Horizon Kinetics Medical ETF

Horizon Kinetics Medical ETF (MEDX) is an actively managed fund for investors who want a manager, not an index, to pick drug, biotech and medical technology stocks, with an emphasis on cancer research. It is concentrated, with Eli Lilly at about 18% of assets as of June 30, 2026. Its 0.85% annual expense ratio is higher than all eight similar health care funds we compared, which average 0.33%.

• Over the year to Oct 27, 2026, MEDX returned +19.1%, 8th of 9 among similar funds.
• Its worst full calendar year was 2024 (-4.7%); its best was 2025 (+28.6%).
• The deepest fall in its price history was 23.1% (Aug 30, 2024 to Apr 10, 2025), recovered by Oct 1, 2025.

As of Jun 30, 2026, the fund held 32 securities; the ten largest made up 67.13% of assets, and 9.19% sat in cash and money-market holdings.

By sector

• Over the three months to Jun 30, 2026, investors withdrew a net $862K (creations minus redemptions, per the N-PORT report).
• Monthly total returns reported for that quarter: -1.99%, +5.00%, +7.01%.

MEDX does not track an index. Its adviser, Horizon Kinetics Asset Management LLC, normally keeps at least 80% of net assets in stocks and similar securities of US and foreign companies in medical research, pharmaceuticals and medical technology. Qualifying firms earn at least half their revenue from that work. The manager looks for heavy investment in research on cancer and other diseases, then reviews balance sheets, revenue, earnings and dividends. Firms of any size qualify.

The prospectus sets no weighting formula or rebalancing schedule, so position sizes are the manager's call. The adviser generally exits a holding once it reaches adequate value, the business deteriorates or a more attractive opportunity appears. As of June 30, 2026, the fund had 32 holdings. The top 10 made up 67% of assets, and Eli Lilly alone was 18.5%. Reported portfolio turnover was 0%, a sign of very little trading.

Being non-diversified, MEDX can hold large stakes in a few companies. The prospectus allows up to 20% in junk bonds (debt rated below investment grade). It may use options, take long or short positions in leveraged or inverse ETFs, lend up to a third of its securities to earn extra return, and move up to 100% into cash-like holdings in adverse markets. As of June 30, 2026, it held no derivatives and about 9% cash.

• MEDX charges 0.85% a year, versus an average of 0.33% for the similar funds below (9th of 9, cheapest first).
• Using the prospectus's standard example, $10,000 invested would cost about $87 in the first year and $1,049 over 10 years (assuming a 5% annual return).

It is a concentrated, actively managed fund of drug and biotech stocks, with about 18% in Eli Lilly as of June 30, 2026, so it fits better as a small side position than as a foundation.

MEDX could add a manager-picked drug and biotech tilt. Its prospectus record goes back before the ETF's January 2023 launch. It shows full-year gains of 9.04% in 2020, the COVID crash year, and 4.21% in the 2022 bear market, but no 2008 figure. Its worst year in that record was 2016, down 8.01%. Since launch, its deepest drop was 23.1%, from August 30, 2024 to April 10, 2025. It recovered by October 1, 2025, about six months after the low. Anyone forced to cash out near the low would have locked in losses.

Income is modest: the yield was 1.11% as of October 27, 2026, paid once a year. Costs run high: 0.85% a year, about $87 in the first year and $1,049 over 10 years on $10,000 in the SEC's standard example. Past results don't predict future ones, and a plan should look at the whole portfolio, not one fund.

Matched by holdings overlap from the latest N-PORT reports.