The Ledger

Guardant Health sold 83,000 of its Shield colon cancer blood tests in the third quarter, up from 24,000 a year ago, and raised its 2026 revenue forecast to $1.36 billion to $1.37 billion. The diagnostics company said in its Form 8-K earnings release that total revenue rose 36% to $361.0 million, and screening revenue rose 180% to $67.6 million, nearly a fifth of the total. The growth is not cheap: Guardant booked a net loss of $124.4 million, and it lifted its 2026 free cash flow burn forecast to $205 million to $220 million from $195 million to $205 million. It ended the quarter with $1.1 billion in cash. For health systems and payers, the signal is that a blood-based screening test is moving from pilot to line item, which puts coverage and ordering policy on the near-term agenda. Confidence: High, from the company’s own filing.

ANI Pharmaceuticals offered about $560 million for Egetis Therapeutics, the maker of the first approved treatment for a rare thyroid disorder called MCT8 deficiency. In a press release filed with its Form 8-K dated November 5, ANI set the price at 11.25 Swedish kronor a share, a 27% premium to the 60-day average price, with enterprise value of about $434 million after the sale of a priority review voucher. Egetis agreed on November 4 to sell that voucher for $190 million gross, and the Food and Drug Administration approved its drug Emcitate on September 28. Shareholders holding about 42% have committed to accept, the offer needs 90% acceptance and regulatory approvals, and the acceptance period is expected to run from about November 20 to December 18. ANI says it will pay with cash on hand and new debt from JPMorgan Chase. Confidence: High on terms, Med on completion.

Evolent Health grew revenue 51% to $725.4 million, but its medical expense ratio rose to 93.0% from 85.0% and adjusted EBITDA fell to $34.3 million. In its Form 8-K earnings release, the specialty care management company showed its risk-bearing Performance Suite revenue nearly doubling to $564.3 million, with revenue per member per month up to $26.14 from $14.77. Adjusted EBITDA (earnings before interest, taxes, depreciation and amortization) margin fell to 4.7% from 8.1%, and the company posted an operating loss of $6.2 million. Even so, it reiterated 2026 revenue of $2.6 billion to $2.7 billion and raised its adjusted EBITDA range to $130 million to $135 million. Against $84.4 million booked through nine months, that implies $45.6 million to $50.6 million in the fourth quarter, well above the third. The prior range is not restated in the release, and the company sold Evolent Care Partners in December 2025, which distorts year-over-year comparisons. Confidence: High on figures, Med on the Q4 math.

Astrana Health narrowed its 2026 guidance, and the new range implies a fourth quarter adjusted EBITDA 20% to 37% below the third. In its Form 8-K earnings release dated November 5, the physician-network and risk-contract company reported third quarter revenue of $1.02 billion, up 7%, and adjusted EBITDA of $77.2 million, up 13%. Fourth quarter guidance is revenue of $939 million to $1.039 billion and adjusted EBITDA of $48.5 million to $61.5 million. Full-year adjusted EBITDA is guided to $261 million to $274 million. The company also said it closed the acquisition of an independent practice association in Georgia on October 1, without disclosing a price. Confidence: High on the figures, Low on why the fourth quarter steps down, which the release does not explain.

Definitive Healthcare reported third quarter results but pulled its guidance and its earnings call, because Advent International’s buyout proposal is still only non-binding. This updates our September 11 coverage. The healthcare data company said in its Form 8-K earnings release that revenue fell 9% to $54.7 million, the net loss narrowed to $5.4 million from $17.8 million, and adjusted EBITDA was $15.7 million against $18.9 million. Nine-month results include a $197.2 million goodwill impairment that took goodwill on the balance sheet to zero. Its special committee of independent directors has received the proposal from Advent, which covers all shares not owned by Advent or founder Jason Krantz, and the release says there is no certainty any transaction results. The release does not restate a price. Confidence: High.

Health Catalyst sold its Vitalware business for $146.3 million, paid off all its debt, and now guides to fourth quarter revenue below the third. The health data and analytics company said in its Form 8-K earnings release that the sale closed July 31, produced a $65.9 million gain, and funded full repayment of its credit agreement, leaving it with zero debt, $53.7 million in cash and $25.2 million in short-term investments. Third quarter revenue fell 26% to $56.3 million and adjusted EBITDA fell 94% to $0.8 million. Its reaffirmed full-year revenue guidance of $246 million to $249 million, set against $197.5 million booked through nine months, implies $48.5 million to $51.5 million in the fourth quarter. The release does not name the Vitalware buyer. Confidence: High on figures, derived on the fourth quarter math.

THE DEAL SHEET

Target	Acquirer/Investor	Vertical	Value	Source
Egetis Therapeutics	ANI Pharmaceuticals	Rare-disease pharma	SEK 11.25 per share, about $560 million equity value, about $434 million enterprise value	ANI Form 8-K press release
Egetis rare pediatric disease priority review voucher	Not named in the release	Pharma regulatory asset	$190 million gross, announced November 4	ANI Form 8-K press release
Definitive Healthcare (non-binding proposal)	Advent International	Healthcare data and analytics	Price not stated in the November 5 release	Definitive Healthcare Form 8-K
Vitalware business (closed July 31, detailed November 5)	Not named in the release	Health IT	$146.3 million total consideration	Health Catalyst Form 8-K
Independent practice association, Georgia (closed October 1)	Astrana Health	Value-based care	Not disclosed	Astrana Form 8-K