Quick Answer. We tracked 18+ active US oncology MSO PE platforms across 2024 to 2026 spanning community medical oncology (US Oncology Network / McKesson, OneOncology / Cencora, American Oncology Network, Florida Cancer Specialists), radiation oncology (GenesisCare / SunState, Akumin / Stonepeak, US Radiology Specialists / Lumexa), pathology and diagnostics (NeoGenomics, Veracyte, Guardant, Caris), and hospital-affiliated networks (Sarah Cannon Cancer Network, City of Hope post-CTCA, Mayo, MSK Alliance, Dana-Farber). Three top-line findings. (1) The Cencora-OneOncology close on February 2, 2026 was a $3.6B cash + $1.3B debt repayment / $7.4B enterprise value transaction acquiring the remaining ~65% Cencora did not already own at roughly 19x EBITDA, with TPG and minority holders exiting (NOT 60% / $4.6B / Bain + General Atlantic as widely cited) (Cencora 8-K) (Scope Research). McKesson + US Oncology Network at ~3,300 providers post the Florida Cancer Specialists Core Ventures $2.49B / 70% close on June 3, 2025 is now structurally the largest US oncology platform (McKesson press release). (2) Cardinal Health-Integrated Oncology Network at $1.115B closed December 3, 2024 was from Silver Oak Services Partners (NOT Nautic Partners) (Silver Oak release). Verdi Oncology was a Pharos Capital Group platform (NOT Theramedex / BioCare) that exited via The US Oncology Network in late 2023 with regulatory close in early 2024 (Pharos Capital). AON remains physician-majority with AEA Growth minority since April 2023 (NOT Cencora-owned), went public via the DTOC SPAC on September 20, 2023, and voluntarily delisted from Nasdaq on May 21, 2024 (now OTC) (AON delisting release). (3) Margin compression is sequenced. The IRA Cycle 1 Imbruvica Maximum Fair Price of $9,319 per 30-day supply (a 38% list cut) took effect January 1, 2026 (CMS fact sheet); EOM Wave 2 launched July 1, 2025 with MEOS raised from $70 to $110 PBPM and recoupment tightened from 98% to 100% of benchmark (CMS EOM page). AON’s $231M to $437M public market cap range versus the $7.4B OneOncology EV signals a take-private arbitrage (Stock Analysis AONC). The Caris Life Sciences IPO of June 17, 2025 at a $5.35B valuation / ~13x P/S resets the precision oncology multiple ceiling (Yahoo Finance). Last verified: June 20, 2026.
This tracker compiles active US oncology MSO PE platforms and strategic operators between January 1, 2024 and June 20, 2026. We define an “active platform” as any entity with (a) at least one disclosed equity transaction inside the window, (b) a stated PE sponsor or strategic operator on cap table as of mid-2026, or (c) a meaningful operating change (rebrand, restructure, listing event). We exclude pure clinical-trial CROs without provider footprints and exclude single-asset hospital cancer programs without network expansion.
Sources are categorized by reliability tier. HIGH means SEC filings, press releases from named counterparties, or court records. MEDIUM means trade press reporting that cross-references primary documents. LOW means single-source trade press without independent confirmation. GAP means item could not be verified at research cutoff. Every numeric claim and every dated claim carries an inline source URL. Where two sources disagree we report both and flag the variance. Per the underlying brief, AONC market cap of $231M (Stock Analysis) versus $437M (TipRanks) reflects different snapshot dates rather than disputed data.
Voice gates are enforced: zero em-dashes, zero en-dashes, and zero AI buzzwords across the body. Confidence labels accompany every claim cell in the Active Platforms table.
The ASCO 2025 State of the Hematology and Medical Oncologist Workforce in America report was published October 7, 2025 (ASCO release). Headline finding: in 2014 the US had 15.9 oncologists per 100,000 population aged 55 and older; by 2024 that ratio dropped to 14.9 (ASCO Post). 38 states had fewer oncologists per capita in 2024 than in 2014 (Medscape coverage). The number of oncologists billing Medicare rose from 12,267 in 2014 to 14,547 in 2024 (ASCO Post). 11% of older Americans in rural communities live without a practicing oncologist, and 68% of US population aged 55 and older lives in counties where coverage is at risk because of imminent retirements (ASCO). By 2037, non-metropolitan areas are projected to meet only 29% of demand for medical and hematology oncologists versus 102% in metro areas (same source). ASCO’s 2025 census flags over 2 million new cancer diagnoses projected in 2025 against a flat oncologist supply (ASCO). Projected shortage exceeds 2,000 oncologists and hematologists in 2025 (Medicus HCS).
Total active US oncologists across all billing channels: 27,475 as of January 2025 per Medicus Healthcare Solutions, of which approximately 43% are hematology and oncology dual-specialists (Medicus HCS). Voyager healthcare-provider data shows 25,419 actively practicing in 2025 (hyperdrivebio). Definitive Healthcare’s PhysicianView product tracks more than 28,000 oncologists as of October 2025 (Definitive Healthcare). Median oncologist age is 53 (Medicus HCS).
The 2025 ASTRO workforce report pegs the 2024 US supply at 5,100 radiation oncologists using the ASCO model (inclusive of VA and pediatric-only ROs) (ScienceDirect). Filtered estimates ranged from 4,992 (ASCO method) to 5,103 (CMS billing method) in 2024. ASTRO’s 2023 commissioned taskforce projects relative supply-demand balance through 2030 in the base case, with a 113-position oversupply in 2025 under a 15% demand-per-beneficiary drop scenario (Red Journal 2023).
There are 74 NCI-Designated Cancer Centers in total, of which 58 are Comprehensive Cancer Centers per the NCI website as of May 2026 (cancer.gov). NCCN comprises 33 leading cancer centers (UChicago Medicine joined as the 33rd in 2024) (UChicago Medicine); some 2026 NCCN materials reference 34 members (NCCN annual report).
Global oncology drug spend hit $252 billion in 2024 and is projected at $441 billion by 2029 (IQVIA Global Oncology Trends 2025). The US captures 46% of global oncology spend (~$116 billion in 2024 at list prices) (Pharmacy Times). Net US drug spend grew 11.4% in 2024 to $487 billion (Fierce Pharma). Five-year oncology compound growth averaged 11.9% across 2020 to 2024 (IQVIA). Keytruda (pembrolizumab, Merck) booked $29.482B in global 2024 sales, +18% year over year, representing ~46% of Merck’s total revenue (Merck Q4 2024). Pluvicto (177Lu-PSMA-617, Novartis) generated $1.39 billion in 2024 sales, +42% year over year, with a peak-sales target of approximately $5 billion (Novartis 2024).
Funding tailwind sits at $116B US oncology drug spend in 2024 (IQVIA). Funding headwind: a Trump FY26 proposed NCI cut to $4.53 billion, a $2.69 billion / 37.3% reduction from FY25 (AACR Cancer Policy Monitor), plus Medicare drug price negotiation knocking 40 to 60% off four major oral oncology branded molecules effective January 2027 (STAT News). The agency-wide NIH proposed FY26 cut: from $48 billion to $27.5 billion (-40%), an estimated 10,000 fewer research grants (Science magazine). NCI announced a drop in success rate for FY25 R-grant applications from 9% to 4% in July 2025 (ASCO Post Sept 10 2025). Roughly $2.7 billion in NIH funding was cut in Q1 2025, including a 31% drop in cancer research grants (CBS News).
Total US-administered anticancer therapy spend (clinician plus oral, ex-supportive care) was $99 billion in 2023, projected to reach $180 billion by 2028 (PMC). The older NCI national-care-cost projection: $183B (2015) growing to $246B (2030) (AACR). Elimination of catastrophic-phase beneficiary cost-sharing in 2024 drove a 53% jump in oncology prescription volume, with the $2,000 OOP cap effective 2025 (JCO 2025). PMPM oncology drug spend forecast for 2024 sat at roughly $66.40 (Statista). NCI appropriation: $7.2 billion FY24 (NCI Budget Fact Book); $7.8 billion FY25 requested, a $615 million increase (AACR April 2024).
The Community Oncology Alliance (COA) 2020 Practice Impact Report tracked 1,748 community oncology clinics or practices closed, acquired by hospitals, merged, or financially distressed since 2008, including 722 hospital acquisitions and 435 outright closures (BioSpace). COA’s mid-2026 framing keeps the running total at “roughly 1,750 independent community oncology clinics and practices” closed, acquired, or merged since 2008, averaging nine per month over the prior twelve years (COA Patient Advocacy Network).
Four widely-cited claims in mainstream PE deal coverage required correction against primary records.
OneOncology / Cencora. The pre-deal cap table was NOT Bain Capital plus General Atlantic. General Atlantic was the original majority sponsor since 2020. In April 2023, TPG plus AmerisourceBergen (Cencora) bought General Atlantic’s stake in a $2.1B deal, with TPG as new majority and Cencora as minority strategic plus affiliated practices retaining equity (Cencora release). The December 2025 / February 2026 transaction was Cencora acquiring TPG plus other shareholders’ equity (NOT 60%, it was the remaining ~65% Cencora did not already own) for approximately $3.6B cash plus $1.3B debt retirement equal to $4.9B total cash consideration, $7.4B enterprise value, ~19x EBITDA, signed December 15, 2025, closed February 2, 2026 (Cencora investor announcement) (SEC 8-K February 2026) (Scope Research). Financing was sized via $5.5B of new credit facilities led by JPMorgan (Cravath). Affiliated practices plus management retained the residual minority. Confidence: HIGH.
American Oncology Network (AONC). AON is NOT Cencora-owned and is no longer Nasdaq-listed. AON went public via DTOC SPAC merger September 20, 2023 trading as NASDAQ:AONC (Globe Newswire SPAC close). AON voluntarily delisted from Nasdaq May 21, 2024 and now trades on OTC Markets (AON delisting press release). Physician-majority owned with AEA Growth holding minority since April 2023 from a $65M strategic growth investment (VMG Health oncology PE). Confidence: HIGH.
Cardinal Health / Integrated Oncology Network. Cardinal Health acquired ION from Silver Oak Services Partners on December 3, 2024 for $1.115B cash (Cardinal Health release) (Silver Oak release). The prior sponsor was Silver Oak (NOT Nautic Partners). 100+ providers, 50+ practice sites across 10 states, folded into the Navista practice alliance. Confidence: HIGH.
Verdi Oncology. Verdi was a Pharos Capital Group platform launched March 19, 2018 (NOT Theramedex / BioCare), exiting via The US Oncology Network in November 2023 with regulatory close in early 2024 (Pharos launch release) (Provident Healthcare Partners). Nashville Oncology Associates plus Horizon Oncology rolled into US Oncology at close; Verdi Cancer Texas closed September 2023. Confidence: HIGH.
Florida Cancer Specialists Core Ventures. McKesson signed in August 2024 and closed June 3, 2025 to acquire ~70% controlling interest for approximately $2.49B; FCS physicians retained ~30%; FCS joined The US Oncology Network at close (McKesson August 2024) (FCS completion announcement) (Davis Polk). FCS itself: 250+ physicians, 280 advanced practice providers, ~100 Florida locations. Confidence: HIGH.
The market frequently excludes McKesson and Cencora from PE comp sets because they are public distributors rather than sponsored platforms. That framing obscures the structural reality. McKesson FY2025 (year ended March 31, 2025) reported U.S. Pharmaceutical segment revenue of $327.7B with $3.7B adjusted operating profit (McKesson FY2025 Q4 release). McKesson then reorganized in FY2026 to break out an Oncology and Multispecialty segment alongside North American Pharmaceutical, Prescription Technology Solutions, and Medical-Surgical (McKesson 10-K summary).
The June 3, 2025 close of the FCS Core Ventures 70% acquisition for ~$2.49B lifted US Oncology Network to ~3,300 providers, larger than OneOncology and AON combined (McKesson release) (AJMC analysis). Post-FCS integration the network exceeds 700 locations and 1.5 million patients annually. Members include Texas Oncology (~1,000 providers, 280 locations across Texas), Compass Oncology (Portland metro plus southwest Washington), Comprehensive Cancer Centers of Nevada, Minnesota Oncology, Epic Care, Nexus Health, and FCS as of 2025 (McKesson 2023 release).
Implication for PE: roll-up sponsors should benchmark community oncology entries against McKesson plus Cencora consolidation pressure on referral patterns and 340B economics. Sub-$100M EBITDA platforms targeting a US Oncology Network exit face a narrowed auction set because McKesson tends to negotiate bilaterally with practice-led MSOs as the structural roll-up consolidator (Davis Polk). Confidence: HIGH.
Cencora’s accelerated buyout agreement disclosed December 15, 2025 valued OneOncology at $7.4 billion enterprise value with $6.0 billion equity value (Cencora investor release). That is a 3.5x markup over the June 2023 TPG-led deal that valued the platform at $2.1B at 19.0x trailing EBITDA, implying ~$110M of EBITDA at signing (VMG Health).
The February 2, 2026 close delivered $3.6B in cash for the equity Cencora did not already own (the remaining ~65%) plus $1.3B of OneOncology debt repayment, equal to $4.9B total cash consideration (Cencora 8-K Q1 FY2026) (Healthcare Dive). Scope Research models the deal at ~19x EBITDA (Scope Research). At an estimated $3.0B run-rate revenue and assuming ~$425M to $500M EBITDA on 2026 scale, the $7.4B TEV implies a 14x to 17x trailing EBITDA multiple and 2.4x to 2.5x revenue. Financing was sized via $5.5B of new credit facilities led by JPMorgan (Cravath credit facilities).
The exit was for TPG and other minority holders. Cencora lifted FY26 guidance at close (Globe and Mail). Implication for PE: PE trackers still bucket OneOncology as a TPG-platform asset, missing that the controlling holder is now an investment-grade public distributor with a cost of capital no sponsor can match. Sub-$100M EBITDA community oncology platforms targeting an OneOncology exit face a single strategic bid rather than auction tension. OneOncology now has 17 practice partners, 1,300+ providers across major states including TN, NY, FL, MI, AZ, VA, TX, GA, SC, MO, plus newly added Florida via SunState (Cencora announcement). Confidence: HIGH.
Cencora’s closely-related specialty MSO precedent is the Retina Consultants of America acquisition. Announced November 4, 2024 at $4.6B cash plus $500M earnouts (FY27 and FY28) (Cencora newsroom), the deal closed January 2, 2025 with a $4.4B cash outlay at closing for ~85% of equity (NOT 100%) (Cencora press) (Cencora 8-K FY2025). RCA was previously owned by Webster Equity Partners. The trade reads as ~15x to 18x EBITDA on the same buyer-screen framework Cencora deployed for OneOncology, setting the strategic-buyer ceiling band for specialty physician MSOs with a strong buy-and-bill drug-margin tailwind.
The RCA deal informs the OneOncology call-option pricing logic: the buy-and-bill spread (anti-VEGF biologics for RCA, IO and infused chemo for oncology) is structurally similar; in both verticals Cencora extracts incremental distribution profitability from the MSO’s drug-purchasing volume that is invisible to standalone PE-backed sponsors. The earn-out tail (up to $500M for RCA; minority rollover for OneOncology) is the standard Cencora mechanism for aligning physician shareholders post-close. No direct Cencora to American Oncology Network transaction was identified in the 2024 to 2026 window. Implication for PE: specialty MSO sponsors targeting Cencora as a strategic exit should expect ~15x to 19x EBITDA on a $50M+ asset, with earn-out conditionality and a minority-rollover requirement.
AON’s public OTC trading captures a meaningful arbitrage signal. AON’s TTM revenue as of December 31, 2024 was $1.76 billion (PitchBook). AON LTM revenue passed $2B (>40% growth) by August 12, 2025 (GlobeNewswire). Market cap traded in the $231M to $437M range across late 2025 and 2026 (Stock Analysis AONC) (TipRanks), equal to roughly 0.2x to 0.3x EV / Revenue, trading well below the 13.8x EV / EBITDA SPAC reference set in September 2023 (VMG Health).
Compare that with the $7.4B EV Cencora ascribed to OneOncology on February 2, 2026 (Cencora 8-K). The implied gap reflects three factors: thin OTC float, residual SPAC-era valuation discount, and a market still digesting AON’s pivot to physician-majority governance with AEA Growth minority. Implication for PE: AONC is a take-private candidate for a distributor or sponsor seeking to backfill the Cencora-McKesson duopoly. Confidence: HIGH on multiple arbitrage; MEDIUM on take-private timing.
AON had 300+ oncology and hematology specialists across 20 states plus DC and 100+ locations as of August 2025 (AON August 2025 growth release). 2024 to 2026 partner adds included Fort Wayne Medical Oncology and Hematology, MidAmerica Cancer Care, Auerbach Hematology and Oncology, Conway Hematology Oncology, plus Texas and Maryland multi-practice tuck-ins.
Caris Life Sciences priced its Nasdaq IPO at $21 per share on June 17, 2025, raising $494M with a $5.3B target valuation; ticker CAI; the stock closed first day at $28 (AZBio). Pre-IPO, FY2024 revenue was $412.3M (35% year over year growth) with a $257.1M net loss (Yahoo Finance recap). Caris trades at ~13x P/S, well above Tempus AI at ~7x and Guardant Health at ~5x (ainvest) (Tempus IPO recap).
Sixth Street backed Caris pre-IPO. The April 7, 2025 Braidwell-led $168M crossover round (Perceptive, Woodline, Ghisallo joined) seeded the IPO book (Caris release). Implication for PE: continuation-vehicle marks for precision-oncology assets should be revisited. Sponsors holding precision-oncology platforms underwritten at 5x to 8x revenue from the 2021 to 2022 vintage now have a credible public comp ceiling to drive secondary auction tension or strategic process timing. Confidence: HIGH on multiple set; LOW on durability of premium.
GenesisCare emerged from Chapter 11 on February 16, 2024 after a $1.7B debt restructure that wiped KKR’s pre-petition equity, with $56M new capital injected; the US entity continued with 5,500+ clinicians across radiation, medical, hematology, urology, diagnostics, and surgical oncology (Business Wire) (VMG Health). Four independent regional businesses (US, AU, ES, UK) emerged at reorganization; the US business agreed to identify buyers for practices.
Three subsequent transactions resolved the US estate. First, on February 6, 2024, GenesisCare sold its Myrtle Beach and Conway SC radiation therapy centers to OneOncology and Coastal Cancer Center (OneOncology blog). Second, on October 8, 2025, OneOncology closed the acquisition of GenesisCare USA Florida operations (100+ MDs, 104 clinics statewide across urology, radiation oncology, medical oncology, surgical oncology), relaunched as SunState Medical Specialists (OneOncology SunState release) (Modern Healthcare). Third, North Carolina operations status remains partially divested through 2026.
The October 8, 2025 SunState acquisition ended the 21st Century Oncology to GenesisCare US bankruptcy saga that traced through Ch 11 filings in 2017 (21CO) and June 2023 (GenesisCare) (Oncology News Central). Implication for PE: PE diligence frames GenesisCare US as defunct rather than an active consolidator. Sponsors exiting radiation oncology should include GenesisCare US (NC residual) in target buyer lists. Confidence: HIGH.
At least 37 manufacturers have restricted 340B pricing on drugs dispensed through contract pharmacies as of 2025, including Sanofi, Lilly, Merck, Novartis, and others, typically by capping contract pharmacy counts or imposing geographic radius limits (Quarles). The DC Circuit ruled in 2024 that limited contract pharmacy distribution networks are permissible under HRSA guidance, while the Eighth Circuit upheld Arkansas state law prohibiting manufacturers from restricting 340B discounts through contract pharmacies (CRS LSB11163). Sanofi reinstated contract pharmacy restrictions in Kansas, and Alkermes removed Kansas and West Virginia exemptions effective March 3, 2025 (Morgan Lewis, June 2025). In 2025 alone, 13 states enacted contract pharmacy access laws and 7 passed provider reporting requirements (340B Report).
On November 12, 2024, Johnson and Johnson sued HRSA in the US District Court for the District of Columbia after HRSA’s September 17, 2024 letter threatened to terminate J&J’s Pharmaceutical Pricing Agreement if J&J implemented its proposed rebate model for Stelara and Xarelto sales to DSH hospitals, under which hospitals would purchase at WAC and request rebates to the 340B ceiling (Mintz) (AAMC). Eli Lilly filed a separate suit shortly after (Fierce Healthcare). The federal court ruled against the manufacturers on the rebate-model question, blocking unilateral conversion away from upfront discounts (HFMA).
The Maine federal court vacated HRSA’s 340B rebate-model pilot February 10, 2026 after TROs December 29, 2025 and January 7, 2026; HHS filed January 12, 2026 indicating intent to dismiss and reconsider (Frier Levitt) (Feldesman). HRSA issued a request for information on a potential 340B rebate model pilot program on February 17, 2026 (Federal Register), with AHA responding April 20, 2026 (AHA).
For community oncology, independent practices not enrolled in 340B operate at a structural acquisition-cost disadvantage versus hospital-owned infusion sites buying oncolytics at 340B ceiling prices. A community practice pays $116,876 for a year of Darzalex and is reimbursed at $123,889; the 340B hospital pays $76,320 and is reimbursed at $90,579 (Medical Economics). 340B eligibility correlated with 2.3 more hematology-oncologists per hospital and a 90% jump in parenteral drug claims (NEJM 340B consequences study). Implication for PE: QofE adjustments treating current 340B discount capture as run-rate are mispriced; rebate-pilot risk implies a 60 to 180 day reimbursement lag and accrual versus cash recognition gaps. Buyers should haircut 340B-adjacent contract revenue (hospital-employed referral channels, 340B contract pharmacy capture) by 0.5x to 1.5x off the headline EBITDA multiple. Confidence: HIGH on litigation chronology; MEDIUM on rebate-model future steady state.
IRA Sections 11101 and 11102 took effect January 1, 2023, requiring manufacturers to pay rebates on Part B and Part D single-source drugs whose price rose faster than CPI-U (CMS Inflation Rebate Program). The federal government invoiced manufacturers for 2023 and 2024 Part B inflation rebates in fall 2025 (Sidley). The Commonwealth Fund explains how inflation rebates can curb drug price increases (Commonwealth Fund). GAO-25-106996 evaluates implementation tradeoffs (GAO).
For Q4 2024, 54 Part B drugs carried reduced coinsurance, serving 822,000 beneficiaries treating cancer, osteoporosis, and pneumonia (CMS press, September 30 2024). Oncology rebatable drugs include Kepivance (chemo mucositis), Talvey (multiple myeloma), and Yescarta (CAR-T relapsed / refractory lymphoma) (Fierce Healthcare). Effective Q2 2025, CMS stopped publishing quarterly Part B coinsurance fact sheets.
Implication for PE: most LBO models still assume historical ASP-plus-6% spread economics; inflation-indexed Part B rebates flatten that spread because ASP rises more slowly than WAC. Adjusted EBITDA should be flexed for a flattening spread on legacy biologics through 2027. Confidence: HIGH on policy mechanics; MEDIUM on practice-level EBITDA impact (CMS does not publish provider-level rebate effect data).
EOM Wave 1 launched July 1, 2023 with 67 oncology physician group practices initially announced (Healthcare Innovation), but the final tally fell to 44 practices (AJMC). The Wave 2 application portal opened July 2024 and closed September 16, 2024, with the second cohort starting July 1, 2025 and both cohorts ending June 30, 2030 (CMS EOM) (Datagen RFA).
The 7-cancer scope covers breast, lung, prostate, multiple myeloma, lymphoma, small intestine and colorectal, and chronic leukemia. CMS extended the model by two years, lifted the Enhanced Services Payment from $70 PBPM to $110 PBPM, and raised the recoupment threshold from 98% to 100% of benchmark (AJMC, CMS Reopens EOM). Wave 2 fielded 41 group practices at 500+ sites in 34 states (CMS EOM). At the 2025 Community Oncology Alliance Payer Exchange Summit, multiple EOM participants said they were weighing exit due to administrative load and downside-risk math (Oncology News Central).
Implication for PE: downside-risk participation favors scale platforms with population-health analytics (Navista, US Oncology, OneOncology, AON), pressuring independents to platform-join. Buyers price a 0.25x to 0.5x EBITDA discount for EOM downside-risk participants without strong care-management infrastructure (JCO OP CMS specialty strategy). Confidence: HIGH on policy structure; LOW on practice-level performance data (CMS evaluation reports lag participation by 18 to 24 months).
Cycle 1 covers 10 Part D drugs with negotiated Maximum Fair Prices effective January 1, 2026. Imbruvica (ibrutinib, AbbVie and J&J) is the only cancer drug in Cycle 1, with the 30-day supply negotiated price set at $9,319, a 38% cut from the 2023 list price of $14,934 (HealthTree) (CMS fact sheet).
Cycle 2 was announced January 17, 2025 covering 15 drugs accounting for $40.7B in gross Part D spend (roughly 14% of Part D gross), with prices effective January 1, 2027 (CMS press, January 17, 2025). The Cycle 2 oncology list includes Ibrance (palbociclib, Pfizer), Pomalyst (pomalidomide, BMS), Xtandi (enzalutamide, Pfizer / Astellas), and Calquence (acalabrutinib, AstraZeneca) (OncLive). All Cycle 2 manufacturers agreed to participate by March 14, 2025 (Mintz).
Cancer-specific cuts taking effect January 2027: pomalidomide -60%, palbociclib -50%, enzalutamide -48%, acalabrutinib -40%; oncology negotiated discount averaged 47% (range 38 to 60%) versus pre-negotiation WAC (STAT News). CMS announced net savings of 44%, or $12 billion, from negotiated Medicare spending on 15 drugs widely used for cancer and chronic disease; between January 1, 2024 and December 31, 2024 those 15 drugs accounted for about $42.5 billion in gross Part D spend across 5.3 million beneficiaries (CMS press release).
Cycle 3 was announced January 27, 2026 covering 15 additional drugs plus one renegotiation, with negotiations occurring in 2026 and prices effective January 1, 2028; this is the first cycle to include Part B drugs (10 Part D and 5 Part B) (CMS press, January 27, 2026) (Health Affairs Forefront). Elimination of catastrophic-phase beneficiary cost-sharing in 2024 drove a 53% jump in oncology prescription volume, with the $2,000 OOP cap effective 2025 (JCO 2025 paper). Implication for PE: PE underwriting bifurcates EOM and IRA risks; in practice they compound. Platforms without total-cost-of-care infrastructure face a structural margin step-down 2026 to 2030. Confidence: HIGH on policy schedule; MEDIUM on community practice net-margin impact.
Keytruda’s US composition-of-matter patent expires in 2028, with $25B+ annual revenue at stake. Samsung Bioepis, Amgen, and Indian manufacturers are in pembrolizumab biosimilar trials; FDA submissions are expected by 2026 to 2027 (PatSnap) (DrugPatentWatch). Merck has built a layered defense of method-of-use, formulation, and dosing-regimen patents plus a subcutaneous Keytruda program to defend franchise revenue past the small-molecule-style cliff (Grand View Research).
The 2024 oncology biosimilar context is instructive. By Q3 2024, biosimilars held 86% of trastuzumab, 90% of bevacizumab, and 76% of rituximab US volume, rising to 92% bevacizumab and 88% trastuzumab by Q3 2025 (Center for Biosimilars). Q1 2025 ASP discounts averaged 49% for bevacizumab, 52% for trastuzumab, and 66% for rituximab biosimilars (AJMC Q1 2025). The US oncology biosimilar market reached $2.68B in 2024 and $3.16B in 2025, with 8 bevacizumab, 6 trastuzumab, and 5 rituximab biosimilars approved (Taylor and Francis).
Implication for PE: oncology practice EBITDA models leaning on Keytruda buy-and-bill spread should be discounted post-2028. Practices with material I-O biosimilar pass-through risk (high Keytruda or Opdivo volume on commercial mix) face an additional 0.25x to 0.50x EBITDA haircut on QofE. Confidence: HIGH on biologic substitution dynamics; MEDIUM on subcutaneous Keytruda revenue defense.
The Intas Pharmaceuticals Ahmedabad FDA inspection failure (February 2023 through 2024 tail) removed approximately 50% of cisplatin and methotrexate US supply (Medscape) (PMC). 81% of impacted patients received community-practice care; cisplatin use dropped 15% while carboplatin use rose 40% in head-and-neck protocols between May and August 2023 (CancerNetwork). Sourcing costs rose up to 10x for smaller centers (Medscape). The M&A read-through: working-capital strain on sub-scale community practices accelerated platform-join decisions through 2024 and 2025. The Intas shortage was a structural input to the McKesson-FCS, Cencora-OneOncology, and Cardinal-ION timelines, removing the most important objection independent practices held against platform-join (loss of formulary control). Buyers underwriting community practice EBITDA in 2024 and early 2025 should adjust for an abnormally-low pre-deal cisplatin / methotrexate gross margin baseline.
FDA Project Optimus launched in 2021 under the Oncology Center of Excellence to push oncology dose selection away from the maximum-tolerated-dose model toward randomized dose optimization (Halloran 2024). FDA published industry dose-optimization guidance in August 2024 requiring broad early-phase populations to assess pharmacokinetics and safety covariates (Applied Clinical Trials). Bayesian early-phase design adoption rose from 48% in 2021 to 75% in 2024 (JCO Oncology Advances). Janet Woodcock retired in early 2024 after 37 years at the agency (Endpoints News). Richard Pazdur, founding director of the OCE since 2017, was appointed CDER director and then announced his retirement at end of December 2024, creating an FDA leadership gap (BioPharma Dive) (Friends of Cancer Research). Implication for PE: oncology asset diligence should now flex for higher Phase 1 cohort sizes (raising trial-program OPEX) and slower regulatory turnaround during the OCE / CDER leadership transition.
On April 30, 2024, USPSTF finalized a B-grade recommendation for biennial breast cancer screening starting at age 40 through age 74, down from the 2016 starting age of 50; the Task Force cited a 19% potential mortality reduction and 40% higher breast cancer mortality among Black women (USPSTF final) (ASCO Post). Lung cancer screening since the 2021 update recommends annual LDCT for ages 50 to 80 with a 20 pack-year history who currently smoke or quit within 15 years (USPSTF lung). Colorectal screening since May 18, 2021 recommends starting at age 45 for average-risk adults, with clinician ordering uptake nearly complete by 2024 (JAMA Network Open). On December 10, 2024, USPSTF released a draft cervical cancer screening recommendation endorsing patient-collected high-risk HPV self-collection for ages 30 to 65 every 5 years; the FDA cleared self-collected vaginal HPV specimens in May 2024 (Medscape).
Key 2024 to 2025 NCCN updates: breast cancer guidelines added a principles-of-adjuvant-endocrine-therapy page and now permit radiation omission after breast-conserving surgery for patients age 65 plus with HR-positive, HER2-negative, pN0, pT tumors 3 cm or less when endocrine therapy is planned (ASCO Post NCCN 2025). NSCLC guidelines added repotrectinib for ROS1-rearranged disease progressing on entrectinib, crizotinib, or ceritinib, while SCLC integrated immunotherapy further (ASCO Post NCCN 2024). Colorectal guidelines now recommend discussing DPYD genetic variant testing before fluoropyrimidine therapy. Across the franchise, 2024 saw tumor-agnostic approvals folded into multiple guidelines, with NSCLC receiving the most revisions. Implication for community oncology PE: shifting screening age cohorts expand the addressable patient population on the front end (especially breast and colorectal), while NCCN-driven biomarker testing expansion (DPYD, ROS1) pulls more molecular-Dx volume to platforms with in-network labs (NeoGenomics, Caris, Veracyte).
| Platform | Sponsor / Owner | Segment | Footprint | 2024-2026 Activity | Confidence |
|---|---|---|---|---|---|
| US Oncology Network | McKesson (NYSE: MCK), strategic operator (McKesson) | Community med onc | ~3,300 providers, 700+ locations, 1.5M patients / yr | FCS Core Ventures 70% close June 3, 2025 for ~$2.49B; Verdi integration 2024; Epic Care, Nexus Health adds 2023 | HIGH |
| OneOncology | Cencora (NYSE: COR) ~92% post Feb 2, 2026 close; minority practices retained (Cencora 8-K) | Community med onc, rad onc, urology, surg onc | 17 partner practices, 1,300+ providers, major-state coverage | $7.4B EV close Feb 2, 2026; SunState / GenesisCare FL Oct 8, 2025; START Center June 2025; Treasure Coast Jun 30, 2025 | HIGH |
| American Oncology Network (AONC) | Physician-majority; AEA Growth minority since April 2023 ($65M); OTC since May 21, 2024 (AON delisting) | Community med onc | 300+ specialists, 20 states + DC, 100+ locations | $2B+ LTM rev (>40% growth) as of Aug 12, 2025; multiple tuck-ins (Fort Wayne, MidAmerica, Auerbach, Conway) | HIGH (cap-table corrected) |
| Florida Cancer Specialists Core Ventures | McKesson 70% Core Ventures since June 3, 2025; FCS physicians 30% (FCS) | Community med onc (largest single state: Florida) | 250+ physicians, 280+ APPs, ~100 locations | Joined US Oncology Network at close | HIGH |
| Integrated Oncology Network (ION) | Cardinal Health (NYSE: CAH) acquired from Silver Oak Services Partners Dec 3, 2024 for $1.115B (Cardinal) | Med onc, rad onc, surg onc, urology | 100+ providers, 50+ sites, 10 states | Folded into Navista practice alliance | HIGH (Silver Oak NOT Nautic) |
| Tennessee Oncology | OneOncology platform (Cencora ~92% via Feb 4, 2026 close) | Med onc, surg onc post 2024 | 180 physicians, 35 clinics, ~50% of TN cancer patients (Nashville Post) | The Surgical Clinic 42 surgeons 2024; Nashville Breast Center 20 docs; gyn-onc adds | HIGH |
| Texas Oncology | McKesson-affiliated (US Oncology Network founding member) | Med onc, rad onc | ~1,000 providers, 280 locations across Texas | Continued infill; Canopy multi-year partnership March 2025; APP-led model research at ASCO 2026 (Businesswire) | HIGH |
| New York Cancer and Blood Specialists (NYCBS) | PE-backed MSO (sponsor not publicly disclosed); physician-majority structure | Med onc, hematology | 60+ locations across NY metro and Long Island | Hudson Valley Cancer Center partnership Sept 2024 (Provident); OncoveryCare survivorship partnership Sept 2025 | MEDIUM (sponsor) |
| GenesisCare US / SunState | OneOncology / Cencora since Oct 8, 2025 (FL operations); pre-emergence Macquarie / China Resources | Rad onc, med onc, urology, surg onc | SunState = 100+ MDs, 104 FL clinics; residual NC operations partially divested | Ch 11 emergence Feb 16, 2024 ($1.7B debt cut + $56M new capital); FL sold to OneOncology Oct 8, 2025 | HIGH |
| Akumin / Alliance HealthCare | Stonepeak Capital Partners (post-Ch11 emergence Feb 8, 2024) (Radiology Business) | Outpatient imaging, rad onc | ~140 outpatient centers, hospital-based service network | Plan approved Feb 6, 2024 cancelling ~$470M debt; Alliance acquired from Thaihot Sept 2021 for $786M | HIGH |
| US Radiology Specialists (Lumexa Imaging) | Welsh Carson Anderson and Stowe ~43% + physician partners ~48% + other 9% (Radiology Business) | Outpatient imaging, oncology imaging | ~$950M revenue 2025; $2.7B 5-yr target | Rebranded Lumexa; 8 de novo since Oct 2024, 12 planned 2025; FTC consent order Jan 2025 over adjacent anesthesia tactics | HIGH |
| Sarah Cannon Cancer Network | HCA Healthcare (NYSE: HCA), strategic public hospital operator (HCA) | Hospital-based med onc, rad onc, cellular therapy | 184 hospitals, 1,000+ daily RT, 1,600+ transplants / yr (#1 US) | 2024 brand launch of Sarah Cannon Cancer Network; Tennessee Cancer Specialists research collab May 23, 2024 | HIGH |
| Sarah Cannon Research Institute (SCRI) | HCA + McKesson JV (October 31, 2022) | Oncology clinical research / trials network | 1,300+ physicians, 250+ locations, 24 states; 850+ first-in-human trials | 2024 ASH preview (SCRI) | HIGH |
| City of Hope (post-CTCA) | Nonprofit 501(c)(3), NCI-designated comprehensive cancer center | Comprehensive academic + community | Duarte CA flagship + former CTCA Atlanta, Chicago, Phoenix rebranded | CTCA Atlanta + Chicago rebranded to City of Hope (NOT closed in 2024); Tulsa + Philadelphia closed 2021 | HIGH (corrected) |
| Memorial Sloan Kettering (MSK Alliance) | Nonprofit NCI-designated comprehensive cancer center | Comprehensive academic + alliance network | Hartford HealthCare (CT), Miami Cancer Institute / Baptist Health (FL), MSK Nassau (Uniondale) | Queens / Jamaica Hospital partnership Jan 17, 2025 ($188M NY State capital); Cancer AI Alliance launched | HIGH |
| Mayo Clinic Cancer Center | Nonprofit academic comprehensive cancer center | Comprehensive academic | Rochester MN flagship + Arizona + Florida regional | $50M Slaggie gift Sept 2024; Cancer Care Beyond Walls home-chemo program; NVIDIA + Aignostics AI pathology | HIGH |
| Dana-Farber Cancer Institute | Nonprofit NCI-designated comprehensive cancer center | Comprehensive academic, post-Brigham split | $1.68B 300-bed freestanding cancer hospital with Beth Israel Lahey at 1 Joslin Place, projected open 2031 | 25-year Brigham clinical affiliation ends 2028; MGB countering with $400M MGB Cancer Institute; staff transition disputes ongoing (Boston Globe Feb 2026) | HIGH |
| NeoGenomics | Public (NASDAQ: NEO) | Cancer genetics testing, CAP / CLIA lab network US + Cambridge UK | FY2025 revenue ~$727M (+10% YoY); FY2026 guide $793-801M | Pathline LLC acquisition closed April 7, 2025 (NJ-based oncology pathology) (NeoGenomics) | HIGH |
| Veracyte | Public (NASDAQ: VCYT) | Genomic diagnostics (Decipher Prostate) | FY2025 revenue $506-510M raised; testing $484-487M (+16%) | Decipher Prostate Q2 2025 revenue $76.3M +24% YoY, 25,500 tests +28%; 13th consecutive Q >25% volume growth | HIGH |
| Guardant Health | Public (NASDAQ: GH) | Liquid biopsy, oncology + Shield CRC screen | FY2025 $982M total revenue (+33% YoY); oncology 67.6%, +26% YoY | Q1 2026 oncology $205M, 86,000 tests +47% YoY (Investing.com) | HIGH |
| Caris Life Sciences | Sixth Street pre-IPO; public (NASDAQ: CAI) post June 17, 2025 IPO | AI-driven precision oncology Dx | FY2024 revenue $412.3M (+35% YoY); IPO at $5.35B; closed first day at $28 vs $21 IPO price | IPO June 17, 2025 $494M raised; Braidwell-led $168M crossover April 7, 2025 (Perceptive, Woodline, Ghisallo) | HIGH |
| PathAI (pending Roche) | D1 Capital, Kaiser, GA, Tiger, 8VC, Adage, Biospring, General Catalyst, KdT, Polaris, Refactor + BMS, Labcorp, Merck GHIF | AI-powered pathology platform | Pending Roche acquisition: up to $1.05B ($750M upfront + $300M milestones), expected close 2H 2026 (MedTech Dive) | Sold PathAI Diagnostics + AISight to Quest 2024; FDA AISight Dx clearance 2025 | HIGH |
| NeoGenomics + Veracyte + Guardant + Caris (Dx cluster) | Multiple public listings; collectively the public diagnostics oncology comp set | Pathology, genomics, liquid biopsy | ~$2.2B+ aggregate FY2025 revenue | Most active diagnostics roll-up segment in 2024-2026; Roche + PathAI pending 2H 2026 | HIGH |
| Compass Oncology | McKesson-affiliated US Oncology Network member | Med onc, rad onc | Pacific Northwest practice (Portland metro, SW WA) | US Oncology Network member | HIGH |
| Comprehensive Cancer Centers of Nevada | McKesson-affiliated US Oncology Network member | Med onc, rad onc | 8+ locations across southern Nevada | US Oncology Network member | HIGH |
| HOACNY (Central NY) | Independent private practice; no PE sponsor | Med onc, hematology | East Syracuse hub + regional sites | Founded 1982; no in-window equity event | MEDIUM (negative confirmation) |
| Pennant Group | Public (NASDAQ: PNTG); home-health + hospice operator | Home health + hospice (oncology-adjacent) | 54 location adds from DOJ-mandated UNH-Amedisys divestitures, $189.3M TTM revenue at close | Signature Healthcare at Home Jan 2025 ($80M); UNH-Amedisys close Oct 1, 2025 ($146.5M) | HIGH (adjacent, not pure oncology) |
| Verdi Oncology (legacy Pharos) | Pharos Capital Group 2018 launch; exited Feb 2024 to US Oncology Network | Med onc | Folded into US Oncology, Nashville Oncology Associates + Horizon Oncology + Verdi Cancer TX | Exit closed Feb 23, 2024 (Provident) | HIGH (corrected: Pharos NOT Theramedex) |
This is the densest active segment. US Oncology Network at ~3,300 providers and OneOncology at 1,300+ providers anchor structural consolidation. AON sits as the public-market take-private candidate. NYCBS, HOACNY, Astera Cancer Care (NJ, OneOncology partner since 2021 spin from RCCA (PR Newswire)), RCCA (US Oncology Network strategic since April 1, 2023 (AJMC)) round out the regional set. Between 2015 and 2022 the count of US oncology practices fell 18% while medical oncologists per practice rose 40% (VMG Health). About 44% of practices remain independent. PE-backed deal flow in Q1 2025 rebounded from 128 to 140 transactions across healthcare services (VMG Health).
Tennessee Oncology stands out as the most strategically active OneOncology founding practice. The practice grew from 116 physicians (2024) to 180 physicians (Nashville Post Leaders 2025), 35 clinics across Tennessee, treats ~50% of TN cancer patients (Nashville Post Leaders 2025). 2024 to 2026 partner adds: Nashville Breast Center (20 docs), The Surgical Clinic (42 surgeons, October 2024 close (PR Newswire)), Nashville Oncology Associates, plus gyn-onc adds from Ascension St. Thomas. Texas Oncology’s Q1 2025 multi-year Canopy partnership pulls a population-health analytics layer onto a 280-location, 1,000-provider Texas footprint (PR Newswire). AON tuck-ins through 2025 included Woodlands Cancer Institute (Houston, March 26, 2024 (AON)) and Q1 2024 Texas and Maryland multi-practice tuck-ins (17 providers; AON crossed $1.2B run-rate at that point (AON Q1 2024 release)).
OneOncology’s late-2024 through mid-2025 partner cadence demonstrates the platform-add tempo. November 2024 brought Mid Florida Cancer Centers (16 providers, 4 centers across DeLand, Orange City, Oviedo, Sanford (OneOncology)). December 2024 concurrent adds included Pacific Cancer Medical Center, Maury Regional Medical Group, and Genesee Cancer (VMG Health). June 30, 2025 partnered with Hematology Oncology Associates of the Treasure Coast (29th OneOncology partner practice; 6 physicians, 4 clinics, St. Lucie + Martin Counties (PR Newswire)). The June 2025 START Center for Cancer Care (San Antonio) add was a phase-I trial-heavy practice adding research density. The July 8, 2025 Cancer and Hematology Centers (Michigan, OneOncology partner) acquisition of Genesee Hematology Oncology added 4 physicians via Flint expansion (CHC).
Radiation oncology is fragmenting structurally. GenesisCare US unwind transferred FL to OneOncology; US Radiology Specialists / Lumexa is pursuing an imaging-centric build; Akumin is under Stonepeak post-Ch11. ASTRO’s 2023 commissioned taskforce projects relative supply-demand balance through 2030 in the base case (Red Journal 2023). Per VMG Health, the market approach dominates radiation oncology due to comparable transaction density, and radiation centers made up 53% of the 700+ PE-acquired oncology clinics 2003 to 2022 (TechTarget on Maryland PE study). Clearview Cancer Institute acquired Alliance Cancer Care (Huntsville AL) May 5, 2026 to launch a radiation oncology division (Huntsville Business Journal).
The 21st Century Oncology to GenesisCare US history spans a decade of restructuring. 21CO filed Ch 11 in 2017, emerged, then merged into GenesisCare in 2020; current operations are the GenesisCare US footprint (Florida operations now SunState / OneOncology; NC operations partially retained) (Oncology News Central). The four geographically separated independent businesses (US, AU, ES, UK) that emerged from Ch 11 on Feb 16, 2024 carried distinct governance structures; the US arm retained Florida plus North Carolina practices (~145 locations at emergence) (GenesisCare AU) (VMG Health). KKR’s pre-petition equity was wiped at emergence; Macquarie and China Resources retained governance through the reorganization (correcting the widely-repeated narrative that “KKR and China Resources exited”; KKR exited pre-Ch11).
Akumin / Alliance HealthCare’s post-Ch11 path is similarly complex. Akumin acquired Alliance HealthCare Services from Thaihot Investment in September 2021 for $786M (Akumin closing). Akumin filed Ch 11 on October 22, 2023; the plan was approved on February 6, 2024, cancelling ~$470M of debt. The post-emergence sponsor is Stonepeak Capital Partners (correcting the widely-cited “TH Lee” reference not supported by public record). The Akumin segment now combines outpatient imaging with radiation oncology service line capacity, positioning Stonepeak to play in both fragmenting segments. US Radiology Specialists’ rebrand to Lumexa Imaging coincided with a January 2025 FTC consent order with WCAS over alleged anti-competitive tactics in adjacent anesthesia roll-up activity (Radiology Business FTC), the first FTC consent of a PE sponsor over physician-MSO competitive practices.
Stonepeak’s post-Akumin Ch 11 capital structure (~$470M pre-petition debt cancelled at emergence February 6, 2024) gives the platform meaningful operating runway through 2027. The strategic question is whether the radiation oncology service-line capacity acquired through the Alliance HealthCare transaction is durable economically as standalone hospital-based contracts roll off or shift to capitated arrangements. Hospital-based radiation oncology service-line contracts typically run 3 to 7 years; renewal economics depend on (1) the hospital’s 340B participation status (which can shift the buy-and-bill margin economics of infused radio-pharmaceutical agents such as Pluvicto and Bexxar), (2) the hospital’s freestanding-versus-hospital-based regulatory designation (which determines Medicare reimbursement at HOPPS versus the lower freestanding RT rate), and (3) the relative scarcity of medical physicists locally (with 25% of AAPM members 65+ by 2030, scarcity has gone from a moderate to a binding constraint). The Akumin / Stonepeak operating posture under the post-Ch 11 governance favors selective re-tendering of hospital-based contracts rather than aggressive de novo expansion, a posture that differs meaningfully from the US Radiology Specialists / Lumexa imaging-centric build (8 de novo since October 2024, 12 planned 2025).
Cigna Evernorth quietly acquired the remaining 51% of CarepathRx (Feb to Mar 2026) from Nautic Partners’ majority, full ownership; OHA approval August 15, 2025 (Oregon HCMO filing) (Fierce Healthcare). CarePartners Pharmacy / Ashlar Capital acquired National Drug Wholesale November 2025 (PE Stakeholder Project). Cencora-RCA (specialty MSO comp): closed January 2, 2025 at ~85% equity for $4.4B cash outlay plus up to $500M FY27 to FY28 earn-outs (Cencora press). The RCA trade reads as ~15 to 18x EBITDA on the same buyer-screen framework Cencora deployed for OneOncology.
Akumin acquired Alliance HealthCare Services from Thaihot Investment in September 2021 for $786M, layering Alliance’s hospital-based imaging contracts and radiation oncology service line capacity on top of Akumin’s outpatient imaging platform (Akumin closing). The combined entity ran ~140 outpatient imaging centers plus a national hospital-based service network. The October 22, 2023 Ch 11 filing was driven by ~$1B in pre-petition debt service post the Alliance acquisition; the plan approved February 6, 2024 cancelled ~$470M of debt and converted Stonepeak Capital Partners’ pre-petition exposure into the post-emergence controlling equity stake. For radiation oncology PE more broadly, the Akumin precedent shows that outpatient imaging-plus-radiation oncology integration is workable from a clinical-operations standpoint but financially fragile at high debt loadings; Stonepeak’s post-emergence operating posture is to reduce debt and focus on hospital-based service-line contract renewals rather than aggressive de novo growth.
The Roche / PathAI deal pending close 2H 2026 anchors AI-driven pathology consolidation (MedTech Dive). NeoGenomics added Pathline LLC at close April 7, 2025 (Yahoo Finance). Sema4 / GeneDx (NASDAQ: WGS) acquired Fabric Genomics May 5, 2025 (Genome Web). Natera acquired Foresight Diagnostics December 2025 for $275M upfront plus $175M earnouts (all-stock) for PhasED-Seq MRD technology (Natera release). Abbott announced acquisition of Exact Sciences on November 20, 2025 at $21B equity / $105 per share (Cologuard plus Oncotype DX, $60B cancer screening / precision Dx segment) (Exact 8-K).
City of Hope (post-CTCA) integration finalized 2023; ongoing BMT plus CAR-T expansion to former CTCA sites in Atlanta, Chicago, Phoenix (NOT closed in 2024). Mayo Clinic Cancer Center received a $50M Slaggie gift September 2024 (Mayo). Cancer Care Beyond Walls home-chemo plus decentralized trials program is active, with NVIDIA plus Aignostics AI pathology partnerships and a New Prague MN infusion expansion underway. Dana-Farber’s 25-year Brigham and Women’s clinical affiliation ends 2028; Dana-Farber is partnering with Beth Israel Lahey on a new $1.68B freestanding 300-bed cancer hospital at 1 Joslin Place, projected open 2031 (Boston Globe) (WGBH state approval). Joslin building decommissioning April 2026. Mass General Brigham is countering with a $400M MGB Cancer Institute investment; staff transition disputes are ongoing (Boston Globe February 2026).
MSK Alliance members include Hartford HealthCare (CT) and Miami Cancer Institute / Baptist Health (FL), plus additional regional alliance affiliates (MSK Alliance site) (Baptist Health Miami). The Cancer AI Alliance (CAIA) launched as part of an ongoing alliance expansion beyond NY metro. MSK Direct’s Queens partnership with Jamaica Hospital was announced January 17, 2025 with $188M NY State capital funding (NY Governor release); no equity transaction. MSK Nassau (Uniondale) is established as a regional satellite. Sarah Cannon Cancer Network’s 2024 brand launch across HCA hospitals, the Tennessee Cancer Specialists research collaboration May 23, 2024 (SCRI), and SCRI / HCA + McKesson JV (effective October 31, 2022) combining US Oncology Research and Sarah Cannon Research now reach 1,300+ physicians at 250+ locations across 24 states (290+ locations with 1,500+ trials via partnerships; 850+ first-in-human trials to date (SCRI 2024 ASH preview)).
The three large US drug distributors hold balance sheets that no PE sponsor can match for community oncology consolidation. McKesson’s FY2025 U.S. Pharmaceutical segment revenue was $327.7B with $3.7B adjusted operating profit (McKesson FY2025). McKesson then split out the new Oncology and Multispecialty segment for FY2026 reporting; the $2.49B FCS Core Ventures acquisition financed at investment-grade rates was an ~7x EV / EBITDA multiple on a ~$355M EBITDA basis (assuming FCS at ~14% EBITDA margin on ~$2.5B revenue), a meaningful discount to the 13.8x AONC SPAC reference and the 19x OneOncology benchmark, driven by McKesson’s distribution-margin uplift accretion math.
Cencora’s $5.5B credit facility to finance the OneOncology buyout was led by JPMorgan and split into a $2.5B revolver plus $3.0B in term loans (Cravath credit facilities). Cencora lifted FY26 guidance at close, signaling that the OneOncology acquisition is mid-single-digit EPS accretive in year-one before synergies (Globe and Mail). Cardinal Health’s $1.115B ION acquisition financed off the parent’s investment-grade rating and immediately folded into Navista’s practice management plus growth services tech stack.
For a PE sponsor underwriting an oncology MSO platform, the comp-set takeaway is brutal: a strategic distributor can pay 15x to 19x EBITDA, finance at 4 to 5% pre-tax, and still hit a 9 to 12% IRR on a 5-year hold thanks to distribution-margin pass-through. A standalone PE sponsor underwriting the same asset must hit 9 to 11x entry, exit at 14x to 16x in 5 years (with platform-build risk), and is structurally outbid on any process where Cencora, McKesson, or Cardinal participates. The implication: PE sponsor activity in community oncology is increasingly relegated to sub-$15M EBITDA platform-build (where strategic distributors prefer to wait for scale) and to specialty subsegments where distribution-margin economics are less applicable (pure radiation, specialty pharmacy, pathology).
The anchor benchmark for the strategic-buyer ceiling is the Cencora-OneOncology February 2, 2026 close at $7.4B EV / ~19x EBITDA (Scope Research). The Cencora-RCA precedent at ~15x to 18x EBITDA sets the comparable specialty-MSO ceiling band (Cencora). The McKesson-FCS Core Ventures June 3, 2025 close at ~$2.49B for 70% sets the structural roll-up benchmark.
| EBITDA Band | Multiple | Anchor |
|---|---|---|
| Sub-$5M community med onc single-site | 5 to 7x SDE / EBITDA | Provident Q1 2024 |
| $5-15M regional group | 7 to 10x; 8.0 to 8.5x oncology services baseline | First Page Sage |
| $15-50M platform | 10 to 13x | AONC 13.8x SPAC reference; Provident Q4 2024 |
| $50M+ scaled platform | 12 to 16x; strategic ceiling 17 to 19x | OneOncology 19x TPG print + Cencora ~19x take-out |
| Radiation oncology center add-on | 5 to 8x EBITDA | VMG market-approach; 53% of 700+ PE-acquired oncology clinics 2003 to 2022 were RT |
| Specialty pharmacy oncology | 8 to 12x | CarePartners / Ashlar; Evernorth / CarepathRx |
| Oncology pathology lab | 6 to 10x | NeoGenomics + Veracyte revenue resets; AISight pending Roche close |
QofE haircuts. Apply 0.5x to 1.5x discount for 340B-exposed referral mix where the practice’s top 3 referring hospitals are 340B DSH participants (Medical Economics). Apply a further 0.5x to 1.0x EBITDA discount for IRA-negotiated-drug Part B concentration; oncology-relevant CMS negotiation cohort selections begin 2027 to 2028 (JCO OP CMS specialty strategy). Apply an additional 0.25x to 0.5x discount for EOM downside-risk participants without strong care-management infrastructure. The median healthcare services EV / EBITDA compressed from 14.5x in 2024 to ~11.5x in 2025 (First Page Sage); oncology specialty pricing has held above that baseline due to distributor strategic activity.
(1) Cencora-OneOncology Feb 2, 2026 collapses the distributor vs MSO distinction. Cencora paid $4.9B total cash for the equity it did not already own in OneOncology at $7.4B EV, closing Feb 2, 2026 (Cencora 8-K). Why mispriced: PE trackers still bucket OneOncology as a TPG platform asset. Implication: sub-$100M EBITDA platforms targeting an OneOncology exit face one strategic bid, not auction tension.
(2) McKesson + US Oncology Network is the structurally largest US oncology platform. ~3,300 providers post FCS Core Ventures close June 3, 2025 (McKesson). Why mispriced: comparable sets exclude McKesson and Cencora as “non-PE,” distorting platform-size benchmarks.
(3) 340B rebate-model litigation is materially mispriced in QofE. The Maine federal court vacated HRSA’s 340B rebate-model pilot Feb 10, 2026 (Frier Levitt). Why mispriced: QofE treats current 340B discount capture as run-rate. Implication: stress-test EBITDA under a manufacturer rebate model.
(4) Medicare Part B inflation rebates flatten ASP-plus-6% spread economics. CMS began invoicing manufacturers in September 2025 for CY2023 and CY2024 quarters (GAO). Why mispriced: LBO models assume historical buy-and-bill spreads.
(5) EOM Wave 2 + IRA Cycle 1 compound. July 2025 MEOS rose to $110 PBPM; January 2026 Imbruvica MFP $9,319 (-38% list). Platforms without total-cost-of-care infrastructure face a structural margin step-down 2026 to 2030.
(6) AON public market arbitrage signals a take-private. $231M to $437M public OTC mcap versus $7.4B OneOncology EV invites a strategic bid. Caris IPO $5.35B / 13x P/S June 17, 2025 separately resets continuation-vehicle marks for precision-oncology assets (AZBio).
(7) Sarah Cannon Cancer Network is the hidden strategic acquirer. HCA’s 184-hospital footprint runs 1,000+ daily radiation treatments (#2 US), 4,500+ annual trial enrollments including 750+ first-in-human studies, and 1,600+ transplants and cellular therapies annually (#1 US) (HCA). Why mispriced: excluded from PE comp sets because captive to a public hospital operator. Implication for PE: HCA should be priced in as a credible strategic acquirer for trial-rich community oncology assets adjacent to its hospital geography.
(8) GenesisCare US emergence February 16, 2024 created a buyer of last resort. GenesisCare emerged from Chapter 11 February 16, 2024 after a $1.7B debt restructure that wiped KKR’s pre-petition equity; the US entity continues with 5,500+ clinicians across radiation, medical, hematology, urology, diagnostics, and surgical oncology (Business Wire). Why mispriced: diligence frames GenesisCare US as defunct rather than an active consolidator. Implication for PE: sponsors exiting radiation oncology should include GenesisCare US (NC residual after the SunState carve-out) in target buyer lists.
(9) The Pennant Group’s DOJ-mandated UNH-Amedisys divestitures created an oncology-adjacent home-health platform. The Pennant Group closed UnitedHealth Group / Amedisys divestitures in TN, GA, AL on October 1, 2025 for $146.5M, adding 54 locations with $189.3M TTM revenue (Pennant 8-K). Pennant labels the deal “the largest transaction in our history.” Why mispriced: home-health-plus-hospice is oncology-adjacent (HHA serves cancer patients on chemo, palliative, end-of-life pathways); the DOJ-divestiture mandate is the largest single-cycle home-health platform-build event from a competing strategic acquirer (UNH-Amedisys closed August 7 to 14, 2025 at $3.3B with 164 location divestitures across 19 states; BrightSpring took 107 locations for $239M). Implication for PE: oncology-platform exits should include Pennant on the strategic buyer list for community sites with material end-of-life or palliative care service-line economics.
The CMS Oncology Care Model (OCM) ran July 1, 2016 through June 30, 2022 with 126 practices and 5 payers, billing a $160 MEOS PBPM plus retrospective performance-based payments (CMS OCM evaluation). OCM cut episode spending by an average $298 per case versus comparison practices, but MEOS plus PBP exceeded gross savings, producing net Medicare losses of $61M to $101M per performance period. Care-team infrastructure investments (nurse navigators, electronic symptom-tracking, after-hours triage) carried over into EOM eligibility for the surviving cohort. The EOM was deliberately re-engineered to constrain CMS net cost: lower MEOS at launch ($70 PBPM versus OCM $160), narrower 7-cancer scope (versus OCM all-cancer), and meaningful downside-risk participation. Wave 2’s MEOS bump to $110 PBPM is a partial concession on the original Wave 1 economic flaw without restoring OCM-era absolute payment levels. For PE-backed platforms, the OCM legacy data is the cleanest empirical baseline for what 6 years of bundled-payment infrastructure can deliver in absolute EBITDA terms: 5-10% Medicare line-margin compression net of MEOS in the historical model, with infrastructure cost amortized only at multi-site scale.
The ASCO 2025 workforce census documents a 14.9 oncologists per 100,000 ratio for the 55+ population in 2024 (down from 15.9 in 2014) and 38 states with declining per-capita density (ASCO). 68% of older Americans live in counties classified as coverage at risk because of retirement-eligible concentration. The ACGME / NRMP 2024 medical specialties match filled 773 certified hematology / oncology fellowship positions at 99.7% fill rate, with 54.5% MD graduates and 26.8% non-US IMG matches (ASCO Connection). The original 2013 ASCO / AAMC projection forecasted shortage emergence by 2025 (JCO OP 2013), and the 2024 cohort numbers confirm the prior projection.
The peer-reviewed companion to ASCO’s October 2025 release is published in JCO Oncology Practice (JCO OP). Projected shortage exceeds 2,000 oncologists and hematologists in 2025 (Medicus HCS). By 2037, non-metropolitan areas are projected to meet only 29% of demand for medical and hematology oncologists versus 102% in metropolitan areas (same source). The geographic maldistribution is a structural input to the community oncology platform-join decision: PE-backed MSOs with multi-state operations can pull oncologists from oversupplied metro markets to underserved markets through recruiting, retention bonuses, and partnership-track structures that independent practices cannot match.
The ASTRO 2025 radiation oncology workforce update tracks employment and location shifts 2015 to 2023 (Red Journal 2025). Residency match continues to soften: radiation oncology has had multiple consecutive years of declining applicants and elevated unmatched positions (ASTRO 2023). Per the AAPM Professional Survey (CY 2024), clinical-role medical physicists with an MS and board certification averaged $245,000 primary salary (ASTROnews Summer 2024). The ABR Alternate Pathway has been criticized as a structural bottleneck for international candidates (JACMP 2025). Hiring expansion sustained through 2026 is driven by proton-therapy build-out and advanced linac platform integration; the board-eligible candidate pool is tight (AAPM Careers).
BCOP pharmacists: 4,377 Board Certified Oncology Pharmacists as of May 2025, the 4th-largest pharmacy specialty (Kelley C PharmD). BPS oncology pharmacy certification homepage: bpsweb.org. HOPA runs the 2025 BCOP Preparation Course (HOPA).
Medical physicists: 15% of AAPM survey respondents planned to retire within 10 years; 25% of AAPM members will be older than 65 by 2030 (ASTROnews Summer 2024). National pool of physicists per BLS OEWS May 2025: ~20,430 (AAPM Careers). A 2025 Red Journal commentary documents the clinical medical physicist shortage in rural and underserved areas, with 120+ CAMPEP-accredited therapeutic residencies and 41 imaging residencies inadequate against demand growth (Red Journal 2025).
Oncology nurse navigator: ONN-CG via AONN+ Foundation for Learning, with 2024 competencies update and exam at the November 2025 AONN+ conference (ONS competencies). Median oncologist age is 53 (Medicus HCS). BLS OEWS May 2024 reports median annual wage for physicians and surgeons at or above $239,200, the maximum reportable category (BLS OOH). Private-database average for hematology / oncology runs ~$496,000 (Barton Associates).
The structural read on community oncology consolidation between 2024 and 2026 is that strategic distributor activity, not sponsor activity, drives platform-size economics. McKesson (FCS Core Ventures, SCRI / HCA JV, US Oncology Network), Cencora (OneOncology, RCA), and Cardinal Health (ION / Navista) all anchored their roll-up activity on specialty-drug distribution economics tied to 340B, buy-and-bill, and oncology drug volume. Cencora FY2025 expanded its specialty leadership through the RCA close. McKesson’s FY2026 reorganization to split out an Oncology and Multispecialty segment reflects the structural importance of the US Oncology Network at ~3,300 providers (McKesson 10-K filing summary). Cardinal Health folded ION into Navista’s practice management plus growth services stack at close December 3, 2024.
For PE sponsors evaluating community oncology entries 2026 forward, the implication is that bilateral negotiation with one of the three distributors is the highest-probability exit, and the price discovery is driven by distribution-margin uplift not standalone practice EBITDA. The corollary: standalone sponsor-to-sponsor secondary auction processes face a structurally thinner bid stack, with the most likely outcome being a strategic-distributor preempt at a 0.5x to 1.5x EBITDA premium to the auction clearing price. The OneOncology TPG print in April 2023 ($2.1B at 19x) and the Cencora take-out February 2026 ($7.4B at ~19x with $4.9B cash) demonstrate the multiple holding through a full hold-period in a strategic-distributor framework.
For an independent owner-operator weighing a 2026 exit, the decision tree starts with EBITDA scale, then routes through trial / research density, sponsor familiarity, and geographic adjacency. Sub-$5M EBITDA single-site practices have three realistic options: tuck-in into a regional MSO (AON, NYCBS, ION-Navista, OneOncology partner-add channel) at 5x to 7x SDE / EBITDA; bilateral negotiation with a hospital system at no-premium (often at a discount versus PE) with employment guarantee tradeoffs; or sustained independent operation at a structural margin disadvantage to 340B-eligible competitors. $5M to $15M EBITDA regional groups (typically 4 to 10 oncologists, 1 to 3 metro-area sites) face a wider buyer set: OneOncology partner program, US Oncology Network practice-add, AON tuck-in, with multiple bands at 7x to 10x EBITDA. The platform-add process for OneOncology and US Oncology Network typically completes in 6 to 9 months from LOI to close, with management equity rollover required and a 3 to 5 year practice continuity covenant standard.
$15M to $50M EBITDA platforms with research-trial density command 10x to 13x EBITDA from SCRI / HCA, OneOncology, AON, and the US Oncology Network. The SPAC reference for AON at 13.8x EV / EBITDA (September 2023) and Provident Q4 2024 commentary on resurgent large-asset activity anchor the band. Practices with first-in-human trial capability, BCOP-led pharmacy, and patient-navigator infrastructure command the top of the band; sponsors discount for missing MA contract maturity, EOM-readiness, and 340B-adjacent referral channels. $50M+ EBITDA scaled multi-state platforms attract direct distributor engagement: Cencora as OneOncology bolt-on path, McKesson as US Oncology Network bolt-on path, or a sponsor-orchestrated IPO process targeting a Caris-style precision-oncology premium. The strategic ceiling at 17x to 19x EBITDA is set by the OneOncology TPG / Cencora prints; the 14x to 16x default band reflects standalone sponsor underwriting without distribution-margin uplift.
Radiation oncology center clusters face a more fragmented buyer set: GenesisCare US residual NC operations, OneOncology / SunState Florida operations, US Radiology Specialists / Lumexa, Akumin / Stonepeak, plus a tail of sponsor-backed regional radiation oncology platforms. The 5x to 8x EBITDA band is anchored by VMG market-approach valuation (53% of the 700+ PE-acquired oncology clinics 2003 to 2022 were radiation centers). Specialty pharmacy oncology infusion attracts Cencora Health, McKesson Specialty Health, Cardinal Specialty Solutions, and Cigna Evernorth (post the February to March 2026 CarepathRx integration), at 8x to 12x EBITDA. Pathology and molecular Dx lab oncology attracts NeoGenomics, Roche (post the PathAI cluster close), Natera, and Caris, at 6x to 10x EBITDA. Urology / surgical oncology with cancer mix attracts the OneOncology surg-onc track (Tennessee Oncology + Surgical Clinic 2024 precedent) and the SunState integrated model, at 8x to 11x EBITDA.
| Seller Profile | Likely Buyer Universe | Multiple Range | Confidence |
|---|---|---|---|
| Sub-$5M EBITDA single-site community med onc | Regional PE-backed MSO tuck-in (AON, NYCBS, ION-Navista, OneOncology partner add) | 5 to 7x EBITDA | HIGH |
| $5-15M EBITDA regional med onc group, 4-10 oncologists | OneOncology partner program, US Oncology Network practice-add, AON tuck-in | 7 to 10x | HIGH |
| $15-50M EBITDA platform with research-trial density | SCRI / HCA, OneOncology, AON, US Oncology Network; potentially Sarah Cannon Cancer Network direct | 10 to 13x | HIGH |
| $50M+ EBITDA scaled multi-state platform | Cencora direct (OneOncology bolt-on); McKesson direct (US Oncology Network bolt-on); strategic sponsor IPO | 12 to 16x; 17 to 19x strategic ceiling | HIGH |
| Radiation oncology center cluster | GenesisCare US residual NC; OneOncology / SunState; US Radiology Specialists / Lumexa; Akumin / Stonepeak | 5 to 8x | MEDIUM |
| Specialty pharmacy oncology infusion | Cencora Health, McKesson Specialty Health, Cardinal Specialty Solutions; Cigna Evernorth (CarepathRx integration) | 8 to 12x | HIGH |
| Pathology / molecular Dx lab oncology | NeoGenomics, Roche (PathAI cluster), Natera, Caris; Abbott (post Exact Sciences integration) | 6 to 10x | HIGH |
| Urology / surgical oncology with cancer mix | OneOncology surg-onc track (Tennessee Oncology + Surgical Clinic 2024 precedent); SunState integrated model | 8 to 11x | MEDIUM |
| Hospital-affiliated cancer service line | HCA Sarah Cannon; City of Hope CTCA platform; Mayo Cancer Care Beyond Walls; MSK Alliance; Dana-Farber post-Brigham | Not applicable (mission-driven nonprofit transactions) | MEDIUM |
Practice-level financials. OneOncology pre-close standalone EBITDA, AON segment EBITDA bridges, GenesisCare US post-emergence EBITDA, and Sarah Cannon segment-level economics are not separately broken out in public filings. Sponsor confidentiality: founder-rollover percentages and management-incentive-plan terms inside the Cencora-OneOncology deal are not disclosed beyond “minority interest retained” language in the Cencora 8-K (Cencora 8-K). 2026 H1 pipeline: sub-$50M EBITDA community oncology deals not yet announced were excluded from the scan. Workforce headcounts: the exact 2025 count of ONN-CG-certified navigators is not published by AONN+. The ASCO census 2024 active medical oncologist integer was not extracted precisely from the JCO OP article (JCO OP). BLS does not publish a separately tabulated median wage for oncologists; $239,200 is the upper-bound floor for the broad physicians-and-surgeons category (BLS). Project Optimus revenue impact: the 15% to 25% adjuvant revenue-per-patient reduction is a sell-side analyst construct; FDA has not published economic modeling (JCO Advances 2025). AONC market cap source contradictions: $231.39M (Stock Analysis) versus $436.72M (TipRanks) reflect different snapshot dates rather than disputed data. 340B status as of June 2026: HRSA’s reconsidered rebate framework had not been re-noticed at research cutoff (Federal Register Feb 17, 2026 RFI). EOM Wave 2 outcomes: practice-level performance data was not yet published; CMS Innovation Center evaluation reports lag participation by 18 to 24 months.
Astera Cancer Care (NJ): no 2024 to 2026 transaction located; practice remains OneOncology partner since 2021 spin from RCCA (PR Newswire). RCCA: strategic relationship with US Oncology Network was April 1, 2023 effective (AJMC); no 2024 to 2026 equity transaction located. Practical Oncology platform: no verifiable deal record located in window. Care to Care platform: no verifiable deal record located in window. Theramedex BioCare: no verifiable oncology platform deal record located in window. MSK Direct (Westchester, Nassau, Direct partner adds): MSK Nassau (Uniondale) is established; Queens partnership with Jamaica Hospital announced January 17, 2025; no equity transaction. Sarah Cannon HCA: 2024 brand launch of Sarah Cannon Cancer Network across HCA hospitals; Tennessee Cancer Specialists research collaboration May 23, 2024; no equity transactions identified. Pennant Group oncology adjacency: no oncology-pure entries; home-health plus hospice purchases serve oncology patients but classified as adjacent. City of Hope post-CTCA: Atlanta, Chicago, Phoenix rebranded (NOT closed); Tulsa + Philadelphia closures occurred in 2021, not 2024. Sema4 / GeneDx oncology exposure is limited; somatic oncology line was shut down for negative gross margins; heritable cancer testing within women’s health segment retained.
The Biden administration’s reignited Cancer Moonshot targeted a 50% reduction in the age-adjusted cancer death rate over 25 years (by 2047), preventing 4 million+ cancer deaths (NIH release) (Congressional Research Service IF12504). The FY24 request sought reauthorization through FY26 with $2.9 billion mandatory appropriations across 2025 to 2026. Cures Act Cancer Moonshot funding formally concluded at the end of FY24 (Contrarian News). The Trump administration FY26 budget calls for an NCI cut to $4.53 billion, a $2.69 billion / 37.3% reduction from FY25 (AACR April 2025). DOGE dissolved the NCI Office of Communications and Public Liaison (OncLive). The implication for community oncology PE is two-sided: reduced research funding compresses clinical-trial enrollment economics for trial-rich platforms (SCRI / HCA / McKesson, MSK Alliance, Mayo, Dana-Farber), but reduced federal funding leaves a larger commercial-payer share of the oncology spend pie, supporting the PE thesis on community-practice MSO scale.
Cencora (NYSE: COR). Cencora closed the acquisition of the remaining ~65% of OneOncology it did not already own on February 2, 2026 for $3.6B in cash plus $1.3B of OneOncology debt repayment, equal to $4.9B total cash consideration and $7.4B enterprise value at ~19x EBITDA (Cencora 8-K). TPG and other minority equity holders exited. Affiliated practices plus management retained the residual minority. Cencora financed the transaction with $5.5B of new credit facilities led by JPMorgan.
No. That is the most commonly miscited version of the transaction. The corrected facts: Cencora acquired the remaining ~65% (not 60%) of OneOncology equity it did not already own, paying $3.6B cash (not $4.6B) plus $1.3B debt repayment for a $4.9B total cash outlay at $7.4B enterprise value. The exit was for TPG plus other minority holders, NOT Bain Capital plus General Atlantic. General Atlantic was the pre-2023 majority sponsor; TPG plus Cencora bought General Atlantic out in April 2023.
McKesson’s US Oncology Network at ~3,300 providers. The June 3, 2025 close of the FCS Core Ventures 70% acquisition for ~$2.49B lifted the network past OneOncology (1,300+ providers post Cencora close) and AON (300+ specialists, 20 states) combined (McKesson).
No. AON is physician-majority with AEA Growth holding minority since April 2023 (from a $65M strategic growth investment). AON went public via the DTOC SPAC merger on September 20, 2023 and voluntarily delisted from Nasdaq on May 21, 2024, now trading on OTC Markets.
Silver Oak Services Partners. NOT Nautic Partners, as some early coverage stated. Cardinal Health closed the Integrated Oncology Network acquisition for $1.115B cash on December 3, 2024 (Silver Oak release). ION was folded into the Navista practice alliance with 100+ providers, 50+ practice sites across 10 states.
Pharos Capital Group. NOT Theramedex or BioCare. Pharos launched Verdi Oncology on March 19, 2018 and exited via The US Oncology Network in November 2023 with regulatory close in early 2024. Verdi included Nashville Oncology Associates plus Horizon Oncology plus Verdi Cancer Texas at exit.
No. CTCA Atlanta and Chicago were rebranded to City of Hope (NOT closed in 2024). Only CTCA Tulsa and Philadelphia closed (in 2021). City of Hope’s CTCA acquisition closed in early 2022; integration finalized in 2023; ongoing BMT plus CAR-T expansion to former CTCA sites Atlanta, Chicago, and Phoenix.
For OneOncology Cencora paid ~19x EBITDA at the February 2, 2026 close. The earlier Cencora-RCA transaction (closed January 2, 2025 at $4.4B cash for ~85% equity, plus up to $500M FY27 to FY28 earn-outs) reads as ~15x to 18x EBITDA, setting the strategic-buyer ceiling band for specialty physician MSOs with a strong buy-and-bill drug-margin tailwind.
Wave 2 launched July 1, 2025 with 41 group practices at 500+ sites in 34 states. MEOS rose from $70 to $110 PBPM; recoupment threshold tightened from 98% to 100% of benchmark; the model now extends through June 30, 2030. Downside-risk participation favors scale platforms with population-health analytics (Navista, US Oncology, OneOncology, AON), pressuring independents to platform-join. Buyers price a 0.25x to 0.5x EBITDA discount for EOM downside-risk participants without strong care-management infrastructure.
$9,319 for a 30-day supply, a 38% cut from the 2023 list price of $14,934. Imbruvica (ibrutinib, AbbVie and J&J) is the only cancer drug in IRA Cycle 1. Cycle 2 oncology drugs (Ibrance, Pomalyst, Xtandi, Calquence) follow with prices effective January 1, 2027.
Caris Life Sciences priced its Nasdaq IPO at $21 per share on June 17, 2025, raising $494M with a $5.35B target valuation; ticker CAI; the stock closed first day at $28. At ~13x P/S, Caris resets the precision-oncology public-comp ceiling well above Tempus AI (~7x) and Guardant Health (~5x). Continuation-vehicle marks for precision-oncology assets should be revisited.
HCA Healthcare’s 184-hospital footprint includes Sarah Cannon Cancer Network running 1,000+ daily radiation treatments (#2 US), 4,500+ annual trial enrollments including 750+ first-in-human studies, and 1,600+ transplants and cellular therapies annually (#1 US). HCA is excluded from PE comp sets because it is a public hospital operator, but the SCRI / HCA + McKesson trial network (1,300+ physicians, 250+ locations, 24 states) gives HCA a credible strategic-acquirer position for trial-rich community oncology assets adjacent to its hospital geography.
Six pending or indicated transactions warrant tracking through H2 2026 close. (1) Roche / PathAI is expected to close 2H 2026 at up to $1.05B ($750M upfront plus $300M milestones), the largest pending AI-pathology transaction; the close will mark the consolidation milestone for digital pathology under a strategic Dx parent and will validate AI-pathology multiples for sponsors holding similar pre-IPO assets (MedTech Dive). (2) Abbott / Exact Sciences announced November 20, 2025 at $21B / $105 per share; the transaction places Abbott in the $60B cancer screening and precision-oncology Dx segment, anchored on Cologuard and Oncotype DX; close is expected mid-2026 pending FTC review (Exact Sciences 8-K). (3) AONC take-private remains a watch item given the public-OTC arbitrage versus the OneOncology EV; both Cencora (as Cardinal-Navista alternative path) and the Cencora-aligned PE sponsor universe could plausibly bid (Stock Analysis AONC). (4) NeoGenomics consolidation at ~$793M to $801M FY2026 guide with Pathline integration could attract strategic interest from a public Dx peer or a sponsor specialty-Dx platform-build process. (5) Sarah Cannon Cancer Network expansion via HCA’s 184-hospital footprint could see a high-visibility community oncology MSO acquisition tied to a hospital geography overlap (most likely candidate states: TX, FL, TN, GA). (6) Cardinal Health Navista platform expansion through additional community oncology tuck-ins is likely as the platform integrates the post-ION acquisition operations.
Related research: for M&A multiples extracted from SEC EDGAR 8-K Item 2.01 + Rule 3-05 target financials disclosures (11,408 filings + 19.4% trigger rate); median public-buyer EV/EBITDA 9.8x; SaaS 6.1x EV/Rev + Rule of 40; healthcare 9.6x compression; data center 25-35x (Aligned/MGX $40B = largest data center deal ever); 42 mega-deal + 30 MM + 25 LMM serial-acquirer named extractions, see the 2024-2026 M&A Multiples Database (EDGAR + Rule 3-05).
Related research: for 17 named US PE sponsors with 3+ platforms in same vertical (Welsh Carson 8 healthcare platforms with USAP 19.99% cap May 12 2025 = first sponsor-level prior-approval remedy; Linden 7; KKR 6; Carlyle 4-MGA NSM+Hilb+Trucordia+Vantage), 10 vertical heat maps, and the state AG patchwork (CA SB 351 + OR SB 951 + WA HB 2548) as the new pre-merger notification regime, see the 2024-2026 PE Sponsor-by-Vertical Concentration Heat Map.
Related research: for every US state AG filing + notification law on healthcare PE 2024-2026 (CA SB 351 effective Jan 1 2026 NOT vetoed AB 3129; OR SB 951 NOT failed HB 4130; IN SEA 9; WA HB 2548 = first US sale-leaseback pre-notify statute; MA H 5159; Walgreens/Sycamore Aug 2025), see the 2024-2026 State AG and Legislature Healthcare PE Enforcement Tracker.
Related research: for DHJLM NBER 26371 applied to named PE bankruptcies 2024-2026 (65,850 documented 2024 layoffs per PESP; Steward 30K, Red Lobster 36K, Yellow Corp 30K, Joann 19K, Prospect Medical 11.3K, Envision 25K), see the 2024-2026 PE Roll-Up Job Cohort Study (QCEW Replication of DHJLM).
Related research: for 31+ named PE take-private failures, withdrawals, re-cuts, forced-closes, and in-hold Ch11s (KKR/Envision $10B wipeout, Cerberus/Steward $3.4B clawback Nov 2025, Vista/Citrix $6.5B hung debt, Twitter forced-close template, TEGNA regblock template, URI/H&E walk template), see the 2020-2026 PE Take-Private Failure Tracker.
Related research: for Evergreen Rubicon+Oak HC/FT+K2 correction, Panoramic Audax, Fresenius Reignite EUR 312M, see the 2026 Dialysis & Renal Disease MSO PE Roll-Up Tracker.
For 2026 community oncology underwriting, the regulatory discount stack is now a multi-step exercise. Step 1: identify 340B-adjacent referral channels (top 3 referring hospitals’ 340B DSH status), apply 0.5x to 1.5x EBITDA haircut. Step 2: identify Part B drug-mix concentration in IRA-negotiated agents (Imbruvica from January 2026; Ibrance, Pomalyst, Xtandi, Calquence from January 2027; first Part B drugs in Cycle 3 effective January 2028), apply 0.5x to 1.0x discount. Step 3: identify EOM Wave 1 or 2 participation status with downside-risk exposure, apply 0.25x to 0.5x discount. Step 4: identify Project Optimus exposure on trial-enrollment economics (raising trial-program OPEX), apply 0.1x to 0.3x discount on trial-revenue contribution to EBITDA. Step 5: identify pembrolizumab biosimilar exposure post-2028 (high Keytruda buy-and-bill spread on commercial mix), apply 0.25x to 0.5x discount on the affected line.
A typical $25M EBITDA community oncology asset at headline 11x EBITDA might thus underwrite at: 11x baseline minus 0.8x (340B) minus 0.6x (IRA) minus 0.3x (EOM) minus 0.2x (Optimus) minus 0.3x (pembrolizumab) equals 8.8x net underwriting multiple. The corresponding standalone PE sponsor underwriting math: $25M EBITDA at 8.8x EV = $220M entry, $300M to $375M exit at 5-year hold (12x to 15x exit on $25M EBITDA assuming flat operating performance), 7% to 11% IRR before debt. The strategic distributor underwriting math at the same asset: $25M EBITDA at 14x EV = $350M entry with distribution-margin pass-through driving 9% to 12% IRR. The gap between sponsor and strategic underwriting is the structural reason the sponsor exit funnel for community oncology assets has narrowed to bilateral negotiation with one of three distributors.
This tracker was compiled by the CT Acquisitions research desk and last verified on June 20, 2026. CT Acquisitions tracks healthcare PE roll-up activity across cardiology, anesthesia, ophthalmology, gastroenterology, orthopedics, urology, fertility, OBGYN, pediatric, dialysis, and (now) oncology MSO segments. We publish 22 active sector trackers as of mid-2026, supported by a SEC-filing and primary-press-release sourcing protocol and a quarterly refresh cycle. For sourcing methodology, see the Methodology section above.
Last updated: June 20, 2026.