The Ledger

Humana’s stock jumped almost 13 percent after the closing bell Thursday and Alignment Healthcare’s fell more than 20 percent, both because of one federal data release: the Centers for Medicare and Medicaid Services (CMS) 2027 Medicare Advantage Star Ratings, which decide how much quality bonus money each insurer collects in 2028. Humana’s share of members in plans rated four stars or higher went from 41 percent to 93 percent, while Alignment’s went from 98 percent to 25 percent, per Healthcare Dive, which also cites TD Cowen estimates of $3 billion or more in added 2028 Humana revenue and more than $170 million in lost 2028 Alignment revenue (analyst estimates, not company figures). In its Humana 8-K, filed October 9, Humana said it exceeded its goal of Stars revenue per member per month 10 percent above the median of a peer group of Centene, CVS, Elevance, Health Care Service Corporation and UnitedHealth, affirmed 2026 adjusted earnings per share guidance of at least $9.00, and said it would detail how it uses the 2028 benefit once it has more 2028 information. Alignment’s 8-K says its California HMO contract, about 75 percent of its health plan members, falls from 4.0 to 3.5 stars, that 2026 and 2027 revenue is unaffected, that the hit lands in 2028 quality bonus payments and is partly offset by provider risk-sharing, and that it will pursue administrative appeals and expects to file litigation over certain measures and methodologies. The operator takeaway: a rating posted now sets bonus dollars two years out, so plan benefit design, provider risk-sharing terms and network payments for 2027 and 2028 get negotiated against these results. Confidence: High on the filings and CMS data; Medium on the analyst dollar estimates and after-hours moves, which come from trade press. The CMS data itself is in the CMS 2027 Star Ratings fact sheet.

Private equity firm Clayton, Dubilier & Rice (CD&R) and drug wholesaler McKesson agreed October 6 to take home-infusion provider Option Care Health private at $32.05 a share, an enterprise value of about $5.8 billion. The price is roughly a 37 percent premium to the October 5 close. CD&R would hold about 51 percent and McKesson would invest about $1.4 billion for about 49 percent, with a framework for McKesson to later acquire CD&R’s interest, subject to conditions and regulatory approvals. McKesson plans to book its stake under the equity method. Option Care withdrew its 2026 financial guidance and will report third quarter results November 4 without its usual conference call. The company has more than 8,000 team members, including more than 5,000 clinicians, in all 50 states, and the deal is expected to close in the first half of 2027 after a stockholder vote and regulatory approvals. For hospital executives and payers, the read is that a wholesaler with a path to full ownership now sits behind a major site-of-care alternative for infused drugs. Confidence: High on terms. Sources: Option Care Health 8-K, joint press release, Exhibit 99.1.

GE HealthCare will pay $945 million in cash for SOFIE Biosciences, a U.S. contract manufacturer of the radioactive tracers used in positron emission tomography (PET) scans, buying the last leg of the supply chain that gets a short-lived isotope to the scanner. The October 5 announcement covers a U.S. network the company describes as 15 manufacturing sites running 21 cyclotrons (the particle accelerators that produce the isotopes) plus a site focused on theranostics, the pairing of diagnostic imaging with targeted radioactive therapy. It also adds U.S. rights to FAPI-74, a tracer in Phase III trials, to GE HealthCare’s existing ex-U.S. rights. The seller is Trilantic North America. GE HealthCare expects the deal to add to revenue growth, adjusted operating margin and adjusted earnings per share in the first full year, with closing expected in the first half of 2027 pending regulatory approvals; SOFIE revenue was not disclosed. Imaging centers and hospital nuclear medicine departments that buy tracers by the dose should watch whether supply contracts with other drug makers change. Confidence: High on terms. Source: GE HealthCare press release.

Japan’s Shionogi agreed October 5 to pay $2 billion upfront for IntraBio, the Texas company behind Aqneursa, a treatment for the neurological symptoms of Niemann-Pick disease type C, a rare inherited disorder. The FDA approved Aqneursa in September 2024 and has since expanded the label to cover ataxia in ataxia-telangiectasia patients weighing 15 kilograms or more. IntraBio becomes a wholly owned subsidiary of Shionogi’s U.S. unit, with closing expected by the end of this year pending regulatory review. Shionogi said it will review the effect on its financial outlook for the fiscal year ending in March. For payers and specialty pharmacies, it is another ultra-rare-disease drug moving under a larger commercial parent. Confidence: Medium. Terms are consistent across law-firm and trade reporting, but this run did not locate Shionogi’s own release. Sources: Cleary Gottlieb deal announcement, BioPharma Dive.

Medicare Advantage insurer Devoted Health closed a $555 million Series G round as part of a $1.18 billion financing, on the same week CMS reset the Medicare Advantage quality map. Advent led the round and Temasek co-led it; a separate $622 million commitment from the same investors will buy shares from existing holders, expected to close later in the fourth quarter. Per Becker’s Payer, Devoted had 538,000 members in September, up from 212,000 in December, and plans to enter 342 new counties and five new states in 2027. Growth on that scale is a bet on star-rating bonuses and risk-adjusted payments holding up. Confidence: Medium. Figures come from trade press citing the company’s October 1 release, which this run did not review; a law firm lists the primary round at $550 million. Sources: Becker’s Payer, Fenwick.

THE DEAL SHEET

Target	Acquirer/Investor	Vertical	Value	Source
Option Care Health	CD&R (about 51%) and McKesson (about 49%)	Home and alternate-site infusion	About $5.8 billion enterprise value	Option Care 8-K
SOFIE Biosciences	GE HealthCare (from Trilantic North America)	PET radiopharmaceutical manufacturing	$945 million cash	GE HealthCare release
IntraBio	Shionogi	Rare disease drugs	$2.0 billion upfront	Cleary Gottlieb
NexDine Hospitality (NexDine, LLC and Xendella, LLC)	Healthcare Services Group	Facility food services (filing does not describe the target’s business)	About $93.5 million plus contingent consideration	HCSG 8-K
Devoted Health	Advent, Temasek and others	Medicare Advantage insurer (financing)	$555 million Series G within a $1.18 billion financing	Becker’s Payer

Most of these were announced October 5 and 6. Our scan did not surface additional transactions announced October 8 or 9.