How Auna S.A. Is Heading Toward Its Net Leverage Target

As of the 2025 fourth-quarter end, Auna S.A.’s AUNA net leverage held steady at 3.6X Net Debt-to-Adjusted EBITDA. The company is aiming to reduce its leverage below 3X over the medium term, supported by a recovery in EBITDA, margin expansion and sustained free cash flow generation. In the quarter, consolidated adjusted EBITDA declined 14% (FX neutral), reflecting Mexico's underperformance and an unfavorable year-over-year comparison in Colombia related to extraordinary items recorded in the prior-year quarter.

However, Auna grew its free cash flow by 35% over 2024, with year-end cash balance up 42% to Peruvian Soles (“PEN”) 335 million, offering solid flexibility to continue investing in its strategic growth initiatives in Mexico and Peru. Management noted that the year-over-year improvement reflected “operational stabilization, enhanced working capital management, and disciplined capital allocation”.

Free cash flow also benefited from PEN 76 million of cash from a portfolio rebalancing at Auna Seguros. The company paid PEN 454 million in interest, which, net of refinancing fees, would have been PEN 407 million — nearly PEN 90 million less than in 2024. This sharp drop in interest expense, with increased interest coverage, leaves Auna well-positioned to continue deleveraging into 2026.

Auna also strengthened its capital structure through $825 million debt refinancing, which extended its maturity profile, reduced interest expense, lowered short-term debt exposure and increased the proportion of direct local currency funding. Excluding refinancing-related expenses, the company still generated cash after interest and expects further improvement in 2026.

Meanwhile, recent performance in Mexico operations shows stabilization, with signs of a return to steady top-line and EBITDA growth this year. Overall, the company seems to be edging closer to achieving its target leverage ratio.

AUNA’s Peer Updates

Ardent Health ARDT strengthened its balance sheet throughout 2025. The company increased its cash balance by roughly $150 million, reaching more than $700 million at the end of 2025, while lease-adjusted net leverage fell nearly 0.5 times to 2.5X. Ardent Health’s IMPACT-driven initiatives to further optimize costs and strengthen margins are gaining traction. The company expects to generate $55 million of savings this year from this program, up from $40 million previously.

AdaptHealth Corp. AHCO generated free cash flow of $219.4 million for full-year 2025, exceeding the top end of its guidance range of $170-$190 million. The company ended the year with $106.1 million in unrestricted cash. AdaptHealth’s net debt stood at $1.69 billion, with a net leverage ratio of 2.75, up from 2.68 at the end of the third quarter. Overall, the company remains focused on its 2.5X net leverage target.

AUNA Stock: Price Performance, Valuation & Estimates

In the past three months, Auna shares have risen 26.9% against the industry’s 11.4%% fall.

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Auna S.A. is trading at a forward, five-year, price-to-earnings (P/E) of 0.32X, lower than its median and industry average.

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Take a look at how estimates for Auna S.A.'s earnings are shaping up.

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AUNA stock sports a Zacks Rank #1 (Strong Buy) at present.You can see the complete list of today’s Zacks #1 Rank stocks here.

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