The pharmaceutical supply chain is plagued by counterfeit and substandard drugs, contributing to significant patient harm and economic losses estimated at over $200 billion annually. This study offers a comprehensive analysis of blockchain technology's role in improving transparency and drug traceability from 2015 to 2022. Employing a mixed-methods approach—including systematic review of literature, examination of 128 implementations across 42 countries, case studies, and quantitative metrics—the research tracks adoption trends, technological frameworks, and outcomes. Findings indicate exponential growth in blockchain projects after 2018, predominantly using permissioned platforms such as Hyperledger Fabric. Implementations reduced drug traceability time from 7–14 days to seconds, cut counterfeit incidents by 31.2%, accelerated product recalls by 89%, and achieved ROI within an average of 21 months through savings in losses, recalls, and operations. While interoperability, scalability, and regulatory hurdles remain challenges, blockchain substantially enhances patient safety, compliance, and efficiency.