Management researchers have traditionally emphasized two main factors in the definition of corporate strategies: internal capabilities and industry competition. However, in less stable, transition economies it is particularly the changing institutional environment that influences strategy definition and performance of multinational corporations (MNCs) as shown by numerous international business (IB) scholars. Yet, how institutions matter remains a largely unresolved question. This article examines how institutions have affected the value chain configuration of Western pharmaceutical firms in China. Our research framework identifies four major strategic shifts along the value chain of Western firms in the pharmaceutical industry: upgrading along the value chain, outsourcing to contract service providers, expansion of geographical scope and diversification of product portfolio. The findings allow concrete managerial implications to be derived for decision makers of Western pharmaceutical firms operating in China.