The pharmaceutical industry is one of the fastest growing knowledge-intensive sectors of the global economy, which has undergone significant changes in recent years. The purpose of this work is threefold: first, to evaluate some trends in the development of the pharmaceutical industry; second, to trace the dynamics of mergers and acquisitions in the pharmaceutical market; third, to identify the features of the development of pharmaceutical R&D outsourcing into China. Based on the research, the authors come to the following conclusions. The leading countries in the global pharmaceutical market (in terms of the share of healthcare costs in GDP and in terms of pharmaceutical output) are the USA, Switzerland, Germany, France, Japan, and, in recent years, China. To strengthen their positions and gain control over other companies in the industry, pharmaceutical multinationals (MNCs) from the leading countries increasingly use the M&A tool, the development of which has become an important trend in the pharmaceutical market. To increase financial stability and reduce R&D costs, pharmaceutical MNCs are also expanding the use of R&D outsourcing. In recent years, China has become the main market for the outsourcing operations of the largest pharmaceutical MNCs, which actively cooperate with Chinese contract research organizations. The economic policy of the Chinese government has become one of the most important factors influencing the accelerated development of China’s pharmaceutical industry. © The Author(s), under exclusive license to Springer Nature Switzerland AG 2023.