Implementing RFID systems is of course not the only answer to the pedigree problem, but is by far the most attractive. A manual paper & pen based system is certainly possible but unworkable as the amount of paper trails will be huge adding to the supply chain inefficiencies.
Bar coding may not serve the purpose as bar codes can be easily counterfeited. However, encrypted RFID tags containing a unique code may be difficult if not impossible to counterfeit. The ideal implementation would be for all drug manufacturers and their distributors, traders and other supply chain participants to enroll in a product identification consortium like EPC Global so that each strip of tablets or bottle of pills could be assigned a unique RFID based product code number. Since this code number would be unique, duplication would be impossible for any counterfeiter. The hospital or pharmacy could hold this bottle of pills near an RFID reader which would be connected to an ERP like system database, which would identify the bottle and give out information related to its batch number, serial number, date of manufacture etc which could be compared with the printed label. If any discrepancy is found, obviously the bottle is a fake. Also, this central database would track the bottle through all its stages of delivery right from its packing, to factory warehouse to transporter warehouse and so on, so the source & pedigree is very clear and transparent.