The sage and the whole Medicinal and Aromatic Plants (MAPs) sector in Albania have experienced significant changes in the production structure in recent years. Sage cultivation has become a mainstream farming activity for thousands of households in the central supply region of Malësia e Madhe, while the traditional activity of harvesting wild sage is in decline. While the sage value chain has provided opportunities to secure thousands of sage cultivators' livelihood, the oversupply from cultivated sage has exceeded demand. The decline of sage cultivators' sales and profits puts the sustainability of their participation in the chain at risk. At the end of the study, we make several recommendations on addressing the situation and making the sage chain more inclusive.