{
  "@context": "https://frontierpicks.com/schemas/dossier.v1.json",
  "ticker": "BTSG",
  "name": "BrightSpring Health Services, Inc.",
  "url": "https://frontierpicks.com/dossiers/BTSG/",
  "json_url": "https://frontierpicks.com/dossiers/BTSG.json",
  "status": "WATCHLIST",
  "current_conviction": "MEDIUM",
  "archetype": {
    "code": "a4",
    "n": 4
  },
  "current_thesis": "BrightSpring Health Services is growing profit faster than revenue, with third-quarter 2026 adjusted EBITDA up 42% on specialty pharmacy margins and acquired home-health branches. Its first 2027 guidance, expected around late February 2027, settles whether growth clears management's goal of at least 15%-20%.",
  "invalidation_trigger": "A daily close below $58.75, the June 2026 secondary-offering price, which would put the shares back under the level where holders last sold stock. First 2027 adjusted EBITDA guidance implying organic growth below 15% at the fourth-quarter report would also break the case.",
  "catalyst_date": null,
  "portfolio": null,
  "pick": null,
  "themes": [
    "managed-care-health-services"
  ],
  "tags": [],
  "sources": [],
  "caveats": [],
  "source_links": [
    {
      "title": "BrightSpring Health Services, Inc. - Form 8-K - FY2026",
      "url": "https://www.sec.gov/Archives/edgar/data/0001865782/000186578226000011/btsg-ex99_1.htm",
      "date": "2026-10-30"
    },
    {
      "title": "[Updated] CMS Finalizes 2027 Home Health Medicare Payment Rule With 2.4% Rate Increase",
      "url": "https://homehealthcarenews.com/2026/11/cms-finalizes-2027-home-health-medicare-payment-rule-with-2-4-rate-increase/",
      "date": "2026-11-04"
    },
    {
      "title": "BTSG Jumps 11.3% in One Week as Strong Growth Tests Its Valuation",
      "url": "https://finance.yahoo.com/healthcare/articles/btsg-jumps-11-3-one-163300079.html",
      "date": "2026-11-05"
    },
    {
      "title": "BrightSpring Soars 12% on Q3 Beat and Raised 2026 Guidance as Adjusted EBITDA Jumps 42%",
      "url": "https://www.tikr.com/blog/brightspring-soars-12-on-q3-beat-and-raised-2026-guidance-as-adjusted-ebitda-jumps-42",
      "date": "2026-10-30"
    },
    {
      "title": "BrightSpring Health Services (NASDAQ:BTSG) Price Target Raised to $84.00",
      "url": "https://www.marketbeat.com/instant-alerts/analyst-brightspring-health-services-nasdaq-btsg-price-target-raised-to-8400-2026-11-03/",
      "date": "2026-11-03"
    },
    {
      "title": "UBS raises BrightSpring Health stock price target to $92 on growth outlook",
      "url": "https://www.investing.com/news/analyst-ratings/ubs-raises-brightspring-health-stock-price-target-to-92-on-growth-outlook-93CH-4990766",
      "date": null
    },
    {
      "title": "BrightSpring prices 20M-share secondary at $41.15",
      "url": "https://www.stocktitan.net/news/BTSG/bright-spring-announces-pricing-of-secondary-offering-of-common-2tilwd26mx4f.html",
      "date": null
    },
    {
      "title": "Mintz",
      "url": "https://www.mintz.com/media/33196",
      "date": null
    }
  ],
  "evidence": [
    {
      "claim": "Q3 2026 revenue $4,213M, up 26%; adjusted EBITDA $227.8M, up 42% from $160.4M; adjusted EPS $0.54 vs $0.30",
      "source": "BrightSpring Q3 2026 8-K earnings release",
      "as_of": "2026-10-30"
    },
    {
      "claim": "FY2026 guidance raised to revenue $15.900B-$16.125B and adjusted EBITDA $850M-$860M (37.6%-39.3% growth)",
      "source": "BrightSpring Q3 2026 8-K earnings release",
      "as_of": "2026-10-30"
    },
    {
      "claim": "Management reiterated at least 15%-20% organic adjusted EBITDA growth for 2027",
      "source": "Zacks article on Yahoo Finance",
      "as_of": "2026-11-05"
    },
    {
      "claim": "Shares trade at 30.9x forward 12-month earnings vs 16.2x for the Zacks sub-industry and 21.8x for the medical sector",
      "source": "Zacks article on Yahoo Finance",
      "as_of": "2026-11-05"
    },
    {
      "claim": "Gross profit per script $28.86, up 27%; prescription volume up 1.5%; home-health average daily census 47,256, up 58%",
      "source": "TIKR summary of Q3 2026 earnings call",
      "as_of": "2026-10-30"
    },
    {
      "claim": "CMS final CY2027 home-health rule: aggregate payments up 2.4% (~$415M), 2.1% payment update, 3% temporary reduction to standardized rate, no added permanent adjustment",
      "source": "Home Health Care News",
      "as_of": "2026-11-04"
    },
    {
      "claim": "Consensus price target $77.81 across 19 analysts (17 Buy, 1 Strong Buy, 1 Hold)",
      "source": "MarketBeat",
      "as_of": "2026-11-03"
    },
    {
      "claim": "PharMerica President Scott Greenwell sold 15,099 shares at $57.91 under a Rule 10b5-1 plan after exercising 11,973 options at $22.27",
      "source": "SEC Form 4 filed 2026-09-16",
      "as_of": "2026-09-14"
    }
  ],
  "view_changes": [],
  "frame": null,
  "filed_numbers": {
    "as_of": "2026-11-13",
    "sector": "Healthcare",
    "financials": {
      "status": "ok",
      "reason": null,
      "close_date": "2026-11-13",
      "latest_quarter": "2026-09-30",
      "figures": {
        "revenue": {
          "status": "ok",
          "quarters": [
            {
              "end": "2026-09-30",
              "filed": "2026-10-30",
              "restated": null,
              "value_musd": 4213.2,
              "yoy_pct": 26.4
            },
            {
              "end": "2026-06-30",
              "filed": "2026-07-31",
              "restated": null,
              "value_musd": 3873.1,
              "yoy_pct": 23
            },
            {
              "end": "2026-03-31",
              "filed": "2026-05-01",
              "restated": null,
              "value_musd": 3613.7,
              "yoy_pct": 25.6
            },
            {
              "end": "2025-12-31",
              "filed": "2026-02-27",
              "restated": null,
              "value_musd": 3550.6,
              "yoy_pct": null
            },
            {
              "end": "2025-09-30",
              "filed": "2025-10-28",
              "restated": null,
              "value_musd": 3334.1,
              "yoy_pct": null
            },
            {
              "end": "2025-06-30",
              "filed": "2025-08-01",
              "restated": null,
              "value_musd": 3147.7,
              "yoy_pct": null
            }
          ]
        },
        "gross_margin": {
          "status": "ok",
          "quarters": [
            {
              "end": "2026-09-30",
              "filed": "2026-10-30",
              "restated": null,
              "pct": 12.3
            },
            {
              "end": "2026-06-30",
              "filed": "2026-07-31",
              "restated": null,
              "pct": 12.7
            },
            {
              "end": "2026-03-31",
              "filed": "2026-05-01",
              "restated": null,
              "pct": 13.3
            },
            {
              "end": "2025-12-31",
              "filed": "2026-02-27",
              "restated": null,
              "pct": 11.6
            },
            {
              "end": "2025-09-30",
              "filed": "2025-10-28",
              "restated": null,
              "pct": 11.8
            },
            {
              "end": "2025-06-30",
              "filed": "2025-08-01",
              "restated": null,
              "pct": 11.9
            }
          ]
        },
        "operating_margin": {
          "status": "ok",
          "quarters": [
            {
              "end": "2026-09-30",
              "filed": "2026-10-30",
              "restated": null,
              "pct": 3.8
            },
            {
              "end": "2026-06-30",
              "filed": "2026-07-31",
              "restated": null,
              "pct": 3.4
            },
            {
              "end": "2026-03-31",
              "filed": "2026-05-01",
              "restated": null,
              "pct": 3.4
            },
            {
              "end": "2025-12-31",
              "filed": "2026-02-27",
              "restated": null,
              "pct": 3
            },
            {
              "end": "2025-09-30",
              "filed": "2025-10-28",
              "restated": null,
              "pct": 2.6
            },
            {
              "end": "2025-06-30",
              "filed": "2025-08-01",
              "restated": null,
              "pct": 1.5
            }
          ]
        },
        "pretax_income": {
          "status": "ok",
          "end": "2026-09-30",
          "filed": "2026-10-30",
          "value_musd": 129.4
        },
        "net_income": {
          "status": "ok",
          "end": "2026-09-30",
          "filed": "2026-10-30",
          "four_quarters_end": "2026-09-30",
          "value_musd": 100.1,
          "four_quarters_musd": 410.3
        },
        "operating_cash_flow": {
          "status": "ok",
          "end": "2026-09-30",
          "filed": "2026-10-30",
          "first_end": "2025-12-31",
          "value_musd": 602.7
        },
        "capital_spending": {
          "status": "ok",
          "end": "2026-09-30",
          "filed": "2026-10-30",
          "first_end": "2025-12-31",
          "value_musd": 110.3
        },
        "free_cash_flow": {
          "status": "ok",
          "end": "2026-09-30",
          "filed": "2026-10-30",
          "first_end": "2025-12-31",
          "value_musd": 492.4
        },
        "diluted_share_change": {
          "status": "ok",
          "end": "2026-09-30",
          "filed": "2026-10-30",
          "base_end": "2025-09-30",
          "pct": 1
        },
        "cash": {
          "status": "ok",
          "end": "2026-09-30",
          "filed": "2026-10-30",
          "value_musd": 717.8
        },
        "debt": {
          "status": "ok",
          "end": "2026-09-30",
          "filed": "2026-10-30",
          "value_musd": 2182.1,
          "composition": "long-term debt"
        },
        "net_cash": {
          "status": "ok",
          "end": "2026-09-30",
          "filed": "2026-10-30",
          "value_musd": -1464.2
        },
        "deferred_revenue": {
          "status": "ok",
          "end": "2026-09-30",
          "filed": "2026-10-30",
          "value_musd": 11,
          "yoy_pct": 33
        },
        "backlog": {
          "status": "not reported"
        },
        "receivables": {
          "status": "ok",
          "end": "2026-09-30",
          "filed": "2026-10-30",
          "value_musd": 1216.4
        },
        "inventory": {
          "status": "ok",
          "end": "2026-09-30",
          "filed": "2026-10-30",
          "value_musd": 671.6
        },
        "equity": {
          "status": "ok",
          "end": "2026-09-30",
          "filed": "2026-10-30",
          "value_musd": 2176.5
        },
        "market_value": {
          "status": "ok",
          "close_date": "2026-11-13",
          "basis_end": "2026-10-27",
          "basis_filed": "2026-10-30",
          "value_musd": 14169.7
        },
        "enterprise_value": {
          "status": "ok",
          "close_date": "2026-11-13",
          "basis_end": "2026-10-27",
          "basis_filed": "2026-10-30",
          "value_musd": 15633.9
        },
        "ev_sales": {
          "status": "ok",
          "close_date": "2026-11-13",
          "basis_end": "2026-10-27",
          "basis_filed": "2026-10-30",
          "multiple": 1
        },
        "ev_ebit": {
          "status": "ok",
          "close_date": "2026-11-13",
          "basis_end": "2026-10-27",
          "basis_filed": "2026-10-30",
          "multiple": 30
        },
        "pe": {
          "status": "ok",
          "close_date": "2026-11-13",
          "basis_end": "2026-10-27",
          "basis_filed": "2026-10-30",
          "multiple": 34.5
        },
        "pb": {
          "status": "ok",
          "close_date": "2026-11-13",
          "basis_end": "2026-10-27",
          "basis_filed": "2026-10-30",
          "multiple": 6.5
        },
        "fcf_yield": {
          "status": "ok",
          "close_date": "2026-11-13",
          "basis_end": "2026-10-27",
          "basis_filed": "2026-10-30",
          "pct": 3.5
        }
      }
    },
    "short_interest": {
      "status": "ok",
      "settlement": "2026-10-15",
      "published": "2026-10-26",
      "short_pct_of_outstanding": 5.77,
      "days_to_cover": 5.2,
      "change_pct": -4.3
    },
    "insiders": {
      "status": "ok",
      "as_of": "2026-11-15",
      "windows": [
        {
          "days": 90,
          "status": "ok",
          "from": "2026-08-18",
          "bought_usd": 0,
          "sold_usd": 874383.09,
          "bought_unpriced": 0,
          "sold_unpriced": 0
        },
        {
          "days": 365,
          "status": "ok",
          "from": "2025-11-16",
          "bought_usd": 0,
          "sold_usd": 1696964148.04,
          "bought_unpriced": 0,
          "sold_unpriced": 0
        }
      ]
    }
  },
  "body_markdown": "## Current Thesis\n\nBrightSpring Health Services is growing profit much faster than revenue, and the evidence modestly favours the shares beating the S&P 500 over the next three months. The first 2027 guidance settles it. That guidance is expected with the fourth-quarter report around late February 2027, and it will show whether profit growth clears management's goal of at least 15%-20% organic growth in adjusted EBITDA (earnings before interest, taxes, depreciation and amortization).\n\nThe company beat estimates and raised guidance in its third-quarter report on 2026-10-30. Revenue rose 26% to $4.213 billion and adjusted EBITDA rose 42% to $227.8 million, per the company's 8-K release. Specialty pharmacy earns more on each prescription. Branches bought from Amedisys and LHC Group add scale in home health.\n\nThe price already assumes the plan works. Zacks put the shares at 30.9 times forward 12-month earnings on 2026-11-05, against 16.2 times for its sub-industry. The shares closed at $71.45 on 2026-11-12, 3.1% below the 52-week intraday high of $73.75 set on 2026-07-27.\n\nThe rating is Medium because the earnings momentum, the 2027 growth goal and the 2026-11-04 Medicare home-health rule all support the case. Against that, the valuation is high, and KKR-affiliated holders sold stock after earnings reports twice in 2026.\n\n## Bull Case\n- **Beat on sales and earnings.** Third-quarter adjusted earnings per share were $0.54, against $0.30 a year earlier and a $0.47 estimate, per Benzinga on 2026-10-30. Revenue of $4.213 billion beat the $3.875 billion estimate, per the same report.\n- **Full-year guidance raised again.** On 2026-10-30 the company raised its 2026 revenue guidance to $15.900-$16.125 billion, from $15.100-$15.425 billion. Adjusted EBITDA guidance rose to $850-$860 million, from $820-$845 million, which the 8-K puts at 37.6%-39.3% growth.\n- **A stated goal for 2027.** Management reiterated at least 15%-20% organic adjusted EBITDA growth for 2027, Zacks reported on 2026-11-05. That gives the February report a clear yardstick.\n- **Specialty pharmacy drives the profit.** Gross profit per prescription rose 27% to $28.86 in the third quarter, per TIKR's 2026-10-30 summary of the call. Chief Financial Officer Jennifer Phipps called 2026 the peak year of the Medicare drug-price hit and expects the 2027 hit to be about half as large.\n- **2027 home-health rates confirmed.** The final rule from the Centers for Medicare & Medicaid Services (CMS), issued on 2026-11-04, raises aggregate 2027 home-health payments by 2.4%, about $415 million, per Home Health Care News. CMS added no further permanent cut to the base rate.\n- **Acquired branches lift home health.** Average daily home-health census, the number of patients served on a typical day, reached 47,256 in the third quarter, up 58%, per TIKR on 2026-10-30. The 107 acquired branches helped drive that growth.\n- **Debt falling quickly.** Leverage was 1.79 times at 2026-09-30, down from 2.15 times at 2026-06-30, per the 8-K. Third-quarter operating cash flow was $204.3 million.\n- **Analysts raised targets after the report.** On 2026-11-02, Leerink raised its target to $92, UBS to $92, TD Cowen to $84, Wells Fargo to $82 and Deutsche Bank to $73.50. Guggenheim moved to $84 on 2026-11-03. MarketBeat put the consensus target at $77.81 across 19 analysts on 2026-11-03.\n\n## Bear Case\n- **The valuation already assumes success.** Zacks reported a forward multiple of 30.9 times earnings on 2026-11-05, against 16.2 times for the sub-industry and 21.8 times for the medical sector. The 2026-11-12 close of $71.45 sits within 2.8% of Deutsche Bank's $73.50 target.\n- **Growth comes from drug mix and price.** Prescription volume rose only 1.5% in the third quarter while gross profit per prescription rose 27%, per TIKR on 2026-10-30. Most of the earnings growth rests on pricing the company does not set.\n- **Medicare drug-price negotiation extends to 2028.** Health Affairs reports that the third negotiation cycle, announced on 2026-01-27, covers 15 drugs plus one renegotiation and is the first to include Part B drugs. Its prices take effect on 2028-01-01.\n- **Holders keep selling into strength.** KKR-affiliated funds and management sold 20 million shares at $41.15 in March 2026 and 15 million more in June 2026 in underwritten offerings. Both sales followed earnings reports.\n- **An insider sold near $58.** PharMerica President Scott Greenwell sold 15,099 shares at $57.91 on 2026-09-14 under a Rule 10b5-1 plan, per his SEC Form 4. The sale followed his exercise of 11,973 options at $22.27.\n- **The home-health rule carries a temporary cut.** The 2027 final rule includes a 3% temporary reduction to the national standardized payment rate, per Home Health Care News on 2026-11-04. CMS will keep analysing 2026 claims to decide whether a permanent adjustment is needed.\n\n## Setup & Price Structure\nThe shares closed at $71.45 on 2026-11-12, down from $72.62 on 2026-11-11 and $72.49 on 2026-11-10. Based on adjusted daily closes, they are up 15.8% over three months from the $61.71 close on 2026-08-14. The 52-week intraday high is $73.75 from 2026-07-27, and the 52-week closing low is $31.36 from 2025-11-17. The shares have more than doubled from that low in a year.\n\nIn adjusted daily closes, the 50-day moving average was $61.73 and the 200-day was $56.03 on 2026-11-12. The last close sits about 16% above the 50-day. The shares rose from $65.86 on 2026-11-05 to $72.49 on 2026-11-10, and no company announcement came in that window.\n\nThe July 2026 high is the level the case now turns on. A close above $73.75 would mark a new 52-week high driven by the third-quarter results. The June 2026 offering price sits below the 50-day average. It marks the level where buyers last took in a large block of stock from holders.\n\nThe next earnings report is more than three months away. The March and June 2026 offerings each followed an earnings report, so a new underwritten offering is the main event that could add supply before February.\n\n## Catalyst Calendar\n\n- **~2026-11-30 (est.):** CMS publishes negotiated prices for the third Medicare drug-price cycle, effective 2028-01-01. It shows how far specialty drug-price pressure extends into 2028, beyond the 2027 easing management describes. The date is the statutory deadline in Mintz's summary of the timeline.\n- **~2027-02-26 (est.):** Q4 and full-year 2026 report with first 2027 guidance. It tests management's goal of at least 15%-20% organic adjusted EBITDA growth in 2027 and the expected halving of the Medicare drug-price hit.\n\n## What Would Change Our Mind\n\nA daily close below $58.75, the June 2026 secondary-offering price, which would put the shares back under the level where holders last sold stock. First 2027 adjusted EBITDA guidance implying organic growth below 15% at the fourth-quarter report would also break the case.\n\nThe risks this note tracks, each with what would confirm it:\n\n- KKR-affiliated holders sell more stock, adding supply as they did after earnings reports in March and June 2026. Confirmed by: A new underwritten secondary offering announced by KKR-affiliated holders or management.\n- Profit growth depends on drug mix and price rather than volume, leaving it exposed to Medicare Part D and Medicaid pricing changes. Confirmed by: Gross profit per script flat or down year over year at the Q4 2026 report, or a new CMS pricing action affecting specialty drugs.\n- 2027 guidance falls short of management's organic growth goal after 2026's 37.6%-39.3% adjusted EBITDA growth. Confirmed by: Initial 2027 adjusted EBITDA guidance at the Q4 report implying organic growth below 15%.\n- A forward multiple of 30.9 times earnings on 2026-11-05 leaves less room for any shortfall than the 16.2 times Zacks shows for the sub-industry. Confirmed by: Shares falling sharply on a report that meets guidance, with analysts cutting targets from the $77.81 MarketBeat consensus.\n- CMS follows the 2027 temporary home-health rate reduction with a permanent cut, slowing the Provider segment. Confirmed by: A CY2028 proposed home-health rule including a permanent base-rate adjustment.\n\n## Correlation Notes\nBrightSpring's own drivers are specialty drug pricing, Medicare Part D and Medicaid reimbursement, and Medicare home-health rates. Its closest overlap is with drug distributors such as McKesson (MCK), which also face Medicare drug-price negotiation. Home-health rate rules move it with other Medicare home-health operators.\n\nMedicare Advantage news that moves Humana (HUM) or agilon health (AGL) has a less direct effect on BrightSpring. Share sales by KKR-affiliated holders are specific to this stock and can move it independently of the health-services group. The company's own results matter more to this case than the direction of the group.",
  "first_seen": "2026-11-10",
  "last_analyzed": "2026-11-12T23:16:39+00:00",
  "last_synthesized": "2026-11-12",
  "date_modified": "2026-11-12",
  "license": "Content © FrontierPicks. Cite the canonical URL."
}