In this chapter we look at knowledge management in India with particular regard to the pharmaceutical industry. In India, changes in government policy linked to global factors are bringing about increased pressures to strategically manage knowledge effectively. At the same time, significant knowledge management initiatives are already underway in other industry sectors. We outline some of the changes affecting the pharmaceutical industry globally, and consider India on some relevant activities. The development of IT solutions is seen as enabling effective knowledge management. We look at a range of knowledge management technologies and their existing or planned use in industry. The IT however merely underpins the knowledge management philosophy, which must be incorporated into processes, strategies and organisational culture for successful adoption. India and its indigenous organisations may be characterised by some specific cultural factors. Effective implementation of KM will depend on a conducive cultural climate, both organisationally and nationally. We also therefore examine the extent of the perceived benefits, that shape the cultural shift from understanding knowledge management as simply an IT problem to recognition of knowledge management as a strategic process as seen by CEOs and top managers in indigenous Indian Fortune 100 companies. We look at how the pharmaceutical industry compares to other organizations of significant size in India across a range of factors concerned with knowledge management activity, using survey and interview techniques. We conclude that while only a few significant sectoral differences are evident, there is generally a heavy orientation towards IT-based conceptions of KM, which may be incompatible with the requirements for future success in the pharmaceutical industry globally.