Sigma Healthcare 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.

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.

BrightSpring Health Services Inc is a home and community-based healthcare services platform, focused on delivering complementary pharmacy and provider services to complex patients. Its platform delivers clinical services and pharmacy solutions across Medicare, Medicaid, and commercially insured populations. Its segments include Pharmacy Solutions, Provider Services, and others. It generates the majority of its revenue from the Pharmacy Solutions 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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Medplus Health Services Ltd is a pharmacy retailer. It offers pharmaceutical and wellness products such as medicines, vitamins, medical devices, test kits, and others. The company also offers an omnichannel platform wherein customers can purchase products through stores, place orders over the telephone, online orders, and a Click and Pick facility. Its operating segments include Retail, Diagnostics, and Others.

Aldawaa Medical Services Co is engaged in online wholesale of pharmaceutical products, pharmaceutical agents, wholesale of pharmaceutical goods, related pharmacy activities, pharmaceutical warehousing activities, retail of medical equipment and other equipment, online retailing, land transport of goods, providing delivery services via electronic platforms, managing and renting self-storage stores and manufacturing of single-use medical products and disposables.

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.

Anhui Huaren Health Pharmaceutical Co Ltd focuses on the pharmaceutical retail industry and forms a retail chain, retail centralized procurement, retail service, and retail e-commerce system.

Yixintang Pharmaceutical Group Co Ltd is a China-based company engages in the operation of pharmaceutical retail chains and wholesale businesses. Its products include traditional Chinese medicine, Western medicine, and medical equipment.

GoodRx Holdings Inc is a consumer-focused digital healthcare platform that aims to lower the cost of healthcare in the United States. It operates a price comparison platform that provides consumers with curated, geographically relevant prescription pricing, and provides access to negotiated prices through codes that can be used to save money on prescriptions across the United States. GoodRx generates revenue from core business from pharmacy benefit managers (PBMs) that manage formularies and prescription transactions including establishing pricing between consumers and pharmacies. It also offers various healthcare products and services, including pharma manufacturer solutions, subscriptions, and telehealth services.

Shu Yu Civilian Pharmacy Corp Ltd is primarily involved in the operation and sales of Chinese and Western patent medicines, health foods, Chinese herbal medicines, health equipment and other products.

Apotea AB (publ) is engaged in the online pharmacy with fast deliveries, good prices and a large selection. Its vision is to be tomorrow's pharmacy by constantly facilitating and simplifying for the customer.

Luyan Pharma Co Ltd engages in the production, operation, distribution, and retail of human health products in China. It provides medical and health products.

Zjamp Group Co Ltd is mainly engaged in the business which covers comprehensive agricultural services, automotive trading services, and pharmaceutical production and sales. It is a leader in the commercial circulation industry under the new development pattern of dual circulation and an enterprise in the urban and rural commercial service industry of the national supply and marketing cooperative system.

Genky Drug Stores Co Ltd sells beauty and pharmaceutical products.

Farmacias Benavides SAB de CV is a drug store chain in Mexico. The company offers prescription and over-the-counter medications.

Cachet Pharmaceutical Co Ltd is a state-owned stock company. Its main business includes: Medicine supply to hospitals, wholesaling of biological products, medical instruments, and traditional Chinese medicines. The Company also involved in pharmaceutical logistics and retail pharmacy chain.

Empreendimentos Pague Menos SA operates a pharmacy chain in Brazil. It engaged in the retail trade of medicines, perfumes, personal hygiene, and beauty products. It revenues arises mainly from the sale of medicines, perfumes, and several self-service products to the end consumer.

Cawachi Ltd is a drug store operator based in Japan. The firm primarily sells pharmaceutical-related products to its customers. It also sells health foods, child care products, cosmetics, grocery, general food and confectionery through its retail outlets. The company operates over 300 stores across Japan.

DocMorris AG is engaged in the fields of online pharmacy, marketplace, and professional healthcare with brands in Germany and other European countries. Its brands are DocMorris, PromoFarma by DocMorris, and TeleClinic. The Group's reportable segments are Germany and Europe. The Germany segment comprises the mail-order business in drugs and health products, as well as services for mail-order pharmacies. The Europe segment comprises the marketplace business of PromoFarma and Doctipharma. The majority of revenue is generated from Germany segment.

JZJ Chain Drugstore Corp is engaged in the retail chain business of health products such as medicines, health foods, personal care products, household health products, convenience foods, and daily consumables and provides related professional services.

Great Tree Pharmacy Co Ltd is engaged in the management and trade of various drugs, health products, goods for mothers and babies, and cosmetics products. The firm also provides coordinated medicine procurement services to various clinics, outpatient centers, and medical communities. Besides, the company is also an agency for domestic and foreign healthcare products sold in clinics, outpatient centers, and medical communities.

Dimed SA Distribuidora de Medicamentos is engaged in the sale of medicines, perfumery, personal care and beauty products, cosmetics and dermocosmetics. Its segments are divided into Retail, Wholesale and Corporate. The Retail segment has 556 stores that sell more than 15,000 items among drugs and personal care and beauty products. The Wholesale segment is the distributor of drugs in Brazil. The Corporate segment includes Wholesale and Retail, as well as the subsidiary Lifar. In addition to adding divisions of cosmetics, drugs and food, Lifar is responsible for the production of brands in Brazil, as well as products of its own brand Panvel.

YSB Inc is a digital pharmaceutical platform serving businesses outside of hospitals in China. The Group mainly engaged in i) wholesales of pharmaceutical and healthcare products offline or online through its online platform; ii) retail of pharmaceutical and healthcare products through its retail shops; iii) operating online platform that enable the pharmaceutical distributors and vendors to sell their own pharmaceutical and healthcare products using the Group’s online platform; iv) providing SaaS solution to downstream pharmacies to streamline their inventory management; and v) providing medical testing services to primary healthcare institutions. The Group principally operates in the PRC and generates the majority of its revenues from the PRC.

Fangzhou Inc is a online chronic disease management platform in China. It has focus on chronic disease management to address the needs of patients with chronic diseases, such as hypertension, cardiovascular and respiratory chronic diseases. The company provide comprehensive medical services and online retail pharmacy services through Jianke Platform. The principal segment of the group are online retail pharmacy services, comprehensive medical services, Wholesale and customized content and marketing solutions. Key revenue is generated from Online retail pharmacy services.

Green Cross Health Ltd is engaged in providing healthcare services in New Zealand. The reportable segments of the group are Pharmacy services and medical services. The majority of the revenue is generated from the Pharmacy services segment. Its pharmacy services segment includes operations like providing pharmacy services through consolidated stores, equity-accounted investments, and franchise stores. The medical service segment provides complete family healthcare services through general practitioners, accident, and medical centers.