November 9, 2026
On November 4, 2026, Medline reported third quarter net sales of $7.9 billion, up 10.4% on the same quarter last year, with organic sales up 10.5%. It raised its full-year 2026 organic sales growth guidance to 10.0% to 10.5%, up from 9.0% to 10.0%. That is the third quarter in a row the company has lifted its sales outlook, having started the year guiding to 8% to 9%. Investors noticed: the stock rose more than 18% on the day of the release.
The headline numbers are worth knowing, but for anyone who builds commercial teams in US healthcare, the more useful story sits underneath them. Medline's growth this year has been driven largely by contracts it signed in 2025 and is now putting into operation inside hospitals and health systems. That is a commercial process with a long tail, and it says a lot about the kinds of people who win large accounts and the kinds of people who make those accounts profitable once they are won.
Medline reports in two segments. Supply Chain Solutions, its distribution business, grew 13.9% to $4.2 billion in the quarter. Medline Brand, the products it manufactures or sources under its own name, grew 6.6% to $3.6 billion. Within Medline Brand, the company said surgical kitting was a key growth driver, and lab and diagnostics sales rose 14% to $272 million.
By channel, US acute care grew 12% to $5.5 billion, which management attributed to new prime vendor customers and growth with existing ones. US non-acute care grew 6% to $1.9 billion, with new business coming mainly from physician offices, surgery centers and post-acute care.
Profitability is a more mixed picture. Net income fell 1.2% to $318 million, which the company put down to inflation in inventory costs, higher operating expenses and customer mix. Adjusted EBITDA guidance of $3.3 billion to $3.4 billion was reaffirmed rather than raised. Management was open that new prime vendor relationships carry lower margins in their first year because of upfront rebates, and that it expects 2027 adjusted EBITDA growth to trail sales growth.
Put simply, Medline is winning volume faster than it is converting that volume into margin. That tension is exactly where commercial talent earns its keep.
Medline tracks a metric it calls total new customer signings: the estimated annual contract value of new contracts from new customers, or from existing customers expanding their relationship, excluding renewals and extensions. In 2025, that figure was $2.4 billion.
On the Q3 call, management said all of those 2025 signings have now gone live. Roughly a quarter of the revenue was recognized in 2025, around 65% is expected in 2026, and the remainder flows into 2027. In other words, a deal signed in one year typically takes two to three years to reach its full run rate.
For 2026, the company set a lower signings goal of $1 billion and said it had secured more than $650 million in the first half. It did not give a third quarter dollar figure but said it remains on track. On the call, CEO Jim Boyle pointed to two Q3 examples: an agreement to supply physician offices for one of the largest health systems in the United States, and a contract to serve the hospital labs of a large Midwest nonprofit integrated delivery network. Earlier in the year, Medline also expanded its prime vendor agreement with Allina Health across acute care, physician offices and other operations.
The pattern is telling. This year's wins are smaller and more numerous than 2025's, and many of them are expansions: a hospital relationship that grows into physician offices, or a lab contract that opens the door to a broader agreement. Management has described landing and expanding within existing networks as part of its playbook.
A prime vendor agreement is a multi-year distribution relationship in which one supplier becomes a health system's main source of med-surg products. Winning one is the start of the work, not the end. Medline said it expects to convert about 10% of a new prime vendor customer's purchases to Medline Brand products in the first year, with a further 2% to 4% a year after that. That conversion is where the margin sits, and it happens one product category, one clinical department and one committee at a time.
There is also an operational cost to winning. In August, Boyle explained that the company sometimes has to add labor three to six months before a new customer's volume starts moving through its distribution centers. Medline is building new distribution capacity and expanding kitting manufacturing at the same time. Every large win creates a period where cost runs ahead of revenue, and the speed and quality of implementation determine how long that period lasts.
For hospital and health system buyers, the takeaway is that large distributors are competing hard on service reliability and breadth across care settings, not only on price. For the suppliers and distributors selling to them, the battleground has shifted from a single signature to the full lifecycle of an account.
Medline's own disclosures are about contracts and revenue, not job titles. What follows is 44 International's view of the commercial capability that this kind of growth model depends on, across Medline and the wider med-surg supply and distribution market.
Enterprise deals with integrated delivery networks are long, multi-stakeholder sales involving supply chain leadership, finance, clinical leaders and often group purchasing organizations. The executives who win them understand contract structure, rebate economics and how a multi-year agreement will perform over its life, not just at signature. Medline's comment that first-year rebates compress margin is a reminder that a deal's value is decided in how it is structured. Hiring managers should look for people who have closed and renewed agreements at health system level and can show how those accounts performed afterwards.
With $2.4 billion of 2025 signings now live and revenue spread across three years, implementation is a revenue function. The people who run conversions, coordinate distribution start dates, manage service levels in the first months and keep a new account stable are directly tied to how quickly signed value becomes recognized sales. Strong candidates have led go-lives across multiple hospitals or sites and can talk specifically about fill rates, transition timelines and how they handled disruption.
Health systems increasingly buy a distributor's operating model as much as its catalogue: inventory programs, data, automation and the ability to serve acute and non-acute sites from one relationship. Consultants who can map a customer's current supply chain, build the business case for change and translate it for both operations and finance leaders are central to both new signings and expansions. Backgrounds in hospital supply chain management, materials management or distribution operations are particularly valuable here.
Converting a hospital to a supplier's own products requires clinical acceptance. Product changes in health systems commonly go through value analysis processes where nurses, surgeons and supply chain leaders weigh cost against clinical outcomes and workflow. People with clinical credentials, often former nurses or OR professionals, who can present evidence credibly and support adoption on the floor are what turn a 10% first-year conversion into the steady gains that follow. This is also why categories such as surgical kitting and lab, where clinical and operational workflows meet, have become growth engines.
The Medline quarter shows a broader truth about selling into US health systems: signing the contract is roughly a third of the commercial job. The rest is implementation, expansion into new care settings and conversion of spend over several years. Teams that hire only for closing ability tend to win accounts they then struggle to grow.
Three practical points follow. First, assess account executives on the lifetime performance of the deals they have signed, not only on signature value. Second, treat implementation and customer success roles as revenue roles and hire for them ahead of volume, as Medline itself does with operational labor. Third, build clinical credibility into the commercial team early, because product conversion and value analysis cannot be handled by sales and supply chain staff alone.
On the Q3 call, Medline's management also said directly: "We're investing in our sales force." With 2026 expected to close with double-digit organic growth and 2027 guided to high-single-digit sales growth, competition for experienced health system commercial talent across med-surg, distribution and MedTech is unlikely to ease soon.
44 International partners with MedTech and healthcare supply businesses to hire the key account leaders, implementation specialists, supply chain consultants and clinical value professionals who win large US health system accounts and make them last. If your 2027 plan depends on new contracts, talk to us about the team that will deliver them.
Medline Inc. (SEC Form 8-K, Exhibit 99.1): "Medline Reports Third Quarter and Nine Months 2026 Results." https://www.sec.gov/Archives/edgar/data/0002046386/000204638626000060/ex9913q26pressrelease.htm. Published November 4, 2026. Used for net sales, organic growth, net income, segment results, raised guidance, signings definition and market position claim.
Medline Inc. (SEC Form 10-Q): Quarterly report for the period ended September 26, 2026. https://www.sec.gov/Archives/edgar/data/0002046386/000204638626000063/mdln-20260926.htm. Filed November 2026. Used for segment percentages, prime vendor definition and IPO date (Nasdaq listing, December 2025).
Medline Newsroom: "Medline reports fourth-quarter and full-year 2025 results." https://newsroom.medline.com/releases/medline-q4-full-year-2025-results/. Published February 25, 2026. Used for $2.4B 2025 signings and original 2026 guidance of 8% to 9%.
Earnings Whispers: "Medline Inc. Q3 F2026 Earnings Call Transcript." https://www.earningswhispers.com/transcript/MDLN/Q32026. November 4, 2026. Used for channel results, Q3 signing examples, $1B goal, implementation timing, first-year rebates, sales force investment and 2027 outlook.
TradingKey: "Medline (MDLN) Q3 2026 Earnings Call: Sales Guidance Raised, 2027 Margin Pressure Ahead." https://www.tradingkey.com/news/transcripts/262275164-. Published November 4, 2026. Used to corroborate 25% / 65% / remainder revenue timing and the 10% first-year plus 2% to 4% brand conversion figures.
Distribution Strategy: "Medline adds customers, distribution capacity as sales rise 11.6%." https://distributionstrategy.com/2026/08/medline-adds-customers-distribution-capacity-as-sales-rise-11-6/. August 2026. Used for the $650M first-half signings, Allina Health expansion, land-and-expand playbook and three-to-six-month labor lead time.
Trefis: "What Just Happened To Medline Stock?" https://www.trefis.com/stock/mdln/articles/623011/what-just-happened-to-medline-stock/2026-11-05. Published November 5, 2026. Used for the 18.4% share price rise on November 4 and the third consecutive guidance raise.
Accuracy notes: Medline did not disclose a Q3 dollar figure for new signings, so none is given. The name of Medline's Canadian prime vendor partner appears differently across transcripts, so the Canada rollout is left out. The quote "We're investing in our sales force" is attributed to management generally because transcript speaker labels were inconsistent. The four commercial profiles are 44 International's analysis, not roles Medline has announced, and no external hiring statistics were included because none could be verified for this specific segment.
Why this topic matters now: Medline released Q3 results on November 4, 2026, less than a year after its December 2025 IPO, and raised its sales outlook for a third straight quarter. As the company describes itself as the largest US provider of med-surg products and supply chain solutions, its results are a useful read on hospital purchasing behavior.
Market trends: Growth is concentrated in Supply Chain Solutions (+13.9%) and US acute care (+12%), both tied to new prime vendor relationships, with non-acute growth coming from physician offices, surgery centers and post-acute settings. This reflects health systems consolidating purchasing across the continuum of care, a priority Boyle also highlighted on the Q4 2025 call alongside value and supply chain resilience.
Hiring trends: Medline management said it is investing in its sales force and has explained that it adds operational labor months ahead of new customer volume. Revenue from 2025 contracts runs into 2027, so the need for implementation and account management capacity extends well beyond the signing year.
Regulatory and cost developments: Q3 results included net refunds of tariffs imposed under the International Emergency Economic Powers Act, while management flagged inflation weighing more heavily in Q4 and a larger-than-usual price increase in early 2027. Pricing and cost pass-through make contract structure and account management more important to commercial outcomes.
Technology and industry shifts: Medline is expanding distribution capacity, adding automation and growing kitting manufacturing. Distributors are increasingly selling an operating model (inventory, data and service across sites), which raises demand for consultative supply chain and implementation skills alongside traditional sales.
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