TAs the industrial environment becomes more competitive, supply chain management (SCM) has become a topic of interest to many authors. In particular, in the last decades, pharmaceutical industry has been interested by significant changes that have lead companies to implement SCM to simultaneously achieve efficiency and effectiveness. The aim of this paper is (1) to explore the existence of a sequence of SCM improvement initiatives in pharmaceutical industry and (2) to highlight the emerging SCM model pharmaceutical companies are adopting to overcome the traditional trade-off between efficiency and effectiveness. It has been found a common sequence of improvement initiatives that encompasses three main steps: the redesigning of supply network to exploit economies of scale; supplier integration; demand integration. Such initiatives are then combined in a SCM model which explains their different contribution in improving supply network efficiency and effectiveness.