McKesson and Clayton Dubilier & Rice announced Tuesday they will take Option Care Health private in a $5.8 billion transaction, the largest home infusion buyout in U.S. healthcare history. The deal pairs a Fortune 10 pharmaceutical distributor with a firm that built Cardinal Health's specialty business, then sold it back to McKesson's direct competitor.
Option Care operates over 100 infusion pharmacies serving approximately 90,000 patients monthly across complex therapies — immunoglobulin, antivirals, total parenteral nutrition. The company reported $4.7 billion in revenue for the trailing twelve months and has been public since its 2019 merger with BioScrip. McKesson already holds a 19.9% stake acquired in 2023 when it bought the company's pharmacy benefit manager. CD&R brings operational depth: the firm previously owned Omnicare, later absorbed into CVS Health, and owned a portion of Kindred Healthcare before its 2021 breakup. The price represents roughly 1.23x trailing revenue, a modest premium in a sector where reimbursement pressure has compressed multiples by 40% since 2021.
The combination solves two problems. McKesson gains full control of specialty distribution without antitrust exposure — infusion sits adjacent to, not inside, traditional pharmacy networks. CD&R gets a scaled platform in the $30 billion U.S. home infusion market as payers push high-acuity care out of hospitals. The number of patients receiving intravenous therapies at home grew 22% from 2020 to 2024, driven by specialty biologics with price tags exceeding $100,000 per patient annually. Option Care's physician-referred model bypasses the retail pharmacy margin squeeze. McKesson can now bundle drug sourcing, infusion delivery, and outcomes data without navigating CLIA lab rules or the Stark Law's anti-kickback thickets that trap hospital-owned infusion units.
The deal structure matters. Joint control with a financial sponsor limits McKesson's balance sheet exposure — the company will not consolidate the entity — and CD&R's presence keeps antitrust regulators at arm's length. No DOJ filing threshold was breached because McKesson's stake stays below 50% voting control. The move follows $12 billion in private equity healthcare services deals year-to-date, but stands apart: distributors almost never co-invest with PE firms at this scale. The precedent is Thoma Bravo's partnership with health systems on revenue cycle platforms, a structure that produced 3.2x returns when Symphony exited in 2024.
Operators should watch for McKesson's next capital deployment decision — the company has $6.1 billion in unallocated cash after this transaction closes, likely in Q2 2027 pending Hart-Scott-Rodino clearance. CD&R will probably replace Option Care's management within eighteen months, following the firm's pattern at Sedgwick and Aston Carter. Payers will reprice infusion network contracts in the March-April 2027 renewal window; expect 6-9% rate cuts as Cigna and Elevance recalibrate now that their largest infusion vendor has new ownership. The November 2026 Medicare Physician Fee Schedule final rule will clarify whether CMS raises home infusion reimbursement codes, a policy shift worth $140 million annually to Option Care's government book.
McKesson shares closed Tuesday up 1.8% at $612.40. The company has not disclosed its equity percentage in the private entity, but prior filings suggest a 40-45% economic stake. CD&R is deploying from its $24 billion Fund XII raised in 2024.
The takeaway
Largest home infusion buyout pairs distribution scale with PE operational rigor as specialty pharmacy moves out of hospitals.
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