Healthcare's middlemen all raised their outlooks in the same week

The same week, the same direction

Six healthcare companies raised their outlooks in the same week. Cigna, Cardinal Health and McKesson, an insurer and two drug distributors, each lifted full-year guidance. Edwards Lifesciences, Privia Health and agilon health did the same. The companies sell different things, but they share a position: they sit between the people who make healthcare products and the people who pay for them. m:…2022 m:…5163 m:…8272 m:…1121 m:…3386 m:…5674

Cigna reported third-quarter revenue of $73.7 billion and raised its 2026 outlook for adjusted income from operations to at least $30.60 a share. The company reported net income of $1.4 billion, or $5.47 a share, and adjusted income from operations of $2.1 billion, or $7.98 a share. It also announced a multi-year $3 billion modernisation and productivity initiative called Accelerate to One, and set long-term targets including adjusted earnings growth of 10% to 14% a year through 2030 and about $50 billion in cumulative operating cash flow through 2030. m:…2022

The distributors

Cardinal Health reported first-quarter fiscal 2027 revenue of $67.5 billion, up 5% from a year earlier, and non-GAAP earnings of $3.26 a share, up 28%. The company raised fiscal 2027 non-GAAP earnings guidance to $12.80 to $13.00 a share, completed a $500 million share repurchase programme in the quarter, and entered a binding letter of intent to renew its pharmaceutical distribution agreements with CVS Health. Its pharmaceutical and specialty solutions segment profit rose 17% to $783 million, though its global medical products and distribution segment profit fell 28% to $33 million. m:…5163

McKesson reported second-quarter revenue of $111.0 billion and adjusted earnings of $11.68 a share, and raised fiscal 2027 adjusted earnings guidance to $45.60 to $46.40 a share. The company signed an agreement to extend its pharmaceutical distribution partnership with CVS Health through June 2032, agreed to invest about $1.4 billion for a 49% minority interest in Option Care Health, and completed the acquisition of Precision Medicine Group on November 2, 2026. It generated $3.1 billion of operating cash flow in the quarter and returned $3.6 billion to shareholders in the first six months of fiscal 2027. m:…8272

The CVS thread ties the two distributors together. Both are locking in their largest customer relationship for years ahead, and both are raising guidance while they do it. Distribution is a thin-margin business, and a renewed contract with the biggest buyer in the market is worth more than a single quarter of growth. m:…8272 m:…5163

Devices and value-based care

Edwards Lifesciences reported third-quarter sales of $1.72 billion, up 10.5% from a year earlier, and adjusted earnings of $0.80 a share. The company raised full-year sales growth guidance to about 11.5% and adjusted earnings guidance to $2.97 to $3.05 a share. Sales of its transcatheter mitral and tricuspid therapies reached $207 million, up 44% from a year earlier, while TAVR sales were $1.24 billion, up 8.0%. The FDA approved its PASCAL Precision system for tricuspid regurgitation in October 2026, and CMS released a final updated national coverage determination for TAVR during the quarter. m:…1121

Privia Health reported third-quarter revenue of $657.0 million, up 13.2% from a year earlier, and net income of $13.5 million, up 96.6%. The company raised full-year revenue guidance to $2,500 million to $2,550 million, acquired American Choice Healthcare MSSP for about $36 million, and said it will exit its Montana partnership with Surgery Partners in January 2027. That Montana partnership generated about $23 million in annual practice collections. agilon health reported revenue of $1.52 billion and net income of $35 million, raised full-year revenue guidance to $5.87 billion to $5.89 billion and adjusted EBITDA guidance to $145 million to $155 million, even as total platform membership fell to 566,000. m:…3386 m:…5674

The value-based care pair tells a narrower story than the distributors. Privia and agilon are both growing revenue and raising guidance while pruning: Privia is leaving Montana, and agilon's membership fell. This suggests a trade, fewer members and fewer partnerships, in exchange for better margins on the ones that remain. m:…3386 m:…5674

What to watch

The open question is whether the guidance raises survive contact with the parts of these businesses that are not raising. Cardinal's medical products segment is shrinking. Privia's Montana exit and agilon's smaller membership both cost growth. Cigna's $3 billion productivity programme is a multi-year bet, not a quarterly result. The raises are real, and they are all in the same direction. The reasons behind them are not all the same. m:…5163 m:…3386 m:…5674 m:…2022