Pharmaceutical innovation is often measured by counting the new drugs approved by regulators. It is a simple and useful metric, but it has shortcomings. One of them is that it says little about the drugs' innovativeness. Are they variations of older medicines or molecules targeting entirely novel modes of action? As prices escalate, and payers and patients demand value, we need a better picture. This article aims to provide it by analyzing the drugs approved by the US Food and Drug Administration between 2000 and 2012. It examines their modes of action, highlights key trends, and discusses their implications for our ability to generate innovation.