The population of Pakistan is fast growing and the need for supply of medicine will continue to increase. The local pharmaceutical market is growing at a faster pace as compared with the international market. Until 1990, the reliance on the supply of medicine to cater to the national demand was on multinational companies holding major market share. Thereafter, the national pharmaceutical companies started investing to improve the quality of their product lines, employing qualif ied professionals, and ensuring compliance with the global standard of quality and good manufacturing practices. Consequently, national com- panies' market share drastically increased and the national demand for medicine is locally produced. The study results based on interviews of key stakeholders and available literature revealed that the local pharmaceutical sector is facing critical challenges of counterfeit medicine, pricing controversies, affordability of the medicine, lack of Research and Development (R&D) initiatives, and unethical marketing (bribing/cash incentives to the doctors). The Drug Regulatory Authority of Pakistan (DRAP) seems ineffective to overcome these challenges, eliminate counterfeit medicines, and take measures to curb the unethical marketing practices that are risking patient life, health, and treatment cost. The study further explored that unethical marketing practices, and prescribing expensive brands by doctors, creates a serious conflict of interests and fast a decline in patient trust and affordability of medicine cost. Thus strong regulatory controls,transparency, moral and ethical values are needed to enforce drug acts and make the stakeholder's groups accountable. There is a need to punish both the companies bribing the doctors on the pretext of product promotion and doctors accepting such benef its to protect the patient's interest and limit treatment cost. Strict regulations and incentive plans for the pharmaceutical sector are needed to promote Research and Development (R&D).