At a glance
FTXH charges 0.6% a year, above the 0.36% average of the 8 funds most like it (the 8th cheapest of 9). It has $36.2M in assets, the 8th largest of that group; it paid 0.67% of its price in distributions over the past 12 months, quarterly. Over the past year it returned +46.9% with distributions reinvested (S&P 500: +11.5%), the best of those 9 funds; over three years it returned +23.4% a year. At its worst it fell 30.2% in the 2020 crash (S&P 500: 33.7%) and 14.3% in the 2022 bear market (S&P 500: 24.5%), and was back at its earlier high 1 month and 2 months after the lows. Its ten largest positions make up 53.1% of the fund, out of 50 in all.
The short version
First Trust Nasdaq Pharmaceuticals ETF (FTXH) tracks the Nasdaq US Smart Pharmaceuticals Index. The index holds 30 to 50 US drug and biotech stocks, picked for profitability and price momentum and weighted by cash flow rather than company size. Its 0.60% annual fee is higher than most similar health care funds. It is also small, with about $36 million in net assets as of June 30, 2026.
Price history
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FTXH +46.9% over the year to Oct 27, 2026, total return with distributions reinvested.
How it has behaved
| YTD | 1 yr | 3 yr | 5 yr | 10 yr | Since start | |
|---|---|---|---|---|---|---|
| FTXH official prospectus, to Dec 31, 2025 | — | +24.03% | — | +6.49% | — | +6.83% |
| FTXH price data to Oct 27, 2026 | +31.5% | +46.9% | +23.4% | +12.6% | +9.8% | +9.0% |
- Over the year to Oct 27, 2026, FTXH returned +46.9%, 1st of 9 among similar funds.
- Its 5-year annualized return was +12.6% and its 10-year +9.8%.
- In the 2020 COVID crash it fell 30.2% and regained its old high 1.1 months after the low.
- Its worst full calendar year was 2018 (-9.4%); its best was 2025 (+24.2%).
- The deepest fall in its price history was 32.1% (Jan 16, 2020 to Mar 23, 2020), recovered by Jul 20, 2020.
Show as a table
| Year | Price data | Prospectus (official) |
|---|---|---|
| 2026 (to date) | +31.5% | — |
| 2025 | +24.2% | +24.03% |
| 2024 | +3.0% | +2.96% |
| 2023 | -1.4% | -1.41% |
| 2022 | +2.6% | +2.51% |
| 2021 | +6.1% | +6.09% |
| 2020 | +11.7% | +10.87% |
| 2019 | +22.1% | +22.35% |
| 2018 | -9.4% | -8.36% |
| 2017 | +19.4% | +18.80% |
| 2008 financial crisis stocks fell Oct 9, 2007 – Mar 9, 2009 | Before this security existed |
|---|---|
| 2020 COVID crash stocks fell Feb 19, 2020 – Mar 23, 2020 | Lost 30.2% over that stretch · deepest drop along the way 30.2%, back to its old high 1.1 months after the low |
| 2022 bear market stocks fell Jan 3, 2022 – Oct 12, 2022 | Lost 9.2% over that stretch · deepest drop along the way 14.3%, back to its old high 2.1 months after the low |
Dividends and income
Show as a table
| Year | Per share | Change |
|---|---|---|
| 2026 (to date) | $0.1600 | |
| 2025 | $0.4700 | +4.4% |
| 2024 | $0.4500 | +9.8% |
| 2023 | $0.4100 | +32.3% |
| 2022 | $0.3100 | +10.7% |
| 2021 | $0.2800 | +33.3% |
| 2020 | $0.2100 | +31.3% |
| 2019 | $0.1600 | -15.8% |
| 2018 | $0.1900 | -59.2% |
| 2017 | $0.4660 |
What's inside
As of Jun 30, 2026, the fund held 50 securities; the ten largest made up 53.06% of assets.
| Holding | Weight | |
|---|---|---|
| ELI LILLY & COMPANY | 7.77% | |
| ABBVIE INC | 7.39% | |
| MERCK & COMPANY INC | 7.07% | |
| JOHNSON & JOHNSON | 6.96% | |
| BRISTOL-MYERS SQUIBB COMPANY | 6.29% | |
| BIOGEN INC | 3.84% | |
| VIATRIS INC | 3.62% | |
| CARDINAL HEALTH INC | 3.53% | |
| VERTEX PHARMACEUTICALS INC | 3.41% | |
| AMGEN INC | 3.18% | |
| PFIZER INC | 2.97% | |
| GILEAD SCIENCES INC | 2.89% | |
| UNITED THERAPEUTICS CORP | 2.72% | |
| REGENERON PHARMACEUTICALS INC | 2.72% | |
| JAZZ PHARMACEUTICALS PLC | 2.49% |
By country
United States 95.48%Ireland 3.84%Bermuda 0.57%By asset type
Stocks 99.9%By sector
Sectors of the companies held, for the 53.1% of the fund in companies that have a stock page here; other holdings and cash aren't classified. Source: N-PORT holdings report as of Jun 30, 2026. Cash, money-market funds and derivatives are shown separately from the securities list.What changed recently
- Over the three months to Jun 30, 2026, investors added a net $3.3M (creations minus redemptions, per the N-PORT report).
- Monthly total returns reported for that quarter: -1.40%, +3.55%, +9.14%.
How it works
FTXH is an index fund. Before fees, it aims to match the Nasdaq US Smart Pharmaceuticals Index, which Nasdaq, Inc. builds and maintains. The fund must keep at least 80% of its net assets in the index's stocks. The index starts with the pharmaceutical and biotechnology companies in the broader Nasdaq US Benchmark Index. It then drops any that fail tests for size, float (shares freely available to trade) and trading volume.
The index doesn't simply pick the biggest companies. It scores each remaining stock on four factors: gross income, return on assets, momentum (recent price strength) and cash flow. Cash flow counts for little in the score and mainly breaks ties. The top 30 to 50 stocks make the cut. Each stock's weight is then set by its cash flow, with limits. No stock can be above 8%, and only five can hold that maximum. All others are capped at 4%, and none can be below 0.50%.
Nasdaq resets the index twice a year, and the fund updates its portfolio soon after. The prospectus filed July 29, 2026, lists portfolio turnover of 35%. As of June 30, 2026, the fund held 50 stocks and no derivatives. Its five largest holdings were Eli Lilly, AbbVie, Merck, Johnson & Johnson and Bristol-Myers Squibb, at 6.3% to 7.8% each. The top 10 made up about 53% of assets.
What it really costs
- FTXH charges 0.6% a year, versus an average of 0.36% for the similar funds below (8th of 9, cheapest first).
In a retirement portfolio
It is a concentrated bet on about 50 US drug and biotech stocks, so it fits best as a small add-on to a diversified portfolio rather than as its foundation.
FTXH adds a focused position in large US drugmakers. Its one-year beta was 0.35 as of October 27, 2026, meaning it tended to move much less than the broad stock market. Even so, it has had sharp drops. In the 2020 COVID crash it fell 30.2%. Its deepest drop, 32.1% from January 16 to March 23, 2020, took about four months to recover. In 2022 it fell 14.3% and recovered in about two months. Its worst calendar year was 2018, down 8.36%. The fund launched in 2016, so it has no 2008 record. Anyone forced to sell during a slide like these would lock in losses.
Income is small: the yield over the past 12 months was 0.67% as of October 27, 2026, paid quarterly. The 0.60% fee is well above the 0.36% average for similar funds. Past results don't predict the future, and a plan should look at the whole portfolio, not one fund.
Who it may suit — and who should look elsewhere
May suit
- Investors wanting a focused stake in large US drugmakers such as Eli Lilly, AbbVie and Merck, on top of a broad index fund.
- Those who prefer a rules-based index that screens for profitability and momentum and weights stocks by cash flow, not company size.
- Long-term holders who can ride out drops like the 32.1% fall in early 2020 and keep this as a small slice.
Look elsewhere if
- Cost-focused investors: FTXH charges 0.60% a year, versus 0.08% for XLV and 0.09% for VHT, which hold broader health care.
- Anyone seeking meaningful income: the 12-month yield was 0.67% as of October 27, 2026, paid quarterly.
- Those preferring a larger fund: FTXH had about $36 million in net assets (June 30, 2026), versus $472 million for Invesco's PJP.
Close alternatives
Matched by holdings overlap from the latest N-PORT reports.
| Fund | Overlap | Cost | Net assets | 1 yr | 3 yr |
|---|---|---|---|---|---|
| FTXH this fund | — | 0.6% | $36.2M | +46.9% | +23.4% |
| PJP Invesco Pharmaceuticals ETF | 49% | 0.56% | $472.1M | +34.0% | +24.3% |
| IYH iShares U.S. Healthcare ETF | 47% | 0.39% | $3.56B | +23.8% | +15.0% |
| VHT Vanguard Health Care ETF | 46% | 0.09% | $22.04B | +28.9% | +16.9% |
| FHLC Fidelity MSCI Health Care Index ETF | 45% | 0.084% | $3.29B | +23.8% | +16.0% |
| XLV Health Care Select Sector SPDR Fund | 45% | 0.08% | $40.60B | +30.2% | +16.2% |
| MEDX Horizon Kinetics Medical ETF | 43% | 0.85% | $19.1M | +19.1% | +13.9% |
| IHE iShares U.S. Pharmaceuticals ETF | 38% | 0.39% | $1.14B | +39.8% | +25.0% |
Questions investors ask
Is FTXH good for retirement income?
Not by itself. FTXH is a pharmaceutical stock fund, not an income fund. Its yield, meaning dividends paid over the prior year as a percentage of the share price, was 0.67% as of October 27, 2026. That works out to about $0.29 per share, paid quarterly. It is a thin payout for anyone drawing on savings for living costs. The fund may suit retirees who want a small slice of drug stocks alongside other income sources and who can accept the swings of a single industry.
What is FTXH's expense ratio?
FTXH's expense ratio, the yearly fee taken out of fund assets, is 0.60%, according to its prospectus filed July 29, 2026. That is higher than most similar funds. The peer average was 0.36%, and FTXH was the 8th-cheapest of 9 comparable funds. Broad health care funds cost far less. The Health Care Select Sector SPDR Fund (XLV) charges 0.08% and Vanguard Health Care ETF (VHT) charges 0.09%, though neither focuses on drugmakers alone.
What's the difference between FTXH and PJP?
PJP is cheaper and much larger, and their returns have differed. Both are pharmaceutical ETFs, and 49% of their holdings overlap. Invesco Pharmaceuticals ETF (PJP) charges 0.56%, compared with 0.60% for FTXH. PJP had $472 million in net assets as of July 31, 2026. FTXH had $36.2 million as of June 30, 2026. As of October 27, 2026, FTXH led over one year, 46.9% versus 34%. PJP was slightly ahead over three years, 24.3% a year versus 23.4%.
What stocks does FTXH hold?
FTXH held 50 drug and biotech stocks as of June 30, 2026, with about 95% of assets in U.S. companies. The largest were Eli Lilly (7.8%), AbbVie (7.4%), Merck (7.1%), Johnson & Johnson (7.0%) and Bristol-Myers Squibb (6.3%). The ten largest made up 53% of the fund. It tracks the Nasdaq US Smart Pharmaceuticals Index. The index ranks companies on gross income, return on assets, momentum (recent price strength) and cash flow. It then weights them by cash flow and caps any one stock at 8%.
How has FTXH performed over the long term?
Its record is mixed. According to its prospectus, FTXH returned 24.03% in 2025. It returned 6.49% a year over five years and 6.83% a year since its September 2016 launch, all through December 31, 2025. Its worst calendar year was 2018, at -8.36%. Its deepest drop was 32.1%, from January 16 to March 23, 2020, and it had recovered by July 20, 2020. Other risks include drug-industry regulation and the fund's small size: net assets were $36.2 million as of June 30, 2026.