Big shifts are underway in China’s pharmaceutical market. They will shape the marketplace for more than 90% of drug sales for the next decade for multi-national corporations and domestic players. While the long-term direction is becoming clear, the transition period over the next three to five years will be particularly challenging. The pending changes will require pharma companies to approach the Chinese marketplace in new ways—they will need to contend with tougher tendering and bidding processes, modify their sales and marketing approaches, and develop new skills for market access. Developing an understanding of the impact and timing of the changes will help companies start adapting now so that they can position themselves to maintain and even increase their sales and share, profitably.