The global pharmaceutical industry has undergone a paradigm shift from the dominance of blockbuster small-molecule drugs to biologics and biosimilars. This transformation is driven by patent expirations, escalating research and development (R&D) costs, advancements in biotechnology, and the increasing burden of chronic diseases. Biologics now constitute a substantial portion of pharmaceutical expenditure, while biosimilars are emerging as cost-effective alternatives that enhance accessibility and sustainability of healthcare systems. This review critically evaluates the historical evolution, economic dynamics, regulatory frameworks, and future prospects of biologics and biosimilars, with a special emphasis on the Indian pharmaceutical landscape. Recent market data (2023–2025) highlight rapid growth in the biosimilars sector, with global expansion supported by regulatory harmonization and technological advancements.