Pharmaceutical supply chain integrity is essential for ensuring medicine authenticity, patient safety, and effective regulatory oversight in India. Increasing distribution complexity, unauthorized pharmaceutical movement, and inconsistent monitoring practices create significant challenges for maintaining product quality and traceability. This narrative review examines pharmaceutical supply chain vulnerabilities, drug authentication technologies, and risk mitigation strategies within the Indian pharmaceutical sector. Drawing on existing academic literature and regulatory perspectives, the study evaluates therapeutic-category risks, distribution-stage weaknesses, drug diversion mechanisms, and emerging technological interventions. The review identifies serialization, QR-code verification, blockchain-based traceability, and digital monitoring as potential approaches for improving product identification and supply chain transparency. However, technological adoption remains constrained by implementation costs, fragmented information systems, limited interoperability, and regulatory coordination challenges. The analysis highlights the importance of integrating digital authentication with supplier verification, inventory monitoring, regulatory compliance, and stakeholder collaboration. The study concludes that strengthening pharmaceutical supply chain integrity requires a coordinated framework combining technological innovation, organizational accountability, and effective regulatory governance. These approaches may contribute to reducing distribution vulnerabilities, improving medicine traceability, and supporting a more secure and resilient pharmaceutical supply chain in India.