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This article explores how radical front end innovation is supported in pharmaceutical companies. The empirical field is an explorative case study of front end innovation in the pharmaceutical industry, with an in-depth case study of the Danish pharmaceutical company, H. Lundbeck A/S, and explorative studies of seven European and American pharmaceutical companies. We aim to show how pharmaceutical innovation is unique in terms of front end innovation (FEI) and what this implies for effective management and organization of radical pharmaceutical FEI. The value added and the contribution of this article to the existing FEI literature is therefore in the specificity of the empirical setting in which the issue is investigated.