Small misconception: L is not S. Chirality is a part and parcel of life and there is no coincidence that a certain enantiomer is more biologically active than the other. You have already noted that. I don't think that patenting is the main driving force to develop chiral medicines. There is a very sad story, called the thalidomide tragedy which led to the birth of severely deformed babies who were crippled for life due to one of its enantiomers. Since 1992, chiral analysis of drugs is a must!
Approximately 63% of drugs approved by the Food and Drug Administration (FDA, USA) between 2015 and 2020 were chiral drugs, according to a survey conducted last year in J. Med. Chem. 2021, 64, 2339-2381). Coming to the main query, large scale preparation of a single enantiomer can come from:
(i) Asymmetric synthesis or enzymatic synthesis
(ii) Biological synthesis e.g., certain antibiotic are synthesized by microrganisms, whose complexity which can startle human minds. Nature is also a synthetic organic lab.
(iii) Chiral crystallization
(iv) Large scale (preparative) chiral chromatography (simulated moving bed etc.)
(v) Countercurrent chromatography, large scale isolation method.