Cencora’s $7.4bn Acquisition of OneOncology
- Feb 4
- 6 min read
By Krissa Mou, Scarlet Park, Rakan Aqrouq, and Terry Zhang (University of British Columbia); Alvaro Aguilar De Nalda (ESADE); Utku Kaya, Omar Kanaa, Nayoung Kim, Harvey Han and Tomiwa Oshai (King’s College London)
Photo: Christina Victoria Craft (Unsplash)
Overview of the deal
Acquirer: Cencora
Target: OneOncology
Implied Equity Value: $6 billion
Total Transaction Size: $7.4 billion
Closed date: End of 2026 Q1
Target advisor: Debevoise & Plimpton LLP (legal)
Acquirer advisor: Citi (financial), JP Morgan Securities LLC (financial), Morgan, Lewis & Bockius LLP (legal), Sidley Austin LLP (legal)
In December 2025, Cencora, Inc. agreed to acquire a majority stake in OneOncology, valuing the physician-led oncology platform at an enterprise value of $7.4 billion. The transaction builds on Cencora’s initial minority investment in 2023 and gives the firm control over a rapidly expanding network of independent community oncology practices across the United States. By increasing its ownership, Cencora improves its exposure to specialty oncology care, one of the most attractive segments within healthcare due to ongoing innovation, complex treatment pathways and growing pharmaceutical demand.
From a strategic perspective, the acquisition allows Cencora to move closer to the point of care, strengthening its pharmaceutical-centric strategy beyond distribution alone. Integrating OneOncology’s clinical, research and practice management capabilities with Cencora’s scale and infrastructure is expected to improve efficiency, lower unit costs and enhance access to innovative therapies in community settings. The deal also positions Cencora defensively by limiting the influence of private equity-backed consolidators and hospital systems, while preserving the independent care model. Although financed with new debt and expected to be earnings-neutral initially, the transaction supports Cencora’s long-term growth ambitions and reinforces its strategic leadership in specialty healthcare services.
“We are excited to accelerate our acquisition of OneOncology, which will advance our management services organisation and aligns with our approach of making growth-oriented investments that support our pharmaceutical-centric strategy” - Bob Mauch, President & CEO of Cencora
Company Details (Acquirer - Cencora, Inc.)
Cencora Inc. is a healthcare distributor that sources and distributes pharmaceutical products in the United States and internationally. Cencora’s U.S. Healthcare Solutions segment is a major distributor of generic, injectable, OTC, and plasma/blood products, while providing complementary pharmacy management, consulting, and supply-chain services to retail pharmacies, clinics and long-term care sites. Cencora’s International Healthcare Solutions segment combines pharmaceutical wholesaling with global commercialization services, distributing medicines and healthcare products to pharmacies, physicians, health centers, and hospitals, while providing specialty biopharma transportation and logistics services for international biopharmaceutical enterprises.
Founded: 1871
Headquartered: Conshohocken, Pennsylvania, USA
CEO: Robert P. Mauch
Number of Employees*: 51,000
Market Cap*: $68.76 Billion USD
EV*: $73.97 Billion USD
LTM Revenue*: $321.33 Billion USD
LTM EBITDA*: $4.81 Billion USD
LTM EV/Revenue*: 0.23x
LTM EV/EBITDA*: 15.37
Recent Transactions: Acquisition of Nextpharma Logistics GmbH (Oct, 2025) , acquisition of Public Health Expertise (Nov, 2024) ,$5.57bn acquisition of Retina Consultants of America (Nov, 2024)
*As of 26/01/2026
Company Details (Target - OneOncology)
OneOncology is an American-based, physician-led network that partners with independent community oncology practices. The company is designed to invest its vast resources in practices within its network to help improve and cheapen care for cancer patients. OneOncology attempts to expand the services of independent practices by supporting the entire continuum of care, ranging from prevention and diagnosis to hospice care. The goal is for community practices to stay independent and to compete with hospital systems with their patient-centric, physician-driven, and technology-powered model. A cloud-based network allows physicians within the network to collaborate nationwide in providing clinical and operational data, as well as the latest research. Currently, OneOncology has 30+ partners within its network, scattered across 15+ states.
Founded: 2018
Headquartered: Nashville, Tennessee, USA
CEO: Dr. Jeff Patton
Number of Employees*: ~200
Market Cap*: N/A
EV*: &7.4 Billion USD
LTM Revenue*: N/A
LTM EBITDA*: N/A
LTM EV/Revenue*: N/A
LTM EV/EBITDA*: N/A
*As of 26/01/2026
Projections and Assumptions
Short-Term Consequences
In the short term, Cencora’s acquisition of OneOncology is expected to be modestly dilutive to earnings as the company absorbs integration costs, higher financing expenses, and ongoing investments needed to align clinical and operational systems. While management has emphasized that the transaction should be earnings neutral over time, the initial financial impact reflects a deliberate decision to prioritise strategic positioning in oncology over immediate EPS accretion.
The transaction also expands Cencora’s product and service offering beyond traditional pharmaceutical distribution into care enablement and practice support within community oncology. In the near term, this broadening of scope changes how Cencora engages with providers, shifting the relationship from transactional supply toward longer-term clinical and operational partnership. Although this does not immediately translate into higher revenues, it enhances Cencora’s ability to offer integrated solutions that address the growing complexity of cancer care.
Geographically, the acquisition strengthens Cencora’s presence across the United States through OneOncology’s nationwide network of community oncology practices. While there is no immediate international expansion effect, the deal deepens Cencora’s penetration in regional and suburban markets where community-based cancer care is increasingly concentrated. This allows Cencora to reinforce its domestic footprint in areas that are becoming more strategically important as care shifts away from hospital settings.
From a leadership and workforce perspective, the transaction introduces short-term organisational challenges as Cencora integrates a physician-led platform into a large corporate structure. Maintaining clinical autonomy, retaining key physician leaders, and aligning incentives across management teams will require careful oversight and clear communication. In the short run, this may increase managerial complexity and slow certain decision-making processes as governance structures are refined.
Market reaction following the announcement has been generally measured and constructive, with investors viewing the acquisition as a forward-looking move into a resilient and high-growth therapeutic area. Rather than focusing on near-term earnings dilution, market participants appear to recognise the strategic logic of embedding more deeply in oncology services. This response suggests cautious confidence in Cencora’s ability to execute the integration while positioning itself for longer-term value creation.
Long-Term Upsides
Cencora’s acquisition of OneOncology is a strategic transaction that strengthens its pharmaceutical-centric strategy by increasing its exposure to cancer care. Oncology is the largest area of global drug spending and one of the fastest-growing areas in healthcare, making this an attractive segment for sustained expansion. By deepening cancer specialization within its U.S. Healthcare Solutions segment, particularly in community-based oncology with high demand for advanced and localized treatment, Cencora is better positioned to leverage OneOncology’s physician-led network to support independent oncology practices.
This integration moves Cencora beyond a pure drug distribution role and enables the company to generate higher-value revenue through expanded research support, clinical trial activity, and technology-enabled practice services over the long term.
Financially, the acquisition is explicitly structured towards durable earnings growth rather than immediate accretion. While the deal is expected to be broadly neutral to adjusted diluted EPS in the first year post-closing, Cencora has raised its long-term guidance to 7-10% adjusted operating income growth and 10-14% adjusted EPS growth to reflect the expected financial benefits of integrating OneOncology. The company has paused share repurchases in anticipation of the transaction, making it more likely that near-term adjusted EPS will fall toward the lower end of its $17.45-$17.75 guidance range. While this may weigh on short-term earnings, it reflects a deliberate shift in capital allocation, with Cencora redirecting cash from share buybacks toward long-term growth investments that management expects to generate higher and more durable earnings over time.
From an ESG perspective, the acquisition also carries positive implications by improving patient access to high quality cancer care in local communities and strengthening coordination between pharmaceutical services and care delivery, supporting more responsible and sustainable healthcare operations.
Risks and Uncertainties
Cencora’s acquisition of OneOncology introduces several interrelated risks and uncertainties that require close monitoring. The deal remains subject to customary closing conditions and required regulatory approvals, so an increasingly strict view on vertical integration in healthcare could delay closing, impose behavioural or structural remedies, or, in an adverse scenario, prevent the transaction from being completed.
In addition, the transaction is being financed with roughly 5 billion dollars of new debt, including a $1.5 billion term loan and a $3.0 billion 364‑day facility, all under a maximum leverage covenant of 4.0x (temporarily 4.5x in the acquisition quarter), which creates refinancing risk when the short‑term facility matures and constrains future balance sheet flexibility if EBITDA underperforms. Cencora also expects the acquisition to be approximately neutral to adjusted diluted EPS in the first year after financing costs and has paused share repurchases to protect its investment‑grade rating, leaving uncertainty about the pace of deleveraging and value creation for shareholders.
Operationally, there is uncertainty around integration, synergy realization, and talent retention. Cencora’s own disclosures highlight the risk of not realizing anticipated benefits, potential disruption to OneOncology’s business, and changes in customer or supplier relationships after closing. OneOncology’s physicians and management will hold only a minority stake, which may not be sufficient to guarantee long‑term alignment if they perceive any loss of independence or an adverse change in practice economics.
“As cancer care becomes increasingly complex, leveraging the significant expertise of Cencora across the healthcare landscape, while still maintaining our independence, will allow us to enhance the value we provide to practices, improving physicians’ ability to focus on delivering accessible and innovative care to their patients.” - Jeff Patton, M.D., Chief Executive Officer (OneOncology)