Recent Operational Highlights
Specialty Pharmacy had record Part D fills drivingSpecialty Pharmacy revenue up 58% in the quarter as compared to prior year same quarter, driven by continued strength in prescription fill volumes as we bring new capitated lives onto the platform, along with the ongoing ramp of ourFlorida delegated arrangements.- Results in the first half of the year have given us the opportunity to raise guidance for revenue and gross profit.
- Preparing to launch our proprietary provider portal, Starling Nexus, in mid-August which is designed to strengthen provider engagement and drive continued adherence to our clinical pathways, particularly for our network physicians.
- Achieved exclusivity in
California with one of our largest partners across all of their delegated medical groups, a relationship that was previously split with another entity. This added approximately 230,000 capitated lives.
Second Quarter 2026 Financial Highlights
All comparisons are to the quarter ended
- Consolidated revenue of
$161.3 million increased 34.6% from$119.8 million - Gross profit of
$27.2 million , increased 55.2% - Net loss of
$9.8 million compared to net loss of$17.0 million - Basic and diluted (loss) earnings per share of
$(0.08) compared to$(0.15) - Adjusted EBITDA* of positive
$229 thousand compared to$(4.1) million - Cash and cash equivalents of
$41.1 million as ofJune 30, 2026
*Adjusted EBITDA is a non-GAAP measure and the reconciliation is included in the Financial Information; Non-GAAP Financial Measures section below.
Management Commentary
Updated Outlook for Fiscal Year 2026
| 2026 Guidance - Previous | 2026 Guidance - Updated | |
| Revenue | ||
| Gross Profit | ||
| Adjusted EBITDA | ||
| Free Cash Flow | Unchanged |
* The Company uses Adjusted EBITDA, Medical Loss Ratio (MLR), and Free Cash flow, each a non-GAAP measure, as an additional tool to assess its operational and financial performance. See "Financial Information: Non-GAAP Financial Measures" below. In reliance on the unreasonable efforts exception provided under Regulation S-K, STLN is not reasonably able to provide a quantitative reconciliation for forward-looking information of Adjusted EBITDA, MLR and Free Cash flow to net (loss) income and net cash provided by operations, respectively, the most directly comparable GAAP financial measures, without unreasonable efforts due to uncertainties regarding capitated lives, direct costs, taxes, capital expenditures, share-based compensation, change in fair value of liabilities, unrealized (gains) losses on investments, consulting and legal fees, transaction costs and other non-cash items. The variability of these items could have an unpredictable, and potentially significant, impact on STLN’s future GAAP financial results.
The Company expects approximately
Third Quarter of 2026 Outlook
For the third quarter of 2026, we anticipate Adjusted EBITDA of
The outlook does not take into account the impact of any unanticipated developments in the business or changes in the operating or economic environment, nor does it take into account the impact of STLN's acquisitions, dispositions or financings. STLN's outlook assumes a largely stable global market, which would likely be negatively impacted if recent tariff rate increases and exchange rate changes persist and adversely affect world trade. The outlook information included in this press release represents management's current estimates as of the date of this release. Actual results may differ materially depending on a number of factors. Investors are urged to read the Forward-Looking Statements included in this release. Management does not assume any obligation to update these estimates other than as required by applicable law.
Webcast and Conference Call
STLN will host a conference call on
The conference call can be accessed live over the phone by dialing 1-800-225-9448, or for international callers, 1-203-518-9708. A replay will be available two hours after the call and can be accessed by dialing 1-844-512-2921, or for international callers, 1-412-317-6671. The passcode for the live call and the replay is 11161701. The replay will be available until
About Starling Oncology, Inc.
Founded in 2007,
Forward-Looking Statements
This press release includes contains forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995, Section 27A of the Securities Act of 1933, as amended (the “Securities Act”) and Section 21E of the Securities Exchange Act of 1934, as amended (the “Exchange Act”). All statements other than statements of historical fact are statements that could be deemed forward-looking statements. Forward-looking statements generally may be identified by words such as “preliminary,” “believe,” “may,” “will,” “estimate,” “continue,” “anticipate,” “intend,” “expect,” “should,” “would,” “plan,” “project,” “predict,” “potential,” “guidance,” “approximately,” “seem,” “seek,” “future,” “outlook,” and similar expressions that predict or indicate future events or trends or that are not statements of historical matters. These forward-looking statements include, but are not limited to, statements regarding projections, anticipated financial results, estimates and forecasts of revenue and other financial and performance metrics and projections of market opportunity and expectations. These statements are based on various assumptions and on the current expectations of STLN and are not predictions of actual performance. These forward-looking statements must not be relied on by anyone as, a guarantee, an assurance, a prediction or a definitive statement of fact or probability. Actual events and circumstances are difficult or impossible to predict and will differ from assumptions. Many actual events and circumstances are beyond the control of STLN. These forward-looking statements are subject to a number of risks and uncertainties, including the accuracy of the assumptions underlying the 2026 full fiscal year outlook and the Q3 2026 outlook with respect to Adjusted EBITDA discussed herein, the outcome of judicial and administrative proceedings to which STLN may become a party or investigations to which STLN may become or is subject that could interrupt or limit STLN’s operations, result in adverse judgments, settlements or fines and create negative publicity; changes in STLN’s patient or payors' preferences, prospects and the competitive conditions prevailing in the healthcare sector; failure to continue to meet stock exchange listing standards; the impact of a cybersecurity incident affecting a software provider on STLN’s business; and those factors discussed in the documents of STLN has filed, or will file, with the
Financial Information; Non-GAAP Financial Measures
STLN uses certain financial information and data, such as Adjusted EBITDA, Medical Loss Ratio (MLR), and Free Cash Flow, that have not been prepared in accordance with
Medical Loss Ratio (MLR): STLN defines MLR as our total direct costs related to capitated contracts divided by the total capitated revenue.
STLN believes that the use of Medical Loss Ratio (MLR) provides management with an additional tool to assess our operational efficiency and commitment to value, to plan and forecast future periods, and to understand the factors and trends in our premium spending. The MLR is utilized by peers across the health industry, and we believe it is helpful to investors in measuring our financial performance and comparing our performance to other health providers. The principal limitation of MLR is that its calculation, relies on definitions and allocations that require management's judgment and may not capture all nuances of our administrative efficiency or investment in long-term infrastructure. Direct Costs for capitation include clinical payroll, IV drug costs, network medical expense, and medical supplies.
Free Cash Flow: STLN defines Free Cash Flow as net cash flow provided by (used in) operations plus cash paid for interest, less capital expenditures. STLN believes that the use of Free Cash Flow provides management with an additional tool to assess the Company's financial performance, evaluate its ability to generate cash from operations, and plan for future investments and obligations. Free Cash Flow is useful in understanding the cash available for strategic initiatives. We believe that Free Cash Flow is helpful to investors in measuring our financial performance and comparing our performance to our peers. Free Cash Flow has important limitations as an analytical tool, and should not be considered in isolation, or as a substitute for analysis of our results as reported under GAAP.
Adjusted EBITDA: STLN defines Adjusted EBITDA as net (loss) income plus depreciation, amortization, interest, taxes, non-cash add-backs comprised of one-time write-offs and non-cash rent expense , share-based compensation, goodwill impairment charges, change in fair value of liabilities, unrealized gains or losses on investments and other adjustments to add-back the following: consulting and legal fees related to acquisitions, one-time consulting and legal fees related to certain advisory projects, software implementations and debt or equity financings, severance expense and temporary labor and recruiting charges to build out our corporate infrastructure.
STLN believes that the use of Adjusted EBITDA provides management with an additional tool to assess our operations and results of our performance, to plan and forecast future periods, and factors and trends. We believe that Adjusted EBITDA is helpful to investors in measuring our financial performance and comparing our performance to our peers. Adjusted EBITDA has important limitations as an analytical tool, and should not be considered in isolation, or as a substitute for analysis of our results as reported under GAAP.
A reconciliation of total direct costs and revenue related to capitated contracts to MLR, net cash flow provided by (used in) operations to Free Cash Flow, and net loss to Adjusted EBITDA, the most comparable GAAP metrics, is set forth below:
| Medical Loss Ratio (MLR) | ||||||||||||||
| Three Months Ended | Change | |||||||||||||
| (dollars in thousands) | 2026 | 2025 | $ | % | ||||||||||
| Direct costs - patient services | $ | 56,771 | $ | 51,150 | $ | 5,621 | 11.0 | % | ||||||
| Direct costs - fee-for-service | (32,860 | ) | (37,769 | ) | 4,909 | (13.0 | )% | |||||||
| Direct costs - capitated | 23,911 | 13,381 | 10,530 | 78.7 | % | |||||||||
| Patient services revenue | 58,827 | 55,891 | 2,936 | 5.3 | % | |||||||||
| Fee-for-service revenue | (30,853 | ) | (37,048 | ) | 6,195 | (16.7 | )% | |||||||
| Capitated revenue | 27,974 | 18,843 | 9,131 | 48.5 | % | |||||||||
| Medical loss ratio related to capitated contracts | 85.5 | % | 71.0 | % | $ | 1,399 | 14.5 | % | ||||||
| Free Cash Flow Reconciliation | |||||||||||||||
| Six Months Ended | Change | ||||||||||||||
| (dollars in thousands) | 2026 | 2025 | $ | % | |||||||||||
| Net cash and cash equivalents provided by (used in) operating activities | $ | 9,725 | $ | (15,190 | ) | $ | 24,915 | 164.0 | % | ||||||
| Cash paid for interest | 1,756 | 2,158 | (402 | ) | 18.6 | % | |||||||||
| Purchases of property and equipment | (1,950 | ) | (1,536 | ) | (414 | ) | (27.0 | )% | |||||||
| Free Cash Flow | $ | 9,531 | $ | (14,568 | ) | $ | 24,099 | 165.4 | % | ||||||
| Adjusted EBITDA Reconciliation | |||||||||||||||||||||||||||||
| Three Months Ended | Change | Six Months Ended | Change | ||||||||||||||||||||||||||
| (dollars in thousands) | 2026 | 2025 | $ | % | 2026 | 2025 | $ | % | |||||||||||||||||||||
| Net loss | $ | (9,789 | ) | $ | (17,009 | ) | $ | 7,220 | 42.4 | % | $ | (12,281 | ) | $ | (36,594 | ) | $ | 24,313 | 66.4 | % | |||||||||
| Depreciation and amortization | 1,838 | 1,805 | 33 | 1.8 | % | $ | 3,454 | $ | 3,589 | (135 | ) | (3.8 | )% | ||||||||||||||||
| Interest expense, net | 1,859 | 1,870 | (11 | ) | (0.6 | )% | $ | 3,793 | $ | 7,440 | (3,647 | ) | (49.0 | )% | |||||||||||||||
| Income tax and other taxes | 86 | (61 | ) | 147 | — | % | $ | 129 | $ | (61 | ) | 190 | — | % | |||||||||||||||
| Non-cash addbacks | (36 | ) | 2,222 | (2,258 | ) | (101.6 | )% | $ | (284 | ) | $ | 2,059 | (2,343 | ) | (113.8 | )% | |||||||||||||
| Share-based compensation | 1,070 | 752 | 318 | 42.3 | % | $ | 2,756 | $ | 2,210 | 546 | 24.7 | % | |||||||||||||||||
| Changes in fair value of liabilities | 3,237 | 4,040 | (803 | ) | (19.9 | )% | (1,927 | ) | 7,392 | (9,319 | ) | (126.1 | )% | ||||||||||||||||
| Unrealized loss on investments | — | — | — | — | % | — | 6 | (6 | ) | (100.0 | )% | ||||||||||||||||||
| Post-combination compensation expense | — | 13 | (13 | ) | (100.0 | )% | — | 26 | (26 | ) | (100.0 | )% | |||||||||||||||||
| Consulting fees | 1,814 | 506 | 1,308 | 258.5 | % | 2,087 | 839 | 1,248 | 148.7 | % | |||||||||||||||||||
| Infrastructure and workforce costs | 150 | 1,771 | (1,621 | ) | (91.5 | )% | 64 | 3,895 | (3,831 | ) | (98.4 | )% | |||||||||||||||||
| Transaction costs | — | 1 | (1 | ) | — | % | — | 1 | (1 | ) | (100.0 | )% | |||||||||||||||||
| Adjusted EBITDA | $ | 229 | $ | (4,090 | ) | $ | 4,319 | 105.6 | % | $ | (2,209 | ) | $ | (9,198 | ) | $ | 6,988 | 76.0 | % | ||||||||||
| Key Business Metrics | |||
| Three Months Ended | |||
| (dollars in thousands) | 2026 | 2025 | |
| 301 | 80 | ||
| Markets | 17 | 20 | |
| Lives under value-based contracts (millions) | 2.1 | 1.9 | |
(1) Number of clinics operated under the STLN PCs, whereby we receive a percentage of revenue under our management services agreements, or MSAs, and are consolidated. Additionally, includes independent oncology practices to which we provide limited management services and have network provider agreements, but do not bear the operating costs.
Consolidated Balance Sheets (Unaudited)
(in thousands except share data)
| Assets | |||||||
| Current assets: | |||||||
| Cash and cash equivalents | $ | 41,094 | $ | 33,565 | |||
| Accounts receivable, net | 66,349 | 58,998 | |||||
| Other receivables | 360 | 322 | |||||
| Inventories | 20,011 | 16,875 | |||||
| Prepaid expenses and other current assets | 1,176 | 2,987 | |||||
| Total current assets | 128,990 | 112,747 | |||||
| Property and equipment, net | 10,583 | 10,684 | |||||
| Operating right of use assets | 21,188 | 22,374 | |||||
| Intangible assets, net | 9,585 | 11,015 | |||||
| 7,230 | 7,230 | ||||||
| Other assets | 657 | 606 | |||||
| Total assets | $ | 178,233 | $ | 164,656 | |||
| Liabilities and stockholders’ deficit | |||||||
| Current liabilities: | |||||||
| Accounts payable | $ | 60,279 | $ | 43,167 | |||
| Current portion of operating lease liabilities | 7,225 | 7,156 | |||||
| Accrued expenses and other current liabilities | 27,435 | 20,639 | |||||
| Total current liabilities | 94,939 | 70,962 | |||||
| Operating lease liabilities | 17,384 | 19,131 | |||||
| Derivative warrant liabilities | 89 | 264 | |||||
| Derivative liabilities | 10,838 | 12,591 | |||||
| Long-term debt, net of unamortized debt issuance costs | 79,867 | 77,400 | |||||
| Other non-current liabilities | 30 | 28 | |||||
| Total liabilities | 203,147 | 180,376 | |||||
| Stockholders’ deficit: | |||||||
| Common Stock, 0.0001 par value, authorized 500,000,000 shares; 102,202,753 and 100,468,979 shares issued and outstanding at | 10 | 10 | |||||
| Series A Convertible Preferred Stock, 0.0001 par value, authorized 10,000,000 shares; 193,507 shares issued and outstanding at | — | — | |||||
| Additional paid-in capital | 259,795 | 256,708 | |||||
| Treasury Stock at cost, 1,733,774 shares at | (1,019 | ) | (1,019 | ) | |||
| Accumulated deficit | (283,700 | ) | (271,419 | ) | |||
| Total stockholders’ deficit | (24,914 | ) | (15,720 | ) | |||
| Total liabilities and stockholders’ deficit | $ | 178,233 | $ | 164,656 | |||
Consolidated Statements of Operations (Unaudited)
(in thousands except share data)
| Three Months Ended | Six Months Ended | ||||||||||||||
| 2026 | 2025 | 2026 | 2025 | ||||||||||||
| Revenue | |||||||||||||||
| Patient services | $ | 58,827 | $ | 55,891 | $ | 117,914 | $ | 108,959 | |||||||
| 98,608 | 62,573 | 186,149 | 111,866 | ||||||||||||
| Clinical trials & other | 3,847 | 1,338 | 4,660 | 3,383 | |||||||||||
| Total operating revenue | 161,282 | 119,802 | 308,723 | 224,208 | |||||||||||
| Operating expenses | |||||||||||||||
| Direct costs?–?patient services | 56,771 | 51,150 | 110,154 | 98,230 | |||||||||||
| Direct costs?–?specialty pharmacy | 77,346 | 51,086 | 148,089 | 90,949 | |||||||||||
| Direct costs?–?clinical trials & other | — | 65 | — | 279 | |||||||||||
| Selling, general and administrative expense | 29,943 | 26,907 | 58,155 | 52,283 | |||||||||||
| Depreciation and amortization | 1,838 | 1,805 | 3,454 | 3,589 | |||||||||||
| Total operating expenses | 165,898 | 131,013 | 319,852 | 245,330 | |||||||||||
| Loss from operations | (4,616 | ) | (11,211 | ) | (11,129 | ) | (21,122 | ) | |||||||
| Other non-operating expense (income) | |||||||||||||||
| Interest expense, net | 1,859 | 1,870 | 3,793 | 7,440 | |||||||||||
| Change in fair value of derivative warrant liabilities | (6 | ) | 53 | (174 | ) | 96 | |||||||||
| Change in fair value of conversion option derivative liabilities | 3,243 | 3,987 | (1,753 | ) | 7,296 | ||||||||||
| Other, net | 77 | 19 | (714 | ) | 771 | ||||||||||
| Total other non-operating expense (income) | 5,173 | 5,929 | 1,152 | 15,603 | |||||||||||
| Loss before provision for income taxes | (9,789 | ) | (17,140 | ) | (12,281 | ) | (36,725 | ) | |||||||
| Income tax benefit (expense) | — | 131 | — | 131 | |||||||||||
| Net loss | $ | (9,789 | ) | $ | (17,009 | ) | $ | (12,281 | ) | $ | (36,594 | ) | |||
| Net loss attributable to common stockholders, basic and diluted | $ | (8,241 | ) | $ | (13,991 | ) | $ | (10,330 | ) | $ | (30,072 | ) | |||
| Net loss per share attributable to common stockholders: | |||||||||||||||
| Basic | $ | (0.08 | ) | $ | (0.15 | ) | $ | (0.10 | ) | $ | (0.35 | ) | |||
| Diluted | $ | (0.08 | ) | $ | (0.15 | ) | $ | (0.10 | ) | $ | (0.35 | ) | |||
| Weighted-average number of shares outstanding: | |||||||||||||||
| Basic | 103,031,493 | 93,203,665 | 102,419,949 | 85,195,734 | |||||||||||
| Diluted | 103,031,493 | 93,203,665 | 102,419,949 | 85,195,734 | |||||||||||
Consolidated Statements of Cash Flows (Unaudited)
(in thousands)
| Six Months Ended | |||||||
| 2026 | 2025 | ||||||
| Cash flows from operating activities: | |||||||
| Net loss | $ | (12,281 | ) | $ | (36,594 | ) | |
| Adjustments to reconcile net loss to cash and cash equivalents used in operating activities: | |||||||
| Depreciation and amortization | 3,454 | 3,589 | |||||
| Amortization of debt issuance costs and debt discount | 2,467 | 6,003 | |||||
| Write-off of assets from clinical trials segment | — | 2,398 | |||||
| Share-based compensation | 2,756 | 2,210 | |||||
| Change in fair value of liability classified warrants | (174 | ) | 96 | ||||
| Change in fair value of liability classified conversion option derivatives | (1,753 | ) | 7,296 | ||||
| Deferred taxes | — | (32 | ) | ||||
| Loss on disposal of property and equipment | 28 | — | |||||
| Changes in operating assets and liabilities: | |||||||
| Accounts receivable | (7,351 | ) | (8,969 | ) | |||
| Other receivables | (38 | ) | (228 | ) | |||
| Inventories | (3,136 | ) | (5,747 | ) | |||
| Prepaid expenses | 1,811 | 1,250 | |||||
| Other assets | (51 | ) | 3 | ||||
| Accounts payable | 17,112 | 11,490 | |||||
| Change in operating leases | (492 | ) | (120 | ) | |||
| Accrued expenses and other current liabilities | 7,353 | 2,262 | |||||
| Other non-current liabilities | 20 | (97 | ) | ||||
| Net cash and cash equivalents provided by (used in) operating activities | 9,725 | (15,190 | ) | ||||
| Cash flows from investing activities: | |||||||
| Purchases of property and equipment | (1,950 | ) | (1,536 | ) | |||
| Proceeds from asset disposition | — | 126 | |||||
| Net cash and cash equivalents used in investing activities | (1,950 | ) | (1,410 | ) | |||
| Cash flows from financing activities: | |||||||
| Proceeds from private placement, net of offering costs | — | 15,359 | |||||
| Proceeds from employee stock purchase plan | 220 | — | |||||
| Payments made for financing of insurance payments | (560 | ) | (456 | ) | |||
| Principal payments on long-term debt | — | (20,000 | ) | ||||
| Principal payments on financing leases | (17 | ) | (20 | ) | |||
| Common stock issued for options exercised | 111 | 2,340 | |||||
| Net cash and cash equivalents provided by (used in) financing activities | (246 | ) | (2,777 | ) | |||
| Net increase (decrease) in cash and cash equivalents | 7,529 | (19,377 | ) | ||||
| Cash and cash equivalents at beginning of period | 33,565 | 49,669 | |||||
| Cash and cash equivalents at end of period | $ | 41,094 | $ | 30,292 | |||
Contacts
Media
StarlingPR@ICRHealthcare.com
Investors
StarlingPR@ICRHealthcare.com
