<p>This paper investigates the influence of science-technology cross-coherence on invention impacts, with a focus on the pharmaceutical sector. By proposing a new indicator derived from a co-occurence probability approach, we capture the joint structural alignment of scientific and technological knowledge within inventions and its nuanced role in shaping inventive outcomes. Utilizing unconditional quantile regressions on a dataset of United States Patent and Trademark Office pharmaceutical patents granted between 2010 and 2019, alongside their citations of scientific publications, we identify an inverted U-shaped relationship between science-technology coherence and invention impact. This effect is particularly pronounced for high-impact and breakthrough inventions. Furthermore, the influential mechanisms of scientific and technological knowledge vary across the impact distribution. Technological diversification exerts contrasting effects on low- versus high-impact inventions, while distant scientific knowledge both in cognitive and geographical terms, contributes most strongly to invention impact at the upper tail of the distribution. Overall, the findings highlight the importance of balanced science-technology coherence in fostering high-impact inventive outcomes and advance a structural perspective on science-technology interactions in innovation.</p>