogue and for reinforcing the strength of the position that we hold.
John, maybe just a quick follow-up. I mean, one of the questions we get a lot is, does this give you a tough comp into next year?
I hope in many instances, it just demonstrates the ability that this organization has to capitalize on the opportunities before us. It is one in which we grow through it. Yes, it will create a little bit of a comp challenge as we lap that competitive closure, but we think that it positions us to continue to grow. As we saw in 2022 when there was the first step down of competitive closures, what it did is it kind of raised the base in which we grew from. Our expectations as we move forward is we kind of reset as we've gone through the year. We'll continue to reset, and that will be the base that we grow from. It's gained confidence of the referral sources to make Option Care Health their partner of choice. We think it gives us opportunities to capture more of the market demand.
We think it'll start to revert back to some of the historical norms. We've been growing in the mid-teens in acute on a therapeutic category that for the most part is a low single digits when you look at volume base. We think that over, as we roll into lapping the exits, you'll start to see us revert back to the historical of that kind of mid-single digit level of acute growth ahead. I hope that folks, if a comp on that basis when we've grown 15% or more over a year because we took advantage of a market opportunity, I hope that that's not punished, but actually rewarded to just demonstrate an organization that can be hyper-responsive to the market realities that we're facing.
It truly was an opportunity. We weren't the only competitor in any of these markets. We're still not the only competitor, but I think we have a proven track record that we have been able to execute whenever these do happen.
Yeah, it makes sense. We got two minutes here. As I think about capital deployment, John, I think you and I have talked about M&A and how valuations are really steep in the infusion space right now. You're generating a lot of cash. How should we think about capital deployment strategies going forward?
Yeah, I think a little bit of repeating what I said before. I mean, our first goal is to deploy capital and CapEx to support the business and to continue to grow there. We're going to continue to look for M&A opportunities. I mean, as we demonstrated earlier this year with the announcement of Intramed Plus, we think there's still value to be had, and we think that there's opportunities that exist there, but we're going to be disciplined. We don't have to chase a headline. We're always looking for opportunities where either we can get density within a market, capability sets that expand us, and/or just market presence that would help move us forward. We're always going to continue to look at that. I think M&A is always going to be on the list of things that we do, but in a very disciplined way.
The best part of it is we still believe that we have an opportunity to buy the best home infusion company out there. At this point, at a very fair value, if not undervalued, in buying shares back. You know, we'll deploy the capital in that way. The balance sheet has never been stronger. Our leverage profile has never been better on that. It just gives us that opportunity to deploy capital in shareholder-friendly ways and continue to return to shareholders' value through those various forms.
What is the most underappreciated thing about Option Care from an investor perspective?
I guess the things I would call out is just the ability to execute. We have demonstrated time and time again the consistency of the performance, the durability of the business model, and the clinical competencies that we have. Going back to where we just ended, the cash flow generation of this business is substantial. I mean, this year we'll generate over $320 million of cash flow from operations. That opportunity to redeploy that capital in shareholder-friendly ways is a high priority for me and the leadership team to be able to do that. We like the position that we have. We don't rest on our laurels. This is a hustle business, but we believe we're well positioned to continue to grow and to execute well.
Awesome. Thank you, John. Thank you, Nicole.
Yeah, thanks, everyone.