PINK’s 58% Gains Since 2021 Come From Picking Winners, Not Owning Everything

Healthcare is often called a “defensive” sector for a simple reason: people still need medicine, surgeries, and insurance even when the economy slows down. But “defensive” doesn’t always mean “boring.” In the last few years, some healthcare companies have delivered eye-catching growth—especially the ones pushing breakthroughs in obesity drugs, cancer treatments, immunology, and next-generation therapies.

That’s the core idea behind the Simplify Health Care ETF (PINK): instead of trying to hold every healthcare stock and accept the sector’s average returns, it aims to own a smaller group of companies that may be driving the biggest innovations. And that choice has mattered. Since launching in October 2021, PINK has returned about 58%, beating the Health Care Select Sector SPDR Fund (XLV) by nearly 8 percentage points. Over the past year alone, PINK gained roughly 26%, which was more than double XLV’s return in the same period.

What Happened: A Quick Snapshot of PINK’s Results

In the simplest terms, PINK’s headline performance has come from concentration and selection:

58% total return since October 2021 (launch).
About 8 percentage points of outperformance versus XLV since launch.
26% gain over the last year, more than doubling XLV’s return.
Roughly 60 holdings, with nearly 90% allocated to healthcare.
Eli Lilly (LLY) and Regeneron (REGN) together make up over 15% of assets, and the top 10 holdings drive roughly half of returns.

Those details point to the bigger theme: PINK is not built to look like the entire healthcare market. It’s built to lean harder into “winners”—which can supercharge gains when the picks work, but can also amplify losses when they don’t.

Why This ETF Stands Out: “Picking Winners” vs. “Owning Everything”

Many sector ETFs (especially the biggest ones) are designed to be broad, simple, and predictable. They often use market-cap weighting, which means the largest companies automatically get the largest allocation. That approach has a big advantage: it’s straightforward and usually low-cost. But it also has a built-in downside: it can leave you heavily invested in companies that are big because they’re big, not necessarily because they are the fastest innovators right now.

PINK is different because it’s meant to be a precision tool. It’s more concentrated, more selective, and less focused on covering the entire sector. According to the article’s description, it’s designed for investors who want exposure to areas like pharma innovation, biotech breakthroughs, and medical device leaders—without spreading money across the full list of healthcare names.

That’s where the “not owning everything” part comes in. The strategy is basically saying: “Don’t water down your returns by owning every healthcare stock. Own the companies that are actually pushing the frontier.”

Of course, that also means one uncomfortable truth: if those frontier companies stumble, this kind of ETF can stumble too.

What PINK Actually Does in a Portfolio

Think of an ETF portfolio like a meal:

Your core holdings are the “main course”—broad, diversified funds meant to provide steady exposure.
Your satellite holdings are the “side dishes”—targeted bets meant to add extra flavor (and sometimes extra risk).

PINK is generally positioned as a satellite holding. The reason is simple: it isn’t trying to be the entire healthcare sector. With about 60 holdings and a heavy tilt toward healthcare, it’s a focused idea.

In other words, an investor might use a broad market ETF for the core, then add PINK as a smaller position to express a belief like:

“I think healthcare innovation will outperform the broader healthcare sector, and I’m willing to accept concentration risk for that chance.”

How Concentration Drives Returns (And Risk)

Here’s one of the most important facts to understand: in PINK, the top holdings matter a lot.

The fund’s two largest positions—Eli Lilly (LLY) and Regeneron (REGN)—represent more than 15% of PINK’s assets. Even more striking, the top 10 holdings are responsible for roughly half of the fund’s returns.

That can be great when the leaders are winning. For example, if a major drugmaker hits on a blockbuster treatment, improves manufacturing, expands globally, or reports strong clinical data, the stock can rise sharply. In a concentrated ETF, those gains show up clearly.

But the same logic works in reverse. A regulatory setback, a trial failure, pricing pressure, patent issues, or a sudden change in market sentiment can hit large positions hard—and a concentrated ETF has less “cushion” from the rest of the portfolio.

So concentration is a multiplier. It multiplies conviction. It can also multiply mistakes.

Performance vs. XLV: Why PINK Beat the Benchmark

PINK is compared in the article to XLV, one of the most widely followed healthcare sector ETFs. The article notes that PINK beat XLV by nearly 8 percentage points since launch and that its past-year gain was far higher.

So what likely explains the gap?

1) A tilt toward high-growth innovators

Broad sector ETFs often carry a mix of mature healthcare companies: insurers, pharmacies, equipment makers, and large drug manufacturers. Many of these businesses are solid, but they may not grow rapidly every year.

PINK is described as aiming for the parts of healthcare where innovation can create outsized gains—particularly pharma and biotech breakthroughs.

2) Stock selection and conviction sizing

Holding “the whole sector” means you accept average exposure. PINK’s approach makes bigger bets in its highest-conviction names, which can lead to stronger performance when those names run.

3) Active decisions (not automatic weighting)

The article attributes the strategy to active management, focused on “future-of-healthcare themes” rather than passive sector tracking.

Put simply: PINK tried to be smarter than a simple index method, and for this period, it worked.

The Tradeoffs: Fees, Income, and Volatility

Outperformance is exciting—but it usually comes with tradeoffs. The article highlights three major ones:

1) Higher cost

PINK charges a 0.51% expense ratio, which the article describes as roughly six times the cost of XLV.

That fee is essentially the “price” of active selection and the fund’s specialized approach. Whether it’s worth it depends on whether the strategy continues to outperform over time.

2) No dividend income

The article states that PINK generates no dividend income, making it a capital appreciation play rather than an income tool.

This matters for retirees or anyone building a portfolio meant to produce cash flow. In that case, a fund with steady distributions may fit better.

3) Concentration risk

Because the largest positions play such a big role, PINK may feel “smoother” when its key holdings are rising—and more painful when they fall. If you’re the type of investor who panics when a position drops quickly, a concentrated ETF can be emotionally tough to hold.

Who Might Consider PINK (And Who Might Not)

Not every fund is meant for every investor. Based on how PINK is described, here are some reasonable “fit” categories:

Investors who might like PINK

Growth-focused investors who want healthcare exposure without holding the entire sector.
People who already have a diversified core and want a healthcare “booster” position.
Investors with a long time horizon who can ride through volatility.
Those who believe innovation will keep driving healthcare gains and want a fund that leans into that theme.

Investors who might avoid PINK

Income investors who need dividends (the article notes PINK generates no dividend income).
Ultra-conservative investors who want maximum diversification inside a sector fund.
Fee-sensitive investors who strongly prefer very low-cost passive exposure.

Why Healthcare Innovation Still Matters

Healthcare isn’t just about “stability.” It’s also one of the most research-intensive parts of the economy. When innovation hits, it can change the revenue outlook for years.

Some examples of what “innovation-driven healthcare” can include (in general terms) are:

Breakthrough medicines that treat chronic conditions more effectively
New therapy platforms (including advanced biologics)
Improved cancer treatments and immunology tools
Medical devices that reduce recovery time or improve outcomes
Better diagnostics and personalized approaches to care

PINK’s philosophy is basically a bet that these kinds of advances will keep creating standout winners—and that owning those winners more heavily can beat a broad basket.

A Practical Way to Think About Position Size

Even if you like PINK’s idea, many investors handle concentrated funds with a simple rule: keep them smaller.

For example, someone might decide that a focused theme ETF belongs at a modest percentage of the overall portfolio, so that:

If it outperforms, it still meaningfully helps returns.
If it underperforms, it doesn’t derail the whole plan.

This is exactly why the article frames PINK as a satellite holding—useful, but not necessarily something you’d build your entire retirement around.

FAQs About PINK and Concentrated Healthcare ETFs

1) What is the Simplify Health Care ETF (PINK)?

PINK is a healthcare-focused ETF that takes a concentrated approach, with about 60 holdings and nearly 90% allocated to healthcare, aiming to focus on innovation-driven healthcare companies rather than owning the whole sector.

2) How much has PINK returned since launch?

According to the article, PINK returned about 58% since its October 2021 launch.

3) How does PINK compare to XLV?

The article states that PINK outpaced XLV by nearly 8 percentage points since launch and gained about 26% over the past year—more than double XLV’s return in that period.

4) What are PINK’s biggest holdings?

The article highlights Eli Lilly (LLY) and Regeneron (REGN) as major positions, together representing over 15% of PINK’s assets.

5) Does PINK pay dividends?

The article notes that PINK generates no dividend income, meaning it’s designed mainly for capital appreciation.

6) What is the expense ratio for PINK?

The article reports a 0.51% expense ratio for PINK, described as roughly six times the cost of XLV.

7) Is PINK “safer” because healthcare is defensive?

Not necessarily. While healthcare demand can be steadier than some sectors, a concentrated fund can still swing more than a broad healthcare ETF because its largest holdings have a bigger impact on performance.

8) Where can I learn more about the fund?

You can read the original coverage from 24/7 Wall St. for the full context and summary details: PINK’s 58% Gains Since 2021 Come From Picking Winners, Not Owning Everything.

Conclusion: The Big Lesson Behind PINK’s Run

PINK’s strong results since 2021 highlight a lesson that shows up again and again in investing: how you diversify matters. Owning “everything” can reduce risk, but it can also dilute the impact of standout winners. Concentrating on a smaller group of high-conviction ideas can boost returns—but it raises the stakes.

In this case, PINK’s approach—focused holdings, heavy exposure to healthcare innovation, and meaningful weight in top positions like Eli Lilly and Regeneron—helped it outperform a broad benchmark like XLV over the period described.

If you believe the next decade of healthcare will be led by breakthrough therapies, next-generation drug platforms, and medical innovation, a fund like PINK may feel like a smart satellite holding. If you prefer low fees, broad diversification, and steady income, a more traditional healthcare ETF may be a better match.

Either way, the story is clear: PINK’s gains didn’t come from owning every healthcare stock. They came from leaning into the companies that have been winning—and accepting the risks that come with that choice.

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How PINK Turned Healthcare Stock-Picking Into 58% Gains Since 2021 (And Why It Didn’t “Own Everything”)