Cardinal Health vs Twilio: Revenue, Profit and Business Model
Cardinal Health reported $254.2B of revenue in FY2026 and $1.7B of net income. Twilio reported $5.1B of revenue in FY2025 and $33.8M of net income.
Latest financial snapshot
Cardinal Health
- Latest revenue
- $254.2B (FY2026)
- Net income
- $1.7B
- Net margin
- 0.7%
- Revenue growth
- +7.7% a year, FY2017–FY2026
Twilio
- Latest revenue
- $5.1B (FY2025)
- Net income
- $33.8M
- Net margin
- 0.7%
- Revenue growth
- +38.1% a year, FY2016–FY2025
Financial summary
Cardinal Health
Cardinal Health combines very large revenue with thin margins. Fiscal 2026 revenue was $254.2 billion, up 14% from $222.6 billion in fiscal 2025, driven by brand and specialty drug volume from existing customers. GAAP operating earnings were $2.6 billion, GAAP diluted EPS was $7.23, and net earnings attributable to Cardinal Health were about $1.7 billion. Non-GAAP diluted EPS rose 37% to $11.26 ($10.95 excluding the IEEPA tariff refund). Operating cash flow was $5.2 billion and adjusted free cash flow was $5.0 billion. The company repurchased $1.4 billion of stock in fiscal 2026 and the board added $5.0 billion to the buyback authorization in August 2026. Fourth-quarter fiscal 2026 revenue was $63.7 billion, up 6%.
Twilio
Twilio moved from heavy losses to profit in three years. Net loss attributable to common stockholders was $1.256 billion in 2022 and $1.015 billion in 2023, narrowed to $109.4 million in 2024, and turned into net income of $33.8 million in 2025 on revenue of $5.067 billion. In Q2 2026 Twilio reported revenue of $1.499 billion, GAAP income from operations of $84.5 million, non-GAAP income from operations of $284.6 million, and record free cash flow of $352.6 million. Q2 2026 GAAP net income of $1.067 billion was inflated by a one-time, non-cash release of a valuation allowance on U.S. deferred tax assets worth $5.91 per diluted share. Dollar-based net expansion improved to 116% from 108% a year earlier. A $2.0 billion buyback authorized in January 2025 continues the capital-return program that followed a $3.0 billion repurchase plan.
Revenue and profit by year
Cardinal Health
| Year | Revenue | Net income | Margin | Growth | Source |
|---|---|---|---|---|---|
| FY2026 | $254.2B | $1.7B | 0.7% | +14.2% | Source |
| FY2025 | $222.6B | $1.6B | 0.7% | -1.9% | Source |
| FY2024 | $226.8B | $852M | 0.4% | +10.7% | Source |
| FY2023 | $205B | $330M | 0.2% | +13.0% | Source |
| FY2022 | $181.3B | -$938M | -0.5% | +11.6% | Source |
| FY2021 | $162.5B | $611M | 0.4% | +6.2% | Source |
| FY2020 | $152.9B | -$3.7B | -2.4% | +5.1% | Source |
| FY2019 | $145.5B | $1.4B | 0.9% | +6.4% | Source |
| FY2018 | $136.8B | $256M | 0.2% | +5.3% | Source |
| FY2017 | $130B | $1.3B | 1.0% | — | Source |
Twilio
| Year | Revenue | Net income | Margin | Growth | Source |
|---|---|---|---|---|---|
| FY2025 | $5.1B | $33.8M | 0.7% | +13.7% | Source |
| FY2024 | $4.5B | -$109.4M | -2.5% | +7.3% | Source |
| FY2023 | $4.2B | -$1B | -24.4% | +8.6% | Source |
| FY2022 | $3.8B | -$1.3B | -32.8% | +34.6% | Source |
| FY2021 | $2.8B | -$949.9M | -33.4% | +61.3% | Source |
| FY2020 | $1.8B | -$491M | -27.9% | +55.3% | Source |
| FY2019 | $1.1B | -$307.1M | -27.1% | +74.5% | Source |
| FY2018 | $650.1M | -$121.9M | -18.8% | +62.9% | Source |
| FY2017 | $399M | -$63.7M | -16.0% | +43.9% | Source |
| FY2016 | $277.3M | -$41.3M | -14.9% | — | Source |
Where the revenue comes from
Cardinal Health
- Pharmaceutical Distribution - Branded, Generic, and Specialty~92%
Product sales and fees from distributing branded, generic, and specialty drugs, plus services from specialty practice platforms. Fiscal 2026 segment revenue was $234.8 billion (up 15%) and segment profit was $2.8 billion (up 23%), driven by brand and specialty volume and generics program performance.
- Medical and Surgical Products Manufacturing and Distribution~5%
Sales of Cardinal Health-brand and national-brand medical, surgical, and laboratory products. Fiscal 2026 GMPD revenue was $12.7 billion and segment profit was $258 million, including a one-time $100 million IEEPA tariff refund benefit. Fiscal 2027 guidance calls for $200-$220 million of segment profit.
- Nuclear Pharmacy, at-Home Solutions, and Logistics~3%
Nuclear and Precision Health Solutions (radiopharmaceuticals), at-Home Solutions (direct-to-patient supplies), and OptiFreight Logistics. Together they generated $6.8 billion of fiscal 2026 revenue (up 26%) and $707 million of segment profit (up 37%), the highest margins in the company.
Twilio
- Core Communications (Messaging, Voice, Video)
Majority of revenue
High-volume, usage-based revenue from programmable messaging, voice, email, verification, and contact-center APIs. Messaging generated $2.878 billion in FY2025, while voice, email, Verify, Flex, and related products diversify Twilio beyond raw SMS routing.
- Customer Data and Engagement (Segment, CustomerAI)
Not separately disclosed
Subscription and consumption-hybrid revenue from Segment, CustomerAI, data activation, and engagement workflows. Twilio does not break this stream out as a standalone FY2025 revenue total in the headline financial profile.
- Email and Other (SendGrid, Verify, Flex)
Not separately disclosed
Revenue from SendGrid email, Verify, Flex, and adjacent engagement products that complement the core communications API platform.
Business model and strategy
Cardinal Health
How it makes money
The business model is large, high-volume logistics divided into two segments: Pharmaceutical and Medical. In the Pharma segment, they buy billions of dollars of drugs from manufacturers (like Pfizer) and distribute them daily to tens of thousands of pharmacies and hospitals, taking a tiny markup.
Growth strategy
Cardinal Health's growth plan rests on three levers. First, specialty pharmaceuticals and physician practice platforms: it bought a 71% stake in GI Alliance for about $2.8 billion (announced November 2024) and funded The Specialty Alliance's roughly $1.9 billion acquisition of urology MSO Solaris Health (completed November 2025).
Competitive advantage
Cardinal Health's advantage is physical scale and regulatory standing. Moving regulated, temperature-sensitive drugs and biologics across the country overnight takes a network of specialized distribution centers and security procedures that cost billions of dollars and take decades to build. The barrier to entry is high, so drug distribution is concentrated among a few large companies.
Twilio
How it makes money
Twilio makes most of its money from usage-based fees: customers pay per message, per voice minute, per email, or per verification sent through its APIs, so revenue rises with their traffic. Messaging alone generated $2.878 billion of FY2025 revenue.
Growth strategy
Twilio is positioning itself as communications and identity infrastructure for AI agents. Its plan combines usage growth in messaging and voice, cross-selling Segment customer data, Flex, and Verify to existing accounts, adding agent identity through the November 2025 Stytch acquisition, and keeping operating costs in check while returning cash through buybacks.
Competitive advantage
Twilio's advantage comes from developer mindshare, API breadth, carrier relationships, global routing, customer integrations, data products, and mission-critical communications workflows.
Questions about Cardinal Health vs Twilio
Which company has higher revenue — Cardinal Health, Inc. or Twilio Inc.?
Cardinal Health, Inc. reported $254.2B (FY2026), while Twilio Inc. reported $5.1B (FY2025). By last reported revenue, Cardinal Health, Inc. is the larger business, with Twilio Inc. reporting a smaller revenue base. Note: these are from different fiscal years and are not a direct like-for-like comparison.
What is the market cap of Cardinal Health, Inc. vs Twilio Inc.?
Cardinal Health, Inc.'s market capitalisation stands at $56.0B, while Twilio Inc.'s is $37.8B. Cardinal Health, Inc. carries the higher market valuation, reflecting investors' expectations of its future earnings power relative to Twilio Inc..
Which is more financially efficient — Cardinal Health, Inc. or Twilio Inc.?
Cardinal Health, Inc. generates $3.98M / employee in revenue per employee, while Twilio Inc. generates $923k / employee. Cardinal Health, Inc. shows higher revenue efficiency per headcount, though this reflects business model differences — capital-light software companies routinely outperform labour-intensive manufacturers on this metric.
How do Cardinal Health, Inc. and Twilio Inc. make money?
Cardinal Health, Inc. and Twilio Inc. generate revenue in fundamentally different ways. Cardinal Health, Inc.: The business model is large, high-volume logistics divided into two segments: Pharmaceutical and Medical. Twilio Inc.: Twilio makes most of its money from usage-based fees: customers pay per message, per voice minute, per email, or per verification sent through its APIs, so revenue rises with their traffic.
Which company is valued higher relative to revenue — Cardinal Health, Inc. or Twilio Inc.?
On a price-to-sales (P/S) basis, Cardinal Health, Inc. trades at 0.2x P/S and Twilio Inc. at 7.5x P/S. Twilio Inc. commands a higher revenue multiple, typically indicating that investors expect faster growth or higher future margins compared to Cardinal Health, Inc.. A higher multiple is not inherently better — it may also signal that the stock is priced for perfection.
Is Cardinal Health, Inc. bigger than Twilio Inc.?
By last reported revenue, Cardinal Health, Inc. ($254.2B (FY2026)) is the larger company compared to Twilio Inc. ($5.1B (FY2025)). Revenue scale is one dimension of size — market capitalisation, employee count, and geographic reach are also relevant depending on the context.
Figures come from each company's filings and the sources linked beside them. Amounts reported in another currency are shown in US dollars at an approximate rate and marked with ~. Back to the Cardinal Health vs Twilio overview