Disruptions in the supply chain network can have significant and far-reaching consequences, especially in pharmaceutical supply chains that affect health and financial outcomes and raise equity concerns. To inform strategies that can address this critical global problem, we study disruptions in pharmaceutical supply chains using multiagent simulations. These simulations include decision-theoretic agents with a theory of mind reasoning that allows them to reason about the other agents in the supply chain, including their trustworthiness. The simulations reveal how supplier-buyer interactions have non-local effects which can exacerbate and extend disruption impacts. In addition, a distributor’s focus on its own short-term profit can lower its long-term profit and damage equity in health centers. We also demonstrate how agents adapt to changes in the environment and changes in other agents’ behavior and how in the absence of explicit communication and coordination, the timing of these adaptations inhibits disruption mitigation efforts from transpiring.