The declines in oil and gas prices in 2014 by 50% or more led governments in the Middle East and North Africa (MENA) region to decrease healthcare budgets correspondingly by more than 30%. The purpose of this multiple case study was to explore the marketing strategies that managers of international pharmaceutical companies have successfully implemented in the MENA region to ensure profitability after the 2014 decreases in the healthcare budgets, which followed the decline in oil and gas prices. The study involved data collection through semistructured interviews of 6 middle and executive managers working in 2 international pharmaceutical companies located in Dubai, United Arab Emirates. The cultural intelligence and strategic flexibility theories constituted the conceptual framework for this study and exploration of challenges associated with implementing marketing strategies for international pharmaceutical companies in the MENA region. Participants had a minimum of 5 years of experience in planning and implementing marketing strategies in the MENA region. The findings from the thematic data analysis led to the identification of major marketing strategies, which have helped to maintain business sustainability of pharmaceutical companies, despite difficulties with the reduction in healthcare budgets in the MENA region. The important themes emerging from this study included: (a) product launch strategy and operating model, (b) transformation of leaders by vision and guidance, (c) recognition of culture and diversity, and (d) the importance of training and learning agility. The results of the study may contribute to positive social change because pharmaceutical and healthcare knowledge benefits human health and may serve to influence positive job creation and enrichment of the economies of the region.