Objective: It analyzes the construction status quo, existing problems and reasons of the drug supply guarantee system of urban medical groups in China, and puts forward countermeasures and suggestions. Methods: Target matching method was used to determine the monitoring indicators, compare the differences of drug supply security system construction in different regions of east, middle and west China, and put forward suggestions combined with field investigation. SPSS 26.0 was used for statistical analysis. Results: A total of 332 urban medical groups were included in the analysis. In terms of drug supply guarantee mechanism construction, drug list linkage was the best index, accounting for 30.12%. In terms of drug use structure, the proportion of bid-winning drugs and the utilization rate of inpatients’essential drugs were 85.16% and 88.73%%, respectively. In terms of rational drug use, the proportion of hospital review prescriptions in total prescriptions and the use intensity of antibiotics in urban medical groups were 28.45% and 25.45 DDDS, respectively. The western region is relatively good in the proportion of bid-winning drugs and rational drug use. Conclusions: It is difficult to unify the drug purchase and supply guarantee mechanism in urban medical groups, but the lead hospital has shown some aspects in optimizing the drug use structure of member units and helping rational drug use, and the development is unbalanced in different regions. To further improve the drug supply guarantee system, it is needed to first accelerate the unification of the drug supply guarantee mechanism, and take the homogenization of pharmaceutical care as the guidance, and give full play to the role of the lead hospital in the drug use structure specification and rational drug use assistance for member units.