This article focuses on patent settlement practices in the bio-pharmaceutical industry from an antitrust perspective. After a brief introduction aimed at considering how the patent explosion that took place from the 1980s onwards has redesigned the threats/opportunities of anti-competitive uses of exclusive rights related to drugs, the issue of patent settlements is framed in the light of recent developments in the US and EU case law. Some relevant trends, such as the unprecedented patent interconnections now underway in the R&D of mRNA vaccines, are also addressed given the envisaged impact on patent settlements and antitrust enforcement.