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Purpose – The purpose of this paper is to present a systemic analysis of the complex interaction of factors affecting the reverse logistics (RL) processes in a pharmaceutical supply chain (PSC). Design/methodology/approach – This study uses a systems thinking approach. Initial problem structuring involved the analysis of behavior-over-time of main variables and incorporated stakeholder analysis. Further, a participative group model building process was used to develop a systems model. Findings – The model was analysed to identify a set of feedback loops operating in the system responsible for the complexities of the problem. To address this, the stakeholders identified three strategic interventions. The first intervention relates to returns avoidance by alleviating market flooding of medicines, second intervention aims at improving the infrastructure for quality and performance management and the third targets balanced risk sharing between the main stakeholders involved in the supply chain. The findings suggest strong linkage between RL network design and key activities in returns management. The study lays a platform for developing a simulation model. Research limitations/implications – Data collection was confined to stakeholders belonging to a PSC based in the South Indian state of Kerala and excluded the participation of doctors due to practical constraints. The application of systems thinking and modelling was limited to the qualitative phases of the methodology. Practical implications – The study illustrates a participative process capable of revealing the differing viewpoints of multiple stakeholders involved in a PSC. Originality/value – It provides a holistic approach based on the systems thinking and modelling methodology for analysing the complexities related to RL in the Indian pharmaceutical industry.