Social media marketing is evolving rapidly and gaining popularity within academia and firms. This chapter highlights the major challenges posed by social media to the pharmaceutical industry, assessing the presence of major pharmaceutical firms on social media platforms such as Facebook, Twitter, and YouTube and characterizing their digital engagement strategies. This study gathered data from the top 20 pharmaceutical companies' official websites, Facebook, Twitter, and YouTube accounts and examined variables such as Internet presence, engagement, fans/followers, and network structure. Findings from this study show that not all pharmaceutical firms are present on social media, and some platforms are used more than others. Notably, the digital engagement strategies varied between the analyzed social media platforms and remained similar on the two periods. Results also show that the level of engagement assessed was not associated with firm size. In several firms, the communication was mostly directed to the general public. Depending on the company, country-based communities were found. This work can be of interest to practitioners aiming to compare and assess their digital activity. It could also assist future researchers focusing on pharmaceutical social media marketing activity, since few researchers have analyzed this using more than one social networking site.