US prediction market Kalshi launches bets on drug trial outcomes

US prediction market Kalshi is launching a pilot programme allowing users to bet on the results of clinical trials and regulatory decisions by the US Food and Drug Administration. The expansion marks a significant shift for the platform, which has built a dominant position in the online predictions space by offering wagers on political and economic events.

The company argues that financial contracts on drug trials will force transparency onto an notoriously opaque industry. Kalshi’s CEO, Tarek Mansour, said in a statement: “Drug development is one of the most important and most information-constrained industries on earth.” A publicly traded contract would produce a “continuously updated, public probability that reflects the weight of the evidence, rather than the preferred message of the trial sponsor”, the company said. The pilot is being launched in partnership with artificial intelligence firm AppliedXL.

The initiative has drawn backing from some healthcare leaders. Anne Wojcicki, founder of 23andMe, wrote in a Kalshi white paper that “most patients don’t know about the choices available in clinical trials or which programs are most promising.” She added that “the opportunity to have an open, transparent dataset about trial probabilities is extremely promising and empowering for people.”

However, the move arrives at a moment of intense scrutiny for prediction platforms, which critics say are vulnerable to insider trading. US federal regulators recently revealed that Donald Trump’s longtime teleprompter operator made tens of thousands of dollars betting on the president’s speeches. The Department of Justice is also investigating former congressman George Santos over alleged insider betting on his own attendance at the State of the Union.

To mitigate these risks, Kalshi said it will mandate employment verification to block insiders from participating, just as it does in its political markets. The platform also pledged to only list contracts after a trial's enrollment closes, preventing interference with patient recruitment. Mansour described the rollout as “compliance-first, carefully scoped, and built for the long term.”

The drug trial market is the latest in a rapid expansion for Kalshi, which surpassed $1bn in trading volume earlier this year and averages over 5 million monthly users. Yet that growth is meeting operational friction. Kalshi recently paused a separate plan to let users bet on flight cancellations after RTX, the parent company of flight tracker FlightAware, threatened to terminate data access. Fortune reported the pause followed concerns that users might deliberately cause airport disruptions to guarantee payouts.

While Kalshi insists it operates a forecasting tool rather than a gambling platform, experts warn the products carry similar addiction risks. The company recently committed $2m to the National Council on Problem Gambling, an acknowledgement of the regulatory and social challenges ahead as it pushes further into real-world event betting.