PurposeThis paper aims to evaluate the implementation of innovative programmes within the downstream domain of the pharmaceutical supply chain (PSC), with the aim of informing improved service provision.Design/methodology/approachA mixed-method approach was used to assess to what extent innovation could be adopted by hospital and community pharmacies to improve the delivery process of pharmaceutical products. Unstructured interviews and 130 questionnaires were collected and analysed to identify factors that facilitate or prevent innovation within PSC processes.FindingsThe analysis led to the creation of the innovative pharmaceutical supply chain framework (IPSCF) that provides guidance to health-care organisations about how supply chain management problems could be addressed by implementing innovative approaches. The results also indicated that the implementation of Lean and Reverse Logistics (RL) practices, supported by integrated information technology systems, can help health-care organisations to enhance their delivery in terms of quality (products and service quality), visibility (knowledge and information sharing), speed (response to customers and suppliers needs) and cost (minimisation of cost and waste).Practical implicationsThe study’s recommendations have potential implications for supply chain theory and practice, particularly for pharmacies in terms of innovation adoption. The IPSCF provides guidance to pharmacies and health-care organisations to develop more efficient and effective supply chain strategies.Originality/valueThis research contributes to the academic literature as it adds novel theoretical insights to highly complex delivery process innovation.