Abstract: This study aimed to analyze China's provincial pharmaceutical reserve management system, and to discuss its current situation, problems and optimization path. Through a systematic search, existing provincial medical reserve management policy documents in China were collected, and based on the analytical framework of "multiple participating subjects-reserve process chain-supervision and feedback mechanism", content analysis was used to study 21 provincial policy documents. The results of the study showed that there were differences and commonalities in the provincial pharmaceutical reserve management in China in terms of participating subjects, reserve process and supervision and feedback mechanism. Accordingly, reflections on optimizing China's provincial pharmaceutical reserve management system were proposed, which included the establishment of a whole-life-cycle pharmaceutical reserve management model; the formation of an expert advisory committee and the establishment of a reserve plan adjustment mechanism that combined dynamics and regularity; the construction of a variety-based reserve management scheme to improve emergency response capabilities; and the construction of an information-based system for the reserve and call-up management platform, among others. These suggestions aimed to provide theoretical basis and practical guidance for the improvement of China's pharmaceutical reserve management system and enhance its ability to respond to public health emergencies.