The increasing integration of digital technologies in business processes calls for a deeper understanding of their impact on business model efficiency. This study explores how digital alignment, composed by strategic decision support and operational support, affects business model efficiency, while also examining the extent to which strategic flexibility moderates this relationship. To test the proposed hypotheses, we adopt a quantitative approach on a sample of Italian small and medium-sized enterprises in the manufacturing industry. In particular, a regression analysis, complemented by a necessary condition analysis, is performed. We find that digital alignment, both in terms of strategic decision support and operational support, fosters business model efficiency. Strategic flexibility strengthens the relationship between strategic decision support and business model efficiency. To the best of our knowledge, this study is the first to operationalise digital alignment as composed of strategic decision support and operational support. Accordingly, this study contributes to the extant literature on digital alignment and business models.