McKesson Pays 11.9x EBITDA for Option Care — Half What Cencora Just Paid for OneOncology

McKesson and Clayton, Dubilier & Rice signed a definitive agreement on October 6, 2026 to take Option Care Health private at $32.05 per share in cash — roughly a 37% premium to the stock's $23.37 close on October 5, 2026 — for an enterprise value of about $5.8 billion including assumed debt. The structure splits control 51% to CD&R and 49% to McKesson, with McKesson writing a $1.4 billion equity check for the minority.

The agreement leaves Option Care's management team in place and keeps the company operating as a standalone entity — a familiar McKesson playbook used in the Core Ventures / Florida Cancer Specialists deal. A side provision gives McKesson the right to later acquire CD&R's controlling stake, subject to conditions and regulatory approval, so the structure doubles as a staged acquisition path. Closing is expected in the first half of calendar 2027, pending shareholder and regulatory clearances.

Option Care is not an oncology-practice acquisition — it is the last-mile delivery channel that ties McKesson's growing practice and research platforms together. Strip away the headline and the deal reads as the closing tile on a vertical integration thesis that McKesson has been assembling since mid-2024.

Together those three transactions commit roughly $10.5 billion of capital across 14 months, with McKesson's oncology-and-multispecialty segment revenue already growing 31% to $48.4 billion in FY2026 and accelerating to +33% in Q1 FY2027. Option Care closes the loop: drugs flow out of McKesson distribution, into US Oncology Network practices under McKesson physician-practice MSAs, get triaged through Precision Medicine research, and arrive at patients via Option Care's home-infusion nurses.

The $5.8 billion enterprise value implies about 11.9x Option Care's midpoint FY2026 adjusted EBITDA guidance of $487.5 million. That is a sharp discount to recent specialty-distributor oncology multiples: Cencora closed its remaining OneOncology stake on February 2, 2026 at a $7.4 billion enterprise value, roughly 19x EBITDA — the highest multiple paid by a Big Three wholesaler for a community oncology platform.

Option Care Health's H1 2026 results make the gap concrete. Net revenue rose 1.9% to $1,442 million in Q2 and adjusted EBITDA reached $117.5 million (+3% YoY) — operating cash flow of $171.5 million in the quarter points to durable conversion. But the segment is structurally low-margin: Option Care buys specialty pharmaceuticals at wholesale and bills medical-benefit payers, with the spread compressed by PBM and payer reimbursement pressure that has been intensifying for two years.

The home-infusion market McKesson is buying into is fundamentally different from the market Cencora and Cardinal Health bought into with OneOncology and Navista. Infusion providers like Option Care buy drugs, send nurses to patients' homes, and bill the medical benefit — a model that was contracting before the deal announcement.

McKesson's strategic logic: rather than fight the PBM squeeze on Option Care's standalone P&L, anchor the company as the preferred infusion partner for US Oncology Network's 3,300-plus providers and route McKesson-distributed specialty biologics through Option Care. Internal volume — not external price negotiation — is the margin lever, and that lever is invisible in a standalone 11.9x multiple.

Of the publicly listed independents, BrightSpring Health Services is the most direct competitor. Its Pharmacy Solutions segment — Infusion and Specialty revenue — grew 39% year over year to $2.2 billion in Q2 2025, and management lifted FY2026 revenue guidance to a $14.98 billion midpoint with adjusted EBITDA above prior expectations. With CVS out of the market and McKesson now owning Option Care, BrightSpring is the largest remaining independent infusion and specialty platform — and the obvious next consolidation candidate if the McKesson-CD&R deal re-rates the sector.

Three near-term catalysts will determine how this deal is digested:

Over a 1–3 year horizon, three forces will test the McKesson thesis: