Objective: To explore the influence of the 2019 edition of National Basic Medical Insurance, Employment Injury Insurance and Maternity Insurance Drug Directory (hereinafter referred to as the Drug Directory) on the management of drug use in hospitals and the ways and methods to strengthen the management of drug use. Methods: The differences between the 2019 edition and the 2017 edition were compared, the characteristics and changes of the 2019 edition were analyzed, and suggestions on how to strengthen the medication management of the hospital after the adjustment of the Drug Directory were put forward. Results: There were a total of 2,643 varieties in the routine access part of the 2019 edition, 150 varieties were transferred out and 148 varieties were transferred in based on the 2017 edition, and 97 varieties were successfully negotiated and included in the list. After the adjustment, the drug structure has undergone great changes, and the scope of payment is more precise, which is conducive to the optimization of hospital drug structure, the standardization of drug use management and the reduction of the burden of insured patients. Conclusion: Hospital pharmacy, medical insurance, medical administration and other departments should form a linkage, strengthen the management of medical insurance drug use, promote rational clinical drug use, accelerate the construction of intelligent medical insurance audit system, and ensure the implementation of the Drug Directory.