Our paper examines one of the key aspects of the organizational economics – the factors of economic success and sustainability of the pharmaceutical small and medium enterprises (SMEs) in India. Indian pharmaceutical industry is known for its high fragmentation and weak generic based R&D initiatives. The study uses inflation adjusted cross section data for 20 SMEs in the year 2013-2014 and applies OLS regression model with robust standard errors. It has found that exports, R&D expenditure, and previous year profits have exercised positive impact on SMEs' growth. The negative, yet statistically significant influence of advertising and marketing expenditure highlights the need to rethink about strategic management policies of SMEs. Our results suggest that SMEs are required to pay more attention towards the global market expansion and value creation through R&D investment, as a part of their long-term growth and survival strategy.