BrightSpring Health Valuation Multiples

CVS Health offers a diverse set of healthcare services. Its roots are in its retail pharmacy operations, where it operates over 9,000 stores primarily in the US. CVS is also a large pharmacy benefit manager (acquired through Caremark), processing about 2 billion adjusted claims annually. It operates a top-tier health insurer (acquired through Aetna) through which it serves about 27 million medical members. The acquisition of Oak Street Health added primary care services to the mix, which could have significant synergies with all existing business lines.

Sigma Healthcare is Australia’s largest retail pharmacy franchisor, most notably owning the Chemist Warehouse brand, which it merged with in 2025. Sigma is also Australia’s largest full-line wholesaler to franchised and independent pharmacies and distributes a broad range of pharmacy products, including prescription medicines, over-the-counter products, and front of store, or FOS, products, at low prices. The group also operates in New Zealand, Ireland, China, and Dubai, has a growing private label range, and offers third-party logistics services.

Dr Sulaiman Al Habib Medical Services Group provides private health and ancillary services in the Kingdom and the region through the establishment, management, and operation of hospitals, medical complexes, day surgery centers, pharmaceutical facilities, and other ancillary areas, including home health care, specialized laboratories, technology and information systems, facility maintenance, tele-medicine, revenue cycle management, medical equipment maintenance, and real estate activity. The company reports in three segments: Hospitals and Healthcare Facilities, Pharmacies, and HMG Solutions and Others. The majority of revenue comes from the Hospitals and Healthcare Facilities segment.

JD Health is the largest healthcare e-commerce platform in China in terms of revenue. The company offers pharmaceutical drugs and healthcare products on its platform, both as a marketplace that connects merchants to consumers and as a first-party, or 1P, direct retailer. It also offers online consultation from real life doctors and separately partners with offline pharmacies that can provide location-based 24/7 delivery as part of an omnichannel initiative to complement its core e-commerce business. Its closest competitors are Alibaba Health and Meituan for its e-commerce business. As of Dec. 31, 2024, the platform has over 200 million active annual users and over 70,000 merchants. JD Health is 67.49% owned by its parent company, JD.com.

Ensign Group Inc provides post-acute healthcare services in the United States. Its regional subsidiaries oversee skilled nursing, assisted living, home health and hospice, mobile ancillary, and urgent care operations. Medicare and Medicaid programs contribute majority of revenue received for Ensign's services. The firm operates through two segments, Skilled services, and Standard Bearer. The skilled services segment includes the operation of skilled nursing facilities and rehabilitation therapy services. The Standard Bearer segment comprises of properties owned by the company through its captive REIT and leased to skilled nursing and assisted living operations. The majority of the revenue is generated from the skilled services segment.

Alibaba Health is of one of China's leading e-commerce platform specializing in healthcare-related products, including prescription drugs, OTC drugs, traditional Chinese medicine, health foods, and so on. The company operates both a third-party B2C service, or 3P, and its own direct-to-consumer business, or 1P, with its own inventory, which can both be accessed by Alibaba’s Tmall app and Alipay. The company also provides online consultation services in a separate app called Yilu or “Dr. Deer,” although its e-commerce businesses remain its core competency in the long-term. E-commerce accounted for 93% of revenue in fiscal year 2022. We estimate that AliHealth holds about 45% of market share in the industry in terms of GMV. AliHealth is 63.74% owned by its parent company, Alibaba Group.

Chemed Corp purchases, operates, and divests subsidiaries engaged in diverse business activities to maximize shareholder value. Through its subsidiaries, the company operates in the following segments: VITAS and Roto-Rooter. The VITAS segment generates the majority of the firm's revenue and provides hospice and palliative care services to patients with terminal illnesses through a network of physicians, registered nurses, home health aides, social workers, and volunteers. The Roto-Rooter segment provides plumbing, drain cleaning, water restoration, and related services to residential and commercial customers.

Hinge Health Inc is a technology platform for individuals seeking to treat and prevent joint and muscle pain. Through a combination of AI-powered motion tracking technology, the Company’s platform helps members address musculoskeletal (MSK) conditions, enables improved member outcomes and supports cost reductions for its clients. The Company’s clients are self-insured employers.

Tsuruha Holdings Inc manages pharmaceutical companies in Japan, where the drugstore business is the core of their operations. The company generates revenue through selling prescription and over-the-counter drugs, medical supplies, nursing care products, discount cosmetics, health products, and a miscellaneous assortment of general merchandise. It also provides blood testing services, disease prevention solutions, and at-home drug delivery services.

Raia Drogasil SA is a large retail drug store operator in Brazil. The company is engaged in the retail sale of medicines, perfumery, personal care and beauty products, cosmetics and dermocosmetics and specialty medicines. Its brands include Impulso, Amplimed, HealthBit, Stix, 4Bio, Drogasil, Raia and others.

MatsukiyoCocokara & Co operates retail drugstores and insurance dispensing pharmacies in Japan. The company's main segments are the Matsumotokiyoshi Group Business, focused on stores under the Matsumotokiyoshi brand; the Cocokara Fine Group Business, centered on Cocokara Fine stores; and the Management Support Business, which procures products, oversees group operations, and manages indirect functions such as advertising and promotion. It generates the majority of its revenue from the Matsumotokiyoshi Group Business segment.

Jointown Pharmaceutical Group Co Ltd is engaged in the business of wholesaling drugs and medical devices. The company offers logistics and other value-added services and mainly serves medical institutions, wholesale enterprises, and retail pharmacies.

China Resources Pharmaceutical is the third-largest medical distributor in China by revenue. It is an integrated pharmaceutical company specializing in research and development, manufacturing, medical distribution, and retail pharmacies. As of 2024, the medical distribution business accounts for 82.8% of its total revenue. CR Pharma’s manufacturing business, 18.0% of total revenue, has subsidiaries with a strong presence in traditional Chinese medicine and consumer healthcare.

Yifeng Pharmacy Chain Co Ltd is mainly engaged in the chain retail business of medicines, health products, medical devices, and health-related daily convenience products. Its operating segments include the Retail segment and the Wholesale segment.

Brookdale Senior Living Inc operates senior living communities throughout the United States. The company has three reportable segments: Independent Living, Assisted Living and Memory Care, and Continuing Care Retirement Communities (CCRs). The majority of the revenue is generated from the Assisted Living and Memory Care segment, which offers housing and assistance with activities of daily living to its customers. The company generates revenue in the form of Resident Fees, which it receives in exchange for the services provided, and in the form of management fees from certain communities under contract in exchange for the management services provided.

National Healthcare Corp Provides long-term care facilities. Its principal business includes the operation of skilled nursing facilities, assisted living facilities, independent living facilities, and home care programs. The company's activities include providing sub-acute and post-acute skilled nursing care, intermediate nursing care, rehabilitative care, memory and Alzheimer's care, senior living services, and home health care services. In addition, the company also provides management services, accounting, and financial services, as well as insurance services to third-party operators of healthcare facilities. Its reportable segments include Inpatient services, and Home care hospice services. Generating, a majority of its revenue from Inpatient services.

Selcuk Ecza Deposu Ticaret ve Sanayi AS and its subsidiaries are in the business of export and import of drugs and patent medicines, medical supplies with pharmacy depot operations and also organize distribution channels between drug manufacturers, hospitals, and pharmacies. The company also distributes cosmetics, personal care, infant food, vitamins, medical and similar products.

Sugi Holdings Co Ltd is a Japan-based company engaged in drugstore operations and the pharmaceutical dispensing business. Through its subsidiaries, the company is involved in selling pharmaceuticals, health foods, cosmetics, daily essentials, and prescription drugs. It also operates community-based drugstores that support home healthcare in collaboration with local medical professionals. The company also supports regional healthcare facilities and provides at-home nursing services.

Nahdi Medical Co is engaged in the wholesale and retail trading of cosmetics, pharmaceutical products, special and healthy foods, and medical equipment. It has two operating segments Front Shop and Pharma.

Clicks Group Ltd operates prominently in health, beauty, and wellness retail across southern Africa. The company predominantly operates a retail pharmacy chain in South Africa, with a limited number of operations in bordering countries. The company has a portfolio of retail franchise brands including The Body Shop, M-Kem, and Sorbet among others. The company's business segments include Retail and Distribution. The company generates revenue from in-store and online sales of health, beauty, and wellness items, plus wholesale pharmaceutical distribution. Geographically, the maximum revenue is generated from South Africa.

COSMOS Pharmaceutical Corp manages retail drugstores in Japan. The company emphasizes convenience regarding its product selection, which includes medical products, health and beauty aids, personal-care items, discount cosmetics, household items, food and beverages, greeting cards, seasonal merchandise, alcoholic beverages, tobacco, insect repellent, and miscellaneous everyday consumables. The majority of the company’s revenue is derived from common grocery sales. It also operates a private grocery brand called ON 365.

DaShenLin Pharmaceutical Group Co Ltd is engaged in the pharmaceutical manufacturing, retail, and wholesale business. The company is based on the development of the pharmacy chain. It primarily offers Chinese herbal medicine such as antibiotics and biochemical drugs. The business activities are geographically carried out through China.

Sundrug Co Ltd is a Japanese-based company engaged in the operation of drug stores and discount stores. The Group operates through two segments: the Drug Store Business, which mainly sells pharmaceuticals, cosmetics, and daily necessities, and the Discount Store Business, which mainly sells food products, household goods, and other related items. It generates the majority of its revenue from the Drugstore business segment.

Ebos is the largest pharmaceutical wholesaler across Australia and New Zealand. It services community pharmacies and hospitals, which contribute around 50% and 30% of revenue, respectively. Drug pricing and wholesale margins for PBS medicine are governed by the Australian government’s Pharmaceutical Benefits Scheme, or PBS. Wholesale gross margins are capped at 7% for community pharmacy and 10% for hospitals, and ongoing price reform typically results in low-single-digit revenue growth. Aside from pharma distribution, Ebos operates an animal health product wholesale, manufacturing and retail business, as well as undertaking third party logistics services. These segments are smaller contributors to group revenue but due to the unregulated nature are higher-margin operations.

Emeis operates a comprehensive care offering of mental health clinics and medical and rehabilitation care, retirement homes, assisted living and home care.

Extendicare Inc is a senior care provider in Canada, focused on long-term care and home health care. The company has three main business segments namely Long-term Care (LTC), Home Health Care, and Managed Services. The Long-term Care segment, operating under the Extendicare brand, represents 53 owned homes in Ontario, Alberta and Manitoba. The Home Health Care segment, operating under the ParaMed brand, provides home health care services annually in Ontario, Alberta, Manitoba and Nova Scotia. The Managed Services segment, operating under the Extendicare Assist and SGP Purchasing Partner Network brands, provides management, consulting and group purchasing services to other care providers across Canada.

Corporativo Fragua SAB de CV is engaged in the drug retail sector in Mexico. The company operates a network of pharmacies under the SuperFarmacia brand name, focusing on selling medicines, medical devices, and a variety of other products, including grocery items, exercise machines, perfumes, housewares, electronics, personal care products, toys, and photographic equipment.

Kusuri No Aoki Holdings is a pharmaceutical retail chain that sells health, beauty, and cleaning supplies. The company operates stores that focus primarily on residential areas in Japan. Kusuri's business includes pharmaceutical drugs, and the company also operates a bone-marrow bank. The company breaks out its sales into four different product lines, including health, beauty, life, and dispensing. The vast majority of the company's revenue is derived from its life product category, followed by beauty products. Most of Kusuri's revenue is derived from the Hokuriku region.

Addus HomeCare Corp is engaged in the provision of in-home care services. The Company has three reportable segments: Personal Care, Hospice, and Home Health. The Personal Care segment provides non-medical assistance with activities of daily living, mainly to the elderly, chronically ill, and disabled individuals. The Hospice segment provides physical, emotional, and spiritual care for terminally ill patients and their families. The Home Health segment provides medical services to individuals requiring care during illness or recovery. It generates the majority of its revenue from the Personal Care segment.

Aveanna Healthcare Holdings Inc is a diversified home care platform that provides care to medically complex, high-cost patient populations. It directly addresses the pressing challenges facing the U.S. healthcare system by providing safe, high-quality care in the home. The firm provides its services through three segments: Private Duty Services (PDS); Home Health & Hospice (HHH); and Medical Solutions (MS). Private Duty Services include private duty nursing (PDN) and pediatric therapy services. Revenue is derived from pediatric healthcare services provided to patients including private duty nursing and therapy services, adult home health and hospice services (collectively patient revenue) and from the delivery of enteral nutrition and other products to patients.

Omnicell Inc provides automation and business analytics software for healthcare providers. The company is engaged in transforming the pharmacy and nursing care delivery model. The company helps its customers define and deliver cost-effective medication management designed to equip and empower pharmacists and nurses to focus on patient care rather than administrative tasks and drive improved clinical, operational, and financial outcomes across all care settings. The company derives the majority of its revenue from the United States.

Sonida Senior Living Inc is an owner operator of senior housing communities in the United States in terms of resident capacity. It provides senior living services to the elderly, including independent living, assisted living, Respite Care and Temporary Care Programs, Home Care Services, and memory care services. The company's objective is to provide value to residents by providing quality senior housing services at reasonable prices. The basic service of the company is comprised of meals, housekeeping, laundry, 24-hour staffing, transportation, social and recreational activities, and healthcare monitoring.

Sienna Senior Living Inc is an owner of seniors' housing, a licensed long-term care operator in Ontario, and a provider of services across the full continuum of care. The firm operates solely within Canada. The company is comprised of the following main business segments, LTC, Retirement, and Other. LTC business division consists of approximately 34 LTC residences in the Province of Ontario, eight seniors' living residences located in the Province of British Columbia and the LTC management services business. The group derives a majority of its revenue from LTC segment.

Healthcare Services Group Inc is a provider of housekeeping and facility management services to the healthcare industry. The company manages and evaluates its operations in two reportable segments: Environmental Services segment includes housekeeping, management of clients' housekeeping departments, cleaning, disinfecting and sanitizing, laundry, bed linen, and uniform services, linen and other services; and Dietary Segment includes dietary department services, food purchasing, meal preparation, and providing dietitian consulting services. Its clients are nursing homes, retirement complexes, rehabilitation centers, and hospitals in the United States of America. The Environmental Services segment derives maximum revenue.

Dis-Chem Pharmacies Ltd is a pharmaceutical company based in South Africa. Its product portfolio includes personal care products, beauty products, healthcare and nutrition products, and dispensary and baby care products. The operating segments of the group are Retail and Wholesale. It derives maximum revenue from the Retail segment, which includes company stores, retailers of pharmaceuticals and a variety of health and beauty products, as well as pharma-logistic services and oncology and retailers of pharmaceutical products. The Wholesale segment consists of the CJ wholesale and company distribution businesses, wholesalers of pharmaceuticals, and a variety of health and beauty products. Geographically, the group carries out its business operations principally in South Africa.

Attendo AB is a company that is engaged in providing private care and healthcare services in the Nordics. It focuses on offering care for older people, care for people with disabilities, individual and family care, and health care. The company also offers health, medical, and as well as staffing services. Geographically, the group's majority revenue is generated from Finland.

Clariane SE operates nursing homes, post-acute and rehabilitation clinics, assisted living facilities, and home care services. The company's nursing homes offer long-term care and medical support for elderly people. Its operating segments are: France, Germany, Benelux, Italy, and Spain & United Kingdom. The majority of its revenue is generated in France.

Redcare Pharmacy NV operates an online pharmacy store. Its product portfolio is focused on prescription medications, over-the-counter medications, and pharmacy-related beauty and personal care products. The company's operating segment includes DACH and International. It generates maximum revenue from the DACH segment, which represents income generated from Germany, Austria, and Switzerland. The International segment represents its income generated from Belgium, the Netherlands, France, and Italy.

InnovAge Holding Corp is a healthcare delivery platform comprising multiple participants focused on providing all-inclusive, capitated care to high-cost seniors, many of whom are dual-eligible. Its programs are designed to address two of the pressing challenges facing the U.S. healthcare industry: rising costs and poor outcomes. The purpose of the participant-centered care delivery approach is to improve the quality of care participants receive, while keeping them in their homes for as long as possible and reducing the overutilization of high-cost care settings, such as hospitals and nursing homes. The company manages its business as one reportable segment, PACE.

Omada Health Inc empowers individuals to make lasting health changes through personalized, virtual care between doctor’s visits. The integrated platform of the company supports members with cardiometabolic conditions like prediabetes, diabetes, hypertension, musculoskeletal issues, and behavioral health needs. The company's specialized care tracks also assist members using GLP-1 medications. The Company delivers measurable health outcomes and value for employers, health plans, health systems, and pharmacy benefit managers.

LBX Pharmacy Chain JSC is a China-based company engages in the sale of medicine and health products. The company is engaged in retailing drugs and other related products, including Chinese and Western medicine, prepared slices of Chinese crude drugs, health equipment, healthy food, and personal care products and life care products. The company is also involved in the wholesale and manufacture of drugs.

Create SD Holdings Co Ltd operates drugstores, pharmacy dispensing businesses, and nursing care services. The company’s drugstores sell pharmaceuticals, cosmetics, and food products, while the dispensing pharmacy business operates regional clinics. Create SD maintains nursing homes that facilitate elderly residents with services regarding health management, diet, and long-term care through preventative training classes.

Ship Healthcare Holdings Co Ltd is a Japanese company engaged in the healthcare business. The company's business is organized into various segments, which include Total Pack Produce Project, Medical Supply, Life Care, Dispensing Pharmacy, and Others. Through its segments, it mainly offers consulting, sales, and leasing services related to medical equipment, sale of medical materials and supplies, private nursing home services, distribution of pharmaceutical products.

Ryman Healthcare Ltd develops, owns, and operates retirement villages and aged-care facilities in New Zealand and Australia. Its villages offer a combination of independent and serviced units, alongside hospital, dementia, and rest-home care. Income is predominantly earned from aged care fees, retirement unit management fees, development margins on new units, and capital gains generated when residents vacate and Ryman resells existing units.

Regis Healthcare is an Australian residential aged care operator providing accommodation and care for individuals who require high levels of support due to health or mobility issues. Residents are typically over 85 years old and are typified by dementia, palliative care, incontinence, and falls risk. Regis also operates smaller retirement village and home care businesses.

Ain Holdings Inc's core business is the dispensing pharmacy business that includes preparing and dispensing drugs based on prescriptions. The company also generates revenue by selling generic drugs wholesale, pharmacy staffing services, and pharmacy consulting services. The company’s additional business activity includes both urban and suburban drug and cosmetic stores. Ain operates the ainz & tuple brand that specifically targets female consumers in urban areas. The company also executes small real estate rental strategies.

Ambea AB is a provider of care in Sweden focused on disabled and elderly residential care in its own management units. The company's segment includes Nytida, Vardaga, Stendi, Altiden, and Klara. The Vardaga segment provides elderly care. The Nytida segment offers disability care. The Stendi segment comprises support for children and young people, personal assistance, residential care facilities, elderly care, and home care in Norway. The Altiden segment comprises operations in elderly care and home care; The Klara segment engages in staffing such as temporary doctors, nurses, and other care workers.

Summerset Group Holdings Ltd develops, owns, and operates integrated retirement villages. The company receives a majority of its revenue from the New Zealand Ministry of Health, which subsidizes fees for eligible aged-care residents. Its revenue is primarily derived from care fees and village services income. Summerset provides a range of care for its residents, including in-home care and 24-hour medical care centers. In addition to its independent-living villas and apartments, Summerset offers supported-living residences, which include assistance with daily activities like shopping and housekeeping.