Starling Oncology Narrows 2026 Adjusted EBITDA Range
Third-quarter Adjusted EBITDA was $3.4 million, above the $0.50 million to $1.5 million outlook, and full-year Adjusted EBITDA guidance moved to $4 million to $6 million.
Starling Oncology, Inc. (STLN), a value-based community oncology group, reported Adjusted EBITDA of $3.4 million for the quarter ended September 30, 2026, a second consecutive positive print after $229 thousand in the second quarter and above its third-quarter outlook of $0.50 million to $1.5 million.
Consolidated revenue was $169.8 million, up 24.3% from $136.6 million a year earlier, after a 34.6% year-over-year increase in the prior quarter. Gross profit was $30.7 million. Net loss narrowed to $15.7 million from $16.5 million a year earlier, or $(0.13) a share versus $(0.14).
Specialty pharmacy was the growth engine. Revenue was $109 million, up 44% year over year, with 24% gross margin, after a 58% year-over-year increase in the second quarter. The company said a continued increase in the capture rate of fills written by Starling physicians was the primary contributor. Patient services revenue was $60.0 million, essentially unchanged from $60.2 million a year earlier.
Capitated revenue grew 40% year over year in the third quarter. The medical loss ratio improved sequentially to 81.0% from 85.5% in the second quarter. Chief executive Daniel Virnich said the capitated business continued to deliver growth and that MLR was performing at expectations. Starling Nexus, the proprietary utilization management portal, is now live for network providers in all markets with delegated capitation arrangements and is the interface through which prior authorizations are submitted.
Affiliated and network clinics were 322 versus 80 a year earlier. Markets were 17 versus 22. Lives under value-based contracts were 2.2 million versus 1.9 million. Cash and cash equivalents were $36.9 million as of September 30, 2026, down from $41.1 million as of June 30, 2026.
The company updated full-year 2026 guidance. Revenue guidance was narrowed to $650 million to $660 million from $650 million to $670 million. Gross profit guidance was raised to $107 million to $110 million from $105 million to $110 million. Adjusted EBITDA guidance was revised to $4 million to $6 million, with the floor raised from $2 million and the ceiling lowered from $7 million. Free cash flow guidance was narrowed to $5 million to $10 million from $5 million to $15 million. Virnich said the company is affirming full-year 2026 guidance based on year-to-date performance and believes it is well positioned for continued growth into 2027.
For the fourth quarter of 2026, Starling anticipates Adjusted EBITDA of $3 million to $5 million as it onboards and ramps Florida delegated lives. The company expects approximately $110 million in capitated revenue in 2026 and anticipates medical loss ratio of 85% to 90% in 2027 with the onboarding of new lives.
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