Option Care Health (NASDAQ:OPCH) reported mixed first-quarter 2026 results, with profitability tracking management expectations but revenue growth falling short amid a sharper-than-anticipated reset in its chronic inflammatory disease (CID) portfolio. Executives said the company is responding with intensified commercial and operational actions while maintaining its full-year adjusted EBITDA and adjusted EPS outlook despite lowering its revenue forecast.
Q1 results: profitability in line, revenue growth below expectations
For the first quarter, Option Care Health posted revenue of $1.4 billion, up slightly more than 1% year over year, according to Executive Vice President and CFO Meenal Sethna. Adjusted EBITDA was $105 million, down 6% from the prior year but “in line with our expectations,” Sethna said. Adjusted EPS was $0.40, flat year over year, including a $0.02 benefit from share repurchases.
Rademacher highlighted continued patient experience metrics, saying the company is still posting “patient satisfaction scores in the low 90s and Net Promoter Score in the mid-70s.”
Acute strength offset by chronic headwinds tied to CID reset
Management pointed to strong execution in acute therapies and a transitional period in chronic therapies. Rademacher said acute revenue grew in the “high single digits, well above market growth,” attributing momentum to strengthening patient transitions, expanding referral relationships, and focusing on “clinical value realization.”
Chronic therapy revenue declined slightly, driven primarily by CID dynamics that proved “more challenging than we anticipated,” Rademacher said. Sethna quantified the impact, stating total company revenue growth was “negatively impacted by approximately 600 basis points due to headwinds within our CID portfolio.”
Rademacher described a significant increase in administrative and payer-related friction during the quarter. The company saw “significantly higher volume of patients that had insurance plan, benefit design, or formulary management changes,” which “doubl[ed] the number of patients requiring benefit reverification and reauthorization versus last year.” That pushed many approvals into late March, and by quarter-end, therapy transitions and patient retention “patterned differently than we expected,” reducing patient census more than anticipated and resulting in a “less favorable” therapy mix.
In Q&A, Rademacher said some prior authorization and benefit changes also included “higher standards” for patients receiving enhanced clinical services, leading to denials in some cases and shifts to “other forms of administration, whether it’s self-administration.” He also acknowledged some patient retention loss to competitors, noting certain pharmacy benefit managers had preferred biosimilars and that “we expect that we lost some of the patients to some of the competitors through that process.” He added that for some preferred biosimilar pathways, “the economics are not the same on all of the biosimilars for us,” and in some cases “it just didn’t make economic sense for us to hold onto those patients.”
When asked whether the issue was primarily tied to Stelara, management said the reset was largely concentrated there. Rademacher said the impact was “been primarily around the shift of the Stelara patient census,” while Sethna described it as “a census of ex-Stelara patients” with multiple alternative therapy choices across the CID portfolio.
Guidance updated: revenue cut, EBITDA and EPS maintained
Based on the first-quarter experience and the CID reset, Option Care Health lowered its full-year 2026 net revenue guidance to $5.675 billion to $5.775 billion, which Sethna said implies “just over 1% growth versus prior year at the midpoint.” The revision reflects a “negative 600 basis point revenue growth headwind higher than the 400 basis point headwind we had previously estimated,” driven by lower CID patient retention and unfavorable therapy mix.
Despite the lower revenue outlook and a larger expected profit drag from CID, the company maintained its February guidance for full-year profitability:
- Adjusted EBITDA: $480 million to $505 million
- Adjusted EPS: $1.82 to $1.92
At the midpoint, Sethna said that corresponds to growth of 5% for EBITDA and 9% for adjusted EPS. She also updated expectations for the CID impact, increasing the estimated full-year gross profit headwind to approximately $55 million, up from a prior estimate of $25 million to $35 million. Sethna said the increase is “in large part because of the patient census and the loss of the patient census and a little bit on the therapy mix,” and management expects the headwind “will pattern out evenly through the rest of the year.”
On expense and cash flow, Sethna said SG&A rose 4% in Q1 due to investments made in 2025 and ongoing commercial investment. For full-year 2026, the company now expects SG&A growth to remain “at or slightly below gross profit growth.” Option Care Health also lowered its operating cash flow target to at least $320 million, reflecting lower revenue and “cash-based EBITDA reductions.”
Operational response, site-of-care momentum, and capital allocation
Management outlined several near-term actions aimed at reaccelerating growth. Rademacher said the company is “increasing the strength and size of our commercial team,” realigning and rebalancing coverage across key accounts, and focusing on operational initiatives to “enhance our admission conversion rate,” including deploying technology to create “a more seamless workflow from referral to start.” He said Option Care is refining its go-to-market model to “simplify the provider experience” and strengthen its specialty pharmacy offerings.
Rademacher also highlighted continued traction in payer and pharmaceutical partnerships. He said existing site-of-care initiatives are “performing better than expected,” and that health plan sponsors have told the company these programs deliver “real cost savings” and improved member satisfaction. On the pharma side, he said program development progressed as expected and the company is preparing for new launches later in the year, though he also noted that some rare and orphan programs experienced launch delays or slower ramps due to regulatory or commercial readiness, which will impact growth expectations later in 2026.
In clinics, Rademacher said ambulatory infusion clinic utilization continued to increase, with visits up 14% year over year. He said Option Care is operating 28 locations with advanced practitioner capabilities and conducted 34% of nursing visits in infusion suites or clinics during the quarter.
On the balance sheet, Sethna said the company ended Q1 with a net debt leverage ratio of 2.2x and expanded its revolving credit facility from $400 million to $850 million to enhance financial flexibility. The company repurchased more than $17 million of shares in the quarter. Addressing capital deployment, Sethna said priorities remain unchanged: “organic” investment first, then acquisitions focused on adjacencies and tuck-ins, and then “periodic share buybacks.” She added the revolver expansion was “in large part” to enable the company to “move forward with some nice M&A deals.”
Looking ahead, Sethna provided modeling commentary for the second quarter, expecting sequential Q2 revenue growth in the “mid-single digits” and sequential EBITDA growth in the “high single digits,” with seasonality consistent with prior years. She also told analysts the company does not expect additional Stelara-related headwinds in 2026 or carryover into 2027, saying Q1 represented “the reset” and that management now has clarity on patient census going forward.
About Option Care Health (NASDAQ:OPCH)
Option Care Health (NASDAQ: OPCH) is a leading provider of home and alternate site infusion services in the United States. The company specializes in the administration of injectable therapies, including antibiotics, nutrition, hydration, immunoglobulin, pain management and specialty pharmaceuticals. Through its nationwide network of infusion pharmacies and nursing professionals, Option Care Health delivers customized care plans and in-home nursing visits to patients managing complex or chronic conditions outside of a hospital setting.
Option Care Health traces its current structure to the completion of its merger with BioScrip in early 2021, combining two of the industry’s most experienced home infusion businesses.
