Objective: This study attempted to explore the necessity and feasibility of pharmacists' participation in the audit of special drugs of medical insurance. Methods: Based on rational drug use, this study established a three-party joint audit mode (physician-pharmacist-medical insurance personnel) of medical insurance drugs with pharmacists as the main auditors to conduct "prior audit" of special medical insurance drugs in hospital according to national policies of medical insurance. Results: During the period from November 2019 to May 2021, a total of 4652 cases were reviewed by pharmacists, with a passing rate of 82%. Among them, 623 cases were rejected due to incomplete declaration materials, and 211 cases were rejected due to exceeding the medical insurance qualification, and the total amount involved in the rejected cases was more than 12 million yuan. Conclusion: The participation of pharmacists in the audit of national negotiated drugs can help reduce the unreasonable expenditure of medical insurance fund and improve the reasonable utilization rate of national negotiated drugs. This study also provides a reference for the refined management of medical insurance in other medical institutions.