The article reflects the significance and peculiarities of the functioning of the entrepreneurial structure of the pharmaceutical industry, which are closely connected with the health system and play one of the key roles in the national economy of any state, influencing the future of the nation. The authors assessed the modern problems of the development of the domestic pharmaceutical industry, studied expert opinions on sustainable development options, and on this basis proposed a set of measures to optimize the economic development of Russian commercial pharmaceutical structures within the framework of the concept of a four-dimensional approach to ensuring sustainable development.