Question: Did homicide of females aged 15 to 44 years (hereinafter, women of reproductive age) recover uniformly after the COVID-19 surge, or did post-2022 trajectories diverge across state abortion policy environments?

Findings: In this study of US mortality data from 2016 through 2024, national homicide mortality decreased after the COVID-19 surge, but post-Dobbs trajectories diverged between states with and without sustained abortion bans. The fitted homicide rate of women of reproductive age in states with total or near-total abortion bans was 7% higher than the modeled counterfactual in 2023 and 15% higher in 2024, corresponding to an estimated 48 and 87 excess deaths, respectively.

Meaning: The findings suggest that national decreases in homicide mortality may mask widening differences in homicide mortality among women of reproductive age across state abortion policy environments.

In July 2026, the online prediction-market platform Kalshi announced that users would soon be able to bet on the results of in-progress clinical trials. One such “contract” available for wagers, for example, asks whether POLARIS-AD, a phase 3 trial of the experimental Alzheimer’s drug AR1001, will meet its primary end point. Although heavily focused on sports betting, commercial prediction markets have expanded into areas including interest rates, elections, weather, and the Academy Awards. Kalshi is entering the drug-development space with contracts on end points in large, late-stage trials but is considering broadening its scope to include earlier-phase trials and additional outcomes, such as the number of reported adverse events for a drug. Other major platforms, including Polymarket, are also introducing betting on drug development.

Importance: Patent protection allows pharmaceutical companies to charge high prices for prescription drugs during periods of market exclusivity, and their expiration usually defines when generic competitors can enter the US market. Patents on drug active ingredients are classified as primary patents, while patents on formulations, methods of use, and delivery devices are nonprimary.

Objective: To evaluate how pharmaceutical patent portfolios for US Food and Drug Administration (FDA)–approved drugs have evolved over time.

Evidence Review: Patents on small-molecule drugs approved by the FDA from 1990 to 2019 were examined and assessed for changes in the number and types of patents per product. The additional duration of total patent exclusivity associated with each patent type was quantified, and how often patents of each type were enforced against generic manufacturers in litigation was determined.

Findings: The FDA approved 1981 small-molecule drugs during the study period, and manufacturers listed 10 940 patents on these drugs. The mean number of patents per drug increased from 2.1 in 1990 to 6.9 in 2019, driven primarily by nonprimary patents. The mean number of nonprimary patents per drug rose from 1.2 in 1990 to 5.6 in 2019. Nonprimary patents represented majorities of FDA-listed patents (84% [9236/10 940]) and litigated patents (87% [4586/5253]). Nearly all patents listed after drug approval were nonprimary (96% [4874/5064]), and these patents extended market exclusivity by a mean of 6.1 years (SD, 5.8 years) and a median of 4.7 years (IQR, 0.2-10.1 years).

Conclusions and Relevance: Pharmaceutical patent portfolios have grown over the last 2 decades. These portfolios have largely been built on nonprimary patents, which are then enforced against generic firms at higher rates than primary patents. Large patent portfolios can complicate routine generic competition and prolong periods of high drug prices.