$650–660 million: Starling Oncology lowers 2026 revenue ceiling
Key Facts
On November 5, Starling Oncology confirmed that its 2026 revenue would range from $650 million to $660 million, lowering the upper end of its previous forecast of $670 million. The update came with the third-quarter results, while the company kept the revenue floor at $650 million. At the same time, it raised the lower end of its adjusted EBITDA outlook to $4 million from $2 million. The range for the metric narrowed to $4 million–$6 million, compared with a previous range of $2 million–$7 million. The figures reflect an adjustment to the revenue ceiling alongside a more focused earnings range, according to the company’s full-year guidance.
Consolidated third-quarter revenue was $169.8 million, up 24.3% from $136.6 million in the same period a year earlier. Specialty pharmacy revenue rose 44% year over year to $109 million. The company attributed the growth mainly to increased capture of prescriptions written by its physicians. In its per-member payment business, revenue grew 40% year over year during the quarter. The company said its medical loss ratio improved to 81% from 85.5% in the second quarter, a measure that puts medical care costs in the context of revenue tied to this business.
The company posted adjusted EBITDA of $3.4 million in the third quarter, compared with an adjusted loss of $3.5 million a year earlier. It said the quarter was the second in a row in which it recorded positive earnings on this basis. Net loss, however, remained positive, at $15.7 million compared with $16.5 million in the third quarter of the previous year. Gross profit was $30.7 million, up 62.1% year over year. The company also reported cash and cash equivalents of $36.9 million as of September 30, 2026.
A review of guidance changes during the year shows that on August 6, the company raised its 2026 revenue forecast to a range of $650 million–$670 million, from $630 million–$650 million. The adjustment followed first-half results, according to the company’s second-quarter filing. In the same update, it forecast approximately $150 million in 2026 revenue from its per-member payment business. It also said it had signed its first delegated-payment contracts outside Florida, in Nevada and Oregon. The company also announced an exclusivity agreement with one of its largest partners in California, adding about 230,000 members to its per-member payment arrangements.
In its third-quarter results, the company raised its 2026 gross profit forecast to $107–110 million from $105–110 million. But it lowered its free cash flow forecast to $5–10 million from $5–15 million. The adjustment points to different directions in the profitability and liquidity metrics cited by the company. On expansion, it said the Starling Nexus utilization management platform had become available to providers in its network across all markets where it has delegated-payment arrangements. The platform is used to submit prior authorization requests for review, according to the company.
For the fourth quarter of 2026, the company expects adjusted EBITDA of $3 million–$5 million. It linked the forecast to the onboarding and expansion of delegated members in Florida. For 2027, it expects the medical loss ratio to range from 85% to 90% as new members are onboarded. In an August filing, Chief Executive Daniel Fernish said the company had signed its first contracts outside Florida and reached the exclusivity agreement in California. The company said actual results could differ materially based on various factors, and that its guidance excludes the effects of unexpected developments or changes in the operating and economic environment.
In trading on November 5, the company’s shares closed at $6.70, according to EL7 data. The close came on the same day the company confirmed its updated 2026 revenue range. The new revenue range remains below the upper end announced in August, while the annual adjusted earnings floor rose and the range narrowed. Fourth-quarter results and the onboarding of members in Florida remain among the upcoming operational developments the company linked to its earnings outlook for the period. Its 2027 guidance includes a medical loss ratio range as its member base expands.