The Indonesian pharmaceutical industry faces significant challenges related to dependence on imported raw materials, exchange rate volatility, production costs, and the need to strengthen research and development (R&D). These conditions highlight the importance of evaluating financial performance through distinct dimensions of efficiency and effectiveness. This study aims to analyze the production cost efficiency and asset utilization effectiveness of six pharmaceutical companies listed on the Indonesia Stock Exchange in fiscal year 2025 and to examine operational and financial factors associated with differences in their performance. A descriptive quantitative approach with a cross-sectional comparative design was employed using audited annual reports and financial statements for 2025. Financial ratios were analyzed alongside pharmaceutical industry management considerations, including production costs, asset utilization, productivity, R&D investment, human resource management, capital structure, and foreign exchange exposure. The findings indicate that Darya-Varia Laboratoria Tbk (DVLA) and Phapros Tbk (PEHA) recorded the highest gross profit margins, at 54.34% and 52.35%, respectively. Meanwhile, Merck Indonesia Tbk (MERK), Kalbe Farma Tbk (KLBF), and Tempo Scan Pacific Tbk (TSPC) achieved the highest returns on assets, at 19.17%, 12.20%, and 11.32%, respectively. However, the multidimensional assessment produced different overall rankings, demonstrating that strong production cost efficiency does not necessarily correspond to superior asset utilization effectiveness. Although PEHA achieved the second-highest gross profit margin, its overall performance was constrained by weaker results in other dimensions and a high debt-to-equity ratio of 224.51%. The study also identifies limitations in the comparability of nonfinancial disclosures concerning R&D, production capacity utilization, and foreign exchange exposure. In conclusion, pharmaceutical companies should evaluate cost efficiency and asset utilization effectiveness separately to obtain a more comprehensive understanding of managerial performance. These findings are limited to six profitable listed companies and should not be generalized to the entire Indonesian pharmaceutical industry.