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The focus of industry is shifting from primary care to specialty medicine which demands complex manufacturing. There is a shift in strategy from being present in ‘few large’ to ‘many small’ segments with high unmet need. The supply-chain disruption and political tensions between various countries has led to the focus of developed economies like the US and EU to localize pharmaceutical manufacturing. Companies re-evaluating their relations with CDMO’s such as location, cost vs. risk and level of services to achieve operational and supply-chain resilience. As the big pharma and large CDMO’s are building capabilities for large molecules, small molecule outsourcing will see upward trend, creating good opportunity for mid and small sized domestic regional CDMO’s to expand. With the increasing convergence between biologics and small-molecules for the development of “hybrids” such as antibody-drug conjugates has make it necessary for the small-molecule CDMOs to build capabilities for handling both types of drugs along with flexible manufacturing to handle small volumes.