Abstract Objective: To learn about the different negotiation mechanisms of medical insurance special drugs in Qingdao city (Shandong province), Jiangsu province, and Zhejiang province. Method: To compare the differences between these three provinces from five aspects of negotiations mechanism, medical care object, medical coverage, financing mechanism, and reimbursement level by consulting the relative policies of medical insurance special drugs in these three provinces. Result: The financial source of Qingdao city is financial allocation. And Qingdao city has the broadest drug negotiation range, which includes drugs and medical materials of critical diseases, rare diseases, and chronic diseases. There is no additional financing mechanism in Jiangsu province, and the drug negotiation mechanism is specific to breast carcinoma and leukemia. In addition, generic drug is included in the negotiation range. In Zhejiang province, the risk sharing mechanism of fiscal subsidies and individual contribution was set. The clinical medication indication is unlimited, and reimbursements are given by sectional expenses compensation. Conclusion: Encouraging the medical company to donate drugs during negotiation would increase the efficiency of drug negotiation. Also, broadening rare diseases coverage and adding more medical materials into negotiation range would perfect the contribution of negotiation mechanisms for medical insurance special drugs. Moreover, the dynamic adjustment mechanism of medical insurance special drugs formulary should be built.