Top 5 Healthcare Small-Caps 2026
Five healthcare small-caps with scores above 88/100. Revenue growth, margins, and risk analysis for each. Start your free 30-day trial.
Healthcare is the single most represented sector among the highest-scoring healthcare small-caps in the SmallCap Signal universe. Out of the top 50 companies we track, 13 — more than a quarter — come from the healthcare sector. That concentration is not random: healthcare small-caps often combine rapid revenue growth with high gross margins, two of the strongest drivers in our scoring model. For context on how those scores are built, see our <a href="/how-it-works">methodology overview</a>.
The five stocks below are the highest-scoring healthcare names in our current universe. Each entry includes the full data table, what drives the score, and the specific risks our model flags.
For broader sector context, read our <a href="/blog/small-cap-healthcare-stocks-sector-analysis-2026">healthcare sector analysis for 2026</a>.
1. SPRY — ARS Pharmaceuticals (Score: 92.2 EXCELLENT)
| Metric | Value |
|---|---|
| Market Cap | $830M |
| Revenue (TTM) | $89.1M |
| Revenue Growth YoY | >1,000% |
| Gross Margin | 98.9% |
| Debt/Equity | 0.02 |
| Runway | >80 months |
| Insider Ownership | 16.7% |
<a href="/stock/SPRY">SPRY</a> is the top-scoring healthcare stock in our universe. The near-perfect gross margin of 98.9% and explosive revenue growth push almost every sub-score to the maximum. With virtually no debt (D/E of 0.02) and over $50M in cash, the balance sheet is pristine.
What drives the score: Perfect marks on revenue growth, gross margin, runway, and Rule of 40. The only area with room to improve is the P/S ratio (9.9x), which is elevated but reasonable given the growth trajectory.
ARS Pharmaceuticals: Product and Regulatory Context
ARS Pharmaceuticals markets Neffy, an intranasal epinephrine product approved by the <a href="https://www.fda.gov" rel="noopener noreferrer" target="_blank">FDA</a> for anaphylaxis. The revenue trajectory reflects a commercial launch from near-zero, which is why year-over-year comparisons exceed 1,000%. The more relevant question is sequential quarter-over-quarter growth, which investors can verify through the company's latest <a href="https://www.sec.gov/cgi-bin/browse-edgar?action=getcompany&CIK=SPRY&type=10-Q&dateb=&owner=include&count=10" rel="noopener noreferrer" target="_blank">SEC EDGAR filings</a>.
Key risk: Revenue growth of this magnitude is coming off a very small base. Sustainability will be the main question going forward. Triple-digit growth rates are rarely maintained beyond the first two to three years of a commercial launch.
2. CGEN — Compugen (Score: 90.1 EXCELLENT)
| Metric | Value |
|---|---|
| Market Cap | $217M |
| Revenue (TTM) | $72.8M |
| Revenue Growth YoY | 161% |
| Gross Margin | 87.3% |
| Operating Margin | 43.1% |
| Debt/Equity | 2.9 |
| P/S Ratio | 3.0 |
<a href="/stock/CGEN">CGEN</a> is a rare find: a small-cap biotech that is not only growing revenue at 161% year-over-year but is already operationally profitable with a 43% operating margin. At a P/S ratio of just 3.0, the stock is attractively valued relative to its growth profile.
What drives the score: Maximum scores on growth, margin, runway, and Rule of 40. The low P/S ratio earns a strong valuation score (90/100). Compugen demonstrates what our model rewards most — high growth combined with profitability, at the same time.
Compugen: Pipeline and Clinical Stage
Compugen's revenue includes license fees and milestones from partners running active programs. Investors should review active trials on <a href="https://clinicaltrials.gov" rel="noopener noreferrer" target="_blank">ClinicalTrials.gov</a> to understand which programs are generating the current revenue and where clinical-stage risk sits. Partnership structures mean revenue can be lumpy — a single large milestone payment can significantly distort year-over-year comparisons.
Key risk: Low insider ownership (2.0%) is the weakest sub-score. When insiders hold a small share of the company, their financial incentives are less tightly coupled to long-term shareholder returns.
3. CARL — Carlsmed (Score: 89.3 EXCELLENT)
| Metric | Value |
|---|---|
| Market Cap | $313M |
| Revenue (TTM) | $50.5M |
| Revenue Growth YoY | 85.9% |
| Gross Margin | 75.3% |
| Operating Margin | -60.5% |
| Runway | 35.5 months |
| Insider Ownership | 43.6% |
<a href="/stock/CARL">CARL</a> stands out for its exceptionally high insider ownership at 43.6% — the highest among our top healthcare picks. When insiders hold a meaningful stake, their financial interests are structurally aligned with shareholders. Revenue growth of 86% and a 75% gross margin are strong fundamentals for a medical device company at this stage.
What drives the score: Perfect insider ownership score (100/100) and near-perfect marks on gross margin and dilution. The company's Rule of 40 score (25.4) reflects the current trade-off between growth and profitability.
Carlsmed: Cash Runway and Dilution Risk
A -60.5% operating margin means the company is burning cash at a significant rate. With a runway of approximately 36 months, the business has time to reach profitability — but it is not guaranteed. Understanding cash runway is essential for evaluating any pre-profitability small-cap; see our <a href="/blog/cash-runway-explained-small-cap-survival">guide to cash runway analysis</a> for the framework we use. Future dilution through capital raises remains a real possibility, particularly if operating losses persist past the 24-month mark.
Key risk: The -60.5% operating margin is significant. Growth is strong, but the path to cash flow breakeven needs monitoring across each quarterly filing.
4. DCTH — Delcath Systems (Score: 89.1 EXCELLENT)
| Metric | Value |
|---|---|
| Market Cap | $342M |
| Revenue (TTM) | $85.2M |
| Revenue Growth YoY | 129% |
| Gross Margin | 86.2% |
| Operating Margin | 0.8% |
| Debt/Equity | 0.8 |
| P/S Ratio | 4.0 |
<a href="/stock/DCTH">DCTH</a> is at the profitability inflection point — operating margin just turned positive at 0.8%. Combined with 129% revenue growth and an 86% gross margin, the company is demonstrating a path from growth-stage cash burn to self-sustaining operations. The Rule of 40 score of 130 is outstanding and reflects how rare this combination is among small-cap healthcare stocks.
What drives the score: Maximum marks on revenue growth, gross margin, runway, and Rule of 40. A manageable D/E ratio of 0.8 and a fair P/S of 4.0 round out the fundamentals.
Delcath Systems: Commercial Execution at the Inflection Point
Delcath markets HEPZATO KIT (melphalan) for hepatic melanoma metastases, a product that received FDA approval in 2023. The 0.8% operating margin represents a genuine commercial milestone — the company has covered its cost of goods and operating expenses from revenue for the first time. Continued execution at this margin level will be the key indicator in upcoming quarters. Dilution of 3.9% over the past 12 months is the weakest sub-score and should be tracked in subsequent filings on SEC EDGAR.
Key risk: Insider ownership at 2.9% is relatively low, and dilution has been elevated. Both metrics suggest management may lean toward equity financing over operational self-funding if growth requires additional capital investment.
5. FENC — Fennec Pharmaceuticals (Score: 88.6 EXCELLENT)
| Metric | Value |
|---|---|
| Market Cap | $272M |
| Revenue (TTM) | $47.5M |
| Revenue Growth YoY | 124% |
| Gross Margin | 93.3% |
| Operating Margin | 5.2% |
| Insider Ownership | 14.2% |
| P/S Ratio | 7.0 |
<a href="/stock/FENC">FENC</a> rounds out the top 5 with a strong combination of triple-digit growth and positive operating margins. The 93.3% gross margin is among the highest in our universe, and the company has already crossed into positive operating territory. Insider ownership of 14.2% provides reasonable alignment between management and shareholders.
What drives the score: Near-perfect scores across revenue growth, gross margin, runway, and Rule of 40. Maximum marks on debt/equity, reflecting a pristine balance sheet.
Fennec Pharmaceuticals: Dilution as the Primary Watch Item
Fennec markets PEDMARQSI (sodium thiosulfate), a drug that reduces cisplatin-induced hearing loss in pediatric cancer patients — a niche indication with limited competitive pressure. The commercial moat is real. But significant dilution of 24% over the past 12 months is the major red flag and the lowest sub-score in this group (6/100). At that pace, shareholder value erosion from share issuance can offset fundamental operating improvements. Monitoring the share count in each quarterly 10-Q filing is essential.
Key risk: 24% dilution in 12 months is the single largest concern across all five stocks. Growth quality is high, but the dilution trajectory needs to stabilize before the fundamental story is fully intact.
What these stocks have in common
Looking across all five picks, several patterns emerge:
1. Explosive Revenue Growth Across the Board
All five are growing revenue at 86% or more year-over-year. Our model allocates 25% of the total score to revenue growth, making it the single largest weighted factor. That weighting reflects the historical finding that top-line momentum is the strongest early indicator of small-cap outperformance, particularly in sectors with high gross margins like healthcare and biotech. For comparison, see how the current crop stacks up against the <a href="/blog/best-small-cap-biotech-stocks-2026">top biotech small-caps of 2026</a>, where growth rates are similarly elevated.
2. High Gross Margins Signal Structural Quality
Every stock in this list has a gross margin above 75%, with three above 85%. This is not typical for small-caps broadly. High gross margins in healthcare typically reflect one of two things: a drug or device with meaningful pricing power, or a platform business where incremental revenue carries very low incremental cost. Either structure supports durable profitability at scale.
3. Three of Five Have Crossed into Profitable Operations
CGEN (43.1%), DCTH (0.8%), and FENC (5.2%) are all operating at a profit. SPRY and CARL are pre-profitability but have strong gross margins that suggest a credible path. The transition from cash-burning to operationally self-sustaining is one of the most powerful re-rating catalysts in small-cap investing — and three names here have already made that transition.
How to use this data
These scores are a starting point, not a buy list. Each score reflects fundamental quality based on publicly available financial data. Before any investment decision:
- Review each company's latest 10-K and 10-Q on SEC EDGAR
- Understand the specific products, their approval status, and the competitive landscape
- Consider your own risk tolerance and portfolio allocation
- Monitor score changes over time — our system updates regularly as new data is filed
SmallCap Signal scores are calculated algorithmically based on 8 fundamental factors. They measure financial health and growth quality, not future stock price performance. Scores are not investment advice.
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